Pharmacy and Biopharmacy Policies To Be Updated As of June 1st

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Effective June 1, 2022: Pharmacy and Biopharmacy Policies


Superior HealthPlan has updated certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on June 1, 2022, at 12:00AM.


Policy

  • Pembrolizumab (Keytruda) (CP.PHAR.322)


Applicable Products 

  • Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter


New Policy Overview Or Updated Policy Revisions 

  • Policy updates include:

    • Removal of previously approved indication for usage as third-line monotherapy for PD-L1 positive gastric/GEJ cancer patients per updated prescribing information



Get contracted with Ambetter through Agility Insurance Services Now! 

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