The following medical drug policies are new and require precertification:
The following medical drug policies are new:
The following medical drug policies were revised:
- Ado-trastuzumab emtansine (Kadcyla)
- Agalsidase beta (Fabrazyme)
- Alemtuzumab (Lemtrada)
- Burosumab (Crysvita)
- Carfilzomib (Kyprolis)
- Contraceptive Management
- Eculizumab (Soliris) and Ravulizumab (Ultomiris)
- Eribulin Mesylate (Halaven)
- Esketamine (Spravato)
- Golimumab (Simponi Aria)
- Inebilizumab-cdon (Uplizna)
- Inotuzumab ozogamicin (Besponsa)
- Ipilimumab (Yervoy)
- Irinotecan Liposomal (Onivyde)
- Ixabepilone (Ixempra)
- Monoclonal Antibodies for the Treatment of Eosinophilic Conditions
- Natalizumab (Tysabri)
- Ocrelizumab (Ocrevus)
- Omacetaxine mepesuccinate (Synribo)
- Plerixafor (Mozobil)
- Viltolarsen (Viltepso)
The following medical drug policies were reviewed with no clinical content change:
- Abatacept (Orencia)
- Alpha1-Proteinase Inhibitors
- Cerliponase Alfa (Brineura)
- Crizanlizumab-tmca (Adakveo)
- Elotuzumab (Empliciti)
- Exondys 51 (eteplirsen)
- Infliximab
- Omalizumab (Xolair)
- Pharmacologic Treatment of Pulmonary Arterial Hypertension
- Siltuximab (Sylvant)
- Treatment of Hereditary Amyloidosis
- Ustekinumab (Stelara) IV
- Vyondys 53 (Golodirsen)
The following new Utilization Management program is effective on the pharmacy benefit effective January 1, 2021:
- Hyperpolarization-Activated Cyclic Nucleotide-Gated (HCN) Channel Blocker (Corlanor)