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Policies & Guidelines

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See policy for list of drugs

Vykat XR

print Print Back Back Policy Number: MP-91085

print Print Back Back Policy Number: MP-91128

print Print Back Back Policy Number: MP-991091

Mandatory Drug Wastage Program

Actemra; Tofidence; Tyenne; Avtozma; Tocilizumab-anoh; Tocilizumab-aazg

H.P. Acthar, Cortrophin

Aldurazyme

Aloxi, Posfrea

Benlysta IV

Berinert

Eylea, Eylea HD, Opuviz, Yesafili, Ahzantive, Enzeevu, Pavblu

Cerezyme

Cimzia

Elaprase

print Print Back Back Hemophilia Products - Factor VIII Prior Authorization Program Summary Policy Number:...

Emend; Fosaprepitant ; Focinvez 

Fabrazyme

Aralast NP; Glassia; Prolastin-C; Zemaira®