Notification/Prior Authorization Required for New Specialty Medications
Probuphine (buprenorphine) subdermal implants are indicated for the maintenance treatment of opioid dependence in patients who have achieved and sustained prolonged clinical stability on low to moderate doses of a transmucosal buprenorphine-containing product (i.e., doses of no more than 8 mg per day of buprenorphine sublingual tablet equivalent).
Cinqair® (reslizumab) and Nucala® (mepolizumab) are indicated for the add-on maintenance treatment of patients with severe asthma who have an eosinophilic phenotype.
Ocrevus™ (ocrelizumab) is anticipated to be indicated for the treatment of primary progressive multiple sclerosis and relapsing/remitting multiple sclerosis. This drug is currently being reviewed by the U.S. Food and Drug Administration (FDA), and a decision is expected by the end of March. Prior notification will be required upon FDA approval.
Gonadotropin-releasing hormone analogs are indicated for the suppression of puberty in adolescents diagnosed with gender dysphoria. This new policy refers to the following GnRH Analog drug products:
Lupron Depot® (leuprolide acetate)
Lupron Depot-Ped® (leuprolide acetate)
Supprelin® LA (histrelin acetate)
Trelstar® (triptorelin pamoate)
Vantas® (histrelin acetate)
Zoladex® (goserelin acetate)
For questions, please contact a member of your B&P Sales Team - 888.722.3373.