| UUHP Individual & Commercial |
pharm-001 |
Acne Vulgaris and Rosacea |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-002 |
Alpha-1-Proteinase-Inhibitors |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| UUHP Individual & Commercial |
pharm-003 |
Ankylosing Spondylitis Retail Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-004 |
Anthelmintics |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| UUHP Individual & Commercial |
pharm-006 |
Brand Antiemetics for Chemotherapy Induced Nausea and Vomiting |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-007 |
Antineoplastics- Retail Drugs |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-008 |
Aranesp |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-011 |
Insulins- Basal |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-012 |
Biosimilars- Retail |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-013 |
Brand Name Medications |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| UUHP Individual & Commercial |
pharm-014 |
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Agents |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-016 |
Migraine- Prevention (CGRPs) |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-017 |
Constipation Medications |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-019 |
Crohn's Disease: Retail Drugs |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-022 |
Dupixent for Asthma, Eosinophilic Esophagitis, or Prurigo Nodularis |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| UUHP Individual & Commercial |
pharm-024 |
Epidiolex |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-026 |
Gonadotropin Releasing Hormone (GnRH) Agonists and Antagonists |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-027 |
Growth Hormones - Adult |
July 01, 2026 |
June 10, 2026 |
July 10, 2027 |
| UUHP Individual & Commercial |
pharm-028 |
Growth Hormones - Child |
July 01, 2026 |
June 10, 2026 |
July 10, 2027 |
| UUHP Individual & Commercial |
pharm-030 |
Hepatitis C Direct Acting Antivirals |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-031 |
Hereditary Angioedema |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-032 |
Hidradenitis Suppurativa: Retail Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-033 |
Hyperkalemia |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-034 |
Irritable Bowel Syndrome with Diarrhea (IBS-D) |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| UUHP Individual & Commercial |
pharm-036 |
Increlex |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| UUHP Individual & Commercial |
pharm-039 |
Interstitial Cystitis |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-041 |
Juvenile Idiopathic Arthritis: Retail Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-043 |
Long Acting Tacrolimus |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| UUHP Individual & Commercial |
pharm-044 |
Multiple Sclerosis Agents |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-045 |
Pulmozyme |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-047 |
Neupro |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-049 |
Off Label Use |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| UUHP Individual & Commercial |
pharm-051 |
Opioids-Chronic use |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| UUHP Individual & Commercial |
pharm-052 |
Opioids-Acute Use |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-054 |
Osteoporosis- Anabolic Agents |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| UUHP Individual & Commercial |
pharm-056 |
Pharmacy Prior Authorization and Medical Necessity Policy |
March 08, 2024 |
March 05, 2024 |
March 05, 2025 |
| UUHP Individual & Commercial |
pharm-057 |
Phosphodiesterase Type 5 (PDE-5) Inhibitor |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-058 |
Phenylbutyrates |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| UUHP Individual & Commercial |
pharm-059 |
Phenylketonuria (PKU) |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| UUHP Individual & Commercial |
pharm-060 |
Promacta |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-061 |
Psoriasis: Retail Drugs |
November 01, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-062 |
Psoriatic Arthritis: Retail Drugs |
November 01, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-063 |
Pulmonary Arterial Hypertension |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-065 |
Rheumatoid Arthritis: Retail Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-066 |
Sandostation LAR |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-069 |
Spravato |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-070 |
Methotrexate- Subcutaneous |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-073 |
Synagis |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| UUHP Individual & Commercial |
pharm-074 |
Topiramate ER Sprinkle Capsules |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-075 |
Ulcerative Colitis: Retail Drugs |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-078 |
Xifaxan |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-079 |
Xolair |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-080 |
Pancreatic Enzymes |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-081 |
Benlysta |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| UUHP Individual & Commercial |
pharm-082 |
Iron Chelation Therapy |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| UUHP Individual & Commercial |
pharm-083 |
Nuedexta |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-086 |
XHANCE |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-087 |
Yupelri |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-088 |
Migraines- Acute Abortive Agents |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-089 |
Parkinson's Agents |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-091 |
Nintedanib |
July 01, 2026 |
June 10, 2026 |
July 10, 2027 |
| UUHP Individual & Commercial |
pharm-094 |
Cablivi |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-099 |
Nexletol and Nexlizet |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-100 |
Prevymis |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-101 |
Humira for Uveitis |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-103 |
Pharmacy Continuity of Care |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| UUHP Individual & Commercial |
pharm-104 |
Cystadrops and Cystaran for Ocular Cystinosis |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-107 |
Sunosi |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-108 |
