Crizanlizumab-tmca

Policy covers crizanlizumab (Adakveo®) intravenous therapy to reduce vaso‑occlusive crises in patients with sickle cell disease. Coverage is limited to individuals aged ≥16 with ≥2 sickle‑cell–related crises requiring medical‑facility visits in the prior 12 months, must follow FDA/authoritative dosing (e.g., 5 mg/kg IV at Weeks 0 and 2 then every 4 weeks), is restricted to FDA‑approved indications (off‑label use requires strong literature support), and is subject to member benefit plan and state regulatory limitations.

"Drug therapy is covered when it is proven effective for the relevant diagnosis or procedure."

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