Medical benefit pharmaceutical policies for providers
See the latest updates to our medical benefit pharmaceutical policies.
MBP 293.0 Qalsody (tofersen)
Qalsody (tofersen) is an anti-sense oligonucleotide that induces ribonuclease H-mediated degradation of superoxide dismutase 1 (SOD1) mRNA, resulting in SOD1 protein synthesis reduction.
New Policy 7/18/23
MBP 269.0 Qutenza (capsaicin topical system)
Capsaicin is an agonist for the transient receptor potential vanilloid 1 receptor (TRPV1), which is an ion channel-receptor complex expressed on nociceptive nerve fibers in the skin. Topical administration of capsaicin causes an initial enhanced stimulation of the TRPV1-expressing cutaneous nociceptors that may be associated with painful sensations. This is followed by pain relief thought to be mediated by a reduction in TRPV1- expressing nociceptive nerve endings. Over the course of several months, there may be a gradual re-emergence of painful neuropathy thought to be due to TRPV1 nerve fiber reinnervation of the treated area.
New Policy 9/20/22
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