Rystiggo® (rozanolixizumab-noli)
EVICORE-MEDICAL_DRUG-147FCE31
Covered: Rystiggo (rozanolixizumab‑noli) is covered for adults (≥18) with generalized myasthenia gravis who are anti‑AChR or anti‑MuSK antibody positive and is excluded for antibody‑negative gMG, ocular‑only disease, or patients <18. Key requirements: prior/current pyridostigmine unless failed/contraindicated, MGFA class II–IV, MG‑ADL ≥3 for non‑ocular symptoms, neurologist prescribing/consultation, weight‑based subcutaneous dosing once weekly ×6 weeks per cycle (do not initiate subsequent cycles sooner than 63 days), initial approval 6 months and reauthorization 12 months with documented clinical benefit.
"Initial authorization: Has received or is currently receiving pyridostigmine unless failed, contraindicated or intolerant to pyridostigmine."
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