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MBP 154.0 Radicava (edaravone)
Radicava (edaravone) is a free radical scavenger with anti-oxidative properties that protects motor neurons from oxidative stress and damage. Oxidative signaling pathways and stress are hypothesized as contributory in the early pathogenesis of amyotrophic lateral sclerosis (ALS).
Revised 1/19/23

MBP 210.0 Reblozyl (luspatercept-aamt)
Reblozyl (luspatercept-aamt) is a recombinant fusion protein that contains a modified form of the extracellular domain of human activin receptor type IIb and links to the human IgG1 Fc domain. It binds several endogenous transforming growth factor-beta (TGF-β) superfamily ligands, which results in reduced Smad2/3 signaling. Inhibition of TGF-β superfamily results in increased differentiation and proliferation of erythroid precursors and improves hematology parameters associated with ineffective erythropoiesis
Revised 9/14/23

MBP 281.0 Rebyota (fecal microbiota, live-jslm)
Rebyota (fecal microbiota, live-jslm) is a fecal microbiome therapy manufactured from human fecal matter sourced from qualified donors.  Rebyota is intended to restore intestinal eubiosis to prevent the recurrence of clostridium difficile infections (CDI) in patients following antibiotic treatment for recurrent CDI.
New Policy 5/16/23

MBP 215.0 Recarbrio (imipenem/cilastatin/relebactam)
Recarbrio (imipenem/cilastatin/relebactam) is a carbapenem antimicrobial that contains imipenem, which inhibits penicillin-binding proteins and leads to the disruption of bacterial cell wall synthesis. Recarbio also contains cilastatin, which is a renal dehydropeptidase inhibitor that limits the renal metabolism of imipenem, and relebactam, which is a beta-lactamase inhibitor that protects imipenem from degradation by beta-lactamases.
Revised 10/2/23

MBP 5.0 Remicade (infliximab) or Inflectra (infliximab-dyyb) or Renflexis (infliximab-abda) or Avsola (infliximab-axxq)
Infliximab is a therapeutic agent that inhibits activity of tumor necrosis factor alpha (TNF-alpha), a biological response mediator of inflammation. TNF-alpha is a key inflammatory mediator in rheumatoid arthritis, Crohn’s disease and other autoimmune disorders. In these chronic conditions, overproduction of TNF-alpha leads to inflammation. Infliximab reduces inflammation by binding to and neutralizing TNF- alpha on the cell membrane and in the blood. Infliximab-dyyb, infliximab-abda, and infliximab-axxq are biosimilar agents of Infliximab.
Revised 7/12/23

MBP 62.0 Remodulin IV (treprostinil sodium) 
Remodulin IV (treprostinil sodium) is a type of medication called a prostaglandin analog which helps the body open blood vessels located within pulmonary and systemic vascular beds.
Revised 1/19/23

MBP 5.0 Renflexis (infliximab-abda) or Remicade (infliximab) or Inflectra (infliximab-dyyb) or Avsola (infliximab-axxq)
Infliximab is a therapeutic agent that inhibits activity of tumor necrosis factor alpha (TNF-alpha), a biological response mediator of inflammation. TNF-alpha is a key inflammatory mediator in rheumatoid arthritis, Crohn’s disease and other autoimmune disorders. In these chronic conditions, overproduction of TNF-alpha leads to inflammation. Infliximab reduces inflammation by binding to and neutralizing TNF- alpha on the cell membrane and in the blood. Infliximab-dyyb, infliximab-abda, and infliximab-axxq are biosimilar agents of Infliximab.
Revised 7/20/21

MBP 193.0 Revcovi (elapegademase-lvlr)
Revcovi (elapegademase-lvlr) is an exogenous source of adenosine deaminase enzyme. Adenosine deaminase is an enzyme that catalyzes the deamination of both adenosine and deoxyadenosine. Hereditary lack of adenosine deaminase activity results in severe immunodeficiency disease, an often fatal disorder. Elapegademase-lvlr in effect, reduces levels of toxic adenosine and deoxyadenosine and increases lymphocytes.
Revised 12/16/22

MBP 313.0 Rezzayo (rezafungin)
Concentration-dependent inhibition of 1,3-beta-D-glucan synthase resulting in reduced formation of 1,3-beta-D-glucan, an essential polysaccharide of fungal (including Candida species) cell walls (absent in mammalian cells); decreased glucan content leads to osmotic instability and cellular lysis.
New Policy 1/16/24

MBP 48.0 Riabni (rituximab-arrx)
Rituxan (rituximab), Truxima (rituximab-abbs), Ruxience (rituximab-pvvr), and Riabni (rituximab-arrx) are genetically engineered chimeric murine/human monoclonal antibodies directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. Rituximab has been shown to be effective in rheumatoid arthritis in three randomized controlled trials and is now FDA-approved for use in combination with methotrexate (MTX) for reducing signs and symptoms in adult patients with moderately- to severely-active rheumatoid arthritis (RA) who have had an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies.
Revised 9/12/23

