Uplizna (inebilizumab-cdon) injection

Covers Uplizna (inebilizumab-cdon) for adult (≥18) patients with laboratory-confirmed AQP4‑antibody–positive NMOSD and excludes AQP4‑seronegative patients or those who do not meet coverage/safety criteria. Key requirements: age ≥18, blood AQP4 seropositivity, prior therapy trial (either prior Soliris/Enspryng OR currently/previously tried two of azathioprine, corticosteroid, mycophenolate mofetil, rituximab), relapse history (≥1 relapse in past 12 months or ≥2 in past 2 years), prescribed by/with a neurologist, dosing per induction (300 mg IV x2 two weeks apart then 300 mg IV every 6 months), initial approval for 12 months and reauthorization only with documented clinical benefit.

"Treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 antibody positive."

Sign up to see full coverage criteria, indications, and limitations.