| Fecha de vigencia | Policy Name | Reviewed Date |
| 6/16/2021 |
Abecma® (idecabtagene vicleucel)
| 4/19/2023 |
| 6/16/2021 |
Abecma® (idecabtagene vicleucel)
| 4/19/2023 |
| 1/1/2023 |
Abecma® (idecabtagene vicleucel)
| 4/19/2023 |
| 12/12/2018 |
Abilify MyCite® (aripiprazole tablets with sensor)
| 3/15/2023 |
| 12/12/2018 |
Abilify MyCite® (aripiprazole tablets with sensor)
| 3/15/2023 |
| 1/1/2021 |
Abilify® (aripiprazole)
| 8/16/2023 |
| 1/1/2023 |
Abraxane (nab- paclitaxel)
| 5/17/2023 |
| 1/1/2023 |
Abraxane (nab) paclitaxel
| 6/29/2023 |
| 1/1/2023 |
Abraxane (nab) paclitaxel
| 5/17/2023 |
| 7/21/2021 |
Accrufer™ (ferric maltol)
| 5/17/2023 |
| 1/1/2021 |
Acitretin
| 8/16/2023 |
| 1/1/2019 |
Actemra® (tocilizumab) Intravenous
| 9/20/2023 |
| 1/1/2019 |
Actemra® (tocilizumab) Intravenous
| 9/20/2023 |
| 1/1/2022 |
Actemra® (tocilizumab) Subcutaneous
| 9/20/2023 |
| 1/1/2022 |
Actemra® (tocilizumab) Subcutaneous
| 9/20/2023 |
| 1/1/2020 |
Actemra® IV (tocilizumab)
| 9/20/2023 |
| 1/1/2006 |
Actimmune® (interferon gamma-1b)
| 8/16/2023 |
| 1/1/2022 |
Actinic Keratosis Agents
| 8/16/2023 |
| 5/8/2020 |
Adakveo® (crizanlizumab-tmca)
| 2/15/2023 |
| 4/27/2022 |
Adbry™ (tralokinumab-ldrm)
| 4/19/2023 |
| 9/1/2011 |
Adcetris® (brentuximab vedotin)
| 2/16/2022 |
| 1/1/2021 |
Adempas® (riociguat)
| 3/15/2023 |
| 1/1/2022 |
ADHD Long Acting Stimulants
| 9/20/2023 |
| 1/1/2024 |
ADHD Long Acting Stimulants
| 9/20/2023 |
| 7/27/2022 |
Adlarity® (donepezil) transdermal patch
| 4/19/2023 |
| 1/1/2024 |
Adlarity® (donepezil) transdermal patch
| 6/21/2023 |
| 9/4/2023 |
Adstiladrin (nadofaragene firadenovec-vncg)
| 8/24/2023 |
| 12/15/2021 |
Aduhelm™ (aducanumab-avwa) intravenous solution
| 3/15/2023 |
| 4/27/2022 |
Aduhelm™ (aducanumab-avwa) intravenous solution
| 3/15/2023 |
| 1/1/2023 |
Aemcolo® (rifamycin)
| 3/15/2023 |
| 1/1/2024 |
Aemcolo® (rifamycin)
| 6/21/2023 |
| 1/1/2022 |
Afinitor/Afinitor Disperz (everolimus)
| 7/20/2022 |
| 1/1/2023 |
Afinitor/Afinitor Disperz (everolimus)
| 5/17/2023 |
| 1/1/2024 |
Afinitor/Afinitor Disperz (everolimus)
| 9/20/2023 |
| 1/1/2022 |
Aflibercept Products (Eylea®, Eylea® HD)
| 10/5/2023 |
| 1/1/2023 |
Aflibercept Products (Eylea®, Eylea® HD)
| 10/5/2023 |
| 12/31/2014 |
Afrezza® (insulin human) Inhalation Powder
| 3/15/2023 |
| 1/1/2017 |
Aggrenox® (aspirin/dipyridamole)
| 1/18/2023 |
| 5/26/2022 |
AHCA Continuity of Care
| 5/19/2022 |
| 10/25/2023 |
AIRSUPRA (albuterol and budesonide) inhalation aerosol
| 10/18/2023 |
| 11/15/2023 |
Akeega (niraparib and abiraterone acetate)
| 11/15/2023 |
| 1/1/2023 |
