Enspryng (satralizumab-mwge) — United Healthcare

Initial criteria

• Diagnosis of neuromyelitis optica spectrum disorder (NMOSD)
• Patient has a positive serologic test for anti-aquaporin-4 (AQP4) antibodies
• Patient is not receiving Enspryng in combination with any of the following: Disease modifying therapies for the treatment of multiple sclerosis [e.g., Gilenya (fingolimod), Tecfidera (dimethyl fumarate), Ocrevus (ocrelizumab), etc.] AND Complement inhibitors [e.g., Soliris (eculizumab), Ultomiris (ravulizumab), etc.] AND Anti-IL6 therapy [e.g., Actemra (tocilizumab)] AND B-cell depletion therapy [e.g., rituximab, Uplizna (inebilizumab-cdon)]

Reauthorization criteria

• Documentation of positive clinical response to Enspryng therapy
• Patient is not receiving Enspryng in combination with any of the following: Disease modifying therapies for the treatment of multiple sclerosis [e.g., Gilenya (fingolimod), Tecfidera (dimethyl fumarate), Ocrevus (ocrelizumab), etc.] AND Complement inhibitors [e.g., Soliris (eculizumab), Ultomiris (ravulizumab), etc.] AND Anti-IL6 therapy [e.g., Actemra (tocilizumab)] AND B-cell depletion therapy [e.g., rituximab, Uplizna (inebilizumab-cdon)]

Approval duration

12 months