EFFECTIVE December 1, 2023
|
Pharmaceutical Policy Name |
Status |
|---|---|
|
Entyvio |
Reviewed |
|
Risankizumab (Skyrizi) |
Updated |
|
Ustekinumab (Stelara) |
Updated |
|
Proton Pump Inhibitor Therapy |
Updated |
|
Hemophilia Factor |
Reviewed |
|
Colony Stimulating Factor |
Updated |
|
Erythropoiesus Stimulating Agents |
Reviewed |
|
Hereditary Angioedema |
Reviewed |
|
Gaucher Disease Type 1 Treatment |
Reviewed |
|
Select Chelating Agents |
Updated |
|
Enteral Therapy VT |
Reviewed |
|
Irritable Bowel Syndrome |
Updated |
|
Biosimilars, Select Medical |
Reviewed |
|
Intestinal Antibiotics |
Reviewed |
|
Mulpleta/Doptelet |
Reviewed |
|
Dojolvi |
Reviewed |
|
Ozanimod (Zeposia) |
Reviewed |
|
Etancercept (Enbrel) |
Reviewed |
|
Tofacitinib (Xeljanz) |
Reviewed |
|
Guzelkumab (Tremfya) |
Reviewed |
|
Tepezza |
Updated |
|
Adakveo |
Updated |
|
Upadacitinib (Rinvoq) |
Updated |
|
Secukinumab (Cosentyx) |
Updated |
|
Adalimumab (Humira) |
Updated |
|
Apremilast (Otezla) |
Updated |
|
Soliris |
New |
|
Ultomiris |
New |
|
Pharmacy Program Management |
Updated |
EFFECTIVE January 1, 2024
|
Pharmaceutical Policy Name |
Status |
|---|---|
|
Multiple Sclerosis Agents |
Updated |
|
GABA Receptor Modulators |
Updated |
|
Duchenne Muscular Dystrophy |
Reviewed |
|
Duchenne Muscular Dystrophy Medicaid |
Reviewed |
|
Movement Disorder |
Updated |
|
Botulinum Toxin Treatment |
Reviewed |
|
Radicava |
Reviewed |
|
Respiratory Syncytial Virus/Synagis (palivizumab) |
Updated |
|
Spravato |
Reviewed |
|
Gabapentin ER |
Reviewed |
|
Nuedexta |
Reviewed |
|
Agents for female sexual dysfunction |
Updated |
|
Adalimumab |
Updated |
|
Monoclonal Antibodies for Alzheimer's Disease (formerly Aduhelm) |
Updated |
|
CAR-T Cell Therapy |
Updated |
|
Daybue |
New |
|
GLP-1 Receptor Agonist Retrospective |
Archived |
|
Select Oral Antipsychotics |
Updated |
|
MVP Medicare Part D Drug Management |
Updated |
|
Oral Allergen Immunotherapy Medications |
Updated |
|
Palforzia |
Reviewed |
|
Pharmacy Programs Administration Internal |
Updated |
|
Prostate Cancer |
Reviewed |
|
Spinal Muscular Atrophy |
Reviewed |
|
Zoladex-Medicaid |
Reviewed |
|
Herceptin (trastuzumab)- Medicaid |
Reviewed |
|
Perjeta (pertuzumab)- Medicaid |
Reviewed |
|
Avastin (bevacizumab)- Medicaid |
Reviewed |
|
Cancer Guidance Program Oncology Medication Coverage and Review |
New |
|
Densoumab (Prolia and Xgeva) |
New |
|
Dose Rounding for Systemic therapy |
New |
|
Entyvio (vedolizumab) Medicare Part B |
Updated |
|
Infliximab Medicare Part B |
Updated |
|
Drug Utilization Review & Monitoring Program |
Updated |
|
Zinplava Medicare Part B |
Updated |
|
Zynteglo Medicare Part B |
Updated |
|
Syfovre |
Updated |
|
Syfovre Medicare Part B |
Updated |
|
Immunoglobulin Therapy Medicare Part B |
Updated |
|
Medicare Part B vs. Part D Determination |
Updated |
|
Medicare Part B Drug Therapy |
Updated |
|
Eylea |
Archived |
|
Skysona Medicare Part B |
Updated |
|
Botulinum Toxin Treatment |
Archived |
|
Botulinum Toxin Treatment Part B |
Archived |
|
Weight Loss Medications |
New |
EFFECTIVE February 1, 2024
|
Pharmaceutical Policy Name |
Status |
|---|---|
|
Entyvio (vedolizumab) |
Updated |
|
Infliximab |
Updated |
|
Certolizumab (Cimzia) |
Updated |
|
Adalimumab (Humira) |
Updated |
|
Risankizumab (Skyrizi) |
Updated |
|
Ustekinumab (Stelara) |
Updated |
|
Antibiotic/Antiviral (oral) Prophylaxis |
Reviewed |
|
Zinplava |
Updated |
|
Government Programs OTC Drug Coverage |
Reviewed |
|
Compounded (Extemporaneous) Medications |
Updated |
|
Skysona |
Updated |
|
D-SNP Over-the-Counter (OTC) and Prescription Drug Coverage |
New |
|
Secukinumab |
Updated |
|
Secukinumab Part B |
New Policy |
|
Omidubicel |
New Policy |
|
Omidubicel Part B |
New Policy |
|
Donislecel |
New Policy |
|
Donislecel Part B |
New Policy |
|
Pulmonary Hypertension (Advanced Agents) Part B |
Archived |
|
Hemophilia Gene Therapy Part B |
New Policy |
|
Vascular Endothelial Growth Factor (VEGF) Inhibitor |
Updated |
|
Vascular Endothelial Growth Factor (VEGF) Inhibitor Part B |
Updated |
|
Syfovre |
Updated |
|
Syfovre Part B |
Updated |
EFFECTIVE April 1, 2024
|
Pharmaceutical Policy Name |
Status |
|---|---|
|
Ganaxolone |
No changes |
|
Teplizumab-mzwv |
No changes |
|
Teplizumab-mzwv Part B |
No changes |
|
Tocilizumab |
Updated |
|
Tocilizumab Part B |
Updated |
|
Golimumab |
Updated |
|
Golimumab Part B |
Updated |
|
Abatacept |
Updated |
|
Abatacept Part B |
Updated |
|
Mail Order |
No changes |
|
Prescribers Treating Self or Family Members |
No changes |
|
Physician Prescription Eligibility |
No changes |
|
Transgender Hormone Therapy (COMM/EXCH/CHP) |
No changes |
|
Transgender Hormone Therapy (Medicaid/HARP) |
No changes |
|
Phenylketonuria Agents |
No changes |
|
Acthar |
No changes |
|
Certolizumab |
Updated |
|
Certolizumab Part B |
Updated |
|
Etanercept |
Updated |
|
Growth Hormone |
No changes |
|
Infertility Drug Therapy (Commercial/Marketplace) |
Updated |
|
Jynarque |
Updated |
|
Male Hypogonadism |
Updated |
|
Metformin ER |
Updated |
|
Vascular Endothelial Growth Factor (VEGF) Inhibitor Effective November 1, 2023 |
New |
|
Zynteglo Effective October 27, 2023 |
Updated |
|
Hemophilia Gene Therapy Effective October 1, 2023 |
New |
Policy Updates
Review other articles in this issue regarding formulary, pharmacy policy, and medical policy updates.