| 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, 2024 |
July 29, 2024 |
July 29, 2025 |
| UUHP Individual & Commercial |
pharm-003 |
Ankylosing Spondylitis Retail Drugs |
February 01, 2025 |
January 29, 2025 |
January 29, 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 |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| 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 |
Basal Insulin |
June 01, 2023 |
May 19, 2023 |
May 19, 2024 |
| UUHP Individual & Commercial |
pharm-012 |
Biosimilar Policy- Retail Drugs |
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 |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-015 |
Clostridium Difficile |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-016 |
Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist for Migraine Prevention |
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 |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-022 |
Dupixent for Asthma, Eosinophilic Esophagitis, or Prurigo Nodularis |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| 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 |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-028 |
Growth Hormones - Child |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-030 |
Hepatitis C Direct Acting Antivirals |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-031 |
Hereditary Angioedema |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-032 |
Hidradenitis Suppurativa: Retail Drugs |
February 01, 2025 |
January 29, 2025 |
January 29, 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) |
June 01, 2024 |
May 22, 2024 |
May 22, 2025 |
| UUHP Individual & Commercial |
pharm-035 |
IL5 Receptor Antagonist for Asthma |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-036 |
Increlex |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| UUHP Individual & Commercial |
pharm-039 |
Interstitial Cystitis |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-041 |
Juvenile Idiopathic Arthritis: Retail Drugs |
July 01, 2025 |
June 11, 2025 |
June 11, 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 |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-045 |
Pulmozyme |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| 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 |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| UUHP Individual & Commercial |
pharm-052 |
Acute Opioid Use Policy |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-054 |
Osteoporosis Medications |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| 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 |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| UUHP Individual & Commercial |
pharm-061 |
Psoriasis: Retail Drugs |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-062 |
Psoriatic Arthritis: Retail Drugs |
May 01, 2025 |
April 09, 2025 |
April 09, 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 |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-066 |
Sandostation LAR |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-067 |
Savella |
April 01, 2023 |
March 15, 2023 |
March 15, 2024 |
| UUHP Individual & Commercial |
pharm-069 |
Spravato |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| UUHP Individual & Commercial |
pharm-070 |
Subcutaneous Methotrexate |
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 |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| UUHP Individual & Commercial |
pharm-075 |
Ulcerative Colitis: Retail Drugs |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-078 |
Xifaxan |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-079 |
Xolair |
June 01, 2024 |
May 22, 2024 |
May 22, 2025 |
| UUHP Individual & Commercial |
pharm-080 |
Pancreatic Enzymes |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-081 |
Benlysta |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| 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 |
Acute Migraine Medications |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-089 |
Parkinson's Agents |
April 01, 2023 |
March 15, 2023 |
March 15, 2024 |
| UUHP Individual & Commercial |
pharm-090 |
Icosapent Ethyl |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-091 |
OFEV®, pirfenidone |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-094 |
Cablivi |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-099 |
Nexletol and Nexlizet |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-100 |
Prevymis |
October 01, 2023 |
September 13, 2023 |
September 13, 2024 |
| 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 |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| UUHP Individual & Commercial |
pharm-108 |
Continuous Glucose Monitor (CGM) Retail Pharmacy |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-109 |
Signifor |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| UUHP Individual & Commercial |
pharm-110 |
Hemophilia and Blood Products |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| 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 |
May 01, 2025 |
April 09, 2025 |
April 09, 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 1, 2022 |
January 19, 2022 |
January 19, 2023 |
| UUHP Individual & Commercial |
pharm-128 |
Oxervate |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| UUHP Individual & Commercial |
pharm-130 |
Leqvio |
October 01, 2023 |
September 13, 2023 |
September 13, 2024 |
| 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 |
January 01, 2023 |
October 26, 2022 |
October 26, 2023 |
| UUHP Individual & Commercial |
pharm-142 |
Non-Radiographic Axial Spondyloarthritis (nrx-SpA) |
February 01, 2025 |
January 29, 2025 |
January 29, 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) |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| UUHP Individual & Commercial |
