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Políticas de cobertura de farmacia

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Fecha de vigenciaPolicy NameReviewed Date
5/24/2023 Cuvrior™ (trientine tetrahydrochloride) tablets
5/17/2023
5/24/2023 Daybue™ (trofinetide) oral solution
5/17/2023
5/24/2023 Igalmi™ (dexmedetomidine)
5/17/2023
5/24/2023 Syfovre™ (pegcetacoplan) intravitreal solution
5/17/2023
5/24/2023 Zynyz (retifanlimab-dlwr)
5/17/2023
4/26/2023 Jaypirca (pirtobrutinib)
4/19/2023
4/26/2023 Pradaxa® (dabigatran etexilate) oral pellet
4/19/2023
4/26/2023 Tzield© (teplizumab) intravenous solution
4/19/2023
4/19/2023 Orserdu (elacestrant)
3/30/2023
3/23/2023 Continuidad de la atención
3/23/2023
3/22/2023 Krazati (adagrasib)
3/2/2023
3/22/2023 Lunsumio (mosunetuzumab-axgb)
3/15/2023
3/22/2023 Sunlenca (lenacapavir)
3/15/2023
3/1/2023 Productos Bevacizumab 
2/23/2023
2/22/2023 Relyvrio™ (sodium phenylbutyrate/taurursodiol)
2/15/2023
2/22/2023 Rezlidhia (olutasidenib)
2/15/2023
2/22/2023 Sotyktu (deucravacitinib)
2/15/2023
2/22/2023 Sotyktu (deucravacitinib)
2/15/2023
2/15/2023 Imjudo (tremelimumab-actl)
1/19/2023
2/15/2023 Lytgobi (futibatinib)
1/19/2023
1/25/2023 Rebyota™ (fecal microbiota, live-jslm)
1/18/2023
1/25/2023 Tascenso ODT™ (fingolimod)
1/18/2023
1/1/2023 Abecma® (idecabtagene vicleucel)
4/19/2023
1/1/2023 Abraxane (nab) paclitaxel
9/22/2022
1/1/2023 Abraxane (nab) paclitaxel
5/17/2023
1/1/2023 Abraxane (nab- paclitaxel)
5/17/2023
1/1/2023 Aemcolo® (rifamycin)
3/15/2023
1/1/2023 Afinitor/Afinitor Disperz (everolimus)
5/17/2023
1/1/2023 Aklief® (trifarotene)
5/17/2023
1/1/2023 Alpha-1 Proteinase Inhibitors (Aralast NP®, Glassia®, Zemaira®)
10/6/2022
1/1/2023 Amitiza® (lubiprostone)
5/17/2023
1/1/2023 Amzeeq (minocycline) topical foam
5/17/2023
1/1/2023 Angiotensin Blocking Agents
5/17/2023
1/1/2023 Aranesp® (darbepoetin alfa)
7/20/2022
1/1/2023 Aubagio® (teriflunomide) tablet
3/16/2023
1/1/2023 Auryxia® (ferric citrate)
3/15/2023
1/1/2023 Avsola® (infliximab-axxq)
11/16/2022
1/1/2023 Bafiertam® (monomethyl fumarate) capsule, delayed release
5/17/2023
1/1/2023 Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta)
7/20/2022
1/1/2023 Beovu® (brolucizumab)
4/19/2023
1/1/2023 Bevacizumab products
2/23/2023
1/1/2023 Bortezomib products (Velcade and Bortezomib for injection)
10/19/2022
1/1/2023 Bowel Prep Agents
5/17/2023
1/1/2023 Breyanzi® (lisocabtagene maraleucel)
4/19/2023
1/1/2023 Brukinsa™ (zanubrutinib)
2/16/2023
1/1/2023 Buprenorphine Containing Products
12/14/2022
1/1/2023 CFTR Modulators
7/20/2022
1/1/2023 Carvykti™ (ciltacabtagene autoleucel)
4/19/2023
1/1/2023 Cholbam® (cholic acid) capsules
10/6/2022
1/1/2023 DPP-IV, SGLT2 Combination Products
7/20/2022
1/1/2023 Deferasirox Products
11/16/2022
1/1/2023 Deferasirox Tablet
8/17/2022