Continuous Glucose Monitor (CGM) Retail Pharmacy |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-109 |
Signifor |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-110 |
Hemophilia and Blood Products |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-111 |
Descovy |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-112 |
Dojolvi |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-115 |
Step Therapy |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-117 |
Evrysdi |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-118 |
Lupkynis |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-127 |
Livtencity |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| UUHP Individual & Commercial |
pharm-128 |
Oxervate |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| UUHP Individual & Commercial |
pharm-130 |
Leqvio |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-131 |
Rezurock |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-135 |
Atopic Dermatitis: Biologics/JAK Inhibitors- Commercial & Individual |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-142 |
Non-Radiographic Axial Spondyloarthritis (nrx-SpA) |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-144 |
Nucala |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-146 |
Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| UUHP Individual & Commercial |
pharm-147 |
Zoryve |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-148 |
Mounjaro and GLP-1’s for Type 2 Diabetes Mellitus |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| UUHP Individual & Commercial |
pharm-149 |
Heavily Treated HIV |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-150 |
Hormone Therapy for Gender Dysphoria |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| UUHP Individual & Commercial |
pharm-152 |
Radicava |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| UUHP Individual & Commercial |
pharm-153 |
Posaconazole |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| UUHP Individual & Commercial |
pharm-154 |
Beyfortus |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| UUHP Individual & Commercial |
pharm-158 |
Zurzuvae |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| UUHP Individual & Commercial |
pharm-160 |
Prurigo Nodularis |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| UUHP Individual & Commercial |
pharm-161 |
L-glutamine |
July 01, 2026 |
June 10, 2026 |
July 10, 2027 |
| UUHP Individual & Commercial |
pharm-162 |
Branded Topicals for Atopic Dermatitis |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-163 |
Eosinophilic Granulomatosis with Polyangiitis (EPGA) |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-164 |
Chronic Spontaneous Urticaria |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-165 |
Giant Cell Arteritis |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| UUHP Individual & Commercial |
pharm-166 |
Immunomodulators For COPD |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| UUHP Individual & Commercial |
pharm-167 |
IgA Nephropathy Agents |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-168 |
Branded Oral Antipsychotics |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-169 |
Otezla for Behcet’s Disease |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-170 |
Opzelura for Vitiligo |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| UUHP Individual & Commercial |
pharm-193 |
VASOMOTOR AGENTS |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| UUHP Individual & Commercial |
pharm-194 |
Biologics for Asthma |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-195 |
HIV Injectables for PrEP |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-030 |
Hepatitis C |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-108 |
CGMs |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-171 |
Airsupra |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-172 |
Antiretovirals |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-173 |
Asthma & COPD |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-174 |
Cabenuva |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-175 |
Enbrel |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-176 |
GLP-1 Angonists |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-177 |
Humira and Biosimilars |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-178 |
Insulins |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-179 |
Monoclonal Antibodies for Atopic Dermatitis |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-180 |
Atopic Dermatitis (Non-Steroidal) |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-181 |
Non-Preferred Immunomodulators |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-182 |
Omnipod |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-183 |
Opzelura |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-184 |
Otezla |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-185 |
Pyzchiva and Biosimilars |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-186 |
Rinvoq, Rinvoq LQ |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-187 |
Rukobia |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-188 |
Sunleca |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-189 |
Taltz |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-190 |
Tyenne and Biosimilars |
April 01, 2026 |
January 30, 2026 |
January 30, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-191 |
Yeztugo |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Healthy U CHIP, Health Choice Utah |
pharm-hyb-192 |
Xeljanz, Xeljanz XR, Xeljanz solution |
July 01, 2026 |
June 12, 2026 |
June 12, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-115 |
Step Therapy |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m018 |
Ankylosing Spondylitis- Medical Infused Drugs |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m019 |
Crohn’s Disease- Medical Infused Drugs |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m020 |
Hidradenitis Suppurativa- Medical Infused Drugs |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m021 |
Juvenile Idiopathic Arthritis - Medical Infused Drugs |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m022 |
Psoriasis- Medical Infused Drugs |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m023 |
Psoriatic Arthritis- Medical Infused Drugs |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m024 |
Rheumatoid Arthritis-Medical Infused Drugs |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m025 |
Rheumatoid Arthritis-Medical Infused Drugs |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m041 |
Non-radiographic Axial Spondyloarthritis- Medical Infused Drugs |
January 01, 2026 |
January 01, 2026 |
