Inebilizumab-cdon

Covers inebilizumab‑cdon (Uplizna) for treatment of neuromyelitis optica spectrum disorder (NMOSD) in adults (≥18 years) who are anti‑aquaporin‑4 (AQP4) antibody seropositive and have a history of relapses (≥1 requiring rescue therapy in the prior 12 months or ≥2 in the prior 24 months) when the policy’s medical necessity criteria are met. Limitations: not covered for AQP4‑seronegative or pediatric patients, not to be used concurrently with other NMOSD biologics, and coverage is subject to the member’s benefit plan/contract and applicable state requirements (with off‑label uses requiring compendia support or two qualifying peer‑reviewed articles).

"Coverage for services is determined by the member's benefit plan, summary plan description, or contract."

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