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Effective November 10, 2020: Pharmacy and Biopharmacy Policies

Date: 11/02/20

Superior HealthPlan has introduced new or revised pharmacy and/or 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 listed below have been revised. Changes in these policies reflect preauthorization requirement amendments that are less burdensome to insureds, physicians, or health care providers.

Policy

Applicable Products

New Policy Overview or Updated Policy Revisions

Somapacitan-beco, Somatropin (Human Growth Hormones) (CP.PCH.25)

Ambetter

Updates include:

  • Added FDA-approved growth hormone analog Sogroya

Ivacaftor (Kalydeco) (CP.PHAR.210)

Ambetter

Updates include:

  • FDA approved pediatric age extension added from 6 months to 4 months with updated dosing

Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (HIM.PA.53)

Ambetter

Updates include:

  • Added new dosage strength (3 mg, 4.5 mg) forms for Trulicity

To review all pharmacy policies, please visit Superior’s 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.