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Adalimumab (Humira® [adalimumab], Abrilada™[adalimumab-afzb], Amjevita™ [adalimumab-atto], Cyltezo®/ adalimumab-adbm [adalimumab-adbm], Hadlima™ [adalimumab-bwwd], [adalimumab-fkjp], Hyrimoz®/adalimumab-adaz [adalimumab-adaz], adalimumab-aacf [adalimumab-aacf], Simlandi®/ adalimumab-ryvk (adalimumab-ryvk), Yuflyma®/adalimumab-aaty [adalimumab-aaty], Yusimry™ [adalimumab-aqvh]
|
02/12/2026 |
|
Alpha-1 Antitrypsin Therapy (AAT) - Medical Benefit
|
11/19/2025 |
|
Amyotrophic Lateral Sclerosis (ALS) Policy - (Qalsody, Radicava and Radicava ORS, Relyvrio, Teglutik & Tiglutik) - Medical & Rx Benefit
|
05/29/2026 |
|
Anti-Amyloid Directed Therapies Policy - (Aduhelm, Kisunla, and Leqembi) (Health Professional Administered) - Medical Benefit
|
01/01/2026 |
|
Antihemophilic Agents for Medicaid Managed Care (MMC), Health and Recovery Program (HARP), and Dual Eligible Special Needs Plan (D-SNP)
|
11/19/2025 |
|
Attention Deficit Hyperactivity Disorder (ADHD) Policy - Adzenys ER, Adzenys XR ODT, Azstarys, Cotempla XR ODT, Desoxyn, Dyanavel XR, Jornay PM, Mydayis, Onyda XR, Qelbree, Quillichew ER, Quillivant, Xelstrym
|
02/12/2026 |
|
Blood Modifiers - (Cosela, Fulphila, Fylnetra, Granix, Neupogen, Nivestym, Nypozi, Nyvepria, Releuko, Rolvedon, Ryzneuta, Stimufend, Ziextenzo) - Rx (Self Administration) & Medical Benefits (Health Professional Administered)
|
11/19/2025 |
|
Botulinum Toxin (Botox, Daxxify, Dysport, Myobloc, Xeomin) – for Medicaid Managed Care (MMC), Health and Recovery Program (HARP), Child Health Plus (CHP), Essential Plan (EP), Exchange Plans, Commercial, and Dual Eligible Special Needs Plan (D-SNP) - Medical Benefit
|
11/19/2025 |
|
Casgevy (exagamglogene autotemcel) Drug Policy (Health Professional Administered) - Medical Benefit
|
03/26/2026 |
|
Chimeric Antigen Receptor T Cell (CAR-T) Therapy – (Health Professional Administered) (Abecma, Aucatzyl, Breyanzi, Carvykti, Kymriah, Tecartus, & Yescarta) - Medical Benefit
|
03/02/2026 |
|
Cimzia(certolizumab pegol) - for Ankylosing Spondylitis, Crohn’s Disease, Psoriatic Arthritis and Rheumatoid Arthritis (Self-Administered or Healthcare Professional Administered) - Rx Benefit or Medical Benefit
|
02/12/2026 |
|
Clinical Review Prior Authorization (CRPA) Medical Drug Policy for Medicaid Managed Care, HARP, Essential Plan & Dual Special Needs Plan (Benlysta IV, Briumvi, Cablivi (Rx & Medical), Ceprotin, Fensolvi, Gazyva, Gonadotropin-releasing hormone (GnRH) Analogs, Hydroxyprogesterone Caproate Injection, Krystexxa, Lemtrada, Leqvio, Ocrevus, Ocrevus Zunovo , Pemgarda, Rebyota, Saphnelo, Spravato, Supprelin LA, Triptodur, Tyruko, Tysabri, Ycanth, Zilretta, & Zoladex) (Self-Administered) OR (Health Professional Administered) – Medical Benefit
|
05/22/2026 |
|
Clinical Review Prior Authorization (CRPA) Rx Drug Policy
|
06/01/2026 |
|
Compounded Drug Products Policy
|
02/12/2026 |
|
