For Advantage U Part D Requests, please visit: Advantage U Medicare Provider Documents & Forms

Policy Name Effective Date Revision Date Next Review Date
ALL
PHARM-PA General Pharmacy Prior Authorization FormN/AN/AN/A
PHARM-FE Pharmacy Formulary Exception Request Form - Commercial and IndividualN/AN/AN/A
PHARM-HU-FE Pharmacy Formulary Exception Request Form - Healthy UN/AN/AN/A
PHARM-MHC-FE MHC Pharmacy Formulary Exception FormN/AN/AN/A
PHARM-MHCPA MHC General Pharmacy Prior Authorization FormN/AN/AN/A
A
pharm-m033AbecmaJune 1, 2022May 18, 2022May 18, 2023
pharm-hu-M033Abecma - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-ma-M033Abecma - Medicare AdvantageJune 01, 2022May 18, 2022May 18, 2023
Pharm-088Acute Migraine Medications - Commercial & IndividualDecember 01, 2022November 21, 2022November 21, 2023
Pharm-hu-088Acute Migraine Medications - Healthy UDecember 01, 2022November 21, 2022November 21, 2023
pharm-001Acne RosaceaOctober 01, 2022September 19, 2022September 19, 2023
pharm-hu-001Acne Vulgaris and Rosacea - Healthy UOctober 01, 2022September 19, 2022September 19, 2023
pharm-002Alpha-1-Proteinase-InhibitorsSeptember 01, 2022August 24, 2022August 24, 2023
pharm-hu-002Alpha-1-Proteinase-Inhibitors - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
PHARM-003Ankylosing SpondylitisSeptember 01, 2022August 24, 2022August 24, 2023
pharm-m018Ankylosing Spondylitis- Medical Infused DrugsApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-003Ankylosing Spondylitis - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
pharm-004AnthelminticJune 01, 2022May 18, 2022May 18, 2023
PHARM-HU-004Anthelmintics - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-006Antiemetics for Chemotherapy Induced Nausea and VomitingNovember 01, 2021October 13, 2021October 13, 2022
pharm-m028AkynzeoJune 1, 2022May 18, 2022May 18, 2023
pharm-hu-M028Akynzeo IV - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-ma-M028Akynzeo IV - Medicare AdvantageJune 01, 2022May 18, 2022May 18, 2023
pharm-m017Antineoplastics - Medical Infused DrugsSeptember 01, 2021August 18, 2021August 18, 2022
pharm-007Antineoplastics - RetailSeptember 01, 2021August 18, 2021August 18, 2022
pharm-008Aranesp - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-008Aranesp - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
pharm-ma-008Aranesp - Medicare AdvantageNovember 01, 2022October 26, 2022October 26, 2023
pharm-009EucrisaOctober 01, 2022September 19, 2022September 19, 2023
pharm-135Atopic Dermatitis: Biologics/JAK InhibitorsJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-135Brand Name Atopic Dermatitis Agents - Healthy UJune 01, 2022May 18, 2022May 18, 2023
B
pharm-011Basal InsulinOctober 01, 2022September 19, 2022September 19, 2023
pharm-hu-011Basal Insulin - Healthy UOctober 01, 2022September 19, 2022September 19, 2023
pharm-012Biosimilar PolicyJanuary 01, 2022August 18, 2021August 18, 2022
PHARM-M030Medical Biosimilar ProductsAugust 01, 2022May 18, 2022May 18, 2023
PHARM-HU-M030Medical Biosimilar Products - Healthy UAugust 01, 2022May 18, 2022May 18, 2023
pharm-013Brand Name MedicationsSeptember 01, 2021August 18, 2021August 18, 2022
pharm-081BenlystaApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-081Benlysta - Healthy UApril 1, 2022March 16, 2022March 16, 2023
pharm-m006Branded Denosumab Products (Prolia, Xgeva)July 1, 2022June 21, 2022June 21, 2023
PHARM-HU-M006Branded Denosumab Products (Prolia, Xgeva) - Healthy UJuly 01, 2022June 21, 2022June 21, 2023
PHARM-MA-M006Branded Denosumab Products (Prolia, Xgeva) - Medicare AdvantageJuly 01, 2022June 21, 2022June 21, 2023
pharm-m034BreyanziJune 1, 2022May 18, 2022May 18, 2023