1/1/2023 Dexilant® (dexlansoprazole)
5/17/2023
1/1/2023 Diacomit® (stiripentol)
11/16/2022
1/1/2023 Differin® (adapalene) and Epiduo® (adapalene and benzoyl peroxide)
5/17/2023
1/1/2023 Dopamine Agonists
9/21/2022
1/1/2023 Dysport® (botulinum toxin)
1/18/2023
1/1/2023 Elahere (mirvetuximab soravtansine-gynx)
12/14/2022
1/1/2023 Elzonris™ (tagraxofusp-erzs)
5/17/2023
1/1/2023 Enhertu (fam-trastuzumab deruxtecan-nxki)
9/21/2022
1/1/2023 Eplerenone Products
7/20/2022
1/1/2023 Epoetin Alfa (Epogen, Procrit, Retacrit)
11/10/2022
1/1/2023 Esbriet® (pirfenidone)
1/19/2023
1/1/2023 Eulexin (Flutamide)
5/17/2023
1/1/2023 Evenity™ (romosozumab-aqqg)
5/17/2023
1/1/2023 Eylea® (aflibercept)
4/19/2023
1/1/2023 Eysuvis™ (loteprednol etabonate)
3/15/2023
1/1/2023 Finacea® (azelaic acid) topical foam
9/21/2022
1/1/2023 Fintepla® (fenfluramine) Oral Solution
8/17/2022
1/1/2023 Fycompa® (perampanel)
3/15/2023
1/1/2023 Gloperba® (colchicine) Oral solution
2/15/2023
1/1/2023 Helicobacter Pylori Agents
4/19/2023
1/1/2023 Herceptin Hylecta (trastuzumab and hyaluronidase-oysk)
5/17/2023
1/1/2023 Herceptin Hylecta  (trastuzumab and hyaluronidase-oysk)
8/17/2022
1/1/2023 Hypomethylating agents (azacitidine, decitabine)
8/17/2022
1/1/2023 Ibrance (palbociclib)
5/17/2023
1/1/2023 Ibrance (palbociclib)
5/17/2023
1/1/2023 Icosapent Ethyl (generic Vascepa)
8/17/2022
1/1/2023 Inflectra ® (infliximab-dyyb)
1/18/2023
1/1/2023 Inhaled Corticosteroids - Long Acting Beta Agonists Inhalers
8/17/2022
1/1/2023 Intranasal Rhinitis Agents
10/19/2022
1/1/2023 Intranasal Rhinitis Agents
10/19/2022
1/1/2023 Istodax (romidepsin)
4/19/2023
1/1/2023 Jemperli (dostarlimab-gxly)
9/22/2022
1/1/2023 Jynarque® (tolvaptan)
5/17/2023
1/1/2023 Keytruda (pembrolizumab)
4/19/2023
1/1/2023 Kisqali (ribociclib)
10/6/2022
1/1/2023 Kisqali (ribociclib)
11/16/2022
1/1/2023 Kymriah™ (tisagenlecleucel)
4/19/2023
1/1/2023 Kynmobi® (apomorphine hydrochloride) sublingual film
10/6/2022
1/1/2023 Levoleucovorin products (Fusilev, Khapzory)
9/22/2022
1/1/2023 Levothyroxine Products
12/14/2022
1/1/2023 Linzess® (linaclotide)
8/17/2022
1/1/2023 Liposomal doxorubucin
8/17/2022
1/1/2023 Lokelma® (sodium zirconium cyclosilicate)
4/19/2023
1/1/2023 Lotronex® (alosetron HCl)
5/17/2023
1/1/2023 Lynparza (olaparib)
12/14/2022
1/1/2023 Mavenclad® (cladribine)
5/17/2023
1/1/2023 Mavenclad® (cladribine) tablet
12/14/2022
1/1/2023 Mayzent® (siponimod) tablet
5/17/2023
1/1/2023 Medical Necessity Determinations
10/20/2022
1/1/2023 Methotrexate Injection (Otrexup®, Rasuvo®)
2/15/2023
1/1/2023 Methotrexate Injection (Otrexup®, Reditrex®)
2/15/2023
1/1/2023 Motegrity® (prucalopride)
5/17/2023
1/1/2023 Muscle Relaxants
7/20/2022
1/1/2023 Myobloc® (botulinum toxin)
1/18/2023
1/1/2023 Naloxone Products (Kloxxado™, Zimhi™)
3/15/2023
1/1/2023 Nebivolol (generic Bystolic)
9/21/2022
