Medical Policies
- Alphabetical
-
Administrative Anesthesiology Allergy/Immunology Behavioral Health Cardiovascular Dermatology Durable Medical Equipment (DME) Ear, Nose, and Throat (ENT) Endocrinology Gastroenterology General Surgery Genetics Genitourinary Hematology/Oncology Infectious Diseases Laboratory/Pathology Nephrology Neurology/Neurosurgery Obstetrics and Gynecology Ophthalmology Oral maxillofacial Orthopedic Pediatrics Pharmacy Physical Medicine Preventive Medicine Pulmonary Radiology, diagnostic Radiation Therapy Transplant Women's Health
Administrative
Reimbursement Policies
Pharmacy
Dental
New Policies
Updated Policies
Upcoming Policies
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 Form | N/A | N/A | N/A |
| PHARM-FE | Pharmacy Formulary Exception Request Form | N/A | N/A | N/A |
| PHARM-MHCFE | MHC Formulary Exception Form | N/A | N/A | N/A |
| PHARM-MHCPA | MHC General Pharmacy Prior Authorization Form | N/A | N/A | N/A |
| A | ||||
| pharm-m033 | Abecma | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-M033 | Abecma - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-ma-M033 | Abecma - Medicare Advantage | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| Pharm-088 | Acute Migraine Medications | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-001 | Acne Rosacea | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-002 | Alpha-1-Proteinase-Inhibitors | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-003 | Ankylosing Spondylitis | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-m018 | Ankylosing Spondylitis- Medical Infused Drugs | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-003 | Ankylosing Spondylitis - Healthy U | June 01, 2022 | April 01, 2022 | April 01, 2023 |
| pharm-004 | Anthelmintic | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| PHARM-HU-004 | Anthelmintics - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-006 | Antiemetics for Chemotherapy Induced Nausea and Vomiting | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-m028 | Akynzeo | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-M028 | Akynzeo IV - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-ma-M028 | Akynzeo IV - Medicare Advantage | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-m017 | Antineoplastics - Medical Infused Drugs | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-007 | Antineoplastics - Retail | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-008 | Aranesp | February 01, 2021 | January 27, 2021 | January 27, 2022 |
| pharm-009 | Eucrisa | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-135 | Atopic Dermatitis: Biologics/JAK Inhibitors | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-135 | Brand Name Atopic Dermatitis Agents - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| B | ||||
| pharm-011 | Basal Insulin | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-012 | Biosimilar Policy | January 01, 2022 | August 18, 2021 | August 18, 2022 |
| PHARM-M030 | Medical Biosimilar Products | January 01, 2022 | August 18, 2021 | August 18, 2022 |
| PHARM-HU-M030 | Medical Biosimilar Products - Healthy U | January 01, 2022 | August 18, 2021 | August 18, 2022 |
| pharm-013 | Brand Name Medications | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-081 | Benlysta | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-081 | Benlysta - Healthy U | April 1, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-m006 | Branded Denosumab Products (Prolia, Xgeva) | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-m034 | Breyanzi | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-M034 | Breyanzi - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-ma-M034 | Breyanzi - Medicare Advantage | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-m014 | Brineura | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-m015 | Botulinum Toxins | May 01, 2021 | April 19, 2021 | April 19, 2022 |
| pharm-126 | Bylvay | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-hu-126 | Bylvay - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| C | ||||
| pharm-094 | Cablivi | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-094 | Cablivi - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-119 | Cabenuva and Vocabria - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-016 | Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-096 | Carisoprodol for Healthy U | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| PHARM-HU-M039 | Carvykti - Healthy U | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-M039 | Carvykti | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-016 | Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonists | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| PHARM-HU-015 | Clostridium Difficile - Healthy U | April 1, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-017 | Constipation | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-108 | Continuous Glucose Monitor (CGM)- Retail Pharmacy | January 01, 2022 | August 18, 2021 | August 18, 2022 |
| PHARM-129 | Cosentyx for ERA | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-129 | Cosentyx for ERA - Healthy U | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-019 | Crohn's Disease | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-m019 | Crohn’s Disease- Medical Infused Drugs | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-019 | Crohn's Disease - Healthy U | June 01, 2022 | April 01, 2022 | April 01, 2023 |