pharm-hu-M034Breyanzi - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-ma-M034Breyanzi - Medicare AdvantageJune 01, 2022May 18, 2022May 18, 2023
pharm-m014BrineuraJanuary 1, 2022December 13, 2021December 13, 2022
pharm-126BylvayFebruary 1, 2022January 19, 2022January 19, 2023
pharm-hu-126Bylvay - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
C
pharm-094CabliviJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-094Cablivi - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-119Cabenuva and Vocabria - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-016Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-hu-143Camyzos - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
pharm-096Carisoprodol for Healthy USeptember 01, 2021August 18, 2021August 18, 2022
PHARM-HU-M039Carvykti - Healthy UApril 01, 2022March 16, 2022March 16, 2023
PHARM-M039CarvyktiApril 01, 2022March 16, 2022March 16, 2023
pharm-016Calcitonin Gene-Related Peptide (CGRP) Receptor AntagonistsNovember 01, 2021October 13, 2021October 13, 2022
PHARM-HU-015Clostridium Difficile - Healthy UApril 1, 2022March 16, 2022March 16, 2023
pharm-017ConstipationNovember 01, 2021October 13, 2021October 13, 2022
pharm-108Continuous Glucose Monitor (CGM)- Retail PharmacySeptember 01, 2022August 24, 2022August 24, 2023
pharm-hu-108Continuous Glucose Monitor (CGM)- Retail Pharmacy - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
PHARM-129Cosentyx for ERAApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-129Cosentyx for ERA - Healthy UApril 01, 2022March 16, 2022March 16, 2023
pharm-019Crohn's Disease - Commercial Retail DrugsOctober 01, 2022September 19, 2022September 19, 2022
pharm-m019Crohn’s Disease - Medical Infused DrugsApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-019Crohn's Disease - Healthy U Retail and Medical DrugsOctober 01, 2022September 19, 2022September 19, 2022
pharm-098CuvposaAugust 10, 2020August 19, 2020August 19, 2021
pharm-104Cystadrops and Cystaran for Ocular Cystinosis - Commercial & IndividualDecember 01, 2022November 21, 2022November 21, 2023
pharm-hu-104Cystadrops and Cystaran for Ocular Cystinosis - Healthy UDecember 01, 2022November 21, 2022November 21, 2023
pharm-014Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) AgentsJanuary 23, 2020January 22, 2020January 23, 2021
pharm-hu-014Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Agents - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
D
pharm-020DalirespMarch 1, 2022February 14, 2022February 14, 2023
pharm-020Daliresp - Healthy UMarch 1, 2022February 14, 2022February 14, 2023
pharm-111DescovyApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-111Descovy - Healthy UApril 1, 2022March 16, 2022March 16, 2023
pharm-112DojolviFebruary 01, 2022January 19, 2022January 19, 2022
pharm-hu-112Dojolvi - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-022DupixentSeptember 01, 2022August 24, 2022August 24, 2023
PHARM-HU-022Dupixent - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
E
pharm-024EpidiolexMarch 1, 2022February 14, 2022February 14, 2023
pharm-091Esbriet/OFEV - Commercial & IndividualDecember 01, 2022November 21, 2022November 21, 2023
pharm-hu-091Esbriet/OFEV - Healthy UDecember 01, 2022November 21, 2022November 21, 2023
pharm-117Evrysdi - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-117Evrysdi - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
G
pharm-026Gonadotropin Releasing Hormone (GnRH) Agonists and AntagonistsJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-026GONADOTROPIN RELEASING HORMONE AGONISTS AND ANTAGONISTS – Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-027Growth Hormones- AdultJuly 01, 2022June 21, 2022June 21, 2023