1/1/2023 Non-Preferred GLP Analogs
9/21/2022
1/1/2023 Non-Preferred Multiple Sclerosis Interferons
12/14/2022
1/1/2023 Non-Preferred Multiple Sclerosis Interferons
5/17/2023
1/1/2023 Non-Preferred Oral Multiple Sclerosis Products
12/14/2022
1/1/2023 Non-Preferred SGLT2
7/20/2022
1/1/2023 Non-Preferred Filgrastim Products - Neupogen (filgrastim) and Releuko (filgrastim-ayow)
8/17/2022
1/1/2023 Antihistamínicos no sedantes
3/15/2023
1/1/2023 Non-preferred Pegfilgrastim Products - Fylnetra (pegfilgrastim-pbbk), Neulasta (pegfilgrastim), Stimufend (pegfilgrastim-fpgk), and Udenyca (pegfilgrastim-cbqv)
5/25/2023
1/1/2023 Non-preferred Pegfilgrastim Products - Fylnetra (pegfilgrastim-pbbk), Neulasta (pegfilgrastim), Nyvepria (pegfilgrastim-apfg), Stimufend (pegfilgrastim-fpgk) and Ziextenzo (pegfilgrastim-bmez)
12/21/2022
1/1/2023 Non-preferred Pegfilgrastim Products - Fylnetra (pegfilgrastim-pbbk), Nyvepria (pegfilgrastim-apfg), Stimufend (pegfilgrastim-fpgk) and Ziextenzo (pegfilgrastim- bmez)
12/21/2022
1/1/2023 Nonsteroidal Anti-Inflammatory Drug Products
3/15/2023
1/1/2023 Ocaliva® (obeticholic acid)
9/21/2022
1/1/2023 Ocrevus® (ocrelizumab) Intravenous Solution
4/19/2023
1/1/2023 Ocrevus® (ocrelizumab) intravenous solution
12/14/2022
1/1/2023 Olinvyk® (olicerdine)
3/15/2023
1/1/2023 Onpattro® (patisiran)
7/20/2022
1/1/2023 Opdivo (nivolumab)
7/20/2022
1/1/2023 Opdualag (nivolumab and relatlimab-rmbw)
9/22/2022
1/1/2023 Ophthalmic Prostaglandins
3/15/2023
1/1/2023 Ophthalmic Cyclosporine (Cequa™, generic Restasis)
3/15/2023
1/1/2023 Ophthalmic Cyclosporine (Cequa™, generic Restasis)
4/19/2023
1/1/2023 Opioid Days' Supply Limitation
10/27/2022
1/1/2023 Orgovyx (relugolix) tablets
5/18/2022
1/1/2023 Otezla® (apremilast)
10/6/2022
1/1/2023 Pediatric Cardiovascular Products
12/14/2022
1/1/2023 Polivy™ (polatuzumab vedotin-piiq)
4/19/2023
1/1/2023 Ponvory® (ponesimod) tablet
5/17/2023
1/1/2023 Preferred Filgrastim Products - Nivestym (filgrastim-aafi) and Zarxio (filgrastim-sndz)
8/17/2022
1/1/2023 Preferred Pegfilgrastim Products -  Neulasta (pegfilgrastim), Fulphila (pegfilgrastim-jmdb), and Udenyca (pegfilgrastim-cbqv)
8/17/2022
1/1/2023 Preferred Pegfilgrastim Products - Fulphila (pegfilgrastim-jmdb), Nyvepria (pegfilgrastim-apfg), and Ziextenzo (pegfilgrastim-bmez)
8/17/2022
1/1/2023 Preferred Pegfilgrastim Products - Fulphila (pegfilgrastim-jmdb) and Udenyca (pegfilgrastim- cbqv)
8/17/2022
1/1/2023 Prolastin-C® (alpha-1 proteinase inhibitor)
10/6/2022
1/1/2023 Pyrukynd® (mitapivat)
10/6/2022
1/1/2023 Rasuvo® (methotrexate injection)
2/15/2023
1/1/2023 Renflexis® (infliximab-abda)
1/18/2023
1/1/2023 Revlimid (lenalidomida)
2/2/2023
1/1/2023 Rinvoq® (upadacitinib)
11/16/2022
1/1/2023 Risperidone Orally Disintegrating Tablets
7/20/2022
1/1/2023 Rituxan Hycela™ (rituximab/hyaluronidase)