January 01, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-022 |
Dupixent for Asthma, Eosinophilic Esophagitis, or Prurigo Nodularis |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-067 |
Savella |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m081 |
Benlysta |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-127 |
Livtencity |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-152 |
Radicava |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-153 |
Posaconazole - Healthy U |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-160 |
Prurigo Nodularis |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-001 |
Acne Vulgaris and Rosacea |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-002 |
Alpha-1-Proteinase-Inhibitors |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-004 |
Anthelmintics |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-006 |
Antiemetics for Chemotherapy Induced Nausea and Vomiting |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-007 |
Antineoplastics- Retail |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-008 |
Aranesp |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-012 |
Biosimilars- Retail |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-013 |
Brand Name Medications |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-014 |
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Agents |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-016 |
Migraine- Prevention (CGRPs) |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-017 |
Constipation Medications |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-022 |
Dupixent for Asthma, Eosinophilic Esophagitis, or Prurigo Nodularis |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-026 |
Gonadotropin Releasing Hormone Agonists and Antagonists – Healthy U |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-027 |
Growth Hormones: Adult |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-028 |
Growth Hormone - Child |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-031 |
Hereditary Angioedema |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-033 |
Hyperkalemia- Healthy U |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-034 |
Irritable Bowel Syndrome with Diarrhea (IBS-D) |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-036 |
Increlex |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-039 |
Interstitial Cystitis |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-044 |
Multiple Sclerosis Agents |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-045 |
Pulmozyme |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-047 |
Neupro |
June 01, 2023 |
May 17, 2023 |
May 17, 2024 |
| Healthy U, Health Choice Utah |
pharm-mm-049 |
Off Label Use |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-051 |
Opioids-Chronic Use |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-052 |
Opioids-Acute Use |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-054 |
Osteoporosis – Anabolic Agents |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-056 |
Pharmacy Prior Authorization and Medical Necessity Policy |
March 08, 2024 |
March 05, 2024 |
March 05, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-058 |
Phenylbutyrates |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-059 |
Phenylketonuria (PKU) |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-060 |
Promacta |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-063 |
Pulmonary Hypertension (PH) Medications |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-066 |
Sandostatin LAR |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-070 |
Methotrexate- Subcutaneous |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-073 |
Synagis |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-077 |
VMAT - 2 Inhibitors |
June 01, 2022 |
May 18, 2022 |
May 18, 2023 |
| Healthy U, Health Choice Utah |
pharm-mm-078 |
Xifaxan |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-079 |
Xolair |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-080 |
Pancreatic Enzymes |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-081 |
Benlysta |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-082 |
Iron Chelation Therapy |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-083 |
Nuedexta |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-086 |
Xhance |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-088 |
Migraines- Acute Abortive Agents |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-089 |
Parkinson's Agents |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-091 |
Nintedanib |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-094 |
Cablivi |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-099 |
Nexletol & Nexlizet |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-100 |
Prevymis |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-103 |
Pharmacy Continuity of Care |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-104 |
Cystadrops and Cystaran for Ocular Cystinosis |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-107 |
Sunosi |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-109 |
Signifor |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-112 |
Dojolvi |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-117 |
Evrysdi |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-127 |
Livtencity |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-128 |
Oxervate |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-130 |
Leqvio |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-131 |
Rezurock |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-144 |
Nucala |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-145 |
Hyftor |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-146 |
Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-147 |
Zoryve |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-150 |
Hormone Therapy for Gender Dysphoria |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-152 |
Radicava |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-153 |
Posaconazole- Healthy U |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-156 |
Opzelura For Treatment Of Nonsegmental Vitiligo |
December 01, 2023 |
November 08, 2023 |
November 08, 2024 |
| Healthy U, Health Choice Utah |
pharm-mm-160 |
Prurigo Nodularis |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-161 |
L-glutamine |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-162 |
Branded Topicals for Atopic Dermatitis |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-163 |
Eosinophilic Granulomatosis with Polyangiitis (EPGA) |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-164 |
