Archived Pharmacy Policies
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A
- Abecma® (idecabtagene vicleucel intravenous infusion – Bristol-Myers Squibb and bluebird bio) - Archived on 04/30/2025
- Actemra® (tocilizumab intravenous infusion – Genentech/Roche) - Archived on 05/28/2025
- Acthar® Gel (repository corticotropin intramuscular and subcutaneous injection – Mallinckrodt) - Archived on 06/20/2025
- Adcetris® (brentuximab intravenous infusion – Seattle Genetics) - Archived on 04/30/2025
- Adstiladrin® (nadofaragene firadenovec-vncg intravesical suspension – Ferring) - Archived on 03/24/2026
- Adstiladrin® (nadofaragene firadenovec-vncg intravesical suspension – Ferring) - Archived on 05/28/2025
- Advate® (Antihemophilic Factor intravenous infusion – Baxalta/Takeda) - Archived on 03/23/2026
- Adynovate® (Antihemophilic Factor PEGylated intravenous infusion – Baxalta/Takeda) - Archived on 03/23/2026
- Afstyla® (Antihemophilic Factor single chain intravenous infusion – CSL Behring) - Archived on 03/23/2026
- Aldurazyme® (laronidase intravenous infusion – Genzyme) - Archived on 05/28/2025
- Alphanate (Antihemophilic Factor/von Willebrand Factor Complex [human] intravenous infusion – Grifols) - Archived on 03/23/2026
- AlphaNine SD (Coagulation Factor IX [plasma-derived] intravenous infusion – Grifols) - Archived on 03/19/2026
- Alprolix® (Coagulation Factor IX [recombinant] Fc fusion protein intravenous infusion – Bioverativ/Sanofi) - Archived on 03/19/2026
- Altuviiio™ (antihemophilic factor [recombinant] Fc-VWF-XTEN fusion protein-ehtl intravenous infusion − Bioverativ/Sanofi) - Archived on 03/19/2026
- Amondys 45™ (casimersen intravenous infusion – Sarepta) - Archived on 03/24/2026
- Amtagvi™ (lifileucel intravenous infusion – Iovance Biotherapeutics) - Archived on 03/24/2026
- Amvuttra™ (vutrisiran subcutaneous injection − Alnyam) - Archived on 04/30/2025
- Anktiva® (nogapendekin alfa inbakicept-pmln intravesical solution – ImmunityBio) - Archived on 03/24/2026
- Anktiva® (nogapendekin alfa inbakicept-pmln intravesical solution – ImmunityBio) - Archived on 05/28/2025
- Aucatzyl® (obecabtagene autoleucel intravenous infusion – Autolus) - Archived on 06/20/2025
B
- BeneFIX (Coagulation Factor IX [recombinant] intravenous infusion – Wyeth/Pfizer) - Archived on 03/19/2026
- Bkemv™ (eculizumab – aeeb intravenous infusion – Amgen) - Archived on 04/30/2025
- Botox® (onabotulinumtoxinA injection – Allergan/AbbVie) - Archived on 05/28/2025
- Breyanzi® (lisocabtagene maraleucel intravenous infusion – Juno Therapeutics) - Archived on 06/20/2025
- Brineura® (cerliponase alfa intraventricular infusion – BioMarin) - Archived on 05/28/2025
C
- Cabenuva® (cabotegravir extended-release intramuscular injection; rilpivirine extended-release intramuscular injection, co-packaged – ViiV/GlaxoSmithKline) - Archived on 03/23/2026
- Cablivi® (caplacizumab-yhdp intravenous infusion and subcutaneous injection – Genzyme/Sanofi) - Archived on 03/19/2026
- Carvykti® (ciltacabtagene autoleucel intravenous infusion – Janssen Biotech) - Archived on 04/30/2025
- Casgevy™ (exagamglogene autotemcel intravenous infusion – Vertex/CRISPR Therapeutics) - Archived on 05/28/2025
- Cerezyme® (imiglucerase intravenous infusion – Genzyme) - Archived on 05/28/2025
- Cinqair® (reslizumab intravenous infusion − Teva Respiratory) - Archived on 05/28/2025
D
E
- Elaprase® (idursulfase intravenous infusion – Shire Human Genetic Therapies) - Archived on 05/28/2025
- Elelyso® (taliglucerase intravenous infusion – Pfizer) - Archived on 05/28/2025
- Eloctate® (Antihemophilic Factor Fc fusion protein intravenous infusion – Bioverativ/Sanofi) - Archived on 03/23/2026
- Empliciti® (elotuzumab intravenous infusion – Bristol-Myers Squibb) - Archived on 05/28/2025
- Entyvio® (vedolizumab intravenous infusion – Takeda) - Archived on 05/28/2025