8/17/2022
1/1/2023 Rituxan Hycela™ (rituximab/hyaluronidase)
8/17/2022
1/1/2023 Rituximab Products
7/20/2022
1/1/2023 Rolvedon™ (eflapegrastim-xnst)
12/14/2022
1/1/2023 Rolvedon™ (eflapegrastim-xnst)
12/14/2022
1/1/2023 Rolvedon™ (eflapegrastim-xnst)
12/14/2022
1/1/2023 Rubraca (rucaparib)
5/17/2023
1/1/2023 Rytary® (carbidopa and levodopa) extended release capsules
4/19/2023
1/1/2023 Signifor® LAR (pasireotide)
9/22/2022
1/1/2023 Site of Care and Specialty Medication Sourcing for Injectable Drugs
2/8/2023
1/1/2023 Somavert® (pegvisomant)
4/19/2023
1/1/2023 Stivarga (regorafenib)
10/6/2022
1/1/2023 Sunosi™ (solriamfetol)
8/17/2022
1/1/2023 Sunosi™ (solriamfetol)
8/17/2022
1/1/2023 Sutent (sunitinib)
5/17/2023
1/1/2023 Sympazan®(clobazam) Oral Film
7/20/2022
1/1/2023 Symproic® (naldemedine)
5/17/2023
1/1/2023 Tecartus™ (brexucabtagene autoleucel)
4/19/2023
1/1/2023 Tecentriq® (atezolizumab)
2/15/2023
1/1/2023 Tecvayli (teclistamab-cqyv)
12/14/2022
1/1/2023 Topical Acne Products
5/17/2023
1/1/2023 Topical Antivirals
5/18/2022
1/1/2023 Topical Antivirals
5/17/2023
1/1/2023 Topical Clindamycin (clindamycin gel, Clindagel®)
5/17/2023
1/1/2023 Topical Diflorasone
5/17/2023
1/1/2023 Topical Onychomycotic Agents
5/17/2023
1/1/2023 Topical Psoriasis Agents
6/15/2022
1/1/2023 Topical Retinoid Products
5/17/2023
1/1/2023 Topical Tazarotene Products (Arazlo®, Fabior®)
5/17/2023
1/1/2023 Topical Vitamin D Products
5/17/2023
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
7/20/2022
1/1/2023 Trulance® (plecanatide)
5/17/2023
1/1/2023 Tykerb (lapatinib)
5/17/2023
1/1/2023 Tyrvaya™ (varenicline)
3/15/2023
1/1/2023 Tyrvaya™ (varenicline)
4/19/2023
1/1/2023 Tysabri (natalizumab) intravenous solution
12/21/2022
1/1/2023 Tysabri® (natalizumab) Intravenous Solution
4/19/2023
1/1/2023 Vabysmo™ (faricimab-svoa)
4/19/2023
1/1/2023 Varubi (rolapitant)
7/20/2022
1/1/2023 Ventavis® (iloprost)
10/6/2022
1/1/2023 Verzenio (abemaciclib)
4/19/2023
1/1/2023 Viberzi® (eluxadoline)
5/17/2023
1/1/2023 Viibryd® (vilazodone)
8/17/2022
1/1/2023 Vumerity® (diroximel fumarate) capsule, delayed release
4/19/2023
1/1/2023 Wakix® (pitolisant)
8/17/2022
1/1/2023 Wakix® (pitolisant)
8/17/2022
1/1/2023 Welchol® (colesevelam)
8/17/2022
1/1/2023 Winlevi® (clascoterone)
5/17/2023
1/1/2023 Xarelto® (rivaroxaban) oral suspension
9/21/2022
1/1/2023 Xatmep™ (methotrexate) oral solution
10/7/2022
1/1/2023 Xeljanz and Xeljanz XR® (tofacitinib)
5/17/2023
1/1/2023 Xeljanz and Xeljanz XR® (tofacitinib)
5/17/2023
1/1/2023 Xifaxan® (rifaximin)
10/19/2022
1/1/2023 Xifaxan® (rifaximin)
5/17/2023
1/1/2023 Xiidra® (lifitegrast ophthalmic solution)
4/19/2023
1/1/2023 Xofigo® (radium Ra 223 dichloride)
7/20/2022
1/1/2023 Xyrem® (sodium oxybate)
3/30/2023
1/1/2023 Xyrem® (sodium oxybate)
3/30/2023
1/1/2023 Xywav™ (calcium, magnesium, potassium, and sodium oxybates)
