Lantidra (donislecel) - MEDICAID - SOUTH CAROLINA

This policy covers Lantidra (donislecel) allogeneic pancreatic islet beta cell infusion for treatment of adults (ages 18–65) with type 1 diabetes. Coverage is limited to patients with recurrent severe hypoglycemia or hypoglycemia unawareness despite intensive diabetes management and education, requires concomitant immunosuppression and medical director review, and allows repeat infusions only if initial criteria are met and insulin independence is not achieved or is lost within one year.

"Individual is pregnant or breastfeeding; OR"

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