Ravulizumab-cwvz (Ultomiris)

Covered only for FDA‑approved uses: Ultomiris (ravulizumab‑cwvz) for adult PNH and for aHUS to inhibit complement‑mediated TMA, excluding Shiga toxin E. coli–related HUS and any non‑FDA uses. Key requirements: PNH patients must be ≥18 with diagnosis confirmed by peripheral blood flow cytometry showing GPI‑anchored protein deficiency on ≥2 cell lineages, prescription by/consult with a hematologist (PNH) or nephrologist (aHUS), IV weight‑based loading and maintenance dosing per dosing tables (maintenance intervals generally every 8 weeks for most weights), documentation of weight and infusion records, and evidence of ongoing clinical benefit for PNH reauthorization (PNH initial approval 6 months/renewal 12 months; aHUS 12 months).

"Documentation of patient age (required to confirm PNH age ≥18 for initial authorization)."

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