pharm-147 |
Zoryve |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-148 |
Mounjaro and GLP-1s |
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, 2024 |
July 29, 2024 |
July 29, 2025 |
| UUHP Individual & Commercial |
pharm-152 |
Radicava |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-153 |
Posaconazole |
June 01, 2023 |
May 19, 2023 |
May 19, 2024 |
| UUHP Individual & Commercial |
pharm-154 |
Beyfortus |
October 07, 2023 |
October 03, 2023 |
October 03, 2024 |
| UUHP Individual & Commercial |
pharm-157 |
Tezspire |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-158 |
Zurzuvae |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| UUHP Individual & Commercial |
pharm-161 |
L-glutamine |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-162 |
Branded Topicals for Atopic Dermatitis |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| 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 |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| UUHP Individual & Commercial |
pharm-165 |
Giant Cell Arteritis |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U |
pharm-hu-001 |
Acne Vulgaris and Rosacea |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-hu-002 |
Alpha-1-Proteinase-Inhibitors |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U |
pharm-HU-003 |
Ankylosing Spondylitis Retail & Medical Drugs |
January 01, 2025 |
December 24, 2024 |
December 24, 2025 |
| Healthy U |
pharm-HU-004 |
Anthelmintics |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U |
pharm-hu-007 |
Antineoplastics- Retail |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-hu-008 |
Aranesp |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-011 |
Basal Insulin |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-hu-012 |
Biosimilar Policy- Retail Drugs |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-hu-013 |
Brand Name Medications |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| Healthy U |
pharm-hu-014 |
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Agents |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-HU-015 |
Clostridium Difficile |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-016 |
Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonists for Migraine Prevention |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-HU-017 |
Constipation Medications |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-HU-019 |
Crohn's Disease Retail & Medical Drugs |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-HU-022 |
Dupixent for Asthma, Eosinophilic Esophagitis, or Prurigo Nodularis |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-026 |
Gonadotropin Releasing Hormone Agonists and Antagonists – Healthy U |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-HU-027 |
Growth Hormones: Adult |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-028 |
Growth Hormone - Child |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-HU-030 |
Hepatitis C Direct Acting Antivirals |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-031 |
Hereditary Angioedema |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-HU-032 |
Hidradenitis Suppurativa Retail Medications |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U |
pharm-hu-033 |
Hyperkalemia- Healthy U |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-034 |
Irritable Bowel Syndrome with Diarrhea (IBS-D) |
June 01, 2024 |
May 22, 2024 |
May 22, 2025 |
| Healthy U |
pharm-hu-035 |
IL5 Receptor Antagonist for Asthma |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-036 |
Increlex |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| Healthy U |
pharm-hu-039 |
Interstitial Cystitis |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-HU-041 |
Juvenile Idiopathic Arthritis Retail & Medical Drugs |
January 01, 2025 |
December 24, 2024 |
December 24, 2025 |
| Healthy U |
pharm-HU-044 |
Multiple Sclerosis Agents |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-045 |
Pulmozyme |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| Healthy U |
pharm-hu-047 |
Neupro |
June 01, 2023 |
May 17, 2023 |
May 17, 2024 |
| Healthy U |
pharm-hu-049 |
Off Label Use |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| Healthy U |
pharm-hu-051 |
Opioids - Chronic |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U |
pharm-hu-052 |
Acute Opioid Use Policy |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-HU-054 |
Osteoporosis Medications |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| Healthy U |
pharm-hu-056 |
Pharmacy Prior Authorization and Medical Necessity Policy |
March 08, 2024 |
March 05, 2024 |
March 05, 2025 |
| Healthy U |
pharm-hu-058 |
Phenylbutyrates |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U |
pharm-hu-059 |
Phenylketonuria (PKU) |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U |
pharm-hu-060 |
Promacta |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U |
pharm-HU-061 |
Psoriasis Retail & Medical Drugs |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-062 |
Psoriatic Arthritis - Psoriatic Arthritis Retail & Medical Drugs |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-063 |
Pulmonary Hypertension (PH) Medications |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-HU-065 |
Rheumatoid Arthritis Retail & Medical Drugs |
January 01, 2025 |
December 24, 2024 |
December 24, 2025 |
| Healthy U |
pharm-hu-066 |
Sandostatin LAR |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-067 |
Savella |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-hu-069 |
Spravato - Healthy U |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U |
pharm-hu-070 |
Subcutaneous Methotrexate |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-HU-073 |
