Políticas de cobertura médica y de farmacia - Inicio

Políticas de cobertura de farmacia

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Fecha de vigenciaPolicy NameReviewed Date
7/15/2020 Tabrecta™ (capmatinib)
5/17/2023
1/1/2021 Tadalafil Products - PAH Indication Only
9/20/2023
1/1/2021 Tafinlar® (dabrafenib)
7/19/2023
1/1/2021 Tafinlar® (dabrafenib)
7/19/2023
1/1/2024 Tagrisso (osimertinib)
7/19/2023
1/1/2020 Tagrisso™ (osimertinib)
2/15/2023
1/1/2024 Takhzyro (lanadelumab-flyo)
7/19/2023
1/1/2024 Takhzyro (lanadelumab-flyo)
7/19/2023
1/1/2022 Takhzyro™ (lanadelumab-flyo)
7/19/2023
1/1/2022 Takhzyro™ (lanadelumab-flyo)
7/19/2023
1/1/2022 Taltz® (ixekizumab)
9/20/2023
1/1/2022 Taltz® (ixekizumab)
9/20/2023
11/22/2023 Talvey (talquetamab)
11/15/2023
12/12/2018 Talzenna™(talazoparib)
7/19/2023
1/1/2024 Tarceva (erlotinib)
6/21/2023
1/1/2020 Tarceva® (erlotinib)
4/19/2023
1/1/2021 Targretin® (bexarotene)
8/16/2023
2/23/2022 Tarpeyo™ (budesonide) delayed-release capsules
2/15/2023
9/28/2022 Tascenso ODT™ (fingolimod)
1/18/2023
1/25/2023 Tascenso ODT™ (fingolimod)
1/18/2023
1/1/2022 Tasigna (nilotinib)
5/17/2023
1/1/2022 Tasigna® (nilotinib)
5/17/2023
1/1/2009 Tasmar® (tolcapone)
6/21/2023
1/1/2024 Tasmar® (tolcapone)
6/21/2023
1/1/2021 Tavalisse® (fostamatinib)
5/17/2023
3/16/2022 Tavneos™ (avacopan)
2/15/2023
1/1/2021 Tazorac® (tazarotene cream and gel)
5/17/2023
7/15/2020 Tazverik™ (tazemetostat)
5/17/2023
9/16/2020 Tecartus™ (brexucabtagene autoleucel)
4/19/2023
1/1/2023 Tecartus™ (brexucabtagene autoleucel)
4/19/2023
4/21/2021 Tecartus™ (brexucabtagene autoleucel)
4/19/2023
1/1/2023 Tecentriq® (atezolizumab)
2/15/2023
1/1/2022 Tecfidera® (dimethyl fumarate)
6/21/2023
1/1/2023 Tecvayli (teclistamab-cqyv)
12/14/2022
12/12/2018 Tegsedi® (inotersen)
9/20/2023
1/1/2020 Temodar® (temozolomide)
4/19/2023
1/1/2022 Tepezza™ (teprotumumab)
6/21/2023
4/7/2021 Tepmetko® (tepotinib)
3/15/2023
1/1/2021 Testosterone Products
6/21/2023
6/22/2022 Tezspire™ (tezepelumab-ekko)
5/17/2023
7/15/2020 Thalomid® (thalidomide)
9/20/2023
1/1/2019 Thiazolidinediones (TZDs)
3/15/2023
1/1/2020 Thiola® and Thiola EC® (tiopronin)
3/15/2023
1/1/2018 Thrombate III® [Antithrombin III (Human)]
11/15/2023
1/1/2024 Thymoglobulin (antithymocyte globulin [rabbit])
6/21/2023
1/1/2014 Thymoglobulin® (anti-thymocyte globulin [rabbit])
3/15/2023
1/1/2020 Tibsovo® (ivosidenib)
8/16/2023
12/12/2018 Tiglutik® (riluzole)
8/16/2023
12/24/2021 Tivdak (tisotumab vedotin-tftv)
11/16/2022
1/1/2024 Tivdak (tisotumab vedotin-tftv)
9/20/2023
1/1/2021 Tivorbex (indomethacin) capsule
3/15/2023
1/1/2022 Tobramycin for Inhalation
10/18/2023
1/1/2024 Tobramycin for Inhalation
10/18/2023
1/16/2019 Tolsura (itraconazole)
10/18/2023
1/1/2023 Topical Acne Products
5/17/2023
1/1/2020 Topical Antifungals
1/18/2023
1/1/2021 Topical Antifungals
7/19/2023
1/1/2023 Topical Antivirals
5/17/2023
1/1/2023 Topical Antivirals
5/18/2022
