Anthem updates Yescarta, Exondys 51 coverage
Anthem Inc. (NYSE:ANTM) said it will cover newly approved chimeric antigen receptor (CAR) T therapy Yescarta axicabtagene ciloleucel (KTE-C19) from the Kite Pharma Inc. unit of Gilead Sciences Inc. (NASDAQ:GILD) for certain patients. The firm also said it will now cover Exondys 51 eteplirsen from Sarepta Therapeutics Inc. (NASDAQ:SRPT), reversing its initial decision to not cover the Duchenne muscular dystrophy (DMD) drug last year.
In a coverage policy note, Anthem said Yescarta is "medically necessary" to treat non-Hodgkin's lymphoma (NHL) only for adult patients with relapsed or refractory disease and a confirmed diagnosis of diffuse large B cell lymphoma (DLBCL), high-grade B cell lymphoma, primary mediastinal large B cell lymphoma or transformed follicular lymphoma who met clinical criteria including Eastern Cooperative Oncology Group (ECOG) performance status and neutrophil, lymphocyte and platelet counts. Patients must also have received adequate prior therapy. Under the policy, Anthem considers Yescarta "investigational and not medically necessary" for patients with central nervous system (CNS) disease, a history of allogeneic stem cell transplant, CAR T therapy or other genetically modified cell therapy, uncontrolled infection, or HIV, HBV or HCV infections...