Part B Pharmacy Policies
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A
- ADAMTS13, recombinant-krhn (Adzynma).pdf
- Abatacept (Orencia).pdf
- Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio).pdf
- Alemtuzumab (Lemtrada).pdf
- Algucosidase alfa (Lumizyme), Avalglucosidase alfa-ngpt (Nexviazyme), Cipaglucosidase alfa-atga (Pombiliti).pdf
- Alpha 1-Antitrypsin Therapy (Prolastin-C, Aralast NP, Glassia, Zemaira).pdf
- Anifrolumab-fnia (Saphnelo).pdf
- Axatilimab-csfr (Niktimvo) for Intravenous Use.pdf
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B
- Belimumab (Benlysta) for Intravenous Use.pdf
- Botulinum Toxin Agents.pdf
- Burosumab-twza (Crysvita).pdf
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C
- CGM Policy .pdf
- Canakinumab (Ilaris).pdf
- Cerliponase alfa (Brineura).pdf
- Coagulation Factors.pdf
- Collagenase Clostridum Histolyticum (Xiaflex), Collagenase Clostridium Histolyticum-Aaes (Qwo).pdf
- Crizanlizumab-tmca (Adakveo).pdf
- Crovalimab-akkz (PiaSky).pdf
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D
- Denosumab (Prolia, Xgeva) and related biosimilars, and Romosozumab-aqqg (Evenity).pdf
- Denosumab (Prolia, Xgeva), Romosozumab-aqqg (Evenity).pdf
- Dofetilide (Tikosyn) Use in the Inpatient Setting.pdf
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E
- Eculizumab (Soliris) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris) for intravenous administration.pdf
- Efgartigimod alfa (Vyvgart) and Efgartigimod alfa and Hyaluronidase qvfc (Vyvgart Hytrulo).pdf
- Emapalumab-lzsq (Gamifant).pdf
- Enteral Nutritional Therapy.pdf
- Enzyme Replacement Therapy for Mucopolysaccharidosis (e.g. Aldurazyme, Elaprase, Vimizim, Naglazyme, Mepsevii, etc.).pdf
- Enzyme Replacement for the Treatment of Gaucher's Disease.pdf
- Eptinezumab jjmr (Vyepti).pdf
- Erythropoeisis Stimulating Agents (ESAs).pdf
- Evinacumab-dgnb (Evkeeza).pdf
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F
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G
- Givosiran (Givlaari) and Panhematin (Hemin).pdf
- Golimumab (Simponi Aria) Intravenous Injection.pdf
- Guselkumab (Tremfya) Injection for Intravenous Use.pdf
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I
- Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG).pdf
- Inclisiran (Leqvio).pdf
- Inebilizumab-cdon (Uplinza).pdf
- Interleukin-5 (IL-5) Antagonist (e.g. Cinqair, Nucala) and IL-5 Receptor Antagonist (e.g. Fasenra).pdf
- Intravenous (IV) Iron Preparations.pdf
- Intravenous Infliximab and Related Biosimilars.pdf
- Intravenous Ketamine (Ketalar) and Intranasal Esketamine (Spravato).pdf
- Intravitreal Vascular Endothelial Growth Factor (VEGF) Antagonists, Combo VEGF-Angiopoietin (Ang-2) Inhibitors, and Biosims.pdf
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L
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M
- Medicare Part B vs Part D Crossover Drugs.pdf
- Mirikizumab-mrkz (Omvoh) for Intravenous Use.pdf
- Monoclonal Antibodies Directed Against Amyloid For The Treatment of Alzheimer Disease.pdf
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N
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O
- Ocrezilumab (Ocrevus) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo).pdf
- Octreotide Acetate (Sandostatin LAR Depot).pdf
- Off-Label Coverage for Prescription Drugs and-or Biologics.pdf
- Olipudase alfa-rpcp (Xenpozyme).pdf
- Omalizumab (Xolair).pdf
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P
- Patisiran (Onpattro) and Vutrisiran (Amvuttra).pdf
- Pegloticase (Krystexxa).pdf
- Pozelimab-bbfg (Veopoz).pdf
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R
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S
- Sebelipase alfa (Kanuma).pdf
- Secukinumab (Cosentyx) for Intravenous Use.pdf
- Spesolimab-sbzo (Spevigo).pdf
- Sutimlimab-jome (Enjaymo).pdf
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T
- Teplizumab-mzwv (Tzield).pdf
- Teprotumumab (Tepezza).pdf
- Tezepelumab-ekko (Tezspire).pdf
- Tildrakizumab-asmn (Ilumya).pdf
- Tocilizumab (Actemra) and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection.pdf
- Total Parenteral Nutrition (TPN), Intradialytic Parenteral Nutrition (IDPN), Intraperitoneal Nutrition (IPN).pdf
- Treatment of Pulmonary Artery Hypertension With Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents.pdf
- Treatments for Complex Regional Pain Syndrome (CRPS).pdf
- Triamcinolone Acetonide Extended Release Injectable (Zilretta).pdf
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U
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V
- Vedolizumab (Entyvio) For Intravenous Use.pdf
- Velmanase alfa (Lamzede).pdf
- Voretigene Neparvovec-Rzyl (Luxturna).pdf