Pharmacy Policies
These pharmacy policies apply to the TRICARE Prime® Demo by CareSource Military & Veterans™ plan.
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
A
B
C
D
E
- Elaprase (idursulfase)
- Enjaymo (sutimlimab)
- Enzyme Replacement Therapy (ERT) for Fabry Disease: Fabrazyme (agalsidase beta) and Elfabrio (pegunigalsidase alfaiwxj)
- Enzyme Replacement Therapy (ERT) for Gaucher Disease: Cerezyme (imiglucerase), Elelyso (taliglucerase alfa), Vpriv (velaglucerase alfa)
- Evenity (romosozumab-aqqg)
- Evkeeza (evinacumab-dgnb)
- Exondys 51 (eteplirsen)
G
H
I
K
L
M
N
O
P
Q
R
- Ranibizumab (Lucentis, Byooviz, Cimerli)
- Reblozyl (luspatercept-aamt)
- Rebyota (fecal microbiota, live - jslm)
- Retisert (fluocinolone acetonide)
- Rituximab (Rituxan, Truxima, Ruxience, Riabni)
- Rivfloza (nedosiran)
- Roctavian (valoctocogene roxaparvovec)
- Ryplazim (plasminogen, human-tvmh)
- Rystiggo (rozanolixizumab-noli)
S
- Saphnelo (anifrolumab-fnia)
- Scenesse (afamelanotide)
- Skyrizi (risankizumab-rzaa)
- Soliris (eculizumab)
- Somatostatin analogs (Injectable; First generation): Sandostatin (octreotide), Sandostatin LAR (octreotide), Somatuline Depot (lanreotide), Bynfezia Pen (octreotide)
- Spevigo (spesolimab-sbzo)
- Spinraza (nusinersen)
- Spravato (esketamine)
- Standard Medical Billing Guidance
- Sunlenca (lenacapavir)
- Supprelin LA (histrelin acetate)
- Susvimo (ranibizumab)
- Syfovre (pegcetacoplan)