- Esperoct® (Antihemophilic factor glycopegylated intravenous infusion – Novo Nordisk) - Archived on 03/23/2026
- Euflexxa® (sodium hyaluronate injection – Ferring) - Archived on 03/24/2026
- Evkeeza® (evinacumab-dgnb intravenous infusion – Regeneron) - Archived on 06/20/2025
- Evusheld™ (tixagevimab intramuscular injection and cilgavimab intramuscular injection − AstraZeneca) - Archived on 03/18/2026
- Exondys 51™ (eteplirsen intravenous infusion – Sarepta) - Archived on 05/28/2025
F
G
- Gel-One® (sodium hyaluronate injection – Seikagaku/Zimmer) - Archived on 03/24/2026
- Gelsyn-3™ (sodium hyaluronate injection – Bioventus) - Archived on 03/24/2026
- GenVisc® 850 (sodium hyaluronate injection – OrthogenRx) - Archived on 03/24/2026
- Grafapex™ (treosulfan intravenous infusion – Medexus) - Archived on 03/24/2026
H
- Hemgenix® (etranacogene dezaparvovec-drlb intravenous infusion − CSL Behring and uniQure) - Archived on 03/23/2026
- Hemofil M (Antihemophilic Factor intravenous infusion – Baxalta/Takeda) - Archived on 03/23/2026
- Humate-P (Antihemophilic Factor/von Willebrand Factor Complex intravenous infusion – CSL Behring) - Archived on 03/23/2026
- Hyalgan (sodium hyaluronate injection − Fidia/Sanofi) - Archived on 03/24/2026
- Hymovis (high molecular weight viscoelastic hyaluronan injection – Fidia) - Archived on 03/24/2026
I
- Idelvion (Coagulation Factor IX [recombinant] albumin fusion protein intravenous infusion – CSL Behring) - Archived on 03/19/2026
- Ilaris® (canakinumab subcutaneous injection – Novartis) - Archived on 03/24/2026
- Ilaris® (canakinumab subcutaneous injection – Novartis) - Archived on 05/28/2025
- Imdelltra™ (tarlatamab-dlle intravenous infusion – Amgen) - Archived on 06/20/2025
- Imlygic® (talimogene laherparepvec intralesional injection – Amgen) - Archived on 05/28/2025
- Ixinity (Coagulation Factor IX [recombinant] intravenous infusion – Medexus) - Archived on 03/19/2026
J
- Jelmyto® (mitomycin solution for pyelocalyceal administration – UroGen) - Archived on 06/20/2025
- Jemperli™ (dostarlimab intravenous infusion – GlaxoSmithKline) - Archived on 06/20/2025
- Jivi® (Antihemophilic Factor PEGylated-aucl intravenous infusion – Bayer HealthCare) - Archived on 03/23/2026
- Jubbonti® (denosumab-bbdz subcutaneous injection – Sandoz) - Archived on 03/18/2026
K
- Kanuma® (sebelipase alfa intravenous infusion – Alexion) - Archived on 05/28/2025
- Keytruda® (pembrolizumab intravenous infusion – Merck) - Archived on 05/28/2025
- Keytruda® (pembrolizumab intravenous infusion – Merck) - Archived on 06/20/2025
- Kimmtrak® (tebentafusp-tebn intravenous infusion – Immunocore) - Archived on 03/24/2026
- Koāte (Antihemophilic Factor intravenous infusion – Grifols/Kedrion Biopharma) - Archived on 03/23/2026
- Kogenate® FS (Antihemophilic Factor intravenous infusion – Bayer HealthCare) - Archived on 03/23/2026
- Kovaltry® (Antihemophilic Factor intravenous infusion – Bayer HealthCare) - Archived on 03/23/2026
- Krystexxa® (pegloticase intravenous infusion – Horizon) - Archived on 06/20/2025
- Kymriah (tisagenlecleucel intravenous infusion – Novartis Oncology) - Archived on 04/30/2025
- Kyprolis (carfilzomib intravenous infusion – Amgen/Onyx) - Archived on 05/28/2025
L
- Lamzede® (velmanase alfa-tycv intravenous infusion − Chiesi) - Archived on 04/30/2025
- Lanreotide subcutaneous injection – Cipla - Archived on 06/20/2025
- Leqvio® (inclisiran subcutaneous injection – Novartis) - Archived on 06/20/2025
- Lumizyme® (alglucosidase intravenous infusion – Genzyme) - Archived on 06/20/2025
- Lutathera® (lutetium Lu 177 dotatate intravenous infusion – Advanced Accelerator Applications USA) - Archived on 05/28/2025
- Lyfgenia® (lovotibeglogene autotemcel intravenous infusion – bluebird bio) - Archived on 03/19/2026