8/17/2022
1/1/2023 Xywav™ (calcium, magnesium, potassium, and sodium oxybates)
8/17/2022
1/1/2023 Yescarta™ (axicabtagene ciloleucel)
4/19/2023
1/1/2023 Zejula (niraparib)
12/14/2022
1/1/2023 Zeposia® (ozanimod) capsule
5/17/2023
1/1/2023 Zeposia® (ozanimod) capsules
10/19/2022
1/1/2023 Zydelig® (idelalisib)
7/20/2022
12/28/2022 Furoscix® (furosemide)
12/14/2022
12/28/2022 Pheburane® (sodium phenylbutyrate) oral pellets
12/14/2022
12/1/2022 Medical Necessity Determinations
10/20/2022
11/30/2022 Auvelity™ (dextromethorphan and bupropion)
3/2/2023
11/30/2022 Pedmark ® (sodium thiosulfate injection)
11/16/2022
11/30/2022 Vivjoa™ (oteseconazole)
11/16/2022
11/30/2022 Xenpozyme™ (olipudase alfa) intravenous solution
11/16/2022
11/23/2022 Methocarbamol tablet
11/16/2022
11/23/2022 Spevigo® (spesolimab-sbzo)
11/16/2022
11/23/2022 Zoryve® (roflumilast) cream
1/5/2023
11/1/2022 Cimerli™ (ranibizumab-eqrn)
4/19/2023
10/26/2022 Camzyos™ (mavacamten)
10/19/2022
10/26/2022 Nexiclon™ XR (clonidine ER) tablet
10/19/2022
10/26/2022 Zonisade™ (zonisamide) oral suspension
10/19/2022
9/28/2022 Amvuttra™ (vutrisiran)
9/21/2022
9/28/2022 Entadfi™ (finasteride and tadalafil)
9/21/2022
9/28/2022 Hyftor™ (sirolimus topical gel)
9/21/2022
9/28/2022 Inhaled Corticosteroid and Long Acting Beta Agonists
9/21/2022
9/28/2022 Meloxicam oral suspension
9/21/2022
9/28/2022 Tascenso ODT™ (fingolimod)
1/18/2023
9/28/2022 Vtama® (tapinarof) cream
9/21/2022
9/28/2022 fluticasone propionate HFA inhaler
9/21/2022
9/1/2022 Qulipta™ (atogepant)
5/18/2023
9/1/2022 Reyvow™ (lasmiditan)
8/18/2022
9/1/2022 Ubrelvy™ (ubrogepant)
8/18/2022
9/1/2022 Vyepti™ (eptinezumab)
5/18/2023
8/24/2022 Verkazia® eye drops in a dropperette
8/17/2022
7/27/2022 Adlarity® (donepezil) transdermal patch
4/19/2023
7/27/2022 Beovu® (brolucizumab)
4/19/2023
7/27/2022 Enjaymo™ (sutimlimab-jome)
7/20/2022
7/27/2022 Ibsrela® (tenapanor)
7/20/2022
7/27/2022 Korsuva™ (difelikefalin)
7/20/2022
7/27/2022 Quviviq™ (daridorexant)
7/20/2022
7/27/2022 RoxyBond™ tablet, oral ONLY (not feeding tubes)
1/5/2023
7/27/2022 Vijoice® (alpelisib) tablets
7/20/2022
7/27/2022 Ztalmy® (ganaxolone) Oral Suspension
7/20/2022
7/1/2022 Olumiant® (baricitinib)
6/23/2022
7/1/2022 Olumiant® (baricitinib)
6/23/2022
6/22/2022 Byooviz™ (ranibizumab-nuna)
4/19/2023
6/22/2022 Camcevi (leuprolide mesylate)
5/17/2023
6/22/2022 Leqvio® (inclisiran)
5/17/2023
6/22/2022 Norliqva® (amlodipine) oral solution
5/17/2023
6/22/2022 Pluvicto (lutetium Lu 177 vipivotide tetraxetan)
5/17/2023
6/22/2022 Tezspire™ (tezepelumab-ekko)
5/17/2023
6/1/2022 Glucagon Products
5/17/2023
5/26/2022 AHCA Continuity of Care
5/19/2022
5/25/2022 Cibinqo™ (abrocitinib)
3/15/2023
5/25/2022 Vabysmo™ (faricimab-svoa)
4/19/2023
5/18/2022 Vonjo (pacritinib)
5/18/2022