Aklief® (trifarotene)
| 5/17/2023 |
| 1/1/2020 |
Akynzeo (fosnetupitant/netupitant-palonosetron)
| 5/17/2023 |
| 1/1/2024 |
Akynzeo (fosnetupitant/netupitant-palonosetron)
| 6/21/2023 |
| 1/1/2013 |
Aldurazyme® (laronidase)
| 9/20/2023 |
| 1/1/2022 |
Alecensa (alectinib)
| 5/17/2023 |
| 1/1/2014 |
Alferon N® (interferon alfa-n3)
| 3/16/2022 |
| 12/20/2017 |
Aliqopa™ (copanlisib)
| 8/16/2023 |
| 12/9/2020 |
Alkindi® (hydrocortisone) sprinkle capsule
| 10/18/2023 |
| 1/1/2019 |
Allergy Ophthalmics
| 10/18/2023 |
| 1/1/2020 |
Allergy Ophthalmics
| 5/25/2023 |
| 1/1/2024 |
Allergy Ophthalmics
| 6/21/2023 |
| 1/1/2019 |
Aloxi (palonosetron)
| 2/23/2023 |
| 1/1/2016 |
Alpha-1 Proteinase Inhibitors (Aralast NP®, Glassia®)
| 9/20/2023 |
| 1/1/2024 |
Alpha-1 Proteinase Inhibitors (Aralast NP®, Glassia®, Prolastin-C®)
| 7/19/2023 |
| 1/1/2023 |
Alpha-1 Proteinase Inhibitors (Aralast NP®, Glassia®, Zemaira®)
| 9/20/2023 |
| 1/1/2016 |
Alpha-1 Proteinase Inhibitors (Prolastin-C®, Zemaira®)
| 9/20/2023 |
| 1/1/2024 |
Alpha-1 Proteinase Inhibitors (Prolastin-C®, Zemaira®)
| 9/20/2023 |
| 1/1/2015 |
Alphagan® P (brimonidine)
| 7/19/2023 |
| 1/1/2024 |
Alphagan® P (brimonidine)
| 9/20/2023 |
| 7/20/2017 |
Alunbrig™ (brigatinib)
| 12/14/2022 |
| 1/1/2023 |
Amitiza® (lubiprostone)
| 5/17/2023 |
| 1/1/2024 |
Amitiza® (lubiprostone)
| 6/21/2023 |
| 6/16/2021 |
Amondys 45 (casimersen) intravenous solution
| 3/15/2023 |
| 1/1/2020 |
Ampyra® (dalfampridine)
| 10/18/2023 |
| 1/1/2020 |
Amrix®, Fexmid® (cyclobenzaprine hydrochloride)
| 2/15/2023 |
| 9/28/2022 |
Amvuttra™ (vutrisiran)
| 9/20/2023 |
| 1/1/2023 |
Amzeeq (minocycline) topical foam
| 5/17/2023 |
| 1/1/2020 |
Angiotensin Blocking & Renin Inhibitor Agents
| 5/17/2023 |
| 1/1/2024 |
Angiotensin Blocking & Renin Inhibitor Agents
| 8/16/2023 |
| 1/1/2023 |
Angiotensin Blocking Agents
| 5/17/2023 |
| 1/1/2019 |
Angiotensin-Calcium Channel Blocking Agents
| 1/18/2023 |
| 1/1/2022 |
Anticholinergics and Central Nervous System Polypharmacy Agents
| 8/17/2023 |
| 1/1/2020 |
Antidepressant Agents
| 11/15/2023 |
| 1/1/2019 |
Antipsychotic Utilization Program
| 3/15/2023 |
| 1/1/2020 |
Apadaz® (benzhydrocodone and acetaminophen)
| 2/15/2023 |
| 1/1/2022 |
Apokyn® (apomorphine) subcutaneous injection
| 6/21/2023 |
| 1/1/2020 |
Aptiom® (eslicarbazepine acetate)
| 11/15/2023 |
| 1/1/2024 |
Aptiom® (eslicarbazepine acetate)
| 6/21/2023 |
| 1/1/2023 |
Aranesp® (darbepoetin alfa)
| 7/19/2023 |
| 4/3/2008 |
Arcalyst® (rilonacept)
| 2/15/2023 |
| 1/1/2020 |
Arikayce® (liposomal amikacin for inhalation)
| 2/15/2023 |
| 12/11/2019 |
