Utilization Management

Prior Authorization and Step Therapy Policies for Commercial and Individual Family Business

A
Allergen Immunotherapy - Grass Pollen Sublingual Products PA Policy Policy
Allergen Immunotherapy - Odactra PA Policy Policy
Allergen Immunotherapy - Ragwitek PA Policy Policy
Alzheimer's Disease Step Therapy Policy Policy
Alzheimers - Namenda, Namenda XR Step Therapy Policy Policy
Amifampridine Products PA Policy Policy
Amifampridine Products PSM Policy Policy
Amyloidosis - Amvuttra PA Policy
Amyloidosis - Tafamidis Products (Vyndaqel and Vyndamax) PA Policy Policy
Amyloidosis - Tegsedi PA Policy Policy
Angiotensin Receptor Blocker Step Therapy Policy Policy
Antibiotics (Inhaled) - Arikayce PA Policy Policy
Antibiotics (Inhaled) - Cayston PA Policy
Antibiotics (Inhaled) - TOBI Podhaler PA Policy Policy
Antibiotics (Inhaled) - Tobramycin Inhalation Solution PA Policy
Antibiotics (Inhaled) - Tobramycin Products Care Value Policy Policy
Antibiotics (Inhaled) - Tobramycin Products PSM Policy Policy
Antibiotics - Linezolid (Zyvox), Sivextro PA Policy Policy
Antibiotics - Vancomycin Capsules PA Policy Policy
Antibiotics - Xifaxan PA Policy Policy
Anticoagulants - Eliquis PA Policy Policy
Anticoagulants - Xarelto PA Policy Policy
Antidepressants - Bupropion Long-Acting Step Therapy Policy Policy
Antidepressants - Selective Serotonin Reuptake Inhibitors Step Therapy Policy Policy
Antidepressants - Serotonin and Norepinephrine Reuptake Inhibitors Step Therapy Policy Policy
Antiepileptics - Topiramate Step Therapy Policy Policy
Antifungals - Cresemba (Oral) PA Policy Policy
Antifungals - Posaconazole (Oral) PA Policy
Antifungals - Voriconazole (Oral) PA Policy Policy
Antifungals for Vulvovaginal Candidiasis Step Therapy Policy Policy
Antiseizure Medications - Clobazam Products PA Policy
Antiseizure Medications - Depakote, Depakene Step Therapy Policy
Antiseizure Medications - Diacomit PA Policy Policy
Antiseizure Medications - Epidiolex PA Policy Policy
Antiseizure Medications - Lamotrigine Step Therapy Policy Policy
Antiseizure Medications - Levetiracetam, Brivaracetam Step Therapy Policy
Antiseizure Medications - Nayzilam PA Policy
Antiseizure Medications - Oxtellar XR, Trileptal ST Policy
Antiseizure Medications - Rufinamide PA Policy
Antiseizure Medications - Topiramate Step Therapy Policy Policy
Antiseizure Medications - Valtoco PA Policy Policy
Antiseizure Medications - Vigabatrin PA Policy
Antiseizure Medications - Ztalmy PA Policy
Antivirals - Ribavirin (Inhaled Products) PA Policy Policy
Antivirals - Ribavirin (Oral Products) PA Policy Policy
Attention Deficit Hyperactivity Disorder Non-Stimulant Medications PA Policy Policy
Attention Deficit Hyperactivity Disorder Non-Stimulant Medications Step Therapy Policy Policy
Attention Deficit Hyperactivity Disorder Stimulant Medications PA Policy Policy
Attention Deficit Hyperactivity Disorder Stimulant Medications Step Therapy Policy Policy
B
Benign Prostatic Hyperplasia - 5-Alpha-Reductase Inhibitors Step Therapy Policy Policy
Benign Prostatic Hyperplasia – Alpha Blockers Step Therapy Policy
Beta Blocker Step Therapy Policy Policy
Bile Acid Sequestrants Step Therapy Policy Policy
Bisphosphonates (Oral) Enhanced Step Therapy Policy Policy
Bone Modifiers - Teriparatide Products PA Policy Policy
Bone Modifiers - Tymlos PA Policy Policy
