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.