UM Program Name | Program Type | Formulary | Update for Provider Letter |
Acute Migraine Agents | PAQL | Commercial, HIM, NetResults | *Clinical criteria and quantity limit criteria update |
Alternative Dosage Form | PAQL | NetResults | *New target agent: Atmeksi |
ATTR Amyloidosis | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Biologic Immunomodulators | PAQL | Commercial, HIM, NetResults | *New target agent, Icotyde
*Clinical criteria update |
Cablivi | QL | Commercial, HIM, NetResults | *No changes on annual review |
Calcitonin Gene-Related Peptide (CGRP) | PAQL | Commercial, HIM, NetResults | *No changes on annual review |
Cannabidiol | PA(QL) | Commercial, HIM, NetResults | *Clinical criteria update and addition of quantity limit and quantity limit criteria |
Cardiac Myosin Inhibitors (previously Camzyos) | PAQL | Commercial, HIM, NetResults | *Program name change from "Camzyos" to "Cardiac Myosin Inhibitors"
*New target agent: Myqorzo
*Clinical criteria update |
Cibinqo | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Constipation Agents | PAQL | NetResults | *Clinical criteria update |
Continuous Glucose Monitor | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Coverage Exception | other | NetResults, HIM | *Removed Litfulo, Leqselvi, and Olumiant for Alopecia Areata as exclusions |
Erectile Dysfunction - PDE 5 Inhibitors | QL | NetResults | *Program name change |
Familial Chylomicronemia Syndrome (FCS) | PAQL | Commercial, HIM, NetResults | *Addition of Redemplo to PAQL program and clinical criteria update |
Fintepla | PAQL | NetResults | *Clinical criteria update |
Gabapentin ER | STQL | ST: Commercial, HIM
QL: Commercial, HIM, NetResults | *No changes on annual review |
Galafold | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Glucose Test Strips and Meters | PAQL | PA: commercial
QL: Commercial, HIM, NetResults | *No changes on annual review |
Growth Hormone | PA | Commercial, HIM, NetResults | *Clinical criteria update |
Harliku | PAQL | NetResults | *Clinical criteria update |
HSDD | PAQL | NetResults | *Clinical criteria update |
IL-1 Inhibitors | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
IL-4 Inhibitor | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Imcivree | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Insomnia Agents | ST/QL | ST: Commercial, HIM
QL: Commercial, HIM, NetResults | *No changes on annual review |
Joenja | PAQL | NetResults | *Clinical criteria update |
Jynarque | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Leucovorin | PAQL | NetResults | *No changes on annual review |
Low Molecular Weight Heparins (LMWH) and Arixtra | QL | Commercial, HIM, NetResults | *Program being retired |
Lupus | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Lyrica and Savella | ST/QL | ST: Commercial and HIM
QL: Commercial, HIM, NetResults | *No changes on annual review |
Medical Indications for Contraceptives | PA | Commercial, NetResults | *No changes on annual review |
Northera | PAQL | Commercial, HIM, NetResults | *Program being retired |
Otezla | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Oxybate | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Pancreatic Enzymes | PA | Commercial, HIM | *No changes on annual review |
PCSK9 Inhibitors | PAQL | Commercial, HIM, NetResults | *No changes on annual review |
Pulmonary Arterial Hypertension | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Pyrukynd | PAQL | Commercial, HIM, NetResults | *No changes on annual review |
Radicava | PAQL | Commercial, HIM, NetResults | *No changes on annual review |
SA Oncology | PAQL | Commercial, HIM, NetResults | *New target agent: Lifyorli
*clinical criteria update |
Samsca | QL | Commercial, HIM, NetResults | *Clinical criteria update |
Skyclarys | PAQL | NetResults | *No changes on annual review |
Spevigo | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Subcutaneous Furosemide | PAQL | Commercial, HIM, NetResults | *Program name change from "Furoscix" to "Subcutaneous Furosemide"
*new target agent: Lasix Onyu
*clinical criteria update |
Substrate Reduction Therapy | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Sunosi | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Tezspire | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Thrombopoietin Receptor Agonists, Tavalisse, and Wayrilz | PAQL | Commercial, HIM, NetResults | *Clinical criteria update |
Triptans | STQL | Commercial, HIM, NetResults | *Clinical criteria update |
Vijoice | PAQL | NetResults | *Clinical criteria update |
Weight Loss Agents | PAQL | Commercial, HIM, NetResults | *Removed target agents: benzphetamine, phendimetrazine, diethylpropion |
Weight Management | PAQL | Commercial, HIM, NetResults | *New target agent: Foundayo |
Zokinvy | PAQL | Commercial, HIM, NetResults | *No changes on annual review |
