These policies apply to drugs billed under the medical benefit.
Amyloidosis - Amvuttra UM Medical De-identified
Amyloidosis - Onpattro UM Medical De-Identified
Amyloidosis - Tegsedi UM Medical De-Identified
Botulinum Toxins - Botox UM Medical De-Identified
Botulinum Toxins - Daxxify UM Medical De-Identified
Botulinum Toxins - Dysport UM Medical De-Identified
Botulinum Toxins - Myobloc UM Medical De-Identified
Botulinum Toxins - Xeomin UM Medical De-Identified
Calcitonin Gene-Related Peptide Inhibitors - Vyepti UM Medical De-identified
Colony Stimulating Factors - Filgrastim Products UM Medical De-identified
Colony Stimulating Factors - Granix UM Medical De-identified
Colony Stimulating Factors - Pegfilgrastim Products UM Medical De-Identified
Colony Stimulating Factors - Rolvedon UM Medical Policy De-Identified
Complement Inhibitors - PiaSky UM Medical De-Identified
Complement Inhibitors - Soliris UM Medical De-identified
Complement Inhibitors - Ultomiris Intravenous UM Medical De-Identified
Complement Inhibitors - Veopaz UM Medical De-Identified
Dermatology - Gene Therapy - Vyjuvek UM De-Identified
Enzyme Replacement Therapy - Elfabrio UM Medical De-Identified
Enzyme Replacement Therapy - Fabrazyme UM Medical De-Identified
ESA - Mircera UM Medical De-Identified
Erythropoiesis-Stimulating Agents - Aranesp UM Medical De-Identified
Erythropoiesis-Stimulating Agents - Epoetin Alfa Products UM Medical De-Identified
Erythropoiesis-Stimulating Agents - Mircera UM Medical Policy
ESA - Epoetin Alfa Products UM Medical De-identified
Gaucher Disease - Enzyme Replacement Therapy - Cerezyme UM Medical De-identified
Gaucher Disease - Enzyme Replacement Therapy - Elelyso UM Medical De-identified
Gaucher Disease - Enzyme Replacement Therapy - Vpriv UM Medical De-identified
GnRH - Implants UM Medical De-identified
GnRH - Injectable Long-Acting Products UM Medical De-identified
Gonadotropin-Releasing Hormone Agonists - Central Precocious Puberty UM Medical De-Identified
Gonadotropin-Releasing Hormone Agonists - Injectable Long-Acting Products UM Medical De-Identified
Hematology - Gene Therapy - Casgevy UM Medical De-Identified
Hematology - Gene Therapy - Zynteglo UM Medical De-Identified
Hemophilia - Altuviiio UM Medical De-Identified
Hemophilia - Gene Therapy - Bequez UM Medical De-Identified
Hemophilia - Factor VIII Products UM Medical De-Identified
Hemophilia - Gene Therapy - Hemgenix UM Medical De-Identified
Hemophilia - Gene Therapy - Roctavian UM Medical De-Identified
Hemophilia - Hemlibra UM Medical De-identified
Hepatology - Givlaari UM Medical De-Identified
Hepatology - Panhematin UM Medical De-Identified
Hyaluronic Acid Derivatives Intraarticular UM Medical Policy
Immune Globulin - Subcutaneous UM Medical De-Identified
Immune Globulin - Intravenous UM Medical De-Identified
Immunologicals - Cinqair UM Medical De-Identified
Immunologicals - Fasenra UM Medical De-Identified
Immunologicals - Nucala UM Medical De-Identified
Immunologicals - Tezspire UM Medical De-Identified
Immunologicals - Xolair UM Medical De-Identified
Inflammatory Conditions - Actemra Intravenous UM Medical De-Identified
Inflammatory Conditions - Cimzia UM Medical De-identified
Inflammatory Conditions - Cosentyx UM Medical De-identified
Inflammatory Conditions - Etanercept Products PA Policy De-identified
Inflammatory Conditions - Entyvio Intravenous UM Medical De-identified
Inflammatory Conditions - Ilumya UM Medical De-identified
Inflammatory Conditions - Infliximab Products UM Medical De-Identified
Inflammatory Conditions - Orencia Intravenous UM Medical De-Identified
Inflammatory Conditions - Omvoh Intravenous UM Medical De-Identified
Inflammatory Conditions - Simponi Aria UM Medical De-Identified
Inflammatory Conditions - Skyrizi Intravenous UM Medical De-identified
Inflammatory Conditions - Stelara Intravenous UM Medical De-identified
Inflammatory Condition - Tocilizumab Intravenous Products UM Medical De-Identified
Inflammatory Condition - Tocilizumab Subcutaneous Products PA De-Identified
Inflammatory Condition - Tremfya Intravenous UM Medical De-Identified
Inflammatory Condition - Zymfentra PA Policy De-Identified
Iron Replacement - Feraheme UM Medical De-Identified
Iron Replacement - Ferrlecit UM Medical De-Identified
Iron Replacement - INFeD UM Medical De-Identified
Iron Replacement - Injectafer UM Medical De-Identified
Iron Replacement - Monoferric UM Medical De-Identified
Iron Replacement - Venofer UM Medical De-Identified
Makena (Hydroxyprogesterone caproate) UM Medical De-Identified
Multiple Sclerosis - Briumvi UM Medical De-Identified
Multiple Sclerosis - Lemtrada UM Medical De-Identified
Multiple Sclerosis - Ocrevus UM Medical De-Identified
Multiple Sclerosis - Ocrevus Zunovo UM Medical De-Identified
Multiple Sclerosis and Crohn's Disease - Tysabri UM Medical De-Identified
Neurology - Gene Therapy - Lenmeldy UM Medical De-Identified
Neurology - Rystiggo UM Medical De-Identified
Neurology - Vyvgart UM Medical De-Identified
Oncology (Injectable) - Bevacizumab Products UM Medical De-Identified
Oncology (Injectable) - Herceptin Hylecta UM Medical De-Identified
Oncology (Injectable) - Phesgo UM Medical De-identified
Oncology (Injectable) - Rituxan Hycela UM Medical De-Identified
Oncology (Injectable) - Trastuzumab Products UM Medical De-identified
Ophthalmology - Luxturna UM Medical De-identified
Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Beovu UM Medical De-Identified
Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Eylea UM Medical De-Identified
Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Susvimo UM Medical De-Identified
Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Vabysmo UM Medical De-Identified
Ophthalmology - VEGF Inhibitors Eylea UM Medical De-identified
Repository Corticotropin - Acthar Gel UM Medical De-identified
Rituximab Intravenous Products UM Medical De-identified
Somatostatin Analogs Lanreotide Products UM Medical De-identified
Somatostatin Analogs - Sandostatin LAR Depot UM Medical
Spinal Muscular Atrophy - Gene Therapy - Zolgensma - UM Medical De-Identified