Asparlas™ (calaspargase pegol-mknl)
| 11/15/2023 |
| 1/1/2024 |
Astagraf XL (tacrolimus extended release)
| 8/16/2023 |
| 1/1/2019 |
Asthma Interleukin Inhibitors (Cinqair® , Nucala™, Fasenra®)
| 5/17/2023 |
| 1/1/2024 |
Atgam (antithymocyte immune globulin, equine)
| 6/21/2023 |
| 1/1/2013 |
Atgam® (antithymocyte immune globulin, equine)
| 6/21/2023 |
| 1/1/2023 |
Aubagio® (teriflunomide) tablet
| 3/16/2023 |
| 1/1/2023 |
Auryxia® (ferric citrate)
| 3/15/2023 |
| 1/1/2022 |
Austedo® & Austedo® XR (deutetrabenazine)
| 7/20/2023 |
| 11/30/2022 |
Auvelity™ (dextromethorphan and bupropion)
| 3/2/2023 |
| 6/17/2020 |
Avsola® (infliximab-axxq)
| 9/20/2023 |
| 1/1/2023 |
Avsola® (infliximab-axxq)
| 9/20/2023 |
| 1/1/2022 |
Avsola™ (infliximab-axxq)
| 9/20/2023 |
| 3/4/2020 |
Ayvakit™ (avapritinib)
| 7/19/2023 |
| 10/17/2018 |
Azedra® (iobenguano I 131)
| 3/15/2023 |
| 1/1/2022 |
Azilect® (rasagiline) tablets
| 1/18/2023 |
| 1/1/2019 |
Azopt® (brinzolamide ophthalmic suspension) 1%
| 10/18/2023 |
| 1/1/2024 |
Azopt® (brinzolamide ophthalmic suspension) 1%
| 9/20/2023 |
| 11/6/2019 |
Baclofen Products (Fleqsuvy™, baclofen oral solution, baclofen oral suspension, Ozobax™, Lyvispah™)
| 7/19/2023 |
| 1/1/2023 |
Bafiertam® (monomethyl fumarate) capsule, delayed release
| 5/17/2023 |
| 1/1/2022 |
Balversa™ (erdafitinib)
| 8/16/2023 |
| 1/1/2022 |
Banzel® (rufinamide)
| 3/15/2023 |
| 1/1/2019 |
Bavencio® (avelumab)
| 8/16/2023 |
| 7/24/2014 |
Beleodaq® (belinostat)
| 2/15/2023 |
| 5/1/2021 |
Bempedoic Acid Products
| 5/11/2023 |
| 1/1/2023 |
Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta)
| 8/3/2023 |
| 1/1/2022 |
Benlysta® (belimumab)
| 8/16/2023 |
| 1/1/2019 |
Benzodiazepine Limited Days' Supply
| 6/15/2023 |
| 7/27/2022 |
Beovu® (brolucizumab)
| 4/19/2023 |
| 1/1/2023 |
Beovu® (brolucizumab)
| 4/19/2023 |
| 1/1/2024 |
Beovu® (brolucizumab)
| 9/20/2023 |
| 1/1/2024 |
Berinert (C1 esterase inhibitor, human)
| 7/19/2023 |
| 1/1/2024 |
Berinert (C1 esterase inhibitor, human)
| 7/19/2023 |
| 1/1/2022 |
Berinert® (C1 esterase inhibitor, human)
| 7/19/2023 |
| 1/1/2022 |
Berinert® (C1 esterase inhibitor, human)
| 7/19/2023 |
| 1/1/2019 |
Besponsa™ (inotuzumab ozogamicin)
| 2/16/2022 |
| 2/16/2022 |
Besremi (ropeginterferon alfa-2b-njft)
| 2/15/2023 |
| 1/1/2022 |
Betaseron® (interferon beta-1b)
| 6/21/2023 |
| 1/1/2023 |
Bevacizumab products
| 2/23/2023 |
| 3/1/2023 |
Productos Bevacizumab
| 2/23/2023 |
| 1/1/2024 |
Bevacizumab products
| 7/19/2023 |
| 1/1/2022 |
BiDil® (isosorbide dinitrate/hydralazine)
| 8/16/2023 |
| 1/1/2019 |
Biguanide Agents
| 7/19/2023 |
