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Clinical Payment Policies | Ambetter from Magnolia Health
Clinical & Payment Policies
Clinical Policies
Clinical policies are one set of guidelines used to assist in administering health plan benefits, either by prior authorization or payment rules. They include but are not limited to policies relating to evolving medical technologies and procedures, as well as pharmacy policies. Clinical policies help identify whether services are medically necessary based on information found in generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by the policy; and other available clinical information.
All policies found in the Magnolia Health Clinical Policy Manual apply to Magnolia Health members. Policies in the Magnolia Health Clinical Policy Manual may have either a Magnolia Health or a “Centene” heading. Magnolia Health utilizes InterQual® criteria for those medical technologies, procedures or pharmaceutical treatments for which a Magnolia Health clinical policy does not exist. InterQual is a nationally recognized evidence-based decision support tool. You may access the InterQual® SmartSheet(s)™ for Adult and Pediatric procedures, durable medical equipment and imaging procedures by logging into the secure provider portal or by calling Magnolia Health. In addition, Magnolia Health may from time to time delegate utilization management of specific services; in such circumstances, the delegated vendor’s guidelines may also be used to support medical necessity and other coverage determinations. Other non-clinical policies (e.g., payment policies) or contract terms may further determine whether a technology, procedure or treatment that is not addressed in the Clinical Policy Manuals or InterQual®criteria is payable by Magnolia Health.
If you have any questions regarding these policies, please contact Member Services and ask to be directed to the Medical Management department.
- 25-hydroxyvitamin D Testing in Children and Adolescents (CP.MP.157) (PDF)
- Acupuncture (CP.MP.92) (PDF)
- Adopted Clinical Practice and Preventive Health Guidelines (CPG Grid) (PDF)
- Air Ambulance (CP.MP.175) (PDF)
- Allergy Testing and Therapy (CP.MP.100) (PDF)
- Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and β-Thalassemia (CP.MP.108) (PDF)
- Applied Behavioral Analysis (CP.BH.104) (PDF)
- Articular Cartilage Defect Repairs (CP.MP.26) (PDF)
- Assisted Reproductive Technology (CP.MP.55) (PDF)
- Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.BH.124) (PDF)
- Bariatric Surgery (CP.MP.37) (PDF)
- Behavioral Health Treatment Documentation Requirements (CP.BH.500) (PDF)
- Biofeedback (CP.MP.168) (PDF)
- Biofeedback for Behavioral Health Disorders (CP.BH.300) (PDF)
- Bone-Anchored Hearing Aid (CP.MP.93) (PDF)
- Bronchial Thermoplasty (CP.MP.110) (PDF)
- Burn Surgery (CP.MP.186) (PDF)
- Cardiac Biomarker Testing (CP.MP.156) (PDF)
- Caudal or Interlaminar Epidural Steroid Injections (CP.MP.164) (PDF)
- Clinical Trials (CP.MP.94) (PDF)
- Cochlear Implant Replacements (CP.MP.14) (PDF)
- Cosmetic and Reconstructive Procedures (CP.MP.31) (PDF)
- Diaphragmatic/Phrenic Nerve Stimulation (CP.MP.203) (PDF)
- Digital EEG Spike Analysis (CP.MP.105) (PDF)
- Disc Decompression Procedures (CP.MP.114) (PDF)
- Discography (CP.MP.115) (PDF)
- Donor Lymphocyte Infusion (CP.MP.101) (PDF)
- Drugs of Abuse: Definitive Drug Testing (CP.MP.50) (PDF)
- Durable Medical Equipment (DME) (CP.MP.107) (PDF)
- EEG in the Evaluation of Headache (CP.MP.155) (PDF)
- Electric Tumor Treating Fields (Optune) (CP.MP.145) (PDF)
- Evoked Potential Testing (CP.MP.134) (PDF)
- Experimental Technologies (CP.MP.36) (PDF)
- Facet Joint Interventions (CP.MP.171) (PDF)
- Facility Based Sleep Studies for Obstructive Sleep Apnea (CP.MP.248) (PDF)
- Fecal Incontinence Treatments (CP.MP.137) (PDF)
- Fertility Preservation (CP.MP.130) (PDF)
- Fetal Surgery in Utero for Prenatally Diagnosed Malformations (CP.MP.129) (PDF)
- Functional MRI (CP.MP.43) (PDF)
- Gastric Electrical Stimulation (CP.MP.40) (PDF)
- Gender-Affirming Procedures (CP.MP.95) (PDF)
- Heart-Lung Transplant (CP.MP.132) (PDF)
- Holter Monitors (CP.MP.113) (PDF)
- Home Births (CP.MP.136) (PDF)
- Home Ventilators (CP.MP.184) (PDF)
- Homocysteine Testing (CP.MP.121) (PDF)
- Hospice Services (CP.MP.54) (PDF)
- Hyperhidrosis Treatments (CP.MP.62) (PDF)
- Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (CP.MP.180) (PDF)
- Implantable Intrathecal or Epidural Pain Pump (CP.MP.173) (PDF)
- Implantable Loop Recorder (CP.MP.243) (PDF)
- Implantable Wireless Pulmonary Artery Pressure Monitoring (CP.MP.160) (PDF)
- Therapeutic Utilization of Inhaled Nitric Oxide (CP.MP.87) (PDF)
- Intensity-Modulated Radiotherapy (CP.MP.69) (PDF)
