09/22/2025
NON-INSURED BENEFITS UPDATES FOR SEPTEMBER 2025
The following medications and products are now covered as open benefits without prior approval:
Orgovyx (relugolix) for the treatment of prostate cancer
Axberi (enoxaparin sodium), a blood thinner, for the prevention or treatment of conditions such as deep vein thrombosis (DVT), unstable angina or heart attack
Cabtreo Gel (clindamycin phosphate/adapalene/benzoyl peroxide gel) for the topical treatment of acne vulgaris
Nextsellis (estetrol monohydrate and drospirenone) for the prevention of pregnancy
Fulphila and Niopeg (pegfilgrastim) to reduce the chance of infection for persons receiving some chemotherapy treatments
The following listings are covered as limited use benefits with prior approval:
Brukinsa (zanubrutinib) for the treatment of chronic lymphocytic leukemia (CLL)
Wezlana (ustekinumab) pre-filled pens for the treatment of plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis
Epidiolex (cannabidiol) for the treatment of certain seizure conditions
Tyenne (tocilizumab) for treatment of rheumatoid arthritis, arthritis in children 2 years of age and older, and giant cell arteritis in adults, a condition that causes inflammation of the arteries
Wainua (eplontersen) for the treatment of polyneuropathy, a condition affecting the nerves
Xcopri (cenobamate) for the treatment of partial-onset seizures in adults
Velsipity (etrasimod) for the treatment of ulcerative colitis
Tibsovo (ivosidenib) for the treatment of patients with newly diagnosed acute myeloid leukemia (AML)
Uplizna (inebilizumab) for the treatment of adult patients with neuromyelitits optica spectrum disorder (NMOSD), an autoimmune disease affecting the central nervous system
Myalepta (metreleptin) for the treatment of leptin deficiency in patients with lipodystrophy
Livmarli (maralixibat) for the treatment of severe itching in patients with Alagille syndrome, a condition affecting the liver and other organs
Coverage of continuous glucose monitoring system: FreeStyle Libre 3
NIHB has added the FreeStyle Libre 3 continuous glucose monitoring (CGM) system reader and sensors, as a limited use benefit for clients managing diabetes with insulin. Prior approval is required
Coverage includes 1 reader every 3 years, and 14 sensors every 6 months. Criteria are listed in the Drug Benefit List
In addition to FreeStyle Libre 3, NIHB continues to cover other CGM systems, including:
FreeStyle Libre 2
Dexcom G6 and Dexcom G7
Guardian Connect
NIHB continues to provide coverage of diabetes test strips. Clients managing diabetes with insulin are eligible for up to 800 test strips per 100 days
MEDICAL SUPPLIES AND EQUIPMENT BENEFIT INFORMATION
New coverage for enteral feeding supplies
NIHB now provides coverage for four new enteral feeding syringe sizes: 6cc/mL, 12cc/mL, 35cc/mL and 60cc/mL
More information can be found in section 9.0 Self-care of the NIHB Medical Supplies and Equipment Guide and Benefit Lists
New installation coverage policy for select self-care items
NIHB now covers installation costs for select self-care medical equipment
Coverage is based on an hourly rate and the estimated time required for installation. Prior approval is required
Coverage is eligible only when certain conditions are met
For more details, see section 9.0 Self-care of the NIHB Medical Supplies and Equipment Guide and Benefit Lists
Coverage for bariatric safety pole
NIHB now provides coverage for bariatric floor-to-ceiling poles as an open benefit at a recommended replacement frequency of 1 every 10 years
For more details, see section 9.0 Self-care of the NIHB Medical Supplies and Equipment Guide and Benefit Lists