| 1/1/2017 |
Bisphosphonates
| 1/18/2023 |
| 10/14/2020 |
Blenrep (belantamab mafodotin-blmf)
| 8/24/2023 |
| 1/1/2020 |
Blincyto® (blinatumomab)
| 5/17/2023 |
| 1/1/2022 |
Bortezomib products (Velcade and Bortezomib for injection)
| 8/16/2023 |
| 1/1/2022 |
Bosentan Products
| 3/15/2023 |
| 1/1/2022 |
Bosulif® (bosutinib)
| 5/17/2023 |
| 1/1/2022 |
Bosulif® (bosutinib)
| 5/17/2023 |
| 9/29/2006 |
Botox® (Botulinum Toxin)
| 8/16/2023 |
| 1/1/2024 |
Botox® (onabotulinumtoxinA)
| 8/31/2023 |
| 1/1/2022 |
Bowel Prep Agents
| 7/20/2023 |
| 1/1/2023 |
Bowel Prep Agents
| 7/20/2023 |
| 1/1/2024 |
Bowel Prep Agents
| 7/20/2023 |
| 1/1/2016 |
BPH Agents
| 6/21/2023 |
| 1/1/2020 |
Braftovi™ (encorafenib) and Mektovi® (binimetinib)
| 11/15/2023 |
| 3/17/2021 |
Breyanzi® (lisocabtagene maraleucel)
| 4/19/2023 |
| 1/1/2023 |
Breyanzi® (lisocabtagene maraleucel)
| 4/19/2023 |
| 4/21/2021 |
Breyanzi® (lisocabtagene maraleucel)
| 4/19/2023 |
| 9/16/2020 |
Breztri Aerosphere™ (budesonide/glycopyrrolate/formoterol fumarate)
| 3/15/2023 |
| 1/1/2024 |
Breztri Aerosphere™ (budesonide/glycopyrrolate/formoterol fumarate)
| 8/16/2023 |
| 2/23/2022 |
Brimonidine-timolol eye drops (generic Combigan)
| 10/18/2023 |
| 7/19/2017 |
Brineura™ (cerliponase alfa)
| 2/15/2023 |
| 6/7/2023 |
Briumvi™ (ublituximab) intravenous solution
| 5/17/2023 |
| 6/7/2023 |
Briumvi™ (ublituximab) intravenous solution
| 5/17/2023 |
| 6/7/2023 |
Briumvi™ (ublituximab) intravenous solution
| 5/17/2023 |
| 6/22/2016 |
Briviact® (brivaracetam)
| 8/16/2023 |
| 1/1/2024 |
Briviact® (brivaracetam)
| 6/21/2023 |
| 11/22/2023 |
Brixadi™ (buprenorphine)
| 11/15/2023 |
| 5/19/2021 |
Bronchitol® (mannitol)
| 3/15/2023 |
| 1/1/2023 |
Brukinsa™ (zanubrutinib)
| 2/16/2023 |
| 1/1/2020 |
Buprenorphine Containing Products
| 8/16/2023 |
| 1/1/2023 |
Buprenorphine Containing Products
| 8/16/2023 |
| 1/1/2022 |
Buprenorphine transdermal patch
| 6/21/2023 |
| 1/1/2022 |
Bupropion Containing Products (Aplenzin®, Forfivo® XL)
| 10/18/2023 |
| 1/1/2021 |
Bupropion Containing Products (Aplenzin®, Forfivo® XL, Wellbutrin XL®)
| 5/17/2023 |
| 11/17/2021 |
Bylvay (odevixibat)
| 7/19/2023 |
| 8/19/2020 |
Bynfezia Pen™ (octreotide acetate) injection
| 4/19/2023 |
| 6/22/2022 |
Byooviz™ (ranibizumab-nuna)
| 4/19/2023 |
| 1/1/2024 |
Byooviz™ (ranibizumab-nuna)
| 11/15/2023 |
| 1/1/2024 |
Byooviz™ (ranibizumab-nuna)
| 8/16/2023 |
| 5/15/2019 |
Cablivi® (caplacizumab-yhdp)
| 1/18/2023 |
| 1/1/2021 |
Cabometyx™ (cabozantinib)
| 9/20/2023 |
| 1/1/2024 |
Calcium Channel Blocking Agents
| 6/21/2023 |
| 1/1/2021 |