- Intestinal and Multivisceral Transplant (CP.MP.58) (PDF)
- Intradiscal Steroid Injections for Pain Management (CP.MP.167) (PDF)
- IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (CP.MP.61) (PDF)
- Lantidra (donislecel): Allogeneic Pancreatic Islet Cellular Therapy (CP.MP.250) (PDF)
- Laser Therapy for Skin Conditions (CP.MP.123) (PDF)
- Liposuction for Lipedema (CP.MP.244) (PDF)
- Long Term Care Placement (CP.MP.71) (PDF)
- Low-frequency Ultrasound and Noncontact Normothermic Wound Therapy (CP.MP.139) (PDF)
- Lung Transplantation (CP.MP.57) (PDF)
- Lysis of Epidural Lesions (CP.MP.116) (PDF)
- Measurement of Serum 1,25-dihydroxyvitamin D (CP.MP.152) (PDF)
- Mechanical Stretching Devices for Joint Stiffness and Contracture (CP.MP.144) (PDF)
- Multiple Sleep Latency Testing (CP.MP.24) (PDF)
- Neonatal Abstinence Syndrome Guidelines (CP.MP.86) (PDF)
- Neonatal Sepsis Management (CP.MP.85) (PDF)
- Nerve Blocks and Neurolysis for Pain Management (CP.MP.170) (PDF)
- Neuromuscular and Peroneal Nerve Electrical Stimulation (NMES) (CP.MP.48) (PDF)
- NICU Apnea Bradycardia Guidelines (CP.MP.82) (PDF)
- NICU Discharge Guidelines (CP.MP.81) (PDF)
- Nonmyeloablative Allogeneic Stem Cell Transplants (CP.MP.141) (PDF)
- Obstetrical Home Care Programs (CP.MP.91) (PDF)
- Orthognathic Surgery (CP.MP.202) (PDF)
- Osteogenic Stimulation (CP.MP.194) (PDF)
- Outpatient Cardiac Rehabilitation (CP.MP.176) (PDF)
- Outpatient Oxygen Use (CP.MP.190) (PDF)
- Pancreas Transplantation (CP.MP.102) (PDF)
- Panniculectomy (CP.MP.109) (PDF)
- Pediatric Heart Transplant (CP.MP.138) (PDF)
- Pediatric Kidney Transplant (CP.MP.246) (PDF)
- Pediatric Liver Transplant (CP.MP.120) (PDF)
- Pediatric Oral Function Therapy (CP.MP.188) (PDF)
- Percutaneous Left Atrial Appendage Closure for Stroke Prevention (CP.MP.147) (PDF)
- Phototherapy for Neonatal Hyperbilirubinemia (CP.MP.150) (PDF)
- Physical, Occupational, and Speech Therapy Services (CP.MP.49) (PDF)
- Posterior Tibial Nerve Stimulation for Voiding Dysfunction (CP.MP.133) (PDF)
- Proton and Neutron Beam Therapies (CP.MP.70) (PDF)
- Pulmonary Function Testing (CP.MP.242) (PDF)
- Omisirge (omidubicel): Nicotinamide-Modified Allogeneic Hematopoietic Progenitor Cell Therapy (CP.MP.249) (PDF)
- Reduction Mammoplasty and Gynecomastia Surgery (CP.MP.51) (PDF)
- Repair of Nasal Valve Compromise (CP.MP.210) (PDF)
- Sacroiliac Joint Infusion (CP.MP.126) (PDF)
- Sacroiliac Joint Interventions for Pain Management (CP.MP.166) (PDF)
- Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins and Other Symptomatic Venous Disorders (CP.MP.146) (PDF)
- Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy (CP.MP.174) (PDF)
- Selective Nerve Root Blocks and Transforaminal Epidural Steriod Injections (CP.MP.165) (PDF)
- Short Inpatient Hospital Stay (CP.MP.182) (PDF)
- Skin Substitutes for Chronic Wounds (CP.MP.185) (PDF)
- Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (CP.MP.117) (PDF)
- Stereotactic Body Radiation Therapy (CP.MP.22) (PDF)
- Tandem Transplant (CP.MP.162) (PDF)
- Thyroid Hormones and Insulin Testing in Pediatrics (CP.MP.154) (PDF)
- Total Artificial Heart (CP.MP.127) (PDF)
- Total Parenteral Nutrition and Intradialytic Parenteral Nutrition (CP.MP.163) (PDF)
- Transcatheter Closure of Patent Foramen Ovale (CP.MP.151) (PDF)
- Transplant Service Documentation Requirements (CP.MP.247) (PDF)
- Trigger Point Injections for Pain Management (CP.MP.169) (PDF)
- Urinary Incontinence Devices and Treatments (CP.MP.142) (PDF)
- Urodynamic Testing (CP.MP.98) (PDF)
- Wheelchair Seating (CP.MP.99) (PDF)
- Wireless Motility Capsule (CP.MP.143) (PDF)
- Vagus Nerve Stimulation (CP.MP.12) (PDF)
- Ventricular Assist Devices (CP.MP.46) (PDF)
Payment Policies
Health care claims payment policies are guidelines used to assist in administering payment rules based on generally accepted principles of correct coding. They are used to help identify whether health care services are correctly coded for reimbursement. Each payment rule is sourced by a generally accepted coding principle. They include, but are not limited to claims processing guidelines referenced by the Centers for Medicare and Medicaid Services (CMS), Publication 100-04, Claims Processing Manual for physicians/non-physician practitioners, the CMS National Correct Coding Initiative policy manual (procedure-to-procedure coding combination edits and medically unlikely edits), Current Procedural Technology guidance published by the American Medical Association (AMA) for reporting medical procedures and services, health plan clinical policies based on the appropriateness of health care and medical necessity, and at times state-specific claims reimbursement guidance.