Cosmetic Medications Drug Policy
|
06/01/2026 |
|
Cytomegalovirus (CMV) Policy (Livtencity (Rx) & Prevymis (Rx & Medical) (Self-Administered) & (Health Professional Administered) – Rx & Medical Benefit
|
01/01/2026 |
|
Diabetic Incretin Mimetic Agents Policy
|
05/07/2026 |
|
Dual Special Needs Plan (D-SNP) 2026 Prior Authorization Policy
|
06/01/2026 |
|
Dual Special Needs Plan (D-SNP) 2026 Step Therapy Policy
|
06/01/2026 |
|
Duchenne Muscular Dystrophy (DMD) - (Agamree, Amondys 45, Duvyzat, Emflaza, Exondys 51, Viltepso and Vyondys 53) (Self-Administered) - Rx Benefit & (Health Professional Administered) - Medical Benefit
|
06/01/2026 |
|
Elevidys (delandistrogene moxeparvovec-rokl) (Medicaid Managed Care, Essential Plan, Commercial, & Medicare) - Medical Benefit
|
01/30/2026 |
|
Enbrel (etanercept) – for Ankylosing Spondylitis, Juvenile Idiopathic Arthritis, Plaque Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis
|
02/12/2026 |
|
Encelto (revakinagene taroretcel-lwey) Implant (Health Professional Administered) - Medical Benefit
|
01/01/2026 |
|
Enteral Nutrition Drug Policy
|
03/04/2026 |
|
Gamma-Aminobutyric Acid (GABA) A Receptor Positive Modulators for Postpartum Depression (Self-Administered) - Rx Benefit
|
11/20/2025 |
|
Generic Advantage Program / MAC Penalty
|
02/20/2025 |
|
Geographic Atrophy Drug Policy (Izervay, Syfovre) (Health Professional Administered) - Medical Benefit
|
02/12/2026 |
|
Growth Hormone Policy
|
03/09/2026 |
|
Headache Disorder – (Aimovig (erenumab-aooe) (Rx), Ajovy (fremanezumab-vfrm) (Rx & Medical), D.H.E 45, dihydroergotamine 1 mg/mL ampule (Rx), Emgality 120 mg (galcanezumab-gnlm) (Rx), Emgality 300 mg (galcanezumab-gnlm) (Rx), Migranal, dihydroergotamine 4 mg/mL nasal spray, Trudhesa (Rx), Nurtec ODT (rimegepant) (Rx), Qulipta (atogepant) (Rx), Reyvow (lasmiditan) (Rx), Ubrelvy (ubrogepant) (Rx), Vyepti (eptinezumab-jjmr) (Medical), Zavzpret (zavegepant) (Rx) & Quantity Limit Criteria for Ubrelvy, Nurtec ODT, Reyvow, and Zavzpret)
|
05/29/2026 |
|
Hemophilia Gene Therapies Policy - (Hemgenix & Roctavian) - Medical Benefit
|
02/12/2026 |
|
Hepatitis-C Virus (HCV) Infection (Pegasys, Peg-Intron, ribavirin, Sovaldi, Harvoni, ledipasvir/sofosbuvir, Zepatier, Epclusa, sofosbuvir/velpatasvir, Vosevi, Mavyret) for Commercial, NYSOH Individual Market, NYSOH Employer Group Market Products, and Managed Medicaid products (Vosevi only) (Self Administered) - Rx Benefit
|
03/13/2026 |
|
Hereditary Angioedema (HAE) for Andembry, Berinert, Cinryze, Dawnzera, Ekterly, Firazyr, Icatibant Haegarda, Kalbitor, Orladeyo, Ruconest, Sajazir, and Takhzyro (Self-Administered & Health Professional Administered) – Rx Benefit & Medical Benefit
|
03/05/2026 |
|
Immune Checkpoint Inhibitor (CPI) (Health Professional Administered) - (Bavencio, Imfinzi, Imjudo, Jemperli, Keytruda, Keytruda Qlex, Libtayo, Loqtorzi, Opdivo, Optivo, Opdualag, Qvantig, Tecentriq, Tecentriq Hybreza, Tevimbra, Unloxcyt, Yervoy, and Zynyz) - Medical Benefit