| pharm-038 | Chronic Insomnia | March 01, 2021 | February 24, 2021 | February 24, 2022 |
| pharm-hu-038 | Healthy U - Chronic Insomnia Medications | April 01, 2022 | February 01, 2022 | February 01, 2023 |
| pharm-098 | Cuvposa | August 10, 2020 | August 19, 2020 | August 19, 2021 |
| pharm-104 | Cystadrops and Cystaran for Ocular Cystinosis | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-014 | Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Agents | January 23, 2020 | January 22, 2020 | January 23, 2021 |
| pharm-hu-014 | Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Agents - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| D | ||||
| pharm-020 | Daliresp | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-020 | Daliresp - Healthy U | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-111 | Descovy | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-111 | Descovy - Healthy U | April 1, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-112 | Dojolvi | February 01, 2022 | January 19, 2022 | January 19, 2022 |
| pharm-hu-112 | Dojolvi - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-022 | Dupixent | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| PHARM-HU-022 | Dupixent - Healthy U | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| E | ||||
| pharm-024 | Epidiolex | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-091 | Esbriet/OFEV | November 01, 2020 | October 28, 2020 | October 28, 2021 |
| pharm-117 | Evrysdi | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-hu-117 | Evrysdi - Healthy U | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| G | ||||
| pharm-026 | Gonadotropin Releasing Hormone (GnRH) Agonists and Antagonists | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-026 | GONADOTROPIN RELEASING HORMONE AGONISTS AND ANTAGONISTS – Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-027 | Growth Hormones- Adult | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-028 | Growth Hormones- Child | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-028 | Growth Hormone - Child - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| H | ||||
| pharm-030 | Hepatitis C Direct Acting Antivirals | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-030 | Hepatitis C Direct Acting Antivirals - Healthy U | April 1, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-110 | Hemophilia and Blood Products | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-031 | Hereditary Angioedema | February 01, 2021 | January 27, 2021 | January 27, 2022 |
| pharm-hu-031 | Hereditary Angioedema - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-032 | Hidradenitis Suppurativa | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-m020 | Hidradenitis Supperativa- Medical Infused Drugs | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-032 | Hidradenitis Suppurativa - Healthy U | June 01, 2022 | April 01, 2022 | April 01, 2023 |
| pharm-101 | Humira for Uveitis | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-033 | Hyperkalemia | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-hu-033 | Hyperkalemia | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-m001 | Hyaluronic Acid for Knee | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| I | ||||
| pharm-034 | Irritable Bowel Syndrome with Diarrhea (IBS-D) | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-hu-034 | Irritable Bowel Syndrome with Diarrhea (IBS-D) - Healthy U | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-035 | Interleukin-5 Receptor Antagonists for Asthma- IL5 (Eosinophilic asthma) | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-036 | Increlex | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-036 | Increlex - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-039 | Interstitial Cystitis | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-hu-039 | Interstitial Cystitis - Healthy U | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-082 | Iron Chelation Therapy | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-091 | Idiopathic Pulmonary Fibrosis | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-m002 | Intravenous Iron | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-105 | Isturisa | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-hu-105 | Istursia - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| J | ||||
| pharm-041 | Juvenile Idiopathic Arthritis | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-m021 | Juvenile Idiopathic Arthritis - Medical Infused Drugs | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-041 | Juvenile Idiopathic Arthritis - Healthy U | June 01, 2022 | April 01, 2022 | April 01, 2023 |
| K | ||||
| pharm-HU002 | Kerendia for Healthy U | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-m036 | Ketamine | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-m029 | Krystexxa | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-m003 | Kymriah | August 01, 2021 | July 21, 2021 | July 21, 2022 |
| L | ||||
| PHARM-130 | Leqvio | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-130 | Leqvio - Healthy U | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-127 | Livtencity | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-hu-127 | Livtencity - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| PHARM-HU-133 | Livmarli - Healthy U | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-043 | Long Acting Tacrolimus | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-118 | Lupkynis | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-118 | Lupkynis - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-m004 | Lutathera | March 01, 2021 | February 24, 2021 | February 24, 2022 |
