Políticas de cobertura médica y de farmacia

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)	8/17/2022
1/1/2023	Abraxane (nab- paclitaxel)	5/17/2023
1/1/2023	Abraxane (nab) paclitaxel	9/22/2022
1/1/2023	Abraxane (nab) paclitaxel	5/17/2023
7/21/2021	Accrufer™ (ferric maltol)	5/17/2023
1/1/2019	Actemra® (tocilizumab) Intravenous	3/15/2023
1/1/2019	Actemra® (tocilizumab) Intravenous	3/15/2023
1/1/2022	Actemra® (tocilizumab) Subcutaneous	3/15/2023
1/1/2022	Actemra® (tocilizumab) Subcutaneous	3/15/2023
1/1/2020	Actemra® IV (tocilizumab)	3/15/2023
1/1/2006	Actimmune® (interferon gamma-1b)	8/17/2022
1/1/2022	Actinic Keratosis Agents	8/17/2022
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	11/16/2022
7/27/2022	Adlarity® (donepezil) transdermal patch	4/19/2023
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
1/1/2022	Afinitor/Afinitor Disperz (everolimus)	7/20/2022
1/1/2023	Afinitor/Afinitor Disperz (everolimus)	5/17/2023
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
1/1/2023	Aklief® (trifarotene)	5/17/2023
1/1/2020	Akynzeo (fosnetupitant/netupitant-palonosetron)	5/17/2023
1/1/2013	Aldurazyme® (laronidase)	9/21/2022
1/1/2022	Alecensa (alectinib)	5/17/2023
1/1/2014	Alferon N® (interferon alfa-n3)	3/16/2022
12/20/2017	Aliqopa™ (copanlisib)	8/17/2022
12/9/2020	Alkindi® (hydrocortisone) sprinkle capsule	10/19/2022
1/1/2019	Allergy Ophthalmics	12/14/2022
1/1/2020	Allergy Ophthalmics	12/14/2022
1/1/2019	Aloxi (palonosetron)	2/23/2023
1/1/2016	Alpha-1 Proteinase Inhibitors (Aralast NP®, Glassia®)	10/19/2022
1/1/2023	Alpha-1 Proteinase Inhibitors (Aralast NP®, Glassia®, Zemaira®)	10/6/2022
1/1/2016	Alpha-1 Proteinase Inhibitors (Prolastin-C®, Zemaira®)	10/19/2022
1/1/2015	Alphagan® P (brimonidine)	7/20/2022
7/20/2017	Alunbrig™ (brigatinib)	12/14/2022
1/1/2023	Amitiza® (lubiprostone)	5/17/2023
6/16/2021	Amondys 45 (casimersen) intravenous solution	3/15/2023
1/1/2020	Ampyra® (dalfampridine) extended-release tablets	11/16/2022
1/1/2020	Amrix®, Fexmid® (cyclobenzaprine hydrochloride)	2/15/2023
9/28/2022	Amvuttra™ (vutrisiran)	9/21/2022
1/1/2023	Amzeeq (minocycline) topical foam	5/17/2023
1/1/2020	Angiotensin Blocking & Renin Inhibitor Agents	5/17/2023
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	8/17/2022
1/1/2020	Antidepressant Agents	11/16/2022
1/1/2019	Antipsychotic Utilization Program	3/15/2023
1/1/2020	Apadaz® (benzhydrocodone and acetaminophen)	2/15/2023
1/1/2022	APOKYN® (apomorphine hydrochloride) subcutaneous injection	1/18/2023
1/1/2020	Aptiom® (eslicarbazepine acetate) tablets	12/14/2022
1/1/2023	Aranesp® (darbepoetin alfa)	7/20/2022
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
1/1/2019	Asthma Interleukin Inhibitors (Cinqair® , Nucala™, Fasenra®)	5/17/2023
1/1/2013	Atgam® (antithymocyte immune globulin, equine)	7/20/2022
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)	5/17/2023
11/30/2022	Auvelity™ (dextromethorphan and bupropion)	3/2/2023
6/17/2020	Avsola® (infliximab-axxq)	1/18/2023
1/1/2023	Avsola® (infliximab-axxq)	11/16/2022
1/1/2022	Avsola™ (infliximab-axxq)	11/16/2022
3/4/2020	Ayvakit™ (avapritinib)	8/17/2022
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%	11/16/2022

Políticas de cobertura de farmacia

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