Políticas de cobertura médica y de farmacia - Inicio

Políticas de cobertura de farmacia

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Fecha de vigenciaPolicy NameReviewed 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)
11/16/2022
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
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