| pharm-116 | Lyrica CR | February 01, 2021 | January 27, 2021 | January 27, 2022 |
| M | ||||
| pharm-HU001 | Myfembree for Healthy U | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-044 | Multiple Sclerosis Agents | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-044 | Multiple Sclerosis Agents - Healthy U | April 1, 2022 | March 16, 2022 | March 16, 2023 |
| N | ||||
| pharm-102 | Nayzilam® and Valtoco® Nasal Spray | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-102 | NAYZILAM and VALTOCO - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-113 | Nerlynx | February 01, 2021 | January 27, 2021 | January 27, 2022 |
| pharm-hu-113 | Nerlynx - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-099 | Nexletol and Nexlizet | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-047 | Neupro | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-047 | Neupro - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-m027 | Neuromyelitis Optica Spectrum Disorder | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-M027 | Neuromyelitis Optica Spectrum Disorder (NMOSD) - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-ma-M027 | Neuromyelitis Optica Spectrum Disorder (NMOSD) - Medicare Advantage | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-122 | Nucala for chronic rhinosinusitis with nasal polyposis (CRSwNP) | October 13, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-048 | Nucala for Eosinophilic Granulomatosis | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-106 | Nucala for Hypereosinophilic Syndrome | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-083 | Nuedexta | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| O | ||||
| pharm-068 | Ocaliva | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-049 | Off Label Use | June 1, 2021 | May 19, 2021 | May 19, 2022 |
| pharm-120 | Omnipod | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-m005 | Ophthalmic VEGF Antagonists | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-050 | Opioid Dependence Agents | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-051 | Opioids - Chronic | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-hu-051 | Opioids - Chronic - Healthy U | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-052 | Opioids - Limitations | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-hu-052 | Opioids - Limitations - Healthy U | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-141 | Opzelura | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-054 | Osteoporosis Medications | May 01, 2021 | April 19, 2021 | April 19, 2022 |
| pharm-m035 | Oxlumo | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-M035 | Oxlumo - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-ma-M035 | Oxlumo - Medicare Advantage | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-128 | Oxervate | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-hu-128 | Oxervate - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| P | ||||
| pharm-080 | Pancreatic Enzymes | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-089 | Parkinson's Agents | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-057 | Phosphodiesterase Type 5 (PDE-5) Inhibitor | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-103 | Pharmacy Continuity of Care | February 01, 2021 | January 27, 2021 | January 27, 2022 |
| pharm-058 | Phenylbutyrates | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-058 | PHENYLBUTYRATES - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-059 | Phenylketonuria (PKU) | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| Pharm-M026 | Place of Service for Pharmaceutical Infusions | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-100 | Prevymis | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-056 | Prior Authorization and Medical Necessity Policy | August 21, 2019 | April 22, 2019 | August 21, 2020 |
| pharm-060 | Promacta | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-060 | Promacta - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-061 | Psoriasis | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-061 | Psoriasis - Healthy U | June 01, 2022 | April 01, 2022 | April 01, 2023 |
| pharm-m022 | Psoriasis- Medical Infused Drugs | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-062 | Psoriatic Arthritis | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-062 | Psoriatic Arthritis - Healthy U | June 01, 2022 | April 01, 2022 | April 01, 2023 |
| pharm-m023 | Psoriatic Arthritis- Medical Infused Drugs | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-063 | Pulmonary Arterial Hypertension | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-045 | Pulmozyme ® | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-045 | Pulmozyme - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| R | ||||
| PHARM-064 | Revcovi | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| PHARM-131 | Rezurock | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-131 | Rezurock - Healthy U | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-065 | Rheumatoid Arthritis | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-065 | Rheumatoid Arthritis - Healthy U | June 01, 2022 | April 01, 2022 | April 01, 2023 |
