Utilization Management
Prior Authorization and Step Therapy Policies for Commercial and Individual Family Business (IFB)
Certain drugs within policies may not be applicable to the specific formulary and plan design. Please refer to the formulary drug list and/or member plan documents to determine coverage status.
| Oncology - Itovebi PA | Policy |
| Oncology - Iwilfin PA | 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 - Mercaptopurine Products ST | Policy |
| Oncology - Nerlynx PA Policy | Policy |
| Oncology - Nexavar PA Policy | Policy |
| Oncology - Nilotinib Products PA | Policy |
| Oncology - Nilotinib PSM | Policy |
| Oncology - Nilutamide PA Policy | Policy |
| Oncology - Ogsiveo PA | Policy |
| Oncology - Ojemda PA | Policy |
| Oncology - Ojjaara PA | Policy |
| Oncology - Orserdu PA | Policy |
| Oncology - Pazopanib PA | Policy |
| Oncology - Revlimid PA Policy | Policy |
| Oncology - Revuforj PA | Policy |
| Oncology - Romvimza PA | Policy |
| Oncology - Sorafenib PA | Policy |
| Oncology - Sprycel PA Policy | Policy |
| Oncology - Stivarga PA Policy | Policy |
| Oncology - Sunitinib PA Policy | Policy |
| Oncology - Tazverik PA Policy | Policy |
| Oncology - Temozolomide Capsules PA Policy | Policy |
| Oncology - Truqap 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 - Vistogard PA Policy | Policy |
| Oncology - Vonjo PA | Policy |
| Oncology - Voranigo PA | Policy |
| Oncology - Xermelo PA Policy | Policy |
| Oncology - Zolinza PA Policy | Policy |
| Oncology - Zydelig PA Policy | Policy |
| Oncology (Injectable - Bispecific - BCMA-Directed) - Elrexfio PA | Policy |
| Oncology (Injectable - Bispecific - BCMA-Directed) - Tecvayli PA | Policy |
| Oncology (Injectable - Bispecific - CD20-Directed) - Columvi PA | Policy |
| Oncology (Injectable - Bispecific - CD20-Directed) - Epkinly PA | Policy |
| Oncology (Injectable - Bispecific - CD20-Directed) - Lunsumio PA | Policy |
| Oncology (Injectable - Bispecific - GPRC5D-Directed) - Talvey PA | Policy |
| Oncology (Injectable - CTLA-4 Antibody) - Imjudo PA | Policy |
| Oncology (Injectable - Programmed Death Receptor-1) - Opdualag PA | Policy |
| Oncology (Injectable - Programmed Death Receptor-1) - Tevimbra PA | Policy |
| Oncology (Injectable - Programmed Death Receptor-1) - Zynyz PA | Policy |
| Oncology (Injectable - Programmed Death-Ligand 1) - Tecentriq Hybreza PA | Policy |
| Oncology (Injectable) - Amtagvi PA | Policy |
| Oncology (Injectable) - Besremi PA | Policy |
| Oncology (Injectable) - Columvi PA | Policy |
| Oncology (Injectable) - Elahere PA | Policy |
| Oncology (Injectable) - Epkinly PA | Policy |
| Oncology (Injectable) - Gonadotropin-Releasing Hormone Analogs PA Policy | Policy |
| Oncology (Injectable) - Gonadotropin-Releasing Hormone Analogs PSM policy | Policy |
| Oncology (Injectable) - Imdelltra PA | Policy |
| Oncology (Injectable) - Synribo PA Policy | Policy |
| Oncology (Injectable) - Tecelra PA | Policy |
| Oncology (Intravesical) - Adstiladrin PA | Policy |
| Oncology (Intravesical) - Anktiva PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Alecensa PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Alunbrig PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Ensacove PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Lorbrena PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Xalkori PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Zykadia PA | Policy |
| Oncology (Oral - Androgen Biosynthesis Inhibitor) - Abiraterone Acetate PA | Policy |
| Oncology (Oral - Androgen Biosynthesis Inhibitor) - Yonsa PA | Policy |
| Oncology (Oral - Androgen Receptor Inhibitor) - Erleada PA | Policy |
| Oncology (Oral - Androgen Receptor Inhibitor) - Nubeqa PA | Policy |
| Oncology (Oral - Androgen Receptor Inhibitor) - Xtandi PA | Policy |
| Oncology (Oral - BRAF Inhibitor) - Braftovi PA | Policy |
| Oncology (Oral - BRAF Inhibitor) - Tafinlar PA | Policy |
| Oncology (Oral - BRAF Inhibitor) - Zelboraf PA | Policy |
| Oncology (Oral - Bruton's Tyrosine Kinase Inhibitor) - Brukinsa PA | Policy |
| Oncology (Oral - Bruton's Tyrosine Kinase Inhibitor) - Imbruvica PA | Policy |
| Oncology (Oral - Bruton's Tyrosine Kinase Inhibitor) - Jaypirca PA | Policy |
| Oncology (Oral - Cyclin-Dependent Kinase 4 and 6 Inhibitor) - Ibrance PA | Policy |
| Oncology (Oral - Cyclin-Dependent Kinase 4 and 6 Inhibitor) - Verzenio PA | Policy |
| Oncology (Oral - Epidermal Growth Factor Receptor Inhibitor) - Erlotinib PA | Policy |
| Oncology (Oral - Epidermal Growth Factor Receptor Inhibitor) - Gefitinib PA | Policy |
| Oncology (Oral - Epidermal Growth Factor Receptor Inhibitor) - Gilotrif PA | Policy |
| Oncology (Oral - Epidermal Growth Factor Receptor Inhibitor) - Lazcluze PA | Policy |
| Oncology (Oral - Epidermal Growth Factor Receptor Inhibitor) - Tagrisso PA | Policy |
| Oncology (Oral - Epidermal Growth Factor Receptor Inhibitor) - Vizimpro PA | Policy |
| Oncology (Oral - Fibroblast Growth Factor Receptor Agent) - Lytgobi PA | Policy |
| Oncology (Oral - Fibroblast Growth Factor Receptor Agent) - Pemazyre PA | Policy |
| Oncology (Oral - FMS-Like Tyrosine Kinase 3 Inhibitor) - Rydapt PA | Policy |
| Oncology (Oral - FMS-Like Tyrosine Kinase 3 Inhibitor) - Vanflyta PA | Policy |
| Oncology (Oral - FMS-Like Tyrosine Kinase 3 Inhibitor) - Xospata PA | Policy |
| Oncology (Oral - Hedgehog Pathway Inhibitor) - Erivedge PA | Policy |
| Oncology (Oral - Hedgehog Pathway Inhibitor) - Odomzo PA | Policy |
| Oncology (Oral - Immunomodulator) - Lenalidomide PA | Policy |
| Oncology (Oral - Immunomodulator) - Pomalyst PA | Policy |
| Oncology (Oral - Immunomodulator) - Thalomid PA | Policy |
| Oncology (Oral - Isocitrate Dehydrogenase 1 Inhibitor) - Rezlidhia PA | Policy |
| Oncology (Oral - Isocitrate Dehydrogenase 1 Inhibitor) - Tibsovo PA | Policy |
| Oncology (Oral - Kirsten RAt Sarcoma Virus Inhibitor) - Krazati PA | Policy |