|
04/13/2026 |
|
Immune Thrombocytopenia (ITP) Drug Policy (Alvaiz, Doptelet and Doptelet Sprinkle, eltrombopag tablet and powder for suspension, Nplate, Promacta, Tavalisse, Wayrilz) (Self-Administered & Health Professional Administered) – Rx Benefit & Medical Benefit
|
01/30/2026 |
|
Inborn Errors of Metabolism Policy (Rx & Medical Benefit) – (Attruby, Amvuttra, Brineura, Carbaglu and generic carglumic acid, Cerdelga, Cerezyme, Cholbam, Crysvita, Ctexli, Dojolvi, Elaprase, Elelyso, Elfabrio, Fabrazyme, Galafold, Givlaari, Harliku, Javygtor and generic sapropterin, Kanuma, Kuvan, Lamzede, Lumizyme, Mepsevii , Naglazyme, Nexviazyme, nitisinone capsule, Nityr, Nulibry, Olpruva, Onpattro, Orfadin, Oxlumo, Palynziq, Pombiliti, Ravicti , Rivfloza, Strensiq, Sucraid, Tegsedi, Vimizim, VPRIV, Vyndaqel, Vyndamax, Wainua, Xenpozyme, Xuriden, Yargesa & Zavesca)
|
06/01/2026 |
|
Infertility Medications Policy
|
10/08/2025 |
|
Inflammatory Conditions Clinical Review Prior Authorization (CRPA) Rx and Medical Drugs - (Actemra (Medical or Rx), Bimzelx, Cibinqo - abrocitinib (Rx), Cosentyx - secukinumab (Rx), Ilumya – tildrakizumab-asmn (Medical), Kevzara – sarilumab (Rx), Kineret - anakinra (Rx), Olumiant – baricitinib (Rx), Orencia - abatacept (Medical or Rx), Otezla - apremilast (Rx), Rhapsido (Rx), Rinvoq – upadacitinib (Rx), Siliq – brodalumab (Rx), Skyrizi – risankizumab-rzaa (Rx), Simponi - golimumab (Medical or Rx), Sotyktu (deucravacitinib) (Rx), Spevigo (spesolimab-sbzo) (Rx), Taltz – ixekizumab (Rx), Tremfya (Medical or Rx), Tofidence (Medical), Tyenne (Medical & Rx), Xeljanz and Xeljanz XR- tofacitinib and tofacitinib ER (Rx), Zeposia- ozanimod (Rx))
|
06/01/2026 |
|
Interleukin Antagonists for Asthma and Other Conditions - (Health Professional Administered) Medical Benefit & (Self-Administered) Rx Benefit - (Adbry, Bullous Pemphigoid, Cinqair, Dupixent, Ebglyss, Exdensur, Fasenra, Icotyde, Nemluvio, & Nucala)
|
06/04/2026 |
|
Intravenous Immune Globulin (IVIG) & Sub-Cutaneous Immune Globulin (SCIG) Therapy (Alyglo, Asceniv, Bivigam, Cutaquig, Cuvitru, Flebogamma, Gammagard Liquid, Gammagard S/D powder, Gammaked, Gammaplex, Gamunex, Gamunex-C, Hizentra, Hyqvia, Octagam, Panzyga, Privigen, Xembify) (Self-Administered) – Rx Benefit & (Health Professional Administered) - Medical Benefit
|
04/14/2026 |
|
Intravenous Iron Replacement Products Policy - Medical Benefit
|
11/19/2025 |
|
Kebilidi (eladocagene exuparvovec-tneq) (Health Professional Administered) - Medical Benefit
|
06/01/2026 |
|
Lantidra (donislecel-jujn) Drug Policy for Commercial, Essential Plan, Medicaid Managed Care & Medicare (Health Professional Administered) - Medical Benefit
|
02/12/2026 |
|
Low Clinical Impact for Rx Drugs Policy
|
06/04/2026 |
|
Lyfgenia (lovotibeglogene autotemcel) Drug Policy (Health Professional Administered) - Medical Benefit
|
01/01/2026 |
|
