Tysabri policy criteria

[chantell.reagan]

In consideration of the latest position statement issued by the American Academy of Neurology (AAN), we decided to review publicly-available policies for 7 plans with regional and national presence.

As reported in an earlier news update, AAN recommends to reserve Tysabri for patients with relapsing remitting MS who have failed other disease modifying drugs (DMDs) or who have a “particularly aggressive initial disease course.”

Overall, the reviewed policies appear to be consistent in the prerequisite of DMD failure: 5 out of 6 plans required failure of at least 1 DMD. However, few plans specifically define treatment failure. Furthermore, only 1 plan has developed criteria for covering Tysabri as first-line therapy in patients with aggressive disease.

The following figure provides a comparative summary of the selected policies (click on the image to enlarge it).



Sources:

Blue Cross and Blue Shield of Florida. Tysabri policy.

The Regence Group. Tysabri policy.

Excellus BlueCross BlueShield. Tysabri prescription drug policy.

Wellpoint, NextRx. Anthem National Drug Formulary.

Aetna. Clinical Policy Bulletin: Tysabri.

Cigna. Tysabri Coverage Policy.


Related link:
Tysabri policy criteria - Crohn's disease