1/1/2023 Topical Clindamycin (clindamycin gel, Clindagel®)
5/17/2023
1/1/2023 Topical Diflorasone
5/17/2023
1/1/2018 Topical Doxepin Products (doxepin, Prudoxin®, Zonalon®)
11/15/2023
1/1/2020 Topical Estradiol Products
3/15/2023
1/1/2024 Topical Estradiol Products
8/16/2023
1/1/2021 Topical Imidazole Antifungals (Econazole, Oxistat®)
7/19/2023
1/1/2021 Topical Nystatin Powder
8/16/2023
1/1/2023 Topical Onychomycotic Agents
5/17/2023
1/1/2021 Topical Psoriasis Agents
10/18/2023
1/1/2023 Topical Psoriasis Agents
10/18/2023
1/1/2023 Topical Retinoid Products
5/17/2023
1/1/2019 Topical Rosacea Products
4/6/2023
1/1/2019 Topical Rosacea Products
4/6/2023
1/1/2019 Topical Seborrheic Dermatitis Agents
3/15/2023
1/1/2023 Topical Tazarotene Products (Arazlo®, Fabior®)
5/17/2023
1/1/2021 Topical Tretinoin Containing Products
5/17/2023
1/1/2021 Topical Vitamin D Products
8/31/2023
1/1/2023 Topical Vitamin D Products
11/15/2023
1/1/2024 Topical Vitamin D Products
8/31/2023
1/1/2024 Torisel (temsirolimus)
9/20/2023
1/1/2019 Torisel® (temsirolimus)
9/20/2023
1/1/2023 Tramadol hydrochloride extended release (ConZip, generic Conzip, tramadol ER tablet)
2/15/2023
1/1/2023 Tramadol hydrochloride extended release capsules (ConZip, generic Conzip)
2/15/2023
1/1/2023 Trastuzumab Products
6/21/2023
1/1/2024 Trastuzumab Products
7/19/2023
1/1/2024 Trelstar (triptorelin pamoate)
8/16/2023
1/1/2020 Trelstar® (triptorelin pamoate)
6/21/2023
1/1/2022 Tremfya® (guselkumab)
5/17/2023
1/1/2022 Tremfya® (guselkumab)
9/20/2023
7/20/2017 Tretten® (Coagulation Factor XIII A-Subunit [Recombinant])
1/19/2022
1/1/2022 Trintellix (vortioxetine)
10/18/2023
1/1/2019 Triptans
5/17/2023
1/1/2019 Triptans
5/17/2023
1/1/2024 Triptans
9/20/2023
10/18/2017 Triptodur™ (triptorelin)
8/16/2023
1/1/2018 Trisenox® (arsenic trioxide)
5/17/2023
6/17/2020 Trodelvy™ (sacituzumab govitecan-hziy)
4/19/2023
5/16/2018 Trogarzo™ (ibalizumab-uiyk)
11/15/2023
10/21/2021 Trudhesa™ (dihydroergotamine mesylate)
9/20/2023
1/1/2023 Trulance® (plecanatide)
5/17/2023
1/1/2024 Trulance® (plecanatide)
9/20/2023
8/18/2021 Truseltiq (infigratinib)
5/17/2023
1/1/2021 Tudorza® (aclidinium) Pressair
3/15/2023
6/17/2020 Tukysa™ (tucatinib)
3/15/2023
9/18/2019 Turalio® (pexidartinib)
5/17/2023
1/1/2023 Tykerb (lapatinib)
5/17/2023
6/21/2017 Tymlos™ (abaloparatide) subcutaneous injection
2/15/2023
1/1/2019 Tymlos™ (abaloparatide) subcutaneous injection
2/15/2023
1/1/2023 Tyrvaya™ (varenicline)
4/19/2023
1/1/2023 Tyrvaya™ (varenicline)
3/15/2023
1/1/2023 Tysabri (natalizumab)
9/20/2023
1/1/2024 Tysabri® (natalizumab)
7/19/2023
1/1/2024 Tysabri® (natalizumab)
8/16/2023
1/1/2021 Tysabri® (natalizumab) intravenous solution
1/18/2023
1/1/2023 Tysabri® (natalizumab) Intravenous Solution
4/19/2023
1/1/2022 Tyvaso® (treprostinil)
5/17/2023
1/1/2024 Tyvaso® (treprostinil)
6/21/2023
4/26/2023 Tzield© (teplizumab) intravenous solution
4/19/2023
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