Bone Modifiers - Xgeva PA Policy Policy
C
Calcium Channel Blockers - Dihydropyridine Products Step Therapy Policy Policy
Calcium Channel Blockers - Verapamil Products Step Therapy Policy Policy
Carbinoxamine Step Therapy Policy Policy
Cardiology - Camzyos PA Policy
Cardiology - Zontivity PA Policy Policy
Chelating Agents - Chemet PA Policy Policy
Chelating Agents - Iron Chelators (Oral) Care Value Policy Policy
Chelating Agents - Iron Chelators (Oral) PA Policy Policy
Chelating Agents - Iron Chelators (Oral) PSM Policy Policy
Chelating Agents - Penicillamine Products PA Policy Policy
Chelating Agents - Trientine Products PA Policy
Chenodal PA Policy Policy
Cholbam PA Policy Policy
Chorionic Gonadotropins PSM Policy Policy
Cinacalcet (Sensipar) PA Policy Policy
Colony Stimulating Factors - Filgrastim Products PA Policy Policy
Colony Stimulating Factors - Filgrastim Products Preferred Specialty Management Policy for Basic Formulary Policy
Colony Stimulating Factors - Leukine PA Policy Policy
Colony Stimulating Factors - Pegfilgrastim Products and Rolvedon Preferred Specialty Management Policy for High Performance and National Preferred Formularies Policy
Colony Stimulating Factors - Pegfilgrastim Products PA Policy Policy
Complement Inhibitors - Empaveli PA Policy Policy
Complement Inhibitors – Ultomiris Intravenous PA Policy Policy
Complement Inhibitors – Ultomiris Subcutaneous PA Policy Policy
Compounded Select Topical Medications PA Policy Policy
Contraceptives - Oral, Patch, and Vaginal Ring Products Step Therapy Policy Policy
Coronavirus Disease - Evusheld PA Policy
Corticosteroids (Intraarticular) - Zilretta PA Policy Policy
Cushing's - Recorlev PA Policy Policy
Cushing's - Signifor PA Policy Policy
Cyclooxygenase - 2 Inhibitor Step Therapy Policy Policy
Cystic Fibrosis - Bronchitol PA Policy Policy
Cystic Fibrosis - Kalydeco PA Policy Policy
Cystic Fibrosis - Orkambi PA Policy Policy
Cystic Fibrosis - Pulmozyme PA Policy Policy
Cystic Fibrosis - Symdeko PA Policy Policy
Cystic Fibrosis - Trikafta PA Policy Policy
D
Dermatology - Hyftor PA Policy
Desmopressin Products - Nocdurna PA Policy Policy
Diabetes - Continuous Glucose Monitoring Systems PA Policy Policy
Diabetes - Dipeptidyl Peptidase-4 Inhibitors Care Value Policy Policy
Diabetes - Dipeptidyl Peptidase-4 Inhibitors Step Therapy Policy
Diabetes - Glucagon-Like Peptide-1 Agonists PA - Optional Policy
Diabetes - Glucagon-Like Peptide-1 Agonists PA Policy Policy
Diabetes - Metformin Care Value Policy Policy
Diabetes - Metformin Step Therapy Policy Policy
Diabetes - Mounjaro PA Policy
Diabetes - Sodium Glucose Co-Transporter-2 and Dipeptidyl Peptidase-4 Inhibitors Step Therapy Policy
Diabetes - Sodium Glucose Co-Transporter-2 Inhibitors Step Therapy Policy
Diabetes - Symlin PA Policy Policy
Diabetes - Thiazolidinedione Step Therapy Policy Policy
Dichlorphenamide PA Policy Policy
Dronabinol Products PA Policy
E
Enspryng PA Policy Policy
Enzyme Replacement Therapy - Strensiq PA Policy Policy
Enzyme Replacement Therapy - Sucraid PA Policy Policy
Epinephrine Auto-Injectors Step Therapy Policy Policy
Erectile Dysfunction - Tadalafil (Cialis) PA Policy Policy
Erythropoiesis - Stimulating Agents Preferred Specialty Management Policy for High Performance and National Preferred Formularies Policy