All policies found in the Magnolia Health Payment Policy Manual apply with respect to Magnolia Health members. Policies in the Magnolia Health Payment Policy Manual may have either a Magnolia Health or a “Centene” heading. In addition, Magnolia Health may from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendor’s guidelines may also be used to determine whether a service has been correctly coded. Other policies (e.g., clinical policies) or contract terms may further determine whether a technology, procedure or treatment that is not addressed in the Payment Policy Manual is payable by Magnolia Health.
If you have any questions regarding these policies, please contact Member Services and ask to be directed to the Medical Management department.
- 30-Day Readmission (PDF)
- 340B Drug Payment Reduction (PDF)
- Concert Laboratory Payment Policy (CG.CC.PP.01) (PDF) Effective Date: 6/1/2024
- E&M Services Billed with Treatment Room Revenue Codes (CC.PP.071) (PDF)
- Endometrial Ablation (CP.MP.106) (PDF)
- Genetic and Molecular Testing Services (CG.PP.551) (PDF)
- Infectious Disease: Dermatologic Lab Testing (CG.CP.MP.03) (PDF) Effective Date: 6/1/2024
- Infectious Disease: Gastroenterologic Lab Testing (CG.CP.MP.04) (PDF) Effective Date: 6/1/2024
- Infectious Disease: Genitourinary Lab Testing (CG.CP.MP.07) (PDF) Effective Date: 6/1/2024
- Infectious Disease: Multisystem Lab Testing (CG.CP.MP.02) (PDF) Effective Date: 6/1/2024
- Infectious Disease: Primary Care & Preventive Lab Screening (CG.CP.MP.05) (PDF) Effective Date: 6/1/2024
- Infectious Disease: Respiratory Lab Testing (CG.CP.MP.01) (PDF) Effective Date: 6/1/2024
- Infectious Disease: Vector-borne and Tropical Diseases Lab Testing (CG.CP.MP.06) (PDF) Effective Date: 6/1/2024
- Leveling of Care: Evaluation and Management Overcoding (PDF)
- Leveling of ER (PDF)
- Non-Emergent ER Services (PDF)
- Non-Obstetrical Pelvic and Transvaginal Ultrasounds (PDF)
- Optum Comprehensive Payment Integrity (CPI) (CC.PP.074) (PDF)
- Physician's Consultation Services (PDF)
- Place of Service Mismatch (PDF)
- Problem Oriented Visits and Prentative Visits (PDF)
- Problem Oriented Visits with Surgical Procedures (PDF)
- Skilled Nursing Facility Leveling (CC.PP.206) (PDF)
- Ultrasound in Pregnancy (CP.MP.38) (PDF)
- Urine Specimen Validity Testing (PDF)
Pharmacy and Biopharmacy Policies
- Abaloparatide (Tymlos) (CP.PHAR.345) (PDF)
- Abametapir (Xeglyze) (CP.PMN.253) (PDF)
- Abemaciclib (Verzenio) (CP.PHAR.355) (PDF)
- Abiraterone (Zytiga, Yonsa) (CP.PHAR.84) (PDF)
- AbobotulinumtoxinA (Dysport) (CP.PHAR.230) (PDF)
- Abrocitinib (Cibinqo) (CP.PHAR.578) (PDF)
- Acalabrutinib (Calquence) (CP.PHAR.366) (PDF)
- Acyclovir Buccal Tablet (Sitavig) (CP.PMN.210) (PDF)
- Adagrasib (Krazati) (CP.PHAR.605) (PDF)
- ADAMTS13, Recombinant-krhn (Adzynma) (CP.PHAR.635) (PDF)
- Adefovir (Hepsera) (CP.PHAR.142) (PDF)
- Ado-Trastuzumab Emtansine (Kadcyla) (CP.PHAR.229) (PDF)
- Aducanumab-avwa (Aduhelm) (CP.PHAR.468) (PDF)
- Afamelanotide (Scenesse) (CP.PHAR.444) (PDF)
- Afatinib (Gilotrif) (CP.PHAR.298) (PDF)
- Aflibercept (Eylea, Eylea HD) (CP.PHAR.184) (PDF)
- Agalsidase Beta (Fabrazyme) (CP.PHAR.158) (PDF)
- Age Limit Override (Codeine, Tramadol, Hydrocodone) (CP.PMN.138) (PDF)