4/27/2022 Adbry™ (tralokinumab-ldrm)
4/19/2023
4/27/2022 Aduhelm™ (aducanumab-avwa) intravenous solution
3/15/2023
4/27/2022 Carvykti™ (ciltacabtagene autoleucel)
4/19/2023
4/27/2022 Carvykti™ (ciltacabtagene autoleucel)
4/19/2023
4/27/2022 Pemetrexed Products
4/19/2023
4/27/2022 Recorlev® (levoketoconazole) Tablet
4/19/2023
4/27/2022 Ryplazim® (plasminogen, human-tvmh)
4/19/2023
4/20/2022 Soaanz® (torsemide)
4/19/2023
4/13/2022 Opdualag (nivolumab and relatlimab-rmbw)
4/7/2022
3/23/2022 Kimmtrak (tebentafusp-tebn)
3/16/2022
3/23/2022 Seglentis® (celecoxib-tramadol)
12/14/2022
3/23/2022 Vyvgart™ (efgartigimod alfa-fcab) intravenous injection
1/18/2023
3/16/2022 Susvimo™ (ranibizumab)
4/19/2023
3/16/2022 Tavneos™ (avacopan)
2/15/2023
2/23/2022 Brimonidine-timolol eye drops (generic Combigan)
12/14/2022
2/23/2022 Dartisla ODT (glycopyrrolate)
1/18/2023
2/23/2022 Fyarro (sirolimus protein-bound particles for injectable suspension)
12/14/2022
2/23/2022 Tarpeyo™ (budesonide) delayed-release capsules
2/15/2023
2/23/2022 Voxzogo™ (vosoritide)
2/15/2023
2/23/2022 Xipere™ (triamcinolone acetonide)
12/14/2022
2/16/2022 Besremi (ropeginterferon alfa-2b-njft)
2/15/2023
2/2/2022 Opsumit® (macitentan)
1/18/2023
1/26/2022 Opzelura™ (ruxolitinib)
10/19/2022
1/19/2022 Livtencity (maribavir) tablet
1/18/2023
1/1/2022 ADHD Long Acting Stimulants
11/16/2022
1/1/2022 APOKYN® (apomorphine hydrochloride) subcutaneous injection
1/18/2023
1/1/2022 Actemra® (tocilizumab) Subcutaneous
3/15/2023
1/1/2022 Actemra® (tocilizumab) Subcutaneous
3/15/2023
1/1/2022 Actinic Keratosis Agents
8/17/2022
1/1/2022 Afinitor/Afinitor Disperz (everolimus)
7/20/2022
1/1/2022 Alecensa (alectinib)
5/17/2023
1/1/2022 Anticholinergics and Central Nervous System Polypharmacy Agents
8/17/2022
1/1/2022 Austedo® & Austedo® XR (deutetrabenazine)
5/17/2023
1/1/2022 Avsola™ (infliximab-axxq)
11/16/2022
1/1/2022 Azilect® (rasagiline) tablets
1/18/2023
1/1/2022 Balversa™ (erdafitinib)
8/17/2022
1/1/2022 Banzel® (rufinamide)
3/15/2023
1/1/2022 Benlysta® (belimumab)
4/19/2023
1/1/2022 Berinert® (C1 esterase inhibitor, human)
8/17/2022
1/1/2022 Berinert® (C1 esterase inhibitor, human)
8/17/2022
1/1/2022 Betaseron® (interferon beta-1b)
7/20/2022
1/1/2022 BiDil® (isosorbide dinitrate/hydralazine)
8/17/2022
1/1/2022 Bortezomib products (Velcade and Bortezomib for injection)
8/17/2022
1/1/2022 Bosentan Products
3/15/2023
1/1/2022 Bosulif® (bosutinib)
5/18/2022
1/1/2022 Bosulif® (bosutinib)
5/18/2022
1/1/2022 Bowel Prep Agents
9/1/2022
1/1/2022 Buprenorphine transdermal patch
12/14/2022
1/1/2022 Bupropion Containing Products (Aplenzin®, Forfivo® XL)
10/19/2022
1/1/2022 Carvedilol ER
5/18/2022
1/1/2022 Cimzia® (certolizumab pegol)
11/17/2022
1/1/2022 Cimzia® (certolizumab pegol)
12/14/2022
1/1/2022 Cinryze® (C1 esterase inhibitor, human)
8/17/2022
