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Humana Medical Policy Updates – January 2023
Click here to view the Humana Medical Policy Updates Updates »
January 2023 Humana Medical Policy Updates:
- Abraxane (nab) paclitaxel
- Abraxane (nab) paclitaxel
- Actemra® (tocilizumab) Intravenous
- Actemra® (tocilizumab) Intravenous
- Aggrenox® (aspirin/dipyridamole)
- AHCA Continuity of Care
- Angiotensin-Calcium Channel Blocking Agents
- Apadaz® (benzhydrocodone and acetaminophen)
- APOKYN® (apomorphine hydrochloride) subcutaneous injection
- Aranesp® (darbepoetin alfa)
- Auryxia® (ferric citrate)
- Avsola® (infliximab-axxq)
- Azilect® (rasagiline) tablets
- Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta)
- Beovu® (brolucizumab)
- Beovu® (brolucizumab)
- Bisphosphonates
- Bosentan Products
- Botox® (Botulinum Toxin)
- Breyanzi® (lisocabtagene maraleucel)
- Buprenorphine Containing Products
- Buprenorphine Containing Products
- Cablivi® (caplacizumab-yhdp)
- Carvykti™ (ciltacabtagene autoleucel)
- CFTR Modulators
- Cimerli™ (ranibizumab-eqrn)
- Corifact® (Factor XIII Concentrate [Human])
- Corlanor® (ivabradine)
- Cosentyx® (secukinumab)
- Crofelemer Products
- Cryoablation
- Cyklokapron® (tranexamic acid)
- Dartisla ODT (glycopyrrolate)
- Deferasirox Products
- Deferasirox Tablet
- Dysport® (botulinum toxin)
- Elahere (mirvetuximab soravtansine-gynx)
- Elepsia™ XR (levetiracetam) extended-release tablets
- Entyvio® (vedolizumab)
- Entyvio® (vedolizumab)
- Entyvio® (vedolizumab)
- EpiPen® and EpiPen Jr® (epinephrine)
- Epoetin Alfa (Epogen, Procrit, Retacrit)
- Erleada™ (apalutamide)
- Esbriet® (pirfenidone)
- Factor IX Replacement Products (Hemophilia B)
- Factor VIII Replacement Products (Hemophilia A)
- Formulary Tier Exception
- Genetic Testing for Cancer Susceptibility
- Genetic Testing for Diagnosis and Monitoring of Cancer
- Gleostine® (lomustine)
- Gloperba® (colchicine)
- Granix® (tbo-filgrastim)
- Hetlioz® and Hetlioz LQ™ (tasimelteon)
- Hip, Knee and Shoulder Arthroscopic Surgeries
- Hip, Knee and Shoulder Arthroscopic Surgeries
- Ilumya® (tildrakizumab)
- Ilumya™ (tildrakizumab)
- Imfinzi (durvalumab)
- Inflectra ® (infliximab-dyyb)
- Inflectra® (infliximab-dyyb)
- Infliximab intravenous solution
- Inlyta (axitinib)
- Jynarque® (tolvaptan)
- Kymriah™ (tisagenlecleucel)
- Levothyroxine Products
- Livtencity (maribavir) tablet
- Lokelma® (sodium zirconium cyclosilicate)
- Lorbrena (lorlatinib)
- Lotronex® (alosetron HCl)
- Lutathera (lutetium Lu 177 dotatate)
- Lynparza (olaparib)
- Lynparza (olaparib)
- Lynparza (olaparib)
- Mavenclad® (cladribine) tablet
- Mupirocin Topical Cream
- Myalept® (metreleptin)
- Myalept® (metreleptin)
- Myobloc® (botulinum toxin)
- Nebulized Beta Agonists
- Neupro® (rotigotine) transdermal patch
- Ninlaro® (ixazomib)
- Non-Preferred Filgrastim Products – Neupogen (filgrastim) and Releuko (filgrastim-ayow)
- Non-Preferred Multiple Sclerosis Interferons
- Non-Preferred Oral Multiple Sclerosis Products
- Non-preferred Pegfilgrastim Products – Fylnetra (pegfilgrastim-pbbk), Neulasta (pegfilgrastim), Nyvepria (pegfilgrastim-apfg), Stimufend (pegfilgrastim-fpgk) and Ziextenzo (pegfilgrastim-bmez)
- Non-preferred Pegfilgrastim Products – Fylnetra (pegfilgrastim-pbbk), Neulasta (pegfilgrastim), Nyvepria (pegfilgrastim-apfg), Stimufend (pegfilgrastim-fpgk) and Ziextenzo (pegfilgrastim-bmez)