- Alectinib (Alecensa) (CP.PHAR.369) (PDF)
- Alemtuzumab (Lemtrada) (CP.PHAR.243) (PDF)
- Alendronate (Binosto, Fosamax Plus D) (CP.PMN.88) (PDF)
- Alglucosidase Alfa (Lumizyme) (CP.PHAR.160) (PDF)
- Allogeneic Cultured Keratinocytes and Dermal Fibroblasts in Murine Collagen-dsat (StrataGraft) (CP.PHAR.562) (PDF)
- Allogenic Processed Thymus Tissue-agdc (Rethymic) (CP.PHAR.563) (PDF)
- Alpelisib (Piqray, Vijoice) (CP.PHAR.430) (PDF)
- Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) (CP.PHAR.94) (PDF)
- Amantadine ER (Gocovri, Osmolex ER) (CP.PMN.89) (PDF)
- Ambrisentan (Letairis) (CP.PHAR.190) (PDF)
- Amifampridine (Firdapse) (CP.PHAR.411) (PDF)
- Amikacin (Arikayce) (CP.PHAR.401) (PDF)
- Amisulpride (Barhemsys) (CP.PMN.236) (PDF)
- Amivantamab-vmjw (Rybrevant) (CP.PHAR.544) (PDF)
- Anifrolumab-fnia (Saphnelo) (CP.PHAR.551) (PDF)
- Anti-Inhibitor Coagulant Complex, Human (Feiba) (CP.PHAR.217) (PDF)
- Antithrombin III (ATryn, Thrombate III) (CP.PHAR.564) (PDF)
- Antithymocyte Globulin (Atgam, Thymoglobulin) (CP.PHAR.506) (PDF)
- Apalutamide (Erleada) (CP.PCH.45) (PDF)
- Apomorphine (Apokyn, Kynmobi) (CP.PHAR.488) (PDF)
- Aprepitant (Aponvie, Emend, Cinvanti), Fosaprepitant (Emend for injection, Focinvez) (CP.PMN.19) (PDF)
- Aprocitentan (Tryvio) (CP.PHAR.676) (PDF)
- Aripiprazole Long-Acting Injections (Abilify Maintena, Abilify Asimtufii, Aristada, Aristada Initio) (CP.PHAR.290) (PDF)
- Aripiprazole Orally Disintegrating Tablet (CP.PCH.37) (PDF)
- Armodafinil (Nuvigil) (CP.PMN.35) (PDF)
- Asciminib (Scemblix) (CP.PHAR.565) (PDF)
- Asenapine (Saphris, Secuado) (CP.PMN.15) (PDF)
- Asfotase Alfa (Strensiq) (CP.PHAR.328) (PDF)
- Aspirin/Dipyridamole (Aggrenox) (CP.PMN.20) (PDF)
- Atezolizumab (Tecentriq) (CP.PHAR.235) (PDF)
- Atogepant (Qulipta) (CP.PHAR.566) (PDF)
- Avacincaptad Pegol (Izervay) (CP.PHAR.641) (PDF)
- Avacopan (Tavneos) (CP.PHAR.515) (PDF)
- Avalglucosidase Alfa-ngpt (Nexviazyme) (CP.PHAR.521) (PDF)
- Avapritinib (Ayvakit) (CP.PHAR.454) (PDF)
- Avatrombopag (Doptelet) (CP.PHAR.130) (PDF)
- Avelumab (Bavencio) (CP.PHAR.333) (PDF)
- Axicabtagene Ciloleucel (Yescarta) (CP.PHAR.362) (PDF)
- Axitinib (Inlyta) (CP.PHAR.100) (PDF)
- Azacitidine (Onureg, Vidaza) (CP.PHAR.387) (PDF)
- Azelaic Acid (Finacea Topical Gel/Foam) (HIM.PA.119) (PDF)
- Aztreonam (Cayston) (CP.PHAR.209) (PDF)
- Baclofen (Fleqsuvy, Gablofen, Lioresal, Lyvispah, Ozobax) (CP.PHAR.149) (PDF)
- Baloxavir Marboxil (Xofluza) (CP.PMN.185) (PDF)
- Bedaquiline (Sirturo) (CP.PMN.212) (PDF)
- Belantamab Mafodotin-blmf (Blenrep) (CP.PHAR.469) (PDF)
- Belatacept (Nulojix) (CP.PHAR.201) (PDF)
- Belimumab (Benlysta) (CP.PHAR.88) (PDF)
- Belinostat (Beleodaq) (CP.PHAR.311) (PDF)
- Belumosudil (Rezurock) (CP.PHAR.552) (PDF)
- Belzutifan (Welireg) (CP.PHAR.553) (PDF)
- Bempedoic Acid (Nexletol), Bempedoic Acid/Ezetimibe (Nexlizet) (CP.PMN.237) (PDF)
- Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta) (CP.PHAR.307) (PDF)
- Benralizumab (Fasenra) (CP.PHAR.373) (PDF)
- Benznidazole (CP.PMN.90) (PDF)
- Berdazimer (Zelsuvmi) (CP.PMN.293) (PDF)
- Beremagene geperpavec-svdt (Vyjuvek) (CP.PHAR.592) (PDF)
- Berotralstat (Orladeyo) (HIM.PA.169) (PDF)
- Betaine (Cystadane) (CP.PHAR.143) (PDF)
- Betamethasone Dipropionate Spray (Sernivo) (CP.PMN.182) (PDF)