Chronic Spontaneous Urticaria |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-166 |
Immunomodulators For COPD |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-167 |
IgA Nephropathy Agents |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-170 |
Opzelura for Vitiligo |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-194 |
Biologics for Asthma |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m002 |
Iron Therapy- Intravenous |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-M004 |
Lutathera |
July 01, 2023 |
June 28, 2023 |
June 28, 2024 |
| Healthy U, Health Choice Utah |
pharm-mm-m005 |
Ophthalmic Injections |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-M006 |
Branded Denosumab Products (Prolia, Xgeva) |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-m007 |
Spinraza |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-M008 |
Testopel |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-M010 |
Zilretta |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m011 |
Xiaflex |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m012 |
Zolgensma |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U, Health Choice Utah |
pharm-mm-m013 |
Atypical Hemolytic Uremic Syndrome |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m014 |
Brineura |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-M016 |
Tepezza |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m017 |
Antineoplastics- Medical |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-M027 |
Neuromyelitis Optica Spectrum Disorder (NMOSD) |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-M028 |
Akynzeo IV |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m029 |
Krystexxa |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m030 |
Biosimilars- Medical |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-M032 |
Vyepti |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-M035 |
Primary Hyperoxaluria Type 1 |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m036 |
Ketamine |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m037 |
Saphnelo |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m044 |
Tzield |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m045 |
NPlate |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m046 |
Myasthenia Gravis |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m047 |
Monoclonal Antibodies for Alzheimer's Disease |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U, Health Choice Utah |
pharm-mm-m048 |
Paroxysmal Nocturnal Hemoglobinuria |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-m001 |
Hyaluronic Acid |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-m002 |
Iron Therapy- Intravenous |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-m005 |
Ophthalmic Injections |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| UUHP Individual & Commercial |
pharm-m006 |
Branded Denosumab Products (Prolia, Xgeva) |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-m007 |
Spinraza |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| UUHP Individual & Commercial |
pharm-m008 |
Testopel |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| UUHP Individual & Commercial |
pharm-m010 |
Zilretta |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-m011 |
Xiaflex |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| UUHP Individual & Commercial |
pharm-m012 |
Zolgensma |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| UUHP Individual & Commercial |
pharm-m013 |
Soliris Ultomiris- Commercial & Individual |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-m014 |
Brineura |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-m016 |
Tepezza |
July 01, 2026 |
June 10, 2026 |
July 10, 2027 |
| UUHP Individual & Commercial |
pharm-m017 |
Antineoplastics - Medical Infused Drugs |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-m018 |
Ankylosing Spondylitis- Medical Infused Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-m019 |
Crohn’s Disease - Medical Infused Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-m020 |
Hidradenitis Supperativa- Medical Infused Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-m021 |
Juvenile Idiopathic Arthritis - Medical Infused Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-m022 |
Psoriasis- Medical Infused Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-m023 |
Psoriatic Arthritis- Medical Infused Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-m024 |
Rheumatoid Arthritis-Medical Infused Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-m025 |
Ulcerative Colitis - Medical Infused Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-M026 |
Place of Service for Pharmaceutical Infusions |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-m027 |
Neuromyelitis Optica Spectrum Disorder |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-m028 |
Akynzeo |
July 01, 2026 |
June 10, 2026 |
July 10, 2027 |
| UUHP Individual & Commercial |
pharm-m029 |
Krystexxa |
July 01, 2026 |
June 10, 2026 |
July 10, 2027 |
| UUHP Individual & Commercial |
pharm-M030 |
Biosimilars- Medical |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-m032 |
Vyepti |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-m035 |
Primary Hyperoxaluria Type 1 |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| UUHP Individual & Commercial |
pharm-m036 |
Ketamine |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-m037 |
Saphnelo |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-m041 |
Non-Radiographic Axial Spondyloarthritis (nrx-SpA) - Medical Infused Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| UUHP Individual & Commercial |
pharm-m045 |
Nplate |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| UUHP Individual & Commercial |
pharm-m046 |
Myasthenia Gravis |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-m048 |
Paroxysmal Nocturnal Hemoglobinuria |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| UUHP Individual & Commercial |
pharm-m049 |
Adakveo |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U CHIP |
pharm-CHIP-001 |
Acne Vulgaris And Rosacea |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-002 |
Alpha-1-Proteinase-Inhibitors |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-003 |
Ankylosing Spondylitis Retail & Medical Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-004 |
Anthelmintics |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U CHIP |
pharm-CHIP-006 |
Antiemetics For Chemotherapy Induced Nausea And Vomiting |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U CHIP |
pharm-CHIP-007 |
