Utilization Management
Prior Authorization and Step Therapy Policies for Medicaid
| Inflammatory Conditions - Skyrizi Intravenous PA | Policy |
| Inflammatory Conditions - Skyrizi Subcutaneous PA Policy | Policy |
| Inflammatory Conditions - Sotyktu PA | Policy |
| Inflammatory Conditions - Spevigo Subcutaneous PA | Policy |
| Inflammatory Conditions - Spevigo Subcutaneous PA | Policy |
| Inflammatory Conditions - Stelara (Ustekinumab Subcutaneous Products) PA Policy with Dosing | Policy |
| Inflammatory Conditions - Stelara Subcutaneous PA Policy | Policy |
| Inflammatory Conditions - Stelara Subcutaneous PA Policy with Dosing | Policy |
| Inflammatory Conditions - Taltz PA Policy | Policy |
| Inflammatory Conditions - Tocilizumab Subcutaneous Products PA | Policy |
| Inflammatory Conditions - Tremfya PA Policy | Policy |
| Inflammatory Conditions - Tremfya Subcutaneous PA | Policy |
| Inflammatory Conditions - Velsipity PA | Policy |
| Inflammatory Conditions - Xeljanz Xeljanz XR PA Policy | Policy |
| Inflammatory Conditions - Zymfentra PA | Policy |
| Inflammatory Conditions - Zymfentra PA | Policy |
| Inpefa PA | Policy |
| Interferon - Actimmune PA Policy | Policy |
| Lidocaine Patch Products PA | Policy |
| Lipodystrophy - Egrifta PA Policy | Policy |
| Lipodystrophy - Myalept PA Policy | Policy |
| Lupus - Benlysta Subcutaneous PA | Policy |
| Lupus – Benlysta Subcutaneous PA Policy | Policy |
| Lyrica CR PA Policy | Policy |
| 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 - Nitisinone Products PA Policy | Policy |
| Metabolic Disorders - Phenylbutyrate Products (Buphenyl, Ravicti) PA Policy | Policy |
| Metabolic Disorders - Primary Hyperoxaluria Medications - Rivfloza PA | Policy |
| Metabolic Disorders - Xuriden PA Policy | 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 - Elyxyb PA | Policy |
| Migraine - Nurtec ODT PA Policy | Policy |
| Migraine - Reyvow PA Policy | Policy |
| Migraine - Zavzpret PA | Policy |
| Multiple Sclerosis - Avonex PA Policy | Policy |
| Multiple Sclerosis - Bafiertam PA Policy | Policy |
| Multiple Sclerosis - Betaseron, Extavia PA Policy | Policy |
| Multiple Sclerosis - Briumvi PA | Policy |
| Multiple Sclerosis - Briumvi PA | Policy |
| Multiple Sclerosis - Dalfampridine PA | 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 - Ocrevus Zunovo PA | Policy |
| Multiple Sclerosis - Plegridy PA | Policy |
| Multiple Sclerosis - Ponvory PA Policy | Policy |
| Multiple Sclerosis - Rebif PA Policy | Policy |
| Multiple Sclerosis - Tascenso ODT PA | 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 |
| Muscular Dystrophy - Agamree PA | Policy |
| Muscular Dystrophy - Duvyzat PA | Policy |
| Natpara PA Policy | Policy |
| Nephrology - Filspari PA Policy | Policy |
| Nephrology - Jesduvroq PA | Policy |
| Nephrology - Tarpeyo PA | Policy |
| Nephrology - Vafseo PA | Policy |
| Nephrology - Vanrafia PA | Policy |
| Nephrology - Xphozah PA | Policy |
| Neurology - Daybue PA | Policy |
| Neurology - Kisunla PA Policy | Policy |
| Neurology - Leqembi PA | Policy |
| Neurology - Leqembi PA | Policy |
| Neurology - Lyrica CR PA with Step Therapy | Policy |
| Neurology - Lyrica CR Prior Authorization with Step Therapy Policy | Policy |
| Neurology - Oxybate Products PA Policy | Policy |
| Neurology - Qalsody PA | Policy |
| Neurology - Relyvrio PA | Policy |
| Neurology - Riluzole Products PA Policy | Policy |
| Neurology - Rystiggo PA | Policy |
| Neurology - Skyclarys PA | Policy |
| Neurology - Vyvgart Hytrulo PA | Policy |
| Niemann-Pick disease type C - Aqneursa PA | Policy |
| Niemann-Pick disease type C - Aqneursa PA | Policy |
| Niemann-Pick disease type C - Miplyffa PA | Policy |
| Non-Preferred PDL Drug Policy | Policy |
| Nuedexta PA Policy | Policy |
| Oncology - Balversa PA Policy | Policy |
| Oncology - Bexarotene (Oral) PA | Policy |
| Oncology - Bexarotene (Topical) PA | Policy |
| Oncology - Bosulif PA Policy | Policy |
| Oncology - Cabometyx PA | Policy |
| Oncology - Caprelsa PA Policy | Policy |
| Oncology - Cometriq PA Policy | Policy |
| Oncology - Everolimus Products PA Policy | Policy |
| Oncology - Fruzaqla PA | Policy |
| Oncology - Gomekli PA | Policy |
| Oncology - Iclusig PA Policy | Policy |