- Lyfgenia® (lovotibeglogene autotemcel intravenous infusion – bluebird bio) - Archived on 05/28/2025
M
N
- Naglazyme® (galsulfase intravenous infusion – BioMarin) - Archived on 05/28/2025
- Nexviazyme® (avalglucosidase alfa-ngpt intravenous infusion – Genzyme) - Archived on 06/20/2025
- Niktimvo™ (axatilimab-csfr intravenous infusion − Incyte/Syndax) - Archived on 06/20/2025
- Novoeight® (Antihemophilic Factor intravenous infusion – Novo Nordisk) - Archived on 03/23/2026
- Nplate® (romiplostim subcutaneous injection – Amgen) - Archived on 05/28/2025
- Nplate® (romiplostim subcutaneous injection – Amgen) - Archived on 06/20/2025
- Nucala® (mepolizumab subcutaneous injection – GlaxoSmithKline) - Archived on 05/28/2025
- Nulibry™ (fosdenopterin intravenous infusion – Origin Biosciences) - Archived on 05/28/2025
- Nuwiq® (Antihemophilic Factor intravenous infusion – Octapharma) - Archived on 03/23/2026
O
- Onivyde® (irinotecan liposome intravenous infusion – Ipsen) - Archived on 03/24/2026
- Opdivo Qvantig™ (nivolumab and hyaluronidase-nvhy subcutaneous injection – Bristol-Myers Squibb and Halozyme) - Archived on 04/30/2025
- Opdivo® (nivolumab intravenous infusion – Bristol-Myers Squibb) - Archived on 04/30/2025
- Opdivo® (nivolumab intravenous infusion – Bristol-Myers Squibb) - Archived on 05/28/2025
- Opdualag™ (nivolumab and relatlimab-rmbw intravenous infusion – Bristol-Myers Squibb) - Archived on 03/24/2026
- Orthovisc (high molecular weight hyaluronan injection –Anika) - Archived on 03/24/2026
P
- Palonosetron intravenous infusion (generic only) - Archived on 06/20/2025
- PiaSky® (crovalimab-akkz intravenous infusion or subcutaneous injection – Genentech) - Archived on 06/20/2025
- Pluvicto ™ (lutetium Lu 177 vipivotide tetraxetan intravenous infusion – Advanced Accelerator Applications/Novartis) - Archived on 05/28/2025
- Pombiliti® (cipaglucosidase alfa-atga intravenous infusion – Amicus) - Archived on 06/20/2025
- Portrazza® (necitumumab intravenous infusion – Eli Lilly) - Archived on 03/24/2026
- Profilnine (Factor IX Complex [plasma-derived] intravenous infusion – Grifols) - Archived on 03/19/2026
- Prolia® (denosumab subcutaneous injection – Amgen) - Archived on 03/18/2026
- Prolia® (denosumab subcutaneous injection – Amgen) - Archived on 06/20/2025
- Provenge® (sipuleucel-T intravenous infusion – Dendreon) - Archived on 05/28/2025
- Provenge® (sipuleucel-T intravenous infusion – Dendreon) - Archived on 06/20/2025
- Purified Cortrophin™ Gel (repository corticotropin subcutaneous and intramuscular injection – ANI) - Archived on 06/20/2025
R
- Radicava® (edaravone intravenous infusion – Mitsubishi Tanabe, generic) - Archived on 04/30/2025
- Rebinyn® (Coagulation Factor IX [recombinant] glycoPEGylated intravenous infusion – NovoNordisk) - Archived on 03/19/2026
- Reclast® (zoledronic acid intravenous infusion – Novartis, generic) - Archived on 04/30/2025
- Recombinate® (Antihemophilic Factor intravenous infusion – Baxalta/Takeda) - Archived on 03/23/2026
- Riabni™ (rituximab-arrx intravenous infusion – Amgen) - Archived on 03/24/2026
- Rituxan Hycela® (rituximab and hyaluronidase human subcutaneous injection – Biogen and Genentech/Roche) - Archived on 03/24/2026
- Rituxan® (rituximab intravenous infusion − Genentech) - Archived on 03/24/2026
- Rivfloza™ (nedosiran subcutaneous injection – Novo Nordisk) - Archived on 05/28/2025
- Rixubis® (Coagulation Factor IX [recombinant] intravenous infusion – Baxalta/Takeda) - Archived on 03/19/2026
- Ruxience® (rituximab-pvvr intravenous infusion – Pfizer) - Archived on 03/24/2026
- Rybrevant® (amivantamab-vmjw intravenous infusion – Janssen) - Archived on 05/28/2025
S
- Sandostatin® LAR Depot (octreotide acetate intramuscular injection – Novartis, generic) - Archived on 03/24/2026
- Sandostatin® LAR Depot (octreotide acetate intramuscular injection – Novartis, generic) - Archived on 04/30/2025