Calquence® (acalabrutinib)
| 3/15/2023 |
| 6/22/2022 |
Camcevi (leuprolide mesylate)
| 5/17/2023 |
| 10/26/2022 |
Camzyos™ (mavacamten)
| 10/18/2023 |
| 1/1/2024 |
Caplyta (lumateperone)
| 10/18/2023 |
| 3/18/2020 |
Caplyta® (lumateperone)
| 3/15/2023 |
| 1/1/2024 |
Caprelsa (vandetanib)
| 6/21/2023 |
| 4/28/2011 |
Caprelsa® (vandetanib)
| 10/18/2023 |
| 11/24/2010 |
Carbaglu® (carglumic acid)
| 2/15/2023 |
| 1/1/2020 |
Carbinoxamine 6mg tablet
| 10/18/2023 |
| 9/20/2017 |
CaroSpir® (spironolactone) oral suspension
| 2/15/2023 |
| 1/1/2024 |
CaroSpir® (spironolactone) oral suspension
| 6/21/2023 |
| 1/1/2022 |
Carvedilol ER
| 5/18/2022 |
| 4/27/2022 |
Carvykti™ (ciltacabtagene autoleucel)
| 4/19/2023 |
| 1/1/2023 |
Carvykti™ (ciltacabtagene autoleucel)
| 4/19/2023 |
| 4/27/2022 |
Carvykti™ (ciltacabtagene autoleucel)
| 4/19/2023 |
| 1/1/2019 |
Cayston® (aztreonam inhalation solution)
| 5/17/2023 |
| 9/18/2014 |
Cerdelga® (eliglustat)
| 8/16/2023 |
| 1/1/2010 |
Cerezyme® (imiglucerase)
| 8/16/2023 |
| 1/1/2023 |
CFTR Modulators
| 6/21/2023 |
| 1/1/2015 |
Chenodal™ (chenodiol)
| 10/18/2023 |
| 1/1/2023 |
Cholbam® (cholic acid)
| 9/20/2023 |
| 1/1/2024 |
Cialis (tadalafil)
| 8/16/2023 |
| 1/1/2021 |
Cialis® (tadalafil)
| 2/15/2023 |
| 5/25/2022 |
Cibinqo™ (abrocitinib)
| 3/15/2023 |
| 11/1/2022 |
Cimerli™ (ranibizumab-eqrn)
| 4/19/2023 |
| 10/1/2023 |
Cimerli™ (ranibizumab-eqrn)
| 8/16/2023 |
| 1/1/2020 |
Cimzia (certolizumab pegol)
| 9/20/2023 |
| 1/1/2022 |
Cimzia® (certolizumab pegol)
| 9/20/2023 |
| 1/1/2022 |
Cimzia® (certolizumab pegol)
| 9/20/2023 |
| 1/1/2024 |
Cinryze (C1 esterase inhibitor, human)
| 7/19/2023 |
| 1/1/2024 |
Cinryze (C1 esterase inhibitor, human)
| 7/19/2023 |
| 1/1/2022 |
Cinryze® (C1 esterase inhibitor, human)
| 7/19/2023 |
| 1/1/2022 |
Cinryze® (C1 esterase inhibitor, human)
| 7/19/2023 |
| 1/1/2020 |
Cinvanti (aprepitant)
| 5/17/2023 |
| 6/16/2021 |
Clemastine fumarate syrup
| 2/15/2023 |
| 1/1/2020 |
Clindagel® (clindamycin phosphate gel)
| 11/15/2023 |
| 1/20/2017 |
Coagadex® (Coagulation Factor X [Human])
| 1/19/2022 |
| 1/1/2021 |
Colcrys (colchicine) Tablet
| 2/15/2023 |
| 9/27/2023 |
Columvi™ (glofitamab-gxbm)
| 9/20/2023 |
| 1/1/2024 |
Cometriq (cabozantinib)
| 7/19/2023 |
| 1/1/2017 |
Cometriq® (cabozantinib)
| 7/19/2023 |
| 1/1/2017 |
Compounded Drugs
| 2/15/2023 |
| 1/1/2021 |
Compounded Medications
| 7/19/2023 |
| 11/11/2020 |
Conjupri® (levamlodipine)
| 9/20/2023 |
| 1/1/2022 |
Consensi® (amlodipine-celecoxib)
| 5/17/2023 |
| 3/23/2023 |
Continuidad de la atención
| 3/23/2023 |
| 1/1/2016 |
Sistemas de monitoreo continuo de glucosa