PHARM-HU-027Growth Hormones: Adult - Healthy UJuly 01, 2022June 21, 2022June 21, 2023
pharm-028Growth Hormones- ChildJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-028Growth Hormone - Child - Healthy UJune 01, 2022May 18, 2022May 18, 2023
H
pharm-030Hepatitis C Direct Acting AntiviralsApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-030Hepatitis C Direct Acting Antivirals - Healthy UApril 1, 2022March 16, 2022March 16, 2023
pharm-110Hemophilia and Blood ProductsSeptember 01, 2021August 18, 2021August 18, 2022
pharm-031Hereditary AngioedemaFebruary 01, 2021January 27, 2021January 27, 2022
pharm-hu-031Hereditary Angioedema - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-032Hidradenitis SuppurativaApril 01, 2022March 16, 2022March 16, 2023
pharm-m020Hidradenitis Supperativa- Medical Infused DrugsApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-032Hidradenitis Suppurativa - Healthy UJune 01, 2022April 01, 2022April 01, 2023
pharm-101Humira for Uveitis - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-101Humira for Uveitis - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
pharm-033HyperkalemiaMarch 1, 2022February 14, 2022February 14, 2023
pharm-hu-033HyperkalemiaMarch 1, 2022February 14, 2022February 14, 2023
pharm-m001Hyaluronic Acid - Commercial & IndividualDecember 01, 2022November 21, 2022November 21, 2023
pharm-ma-m001Hyaluronic Acid - Medicare AdvantageDecember 01, 2022November 21, 2022November 21, 2023
I
pharm-034Irritable Bowel Syndrome with Diarrhea (IBS-D)March 1, 2022February 14, 2022February 14, 2023
pharm-hu-034Irritable Bowel Syndrome with Diarrhea (IBS-D) - Healthy UMarch 1, 2022February 14, 2022February 14, 2023
pharm-035IL5 Receptor Antagonist for Asthma - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-035IL5 Receptor Antagonist for Asthma - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
pharm-036IncrelexJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-036Increlex - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-039Interstitial CystitisMarch 1, 2022February 14, 2022February 14, 2023
pharm-hu-039Interstitial Cystitis - Healthy UMarch 1, 2022February 14, 2022February 14, 2023
pharm-082Iron Chelation TherapyOctober 01, 2022September 19, 2022September 19, 2023
pharm-082Iron Chelation Therapy - Healthy UOctober 01, 2022September 19, 2022September 19, 2023
pharm-091Idiopathic Pulmonary FibrosisJanuary 1, 2022December 13, 2021December 13, 2022
pharm-m002Intravenous IronNovember 01, 2021October 13, 2021October 13, 2022
pharm-105IsturisaJanuary 1, 2022December 13, 2021December 13, 2022
pharm-hu-105Istursia - Healthy UJune 01, 2022May 18, 2022May 18, 2023
J
pharm-041Juvenile Idiopathic ArthritisApril 01, 2022March 16, 2022March 16, 2023
pharm-m021Juvenile Idiopathic Arthritis - Medical Infused DrugsApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-041Juvenile Idiopathic Arthritis - Healthy UJune 01, 2022April 01, 2022April 01, 2023
K
PHARM-HU-124Kerendia - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
pharm-m036KetamineOctober 01, 2022September 19, 2022September 19, 2023
pharm-hu-m036Ketamine - Healthy UOctober 01, 2022September 19, 2022September 19, 2023
pharm-ma-m036Ketamine - Medicare AdvantageOctober 01, 2022September 19, 2022September 19, 2023
pharm-m029KrystexxaJanuary 1, 2022December 13, 2021December 13, 2022
pharm-hu-m029Krystexxa - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
pharm-m003Kymriah - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-m003Kymriah - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
L
PHARM-130LeqvioApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-130Leqvio - Healthy UApril 01, 2022March 16, 2022March 16, 2023
