The following medical drug policies are new:

Levoleucovorin (Fusilev or Khapzory)
Plerixafor (Mozobil)
Trabectedin (Yondelis)

The following medical drug policies were revised:

Alemtuzumab (Lemtrada™)
Belatacept (Nulojix)
Carfilzomib (Kyprolis)
Continuous Glucose Monitors (CGMS)
Copanlisib (Aliqopa)
Daratumumab (Darzalex)
Edaravone (Radicava)
Elotuzumab (Empliciti)
Exondys 51 (eteplirsen)
Galsulfase (Naglazyme)
Infliximab
Inotuzumab Ozogamicin (Besponsa)
Intra-Articular Hyaluronan Injections for Osteoarthritis of the Knee
Laronidase (Aldurazyme)
Natalizumab (Tysabri®)
Ocrelizumab (Ocrevus)
Omacetaxine mepesuccinate (Synribo)
Pegloticase (Krystexxa))
Pertuzumab (Perjeta)
Programmed Death Receptor (PD-1) / Programmed Death-Ligand (PD-L1) Blocking Antibodies
Sebelipase alfa (Kanuma)
Treatment of Gaucher Disease
Ustekinumab (Stelara®) IV
Vestronidase Alfa-vjbk (Mepsevii)

The following pharmacy utilization management programs are effective January 1, 2020:

Cablivi (caplacizumab-yhdp) – Quantity Limit Criteria Program
Sunosi (solriamfetol) – Prior Authorization with Quantity Limit Criteria Program