| 5/17/2023 |
| 6/3/2020 |
Contraceptive Medications
| 3/15/2023 |
| 12/12/2018 |
Copiktra™ (duvelisib)
| 3/16/2022 |
| 1/1/2021 |
Coreg CR® (carvedilol ER)
| 5/17/2023 |
| 1/20/2017 |
Corifact® (Factor XIII Concentrate [Human])
| 1/18/2023 |
| 1/1/2022 |
Corlanor® (ivabradine)
| 5/25/2023 |
| 1/1/2020 |
Corticotropin Products
| 8/16/2023 |
| 1/1/2024 |
Corticotropin Products
| 6/21/2023 |
| 4/21/2021 |
Cosela (trilaciclib)
| 4/19/2023 |
| 11/22/2023 |
Cosentyx (secukinumab) intravenous solution
| 11/15/2023 |
| 11/22/2023 |
Cosentyx (secukinumab) intravenous solution
| 11/15/2023 |
| 11/22/2023 |
Cosentyx (secukinumab) intravenous solution
| 11/15/2023 |
| 1/1/2022 |
Cosentyx (secukinumab) subcutaneous solution
| 1/18/2023 |
| 1/1/2016 |
Cosopt® (dorzolamide and timolol ophthalmic solution)
| 7/19/2023 |
| 1/1/2021 |
Cotellic® (cobimetinib)
| 11/15/2023 |
| 1/1/2021 |
Cotellic® (cobimetinib)
| 11/15/2023 |
| 1/1/2006 |
Medicamentos para tos y resfríos
| 9/20/2023 |
| 5/28/2015 |
Cresemba® (isavuconazonium sulfate)
| 6/21/2023 |
| 3/7/2013 |
Crofelemer Products
| 7/19/2023 |
| 1/1/2020 |
Crotamiton Topical Products
| 2/15/2023 |
| 1/1/2020 |
Crysvita® (burosumab)
| 4/19/2023 |
| 5/24/2023 |
Cuvrior™ (trientine tetrahydrochloride) tablets
| 5/17/2023 |
| 1/1/2017 |
Cycloset® (bromocriptine)
| 2/15/2023 |
| 1/1/2013 |
Cyklokapron® (tranexamic acid)
| 1/18/2023 |
| 1/1/2021 |
Cyramza™ (ramucirumab)
| 6/21/2023 |
| 5/9/2013 |
Cysteamine Ophthalmic Products (Cystaran™, Cystadrops®)
| 10/18/2023 |
| 1/1/2013 |
Cytogam® (cytomegalovirus immune globulin, human)
| 6/21/2023 |
| 2/17/2021 |
Danyelza® (naxitamab-gqgk)
| 10/18/2023 |
| 2/23/2022 |
Dartisla ODT (glycopyrrolate)
| 1/18/2023 |
| 1/1/2022 |
Darzalex Faspro™ (daratumumab and hyaluronidase- fihj)
| 8/16/2023 |
| 1/1/2022 |
Darzalex® (daratumumab)
| 8/17/2022 |
| 1/16/2019 |
Daurismo™ (glasdegib)
| 5/25/2023 |
| 1/1/2024 |
Daxxify® (daxibotulinumtoxinA-lanm)
| 9/20/2023 |
| 10/1/2023 |
Daxxify® (daxibotulinumtoxinA-lanm)
| 9/20/2023 |
| 5/24/2023 |
Daybue™ (trofinetide) oral solution
| 5/17/2023 |
| 1/1/2022 |
Dayvigo™ (lemborexant)
| 6/21/2023 |
| 1/1/2023 |
Deferasirox Products
| 10/18/2023 |
| 1/1/2024 |
Deferasirox products
| 10/18/2023 |
| 1/1/2023 |
Deferasirox Tablet
| 10/18/2023 |
| 1/1/2022 |
Defitelio® (defibrotide sodium)
| 10/18/2023 |
| 1/1/2022 |
Desmopressin Nasal Spray
| 6/21/2023 |
| 1/1/2020 |
Desvenlafaxine Containing Products
| 5/17/2023 |
| 1/1/2022 |
Dexchlorpheniramine oral solution
| 3/15/2023 |
| 1/1/2023 |
Dexilant® (dexlansoprazole)
| 5/17/2023 |
