Specialty Drug Management Policy

Covers newly FDA‑approved specialty drugs for chronic, complex non‑cancer diseases on a case‑by‑case basis and excludes cancer‑related indications. Coverage requires the request be for an FDA‑approved indication supported by adequate clinical trial evidence, absence of label contraindications (including for combinations), submission of required lab/test results and documentation of prior therapy failure when applicable, dosing limited to FDA‑approved amounts, and is subject to clinical review and the member’s plan benefit limits.

"Requests for recently launched specialty drugs where a clinical guideline is in development but has not completed organizational and regulatory review."

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