Synagis |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-HU-075 |
Ulcerative Colitis Retail & Medical Drugs |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-077 |
VMAT - 2 Inhibitors |
June 01, 2022 |
May 18, 2022 |
May 18, 2023 |
| Healthy U |
pharm-hu-078 |
Xifaxan |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-079 |
Xolair |
June 01, 2024 |
May 22, 2024 |
May 22, 2025 |
| Healthy U |
pharm-hu-080 |
Pancreatic Enzymes |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-HU-081 |
Benlysta |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-HU-082 |
Iron Chelation Therapy |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U |
pharm-hu-083 |
Nuedexta |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-HU-086 |
Xhance |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-hu-087 |
Yupelri |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-088 |
Acute Migraine |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| Healthy U |
pharm-hu-089 |
Parkinson's Agents |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-hu-090 |
Icosapent Ethyl |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-091 |
OFEV®, pirfenidone |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-094 |
Cablivi |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-099 |
Nexletol & Nexlizet |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-100 |
Prevymis |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-hu-101 |
Uveitis |
January 01, 2025 |
December 24, 2024 |
December 24, 2025 |
| Healthy U |
pharm-hu-103 |
Pharmacy Continuity of Care |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U |
pharm-hu-104 |
Cystadrops and Cystaran for Ocular Cystinosis |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-107 |
Sunosi |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U |
pharm-hu-108 |
Continuous Glucose Monitor (CGM) Retail Pharmacy |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-109 |
Signifor |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| Healthy U |
pharm-HU-111 |
Descovy |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-112 |
Dojolvi |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-115 |
Step Therapy |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-117 |
Evrysdi |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-119 |
Cabenuva & Vocabria |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-127 |
Livtencity |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-hu-128 |
Oxervate |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| Healthy U |
pharm-HU-130 |
Leqvio |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-HU-131 |
Rezurock |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-hu-134 |
Apretude |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-135 |
Brand Name Atopic Dermatitis Agents |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-142 |
Non-Radiographic Axial Spondyloarthritis (nrx-SpA) Retail & Medical Drugs |
September 01, 2022 |
August 24, 2022 |
August 24, 2023 |
| Healthy U |
pharm-hu-144 |
Nucala |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-hu-145 |
Hyftor |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-146 |
Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| Healthy U |
pharm-hu-147 |
Zoryve |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-148 |
Mounjaro and GLP-1s |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U |
pharm-hu-149 |
Heavily Treated HIV |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-150 |
Hormone Therapy for Gender Dysphoria |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U |
pharm-hu-152 |
Radicava |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-153 |
Posaconazole- Healthy U |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-hu-156 |
Opzelura For Treatment Of Nonsegmental Vitiligo |
December 01, 2023 |
November 08, 2023 |
November 08, 2024 |
| Healthy U |
pharm-hu-157 |
Tezspire |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-159 |
Kevzara for Polymyalgia Rheumatica |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-160 |
Prurigo Nodularis |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-hu-161 |
L-glutamine |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-163 |
Eosinophilic Granulomatosis with Polyangiitis (EPGA) |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-164 |
Chronic Spontaneous Urticaria |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U |
pharm-hu-165 |
Giant Cell Arteritis |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U |
pharm-hu-m002 |
Intravenous Iron Therapy |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-HU-M004 |
Lutathera |
July 01, 2023 |
June 28, 2023 |
June 28, 2024 |
| Healthy U |
pharm-hu-m005 |
Ophthalmic Injections |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U |
pharm-HU-M006 |
Branded Denosumab Products (Prolia, Xgeva) |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-m007 |
Spinraza |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U |
pharm-HU-M008 |
Testopel |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-HU-M010 |
Zilretta |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-hu-m011 |
Xiaflex |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U |
pharm-hu-m012 |
Zolgensma |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U |
pharm-hu-m013 |
Atypical Hemolytic Uremic Syndrome |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U |
pharm-hu-m014 |
Brineura |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-M016 |
Tepezza |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-m017 |
Biosimilar Policy- Medical Infused Drugs |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-hu-M027 |
