Utilization Management
Prior Authorization and Step Therapy Policies for Commercial and Individual Family Business
| Oncology - Retevmo PA Policy | Policy |
| Oncology - Revlimid PA Policy | Policy |
| Oncology - Revuforj PA | Policy |
| Oncology - Romvimza PA | Policy |
| Oncology - Rozlytrek PA Policy | Policy |
| Oncology - Sorafenib PA | Policy |
| Oncology - Sprycel PA Policy | Policy |
| Oncology - Stivarga PA Policy | Policy |
| Oncology - Sunitinib PA Policy | Policy |
| Oncology - Tabrecta PA Policy | Policy |
| Oncology - Tagrisso PA Policy | Policy |
| Oncology - Tasigna (Nilotinib Products) PA | Policy |
| Oncology - Tazverik PA Policy | Policy |
| Oncology - Temozolomide Capsules PA Policy | Policy |
| Oncology - Truqap PA | Policy |
| Oncology - Tukysa PA Policy | Policy |
| Oncology - Turalio PA Policy | Policy |
| Oncology - Ukoniq PA Policy | Policy |
| Oncology - Valchlor PA Policy | Policy |
| Oncology - Venclexta PA Policy | Policy |
| Oncology - Vistogard PA Policy | Policy |
| Oncology - Vitrakvi PA Policy | Policy |
| Oncology - Vizimpro PA Policy | Policy |
| Oncology - Vonjo PA | Policy |
| Oncology - Voranigo PA | Policy |
| Oncology - Xermelo PA Policy | Policy |
| Oncology - Zolinza PA Policy | Policy |
| Oncology - Zydelig PA Policy | Policy |
| Oncology (Injectable - Bispecific - BCMA-Directed) - Elrexfio PA | Policy |
| Oncology (Injectable - Bispecific - BCMA-Directed) - Tecvayli PA | Policy |
| Oncology (Injectable - Bispecific - CD20-Directed) - Lunsumio PA | Policy |
| Oncology (Injectable - Bispecific - GPRC5D-Directed) - Talvey PA | Policy |
| Oncology (Injectable - CTLA-4 Antibody) - Imjudo PA | Policy |
| Oncology (Injectable - Programmed Death Receptor-1) - Opdualag PA | Policy |
| Oncology (Injectable - Programmed Death Receptor-1) - Tevimbra PA | Policy |
| Oncology (Injectable - Programmed Death Receptor-1) - Zynyz PA | Policy |
| Oncology (Injectable - Programmed Death-Ligand 1) - Tecentriq Hybreza PA | Policy |
| Oncology (Injectable) - Amtagvi PA | Policy |
| Oncology (Injectable) - Besremi PA | Policy |
| Oncology (Injectable) - Columvi PA | Policy |
| Oncology (Injectable) - Epkinly PA | Policy |
| Oncology (Injectable) - Gonadotropin-Releasing Hormone Analogs PA Policy | Policy |
| Oncology (Injectable) - Gonadotropin-Releasing Hormone Analogs PSM policy | Policy |
| Oncology (Injectable) - Synribo PA Policy | Policy |
| Oncology (Injectable) - Tecelra PA | Policy |
| Oncology (Intravesical) - Adstiladrin PA | Policy |
| Oncology (Intravesical) - Anktiva PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Alecensa PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Alunbrig PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Lorbrena PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Xalkori PA | Policy |
| Oncology (Oral - Anaplastic Lymphoma Kinase [ALK]-Positive Agent) - Zykadia PA | Policy |
| Oncology (Oral - Androgen Biosynthesis Inhibitor) - Abiraterone Acetate PA | Policy |
| Oncology (Oral - Androgen Biosynthesis Inhibitor) - Yonsa PA | Policy |
| Oncology (Oral - Androgen Receptor Inhibitor) - Erleada PA | Policy |
| Oncology (Oral - Androgen Receptor Inhibitor) - Nubeqa PA | Policy |
