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Effective June 1, 2024: Pharmacy and Biopharmacy Policies

Date: 03/21/24

Superior HealthPlan has added, updated, or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on June 1, 2024, at 12:00AM.

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Erdafitinib (Balversa) (CP.PHAR.423)

Ambetter

Policy updates include:

  • Updated (Food and Drug Administration) FDA labeled indication for urothelial carcinoma to remove accelerated approval language and include limitation of use
  • Removed coverage of patients with FGFR2 genetic alterations to be consistent with revised (Food and Drug Administration) FDA indication and National Comprehensive Cancer Network recommendations
  • Added initial and continued therapy criteria to use generic erdafitinib if available

 

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.

Prior to updates, pharmacy and biopharmacy clinical policies are reviewed and approved by the Pharmacy and Therapeutics (P&T) Committee.

For questions or additional information, please contact Superior’s Pharmacy Department at 1-800-218-7453, ext. 22272.