Enspryng (satralizumab-mwge subcutaneous injection – Genentech) — Cigna

Initial criteria

• Patient is ≥ 18 years of age; AND
• Diagnosis was confirmed by a positive blood serum test for anti-aquaporin-4 antibody; AND
• The medication is being prescribed by or in consultation with a neurologist.

Reauthorization criteria

• Patient is ≥ 18 years of age; AND
• Diagnosis was confirmed by a positive blood serum test for anti-aquaporin-4 antibody; AND
• According to the prescriber, patient has had clinical benefit from the use of Enspryng (e.g., reduction in relapse rate, reduction in symptoms, slowing in progression of symptoms); AND
• The medication is being prescribed by or in consultation with a neurologist.

Approval duration

1 year