Antineoplastics- Retail Drugs |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-008 |
Aranesp |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-011 |
Insulins-Basal |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U CHIP |
pharm-CHIP-012 |
Biosimilars- Retail |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-013 |
Brand Name Medications |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-014 |
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Agents |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U CHIP |
pharm-CHIP-016 |
Migraine- Prevention (CGRPs) |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-017 |
Constipation Medications |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-019 |
Crohn's Disease Retail & Medical Drugs |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-022 |
Dupixent For Asthma, Eosinophilic Esophagitis, Or Prurigo Nodularis |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U CHIP |
pharm-CHIP-024 |
Epidiolex |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-026 |
Gonadotropin Releasing Hormone Agonists And Antagonists |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-027 |
Growth Hormones: Adult |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-028 |
Growth Hormones: Child |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U CHIP |
pharm-CHIP-030 |
Hepatitis C Direct Acting Antivirals |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-031 |
Hereditary Angioedema |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U CHIP |
pharm-CHIP-032 |
Hidradenitis Suppurativa Retail & Medical Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-033 |
Hyperkalemia |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-034 |
Irritable Bowel Syndrome With Diarrhea (IBS-D) |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-036 |
Increlex |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-038 |
Chronic Insomina Medications |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-039 |
Interstitial Cystitis |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U CHIP |
pharm-CHIP-041 |
Juvenile Idiopathic Arthritis Retail & Medical Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-043 |
Long Acting Tacrolimus |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U CHIP |
pharm-CHIP-044 |
Multiple Sclerosis Agents |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U CHIP |
pharm-CHIP-045 |
Pulmozyme |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U CHIP |
pharm-CHIP-047 |
Neupro |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-049 |
Off Label Policy |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-050 |
Opoid Dependance Agents |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-051 |
Opioids-Chronic Use |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-052 |
Opioids-Acute Use |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-054 |
Osteoporosis – Anabolic Agents |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-056 |
Prior Authorization And Medical Necessity Policy |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-058 |
Phenylbutyrates |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U CHIP |
pharm-CHIP-059 |
Phenylketonuria (PKU) |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U CHIP |
pharm-CHIP-060 |
Promacta |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U CHIP |
pharm-CHIP-061 |
Psoriasis Retail & Medical Drugs |
November 01, 2025 |
October 27, 2025 |
October 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-062 |
Psoriatic Arthritis - Psoriatic Arthritis Retail & Medical Drugs |
November 01, 2025 |
October 27, 2025 |
October 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-063 |
Pulmonary Hypertension (PH) Medications |
January 01, 2026 |
December 18, 2025 |
December 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-065 |
Rheumatoid Arthritis Retail & Medical Drugs |
November 27, 2025 |
October 27, 2025 |
October 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-066 |
Sandostatin LAR |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-069 |
Spravato |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U CHIP |
pharm-CHIP-070 |
Methotrexate- Subcutaneous |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-073 |
Synagis |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-074 |
Topiramate ER Sprinkle Capsules |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-075 |
Ulcerative Colitis Retail & Medical Drugs |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-078 |
Xifaxan |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U CHIP |
pharm-CHIP-079 |
Xolair |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-080 |
Pancreatic Enzymes |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-081 |
Benlysta |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U CHIP |
pharm-CHIP-082 |
Iron Chelation Therapy |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-083 |
Nuedexta |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-086 |
Xhance |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-087 |
Yupelri |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-088 |
Migraines- Acute Abortive Agents |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-089 |
Parkinson's Agents |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-091 |
Nintedanib |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U CHIP |
pharm-CHIP-094 |
Cablivi |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-099 |
Nexletol & Nexlizet |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U CHIP |
pharm-CHIP-100 |
Prevymis |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U CHIP |
pharm-CHIP-101 |
Uveitis |
January 01, 2025 |
December 24, 2024 |
December 24, 2025 |
| Healthy U CHIP |
pharm-CHIP-103 |
Pharmacy Continuity of Care |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-104 |
Cystadrops And Cystaran For Ocular Cystinosis |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-107 |
Sunosi |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-108 |
Continuous Glucose Monitor (CGM) Retail Pharmacy |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-109 |
Signifor |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| Healthy U CHIP |
pharm-CHIP-110 |
Hemophilia |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U CHIP |
pharm-CHIP-111 |
Descovy |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-112 |
Dojolvi |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-115 |
Step Therapy |
January 01, 2026 |
December 18, 2025 |
December 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-117 |
Evrysdi |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-119 |
