Utilization Management
Prior Authorization and Step Therapy Policies for Medicaid
| Gaucher Disease Substrate Reduction Therapy - Cerdelga PA Policy | Policy |
| Gaucher Disease Substrate Reduction Therapy - Miglustat PA | Policy |
| Gonadotropin-Releasing Hormone Agonist - Lupron Depot PA | Policy |
| Gonadotropin-Releasing Hormone Agonists - Central Precocious Puberty 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 Antagonists - Oriahnn PA Policy | Policy |
| Gonadotropin-Releasing Hormone Antagonists - Orilissa PA Policy | Policy |
| Growth Disorders - Growth Hormone PA | Policy |
| Growth Disorders - Increlex PA Policy | Policy |
| Growth Disorders - Ngenla PA | Policy |
| Growth Disorders - Sogroya PA | Policy |
| Growth Disorders - Voxzogo PA | Policy |
| Hemangeol PA with Step Therapy Policy | Policy |
| Hematology - Adzynma PA | Policy |
| Hematology - Aphexda PA | Policy |
| Hematology - Cablivi PA Policy | Policy |
| Hematology - Enjaymo PA Policy | Policy |
| Hematology - Gene Therapy - Casgevy PA | Policy |
| Hematology - Gene Therapy - Casgevy PA | Policy |
| Hematology - Gene Therapy - Lyfgenia PA | Policy |
| Hematology - Gene Therapy - Lyfgenia PA | Policy |
| Hematology - Gene Therapy - Zynteglo PA | Policy |
| Hematology - Gene Therapy - Zynteglo PA | Policy |
| Hematology - Pyrukynd PA | Policy |
| Hematology - Ryplazim PA | Policy |
| Hematology - Rytelo PA | Policy |
| Hemophilia - Alhemo PA | Policy |
| Hemophilia - Altuviiio PA | Policy |
| Hemophilia - Altuviiio PA | Policy |
| Hemophilia - Gene Therapy - Beqvez PA | Policy |
| Hemophilia - Gene Therapy - Beqvez PA | Policy |
| Hemophilia - Gene Therapy - Hemgenix PA | Policy |
| Hemophilia - Gene Therapy - Roctavian PA | Policy |
| Hemophilia - Hympavzi PA | Policy |
| Hepatitis C - Epclusa PA Policy | Policy |
| Hepatitis C - Harvoni PA Policy | Policy |
| Hepatitis C - Mavyret PA Policy | Policy |
| Hepatitis C - PDL Drug Policy | Policy |
| Hepatitis C - Ribavirin PA Policy | Policy |
| Hepatitis C - Sovaldi PA Policy | Policy |
| Hepatitis C - Viekira Pak PA Policy | Policy |
| Hepatitis C - Vosevi PA Policy | Policy |
| Hepatitis C - Zepatier PA Policy | Policy |
| Hepatology - Iqirvo PA | Policy |
| Hepatology - Livdelzi PA | Policy |
| Hepatology - Ocaliva PA Policy | Policy |
| Hepatology - Rezdiffra PA | Policy |
| Hereditary Angioedema - C1 Esterase Inhibitors (Intravenous) PA Policy | Policy |
| Hereditary Angioedema - C1 Esterase Inhibitors (Subcutaneous) PA Policy | Policy |
| Hereditary Angioedema - Icatibant (Firazyr) PA Policy | Policy |
| Hereditary Angioedema - Kalbitor PA | 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 - Apretude PA | Policy |
| Human Immunodeficiency Virus - Sunlenca PA | Policy |
| Hyperhidrosis - Qbrexza PA | Policy |
| Hyperlipidemia - Omega-3 Fatty Acid Products PA Policy | Policy |
| Hypoparathyroidism - Natpara PA | Policy |
| Hypoparathyroidism - Yorvipath PA | Policy |
| Idiopathic Pulmonary Fibrosis and Related Lung Disease - Esbriet PA Policy | Policy |
| Idiopathic Pulmonary Fibrosis and Related Lung Disease - Ofev PA Policy | Policy |
| Immune Disorder - Joenja PA | Policy |
| Immunologicals - Dupixent PA Policy | Policy |
| Immunologicals - Ebglyss PA | Policy |
| Immunologicals - Fasenra PA Policy | Policy |
| Immunologicals - Nemluvio PA | Policy |
| Immunologicals - Nucala PA | Policy |
| Immunologicals - Tezspire PA | Policy |
| Immunologicals - Tezspire PA Policy | Policy |
| Immunologicals - Xolair PA Policy | Policy |
| Immunologicals – Adbry PA | Policy |
| Infectious Disease - Impavido PA Policy | Policy |
| Infectious Disease - Ivermectin Tablets PA Policy | Policy |
| Infectious Disease - Livtencity PA | Policy |
| Infectious Disease - Pyrimethamine PA Policy | Policy |
| Infectious Disease - Sirturo PA Policy | Policy |
| Inflammatory Conditions - Adalimumab Products PA Policy | Policy |
| Inflammatory Conditions - Bimzelx PA | Policy |
| Inflammatory Conditions - Cibinqo PA Policy | Policy |
| Inflammatory Conditions - Cimzia PA Policy | Policy |
| Inflammatory Conditions - Cosentyx Intravenous PA | Policy |
| Inflammatory Conditions - Cosentyx Intravenous PA | Policy |
| Inflammatory Conditions - Entyvio Subcutaneous PA | Policy |
| Inflammatory Conditions - Entyvio Subcutaneous PA | Policy |
| Inflammatory Conditions - Etanercept Products PA Policy | Policy |
| Inflammatory Conditions - Ilumya PA Policy | Policy |
| Inflammatory Conditions - Kevzara PA Policy | Policy |
| Inflammatory Conditions - Kineret PA Policy | Policy |
| Inflammatory Conditions - Litfulo PA | Policy |
| Inflammatory Conditions - Omvoh Intravenous PA | Policy |
| Inflammatory Conditions - Omvoh Subcutaneous PA | Policy |
| Inflammatory Conditions - Omvoh Subcutaneous PA | Policy |
| Inflammatory Conditions - Orencia Subcutaneous PA Policy | Policy |
| Inflammatory Conditions - Otezla PA Policy | Policy |
| Inflammatory Conditions - Rinvoq PA Policy | Policy |
| Inflammatory Conditions - Siliq PA Policy | Policy |
| Inflammatory Conditions - Simponi Subcutaneous PA Policy | Policy |