- Betibeglogene Autotemcel (Zynteglo) (CP.PHAR.545) (PDF)
- Bevacizumab (Alymsys, Avastin, Avzivi, Mvasi, Vegzelma, Zirabev) (CP.PHAR.93) (PDF)
- Bexarotene (Targretin Capsules, Gel) (CP.PHAR.75) (PDF)
- Bezlotoxumab (Zinplava) (CP.PHAR.300) (PDF)
- Bimatoprost Implant (Durysta) (CP.PHAR.486) (PDF)
- Binimetinib (Mektovi) (CP.PHAR.50) (PDF)
- Biologic and Non-biologic DMARDs (HIM.PA.SP60) (PDF)
- Birch Triterpenes (Filsuvez) (CP.PHAR.669) (PDF)
- Blinatumomab (Blincyto) (CP.PHAR.312) (PDF)
- Bortezomib (Velcade) (CP.PHAR.410) (PDF)
- Bosentan (Tracleer) (CP.PHAR.191) (PDF)
- Bosutinib (Bosulif) (CP.PHAR.105) (PDF)
- Brand Name Override and Non-Formulary Medications (HIM.PA.103) (PDF)
- Brentuximab Vedotin (Adcetris) (CP.PHAR.303) (PDF)
- Brexanolone (Zulresso) (CP.PHAR.417) (PDF)
- Brexpiprazole (Rexulti) (CP.PMN.68) (PDF)
- Brexucabtagene Autoleucel (Tecartus) (CP.PHAR.472) (PDF)
- Brigatinib (Alunbrig) (CP.PHAR.342) (PDF)
- Brimonidine Tartrate (Mirvaso) (CP.PMN.192) (PDF)
- Brinzolamide/Brimonidine (Simbrinza) (HIM.PA.15) (PDF)
- Brivaracetam (Briviact) (CP.PCH.26) (PDF)
- Brolucizumab-dbll (Beovu) (CP.PHAR.445) (PDF)
- Budesonide (Eohilia, Uceris) (CP.PMN.294) (PDF)
- Budesonide (Tarpeyo) (CP.PHAR.572) (PDF)
- Buprenorphine (Subutex) (CP.PMN.82) (PDF)
- Buprenorphine Injection (Sublocade, Brixadi) (CP.PHAR.289) (PDF)
- Buprenorphine/Naloxone (Suboxone, Zubsolv) (CP.PMN.81) (PDF)
- Bupropion/Naltrexone (Contrave) (CP.PCH.12) (PDF)
- Burosumab-twza (Crysvita) (CP.PHAR.11) (PDF)
- Butorphanol Nasal Spray (HIM.PA.46) (PDF)
- C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda, Ruconest) (HIM.PA.170) (PDF)
- Cabazitaxel (Jevtana) (CP.PHAR.316) (PDF)
- Cabotegravir (Apretude), Cabotegravir/Rilpivirine (Cabenuva) (CP.PHAR.573) (PDF)
- Cabozantinib (Cabometyx, Cometriq) (CP.PHAR.111) (PDF)
- Calcifediol (Rayaldee) (CP.PMN.76) (PDF)
- Calcipotriene/Betamethasone Dipropionate Foam (Enstilar) (CP.PMN.181) (PDF)
- Canakinumab (Ilaris) (CP.PHAR.246) (PDF)
- Cannabidiol (Epidiolex) (CP.PMN.164) (PDF)
- Capecitabine (Xeloda) (CP.PHAR.60) (PDF)
- Capivasertib (Truqap) (CP.PHAR.663) (PDF)
- Caplacizumab-yhdp (Cablivi) (CP.PHAR.416) (PDF)
- Capmatinib (Tabrecta) (CP.PHAR.494) (PDF)
- Carbidopa/Levodopa ER Capsules (Rytary), Enteral Suspension (Duopa), IR Tablets (Dhivy) (CP.PMN.238) (PDF)
- Carfilzomib (Kyprolis) (CP.PHAR.309) (PDF)
- Carglumic Acid (Carbaglu) (CP.PHAR.206) (PDF)
- Cariprazine (Vraylar) (CP.PMN.91) (PDF)
- Casimersen (Amondys 45) (CP.PHAR.470) (PDF)
- Celecoxib (Celebrex, Elyxyb) (CP.PMN.122) (PDF)
- Cemiplimab-rwlc (Libtayo) (CP.PHAR.397) (PDF)
- Cenegermin-bkbj (Oxervate) (CP.PMN.186) (PDF)
- Cenobamate (Xcopri) (CP.PMN.231) (PDF)
- Ceritinib (Zykadia) (PDF) (CP.PHAR.349)
- Cerliponase Alfa (Brineura) (CP.PHAR.338) (PDF)
- Cetuximab (Erbitux) (CP.PHAR.317) (PDF)
- Chenodiol (Chenodal) (CP.PMN.239) (PDF)
- Chlorambucil (Leukeran) (CP.PHAR.554) (PDF)
- Chloramphenicol Sodium Succinate (CP.PHAR.388) (PDF)
- Cholic Acid (Cholbam) (CP.PHAR.390) (PDF)
- Ciclopirox Topical Solution 8% (CP.PMN.24) (PDF)
- Ciltacabtagene Autoleucel (Carvykti) (CP.PHAR.533) (PDF)
- Cinacalcet (Sensipar) (CP.PHAR.61) (PDF)
- Cipaglucosidase Alfa-atga + Miglustat (Pombiliti + Opfolda) (CP.PHAR.567) (PDF)
