Utilization Management
Prescription Drug Prior Authorization and Step Therapy Policies for Cascade Select Marketplace Business
Not all medications will be covered on the formulary. Non-formulary medications are subject to the Medical Necessity for Non-Formulary Medications policy. Please consult the formulary to verify coverage.
Oncology - Cometriq PA Policy De-Identified | Policy |
Oncology - Copiktra PA Policy De-Identified | Policy |
Oncology - Cotellic PA Policy De-Identified | Policy |
Oncology - Cyclin Dependent Kinases 4,6 Inhibitors PSM Policy De-Identified | Policy |
Oncology - Daurismo PA Policy De-Identified | Policy |
Oncology - Erivedge PA Policy De-Identified | Policy |
Oncology - Erleada PA Policy De-Identified | Policy |
Oncology - Erlotinib DQM Policy - Per Rx De-Identified | Policy |
Oncology - Erlotinib PA Policy De-Identified | Policy |
Oncology - Everolimus DQM Policy - Per Rx De-Identified | Policy |
Oncology - Everolimus Products PA Policy De-Identified | Policy |
Oncology - Everolimus Products PSM Policy De-Identified | Policy |
Oncology - Exkivity PA Policy De-Identified | Policy |
Oncology - Farydak PA Policy De-Identified | Policy |
Oncology - Fotivda PA Policy De-Identified | Policy |
Oncology - Gavreto DQM Policy - Per Rx De-Identified | Policy |
Oncology - Gavreto PA Policy De-Identified | Policy |
Oncology - Gilotrif PA Policy De-Identified | Policy |
Oncology - Ibrance PA Policy De-Identified | Policy |
Oncology - Iclusig PA Policy De-Identified | Policy |
Oncology - Idhifa PA Policy De-Identified | Policy |
Oncology - Imatinib DQM Policy - Per Rx De-Identified | Policy |
Oncology - Imatinib PA Policy De-Identified | Policy |
Oncology - Imatinib PSM Policy De-Identified | Policy |
Oncology - Imbruvica PA Policy De-Identified | Policy |
Oncology - Imbruvica PSM Policy De-Identified | Policy |
Oncology - Inlyta PA Policy De-Identified | Policy |
Oncology - Inqovi PA Policy De-Identified | Policy |
Oncology - Inrebic PA Policy De-Identified | Policy |
Oncology - Iressa DQM Policy - Per Rx De-Identified | Policy |
Oncology - Iressa PA Policy De-Identified | Policy |
Oncology - Jakafi PA Policy De-Identified | Policy |
Oncology - Kisqali and Kisqali Femara Co-Pack PA Policy De-Identified | Policy |
Oncology - Koselugo PA De-Identified | Policy |
Oncology - Krazati PA Policy De-Identified | Policy |
Oncology - Lapatinib DQM Policy - Per Rx De-Identified | Policy |
Oncology - Lapatinib PA Policy De-Identified | Policy |
Oncology - Lenalidomide PA Policy De-Identified | Policy |
Oncology - Lenvima PA Policy De-Identified | Policy |
Oncology - Lonsurf PA Policy De-Identified | Policy |
Oncology - Lorbrena PA Policy De-Identified | Policy |
Oncology - Lumakras PA Policy De-Identified | Policy |
Oncology - Lynparza PA Policy De-Identified | Policy |
Oncology - Lytgobi PA Policy De-Identified | Policy |
Oncology - Mekinist PA Policy De-Identified | Policy |
Oncology - Mektovi PA Policy De-Identified | Policy |
Oncology - Nerlynx PA Policy De-Identified | Policy |
Oncology - Nilutamide PA Policy De-Identified | Policy |
Oncology - Ninlaro PA Policy De-Identified | Policy |
Oncology - Nubeqa PA Policy De-Identified | Policy |
Oncology - Odomzo PA Policy De-Identified | Policy |
Oncology - Onureg PA Policy De-Identified | Policy |
Oncology - Orgovyx DQM Policy - Per Rx De-Identified | Policy |
Oncology - Orgovyx PA Policy De-Identified | Policy |
Oncology - Pemazyre PA Policy De-Identified | Policy |
Oncology - Piqray PA Policy De-Identified | Policy |
Oncology - Pomalyst PA Policy De-Identified | Policy |
Oncology - Qinlock DQM Policy - Per Rx De-Identified | Policy |
Oncology - Qinlock PA Policy De-Identified | Policy |
Oncology - Retevmo PA Policy De-Identified | Policy |
Oncology - Rezlidhia PA Policy De-Identified | Policy |
Oncology - Rozlytrek DQM Policy - Per Rx De-Identified | Policy |
Oncology - Rozlytrek PA Policy De-Identified | Policy |
Oncology - Rubraca PA Policy De-Identified | Policy |
Oncology - Rydapt PA Policy De-Identified | Policy |
Oncology - Scemblix PA Policy De-Identified | Policy |
Oncology - Sorafenib PA Policy De-Identified | Policy |
Oncology - Sorafenib PSM Policy De-Identified | Policy |
Oncology - Sprycel DQM Policy - Per Rx De-Identified | Policy |
Oncology - Sprycel PA Policy De-Identified | Policy |
Oncology - Stivarga PA Policy De-Identified | Policy |
Oncology - Sunitinib PA Policy De-Identified | Policy |
Oncology - Sunitinib PSM Policy De-Identified | Policy |
Oncology - Sutent DQM Policy - Per Rx De-Identified | Policy |
Oncology - Tabrecta PA Policy De-Identified | Policy |
Oncology - Tafinlar PA Policy De-Identified | Policy |
Oncology - Tagrisso PA Policy De-Identified | Policy |
Oncology - Talzenna PA Policy De-Identified | Policy |
Oncology - Tasigna DQM Policy - Per Rx De-Identified | Policy |
Oncology - Tasigna PA Policy De-Identified | Policy |
Oncology - Tazverik PA Policy De-Identified | Policy |
Oncology - Temozolomide Capsules PA Policy De-Identified | Policy |
Oncology - Tepmetko PA Policy De-Identified | Policy |
Oncology - Thalomid PA Policy De-Identified | Policy |
Oncology - Tibsovo PA Policy De-Identified | Policy |
Oncology - Truseltiq PA Policy De-Identified | Policy |
Oncology - Tukysa PA Policy De-Identified | Policy |
Oncology - Turalio PA Policy De-Identified | Policy |
Oncology - Valchlor PA Policy De-Identified | Policy |
Oncology - Venclexta DQM policy - Per Rx De-Identified | Policy |
Oncology - Venclexta PA Policy De-Identified | Policy |
Oncology - Verzenio PA Policy De-Identified | Policy |
Oncology - Vistogard DQM Policy - Per Rx De-Identified | Policy |
Oncology - Vistogard PA Policy De-Identified | Policy |
Oncology - Vitrakvi DQM Policy - Per Rx De-Identified | Policy |
Oncology - Vitrakvi PA Policy De-Identified | Policy |
Oncology - Vizimpro PA Policy De-Identified | Policy |
Oncology - Vonjo PA Policy De-Identified | Policy |
Oncology - Votrient PA Policy De-Identified | Policy |
Oncology - Welireg PA Policy De-Identified | Policy |