High impact
Natalizumab (CPB 0751, reviewed 2025-12-02)
Aetna·Effective Dec 2, 2025
Aetna updated its natalizumab (Tysabri/Tyruko) medical policy effective 2025-12-02, clarifying coverage criteria for Crohn's disease, relapsing-form multiple sclerosis, and clinically isolated syndrome. The policy requires precertification for all natalizumab treatments, mandates JCV antibody testing before initiation, and specifies that only gastroenterologists (CD) or neurologists (MS) may prescribe. Billing teams must implement prior authorization workflows and update system rules to enforce these requirements.