Adakveo Update

Attention: HematologistsEffective Date: May 26, 2020Call to action: Adakveo, Injection, crizanlizumab - clinician administered drug HCPCS code C9053 is an at risk drug. Currently, there is no prior authorization required; however, beginning May 26, 2020 authorization guidelines will be in place. The required criteria to receive Adakveo include:

• HbSS (sickle cell) diagnosis
• Patients over the age of 16 years-old
• Patients that have experienced more than two vaso-occlusive crisis (VOC) events in the past 12-months

How this impacts providers: Prescribers should adhere to the guidelines and acquire the necessary prior-authorizations. References: https://www.novartis.us/sites/www.novartis.us/files/adakveo.pdf TMPPM criteria is pending publication therefore, peer reviewed literature will be applied in absence of state criteria. Next steps for providers: Prescribers should regularly check the prior authorization requirements with the Texas vendor Drug Program: https://www.txvendordrug.com/sites/txvendordrug/files/docs/prior-authorization/cpa-assistance-chart.pdfIf you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.