Erythropoiesis-Stimulating Agents - Epoetin Alfa Products PA Policy Policy
Estrogen - Transdermal Step Therapy Policy Policy
Ezetimibe (Zetia) Step Therapy Policy Policy
F
Fabry Disease - Galafold PA Policy Policy
Fenofibrate Step Therapy Policy Policy
G
Gabapentin Step Therapy Policy Policy
Gaucher Disease - Substrate Reduction Therapy Care Value Policy Policy
Gaucher Disease - Substrate Reduction Therapy PSM Policy Policy
Gaucher Disease Substrate Reduction Therapy - Cerdelga PA Policy Policy
Gaucher Disease Substrate Reduction Therapy - Miglustat (Zavesca) PA Policy Policy
Gonadotropin-Releasing Hormone Agonist - Synarel PA Policy Policy
Gonadotropin-Releasing Hormone Agonists - Central Precocious Puberty PA Policy Policy
Gonadotropin-Releasing Hormone Agonists - Injectable Long-Acting Products (Lupron Depot-Ped and Triptodur) PA Policy
Gonadotropin-Releasing Hormone Agonists - Injectable Long-Acting Products PA Policy Policy
Gonadotropin-Releasing Hormone Antagonists - Oriahnn PA Policy Policy
Gonadotropin-Releasing Hormone Antagonists - Orilissa PA Policy Policy
Gout Medications Step Therapy Policy Policy
Growth Disorders - Growth Hormone PA Policy
Growth Disorders - Growth Hormone Short-Acting Products PSM Policy Policy
Growth Disorders - Increlex PA Policy Policy
H
Hematology - Cablivi PA Policy Policy
Hematology - Enjaymo PA Policy Policy
Hepatitis C - Epclusa PA Policy Policy
Hepatitis C - Harvoni PA Policy Policy
Hepatitis C - Ribavirin PA Policy Policy
Hepatitis C - Viekira Pak PA Policy Policy
Hepatitis C - Vosevi PA Policy Policy
Hepatitis C - Zepatier PA Policy Policy
Hepatitis C Virus Direct - Acting Antivirals PSM Policy for National Preferred Formulary and Basic Formulary Policy
Hepatology - Ocaliva PA Policy Policy
Hereditary Angioedema - C1 Esterase Inhibitors (Intravenous) PA Policy Policy
Hereditary Angioedema - C1 Esterase Inhibitors (Subcutaneous) PA Policy Policy
Hereditary Angioedema - Icatibant (Firazyr) Care Value Policy Policy
Hereditary Angioedema - Icatibant (Firazyr) PA Policy Policy
Hereditary Angioedema - Icatibant (Firazyr) PSM Policy Policy
Hereditary Angioedema - Kalbitor PA Policy Policy
Hereditary Angioedema - Orladeyo PA Policy Policy
Hereditary Angioedema - Takhzyro PA Policy Policy
Hetlioz PA – Hetlioz LQ (tasimelteon oral suspension) Policy
Homozgous Familial Hypercholesterolemia - Juxtapid PA Policy Policy
Human Immunodeficiency Virus - Apretude PA Policy
Human Immunodeficiency Virus - Truvada PSM Policy Policy
Hydrocortisone Acetate Suppository Step Therapy Policy Policy
Hydroxy-methylglutaryl-coenzyme A Reductase Inhibitors Step Therapy Policy Policy
Hyperlipidemia - Nexletol PA Policy Policy
Hyperlipidemia - Nexlizet PA Policy Policy
Hyperlipidemia - Omega-3 Fatty Acid Products PA Policy Policy
I
Idiopathic Pulmonary Fibrosis and Related Lung Disease - Esbriet PA Policy Policy
Idiopathic Pulmonary Fibrosis and Related Lung Disease - Ofev PA Policy Policy
Immunologicals - Anti-Interleukin-5 Agents PSM Policy Policy
Immunologicals - Dupixent PA Policy Policy
Immunologicals - Fasenra PA Policy Policy
Immunologicals - Nucala PA Policy
Immunologicals - Tezspire PA Policy Policy
Immunologicals - Xolair PA Policy Policy
Infectious Disease - Impavido PA Policy Policy
Infectious Disease - Ivermectin Tablets PA Policy Policy
Infectious Disease - Pretomanid PA Policy Policy
