Utilization Management

Prescription Drug Prior Authorization and Step Therapy Policies for Cascade Select Marketplace Business

Not all medications will be covered on the formulary. Non-formulary medications are subject to the Medical Necessity for Non-Formulary Medications policy. Please consult the formulary to verify coverage.

Chelating Agents - Trientine Products PA Policy Policy
Chelating Agents – Iron Chelators (Oral) PSM Policy Policy
Chenodiol Products PA Policy Policy
Cholbam PA Policy Policy
Chorionic Gonadotropins DQM Policy - Per Rx Policy
Chorionic Gonadotropins PSM Policy Policy
Cinacalcet PA Policy
Colchicine Products Preferred Step Therapy Policy Policy
Colony Stimulating Factors - Filgrastim Products PSM Policy for Flex, High Performance, and National Preferred Formularies Policy
Colony Stimulating Factors - Leukine PA Policy Policy
Colony Stimulating Factors - Pegfilgrastim Products, Rolvedon and Ryzneuta PSM Policy For Flex, High Performance, and National Preferred Formularies Policy
Complement Inhibitors - Eculizumab Products PA Policy Policy
Complement Inhibitors - Empaveli PA Policy Policy
Complement Inhibitors - Fabhalta PA Policy Policy
Complement Inhibitors - PiaSky PA Policy Policy
Complement Inhibitors - Ultomiris PA Policy Policy
Complement Inhibitors - Voydeya PA Policy Policy
Complement Inhibitors - Zilbrysq PA Policy Policy
Complement System Disorders - WHIM Syndrome - Xolremdi PA Policy Policy
Coronavirus – Oral Medications for Treatment of COVID-19 DQM Policy – Per Days Policy
Coronavirus Disease - Evusheld PA Policy Policy
Coronavirus Disease - Veklury PA Policy Policy
Corticosteroids (Intraarticular) - Zilretta PA Policy Policy
Corticosteroids (Nasal) - Mometasone DQM Policy - Per Rx Policy
Corticosteroids (Nebulized) - Budesonide DQM Policy - Per Rx Policy
Crysvita PA Policy Policy
Cystic Fibrosis - Bronchitol PA Policy Policy
Cystic Fibrosis - Pulmozyme PA Policy Policy
Cystic Fibrosis - Trikafta DQM Policy - Per Rx Policy
Cystic Fibrosis Transmembrane Conductance Regulator - Alyftrek PA Policy Policy
Cystic Fibrosis Transmembrane Conductance Regulator - Kalydeco PA Policy Policy
Cystic Fibrosis Transmembrane Conductance Regulator - Orkambi PA Policy Policy
Cystic Fibrosis Transmembrane Conductance Regulator - Symdeko PA Policy Policy
Cystic Fibrosis Transmembrane Conductance Regulator - Trikafta PA Policy Policy
Dermatology - Anzupgo DQM Policy - Per Days Policy
Dermatology - Anzupgo PA Policy Policy
Dermatology - Filsuvez PA Policy Policy
Dermatology - Gene Therapy - Vyjuvek PA Policy Policy
Dermatology - Opzelura PA Policy Policy
Dermatology - Vtama DQM Policy - Per Days Policy
Dermatology - Zoryve DQM Policy - Per Days Policy
Desmopressin Products - Nocdurna PA Policy Policy
Diabetes - Canagliflozin Products DQM Policy - Per Rx Policy
Diabetes - Dipeptidyl Peptidase-4 Inhibitors Step Therapy Policy Policy
Diabetes - Glucagon-Like Peptide-1 Agonists PA Policy Policy
Diabetes - Metformin Extended-Release DQM Policy - Per Rx Policy
Diabetes - Metformin Step Therapy Policy Policy
Diabetes - Omnipod Pods DQM Policy - Per Days Policy
Diabetes - Sodium Glucose Co-Transporter-2 Inhibitors Step Therapy Policy Policy
Diabetes - Symlin PA Policy Policy
Diabetes - Tzield PA Policy Policy
Dichlorphenamide PSM Policy Policy
Diuretic - Enbumyst PA with Step Therapy Policy Policy
Diuretics - Loop Products Step Therapy Policy Policy
Diuretics – Hydrochlorothiazide Step Therapy Policy Policy
Dronabinol Products PA with Step Therapy Policy Policy
Droxidopa PA Policy Policy
Enzyme Replacement Therapy - Aldurazyme PA Policy Policy
Enzyme Replacement Therapy - Elaprase PA Policy Policy
Enzyme Replacement Therapy - Elfabrio PA Policy Policy
Enzyme Replacement Therapy - Fabrazyme PA Policy Policy
Enzyme Replacement Therapy - Kanuma PA Policy Policy
Enzyme Replacement Therapy - Lamzede PA Policy Policy
Enzyme Replacement Therapy - Mepsevii PA Policy Policy
Enzyme Replacement Therapy - Naglazyme PA Policy Policy
Enzyme Replacement Therapy - Revcovi PA Policy Policy
Enzyme Replacement Therapy - Strensiq PA Policy Policy
Enzyme Replacement Therapy - Sucraid PA Policy Policy
Enzyme Replacement Therapy - Vimizim PA Policy Policy
Enzyme Replacement Therapy - Xenpozyme PA Policy Policy
Epinephrine Auto-Injectors Step Therapy Policy Policy
Erectile Dysfunction - Alprostadil Products PA Policy Policy
Erectile Dysfunction - Avanafil PA Policy Policy
Erectile Dysfunction - Sildenafil PA Policy Policy
Erectile Dysfunction - Tadalafil PA Policy Policy
Erectile Dysfunction - Vardenafil PA Policy Policy
Erectile Dysfunction Agents DQM Policy - Per Days Policy
Erythropoiesis-Stimulating Agents PSM Policy for High Performance and National Preferred Formularies Policy
Estrogens (Topical) - Estradiol Gel DQM Policy - Per Rx Policy
Estrogens (Topical) - Patches DQM Policy - Per Days Policy
Fabry Disease - Galafold PA Policy Policy
Fenofibrate Step Therapy Policy Policy
Gabapentin Step Therapy Policy Policy
Gamifant PA Policy Policy
Gastroenterology - Eohilia DQM Policy - Per Days Policy
Gastroenterology - Eohilia PA Policy Policy
Gastroenterology - Gattex PA Policy Policy
Gastroenterology - Gimoti PA Policy Policy
Gaucher Disease - Enzyme Replacement Therapy - Cerezyme PA Policy Policy
Gaucher Disease - Enzyme Replacement Therapy PSM Policy Policy
Gaucher Disease - Substrate Reduction Therapy - Cerdelga PA Policy Policy
Gaucher Disease - Substrate Reduction Therapy - Miglustat PA Policy Policy
Gaucher Disease - Substrate Reduction Therapy PSM Policy Policy
Gonadotropin-Releasing Hormone Agonist - Synarel PA Policy Policy
Gonadotropin-Releasing Hormone Agonists - Central Precocious Puberty PA Policy Policy
Gonadotropin-Releasing Hormone Agonists - Implants PA Policy Policy
Gonadotropin-Releasing Hormone Agonists - Lupron Depot PA Policy Policy
Gonadotropin-Releasing Hormone Antagonists - Myfembree PA Policy Policy
Gonadotropin-Releasing Hormone Antagonists - Oriahnn PA Policy Policy
Gout - Krystexxa PA Policy Policy
Regressar al principio de la pagina