Medicare Part B Step Therapy Drug List
|
05/06/2026 |
|
Medicare Part D 2026 Prior Authorization Policy
|
06/01/2026 |
|
Medicare Part D 2026 Step Therapy Policy
|
06/01/2026 |
|
Medicare Part D Formulary Level Cumulative Opioid and Opioid / Buprenorphine POS Edits
|
03/11/2025 |
|
Monoclonal Antibodies for the Treatment of Hemophilia – (Health Professional Administered) Medical Benefit & (Self-Administered) Rx Benefit - (Alhemo, Hemlibra, Hympavzi, Qfitlia)
|
04/17/2026 |
|
Non-Formulary Medication Exception Review Policy
|
06/01/2026 |
|
Off-Label Use of FDA Approved Drugs
|
06/01/2026 |
|
Ohtuvayre (ensifentrine) Policy for Commercial, Exchange, & SafetyNet - Rx Benefit; Medicare Advantage & DSNP - Medical Benefit
|
02/12/2026 |
|
Omisirge (omidubicel-onlv) (Health Professional Administered) - Medical Benefit
|
02/19/2026 |
|
Oncology Biosimilar Drug Policy - (Avastin (bevacizumab) and Alymsys (bevacizumab-maly), Herceptin (trastuzumab), Herceptin Hylecta (trastuzumab and hyaluronidase-oysk), Hercessi (trastuzumab-strf), Jobevne (bevacizumab-mwgd) Ogivri (trastuzumab-dkst), Ontruzant (trastuzumab-dttb), and Herzuma (trastuzumab-pkrb), Rituxan (rituximab), Rituxan Hycela (rituximab hyaluronidase), Riabni (rituximab-arrx) and Vegzelma (bevacizumab-adcd)) – Medical Benefit
|
02/12/2026 |
|
Oncology Clinical Review Prior Authorization (CRPA) Medical Drug Policy (Abraxane, Adcetris, Adstiladrin, Amtagvi, Anktiva, Arzerra, Asparlas, Aukelso, Avgemsi, Axtle, Beizray, Beleodaq, Belrapzo, Bendamustine HCL, Bendeka, Besponsa, Bilprevda, Bispecific T-Cell Engagers (BiTE), Bizengri, Blenrep, Blincyto, Bomyntra, Boruzu, Camcevi, Cinvanti, Colimvi, Cyramza, Danyelza, Darzalex, Darzalex Faspro, Datroway, Docivyx, Elahere, Elitek, Elrexfio, Elzonris, Empliciti, Emrelis, Enhertu, Epkinly, Erwinaze, Focinvez, Folotyn, Fosaprepitant, Fyarro, Gazyva, Hepzato Kit, Imdelltra, Infugem, Inlexzo, Istodax, Ivra, Jelmyto, Kadcyla, Kimmtrak, Kyprolis, Kyxata, Lartruvo, Leuprolide Acetate Depot, Lumoxiti, Lunsumio, Lutrate Depot, Lymphir, Lynozyfic, Margenza, Monjuvi, Mylotarg, Niktimvo, Oncaspar, Onivyde, Osenvelt, Paclitaxel protein-bound particles, Padcev, Pedmark, Pemfexy, Pemrydi, Phesgo, Polivy, Portrazza, Posfrea, Poteligeo, Pralatrexate, Provenge, Romidepsin, Rybrevant, Rybrevant Faspro, Rylaze, Rytelo, Sarclisa, Talvey, Tecelra, Tecvayli, Temsirolimus, Tepylute, Tivdak, Torisel, Treanda, Trodelvy, Vectibix, Vivimusta, Vyloy, Vyxeos, Wyost, Xgeva, Xtrenbo, Yondelis, Zaltrap, Zepzelca, Ziihera, Zusduri, & Zynlonta) (Health Professional Administered) - Medical Benefit
|
05/06/2026 |
|
