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Medical benefit pharmaceutical policies for providers

See the latest updates to our medical benefit pharmaceutical policies. 

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H

MBP 88.0 Halaven (eribulin mesylate)
Halaven (eribulin) is a nontaxane microtubule dynamics inhibitor that inhibits the growth phase of microtubules without affecting the shortening phase, and sequesters tubulin into nonproductive aggregates. Eribulin exerts its effects via a tubulin-based antimitotic mechanism leading to G2/M cell-cycle block, disruption of mitotic spindles, and, ultimately, apoptotic cell death after prolonged mitotic blockage
Reviewed 1/24/18

MBP 179.0 Hemlibra (emicizumab-kxwh)
Hemlibra (emicizumab-kxwh) is a humanized monoclonal modified immunoglobulin G4 (IgG4) antibody with a bispecific factor IXa- and factor X-directed antibody, bridges activated factor IX and factor X to restore the function of missing activated factor VIII that is needed for effective hemostasis. Emicizumab-kxwh has no structural relationship or sequence homology to FVIII and, therefore, does not induce or enhance the development of direct inhibitors to FVIII.
New Policy 7/17/18

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