Eculizumab Products (Soliris®, Bkemv™, Epysqli®)

Eculizumab products (Soliris, Bekemv, Epysqli) are covered only for FDA‑approved indications — PNH (age ≥18), aHUS (excluding Shiga toxin–related HUS), anti‑AChR antibody–positive gMG (patients ≥6 years), and anti‑AQP4 antibody–positive NMOSD (adults) — and only as IV infusions. Coverage requires indication‑specific confirmatory testing, specialist prescribing/consultation (hematology for PNH, nephrology for aHUS, neurology for gMG/NMOSD), age and gMG prior‑therapy criteria for adults (pyridostigmine plus trial of two immunosuppressants unless contraindicated), specified approval durations, and documentation of continued clinical benefit for reauthorization.

"Eculizumab is indicated for the treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis."

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