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Medical Policy Updates

Table Of Contents

Notification of Policy Revisions Effective January 26, 2016 (Posted November 24, 2015)

Medical Policy Revision
PD-1 Inhibitors "Notification" Under "When Covered" section added additional criteria for Keytruda under bullet #2 and also for Opdivo under bullet #2: "and the patient with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving Keytruda or Opdivo." Notification given 11/24/15 for effective date 1/26/16.
Repository Corticotropin (H.P. Acthar Gel) "Notification" Policy extensively revised. Repository corticotropin is medically necessary for infantile spasms (West syndrome) and acute exacerbations of multiple sclerosis when criteria are met. Senior Medical Director review 1/30/2014. Specialty Matched Consultant review 2/11/2014. Specialty Matched Consultant Advisory Panel review 5/27/2014. Specialty Matched Consultant Advisory Panel review 5/27/2015. References added. Notification given 11/24/2015. Policy effective date 1/26/2016.