Specialty Drug Management Policy

Covers case‑by‑case approval of newly FDA‑approved specialty drugs for chronic and complex non‑cancer conditions (excludes cancer and related disorders). Coverage requires the drug be requested for an FDA‑approved indication supported by Phase III or Phase IIb evidence, no contraindications per the prescribing information (including for combination use), submission of any required labs/tests, documentation of prior therapy failure when specified, and adherence to FDA‑approved dosing unless an eviCore guideline applies, with plan benefit limits and eviCore management able to further restrict coverage.

"This policy addresses the management of newly approved specialty drug products by the United States Food & Drug Administration (FDA) that are used to treat chronic and complex diseases other than c..."

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