Oncology Clinical Review Prior Authorization (CRPA) Rx Drug (Abiraterone 500 mg tablet, Afinitor, Afinitor Disperz, Akeega, Alecensa, Alunbrig, Augtyro, Avmapki Fakzynja co-pack, Ayvakit, Balversa, Besremi, (both Rx and Medical benefit drug), Bexarotene Capsules, Bosulif, Braftovi, Brukinsa, Cabometyx, Calquence, Caprelsa, Cometriq, Copiktra, Cotellic, Danziten, Dasatinib, Daurismo, Ensacove, Erivedge, Erleada, Erlotinib, Everolimus tablets or suspension), Fotivda, Fruzaqla, Gavreto, Gefitinib, Gilotrif, Gomekli, Hemady, Hernexeos, Ibrance, Ibtrozi, Iclusig, Idhifa, Imbruvica (tablets or suspension), Imkeldi suspension, Inqovi, Inluriyo, Inlyta, Inrebic, Iressa, Itovebi, Iwilfin, Jakafi, Jaypirca, Kisqali, Komzifti, Koselugo, Krazati, Lapatinib, Lazcluze, Lenvima, Lifyorli, Lonsurf, Lorbrena, Lumakras, Lynparza tablets, Lytgobi, Mekinist, Mektovi, Mercaptopurine oral suspension, Modeyso, Nerlynx, Nexavar, Nilotinib, Nilotinib d-tartrate, Ninlaro, Nubeqa, Odomzo, Ogsiveo, Ojemda, Ojjaara, Onureg, Orgovyx, Orserdu, Pazopanib, Pemazyre, Phyrago, Piqray, Pomalidomide, Pomalyst, Purixan, Qinlock, Retevmo, Revuforj, Rezlidhia Rezurock, Romvimza, Rozlytrek, Rubraca, Rydapt, Scemblix, Soltamox, Sorafenib, Sprycel, Stivarga, Sutent, Tabrecta, Tafinlar, Tagrisso, Talzenna, Tarceva, Targretin capsules, Targretin gel, Tasigna, Tazverik, Tepmetko, Tibsovo, Torpenz, Truqap, Tukysa, Turalio, Tykerb, Valchlor, Vanflyta, Venclexta, Verzenio, Vitrakvi, Vizimpro, Vonjo, Voranigo, Votrient, Welireg, Xalkori, Xermelo, Xospata, Xpovio Xtandi, Yonsa, Zejula, Zelboraf, Zolinza, Zydelig, Zykadia, Zytiga) (Self-Administration) - Rx Benefit
|
05/22/2026 |
|
Ophthalmic Vascular Endothelial Growth Factor (VEGF) Inhibitors (Beovu, Byooviz, Cimerli, Eylea, Eylea HD, Lucentis, Pavblu, Susvimo, Vabysmo) (Health Professional Administered) – Medical Benefit
|
04/15/2026 |
|
Opioid Management Health and Safety Program - (Concurrent use of Opioid/Buprenorphine Products, Extended-release (long-acting) opioids, Morphine Milligram Equivalents (MME), Levorphanol, Opioid-naïve ADULT 7-day supply for first FOUR fills limit, Opioid-naïve PEDIATRIC 3-day supply for first FOUR fills limit, Opioid Cough & Cold medicines, Opioids drugs requiring Step Therapy, Prolate Solution & Generic oxycodone-APAP 100-300mg/5ml, Prolate tablets, Nalocet, & generic oxycodone-APAP 5mg/300mg and oxycodone-APAP 10mg/300mg & oxycodone-APAP 2.5mg/300mg, and Roxybond
|
02/19/2026 |
|
Osteoporosis Drug Policy – (Bildyos, Bonsity, Bosaya, calcitonin salmon injection, Conexxence, Evenity®, Forteo®, Jubbonti, Miacalcin injection®, Ospomyv, Prolia®, Stoboclo (denosumab-bmwo), Teriparatide, Tymlos®) Rx Benefit (Self-Administered) & Medical Benefit (Health Professional Administered)
|
03/19/2026 |
|
Palforzia® (peanut [Arachis hypogaea] allergen powder-dnfp)
|
05/08/2025 |
|
Papzimeos™ (zopapogene imadenovec-drba) Drug Policy
|
01/16/2026 |
|
Parkinson’s Disease Drug Policy – (Self Administration) - Rx Benefit OR (Health Professional Administered) - Medical Benefit - (Apokyn & apomorphine hydrochloride injection (Rx), Gocovri - amantadine ER capsules (Rx), Inbrija - levodopa inhalation (Rx), Mirapex ER and pramipexole ER (Rx), Neupro - rotigotine patch (Rx), Nourianz - istradefylline tablets (Rx), Nuplazid - pimavanserin tablets & capsules (Rx), Onapgo (apomorphine) (Rx & Medical), Osmolex - amantadine ER tablet (Rx), Rytary and Crexont - carbidopa/levodopa ER capsule (Rx), Vyalev (foscarbidopa/foslevodopa injection) (Rx & Medical), Xadago (safinamide mesylate), Zelapar ODT - Selegiline Hydrochloride (L-Deprenyl) tablet (Rx)
