Enjaymo® (Sutimlimab-Jome) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Enjaymo (sutimlimab‑jome) for cold agglutinin disease (CAD) only when strict criteria are met — diagnosis by or in consultation with a hematologist, documented chronic hemolysis, positive polyspecific DAT and C3d monospecific DAT, IgG DAT ≤1+, cold agglutinin titer ≥64 at 4°C, exclusion of secondary causes, baseline hemoglobin ≤10 g/dL for initial therapy, and dosing per FDA labeling. Use is excluded for secondary CAD and concomitant use with other complement inhibitors; initial and renewal authorizations are limited to ≤12 months and continuation requires hematology oversight plus documented clinical response (e.g., increased Hb, fewer transfusions, or reduced hemolysis markers).

"Immunoglobulin G (IgG) DAT ≤ 1+ (document lab result)"

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