Effective December 1, 2023

Pharmaceutical Policy Name

Status

Entyvio

Reviewed

Risankizumab (Skyrizi)

Updated

Ustekinumab (Stelara)

Updated

Proton Pump Inhibitor Therapy

Updated

Hemophilia Factor

Reviewed

Colony Stimulating Factor

Updated

Erythropoiesus Stimulating Agents

Reviewed

Hereditary Angioedema

Reviewed 

Gaucher Disease Type 1 Treatment

Reviewed

Select Chelating Agents

Updated

Enteral Therapy VT

Reviewed

Irritable Bowel Syndrome

Updated

Biosimilars, Select Medical

Reviewed

Intestinal Antibiotics

Reviewed

Mulpleta/Doptelet

Reviewed

Dojolvi

Reviewed

Ozanimod (Zeposia)

Reviewed

Etancercept (Enbrel)

Reviewed

Tofacitinib (Xeljanz)

Reviewed

Guzelkumab (Tremfya)

Reviewed

Tepezza

Updated

Adakveo

Updated

Upadacitinib (Rinvoq)

Updated

Secukinumab (Cosentyx)

Updated

Adalimumab (Humira)

Updated

Apremilast (Otezla)

Updated

Soliris

New

Ultomiris

New

Vascular Endothelial Growth Factor (VEGF) Inhibitor *Effective 11/1/2023*

New

Weight Loss Medications *Effective 1/1/2024*

New

Hemophilia Gene Therapy *Effective 10/1/2023*

New

Effective January 1, 2024

Pharmaceutical Policy Name

Status

Multiple Sclerosis Agents

Updated

GABA Receptor Modulators 

Updated

Duchenne Muscular Dystrophy

Reviewed

Duchenne Muscular Dystrophy Medicaid

Reviewed

Movement Disorder 

Updated

Botulinum Toxin Treatment 

Reviewed

Radicava

Reviewed

Respiratory Syncytial Virus/Synagis (palivizumab)

Updated

Spravato

Reviewed

Gabapentin ER

Reviewed

Nuedexta

Reviewed

Agents for female sexual dysfunction 

Updated

Adalimumab

Updated

Monoclonal Antibodies for Alzheimer's Disease (formerly Aduhelm)

Updated

CAR-T Cell Therapy

Updated

Daybue

New 

GLP-1 Receptor Agonist Retrospective

Archived

Select Oral Antipsychotics

Updated

MVP Medicare Part D Drug Management

Updated

Oral Allergen Immunotherapy Medications

Updated

Palforzia

Reviewed

Pharmacy Programs Administration Internal

Updated

Prostate Cancer

Reviewed

Spinal Muscular Atrophy

Reviewed

Zoladex-Medicaid

Reviewed

Herceptin (trastuzumab)- Medicaid

Reviewed

Perjeta (pertuzumab)- Medicaid

Reviewed

Avastin (bevacizumab)- Medicaid

Reviewed

Cancer Guidance Program Oncology Medication Coverage and Review

New 

Densoumab (Prolia and Xgeva)

New 

Dose Rounding for Systemic therapy

New 

Policy Updates

Review other articles in this issue regarding formulary, pharmacy policy, and medical policy updates.