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Updated Drug Therapy Guideline and Medical Protocol

Date:
November 21, 2019

To: All Providers

Updated Drug Therapy Guideline: Taltz

An updated drug therapy guideline for Taltz will be posted today and effective on December 25, 2019. Taltz has recently been approved by the U.S. Food and Drug Administration for an additional indication, the treatment of adults with active Ankylosing Spondylitis (AS). This new indication has been added to the existing Taltz guideline reflecting our standard AS clinical criteria as well as plan-preferred medications.

Updated Medical Protocol: Technology Assessment

Effective March 1, 2020, the title of the existing medical protocol “Technology Assessment” will be changed to “Technology Assessment and Medically Necessary Services.”

 

Protocol changes:

In addition to the title change, a medically necessary definition is included, as well as wording changes throughout the protocol from the word “technology” to the word “services.” Standard language for durable medical equipment is defined. Criteria for medically necessary, investigational, and not medically necessary services are defined. Preauthorization is required for services for which we have no published protocol, and that do not meet the guidelines contained in this protocol.

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