pharm-127LivtencityFebruary 1, 2022January 19, 2022January 19, 2023
pharm-hu-127Livtencity - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
PHARM-HU-133Livmarli - Healthy UApril 01, 2022March 16, 2022March 16, 2023
pharm-043Long Acting TacrolimusMarch 1, 2022February 14, 2022February 14, 2023
pharm-118LupkynisJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-118Lupkynis - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-m004LutatheraJuly 01, 2022June 21, 2022June 21, 2023
PHARM-HU-M004Lutathera - Healthy UJuly 01, 2022June 21, 2022June 21, 2023
PHARM-MA-M004Lutathera - Medicare AdvantageJuly 01, 2022June 21, 2022June 21, 2023
M
pharm-hu-123Myfembree - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
PHARM-044Multiple Sclerosis AgentsNovember 01, 2022August 24 , 2022August 24, 2023
PHARM-HU-044Multiple Sclerosis Agents - Healthy UNovember 01, 2022August 24 , 2022August 24, 2023
N
pharm-102Nayzilam® and Valtoco® Nasal SprayJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-102NAYZILAM and VALTOCO - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-113NerlynxFebruary 01, 2021January 27, 2021January 27, 2022
pharm-hu-113Nerlynx - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-099Nexletol and NexlizetSeptember 01, 2021August 18, 2021August 18, 2022
pharm-047NeuproJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-047Neupro - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-m027Neuromyelitis Optica Spectrum Disorder June 1, 2022May 18, 2022May 18, 2023
pharm-hu-M027Neuromyelitis Optica Spectrum Disorder (NMOSD) - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-ma-M027Neuromyelitis Optica Spectrum Disorder (NMOSD) - Medicare AdvantageJune 01, 2022May 18, 2022May 18, 2023
pharm-142Non-Radiographic Axial Spondyloarthritis (nrx-SpA)September 01, 2022August 24, 2022August 24, 2023
pharm-hu-142Non-Radiographic Axial Spondyloarthritis (nrx-SpA) - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
pharm-m041Non-Radiographic Axial Spondyloarthritis (nrx-SpA) - Medical Infused DrugsSeptember 01, 2022August 24, 2022August 24, 2023
pharm-083Nuedexta - Commercial & IndividualDecember 01, 2022November 21, 2022November 21, 2023
pharm-hu-083Nuedexta - Healthy UDecember 01, 2022November 21, 2022November 21, 2023
O
pharm-068OcalivaSeptember 01, 2021August 18, 2021August 18, 2022
pharm-049Off Label UseJune 1, 2021May 19, 2021May 19, 2022
pharm-m005Ophthalmic VEGF AntagonistsSeptember 01, 2021August 18, 2021August 18, 2022
pharm-050Opioid Dependence AgentsJune 01, 2022May 18, 2022May 18, 2023
pharm-051Opioids - ChronicMarch 1, 2022February 14, 2022February 14, 2023
pharm-hu-051Opioids - Chronic - Healthy UMarch 1, 2022February 14, 2022February 14, 2023
pharm-052Acute Opioid Use PolicySeptember 01, 2022August 24, 2022August 24, 2023
pharm-hu-052Acute Opioid Use Policy - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
pharm-141OpzeluraJune 01, 2022May 18, 2022May 18, 2023
pharm-054Osteoporosis MedicationsJuly 01, 2022June 21, 2022June 21, 2023
PHARM-HU-057Osteoporosis Medications - Healthy UJuly 01, 2022June 21, 2022June 21, 2023
pharm-m035OxlumoJune 1, 2022May 18, 2022May 18, 2023
pharm-hu-M035Oxlumo - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-ma-M035Oxlumo - Medicare AdvantageJune 01, 2022May 18, 2022May 18, 2023
pharm-128OxervateFebruary 1, 2022January 19, 2022January 19, 2023
pharm-hu-128Oxervate - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
P
pharm-080Pancreatic Enzymes - Commercial & IndividualDecember 01, 2022November 21, 2022November 21, 2023
pharm-hu-080Pancreatic Enzymes - Healthy UDecember 01, 2022November 21, 2022November 21, 2023
pharm-089Parkinson's AgentsJanuary 1, 2022December 13, 2021December 13, 2022
