Anifrolumab-fnia

This policy covers anifrolumab‑fnia (Saphnelo) intravenous therapy for adults (≥18 years) with active moderate-to-severe systemic lupus erythematosus (SLE) who have laboratory evidence of autoimibodies and persistent disease activity despite stable standard-of-care therapy. Coverage excludes patients with severe active lupus nephritis or severe active CNS lupus, prohibits concurrent use with other SLE biologics (e.g., belimumab, rituximab), and is subject to member benefit, state requirements, and the policy’s evidentiary criteria.

"Coverage of any FDA-approved drug when prescribed for a use recognized as safe and effective in one or more standard medical reference compendia adopted by the U."

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