Most of you must have read
@Scottdish post highlighting Blue Cross & Blue Shield Minnesota's Provider Bulletin for covering aGVHD (of course, pending FDA approval).
I thought we need a separate thread so we can update insurer provider info as more providers come onboard.
Hence this new thread.
Here is another major insurer getting ready for providing coverage for aGVHD in the US.
Centene is the largest Medicaid managed care organization in the U.S.,
and a leader in California, Florida, New York and Texas, four of the largest Medicaid states.Here's the Centene Bulletin:
https://www.superiorhealthplan.com/content/dam/centene/policies/pharmacy-policies/CP.PHAR.474%20Remestemcel-L.pdfI have also attached it as a pdf file in case some of you are unable to open the link.
CP.PHAR.474 Remestemcel-L.pdf
What's real exciting to note is this:
While Blue Cross & Blue Shield Minnesota's Bulletin was effective July 1, 2020, Centene jumped on Remestemcel-L Clinical Policy and Bulletin
way back on March 3, 2020. So Centene did not waste any time in getting on board with Remestemcel-L.
What's remarkable is:
1. Centene clearly lays out
every exacting detail regarding
Approval Criteria, Dosage, Duration, Continued Therapy (and its associate Dosage and Duration), a list of alternative drugs recommended in the Approval Criteria - these drugs are immuno-suppresants/steroids such as mycophenolate mofetil, cyclosporine, betamethasone, dexamethasone etc. It also lists their dosage.
2.
Centene operates in all 50 US States for Medicaid- and is not just a state specific program like Blue Cross & Blue Shield. Centene had revenues of $75 billion USD in 2019
3. Centene serves as a major intermediary for both government-sponsored and privately insured health care programs
4. As the largest Medicaid managed care organization in the US, Centene is best positioned to cover a LOT of patients. For those who do not know what Medicaid is:
Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources.
5. Most importantly - and get this - treatment costs must have already been figured out and approved by organizations such as Centene and Blue Cross & Blue Shield to be issuing Approval Bulletins out waaaay ahead of the PDUFA date.
Exciting times!
(20min delay)