| Oncology (Oral - Androgen Receptor Inhibitor) - Xtandi PA | Policy |
| Oncology (Oral - BRAF Inhibitor) - Braftovi PA | Policy |
| Oncology (Oral - BRAF Inhibitor) - Tafinlar PA | Policy |
| Oncology (Oral - BRAF Inhibitor) - Zelboraf PA | Policy |
| Oncology (Oral - Bruton's Tyrosine Kinase Inhibitor) - Brukinsa PA | Policy |
| Oncology (Oral - Bruton's Tyrosine Kinase Inhibitor) - Imbruvica PA | Policy |
| Oncology (Oral - Bruton's Tyrosine Kinase Inhibitor) - Jaypirca PA | Policy |
| Oncology (Oral - Cyclin-Dependent Kinase 4 and 6 Inhibitor) - Ibrance PA | Policy |
| Oncology (Oral - Cyclin-Dependent Kinase 4 and 6 Inhibitor) - Verzenio PA | Policy |
| Oncology (Oral - EGFR Inhibitor) - Erlotinib PA | Policy |
| Oncology (Oral - EGFR Inhibitor) - Gefitinib PA | Policy |
| Oncology (Oral - FMS-Like Tyrosine Kinase 3 Inhibitor) - Rydapt PA | Policy |
| Oncology (Oral - FMS-Like Tyrosine Kinase 3 Inhibitor) - Vanflyta PA | Policy |
| Oncology (Oral - FMS-Like Tyrosine Kinase 3 Inhibitor) - Xospata PA | Policy |
| Oncology (Oral - Hedgehog Pathway Inhibitor) - Erivedge PA | Policy |
| Oncology (Oral - Hedgehog Pathway Inhibitor) - Odomzo PA | Policy |
| Oncology (Oral - Immunomodulator) - Lenalidomide PA | Policy |
| Oncology (Oral - Immunomodulator) - Pomalyst PA | Policy |
| Oncology (Oral - Immunomodulator) - Thalomid PA | Policy |
| Oncology (Oral - Isocitrate Dehydrogenase 1 Inhibitor) - Rezlidhia PA | Policy |
| Oncology (Oral - Isocitrate Dehydrogenase 1 Inhibitor) - Tibsovo PA | Policy |
| Oncology (Oral - MEK Inhibitor) - Cotellic PA | Policy |
| Oncology (Oral - MEK Inhibitor) - Mekinist PA | Policy |
| Oncology (Oral - MEK Inhibitor) - Mektovi PA | Policy |
| Oncology (Oral - Poly [ADP-Ribose] Polymerase Inhibitor) - Akeega PA | Policy |
| Oncology (Oral - Poly [ADP-Ribose] Polymerase Inhibitor) - Lynparza PA | Policy |
| Oncology (Oral - Poly [ADP-Ribose] Polymerase Inhibitor) - Rubraca PA | Policy |
| Oncology (Oral - Poly [ADP-Ribose] Polymerase Inhibitor) - Talzenna PA | Policy |
| Oncology (Oral - Poly [ADP-Ribose] Polymerase Inhibitor) - Zejula PA | Policy |
| Oncology (Oral - Proteasome Inhibitor) - Ninlaro PA | Policy |
| Ophthalmic - Glaucoma - Alpha-Adrenergic Agonists Step Therapy Policy | Policy |
| Ophthalmic - Glaucoma - Beta-adrenergic Blockers Step Therapy Policy | Policy |
| Ophthalmic - Glaucoma - Carbonic Anhydrase Inhibitors Step Therapy Policy | Policy |
| Ophthalmic - Glaucoma - Combination Products Step Therapy Policy | Policy |
| Ophthalmic - Glaucoma - Prostaglandins and Rho Kinase Inhibitors | Policy |
| Ophthalmic - Glaucoma - Prostaglandins and Rho Kinase Inhibitors Step Therapy Policy | Policy |
| Ophthalmic - Glaucoma - Prostaglandins PA Policy | Policy |
| Ophthalmic Anti-Allergics - Mast Cell Stabilizers Step Therapy Policy | Policy |
| Ophthalmic Anti-Allergics - Miscellaneous Step Therapy Policy | Policy |
| Ophthalmic Corticosteroids Step Therapy Policy | Policy |
| Ophthalmic for Dry Eye Disease - Cyclosporine Products PA Policy | Policy |
| Ophthalmic for Dry Eye Disease - Eysuvis PA Policy | Policy |
| Ophthalmic for Dry Eye Disease - Lacrisert PA Policy | Policy |
| Ophthalmic for Dry Eye Disease - Xiidra PA Policy | Policy |