Ultomiris (ravulizumab-cwvz)

Ultomiris is covered for FDA‑approved PNH (patients ≥1 month), aHUS (patients ≥1 month) and anti‑AChR antibody‑positive generalized myasthenia gravis (adults ≥18), with aHUS coverage excluding Shiga toxin E. coli–related HUS. Coverage requires specialist prescribing/consultation (hematology for PNH, nephrology for aHUS, neurology for gMG), confirmatory documentation (PNH: flow cytometry showing GPI‑anchored protein deficiency on ≥2 lineages; aHUS: exclusion of Shiga toxin E. coli HUS; gMG: anti‑AChR positivity, MGFA class II–IV, MG‑ADL ≥6), prior therapy documentation for gMG (pyridostigmine and two immunosuppressants ≥1 year unless failed/contraindicated), weight‑based dosing per policy, demonstration of clinical benefit for reauthorization, and specified approval durations (PNH initial 6 months/renewal 12 months; aHUS 12 months).

"Generalized Myasthenia Gravis (gMG) — re-authorization: "Is 18 years of age or older;""