Utilization Management
Prior Authorization and Step Therapy Policies for Commercial and Individual Family Business
| Migraine - Nurtec ODT PA Policy | Policy |
| Migraine - Qulipta PA Policy | Policy |
| Migraine - Reyvow PA Policy | Policy |
| Migraine - Ubrelvy PA Policy | Policy |
| Migraine - Zavzpret PA | Policy |
| Migraine Medication Step Therapy Policy | Policy |
| Multiple Sclerosis - Avonex PA Policy | Policy |
| Multiple Sclerosis - Bafiertam PA Policy | Policy |
| Multiple Sclerosis - Betaseron, Extavia PA Policy | Policy |
| Multiple Sclerosis - Briumvi PA | Policy |
| Multiple Sclerosis - CD20-Directed Cytolytic Antibody Infused Products | Policy |
| Multiple Sclerosis - Dalfampridine PSM Policy | Policy |
| Multiple Sclerosis - Dimethyl Fumarate PA Policy | Policy |
| Multiple Sclerosis - Fingolimod PA Policy | Policy |
| Multiple Sclerosis - Glatiramer Products PA Policy | Policy |
| Multiple Sclerosis - Kesimpta PA Policy | Policy |
| Multiple Sclerosis - Mavenclad PA Policy | Policy |
| Multiple Sclerosis - Mayzent PA Policy | Policy |
| Multiple Sclerosis - Ocrevus Zunovo PA | Policy |
| Multiple Sclerosis - Plegridy PA | Policy |
| Multiple Sclerosis - Ponvory PA Policy | Policy |
| Multiple Sclerosis - Rebif PA Policy | Policy |
| Multiple Sclerosis - Tascenso ODT PA | Policy |
| Multiple Sclerosis - Teriflunomide PA | Policy |
| Multiple Sclerosis - Vumerity PA Policy | Policy |
| Multiple Sclerosis and Ulcerative Colitis - Zeposia PA Policy | Policy |
| Multiple Sclerosis and Ulcerative Colitis - Zeposia PSM for National Preferred, High Performance, and Basic Formularies - Choice, Alternate | Policy |
| Multiple Sclerosis Care Value Policy | Policy |
| Multiple Sclerosis PSM Policy | Policy |
| Muscular Dystrophy - Agamree PA | Policy |
| Muscular Dystrophy - Deflazacort PSM | Policy |
| Muscular Dystrophy - Duvyzat PA | Policy |
| Naloxone Injection Step Therapy Policy | Policy |
| Nasal Steroids Step Therapy Policy | Policy |
| Natpara PA Policy | Policy |
| Nephrology - Filspari PA Policy | Policy |
| Nephrology - Jesduvroq PA | Policy |
| Nephrology - Tarpeyo PA | Policy |
| Nephrology - Vafseo PA | Policy |
| Nephrology - Xphozah PA | Policy |
| Neurology - Daybue PA | Policy |
| Neurology - Leqembi PA | Policy |
| Neurology - Oxybate Products PA Policy | Policy |
| Neurology - Relyvrio PA | Policy |
| Neurology - Riluzole Products PA Policy | Policy |
| Neurology - Skyclarys PA | Policy |
| Niemann-Pick disease type C - Aqneursa PA | Policy |
| Niemann-Pick disease type C - Aqneursa PA | Policy |
| Niemann-Pick disease type C - Miplyffa PA | Policy |
| Nonsteroidal Anti-Inflammatory Drug Step Therapy Policy | Policy |
| Nonsteroidal Anti-Inflammatory Drugs Step Therapy Policy | Policy |
| Nuedexta PA Policy | Policy |
| Oncology - Abiraterone Acetate (Zytiga) Care Value Policy | Policy |
| Oncology - Abiraterone Acetate (Zytiga) PSM Policy | Policy |
| Oncology - Augtyro PA | Policy |
| Oncology - Ayvakit PA Policy | Policy |
| Oncology - Balversa PA Policy | Policy |
| Oncology - Bexarotene (Oral) PA | Policy |
| Oncology - Bexarotene (Topical) PA | Policy |
| Oncology - Bosulif PA Policy | Policy |
| Oncology - Cabometyx PA | Policy |
| Oncology - Caprelsa PA Policy | Policy |
| Oncology - Cometriq PA Policy | Policy |
| Oncology - Copiktra PA Policy | Policy |
| Oncology - Cyclin Dependent Kinases 4,6 Inhibitors for Breast Cancer | Policy |
| Oncology - Cyclin Dependent Kinases 4,6 Inhibitors PSM Policy | Policy |
| Oncology - Dasatinib PSM | Policy |
| Oncology - Daurismo PA Policy | Policy |
| Oncology - Everolimus Products PA Policy | Policy |
| Oncology - Everolimus Products PSM Policy | Policy |
| Oncology - Farydak PA Policy | Policy |
| Oncology - Fruzaqla PA | Policy |
| Oncology - Gavreto PA Policy | Policy |
| Oncology - Gilotrif PA Policy | Policy |
| Oncology - Gomekli PA | Policy |
| Oncology - Iclusig PA Policy | Policy |
| Oncology - Idhifa PA Policy | Policy |
| Oncology - Imatinib Products PA | Policy |
| Oncology - Imatinib PSM Policy | Policy |
| Oncology - Imbruvica PSM Policy | Policy |
| Oncology - Inlyta PA Policy | Policy |
| Oncology - Itovebi PA | Policy |
| Oncology - Iwilfin PA | Policy |
| Oncology - Jakafi PA Policy | Policy |
| Oncology - Koselugo PA | Policy |
| Oncology - Krazati PA | Policy |
| Oncology - Lapatinib (Tykerb) PA Policy | Policy |
| Oncology - Lazcluze PA | Policy |
| Oncology - Lenvima PA Policy | Policy |
| Oncology - Lonsurf PA Policy | Policy |
| Oncology - Lytgobi PA | Policy |
| Oncology - Nerlynx PA Policy | Policy |
| Oncology - Nexavar PA Policy | Policy |
| Oncology - Nilutamide PA Policy | Policy |
| Oncology - Ogsiveo PA | Policy |
| Oncology - Ojemda PA | Policy |
| Oncology - Ojjaara PA | Policy |
| Oncology - Orserdu PA | Policy |
| Oncology - Pazopanib PA | Policy |
| Oncology - Pemazyre PA Policy | Policy |