Part B Pharmacy Policies
Navigate directly to a letter:
-
A
- ANIFRO~2.PDF
- Abatacept (Orencia)
- Agalsidase Beta (Fabrazyme)
- Alemtuzumab (Lemtrada)
- Alglucosidase alfa (e.g., Lumizyme), Avalglucosidase alfa-ngpt (Nexviazyme)
- Alpha 1-Antitrypsin Therapy (Prolastin-C, Aralast NP, Glassia, Zemaira)
- Anifrolumab-Fnia (Saphnelo)
- Anifrolumab-fnia_(Saphnelo)_2.pdf
-
B
- Belimumab (Benlysta) for Intravenous Use
- Botulinum_Toxin_Agents.pdf
- Botulinum_Toxin_Agents_2.pdf
- Burosumab-Twza (Crysvita)
-
C
- CGM Policy
- Canakinumab (Ilaris)
- Cerliponase Alfa (Brineura)
- Coagulation Factors
- Collagenase Clostridum Histolyticum (Xiaflex), Collagenase Clostridium Histolyticum-Aaes (Qwo)
- Crizanlizumab-Tmca (Adakveo)
-
D
- Denosumab (Prolia, Xgeva), Romosozumab-Aqqg (Evenity)
- Dofetilide (Tikosyn) Use in the Inpatient Setting
-
E
- ECULIZ~2.PDF
- EVINAC~2.PDF
- Eculizumab (Soliris) and Related Biosimilars, Ravulizumab-Cwvz (Ultomiris)
- Eculizumab_(Soliris)_and_Related_Biosimilars,_Ravulizumab-cwvz_(Ultomiris)_2.pdf
- Efgartigimod Alfa (Vyvgart) and Efgartigimod Alfa and Hyaluronidase Qvfc (Vyvgart Hytrulo)
- Emapalumab-lzsq (Gamifant)
- Enteral_Nutritional_Therapy.pdf
- Enteral_Nutritional_Therapy_2.pdf
- Enzyme Replacement Therapy for Mucopolysaccharidosis
- Enzyme Replacement for the Treatment of Gaucher's Disease
- Eptinezumab_Jjmr_(Vyepti).pdf
- Erythropoeisis Stimulating Agents (ESAs)
- Evinacumab-Dgnb (Evkeeza)
- Evinacumab-dgnb_(Evkeeza)_2.pdf
- Exon Skipping for Duchenne Muscular Dystrophy (DMD)
- easset_upload_file29400_381554_e.pdf
-
F
Back to top -
G
Back to top -
I
- Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
- Immune_Globulin_Intravenous_(IVIG),_Subcutaneous_(SCIG)_2.pdf
- Inclisiran (Leqvio)
- Inebilizumab-Cdon (Uplinza)
- Infliximab and Related Biosimilars
- Interleukin-5 (IL-5) Antagonist (e.g Cinqair, Nucala) and IL-5 Receptor Antagonist (e.g. Fasenra)
- Intravenous_Ketamine_(Ketalar)_and_Intranasal_Esketamine_(Spravato).pdf
- Intravenous_Ketamine_(Ketalar)_and_Intranasal_Esketamine_(Spravato)_2.pdf
- Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists
-
L
Back to top -
M
- Medicare_Part_B_vs_Part_D_Crossover_Drugs.pdf
- Monoclonal Antibodies Directed Against Amyloid For The Treatment of Alzheimer's Disease
- Monoclonal_Antibodies_Directed_Against_Amyloid_For_The_Treatment_of_Alzheimer_Disease.pdf
-
N
Back to top -
O
- Ocrezilumab (Ocrevus)
- Octreotide_Acetate_(Sandostatin_LAR_Depot).pdf
- Octreotide_Acetate_(Sandostatin_LAR_Depot)_2.pdf
- Off-Label Coverage for Prescription Drugs and-or Biologics
- Olipudase Alfa-Rpcp (Xenpozyme)
- Omalizumab (Xolair)
-
P
Back to top -
R
- RISANK~2.PDF
- Risankizumab-Rzaa (Skyrizi) for Intravenous Use
- Risankizumab-rzaa_(Skyrizi)_for_Intravenous_Use_2.pdf
- Rozanolixizumab-Noli_(Rystiggo).pdf
-
S
- SPESOL~2.PDF
- Sebelipase Alfa (Kanuma)
- Spesolimab-Sbzo (Spevigo)
- Spesolimab-sbzo_(Spevigo)_2.pdf
- Sutimlimab-Jome (Enjaymo)
-
T
- Teplizumab-Mzwv (Tzield)
- Teprotumumab (Tepezza)
- Tezepelumab-Ekko (Tezspire)
- Tildrakizumab-Asmn (Ilumya)
- Tocilizumab (Actemra) for IV Infusion and SQ Injection
- Tofersen (Qalsody)
- Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN)
- Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous,
- Treatments for Complex Regional Pain Syndrome (CRPS)
- Triamcinolone Acetonide Extended Release Injectable (Zilretta)
-
U
Back to top -
V
- Vedolizumab (Entyvio) For Intravenous Use
- Velmanase alfa (Lamzede)
- Voretigene Neparvovec-Rzyl (Luxturna)