Infectious Disease - Pyrimethamine PA Policy Policy
Infectious Disease - Sirturo PA Policy Policy
Infertility - Gonadotropin-Releasing Hormone Antagonists PSM Policy Policy
Infertility – Follitropins, Clomiphene Preferred Specialty Management Policy
Inflammatory Conditions - Adalimumab Products PA Policy Policy
Inflammatory Conditions - Adalimumab Products PSM Policy
Inflammatory Conditions - Arcalyst PA Policy Policy
Inflammatory Conditions - Care Value Policy Policy
Inflammatory Conditions - Etanercept Products PA Policy Policy
Inflammatory Conditions - Otezla PA Policy Policy
Inflammatory Conditions - Rinvoq PA Policy Policy
Inflammatory Conditions - Skyrizi Subcutaneous PA Policy Policy
Inflammatory Conditions - Stelara Subcutaneous PA Policy Policy
Inflammatory Conditions - Taltz PA Policy Policy
Inflammatory Conditions - Tocilizumab Subcutaneous Products PA Policy
Inflammatory Conditions - Tremfya PA Policy Policy
Inflammatory Conditions - Xeljanz Xeljanz XR PA Policy Policy
Interferon - Actimmune PA Policy Policy
Interleukin-1 Blockers for Cryopyrin-Associated Periodic Syndromes PSM Policy Policy
Isotretinoin Step Therapy Policy Policy
L
Lidocaine Patch Products PA Policy
Lipodystrophy - Egrifta PA Policy Policy
Lipodystrophy - Myalept PA Policy Policy
Lupus – Benlysta Subcutaneous PA Policy Policy
M
Metabolic Disorders - Carbaglu PA Policy Policy
Metabolic Disorders - Cystaran PA Policy Policy
Metabolic Disorders - Cysteamine (Oral) Products (Cystagon, Procysbi) PA Policy Policy
Metabolic Disorders - Cysteamine Ophthalmic Solution PA Policy Policy
Metabolic Disorders - Dojolvi PA Policy Policy
Metabolic Disorders - Imcivree PA Policy Policy
Metabolic Disorders - Nitisinone Products PA Policy Policy
Metabolic Disorders - Phenylbutyrate Products (Buphenyl, Ravicti) PA Policy Policy
Metabolic Disorders - Tiopronin Products PA Policy Policy
Metabolic Disorders - Xuriden PA Policy Policy
Methotrexate Injection Step Therapy Policy
Methylergonovine (Methergine) PA Policy Policy
Migraine - Calcitonin Gene-Related Peptide Inhibitors - Aimovig PA Policy Policy
Migraine - Calcitonin Gene-Related Peptide Inhibitors - Ajovy PA Policy Policy
Migraine - Calcitonin Gene-Related Peptide Inhibitors - Emgality PA Policy Policy
Migraine - Nurtec ODT PA Policy Policy
Migraine - Qulipta PA Policy Policy
Migraine - Reyvow PA Policy Policy
Migraine - Ubrelvy PA Policy Policy
Migraine Medication Step Therapy Policy Policy
Multiple Sclerosis - Avonex PA Policy Policy
Multiple Sclerosis - Bafiertam PA Policy Policy
Multiple Sclerosis - Betaseron, Extavia PA Policy Policy
Multiple Sclerosis - Dalfampridine PSM Policy Policy
Multiple Sclerosis - Dimethyl Fumarate PA Policy Policy
Multiple Sclerosis - Fingolimod PA Policy Policy
Multiple Sclerosis - Glatiramer Products PA Policy Policy
Multiple Sclerosis - Kesimpta PA Policy Policy
Multiple Sclerosis - Lemtrada PA Policy Policy
Multiple Sclerosis - Mavenclad PA Policy Policy
Multiple Sclerosis - Mayzent PA Policy Policy
Multiple Sclerosis - Plegridy PA Policy
Multiple Sclerosis - Ponvory PA Policy Policy
Multiple Sclerosis - Rebif PA Policy Policy
Multiple Sclerosis - Teriflunomide PA Policy
Multiple Sclerosis - Vumerity PA Policy Policy
Multiple Sclerosis and Crohn's Disease - Tysabri PA Policy Policy
Multiple Sclerosis and Ulcerative Colitis - Zeposia PA Policy Policy
