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Please contact your source of eligibility Division of Medicaid or Social Security Administration if you have a change of address.

Please contact your source of eligibility Division of Medicaid or Social Security Administration if you have a change of address.

Effective April 1, 2026: Pharmacy and Biopharmacy Policies

Date: 01/26/26

Magnolia Health Plan has added, updated or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on April 1, 2026, at 12:00AM.

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Inebilizumab-cdon (Uplizna) (CP.PHAR.458)

Medicaid and CHIP

Policy updates include:

·         Added criteria for the newly approved indication of gmg

·         For neuromyelitis optica spectrum disorder and immunoglobulin G4-related disease (IGG4-RD), extended initial approval durations for Medicaid and Ambetter from 6 to 12 months

Fibrinogen concentrate (human) (Fibryga, RiaSTAP), Fibrinogen Human-chmt (Fesility) (CP.PHAR.526)

Medicaid and CHIP

Policy updates include:

·         Added newly approved Fesilty

Retifanlimab-dlwr (Zynyz) (CP.PHAR.629)

Medicaid and CHIP

Policy updates include:

·         Updated Food and Drug Administration (FDA) Approved Indication(s) section for MCC from accelerated approval to full approval

·         Extended Medicaid and Ambetter initial approval durations from 6 months to 12 months for this maintenance medication for a chronic condition

·         For Merkel cell carcinoma, added pathway for in-transit regional disease and primary regional disease per National Comprehensive Cancer Network (NCCN) compendium and removed requirement of “Disease is not amenable to surgery or radiation therapy” for metastatic or recurrent locally advanced disease

To review all policies, please visit Magnolia's Clinical & Payment Policies webpage.

Prior to updates, pharmacy and biopharmacy clinical policies are reviewed and approved by the Pharmacy and Therapeutics (P&T) Committee.

For questions or additional information, please contact Magnolia’s Pharmacy Department at 1-866-912-6285, ext. 66409.