Pharmacy Policies
These pharmacy policies apply to our HAP CareSource™ MI Health Link (Medicare-Medicaid) plan.
Pharmacy policies offer guidance on determination of medical necessity coverage of pharmaceutical products. The coverage criteria are consistent with FDA-approved prescribing information, treatment guidelines and literature. The policies listed on this page are not inclusive of all pharmaceutical products. New policies will be added as new pharmaceutical products become available or as needed. Existing policies are regularly reviewed and updated to reflect current treatment guidelines and prescribing information.
Current Pharmacy Policies
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
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- Abraxane (paclitaxel albumin-bound suspension, intravenous infusion – Celgene, generic)
- Aduhelm® (aducanumab-avwa intravenous infusion – Biogen/Eisai)
- Alimta (pemetrexed intravenous infusion – Eli Lilly, generics)
- Aranesp® (darbepoetin alfa intravenous or subcutaneous injection − Amgen)
- Atgam® (lymphocyte immune globulin, anti-thymocyte globulin [equine] intravenous infusion – Pfizer)