Multiple Sclerosis and Ulcerative Colitis – Zeposia PSM Policy for National Preferred, High Performance, and Basic Formularies Policy
Multiple Sclerosis Care Value Policy Policy
Multiple Sclerosis PSM Policy Policy
N
Naloxone Injection Step Therapy Policy Policy
Nasal Steroids Step Therapy Policy Policy
Natpara PA Policy Policy
Neurology - Oxybate Products PA Policy Policy
Neurology - Riluzole Products PA Policy Policy
Nonsteroidal Anti-Inflammatory Drug Step Therapy Policy Policy
Northera PA Policy Policy
Nuedexta PA Policy Policy
O
Oncology (Injectable) - Elahere PA Policy
Oncology (Injectable) - Gonadotropin-Releasing Hormone Analogs PA Policy Policy
Oncology (Injectable) - Gonadotropin-Releasing Hormone Analogs PSM policy Policy
Oncology (Injectable) - Synribo PA Policy Policy
Oncology - Abiraterone Acetate (Zytiga) Care Value Policy Policy
Oncology - Abiraterone Acetate (Zytiga) PA Policy Policy
Oncology - Abiraterone Acetate (Zytiga) PSM Policy Policy
Oncology - Alecensa PA Policy Policy
Oncology - Alunbrig PA Policy Policy
Oncology - Ayvakit PA Policy Policy
Oncology - Balversa PA Policy Policy
Oncology - Bexarotene (Oral) PA Policy
Oncology - Bexarotene (Topical) PA Policy
Oncology - Bosulif PA Policy Policy
Oncology - Braftovi PA Policy Policy
Oncology - Brukinsa PA Policy Policy
Oncology - Cabometyx PA Policy
Oncology - Caprelsa PA Policy Policy
Oncology - Cometriq PA Policy Policy
Oncology - Copiktra PA Policy Policy
Oncology - Cotellic PA Policy Policy
Oncology - Cyclin Dependent Kinases 4,6 Inhibitors PSM Policy Policy
Oncology - Daurismo PA Policy Policy
Oncology - Erivedge PA Policy Policy
Oncology - Erleada PA Policy Policy
Oncology - Erlotinib PA Policy Policy
Oncology - Everolimus Products PA Policy Policy
Oncology - Everolimus Products PSM Policy Policy
Oncology - Farydak PA Policy Policy
Oncology - Gavreto PA Policy Policy
Oncology - Gefitinib PA Policy
Oncology - Gilotrif PA Policy Policy
Oncology - Ibrance PA Policy Policy
Oncology - Iclusig PA Policy Policy
Oncology - Idhifa PA Policy Policy
Oncology - Imatinib (Gleevec) PA Policy Policy
Oncology - Imatinib PSM Policy Policy
Oncology - Imbruvica PA Policy Policy
Oncology - Imbruvica PSM Policy Policy
Oncology - Inlyta PA Policy Policy
Oncology - Jakafi PA Policy Policy
Oncology - Koselugo PA Policy
Oncology - Lapatinib (Tykerb) PA Policy Policy
Oncology - Lenvima PA Policy Policy
Oncology - Lonsurf PA Policy Policy
Oncology - Lorbrena PA Policy Policy
Oncology - Lynparza PA Policy
Oncology - Mekinist PA Policy Policy
Oncology - Mektovi PA Policy Policy
Oncology - Nerlynx PA Policy Policy
Oncology - Nexavar PA Policy Policy
Oncology - Nilutamide PA Policy Policy
Oncology - Ninlaro PA Policy Policy
Oncology - Nubeqa PA Policy Policy
Oncology - Odomzo PA Policy Policy
Oncology - Pemazyre PA Policy Policy
Oncology - Pomalyst PA Policy Policy
Oncology - Retevmo PA Policy Policy
Oncology - Revlimid PA Policy Policy
Oncology - Rozlytrek PA Policy Policy
Oncology - Rubraca PA Policy Policy
Oncology - Rydapt PA Policy Policy
Oncology - Sprycel PA Policy Policy
Oncology - Stivarga PA Policy Policy
Oncology - Sunitinib PA Policy Policy
Oncology - Tabrecta PA Policy Policy
Oncology - Tafinlar PA Policy Policy
Oncology - Tagrisso PA Policy Policy
Oncology - Talzenna PA Policy Policy