1/1/2022 Cinryze® (C1 esterase inhibitor, human)
8/17/2022
1/1/2022 Consensi® (amlodipine-celecoxib)
5/17/2023
1/1/2022 Corlanor® (ivabradine)
5/25/2023
1/1/2022 Cosentyx® (secukinumab)
1/18/2023
1/1/2022 Darzalex Faspro™ (daratumumab and hyaluronidase- fihj)
8/17/2022
1/1/2022 Darzalex® (daratumumab)
8/17/2022
1/1/2022 Dayvigo™ (lemborexant)
7/21/2022
1/1/2022 Defitelio® (defibrotide sodium)
10/19/2022
1/1/2022 Desmopressin Nasal Spray
7/21/2022
1/1/2022 Dexchlorpheniramine oral solution
3/15/2023
1/1/2022 Dihydroergotamine Products
10/19/2022
1/1/2022 Duopa® (carbidopa and levodopa) enteral suspension
2/15/2023
1/1/2022 Dupixent® (dupilumab) injection
11/16/2022
1/1/2022 EMSAM® (selegiline transdermal system)
7/21/2022
1/1/2022 Elidel® (pimecrolimus)
4/19/2023
1/1/2022 Empliciti (elotuzumab)
8/17/2022
1/1/2022 Enbrel® (etanercept)
5/17/2023
1/1/2022 Entocort® (budesonide)
5/17/2023
1/1/2022 Entyvio® (vedolizumab)
11/16/2022
1/1/2022 Epidiolex® (cannabidiol) oral solution
2/15/2023
1/1/2022 Erleada™ (apalutamide)
12/14/2022
1/1/2022 Eucrisa® (crisaborole)
4/19/2023
1/1/2022 Exondys 51™ (eteplirsen) intravenous solution
2/15/2023
1/1/2022 Eylea® (aflibercept)
4/19/2023
1/1/2022 Ferriprox® (deferiprone)
8/17/2022
1/1/2022 Fetzima® (levomilnacipran)
10/19/2022
1/1/2022 Firazyr® (icatibant)
8/17/2022
1/1/2022 Gilenya® (fingolimod)
7/20/2022
1/1/2022 Gocovri® (amantadine) extended-release capsules
2/15/2023
1/1/2022 Granix® (tbo-filgrastim)
7/20/2022
1/1/2022 Growth Hormone (Hormona del crecimiento)
2/15/2023
1/1/2022 Haegarda® (C1 esterase inhibitor, human)
8/17/2022
1/1/2022 Humira® (adalimumab)
5/17/2023
1/1/2022 IVIG (Immune Globulin)
2/15/2023
1/1/2022 Iclusig® (ponatinib)
5/17/2023
1/1/2022 Ilumya® (tildrakizumab)
11/16/2022
1/1/2022 Imbruvica® (ibrutinib)
10/19/2022
1/1/2022 Imbruvica® (ibrutinib)
3/16/2022
1/1/2022 Inbrija ® (levodopa) capsule for inhalation
7/20/2022
1/1/2022 Inbrija® (levodopa) capsule for inhalation
7/20/2022
1/1/2022 Infliximab intravenous solution
1/18/2023
1/1/2022 Ingrezza® (valbenazine)
7/28/2022
1/1/2022 Inlyta (axitinib)
7/20/2022
1/1/2022 Intravenous Iron Products
4/19/2023
1/1/2022 Kalbitor® (ecallantide)
8/17/2022
1/1/2022 Kalbitor® (ecallantide)
8/17/2022
1/1/2022 Keppra XR® (levetiracetam extended-release)
2/15/2023
1/1/2022 Kevzara® (sarilumab)
4/19/2023
1/1/2022 Kineret® (anakinra)
7/20/2022
1/1/2022 Kineret® (anakinra)
8/17/2022
1/1/2022 Koselugo (selumetinib)
5/17/2023
1/1/2022 Kuvan® (sapropterin)
5/17/2023
1/1/2022 Kyprolis® (carfilzomib)
8/17/2022
1/1/2022 Lenvima (lenvatinib)
4/19/2023
1/1/2022 Lifetime Dosing Limits
10/21/2021
1/1/2022 Livalo® (pitavastatin)
5/17/2023
1/1/2022 Long Acting Anticholinergics
5/17/2023
1/1/2022 Long Acting Opioids
2/15/2023
1/1/2022 Lorbrena (lorlatinib)
5/17/2023
1/1/2022 Lucentis® (ranibizumab)
4/19/2023
