Crizanlizumab-tmca (Adakveo) (CPB 0964, reviewed 2025-12-09)
Summary
Aetna considers Adakveo (crizanlizumab-tmca) medically necessary for reducing the frequency of vaso-occlusive crises in members 16 years of age or older with sickle cell disease, when the member has had at least one vaso-occlusive crisis in the previous 12 months and either has HbSC, HbSβ+, or another genotypic variant of sickle cell disease, or has HbSS or HbSβ0 genotype and has had an inadequate response to, an intolerance of, or a contraindication to hydroxyurea, or will use Adakveo with concurrent hydroxyurea. Continuation is considered medically necessary when the frequency of vaso-occlusive crises has been reduced since starting therapy or has stayed reduced, and Adakveo must be prescribed by or in consultation with a hematologist or sickle cell disease specialist. All other indications are considered experimental, investigational, or unproven, including treatment and prevention of adverse outcomes in COVID-19. This policy covers commercial medical plans, and Medicare criteria are in Medicare Part B Criteria.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.