Inebilizumab-cdon (Uplizna)

Covered: Uplizna (inebilizumab‑cdon) for treatment of NMOSD in adults who are anti‑aquaporin‑4 (AQP4) antibody positive; AQP4‑negative patients and off‑label uses are excluded. Key requirements: age ≥18, documented serum AQP4 positivity, prior trial of azathioprine, corticosteroid, mycophenolate mofetil, rituximab, or Soliris, prescribed by or in consultation with a neurologist, dosed per label (300 mg IV ×2 doses 2 weeks apart then 300 mg IV every 6 months), 12‑month authorization and documentation of all criteria.

"Treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 antibody positive."

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