|
02/12/2026 |
|
Patient Protection and Affordable Care Act (PPACA) - Preventive Items and Services
|
02/12/2026 |
|
Pulmonary Hypertension (PH) Drug Policy - Adcirca (tadalafil (including Alyq)(Rx)), Adempas (riociguat (Rx)), epoprostenol (Medical)), Flolan, Letairis (ambrisentan (Rx)), Liqrev, Opsumit (macitentan (Rx)), Opsynvi (macitentan & tadalafil (Rx)), Orenitram (treprostinil (Rx)), Remodulin (treprostinil (Medical)), Revatio (sildenafil (Rx)), Tadliq (Rx)), Tracleer (bosentan (Rx)), Tyvaso (treprostinil) inhalation (Rx), Tyvaso DPI (Rx)), Uptravi (selexipag) Rx)), Veletri (Medical), Ventavis (iloprost) inhalation (Medical)), Winrevair (sotatercept) (Rx & Medical)), & Combination Therapy (Ambrisentan and tadalafil)
|
03/05/2026 |
|
Qalsody (tofersen) Drug Policy (Health Professional Administered) - Medical Benefit
|
02/12/2026 |
|
Quantity Limit
|
11/13/2025 |
|
Rare Diseases CRPA Policy (Actimmune (Medical & Rx), Adzynma (Medical), Aldurazyme (Medical), Aqvesme (Rx), Arcalyst (Rx), Bkemv (Medical), Bylvay (Rx), Camzyos (Rx), Crenessity (Rx), Cuprimine and generic penicillamine capsules (Rx), Cuvrior (Rx), Daybue (Rx), Empaveli (Rx), Enjaymo (Medical), Enspryng (Rx or Medical), Epysqli (Medical), Evkeeza (Medical), Fabhalta (Rx), Filspari (Rx), Firdapse (Rx), Galzin (Rx), Gamifant (Medical), Hyftor 0.2% gel (Rx), Ilaris (Medical), Imcivree (Rx), Increlex (Rx), Isturisa (Rx), Joenja (Rx), Juxtapid (Rx), Keveyis (Rx), Korlym (Rx), Livmarli (Rx), Luxturna (Medical), Myalept (Rx), Mycapssa (Rx), Ormalvi (Rx), Piasky (Medical), Procysbi (Rx), Pyrukynd (Rx), Reblozyl (Medical), Recombinant (Rx), Recorlev (Rx), Redemplo (Rx), Rethymic (Medical), Revcovi - (Medical & Rx), rh-IGF-1 (Rx), Ryplazim (Medical & Rx), Rystiggo (Medical), Sandostatin LAR and octreotide intramuscular injection (Rx & Medical), Scenesse (Medical), Signifor LAR (Medical), Signifor SC (Rx), Skyclarys (Rx), Skysona (Medical), Sohonos (Rx), Soliris 2mg & 10mg (Medical), Somavert (Rx), Sylvant (Medical), Syprine, generic trientine capsules (Rx), Tarpeyo (Rx), Tavneos (Rx), Tepezza (Medical), Thiola, Thiola EC, and generic tiopronin (Rx), Tryngolza (Rx), Tzield (Medical), Ultomiris (Medical), Uplizna (Medical), Vanrafia, (Rx), Venxxiva (Rx), Veopoz (Medical), Vijoice (Rx), Voxzogo (Rx), Voydeya (Rx), Vyjuvek (Medica & Rxl), Vyvgart (Medical), Vyvgart Hytrulo (Medical), Xolremdi (Rx), Yorvipath (Rx), Zevaskyn (Medical), Zilbrysq (Rx), Zokinvy (Rx), Ztalmy (Rx), Zynteglo (Rx)) (Health Professional Administered) - Medical Benefit OR (Self-Administered) - Rx Benefit
|
05/07/2026 |
|
