Payer PolicyActive
Luspatercept-aamt (Reblozyl®)
EVICORE-MEDICAL_DRUG-7A5FB2D9
EviCore by Evernorth
Effective: January 1, 2023
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Reblozyl (luspatercept‑aamt) is covered only for adults (≥18 years) with beta thalassemia who require regular RBC transfusions (transfusion‑dependent); non‑transfusion‑dependent patients and non‑FDA indications are excluded. Initial approval requires hematologist prescribing/consultation, documented transfusion dependence and age, dosing ≤1.25 mg/kg SC every ≥3 weeks with a 4‑month initial approval and 12‑month renewals contingent on documented clinically meaningful reduction in transfusion burden.
Coverage Criteria Preview
Key requirements from the full policy
"Reblozyl is indicated for the treatment of anemia in adult patients with beta thalassemia who require regular red blood cell (RBC) transfusions."
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