Provider Alert! Adakveo Update
Attention: Hematologists
Effective Date: May 26, 2020
Call to action: Adakveo, Injection, crizanlizumab – clinician administered drug HCPCS code C9053 is an at risk drug. Currently, there is no prior authorization required; however, beginning May 26, 2020 authorization guidelines will be in place. The required criteria to receive Adakveo include:
- HbSS (sickle cell) diagnosis
- Patients over the age of 16 years-old
- Patients that have experienced more than two vaso-occlusive crisis (VOC) events in the past 12-months
How this impacts providers: Prescribers should adhere to the guidelines and acquire the necessary prior-authorizations.
References: https://www.novartis.us/sites/www.novartis.us/files/adakveo.pdf
TMPPM criteria is pending publication therefore, peer reviewed literature will be applied in absence of state criteria.
Next steps for providers: Prescribers should regularly check the prior authorization requirements with the Texas vendor Drug Program:
https://www.txvendordrug.com/sites/txvendordrug/files/docs/prior-authorization/cpa-assistance-chart.pdf
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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