Drug Plan Policy

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Medical Policies

Providing healthcare professionals and administrators with access to our comprehensive Medical Drug Policies. These policies outline the guidelines and criteria for coverage.

Acthar Gel

Effective Date: 4/1/2025


Last review date: 6/17/2024

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Acute Hepatic Porphyria (AHP)

Effective Date: 4/1/2025


Last review date: 6/17/2024

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Bevacizumabs

Effective Date: 4/1/2025


Last review date: 6/18/2024

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Botulinum Toxins

Effective Date: 4/1/2025


Last review date: 6/19/2024

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Casgevy

Effective Date: 4/1/2025


Last review date: 8/23/2024

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Colony Stimulating Factors

Effective Date: 4/1/2025


Last review date: 6/17/2024

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Elevidys

Effective Date: 4/1/2025


Last review date: 6/20/2024

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Erythropoesis Stimulating Agents (ESA)

Effective Date: 4/1/2025


Last review date: 6/14/2024

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Fabry Disease

Effective Date: 4/1/2025


Last review date: 6/13/2024

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Gaucher's Disease Type 1

Effective Date: 4/1/2025


Last review date: 6/13/2024

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Gonadotropin Releasing Hormones (GnRH) Analogs

Effective Date: 4/1/2025


Last review date: 3/24/2025

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Hereditary transthyretin amyloidosis (hATTR)

Effective Date: 4/1/2025


Last review date: 3/24/2025

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Hemgenix

Effective Date: 4/1/2025


Last review date: 5/20/2024

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Hemophilia

Effective Date: 4/1/2025


Last review date: 6/18/2024

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Hyaluronic Acid Derivatives (HAD)

Effective Date: 4/1/2025


Last review date: 6/13/2024

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Immune Globulins

Effective Date: 4/1/2025


Last review date: 1/13/2025

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Inflammatory Conditions

Effective Date: 4/1/2025


Last review date: 3/24/2025

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Infliximabs

Effective Date: 4/1/2025


Last review date: 6/19/2024

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IUDs

Effective Date: 4/1/2025


Last review date: 6/13/2024

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Intravenous Iron

Effective Date: 4/1/2025


Last review date: 6/18/2024

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Lenmeldy

Effective Date: 4/1/2025


Last review date: 8/20/2024

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Lyfgenia

Effective Date: 4/1/2025


Last review date: 3/26/2024

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Multiple Sclerosis

Effective Date: 4/1/2025


Last review date: 10/1/2024

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Myasthenia Gravis

Effective Date: 4/1/2025


Last review date: 1/13/2025

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Phesgo

Effective Date: 4/1/2025


Last review date: 6/18/2024

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Primary Hyperoxalruia Type 1 (PH1)

Effective Date: 4/1/2025


Last review date: 6/20/2024

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Prostacyclin Analogs

Effective Date: 4/1/2025


Last review date: 6/17/2024

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Rituximabs

Effective Date: 4/1/2025


Last review date: 1/1/25

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Roctavian

Effective Date: 4/1/2025


Last review date: 3/25/2024

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Somatostatin

Effective Date: 4/1/2025


Last review date: 6/20/2024

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Specialty Asthma

Effective Date: 4/1/2025


Last review date: 6/20/2024

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Spinal Muscular Atrophy

Effective Date: 4/1/2025


Last review date: 6/15/2024

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Substance Use Disorder

Effective Date: 4/1/2025


Last review date: 1/13/2025

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Traztuzumabs

Effective Date: 4/1/2025


Last review date: 6/20/2024

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VEGF Inhibitors

Effective Date: 4/1/2025


Last review date: 1/1/2025

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Vyjuvek

Effective Date: 4/1/2025


Last review date: 6/17/2024

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Ycanth

Effective Date: 4/1/2025


Last review date: 6/13/2024

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Zynteglo

Effective Date: 4/1/2025


Last review date: 3/23/2024

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