Payer PolicyActive
Crizanlizumab-tmca (Adakveo)
EVICORE-MEDICAL_DRUG-7ACBDA31
EviCore by Evernorth
Effective: March 1, 2020
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Adakveo (crizanlizumab‑tmca) is covered only to reduce vaso‑occlusive crises in sickle cell disease patients aged ≥16 years and is not covered for patients <16 or for non‑FDA‑approved indications. Coverage requires documentation of SCD diagnosis and age, prescription by or consultation with an SCD specialist, adherence to the 5 mg/kg IV dosing schedule (week 0, week 2, then every 4 weeks), and authorization is granted for up to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Adakveo is indicated to reduce the frequency of vasoocclusive crises (VOCs) in adults and pediatric patients aged 16 years and older with sickle cell disease."
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