- Ciprofloxacin/Dexamethasone (Ciprodex) (CP.PMN.248) (PDF)
- Ciprofloxacin/Fluocinolone (Otovel) (CP.PMN.249) (PDF)
- Cladribine (Mavenclad) (CP.PHAR.422) (PDF)
- Clascoterone (Winlevi) (CP.PMN.257) (PDF)
- Clobazam (Onfi, Sympazan) (CP.PMN.54) (PDF)
- CNS Stimulants (CP.PMN.92) (PDF)
- Cobimetinib (Cotellic) (CP.PHAR.380) (PDF)
- Colchicine (Colcrys, Lodoco) (CP.PMN.123) (PDF)
- Colesevelam (Welchol) (CP.PMN.250) (PDF)
- Collagenase Clostridium Histolyticum (Xiaflex) (CP.PHAR.82) (PDF)
- Colonoscopy Preparation Products (CP.PCH.43) (PDF)
- Compounded Medications (CP.PMN.280) (PDF)
- Conjugated Estrogens/Bazedoxifene (Duavee) (CP.PMN.258) (PDF)
- Continuous Glucose Monitors (CP.PMN.214) (PDF)
- Copanlisib (Aliqopa) (CP.PHAR.357) (PDF)
- Corticosteroids for Ophthalmic Injection (Dextenza, Iluvien, Ozurdex, Retisert, Xipere, Yutiq) (CP.PHAR.385) (PDF)
- Cosyntropin (Cortrosyn) (CP.PHAR.203) (PDF)
- Crisaborole (Eucrisa) (CP.PMN.110) (PDF)
- Crizanlizumab-tmca (Adakveo) (CP.PHAR.449) (PDF)
- Crizotinib (Xalkori) (CP.PHAR.90) (PDF)
- Crovalimab (PiaSky) (CP.PHAR.664) (PDF)
- Cyclosporine (Cequa, Restasis, Verkazia, Vevye) (CP.PMN.48) (PDF)
- Cysteamine Ophthalmic (Cystaran, Cystadrops) (CP.PMN.130) (PDF)
- Cysteamine oral (Cystagon, Procysbi) (CP.PHAR.155) (PDF)
- Cytomegalovirus Immune Globulin (CytoGam) (CP.PHAR.277) (PDF)
- Dabrafenib (Tafinlar) (CP.PHAR.239) (PDF)
- Dacomitinib (Vizimpro) (CP.PHAR.399) (PDF)
- Dalfampridine (Ampyra) (CP.PHAR.248) (PDF)
- Dalteparin (Fragmin) (CP.PHAR.225) (PDF)
- Daprodustat (Jesduvroq) (CP.PHAR.628) (PDF)
- Dapsone (Aczone Gel) (CP.PCH.32) (PDF)
- Daptomycin (Cubicin, Cubicin RF, Dapzura RT) (CP.PHAR.351) (PDF)
- Daratumumab (Darzalex), Daratumumab/Hyaluronidase-fihj (Darzalex Faspro) (CP.PHAR.310) (PDF)
- Darbepoetin Alfa (Aranesp) (CP.PHAR.236) (PDF)
- Darolutamide (Nubeqa) (CP.PHAR.435) (PDF)
- Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir (Viekira Pak) (HIM.PA.SP61) (PDF)
- Dasatinib (Sprycel, Phyrago) (CP.PHAR.72) (PDF)
- Daunorubicin/Cytarabine (Vyxeos) (CP.PHAR.352) (PDF)
- DaxibotulinumtoxinA-lanm (Daxxify) (CP.PHAR.651) (PDF)
- Decitabine/Cedazuridine (Inqovi) (CP.PHAR.479) (PDF)
- Deferasirox (Exjade, Jadenu) (CP.PHAR.145) (PDF)
- Deferoxamine (Desferal) (CP.PHAR.146) (PDF)
- Deflazacort (Emflaza) (CP.PHAR.331) (PDF)
- Degarelix Acetate (Firmagon) (CP.PHAR.170) (PDF)
- Delafloxacin (Baxdela) (CP.PMN.115) (PDF)
- Delandistrogene Moxeparvovec-rokl (Elevidys) (CP.PHAR.593) (PDF)
- Denosumab (Prolia, Xgeva) (CP.PHAR.58) (PDF)
- Desmopressin Acetate (DDAVP, Stimate, Nocdurna) (CP.PHAR.214) (PDF)
- Deutetrabenazine (Austedo) (CP.PCH.42) (PDF)
- Dexrazoxane (Totect) (CP.PHAR.418) (PDF)
- Dextromethorphan/Bupropion (Auvelity) (CP.PMN.284) (PDF)
- Dextromethorphan-Quinidine (Nuedexta) (CP.PMN.93) (PDF)
- Diazepam Nasal Spray (Valtoco) (CP.PMN.216) (PDF)
- Dichlorphenamide (Keveyis) (CP.PMN.261) (PDF)
- Diclofenac (Cambia, Flector, Licart, Pennsaid, Solaraze, Zipsor, Zorvolex) (CP.PCH.28) (PDF)
- Dimethyl Fumarate (Tecfidera), Diroximel Fumarate (Vumerity), Monomethyl Fumarate (Bafiertam) (CP.PHAR.249) (PDF)
- Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (HIM.PA.58) (PDF)
- Dolasetron (Anzemet) (CP.PMN.141) (PDF)
