Archived Pharmacy Policies
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
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 05/28/2025
- Aldurazyme® (laronidase intravenous infusion – Genzyme) - Archived on 05/28/2025
- Amvuttra™ (vutrisiran subcutaneous injection − Alnyam) - Archived on 04/30/2025
- 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
- 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
- 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
- Empliciti® (elotuzumab intravenous infusion – Bristol-Myers Squibb) - Archived on 05/28/2025
- Entyvio® (vedolizumab intravenous infusion – Takeda) - Archived on 05/28/2025
- Evkeeza® (evinacumab-dgnb intravenous infusion – Regeneron) - Archived on 06/20/2025
- Exondys 51™ (eteplirsen intravenous infusion – Sarepta) - Archived on 05/28/2025
F
I
J
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
- 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 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
- 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
O
- 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
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
- 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
- Reclast® (zoledronic acid intravenous infusion – Novartis, generic) - Archived on 04/30/2025
- Rivfloza™ (nedosiran subcutaneous injection – Novo Nordisk) - Archived on 05/28/2025
- Rybrevant® (amivantamab-vmjw intravenous infusion – Janssen) - Archived on 05/28/2025
S
- 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
- 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
- Susvimo™ (ranibizumab intravitreal injection via ocular implant – Genentech) - Archived on 04/30/2025
- Sylvant® (siltuximab intravenous infusion – EUSA) - Archived on 05/28/2025
T
- Tecartus® (brexucabtagene autoleucel intravenous infusion – Kite Pharma) - Archived on 06/20/2025
- 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
- Tyenne® (tocilizumab-aazg intravenous infusion – Fresenius Kabi) - Archived on 05/28/2025
U
V
X
Y
- 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