Lantidra (donislecel) - MEDICAID - VIRGINIA

Covers allogeneic (deceased-donor) pancreatic islet cell infusion (Lantidra/donislecel) administered via intraportal infusion for treatment of type 1 diabetes. Coverage is limited to adults 18–65 with T1D who have recurrent severe hypoglycemia or hypoglycemia unawareness and are unable to reach target A1c despite intensive diabetes management and education; required concomitant immunosuppression, prior authorization/medical director review through the Corporate Transplant Department, lifetime maximum of three infusions, specific repeat‑infusion timing criteria, and portal‑vein thrombosis–related restrictions apply.

"Documentation of patient age (18 through 65 years)."

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