- Sandostatin® LAR Depot (octreotide acetate intramuscular injection – Novartis, generic) - Archived on 06/20/2025
- Sarclisa® (isatuximab-irfc intravenous infusion – Sanofi-Aventis) - Archived on 05/28/2025
- Signifor® LAR (pasireotide intramuscular injection – Recordati Rare Diseases) - Archived on 05/28/2025
- Sodium hyaluronate 1% injection – Teva - Archived on 03/24/2026
- Soliris® (eculizumab intravenous infusion – Alexion) - Archived on 04/30/2025
- Somatuline® Depot (lanreotide subcutaneous injection – Ipsen, generic) - Archived on 06/20/2025
- Spevigo® (spesolimab-sbzo intravenous infusion − Boehringer Ingelheim) - Archived on 05/28/2025
- Spravato® (esketamine nasal spray – Janssen) - Archived on 06/20/2025
- Supartz FX™ (sodium hyaluronate injection − Seikagaku/Bioventus) - Archived on 03/24/2026
- Susvimo™ (ranibizumab intravitreal injection via ocular implant – Genentech) - Archived on 04/30/2025
- Sylvant® (siltuximab intravenous infusion – EUSA) - Archived on 05/28/2025
- SynoJoynt™ (sodium hyaluronate injection − Arthrex) - Archived on 03/24/2026
- Synvisc (hylan G-F 20 sodium hyaluronate injection – Genzyme/Sanofi), Synvisc-One® (hylan G-F 20 sodium hyaluronate injection – Genzyme/Sanofi) - Archived on 03/24/2026
T
- Tecartus® (brexucabtagene autoleucel intravenous infusion – Kite Pharma) - Archived on 06/20/2025
- Tepezza™ (teprotumumab intravenous infusion – Horizon) - Archived on 03/24/2026
- Tevimbra® (tislelizumab-jsgr intravenous infusion – BeiGene) - Archived on 06/20/2025
- Tofidence™ (tocilizumab-bavi intravenous infusion – Biogen) - Archived on 05/28/2025
- Tremfya® (guselkumab intravenous infusion – Janssen Biotech/Johnson & Johnson) - Archived on 05/28/2025
- Triluron™ (sodium hyaluronate injection – Fidia) - Archived on 03/24/2026
- TriVisc™ (sodium hyaluronate injection – OrthogenRx) - Archived on 03/24/2026
- Truxima® (rituximab-abbs intravenous infusion – Celltrion/Teva) - Archived on 03/24/2026
- Tyenne® (tocilizumab-aazg intravenous infusion – Fresenius Kabi) - Archived on 05/28/2025
U
V
- Vimizim® (elosulfase alfa intravenous infusion – BioMarin) - Archived on 05/28/2025
- Visco-3™ (sodium hyaluronate injection – Seikagaku/Zimmer) - Archived on 03/24/2026
- Vpriv® (velaglucerase intravenous infusion – Shire Human Genetic Therapies) - Archived on 05/28/2025
- Vyepti® (eptinezumab-jjmr intravenous infusion – Lundbeck) - Archived on 05/28/2025
W
X
- Xgeva® (denosumab subcutaneous injection – Amgen) - Archived on 03/18/2026
- Xgeva® (denosumab subcutaneous injection – Amgen) - Archived on 06/20/2025
- Xolair® (omalizumab subcutaneous injection − Genentech/Novartis) - Archived on 04/30/2025
- Xolair® (omalizumab subcutaneous injection − Genentech/Novartis) - Archived on 05/28/2025
- Xyntha®/Xyntha® Solofuse™ (Antihemophilic Factor intravenous infusion, plasma/albumin-free – Wyeth/Pfizer) - Archived on 03/23/2026
Y
- Ycanth™ (cantharidin 0.7% topical solution − Verrica) - Archived on 03/18/2026
- Ycanth™ (cantharidin 0.7% topical solution − Verrica) - Archived on 04/30/2025
- Yervoy® (ipilimumab intravenous infusion – Bristol-Myers Squibb) - Archived on 05/28/2025
- Yescarta® (axicabtagene ciloleucel intravenous infusion – Kite Pharma) - Archived on 04/30/2025
- Yescarta® (axicabtagene ciloleucel intravenous infusion – Kite Pharma) - Archived on 06/20/2025
Z
- Zilretta® (triamcinolone acetonide extended-release intraarticular injection – Pacira) - Archived on 06/20/2025
- Zometa® (zoledronic acid intravenous infusion – generic only) - Archived on 04/30/2025
- Zynteglo™ (betibeglogene autotemcel intravenous infusion − Bluebird Bio) - Archived on 05/28/2025
- Zynyz™ (retifanlimab-dlwr intravenous infusion – Incyte) - Archived on 04/30/2025
- Zynyz™ (retifanlimab-dlwr intravenous infusion – Incyte) - Archived on 06/20/2025