Neuromyelitis Optica Spectrum Disorder (NMOSD) |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-hu-M028 |
Akynzeo IV |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| Healthy U |
pharm-hu-m029 |
Krystexxa |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-m030 |
Biosimilar Policy- Medical Infused Drugs |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U |
pharm-hu-M032 |
Vyepti |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-M035 |
Primary Hyperoxaluria Type 1 |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| Healthy U |
pharm-hu-m036 |
Ketamine |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-m037 |
Saphnelo |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U |
pharm-hu-m044 |
Tzield |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U |
pharm-hu-m045 |
NPlate |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U |
pharm-hu-m046 |
Myasthenia Gravis |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| Healthy U |
pharm-hu-m047 |
Monoclonal Antibodies for Alzheimer's Disease |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U |
pharm-hu-m048 |
Paroxysmal Nocturnal Hemoglobinuria |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| UUHP Individual & Commercial |
pharm-m001 |
Hyaluronic Acid |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| UUHP Individual & Commercial |
pharm-m002 |
Intravenous Iron Therapy |
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 |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| 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 |
July 01, 2025 |
June 11, 2025 |
June 11, 2025 |
| UUHP Individual & Commercial |
pharm-m014 |
Brineura |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| UUHP Individual & Commercial |
pharm-m016 |
Tepezza |
October 01, 2023 |
September 13, 2023 |
September 13, 2024 |
| 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 |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| UUHP Individual & Commercial |
pharm-m019 |
Crohn’s Disease - Medical Infused Drugs |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| UUHP Individual & Commercial |
pharm-m020 |
Hidradenitis Supperativa- Medical Infused Drugs |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| UUHP Individual & Commercial |
pharm-m021 |
Juvenile Idiopathic Arthritis - Medical Infused Drugs |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| UUHP Individual & Commercial |
pharm-m022 |
Psoriasis- Medical Infused Drugs |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| UUHP Individual & Commercial |
pharm-m023 |
Psoriatic Arthritis- Medical Infused Drugs |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| UUHP Individual & Commercial |
pharm-m024 |
Rheumatoid Arthritis-Medical Infused Drugs |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| UUHP Individual & Commercial |
pharm-m025 |
Ulcerative Colitis - Medical Infused Drugs |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| 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 |
June 1, 2022 |
May 18, 2022 |
May 18, 2023 |
| UUHP Individual & Commercial |
pharm-m028 |
Akynzeo |
January 01, 2025 |
December 12, 2024 |
December 12, 2025 |
| UUHP Individual & Commercial |
pharm-m029 |
Krystexxa |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| UUHP Individual & Commercial |
pharm-M030 |
Biosimilar Policy- Medical Infused Drugs |
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 |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| 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 |
January 01, 2023 |
November 21, 2022 |
November 21, 2023 |
| UUHP Individual & Commercial |
pharm-m045 |
Nplate |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| UUHP Individual & Commercial |
pharm-m046 |
Myasthenia Gravis |
April 01, 2024 |
March 27, 2024 |
March 27, 2025 |
| 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, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U CHIP |
pharm-CHIP-003 |
Ankylosing Spondylitis Retail & Medical Drugs |
January 01, 2025 |
December 24, 2024 |
December 24, 2025 |
| 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 |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| 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 |
Basal Insulin |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-012 |
Retail Biosimilar Policy |
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 |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-015 |
Clostridium Difficile |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-016 |
Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist For Migraine Prevention |
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 |
June 01, 2025 |
May 27, 2025 |
May 27, 2026 |
| Healthy U CHIP |
pharm-CHIP-022 |
Dupixent For Asthma, Eosinophilic Esophagitis, Or Prurigo Nodularis |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| 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 |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| 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 |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-032 |
Hidradenitis Suppurativa Retail & Medical Drugs |
July 01, 2025 |
June 11, 2025 |
June 11, 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) |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-035 |
IL5 Receptor Antagonist For Asthma |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-036 |
Increlex |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| 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 |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-041 |
Juvenile Idiopathic Arthritis Retail & Medical Drugs |
January 01, 2025 |
December 24, 2024 |
December 24, 2025 |
| 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 |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-045 |
