Políticas de cobertura médica y de farmacia - Inicio

Políticas de cobertura de farmacia

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Fecha de vigenciaPolicy NameReviewed Date
1/1/2024 Sabril (vigabatrin)
7/19/2023
1/1/2020 Sabril® (vigabatrin)
7/6/2023
1/1/2022 Samsca® (tolvaptan)
5/17/2023
1/1/2022 Sancuso (granisetron) Transdermal
8/16/2023
1/1/2022 Sandostatin® S.C., Sandostatin LAR® Depot (octreotide acetate for injection)
4/19/2023
1/1/2024 Sandostatin® S.C., Sandostatin LAR® Depot (octreotide acetate for injection)
9/20/2023
1/1/2021 Santyl (collagenase)
8/16/2023
12/15/2021 Saphnelo™ (anifrolumab-fnia)
11/15/2023
1/1/2020 Saphris® (asenapine)
3/15/2023
1/1/2022 Sarclisa (isatuximab-irfc)
8/16/2023
1/22/2015 Savaysa® (edoxaban)
9/20/2023
1/1/2019 Savella® (milnacipran)
10/18/2023
12/15/2021 Scemblix® (asciminib)
5/17/2023
6/17/2020 Scenesse® (afamelanotide)
2/15/2023
3/25/2020 Secuado (asenapine) Transdermal System
3/15/2023
3/23/2022 Seglentis® (celecoxib-tramadol)
6/21/2023
1/1/2024 Seroquel XR (quetiapine fumarate) extended release tablets
8/16/2023
1/1/2020 Seroquel XR® (quetiapine fumarate) extended release tablets
3/15/2023
1/1/2020 Serostim® (somatropin)
4/19/2023
1/1/2021 SGLT2 Inhibitors
3/15/2023
1/17/2018 Shingrix (zoster vaccine recombinant, adjuvanted)
3/16/2022
2/20/2019 Short Acting Beta Agonists
10/18/2023
3/21/2013 Signifor® (pasireotide)
2/15/2023
1/1/2020 Signifor® LAR (pasireotide)
2/15/2023
1/1/2023 Signifor® LAR (pasireotide)
9/20/2023
1/1/2024 Signifor® LAR (pasireotide)
7/19/2023
12/14/2018 Siklos® (hydroxyurea)
2/15/2023
1/1/2022 Siliq® (brodalumab) injection
9/20/2023
1/1/2022 Siliq® (brodalumab) injection
9/20/2023
5/2/2013 Simbrinza™ (brinzolamide/brimonidine ophthalmic suspension)
5/17/2023
1/1/2024 Simbrinza™ (brinzolamide/brimonidine ophthalmic suspension)
9/20/2023
1/1/2019 Simponi ARIA (golimumab)
9/20/2023
1/1/2022 Simponi® (golimumab)
9/20/2023
1/1/2022 Simponi® (golimumab)
9/20/2023
3/21/2018 Sinuva™ (mometasone furoate) sinus implant
11/15/2023
5/2/2013 Sirturo® (bedaquiline)
11/15/2023
5/22/2014 Sitavig® (acyclovir)
10/18/2023
7/26/2023 Site of Care for Injectable Drugs
6/29/2023
6/28/2023 Skyclarys™ (omaveloxolone)
6/21/2023
1/1/2022 Skyrizi® (risankizumab-rzaa)
1/18/2023
7/7/2019 Smart Maintenance Dose
4/20/2023
4/20/2022 Soaanz® (torsemide)
4/19/2023
1/1/2021 Sofosbuvir/velpatasvir
8/16/2023
9/22/2021 Sofosbuvir/velpatasvir
8/16/2023
1/1/2020 Soliris® (eculizumab)
5/17/2023
1/1/2024 Soliris® (eculizumab)
7/19/2023
2/21/2018 Solosec™ (secnidazole)
11/15/2023
1/1/2019 Somatuline® Depot (lanreotide)
2/15/2023
1/1/2024 Somatuline® Depot (lanreotide)
7/19/2023
1/1/2023 Somavert® (pegvisomant)
4/19/2023
2/22/2023 Sotyktu (deucravacitinib)
9/20/2023
2/22/2023 Sotyktu (deucravacitinib)
9/20/2023
1/1/2021 Sovaldi® (sofosbuvir)
8/16/2023
1/1/2022 Sovaldi® (sofosbuvir)
8/16/2023
11/23/2022 Spevigo® (spesolimab-sbzo)
11/15/2023
1/1/2024 Spinraza® (nusinersen)
6/21/2023
1/1/2021 Spinraza® (nusinersen) injection
3/15/2023
1/1/2024 Spiriva Handihaler® (tiotropium bromide) ETB
9/20/2023
5/15/2019 Spravato™ (esketamine) Nasal Spray
7/19/2023
1/1/2020 Spritam® (levetiracetam)
10/18/2023
1/1/2020 Sprix® (ketorolac tromethamine) nasal spray
11/15/2023
1/1/2022 Sprycel® (dasatinib)
5/18/2022
1/1/2022 Sprycel® (dasatinib)
5/17/2023
1/1/2022 Statin Products
4/19/2023
1/1/2022 Statin Products
4/19/2023
1/1/2022 Stelara® (ustekinumab)
9/20/2023
1/1/2020 Stem cell mobilizing agents (Mozobil, Aphexda, Plerixafor)
10/18/2023
1/1/2023 Stivarga (regorafenib)
10/12/2023
1/1/2024 Stivarga (regorafenib)
10/12/2023
3/17/2021 Strensiq® (asfotase alfa)
3/15/2023
2/15/2017 Sublingual Allergen Extract
7/19/2023
1/1/2022 Sublingual Allergen Extract
5/17/2023
1/1/2020 Sublocade™ (buprenorphine extended-release) injection
11/15/2023
1/1/2022 Sucraid® (sacrosidase)
8/16/2023
3/22/2023 Sunlenca (lenacapavir)
3/15/2023
1/1/2023 Sunosi™ (solriamfetol)
7/19/2023
1/1/2023 Sunosi™ (solriamfetol)
7/19/2023
8/28/2008 Supprelin® LA (histrelin acetate implant)
8/16/2023
1/1/2019 Sustol® (granisetron)
8/16/2023
3/16/2022 Susvimo™ (ranibizumab)
4/19/2023
1/1/2024 Susvimo™ (ranibizumab)
9/20/2023
1/1/2024 Susvimo™ (ranibizumab)
8/16/2023
1/1/2023 Sutent (sunitinib)
5/17/2023
1/1/2024 Sutent (sunitinib)
7/19/2023
5/24/2023 Syfovre™ (pegcetacoplan) intravitreal solution
5/17/2023
1/1/2020 Sylatron™ (peginterferon alfa-2b)
6/15/2022
6/12/2014 Sylvant® (siltuximab)
2/15/2023
1/1/2023 Sympazan® (clobazam) Oral Film
7/19/2023
1/1/2023 Symproic® (naldemedine)
5/17/2023
1/1/2024 Symproic® (naldemedine)
6/21/2023
1/1/2022 Synagis® (palivizumab)
10/18/2023
1/1/2008 Synarel® (nafarelin acetate)
4/19/2023
1/1/2020 Syndros (dronabinol) oral solution
5/17/2023
1/1/2024 Syndros (dronabinol) oral solution
6/21/2023
1/1/2020 Synera® (lidocaine and tetracaine) topical patch
12/14/2022
11/21/2012 Synribo® (omacetaxine mepesuccinate)
10/18/2023
1/1/2020 Syprine® (trientine hydrochloride) capsules
1/18/2023
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