MBP 48.0 Rituxan (rituximab)
Rituxan (rituximab), Truxima (rituximab-abbs), Ruxience (rituximab-pvvr), and Riabni (rituximab-arrx) are genetically engineered chimeric murine/human monoclonal antibodies directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. Rituximab has been shown to be effective in rheumatoid arthritis in three randomized controlled trials and is now FDA-approved for use in combination with methotrexate (MTX) for reducing signs and symptoms in adult patients with moderately- to severely-active rheumatoid arthritis (RA) who have had an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies.
Revised 9/12/23

MBP 165.0 Rituxan Hycela (rituximab/hyaluronidase)
Rituxan Hycela is a combination product containing rituximab and hyaluronidase. Rituximab is a monoclonal antibody directed against the CD20 antigen on the surface of pre-B and mature B-lymphocytes. CD20 regulates cell cycle initiation; and, possibly, functions as a calcium channel. Rituximab binds to the antigen on the cell surface, activating complement-dependent B-cell cytotoxicity; and to human Fc receptors, mediating cell killing through an antibody-dependent cellular toxicity. Hyaluronidase increases the absorption rate of rituximab-containing products by increasing permeability of subcutaneous tissue through temporary depolymerization of hyaluronan.
Revised 10/26/23

MBP 308.0 Roctavian (valoctocogene roxaparvovec-rvox)
Valoctocogene roxaparvovec is an adeno-associated virus serotype 5 (AAV5)–based gene therapy vector. It is designed to introduce a functional copy of a transgene encoding the B-domain deleted SQ form of human coagulation factor VIII (hFVIII-SQ). Transcription of this transgene occurs within the liver, using a liver-specific promoter, which results in hFVIII-SQ expression. The expressed hFVIII-SQ replaces the missing coagulation factor VIII required for effective hemostasis.
New Policy 12/22/23

MBP 124.0 Ruconest (C1 esterase inhibitor, recombinant)
Ruconest (C1 esterase inhibitor, recombinant) is indicated for the treatment of acute hereditary angioedema (HAE) attacks in adults and adolescent patients. Ruconest is a recombinant C1 esterase inhibitor (rhC1INH) which irreversibly binds target proteases (activated C1s, kallikrein, factor XIIa, and factor XIa) of the contact and complement systems.
Revised 1/9/24

MBP 48.0 Ruxience (rituximab-pvvr)
Rituxan (rituximab), Truxima (rituximab-abbs), Ruxience (rituximab-pvvr), and Riabni (rituximab-arrx) are genetically engineered chimeric murine/human monoclonal antibodies directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. Rituximab has been shown to be effective in rheumatoid arthritis in three randomized controlled trials and is now FDA-approved for use in combination with methotrexate (MTX) for reducing signs and symptoms in adult patients with moderately- to severely-active rheumatoid arthritis (RA) who have had an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies.
Revised 9/12/23

MBP 239.0 Rybrevant (amivantamab-vmjw)
Rybrevant (amivantamab-vmjw) is a bispecific antibody that targets both epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition (MET). Rybrevant binds to the EGFR and MET extracellular domains and disrupts EGFR and MET signaling by blocking ligand binding and, in exon 20 insertion mutation models, degrading EGFR and MET. The presence of EGFR and MET on tumor cell surfaces also allows for targeted cell destruction by immune effector cells, such as natural killer cells and macrophages, via antibody-dependent cellular cytotoxicity and trogocytosis mechanisms, respectively.
Revised 7/11/23

MBP 244.0 Rylaze (asparaginase erwinia chrysanthemi (recombinant)- rywn)
Asparaginase (Erwinia [recombinant]) is an enzyme that catalyzes the deamidation of asparagine to aspartic acid and ammonia, reducing circulating levels of asparagine. Leukemia cells lack asparagine synthetase and are unable to synthesize asparagine. Asparaginase reduces the exogenous asparagine source for the leukemic cells, resulting in cytotoxicity specific to leukemic cells. Asparaginase (Erwinia [recombinant]) is produced by fermentation of a genetically engineered Pseudomonas fluorescens bacterium containing the DNA that encodes for asparaginase Erwinia chrysanthemi.
Revised 9/21/22

MBP 258.0 Ryplazim (plasminogen, human-tvmh)
Ryplazim (plasminogen, human-tvmh) functions by temporarily increasing plasminogen levels in the blood, providing a temporary correction of the plasminogen deficiency and reduction or resolution of extravascular fibrinous lesions.
Revised 5/11/23

MBP 305.0 Rystiggo (rozanolixizumab-noli)
Rozanolixizumab-noli, a humanized IgG4 monoclonal antibody, binds to the neonatal Fc receptor (FcRn), reducing circulating IgG.
New Policy 11/21/23