Prescription Drug Policies
View our plain language policies below
- AAT Deficiency
- Acthar Gel – corticotropin
- Actimmune - Interferon Gamma-1b
- Acute CGRP Antagonist Therapies
- Adakveo - Crizanlizumab
- Adalimumab Products
- Additional Quantities Requests
- Adempas - Riociguat
- Adzynma - ADAMTS13 Recombinant
- Agamree – vamorolone
- Aldurazyme - Laronidase
- Alopecia Areata Products
- Altabax - Retapamulin Step - Edit
- Amvuttra
- Ankylosing Spondylitis Immunomodulator Therapies
- Anticoagulant Novel Savaysa Step - Edit
- Antifungals Topical Step - Edit
- Aphexda – motixafortide
- Apomorphine HCL
- Aptiom Step Edit
- ARB - Angiotensin II Receptor Blocker - Generic First Step Edit
- Arcalyst - Rilonacept
- Arikayce -amikacin liposomal
- Atopic Dermatitis Immunomodulator Therapies
- Austedo -deutetrabenazine
- Azelaic Acid
- Behavioral Health
- Benlysta -belimumab
- Bisphosphonate - Oral Step-Edit
- Botox -onabotuliumtoxin A
- Brexafemme - ibrexafungerp
- Brimonidine Tartrate Gel
- Brineura -cerliponase alfa
- Briumvi - ublituximab
- Briviact -brivaracetam Step-Edit
- Bronchitol (mannitol)
- Bylvay – odevixibat
- Cablivi – caplacizumab
- Camzyos - mavacamten
- Carbaglu - carglumic acid
- Casgevy – exagamglogene autotemcel
- Cayston - aztreonam
- Cerdelga - Eiglustat Tartrate
- Cerezyme - imiglucerase
- Chenodal – chenodiol
- Cholbam - cholic acid
- Cinqair - Reslizumab
- Condylox Step Edit
- Continuous Glucose monitors
- Contraceptive Coverage Under Preventative Health Services in Wellness Benefit
- Corlanor -ivabradine
- Cosela – trilaciclib
- Cosentyx – secukinumab
- Cresemba -isavuconazonium sulfate
- Crohns Disease Immunomodulator Therapies
- Crotan - crotamiton
- Crysvita - burosumab
- Cystadrops
- Cytogam -cytomegalovirus immune globulin- human
- Dalfampridine
- Daliresp - roflumilast
- Denavir - penciclovir cream Step-Edit
- Diabetes Drug Therapies
- Doptelet - avatrombopag
- Doxercalciferol
- Dry Eye Disease Step Edit
- Dupixent - dupilumab
- Duvyzat – givinostat
- Dyanavel XR -amphetamine ER Suspension
- Dysport -abobotulinumtoxin A
- Egrifta -tesamorelin acetate
- EHB Combination Medications
- Elaprase - idursulfase
- Elelyso - taliglucerase alfa
- Elevidys - delandistrogene moxeparvovec
- Emflaza - deflazacort
- Empaveli – pegcetacoplan
- Enjaymo - sutimlimab
- Enspryng -satralizumab
- Entyvio - vedolizumab
- Epidiolex -cannabidiol
- Erectile Dysfunction Medications
- Esbriet - pirfenidone and Ofev -nintedanib esylate
- Eucrisa - crisaborole
- Evenity - romosozumab
- Evkeeza (evinacumab)
- Evrysdi - risdiplam
- Excluded Drug List
- Exjade - Deferasirox and Jadenu - Deferasirox
- Experimental Medications
- Fabhalta – iptacopan
- Fabrazyme and Elfabrio
- Fasenra - Benralizumab
- Fentanyl Breakthrough Pain
- Ferriprox - Deferiprone
- Fintepla - Fenfluramine
- Firdapse - amifampridine
- Fish Oil - Lovaza
- Flector Patch - Diclofenac Transdermal
- Forteo - Teriparatide
- Gabapentin Extended Release - Gralise and Horizant
- Galafold - Migalastat
- Gamifant - Emapalumab
- Gattex - Teduglutide
- Givlaari - Givosiran
- Growth Hormone
- Hemgenix - etranacogene dezaparvovec
- Hepatitis B Treatment
- Hepatitis C Treatment
- Hereditary Angioedema
- Hetlioz - tasimelteon
- Hyftor - topical sirolimus
- Ilaris - Canakinumab
- Imcivree - setmelanotide
- Immune Globulin Products