| 1/1/2017 |
Diabetic Test Strips and Meters
| 9/20/2023 |
| 1/1/2023 |
Diacomit® (stiripentol)
| 11/15/2023 |
| 1/1/2023 |
Differin® (adapalene) and Epiduo® (adapalene and benzoyl peroxide)
| 5/17/2023 |
| 1/1/2022 |
Dihydroergotamine Products
| 9/20/2023 |
| 9/2/2020 |
Dojolvi™ (triheptanoin) Oral Liquid
| 7/19/2023 |
| 1/1/2021 |
Dopamine Agonists
| 8/16/2023 |
| 1/1/2023 |
Dopamine Agonists
| 8/16/2023 |
| 9/26/2018 |
Doptelet® (Avatrombopag)
| 5/17/2023 |
| 1/1/2021 |
Doxycycline Antibiotics
| 7/19/2023 |
| 1/1/2020 |
DPP-IV inhibitors
| 3/15/2023 |
| 1/1/2021 |
DPP-IV inhibitors
| 3/15/2023 |
| 1/1/2024 |
DPP-IV inhibitors
| 6/21/2023 |
| 1/1/2021 |
DPP-IV, SGLT2 Combination Products
| 6/21/2023 |
| 1/1/2023 |
DPP-IV, SGLT2 Combination Products
| 7/19/2023 |
| 1/1/2024 |
DPP-IV, SGLT2 Combination Products
| 8/16/2023 |
| 1/1/2024 |
DPP-IV, SGLT2 Combination Products
| 6/21/2023 |
| 1/1/2014 |
Dronabinol (GENERIC)
| 2/15/2023 |
| 1/1/2014 |
Dronabinol containing products (BRAND)
| 2/15/2023 |
| 1/24/2019 |
Drug Management Program-Opioid Program
| 11/21/2023 |
| 8/28/2010 |
Drug Utilization Management and Clinical Edits Tools
| 2/15/2023 |
| 1/1/2015 |
Duavee® (conjugated estrogens/bazedoxifene tablet)
| 3/15/2023 |
| 1/1/2024 |
Duavee® (conjugated estrogens/bazedoxifene tablet)
| 6/21/2023 |
| 1/1/2020 |
Duexis® (ibuprofen-famotidine)
| 6/21/2023 |
| 1/1/2021 |
Duexis® (ibuprofen-famotidine) tablet
| 10/18/2023 |
| 10/16/2019 |
Duloxetine Containing Products
| 10/18/2023 |
| 1/1/2021 |
Duobrii® (halobetasol propionate and tazarotene)
| 5/17/2023 |
| 1/1/2022 |
Duopa® (carbidopa and levodopa) enteral suspension
| 2/15/2023 |
| 1/1/2024 |
Duopa® (carbidopa and levodopa) enteral suspension
| 6/21/2023 |
| 4/21/2021 |
Dupixent® (dupilumab) injection
| 11/15/2023 |
| 1/1/2022 |
Dupixent® (dupilumab) injection
| 11/15/2023 |
| 1/1/2024 |
Dupixent® (dupilumab) injection
| 8/16/2023 |
| 1/1/2024 |
Dupixent® (dupilumab) injection
| 8/16/2023 |
| 10/15/2015 |
Durlaza® (aspirin extended-release)
| 2/15/2023 |
| 8/19/2020 |
Durysta™ (bimatoprost implant)
| 2/15/2023 |
| 1/1/2023 |
Dysport® (abobotulinumtoxinA)
| 8/16/2023 |
| 1/1/2024 |
Dysport® (abobotulinumtoxinA)
| 8/16/2023 |
| 1/1/2018 |
Effient® (prasugrel)
| 10/18/2023 |
| 12/16/2010 |
Egrifta® (tesamorelin acetate)
| 3/15/2023 |
| 1/1/2023 |
Elahere (mirvetuximab soravtansine-gynx)
| 6/8/2023 |
| 9/29/2008 |
Elaprase® (idursulfase)
| 11/15/2023 |
| 5/22/2012 |
Elelyso® (taliglucerase alfa)
| 8/16/2023 |
| 4/21/2021 |
Elepsia™ XR (levetiracetam) extended-release tablets
| 1/18/2023 |
| 9/27/2023 |