pharm-057Phosphodiesterase Type 5 (PDE-5) InhibitorSeptember 01, 2021August 18, 2021August 18, 2022
pharm-103Pharmacy Continuity of CareFebruary 01, 2021January 27, 2021January 27, 2022
pharm-058Phenylbutyrates - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-058Phenylbutyrates - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-058PHENYLBUTYRATES - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-059Phenylketonuria (PKU)October 01, 2022September 19, 2022September 19, 2023
pharm-hu-059Phenylketonuria (PKU) - Healthy UOctober 01, 2022September 19, 2022September 19, 2023
Pharm-M026Place of Service for Pharmaceutical InfusionsSeptember 01, 2021August 18, 2021August 18, 2022
pharm-100PrevymisOctober 01, 2022September 19, 2022September 19, 2023
pharm-hu-100Prevymis - Healthy UOctober 01, 2022September 19, 2022September 19, 2023
pharm-056Prior Authorization and Medical Necessity Policy - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-056Prior Authorization and Medical Necessity Policy - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
pharm-060PromactaJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-060Promacta - Healthy UJune 01, 2022May 18, 2022May 18, 2023
PHARM-061PsoriasisJuly 01, 2022May 01, 2022March 16, 2023
PHARM-HU-061Psoriasis - Healthy UJune 01, 2022April 01, 2022April 01, 2023
pharm-m022Psoriasis- Medical Infused DrugsApril 01, 2022March 16, 2022March 16, 2023
PHARM-062Psoriatic ArthritisJuly 01, 2022May 01, 2022March 16, 2023
PHARM-HU-062Psoriatic Arthritis - Healthy UJune 01, 2022April 01, 2022April 01, 2023
pharm-m023Psoriatic Arthritis- Medical Infused DrugsApril 01, 2022March 16, 2022March 16, 2023
pharm-063Pulmonary Arterial HypertensionSeptember 01, 2021August 18, 2021August 18, 2022
pharm-045Pulmozyme ®June 01, 2022May 18, 2022May 18, 2023
pharm-hu-045Pulmozyme - Healthy UJune 01, 2022May 18, 2022May 18, 2023
R
PHARM-064RevcoviSeptember 01, 2021August 18, 2021August 18, 2022
PHARM-131RezurockApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-131Rezurock - Healthy UApril 01, 2022March 16, 2022March 16, 2023
pharm-065Rheumatoid ArthritisApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-065Rheumatoid Arthritis - Healthy UJune 01, 2022April 01, 2022April 01, 2023
pharm-m024Rheumatoid Arthritis-Medical Infused DrugsApril 01, 2022March 16, 2022March 16, 2023
pharm-114Rocklatan and RhopressaFebruary 01, 2021January 27, 2021January 27, 2022
pharm-hu-114Rocklatan and Rhopressa - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-084Ruzurgi- FirdapseNovember 01, 2021October 13, 2021October 13, 2022
S
pharm-066Sandostation LARJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-066Sandostatin LAR - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-ma-066Sandostatin LAR - Medicare AdvantageJune 01, 2022May 18, 2022May 18, 2023
pharm-m037SaphneloFebruary 1, 2022January 19, 2022January 19, 2023
pharm-ma-m037Saphnelo - Advantage UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-hu-m037Saphnelo - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-067SavellaMarch 1, 2022February 14, 2022February 14, 2023
pharm-hu-067Savella - Healthy UMarch 1, 2022February 14, 2022February 14, 2023
pharm-109SigniforJanuary 1, 2022December 13, 2021December 13, 2022
pharm-m013Soliris & UltomirisNovember 01, 2021October 13, 2021October 13, 2022
pharm-069SpravatoJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-069Spravato - - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-m007Spinraza - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-m007Spinraza - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