Oncology - Tasigna PA Policy Policy
Oncology - Tazverik PA Policy Policy
Oncology - Temozolomide Capsules PA Policy Policy
Oncology - Thalomid PA Policy Policy
Oncology - Tibsovo PA Policy
Oncology - Tukysa PA Policy Policy
Oncology - Turalio PA Policy Policy
Oncology - Ukoniq PA Policy Policy
Oncology - Valchlor PA Policy Policy
Oncology - Venclexta PA Policy Policy
Oncology - Verzenio PA Policy Policy
Oncology - Vistogard PA Policy Policy
Oncology - Vitrakvi PA Policy Policy
Oncology - Vizimpro PA Policy Policy
Oncology - Votrient PA Policy Policy
Oncology - Xalkori PA Policy
Oncology - Xermelo PA Policy Policy
Oncology - Xospata PA Policy Policy
Oncology - Xtandi PA Policy Policy
Oncology - Yonsa PA Policy Policy
Oncology - Zejula PA Policy Policy
Oncology - Zelboraf PA Policy Policy
Oncology - Zolinza PA Policy Policy
Oncology - Zydelig PA Policy Policy
Oncology - Zykadia PA Policy Policy
Ophthalmic - Glaucoma - Alpha-Adrenergic Agonists Step Therapy Policy Policy
Ophthalmic - Glaucoma - Beta-adrenergic Blockers Step Therapy Policy Policy
Ophthalmic - Glaucoma - Carbonic Anhydrase Inhibitors Step Therapy Policy Policy
Ophthalmic - Glaucoma - Combination Products Step Therapy Policy Policy
Ophthalmic - Glaucoma - Prostaglandins and Rho Kinase Inhibitors Step Therapy Policy Policy
Ophthalmic - Glaucoma - Prostaglandins PA Policy Policy
Ophthalmic Anti-Allergics - Mast Cell Stabilizers Step Therapy Policy Policy
Ophthalmic Anti-Allergics - Miscellaneous Step Therapy Policy Policy
Ophthalmic Corticosteroids Step Therapy Policy Policy
Ophthalmic for Dry Eye Disease - Cyclosporine Products PA Policy Policy
Ophthalmic for Dry Eye Disease - Eysuvis PA Policy Policy
Ophthalmic for Dry Eye Disease - Lacrisert PA Policy Policy
Ophthalmic for Dry Eye Disease - Xiidra PA Policy Policy
Ophthalmic Nonsteroidal Antiinflammatory Drugs Step Therapy Policy Policy
Ophthalmic Prostaglandin Step Therapy Policy Policy
Ophthalmic Quinolone Antibiotics Step Therapy Policy Policy
Ophthalmology - Dry Eye Disease - Cyclosporine Products PA Policy
Ophthalmology - Oxervate PA Policy Policy
Opioids - Fentanyl Transmucosal Drugs PA Policy Policy
Opioids - Long-Acting Products PA Policy Policy
Opioids - Tramadol Extended-Release Products PA Policy
Otic Quinolone - Ciprofloxacin Step Therapy Policy Policy
Overactive Bladder Medications Step Therapy Policy Policy
P
Parkinson's Disease - Carbidopa PA Policy
Parkinson's Disease - Inbrija PA Policy Policy
Parkinson's Disease - Kynmobi PA Policy Policy
Parkinson's Disease - Monoamine Oxidase Type B Inhibitors Step Therapy Policy Policy
Parkinson's Disease - Nourianz PA Policy Policy
Parkinson's Disease - Tolcapone PA Policy
Parkinson’s Disease - Amantadine Extended-Release Drugs PA with Step Therapy Policy
Parkinson’s Disease - Nuplazid PA Policy Policy
Pegylated Interferons PA Policy Policy
Phenylketonuria - Palynziq PA Policy Policy
Phenylketonuria - Sapropterin (Kuvan) PA Policy Policy
Pheochromocytoma - Metyrosine and Phenoxybenzamine (Oral) PA Policy Policy
Proprotein Convertase Subtilisin Kexin Type 9 Inhibitors - Repatha PA Policy Policy
Proton Pump Inhibitors Step Therapy Policy Policy
Pulmonary - Corticosteroid Inhalers Care Value Policy
Pulmonary - Corticosteroid Long-Acting Beta2-Agonist Combination Inhalers PA Policy Policy
