Payer PolicyActive
Crizanlizumab-tmca (Adakveo)
EVICORE-MEDICAL_DRUG-1B419426
EviCore by Evernorth
Effective: March 15, 2021
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Adakveo (crizanlizumab‑tmca) is covered only to reduce vaso‑occlusive crises in patients with sickle cell disease aged ≥16 years for the FDA‑approved indication; use in patients <16 years or for non‑FDA indications is not authorized. Authorization requires prescription by or consultation with a sickle cell specialist, documentation of diagnosis and age, adherence to the dosing schedule (5 mg/kg IV at week 0, week 2, then no more frequently than every 4 weeks), meeting applicable safety criteria, and is approved for up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"When requesting Adakveo (crizanlizumab-tmca), the individual requiring treatment must be diagnosed with an FDA-approved indication and meet the specific coverage guidelines and applicable safety cr..."
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