pharm-071Brand StatinsJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-071Brand Statins - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-115Step Therapy - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-115Step Therapy - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
pharm-070Subcutaneous MethotrexateSeptember 01, 2022August 24, 2022August 24, 2023
pharm-hu-070Subcutaneous Methotrexate - Healthy USeptember 01, 2022August 24, 2022August 24, 2023
pharm-107SunosiJanuary 1, 2022December 13, 2021December 13, 2022
pharm-073SynagisOctober 01, 2022September 19, 2022September 19, 2023
pharm-hu-073Synagis - Healthy UOctober 01, 2022September 19, 2022September 19, 2023
T
PHARM-HU-132Tavneous - Healthy UApril 01, 2022March 16, 2022March 16, 2023
pharm-m031TecartusNovember 01, 2020October 28, 2020October 28, 2021
pharm-ma-m031Tecartus - Advantage UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-m016TepezzaJune 1, 2022May 18, 2022May 18, 2023
pharm-hu-M016Tepezza - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-ma-M016Tepezza - Medicare AdvantageOctober 01, 2022September 19, 2022September 19, 2023
pharm-m008TestopelSeptember 01, 2021August 18, 2021August 18, 2022
PHARM-HU-M038Tezspire - Healthy UApril 01, 2022March 16, 2022March 16, 2023
PHARM-M038TezspireApril 01, 2022March 16, 2022March 16, 2023
pharm-074Topiramate ER Sprinkle CapsulesSeptember 01, 2021August 18, 2021August 18, 2022
U
pharm-075Ulcerative ColitisJune 01, 2022May 18, 2022May 18, 2023
PHARM-HU-075Ulcerative Colitis - Healthy UJune 01, 2022April 01, 2022April 01, 2023
pharm-m025Ulcerative Colitis - Medical Infused DrugsApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-M025Ulcerative Colitis Medical Infused Drugs - Healthy UJanuary 01, 2022January 01, 2022January 27, 2022
V
pharm-085Vasopressin Receptor Antagonists (VRA)November 01, 2020October 28, 2020October 28, 2021
pharm-hu-085Vasopressin Receptor Antagonists - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-090VascepaJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-090Vascepa - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-077VMAT-2 InhibitorsJune 01, 2022May 18, 2022May 18, 2023
pharm-hu-077VMAT - 2 Inhibitors - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-m032VyeptiJune 1, 2022May 18, 2022May 18, 2023
pharm-hu-M032Vyepti - Healthy UJune 01, 2022May 18, 2022May 18, 2023
W
pharm-125WakixFebruary 1, 2022January 19, 2022January 19, 2023
pharm-hu-125Wakix - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
X
pharm-078XifaxanJuly 01, 2021May 01, 2021April 19, 2022
pharm-hu-078Xifaxan - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-ma-m011Xiaflex - Advantage UFebruary 1, 2022January 19, 2022January 19, 2023
pharm-079Xolair - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-079Xolair - Healthy UNovember 01, 2022October 26, 2022October 26, 2023
pharm-086XHANCEApril 01, 2022March 16, 2022March 16, 2023
PHARM-HU-086Xhance - Healthy UApril 1, 2022March 16, 2022March 16, 2023
pharm-m011XiaflexFebruary 01, 2021January 27, 2021January 27, 2022
Y
pharm-m009YescartaJune 1, 2022May 18, 2022May 18, 2023
pharm-hu-M009Yescarta - Healthy UJune 01, 2022May 18, 2022May 18, 2023
pharm-ma-M009Yescarta - Medicare AdvantageJune 01, 2022May 18, 2022May 18, 2023
pharm-087YupelriDecember 01, 2020November 23, 2020November 23, 2021
pharm-hu-087Yupelri - Healthy UFebruary 1, 2022January 19, 2022January 19, 2023
Z
pharm-m010ZilrettaJuly 01, 2022June 21, 2022June 21, 2023
PHARM-MA-M010Zilretta - Medicare AdvantageJuly 01, 2022June 21, 2022June 21, 2023
PHARM-HU-M010Zilretta - Healthy UJuly 01, 2022June 21, 2022June 21, 2023
pharm-m012Zolgensma - Commercial & IndividualNovember 01, 2022October 26, 2022October 26, 2023
pharm-hu-m012Zolgensma - Healthy UNovember 01, 2022October 26, 2022October 26, 2023