Remicade® (infliximab), Infliximab, Renflexis® (infliximab-abda), Avsola® (infliximab-axxq), Inflectra® (infliximab-dyyb) - (Health Professional Administered) - Medical Benefit
|
02/12/2026 |
|
Repository Corticotropin Injection (Medical & Rx Benefit) (Acthar HP and Purified Cortrophin gel) - for Infantile Spasms, Multiple Sclerosis Exacerbations
|
02/12/2026 |
|
Respiratory Syncytial Virus (RSV) Prophylaxis Drug Policy (Health Professional Administered) - Medical Benefit
|
11/19/2025 |
|
Rezdiffra (resmetirom) Drug Policy (Self Administration) - Rx Benefit
|
01/01/2026 |
|
Ryoncil (remestemcel-l-rknd) Drug Policy - (Health Professional Administered) - Medical Benefit
|
11/19/2025 |
|
Sickle Cell Disease Management - Adakveo (crizanlizumab-tmca (Medical)), Endari (L-glutamine oral powder (Rx)), Oxbryta (voxelotor (Rx) for 300 mg Tablets, 500mg Tablets and 300mg Tablets for Oral Suspension, Siklos (hydroxyurea tablets (Rx), Xromi (Rx))
|
03/05/2026 |
|
Site of Care Redirection for Medical Specialty Drug Administration Policy
|
04/01/2026 |
|
Spinal Muscular Atrophy (SMA) - Medical Benefit (Evrysdi (risdiplam), Spinraza (nusinersen), Zolgensma (onasemnogene abeparovec-xioi))
|
06/01/2026 |
|
Spravato® (esketamine) Nasal Spray Drug Policy
|
05/29/2026 |
|
Step Therapy Drug Policy
|
06/04/2026 |
|
Systemic Lupus Erythematosus (SLE) and Lupus Nephritis (LN): Benlysta IV (benlimumab), Gazyva (obintuzumab), Lupkynis (voclosporin), and Saphnelo (anifrolumab-fnia) Drug Policy
|
05/22/2026 |
|
Testosterone Drug Policy (Testopel, Aveed, & Azmiro) (Health Professional Administered) - Medical Benefit
|
01/21/2026 |
|
Tezspire™ (tezepelumab-ekko subcutaneous injection)
|
02/12/2026 |
|
Ustekinumab Drug Policy (Imuldosa [ustekinumab-srlf], Otulfi [ustekinumab-aauz], Pyzchiva [ustekinumab-ttwe], Pyzchiva [ustekinumab-ttwe][Cordavis]], (Selarsdi [ustekinumab-aekn], Stelara [ustekinumab], Steqeyma [ustekinumab-stba], ustekinumab [Janssen Biotech], ustekinumab-aekn, ustekinumab-ttwe [Quallent], Wezlana [ustekinumab-auub][Optum-Nuvalia]], Yesintek [ustekinumab-kfce]) (Self-Administered & Health Professional Administered) – Rx Benefit & Medical Benefit
|
06/01/2026 |
|
Viscosupplementation with Hyaluronic Acid (Durolane, Euflexxa, Gel-One, Gelsyn-3, Genvisc 850, Hyalgan, Hymovis, Hymovis One, Monovisc, Orthovisc, Supartz, Synojoynt, Synvisc One, Triluron, TriVisc, Visco-3) (Health Professional Administered) – Medical Benefit
|
12/17/2025 |
|
Weight Related Comorbidities for Overweight, Obesity, Noncirrhotic Metabolic Dysfunction - Associated Steatohepatitis (MASH) & Cardiovascular Disease (Contrave, Foundayo, Liraglutide, Orlistat, Qsymia, phentermine-topiramate ER, Saxenda, Wegovy, Xenical, & Zepbound) (Self-Administration) - Rx Benefit (New Start and Recertification)
|
06/01/2026 |
|
Xiaflex - Medical Benefit (collagenase clostridium histolyticum) Policy
|
01/15/2026 |
|
Xolair (omalizumab) Drug Policy
|
11/19/2025 |