1/1/2022 Lynparza (olaparib)
12/14/2022
1/1/2022 Mircera® (methoxy polyethylene glycol-epoetin beta)
11/3/2022
1/1/2022 Myrbetriq® and Myrbetriq® Granules (mirabegron)
8/17/2022
1/1/2022 Nexavar (sorafenib)
7/20/2022
1/1/2022 Ninlaro® (ixazomib)
8/17/2022
1/1/2022 Nourianz™ (istradefylline) tablets
2/15/2023
1/1/2022 Nubeqa® (darolutamide)
12/14/2022
1/1/2022 Nuedexta® (dextromethorphan and quinidine)
7/20/2022
1/1/2022 Nurtec™ ODT (rimegepant)
5/18/2023
1/1/2022 Ocrevus® (ocrelizumab)
11/17/2021
1/1/2022 Opioid Days' Supply Limitation
10/27/2022
1/1/2022 Oral Acne Antibiotics
5/17/2023
1/1/2022 Orencia® (abatacept) Subcutaneous
2/15/2023
1/1/2022 Orencia® (abatacept) Subcutaneous
5/17/2023
1/1/2022 Orencia® IV (abatacept)
1/18/2023
1/1/2022 Orenitram® (treprostinil)
4/19/2023
1/1/2022 Otic Antibiotics
5/17/2023
1/1/2022 Overactive Bladder Agents
8/17/2022
1/1/2022 Oxycodone-Acetaminophen Products
7/20/2022
1/1/2022 Panretin® (alitretinoin)
4/19/2023
1/1/2022 Pegasys (peginterferon alpha-2a)
8/17/2022
1/1/2022 Pomalyst® (pomalidomide)
11/16/2022
1/1/2022 Preferred Multiple Sclerosis Products
3/16/2023
1/1/2022 Inhibidores de la bomba de protones
3/30/2023
1/1/2022 Rayos® (prednisone delayed-release)
4/19/2023
1/1/2022 Reditrex® (methotrexate)
2/15/2023
1/1/2022 Renflexis® (infliximab-abda)
1/18/2023
1/1/2022 Rexulti (brexpiprazole)
12/14/2022
1/1/2022 Ridaura® (auranofin)
4/19/2023
1/1/2022 Rocklatan® (netarsudil and latanoprost)
7/20/2022
1/1/2022 Rubraca (rucaparib)
5/17/2023
1/1/2022 Ruconest® (C1 esterase inhibitor, recombinant)
8/17/2022
1/1/2022 Ruconest® (C1 esterase inhibitor, recombinant)
8/17/2022
1/1/2022 Samsca® (tolvaptan)
5/17/2023
1/1/2022 Sancuso (granisetron) Transdermal
8/17/2022
1/1/2022 Sandostatin® S.C., Sandostatin LAR® Depot (octreotide acetate for injection)
4/19/2023
1/1/2022 Sarclisa (isatuximab-irfc)
8/18/2021
1/1/2022 Siliq® (brodalumab) injection
4/19/2023
1/1/2022 Siliq® (brodalumab) injection
4/19/2023
1/1/2022 Simponi® (golimumab)
4/19/2023
1/1/2022 Simponi® (golimumab)
4/19/2023
1/1/2022 Skyrizi® (risankizumab-rzaa)
1/18/2023
1/1/2022 Sovaldi® (sofosbuvir)
8/18/2022
1/1/2022 Sprycel® (dasatinib)
5/18/2022
1/1/2022 Sprycel® (dasatinib)
5/18/2022
1/1/2022 Statin Products
4/19/2023
1/1/2022 Statin Products
4/19/2023
1/1/2022 Stelara® (ustekinumab)
9/21/2022
1/1/2022 Sublingual Allergen Extract
5/17/2023
1/1/2022 Sucraid® (sacrosidase)
8/17/2022
1/1/2022 Synagis® (palivizumab)
10/19/2022
1/1/2022 Takhzyro™ (lanadelumab-flyo)
8/17/2022
1/1/2022 Takhzyro™ (lanadelumab-flyo)
8/17/2022
1/1/2022 Taltz® (ixekizumab)
11/17/2022
1/1/2022 Taltz® (ixekizumab)
12/14/2022
1/1/2022 Tasigna® (nilotinib)
5/18/2022
1/1/2022 Tasigna® (nilotinib)
5/18/2022
1/1/2022 Tecfidera® (dimethyl fumarate)
7/20/2022
1/1/2022 Tepezza™ (teprotumumab)
12/14/2022
1/1/2022 Tobramycin for Inhalation