- Dornase Alfa (Pulmozyme) (CP.PHAR.212) (PDF)
- Dostarlimab-gxly (Jemperli) (CP.PHAR.540) (PDF)
- Doxepin (Silenor, Prudoxin, Zonalon) (HIM.PA.147) (PDF)
- Doxycycline Hyclate (Acticlate, Doryx), Doxycycline (Oracea) (CP.PMN.79) (PDF)
- Dupilumab (Dupixent) (HIM.PA.SP69) (PDF)
- Durvalumab (Imfinzi) (CP.PHAR.339) (PDF)
- Dutasteride (Avodart), Dutasteride/Tamsulosin (Jalyn) (CP.PMN.128) (PDF)
- Duvelisib (Copiktra) (CP.PHAR.400) (PDF)
- Ecallantide (Kalbitor) (CP.PHAR.177) (PDF)
- Eculizumab (Soliris) (CP.PHAR.97) (PDF)
- Edaravone (Radicava, Radivaca ORS) (CP.PHAR.343) (PDF)
- Efgartigimod Alfa-fcab, Efgartigimod/Hyaluronidase-qvfc (Vyvgart, Vyvgart Hytrulo) (CP.PHAR.555) (PDF)
- Efinaconazole (Jublia) (CP.PMN.25) (PDF)
- Eflornithine (Iwilfin) (CP.PHAR.670) (PDF)
- Elacestrant (Orserdu) (CP.PHAR.623) (PDF)
- Elafibranor (Iqirvo) (CP.PHAR.688) (PDF)
- Elagolix (Orilissa), Elagolix/Estradiol/Norethinedrone (Oriahnn) (CP.PHAR.136) (PDF)
- Elapegademase-lvlr (Revcovi) (CP.PHAR.419) (PDF)
- Elbasvir/Grazoprevir (Zepatier) (HIM.PA.SP62) (PDF)
- Elexacaftor/Ivacaftor/Tezacaftor; Ivacaftor (Trikafta) (CP.PHAR.440) (PDF)
- Eliglustat (Cerdelga) (CP.PHAR.153) (PDF)
- Elivaldogene Autotemcel (Skysona) (CP.PHAR.556) (PDF)
- Elosulfase Alfa (Vimizim) (CP.PHAR.162) (PDF)
- Elotuzumab (Empliciti) (CP.PHAR.308) (PDF)
- Elranatamab-bcmm (Elrexfio) (CP.PHAR.652) (PDF)
- Eltrombopag (Alvaiz, Promacta) (CP.PHAR.180) (PDF)
- Eluxadoline (Viberzi) (CP.PMN.170) (PDF)
- Emapalumab-lzsg (Gamifant) (CP.PHAR.402) (PDF)
- Emicizumab-kxwh (Hemlibra) (CP.PHAR.370) (PDF)
- Emtricitabine/Tenofovir Alafenamide (Descovy) (PDF)
- Enasidenib (Idhifa) (CP.PHAR.363) (PDF)
- Encorafenib (Braftovi) (CP.PHAR.127) (PDF)
- Enfortumab Vedotin-ejfv (Padcev) (CP.PHAR.455) (PDF)
- Enfuvirtide (Fuzeon) (CP.PHAR.41) (PDF)
- Enoxaparin (Lovenox) (CP.PHAR.224) (PDF)
- Entecavir (Baraclude) (HIM.PA.08) (PDF)
- Entrectinib (Rozlytrek) (CP.PHAR.441) (PDF)
- Enzalutamide (Xtandi) (CP.PHAR.106) (PDF)
- Epcoritamab-bysp (Epkinly) (CP.PHAR.634) (PDF)
- Eplontersen (Wainua) (CP.PHAR.633) (PDF)
- Epoetin Alfa (Epogen, Procrit), Epoetin Alfa-epbx (Retacrit) (CP.PHAR.237) (PDF)
- Epoprostenol (Flolan, Veletri) (CP.PHAR.192) (PDF)
- Eptinezumab-jjmr (Vyepti) (HIM.PA.SP64) (PDF)
- Erdafitinib (Balversa) (CP.PHAR.423) (PDF)
- Erenumab-aooe (Aimovig) (HIM.PA.SP65) (PDF)
- Eribulin Mesylate (Halaven) (CP.PHAR.318) (PDF)
- Erlotinib (Tarceva) (CP.PHAR.74) (PDF)
- Erwinia Asparaginase (Rylaze) (CP.PHAR.301) (PDF)
- Esketamine (Spravato) (CP.PMN.199) (PDF)
- Estradiol Vaginal Ring (Femring) (CP.PMN.263) (PDF)
- Etelcalcetide (Parsabiv) (CP.PHAR.379) (PDF)
- Eteplirsen (Exondys 51) (CP.PHAR.288) (PDF)
- Etranacogene Dezaparvovec-drlb (Hemgenix) (CP.PHAR.580) (PDF)
- Everolimus (Afinitor, Afinitor Disperz, Zortress) (CP.PHAR.63) (PDF)
- Evinacumab-dgnb (Evkeeza) (HIM.PA.166) (PDF)
- Evolocumab (Repatha) (HIM.PA.156) (PDF)
- Exagamglogene Autotemcel (Casgevy) (CP.PHAR.603) (PDF)
- Factor IX (Human, Recombinant) (CP.PHAR.218) (PDF)
- Factor IX Complex, Human (Profilnine) (CP.PHAR.219) (PDF)
- Factor VIIa, Recombinant (NovoSeven RT, SevenFact) (CP.PHAR.220) (PDF)
- Factor VIII (Human, Recombinant) (CP.PHAR.215) (PDF)
