Inebilizumab-cdon (Uplizna®) Injection

Covered: Uplizna (inebilizumab‑cdon) is covered only for FDA‑approved treatment of adult (≥18) NMOSD patients who are blood serum anti‑AQP4 antibody positive; AQP4‑negative patients and non‑FDA indications are excluded. Key requirements: prescribed by or in consultation with a neurologist, documented AQP4 seropositivity and prior trial of Soliris (eculizumab) or Enspryng (satralizumab) OR current/prior use of two of {azathioprine, corticosteroid, mycophenolate mofetil, rituximab}, dosing per policy (300 mg IV x2 two weeks apart then 300 mg IV every 6 months), approvals limited to 12 months and reauthorization requires documented clinical benefit.

"Treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti‑aquaporin‑4 (AQP4) antibody positive (FDA‑approved indication)."

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