Used to treat B-cell precursor acute lymphoblastic leukemia and diffuse large B-cell lymphoma; requires pre-authorization.
BI667 New
Tecartus
01/01/21
Used to treat large B-cell lymphoma; requires pre-authorization.
BI668 New
Yescarta
01/01/21
Used to treat large B-cell lymphoma; requires pre-authorization.
BI669 New
Zolgensma
01/01/21
Used to treat spinal muscular atrophy (SMA) in patients less than 2 years old. Specialty medication covered under the medical benefit; requires pre-authorization.
Clarified distinction between routine coverage of pediatric/adolescent Hep B vaccination (19 and under) and adult Hep B vaccination (20 and over).
For questions about QualChoice Medical Coverage Policies, please contact your Provider Relations Representative at 800.235.7111 or 501.228.7111, ext. 7004, Monday through Friday, 8:00 a.m. to 5:00 p.m.