| pharm-m024 | Rheumatoid Arthritis-Medical Infused Drugs | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-114 | Rocklatan and Rhopressa | February 01, 2021 | January 27, 2021 | January 27, 2022 |
| pharm-hu-114 | Rocklatan and Rhopressa - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-084 | Ruzurgi- Firdapse | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| S | ||||
| pharm-066 | Sandostation LAR | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-066 | Sandostatin LAR - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-ma-066 | Sandostatin LAR - Medicare Advantage | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-m037 | Saphnelo | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-ma-m037 | Saphnelo - Advantage U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-hu-m037 | Saphnelo - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-067 | Savella | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-hu-067 | Savella - Healthy U | March 1, 2022 | February 14, 2022 | February 14, 2023 |
| pharm-109 | Signifor | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-m013 | Soliris & Ultomiris | November 01, 2021 | October 13, 2021 | October 13, 2022 |
| pharm-069 | Spravato | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-069 | Spravato - - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-m007 | Spinraza | April 01, 2021 | January 27, 2021 | January 27, 2022 |
| pharm-071 | Brand Statins | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-071 | Brand Statins - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-115 | Step Therapy | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-hu-115 | Step Therapy - Healthy U | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-070 | Subcutaneous Methotrexate | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-070 | Subcutaneous Methotrexate - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-107 | Sunosi | January 1, 2022 | December 13, 2021 | December 13, 2022 |
| pharm-073 | Synagis | February 01, 2021 | January 27, 2021 | January 27, 2022 |
| pharm-hu-073 | Synagis - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| T | ||||
| PHARM-HU-132 | Tavneous - Healthy U | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-m031 | Tecartus | November 01, 2020 | October 28, 2020 | October 28, 2021 |
| pharm-ma-m031 | Tecartus - Advantage U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-m016 | Tepezza | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-M016 | Tepezza - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-ma-M016 | Tepezza - Medicare Advantage | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-m008 | Testopel | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| PHARM-HU-M038 | Tezspire - Healthy U | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-M038 | Tezspire | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-074 | Topiramate ER Sprinkle Capsules | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| U | ||||
| pharm-075 | Ulcerative Colitis | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| PHARM-HU-075 | Ulcerative Colitis - Healthy U | June 01, 2022 | April 01, 2022 | April 01, 2023 |
| pharm-m025 | Ulcerative Colitis - Medical Infused Drugs | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-M025 | Ulcerative Colitis Medical Infused Drugs - Healthy U | January 01, 2022 | January 01, 2022 | January 27, 2022 |
| V | ||||
| pharm-085 | Vasopressin Receptor Antagonists (VRA) | November 01, 2020 | October 28, 2020 | October 28, 2021 |
| pharm-hu-085 | Vasopressin Receptor Antagonists - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-090 | Vascepa | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-090 | Vascepa - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-077 | VMAT-2 Inhibitors | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-077 | VMAT - 2 Inhibitors - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-m032 | Vyepti | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-M032 | Vyepti - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-ma-M032 | Vyepti - Medicare Advantage | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| W | ||||
| pharm-125 | Wakix | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-hu-125 | Wakix - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| X | ||||
| pharm-078 | Xifaxan | July 01, 2021 | May 01, 2021 | April 19, 2022 |
| pharm-hu-078 | Xifaxan - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-ma-m011 | Xiaflex - Advantage U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| pharm-079 | Xolair | September 01, 2021 | August 18, 2021 | August 18, 2022 |
| pharm-086 | XHANCE | April 01, 2022 | March 16, 2022 | March 16, 2023 |
| PHARM-HU-086 | Xhance - Healthy U | April 1, 2022 | March 16, 2022 | March 16, 2023 |
| pharm-m011 | Xiaflex | February 01, 2021 | January 27, 2021 | January 27, 2022 |
| Y | ||||
| pharm-m009 | Yescarta | June 1, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-hu-M009 | Yescarta - Healthy U | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-ma-M009 | Yescarta - Medicare Advantage | June 01, 2022 | May 18, 2022 | May 18, 2023 |
| pharm-087 | Yupelri | December 01, 2020 | November 23, 2020 | November 23, 2021 |
| pharm-hu-087 | Yupelri - Healthy U | February 1, 2022 | January 19, 2022 | January 19, 2023 |
| Z | ||||
| pharm-m010 | Zilretta | August 01, 2021 | July 21, 2021 | July 21, 2022 |
| pharm-m012 | Zolgensma | January 1, 2022 | December 13, 2021 | December 13, 2022 |