Uplizna® (Inebilizumab-Cdon) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Uplizna for adult AQP4‑IgG–positive NMOSD and for IgG4‑related disease when all policy criteria are met, excludes AQP4‑IgG seronegative NMOSD, and prohibits concomitant use with specified immunotherapies (e.g., rituximab/other anti‑CD20 agents, complement inhibitors, anti‑IL‑6 agents, and MS disease‑modifying therapies). Coverage requires specialist‑confirmed diagnosis, FDA‑labeled dosing, prior‑therapy requirements (rituximab failure or contraindication/intolerance with physician attestation that the same event is unlikely with Uplizna; plus glucocorticoid failure for IgG4‑RD), documentation of relapse history for NMOSD and positive clinical response for continuation, and authorizations are limited to 12 months.

"Treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients when all policy criteria are met."

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