Pulmonary - Short-Acing Beta2-Agonist Inhalers Step Therapy Policy Policy
Pulmonary Arterial Hypertension - Adempas PA Policy Policy
Pulmonary Arterial Hypertension - Endothelin Receptor Antagonist PSM Policy Policy
Pulmonary Arterial Hypertension - Endothelin Receptor Antagonists PA Policy Policy
Pulmonary Arterial Hypertension - Orenitram PA Policy Policy
Pulmonary Arterial Hypertension - Phosphodiesterase Type 5 Inhibitors PA Policy Policy
Pulmonary Arterial Hypertension - Phosphodiesterase Type 5 Inhibitors PSM Policy Policy
Pulmonary Arterial Hypertension - Uptravi PA Policy Policy
Q
Qbrexza PA Policy Policy
R
Repository Corticotropin - Acthar Gel PA Policy Policy
S
Sedative Hypnotics Step Therapy Policy Policy
Sickle Cell Disease - Endari PA Policy Policy
Somatostatin Analogs - Octreotide Immediate-Release Products PA Policy Policy
Somatostatin Analogs - Octreotide Immediate-Release Products PSM Policy Policy
Somatostatin Analogs - Somatuline Depot PA Policy Policy
Somatostatin Analogs for Acromegaly PSM Policy Policy
Somavert PA Policy Policy
Spinal Muscular Atrophy - Evrysdi PA Policy Policy
ST: Antidepressants Bupropion to Antidepressants Bupropion Long Acting Policy
T
Testosterone (injectable) Products PA Policy Policy
Testosterone (Oral, Topical, and Nasal) Products PA Policy Policy
Tetracyclines (Oral) Step Therapy Policy
Thrombocytopenia - Doptelet PA Policy Policy
Thrombocytopenia - Eltromboppag Products PA Policy
Tolvaptan Products - Jynarque PA Policy Policy
Tolvaptan Products - Tolvaptan (Samsca) PA Policy Policy
Topical Acne - Cleansers Step Therapy Policy Policy
Topical Acne - Kits Step Therapy Policy Policy
Topical Acne - Topical Products Step Therapy Policy Policy
Topical Acyclovir Products PA Policy Policy
Topical Agents for Atopic Dermatitis Step Therapy Policy Policy
Topical Alpha-Adrenergic Agonists for Rosacea - Rhofade PA Policy
Topical Antibacterials Step Therapy Policy
Topical Antifungals for Onychomycosis Step Therapy Policy Policy
Topical Corticosteroids Step Therapy Policy Policy
Topical Diclofenac Sodium 3% Gel Policy
Topical Doxepin Step Therapy Policy Policy
Topical Medications for Inflammatory Rosacea Step Therapy Policy
Topical Podofilox Products Step Therapy Policy Policy
Topical Retinoids - Aklief PA Policy Policy
Topical Retinoids - Panretin PA Policy Policy
Topical Retinoids - Tazarotene Products PA Policy Policy
Topical Retinoids - Tretinoin Products PA Policy Policy
Topical Vitamin D Analogs Step Therapy Policy Policy
V
Vecamyl PA Policy Policy
Veregen PA Policy Policy
Vesicular Monoamine Transporter Type 2 Inhibitors - Austedo PA Policy Policy
Vesicular Monoamine Transporter Type 2 Inhibitors - Ingrezza PA Policy Policy
Vesicular Monoamine Transporter Type 2 Inhibitors - Tetrabenazine PA Policy Policy
Vesicular Monoamine Transporter Type 2 Inhibitors PSM Policy Policy
Vitamin B12 (Cyanocobalamin) Products Step Therapy Policy Policy
Vitamin D Analog (Oral) Step Therapy Policy Policy
W
Wakefulness-Promoting Agents - Armodafinil, Modafinil PA with Step Therapy Policy Policy
Wakefulness-Promoting Agents - Sunosi PA Policy with Step Therapy Policy
Wakefulness-Promoting Agents - Wakix PA Policy with Step Therapy Policy
Weight Loss - Glucagon-Like Peptide - 1 Agonists PA Policy Policy
Weight Loss - Other Appetite Suppressants and Orlistat PA Policy
Z
Zokinvy PA Policy Policy