Archived Pharmacy Policies
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
A
- 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
- 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
B
C
E
- Eloctate® (Antihemophilic Factor Fc fusion protein intravenous infusion – Bioverativ/Sanofi) - Archived on 03/23/2026
- Esperoct® (Antihemophilic factor glycopegylated intravenous infusion – Novo Nordisk) - Archived on 03/23/2026
- Evusheld™ (tixagevimab intramuscular injection and cilgavimab intramuscular injection − AstraZeneca) - Archived on 03/18/2026
G
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
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
- Ixinity (Coagulation Factor IX [recombinant] intravenous infusion – Medexus) - Archived on 03/19/2026
J
K
- 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
L
M
N
O
P
R
- Rebinyn® (Coagulation Factor IX [recombinant] glycoPEGylated intravenous infusion – NovoNordisk) - Archived on 03/19/2026
- Recombinate® (Antihemophilic Factor intravenous infusion – Baxalta/Takeda) - Archived on 03/23/2026
- Rixubis® (Coagulation Factor IX [recombinant] intravenous infusion – Baxalta/Takeda) - Archived on 03/19/2026