- Impavido - Miltefosine
- Inbrija - Levodopa Inhalation Powder
- Increlex -mecasermin
- Ingrezza -valbenazine
- Irritable Bowel Syndrome – Constipation Step-Edit
- Isotretinoin Oral
- Isturisa (osilodrostat)
- Ivermectin
- Jakafi -ruxolitinib
- Joenja – leniolisib
- Jublia -efinaconazole and Kerydin -tavaborole
- Juxtapid -lomitapide
- Jynarque -tolvaptan
- Kalydeco -ivacaftor
- Kanuma -sebelipase alfa
- Kerendia - finerenone
- Kepivance – palifermin
- Keveyis -dichlorphenamide
- Kevzara – sarilumab
- Kineret -anakinra
- Klisyri -tirbanibulin-
- Korlym -mifepristone
- Krystexxa -pegloticase
- Kuvan -sapropterin
- Lamzede – velmanase alfa
- Lemtrada -alemtuzumab
- Leqembi – lecanemab
- Leqvio - inclisiran
- Lenmeldy - atidarsagene autotemcel
- Leuprolide Acetate -Fensolvi - Lupron Depot - Lupron Depot-Ped - Leuprolide acetate - Lupaneta
- Livmarli – maralixibat
- Livtencity - maribavir
- Lokelma -sodium zirconium cyclosilicate
- Lumizyme -alglucosidase
- Lupkynis -voclosporin
- Luxturna -voretigene neparvovec
- Mandatory Generic Override Review
- Mavenclad -cladribine
- Illinois Medical Exception Process
- Medical Exception for Non-Covered Glucose Test Strips
- Medical Exception for Preferred BrandCopayment
- Medication Refill Threshold and Early Refill Exceptions Policy
- Mepsevii
- Migranal -dihydroergotamine mesylate Nasal Spray
- Mozobil -plerixafor
- Mulpleta -lusutrombopag
- Myalept -metreleptin
- Myobloc -rimabotulinumtoxin B
- Myfembree -relugolix-estradiol-norethindrone
- Mytesi -crofelemer
- Naglazyme -galsulfase
- Newly Approved Medications, Products, & Indications
- Nexletol -bempedoic acid and Nexlizet -bempedoid acid-ezetimibe
- Nexviazyme - alglucosidase alfa-ngpt
- Non Preferred ICS-LABA Combination Inhalers
- Non Preferred ICS Inhalers
- Non Radiographical Axial Sponyloarthritis
- Northera -droxidopa
- Nourianz -istradefylline
- Nplate -romiplostim
- Nucala -mepolizumab
- Nuedexta - dextromethorphan quinidine
- Nulibry - fosdenopterin
- Nuplazid
- Ocaliva -obeticholic acid
- Ocrevus - ocrelizumab
- Oncology Regimen Review
- Ongentys
- Onpattro -patisiran
- Opioids -Long Acting and Short Acting
- Opioid Partial Agonists Reverse Edit Policy
- Opzelura – ruxolitinib
- Oral Budesonide Products
- Orfadin -nitisinone and Nityr -nitisinone
- Oriahnn (elagolix, estradiol, and norethindrone)
- Orilissa -elagolix
- Orkambi -lumacaftor-ivacaftor
- Otezla -apremilast
- Oxbryta -voxelotor
- Oxervate -cenegermin
- Oxlumo - lumasiran
- Palforzia -peanut allergen powder
- Palynziq -pegvaliase-pqpz
- Paricalcitol Capsule Step-Edit
- Phenoxybenzamine
- Photrexa Viscous - Riboflavin 5 Phosphate
- Plaque Psoriasis Immunomodulator Therapies
- Polyarticular Juvenile Idiopathic Arthritis Immunomodulator Therapies
- Pombiliti and Opfolda
- PPI - Proton Pump Inhibitor - Coverage
- Pretomanid
- Preventive Vaccine
- Prevymis - letermovir
- Promacta - eltrombopag
- Prophylactic Calcitonin Gene-Related Peptide - CGRP - Inhibitor Therapies
- Psoriatic Arthritis Immunomodulator Therapies
- Pulmonary Arterial Hypertension Products
- Pulmozyme - dornase alfa
- Pyrukynd - mitapivat
- Qbrexza - glycopyrronium
- QHP - Coverage of Erectile Dysfunction Drugs
- Qudexy XR - topiramate ER - and Trokendi XR - topiramate ER
- Quillichew - methylphenidate HCl chew tab - ER
- Quillivant XR - methylphenidate HCL susp
