Reblozyl® (Luspatercept-Aamt) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers luspatercept (Reblozyl) for adults with transfusion‑dependent beta thalassemia, symptomatic lower‑risk MDS meeting ring sideroblast/SF3B1 and EPO criteria (no del(5q)), MDS/MPN with SF3B1 mutation plus thrombocytosis, and select myelofibrosis‑associated anemia (must be used with a JAK inhibitor if splenomegaly/constitutional symptoms are present), and excludes pediatric use, alpha thalassemia, non‑transfusion‑dependent beta thalassemia, sickle beta thalassemia, and NCCN Category 3 indications. Coverage requires specialist prescribing/consultation, FDA‑label dosing, specific documentation (e.g., ≥6 PRBC units in prior 24 weeks with no transfusion‑free period >35 days for beta thalassemia; IPSS‑R risk, ring sideroblast %, SF3B1 and EPO ≤500 mU/mL as applicable; platelet ≥450×10^9/L for MDS/MPN; JAK inhibitor name if required), initial/renewal authorizations limited to 12 months, and evidence of clinical benefit (reduced transfusions or increased hemoglobin) for continuation.