Elevidys (delandistrogene moxeparvovec-rokl)
| 10/18/2023 |
| 1/1/2022 |
Elidel® (pimecrolimus)
| 4/19/2023 |
| 1/1/2024 |
Elidel® (pimecrolimus)
| 6/21/2023 |
| 1/1/2020 |
Eligard® (leuprolide acetate)
| 11/15/2023 |
| 1/1/2012 |
Elitek® (rasburicase)
| 2/15/2023 |
| 11/15/2023 |
Elrexfio (elranatamab-bcmm)
| 11/15/2023 |
| 1/1/2023 |
Elzonris™ (tagraxofusp-erzs)
| 5/17/2023 |
| 1/1/2020 |
Emend IV (fosaprepitant)
| 5/17/2023 |
| 1/1/2008 |
Emend® Oral (aprepitant)
| 2/15/2023 |
| 1/1/2020 |
Emflaza® (deflazacort)
| 11/15/2023 |
| 1/1/2024 |
Emgality® (galcanezumab)
| 8/16/2023 |
| 1/1/2024 |
Empaveli (pegcetacoplan)
| 7/19/2023 |
| 7/21/2021 |
Empaveli™ (pegcetacoplan)
| 2/23/2023 |
| 1/1/2022 |
Empliciti (elotuzumab)
| 8/16/2023 |
| 1/1/2022 |
EMSAM® (selegiline transdermal system)
| 6/21/2023 |
| 1/1/2022 |
Enbrel® (etanercept)
| 5/17/2023 |
| 11/8/2017 |
Endari™ (L-glutamine)
| 2/15/2023 |
| 1/1/2023 |
Enhertu (fam-trastuzumab deruxtecan-nxki)
| 9/20/2023 |
| 7/27/2022 |
Enjaymo™ (sutimlimab-jome)
| 7/19/2023 |
| 1/20/2021 |
Enspryng™ (satralizumab-mwge)
| 9/20/2023 |
| 1/1/2024 |
Entadfi (finasteride and tadalafil)
| 8/16/2023 |
| 9/28/2022 |
Entadfi™ (finasteride and tadalafil)
| 8/16/2023 |
| 1/1/2022 |
Entocort® (budesonide)
| 5/17/2023 |
| 11/22/2023 |
Entyvio® (vedolizumab)
| 11/15/2023 |
| 11/22/2023 |
Entyvio® (vedolizumab)
| 11/15/2023 |
| 11/22/2023 |
Entyvio® (vedolizumab)
| 11/15/2023 |
| 1/1/2019 |
Envarsus XR® (tacrolimus extended-release)
| 6/21/2023 |
| 1/1/2021 |
Envarsus XR® (tacrolimus extended-release)
| 6/21/2023 |
| 1/1/2021 |
Epclusa® (sofosbuvir/velpatasvir)
| 8/16/2023 |
| 1/1/2024 |
Epidiolex® (cannabidiol)
| 7/19/2023 |
| 1/1/2022 |
Epidiolex® (cannabidiol) oral solution
| 2/15/2023 |
| 1/1/2019 |
EpiPen® and EpiPen Jr® (epinephrine)
| 1/18/2023 |
| 8/23/2023 |
Epkinly™ (epcoritamab-bysp)
| 8/16/2023 |
| 1/1/2023 |
Eplerenone Products
| 7/19/2023 |
| 1/1/2024 |
Eplerenone Products
| 6/21/2023 |
| 1/1/2023 |
Epoetin Alfa (Epogen, Procrit, Retacrit)
| 10/18/2023 |
| 1/1/2021 |
Epoprostenol Products
| 5/17/2023 |
| 1/1/2024 |
Epoprostenol Products
| 6/21/2023 |
| 12/15/2021 |
Eprontia™ (topiramate) oral solution
| 10/18/2023 |
| 1/1/2021 |
Equetro® (carbamazepine)
| 7/19/2023 |
| 1/1/2024 |
Erbitux (cetuximab)
| 6/21/2023 |
| 1/1/2021 |
Erbitux® (cetuximab)
| 6/21/2023 |
| 1/4/2017 |
Erectile Dysfunction Medications
| 2/15/2023 |
| 2/9/2012 |
Erivedge® (vismodegib)
| 10/18/2023 |
| 1/1/2022 |
Erleada™ (apalutamide)
| 12/14/2022 |
| 1/1/2019 |
Erwinaze® (asparaginase Erwinia chrysanthemi)
| 2/16/2022 |
| 1/1/2023 |
|