Pulmozyme |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| 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 |
Chronic Opioid Medications |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-052 |
Acute Opioid Use |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-054 |
Osteoporosis Medications |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| 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 |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U CHIP |
pharm-CHIP-061 |
Psoriasis Retail & Medical Drugs |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-062 |
Psoriatic Arthritis - Psoriatic Arthritis Retail & Medical Drugs |
January 01, 2025 |
December 24, 2024 |
December 24, 2025 |
| Healthy U CHIP |
pharm-CHIP-063 |
Pulmonary Hypertension (PH) Medications |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-065 |
Rheumatoid Arthritis Retail & Medical Drugs |
January 01, 2025 |
December 24, 2024 |
December 24, 2025 |
| Healthy U CHIP |
pharm-CHIP-066 |
Sandostatin LAR |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-067 |
Savella |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-069 |
Spravato |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U CHIP |
pharm-CHIP-070 |
Subcutaneous Methotrexate |
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 |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| Healthy U CHIP |
pharm-CHIP-075 |
Ulcerative Colitis Retail & Medical Drugs |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-078 |
Xifaxan |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-079 |
Xolair |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-080 |
Pancreatic Enzymes |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-081 |
Benlysta |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| 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 |
Acute Migraine |
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-090 |
Icosapent Ethyl |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-091 |
OFEV®, Pirfenidone |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-094 |
Cablivi |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-099 |
Nexletol & Nexlizet |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-100 |
Prevymis |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| 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 |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| 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, 2025 |
April 09, 2025 |
April 09, 2026 |
| 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 |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| 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 |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-128 |
Oxervate |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| Healthy U CHIP |
pharm-CHIP-130 |
Leqvio |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| 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 |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-142 |
Non-Radiographic Axial Spondyloarthritis (Nrx-SpA) Retail & Medical Drugs |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| 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 |
September 01, 2024 |
August 29, 2024 |
August 29, 2025 |
| 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-1s |
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 |
Hormone Therapy For Gender Dysphoria |
August 01, 2024 |
July 29, 2024 |
July 29, 2025 |
| Healthy U CHIP |
pharm-CHIP-151 |
Formulary Exceptions |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-152 |
Radicava |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-153 |
Posaconazole |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-154 |
Beyfortus |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| 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-157 |
Tezspire |
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 |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-161 |
L-glutamine |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| 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-M002 |
Intravenous Iron Therapy |
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, 2024 |
July 29, 2024 |
July 29, 2025 |
| 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 |
July 01, 2025 |
June 11, 2025 |
June 11, 2026 |
| Healthy U CHIP |
pharm-CHIP-M014 |
Brineura |
May 01, 2025 |
April 09, 2025 |
April 09, 2026 |
| Healthy U CHIP |
pharm-CHIP-M016 |
Tepezza |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-M017 |
Antineoplastics - Medical Infused Drugs |
June 01, 2025 |
May 27, 2025 |
May 27, 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) |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-M028 |
Akynzeo IV |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| Healthy U CHIP |
pharm-CHIP-M029 |
Krystexxa |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U CHIP |
pharm-CHIP-M030 |
Biosimilar Policy- Medical Infused Drugs |
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 |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| 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-M044 |
Tzield |
April 01, 2025 |
March 18, 2025 |
March 18, 2026 |
| Healthy U CHIP |
pharm-CHIP-M045 |
NPlate |
February 01, 2025 |
January 29, 2025 |
January 29, 2026 |
| Healthy U CHIP |
pharm-CHIP-M046 |
Myasthenia Gravis |
July 01, 2024 |
July 29, 2024 |
July 01, 2025 |
| 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 |
October 01, 2024 |
September 18, 2024 |
September 18, 2025 |
| Healthy U CHIP |
pharm-CHIP-M049 |
Adakveo |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |
| Healthy U |
pharm-hu-m049 |
Adakveo |
December 01, 2024 |
November 13, 2024 |
November 13, 2025 |