- Radicava -edaravone
- Ravicti - glycerol phenylbutyrate
- Rayaldee - calcifediol
- Reblozyl - luspatercept
- Rebyota - fecal microbiota live
- Recorlev
- Regranex -becaplermin
- Relistor -methylnaltrexone bromide
- Remicade and Biosimilars
- Revatio -sildenafil
- Revcovi -elapegademase
- Reyvow -lasmiditan
- Rezurock - belumosudil
- Rheumatoid Arthritis Immunomodulator Therapies
- Rhofade -oxymetazoline
- Rituxan Ruxience and Truxima - rituximab
- Ryplazim – human plasminogen
- Rystiggo - rozanolixizumab
- Sabril -vigabatrin
- Samsca -tolvaptan
- Sandostatin -octreotide and Sandostatin LAR -octreotide
- Saphnelo - anifrolumab
- Savella -milnacipran
- Scenesse -afamelanotide-
- Sensipar -cinacalcet
- Signifor and Signifor LAR -pasireotide
- Sirturo -bedaquiline
- Skyclarys - omaveloxolone
- Sodium Glucose Co-Transporter (SGLT) 2 Non-Diabetes Indications
- Sodium Oxybate Products
- Sohonos – palovarotene
- Soliris -eculizumab
- Somatuline Depot -lanreotide acetate
- Somavert -pegvisomant
- Spevigo – spesolimab
- Spinraza -nusinersen
- Spravato -esketamine
- Spritam -levetiracetam ODT Step-Edit
- Statin -HMG CoA reductase inhibitor - Brand Name
- Strensiq - asfotase alfa
- Sucraid -sacrosidase
- Sunosi -soriamfetol
- Supprelin LA -histrelin acetate
- Symdeko -tezacaftor-ivacaftor
- Synagis -palivizumab
- Synarel
- Syprine -trientine hydrochloride
- Tavalisse -fostamatinib
- Tavneos – avacopan
- Tazorac - tazarotene
- Tegsedi -inotersen
- Tenapanor Products
- Tepezza - teprotumumab
- Testosterone -Implantable -Topical -Oral -and Nasal
- Tezspire - tezepelumab
- Thiola -tiopronin
- Tobi-tobramycin -Bethkis-tobramycin -Kitabis Pak-tobramycin - Tobramycin Compound for Inhalation
- Tocilizumab Products – pharmacy benefit
- Tocilizumab Products – medical benefit
- Topical Ivermectin Cream
- Topical Vitamin D3 - Taclonex and Vectical Step Edit
- Trikafta -elexacaftor-tezacaftor-ivacaftor
- Triptan Managed Dose Limit
- Triptodur -triptorelin
- Tymlos -abaloparatide
- Tysabri -natalizumab
- Tyvaso - treprostinil
- Tzield – teplizumab
- Ulcerative Colitis Immunomodulator Therapies
- Ultomiris -ravulizumab
- Uplizna -inebilizumab
- Veltassa -patiromer
- Veozah Step-Edit
- Verquvo (vericiguat)
- Viberzi
- Vijoice - alpelisib
- Vimizim -elosulfase alfa
- Virazole - ribavirin oral inhalation
- Vivjoa - oteseconazole
- Voquezna – vonoprazan
- Voxzogo – vosoritide
- VPRIV -velaglucerase alfa
- Vtama
- Vyjuvek - beremagene geperpavec
- Vyndaqel-Vyndamax -tafamidis meglumine
- Vyvgart
- WA Medical Exception Process
- Wakix -pitolisant
- Wainua - eplontersen
- Wegovy – semaglutide
- Wellness Coverage for HIV Prophylaxis Regimens
- Wellness Coverage for Statin Medications -HMG CoA reductase inhibitors
- Winlevi -clascoterone-
- Xcopri -cenobamate
- Xdemvy – lotilaner
- Xenazine -tetrabenazine
- Xenpozyme – olipudase alfa
- Xeomin -incobotulinumtoxin A
- Xepi - ozenoxacin Step-Edit
- Xermelo - telotristat ethyl
- Xiaflex - collagenase clostridium histolyticum
- Xifaxan - rifaximin
- Xolair - omalizumab
- Xolremdi – mavorixafor
- Xuriden - uridine triacetate
- Yupelri
- Zavesca - miglustat
- Zilbrysq – zilucoplan
- Zokinvy - lonafarnib
- Zoladex
- Zolgensma -onasemnogene abeparvovec
- Zoryve
- Ztalmy
- Zurzuvae – zuranolone
- -Medications Excluded Due to Lack of Clinical Benefit