- Non-preferred Pegfilgrastim Products – Fylnetra (pegfilgrastim-pbbk), Neulasta (pegfilgrastim), Stimufend (pegfilgrastim-fpgk), and Udenyca (pegfilgrastim-cbqv)
- Non-preferred Pegfilgrastim Products – Fylnetra (pegfilgrastim-pbbk), Neulasta (pegfilgrastim), Stimufend (pegfilgrastim-fpgk), and Udenyca (pegfilgrastim-cbqv)
- Non-preferred Pegfilgrastim Products – Fylnetra (pegfilgrastim-pbbk), Nyvepria (pegfilgrastim-apfg), Stimufend (pegfilgrastim-fpgk) and Ziextenzo (pegfilgrastim- bmez)
- Non-preferred Pegfilgrastim Products – Fylnetra (pegfilgrastim-pbbk), Nyvepria (pegfilgrastim-apfg), Stimufend (pegfilgrastim-fpgk) and Ziextenzo (pegfilgrastim- bmez)
- Nonsteroidal Anti-Inflammatory Drug Products
- Nubeqa® (darolutamide)
- Ocrevus® (ocrelizumab) intravenous solution
- Opdivo (nivolumab)
- Opioid Days’ Supply Limitation
- Opsumit® (macitentan)
- Oral Acne Antibiotics
- Oral Penicillamine Products
- Orencia® (abatacept) Intravenous
- Orencia® (abatacept) Intravenous
- Orencia® IV (abatacept)
- Orencia® IV (abatacept)
- Oriahnn™ (elagolix, estradiol, and norethindrone acetate)
- Orilissa™ (elagolix)
- Ortikos™ (budesonide)
- Osmolex ER™ (amantadine) extended-release tablets
- Oxbryta™ (voxelotor)
- Pediatric Cardiovascular Products
- Pliaglis® (lidocaine-tetracaine) cream
- Pomalyst® (pomalidomide)
- Preferred Multiple Sclerosis Products
- Pyrukynd® (mitapivat)
- Qualaquin® (quinine sulfate)
- Qudexy XR®, Trokendi XR® (topiramate) extended-release capsules
- Radicava® and Radicava ORS® (edaravone)
- Rapid-Acting Fentanyl products
- Rayos® (prednisone delayed-release)
- Rebyota™ (fecal microbiota, live-jslm)
- Relistor® (methylnaltrexone)
- Remicade® (infliximab)
- Remicade® (infliximab)
- Renflexis (infliximab-abda)
- Renflexis® (infliximab-abda)
- Renflexis® (infliximab-abda)
- Rexulti (brexpiprazole)
- Rolvedon™ (eflapegrastim-xnst)
- Rolvedon™ (eflapegrastim-xnst)
- Rolvedon™ (eflapegrastim-xnst)
- RoxyBond™ tablet, oral ONLY (not feeding tubes)
- Rubraca (rucaparib)
- Rubraca (rucaparib)
- Rubraca (rucaparib)
- Signifor® LAR (pasireotide)
- Sinuva™ (mometasone furoate) sinus implant
- Skyrizi® (risankizumab-rzaa)
- Skyrizi® (risankizumab-rzaa)
- Spinal Decompression Surgery
- Synera® (lidocaine and tetracaine) topical patch
- Syprine® (trientine hydrochloride) capsules
- Tascenso ODT™ (fingolimod)
- Tascenso ODT™ (fingolimod)
- Tecartus™ (brexucabtagene autoleucel)
- Tecvayli (teclistamab-cqyv)
- Tezspire™ (tezepelumab-ekko)
- Topical Acne Products
- Topical Antifungals
- Topical Rosacea Products
- Topical Rosacea Products
- Turalio® (pexidartinib)
- Tysabri (natalizumab) intravenous solution
- Tysabri® (natalizumab) intravenous solution
- Tysabri® (natalizumab) Intravenous Solution
- Uplizna® (inebilizumab-cdon)
- Varubi (rolapitant)
- Ventavis® (iloprost)
- Verquvo® (vericiguat)
- Viberzi® (eluxadoline)
- Vyondys 53™ (golodirsen)
- Vyvgart™ (efgartigimod alfa-fcab) intravenous injection
- Xalkori (crizotinib)
- Xeomin® (botulinum toxin)
- Xepi (ozenoxacin) topical cream
- Xiidra® (lifitegrast ophthalmic solution)
- Xpovio® (selinexor)
- Xyrem® (sodium oxybate)
- Xyrem® (sodium oxybate)
- Zejula (niraparib)
- Zejula (niraparib)
- Zejula (niraparib)
- Zejula (niraparib)
- Zortress® (everolimus)
- Zortress® (everolimus)
- Zoryve® (roflumilast) cream
- Zynlonta™ (loncastuximab tesirine-Ipyl)
Click here to view the Humana Medical Policy Updates Updates »
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