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July 10, 2023Standard Clinical Review List
August 10, 2023As your Prescription Benefit Facilitator, BeneCard PBF is committed to providing the highest quality service, innovative clinical solutions, and valuable trend management strategies.
BeneCard PBF controls trend through several factors, including our unique pass-through model, generic maximization, clinical programs, and formulary management. The BeneCard PBF Pharmacy and Therapeutics (P&T) Committee continually reviews the latest information available to keep our clinical rules and programs up to date to improve care and reduce costs.
As a result of detailed discussions regarding each medication, its indications, FDA guidelines, and potential member safety issues, the following changes have been approved.
Additions to the Specialty Medication and Standard Clinical Review List
For your reference, we have included the Therapeutic Category as well as the medication use.
- A respiratory syncytial virus (RSV) F protein‑directed fusion inhibitor.
- Indicated for the prevention of RSV lower respiratory tract disease in:
- Neonates and infants born during or entering their first RSV season.
- Children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season.
- A partial opioid agonist.
- Indicated for the treatment of moderate to severe opioid use disorder in patients who have initiated treatment with a single dose of a transmucosal buprenorphine product or who are already being treated with buprenorphine.
- There is a black box warning for risk of serious harm or death with intravenous administration; Brixadi risk evaluation, and mitigation strategy.
- A bispecific CD20-directed CD3 T-cell engager.
- Indicated for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS) or large B-cell lymphoma (LBCL) arising from follicular lymphoma, after two or more lines of systemic therapy.
- There is a black box for cytokine release syndrome.
- An adeno-associated virus vector-based gene therapy.
- Indicated for the treatment of ambulatory pediatric patients aged 4 through 5 years with Duchenne muscular dystrophy (DMD) with a confirmed mutation in the DMD gene.
- There are warnings for acute serious liver injury, immune-mediated myositis, myocarditis, and pre-existing immunity against AAVrh74.