Adakveo® (Crizanlizumab-Tmca) – Commercial Medical Benefit Drug Policyopen_in_new

This policy covers Adakveo (crizanlizumab‑tmca) for reduction of vasoocclusive crises in patients with sickle cell disease (including HbSS, HbSC, sickle β0/β+ thalassemia) who are 16 years of age or older. Coverage is limited to patients meeting specific criteria — e.g., ≥2 VOCs in the prior 12 months or transition from Oxbryta, current hydroxyurea therapy or documented hydroxyurea failure/intolerance/contraindication or genotype‑based attestation of hydroxyurea inappropriateness — and requires prescribing by or in consultation with a hematologist, FDA‑label dosing, no concomitant chronic prophylactic transfusions or Oxbryta, and authorization/reauthorization limited to 12 months (not indicated for patients <16 years or for myelofibrosis).

"Adakveo is proven and/or medically necessary to reduce the frequency of vasoocclusive crises in patients with sickle cell disease who meet all of the following criteria:"