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