Cabenuva & Vocabria |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-127 |
Livtencity |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U CHIP |
pharm-CHIP-128 |
Oxervate |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-130 |
Leqvio |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U CHIP |
pharm-CHIP-131 |
Rezurock |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-134 |
Apretude |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-135 |
Brand Name Atopic Dermatitis Agents |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-142 |
Non-Radiographic Axial Spondyloarthritis (Nrx-SpA) Retail & Medical Drugs |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-144 |
Nuucala |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-145 |
Hyftor |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-146 |
Nasal Polyposis |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-147 |
Zoryve |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-148 |
Mounjaro and GLP-1’s for Type 2 Diabetes Mellitus |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U CHIP |
pharm-CHIP-149 |
Heavily Treated HIV |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-150 |
Hormones Therapy for Gender Dysphoria |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-151 |
Formulary Exceptions |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-152 |
Radicava |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U CHIP |
pharm-CHIP-153 |
Posaconazole |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U CHIP |
pharm-CHIP-154 |
Monoclonal Antibodies for RSV Prevention |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U CHIP |
pharm-CHIP-156 |
Opzelura For Treatment Of Nonsegmental Vitiligo |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-158 |
Zurzuvae |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-159 |
Kevzara For Polymyalgia Rheumatica |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-160 |
Prurigo Nodularis |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |
| Healthy U CHIP |
pharm-CHIP-161 |
L-glutamine |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U CHIP |
pharm-CHIP-162 |
Branded Topicals for Atopic Dermatitis |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U CHIP |
pharm-CHIP-163 |
Eosinophilic Granulomatosis with Polyangiitis (EPGA) |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-164 |
Chronic Spontaneous Urticaria |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U CHIP |
pharm-CHIP-165 |
Giant Cell Arteritis |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U CHIP |
pharm-CHIP-166 |
Immunomodulators For COPD |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-167 |
IgA Nephropathy Agents |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-168 |
Branded Oral Antipsychotics |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-169 |
Otezla for Behcet’s Disease |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-170 |
Opzelura for Vitiligo |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-194 |
Biologics for Asthma |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U CHIP |
pharm-CHIP-M002 |
Iron Therapy- Intravenous |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-M004 |
Lutathera |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-M005 |
Ophthalmic Injections |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-M006 |
Branded Denosumab Products (Prolia, Xgeva) |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-M007 |
Spinraza |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M008 |
Testopel |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-M011 |
Xiaflex |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M012 |
Zolgensma |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M013 |
Soliris, Ultomiris |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-M014 |
Brineura |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-M016 |
Tepezza |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U CHIP |
pharm-CHIP-M017 |
Antineoplastics - Medical Infused Drugs |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-M018 |
Ankylosing Spondylitis- Medical Infused Drugs |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M019 |
Crohn’s Disease- Medical Infused Drugs |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M020 |
Hidradenitis Suppurativa- Medical Infused Drugs |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M021 |
Juvenile Idiopathic Arthritis - Medical Infused Drugs |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M022 |
Psoriasis- Medical Infused Drugs |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M023 |
Psoriatic Arthritis- Medical Infused Drugs |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M024 |
Rheumatoid Arthritis-Medical Infused Drugs |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M025 |
Ulcerative Colitis - Medical Infused Drugs |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M026 |
Place of Service for Pharmaceutical Infusions |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-M027 |
Neuromyelitis Optica Spectrum Disorder (NMOSD) |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-M028 |
Akynzeo IV |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U CHIP |
pharm-CHIP-M029 |
Krystexxa |
July 01, 2026 |
June 10, 2026 |
June 10, 2027 |
| Healthy U CHIP |
pharm-CHIP-M030 |
Biosimilars- Medical |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-M032 |
Vyepti |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-M035 |
Primary Hyperoxaluria Type 1 (PH1) |
August 01, 2025 |
July 25, 2025 |
July 25, 2026 |
| Healthy U CHIP |
pharm-CHIP-M036 |
Ketamine |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-M037 |
Saphnelo |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-M041 |
Non-radiographic Axial Spondyloarthritis- Medical Infused Drugs |
January 01, 2026 |
December 18, 2025 |
December 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M044 |
Tzield |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M045 |
NPlate |
October 01, 2025 |
September 10, 2025 |
September 10, 2026 |
| Healthy U CHIP |
pharm-CHIP-M046 |
Myasthenia Gravis |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-M047 |
Leqembi |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-M048 |
Paroxysmal Nocturnal Hemoglobinuria |
December 01, 2025 |
November 12, 2025 |
November 12, 2026 |
| Healthy U CHIP |
pharm-CHIP-M049 |
Adakveo |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-m049 |
Adakveo |
May 01, 2026 |
April 08, 2026 |
April 07, 2027 |
| Healthy U, Health Choice Utah |
pharm-mm-193 |
Vasamotor Agents |
February 01, 2026 |
January 14, 2026 |
January 14, 2027 |