- Factor VIII/von Willebrand Factor Complex (Human – Alphanate, Humate-P, Wilate); von Willebrand Factor (Recombinant – Vonvendi) (CP.PHAR.216) (PDF)
- Factor XIII A-Subunit, Recombinant (Tretten) (CP.PHAR.222) (PDF)
- Factor XIII, Human (Corifact) (CP.PHAR.221) (PDF)
- Fam-Trastuzumab Deruxtecan-nxki (Enhertu) (CP.PHAR.456) (PDF)
- Faricimab-svoa (Vabysmo) (CP.PHAR.581) (PDF)
- Febuxostat (Uloric) (CP.PMN.57) (PDF)
- Fecal Microbiota Spores, Live-brpk (Vowst) (CP.PHAR.632) (PDF)
- Fecal Microbiota, Live-jslm (Rebyota) (CP.PHAR.613) (PDF)
- Fedratinib (Inrebic) (CP.PHAR.442) (PDF)
- Fenfluramine (Fintepla) (CP.PMN.246) (PDF)
- Fentanyl IR (Actiq, Fentora, Lazanda, Subsys) (CP.PMN.127) (PDF)
- Ferric Carboxymaltose (Injectafer) (CP.PHAR.234) (PDF)
- Ferric Derisomaltose (Monoferric) (CP.PHAR.480) (PDF)
- Ferric Maltol (Accrufer)Ferric Maltol (Accrufer) (CP.PMN.213) (PDF)
- Ferric Pyrophosphate (Triferic, Triferic Avnu) (CP.PHAR.624) (PDF)
- Ferumoxytol (Feraheme) (CP.PHAR.165) (PDF)
- Fezolinetant (Veozah) (CP.PMN.289) (PDF)
- Fibrinogen Concentrate [Human] (Fibryga, RiaSTAP) (CP.PHAR.526) (PDF)
- Filgrastim (Neupogen), Filgrastim-sndz (Zarxio), Tbo-filgrastim (Granix), Filgrastim-aafi (Nivestym), Filgrastim-ayow (Releuko) (CP.PHAR.297) (PDF)
- Finerenone (Kerendia) (CP.PMN.266) (PDF)
- Fingolimod (Gilenya, Tascenso ODT) (CP.PCH.38) (PDF)
- Flibanserin (Addyi) (CP.PHAR.446) (PDF)
- Fluorouracil Cream (Tolak) (CP.PMN.165) (PDF)
- Fluticasone Propionate (Xhance) (CP.PMN.95) (PDF)
- Fondaparinux (Arixtra) (CP.PHAR.226) (PDF)
- Fosdenopterin (Nulibry) (CP.PHAR.471) (PDF)
- Fostamatinib (Tavalisse) (CP.PHAR.24) (PDF)
- Fostemsavir (Rukobia) (CP.PHAR.516) (PDF)
- Fremanezumab-vfrm (Ajovy) (HIM.PA.SP66) (PDF)
- Fruquintinib (Fruzaqla) (CP.PHAR.666) (PDF)
- Fulvestrant (Faslodex Injection) (CP.PHAR.424) (PDF)
- Furosemide (Furoscix) (CP.PHAR.608) (PDF)
- Futibatinib (Lytgobi) (CP.PHAR.604) (PDF)
- Gabapentin ER (Gralise, Horizant) (CP.PMN.240) (PDF)
- Galcanezumab-gnlm (Emgality) (HIM.PA.SP67) (PDF)
- Galsulfase (Naglazyme) (CP.PHAR.161) (PDF)
- Ganaxolone (Ztalmy) (CP.PMN.278) (PDF)
- Gefitinib (Iressa) (CP.PHAR.68) (PDF)
- Gemtuzumab Ozogamicin (Mylotarg) (CP.PHAR.358) (PDF)
- Gepirone (Exxua) (CP.PMN.292) (PDF)
- Gilteritinib (Xospata) (CP.PHAR.412) (PDF)
- Givosiran (Givlaari) (CP.PHAR.457) (PDF)
- Glasdegib (Daurismo) (CP.PHAR.413) (PDF)
- Glatiramer Acetate (Copaxone, Glatopa) (CP.PHAR.252) (PDF)
- Glaucoma Agents (CP.PMN.286) (PDF)
- Glecaprevir/Pibrentasvir (Mavyret) (HIM.PA.SP36) (PDF)
- Glofitamab-gxbm (Columvi) (CP.PHAR.636) (PDF)
- Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (HIM.PA.53)(PDF)
- Glycerol Phenylbutyrate (Ravicti) (CP.PHAR.207) (PDF)
- Golodirsen (Vyondys 53) (CP.PHAR.453) (PDF)
- Goserelin Acetate (Zoladex) (CP.PHAR.171) (PDF)
- Granisetron (Sancuso, Sustol) (CP.PMN.74) (PDF)
- Halcinonide (Halog) (HIM.PA.20) (PDF)
- Halobetasol Propionate (Bryhali, Lexette, Ultravate) (CP.PMN.180) (PDF)
- Halobetasol Propionate/Tazarotene (Duobrii) (CP.PMN.208) (PDF)
- Hemin (Panhematin) (CP.PHAR.181) (PDF)
- Histrelin Acetate (Vantas, Supprelin LA) (CP.PHAR.172) (PDF)
- House Dust Mite Allergen Extract (Odactra) (CP.PMN.111) (PDF)
- Human Growth Hormone (Somapacitan, Somatrogon, Somatropin) (HIM.PA.161) (PDF)
- Hyaluronate Derivatives (CP.PHAR.05) (PDF)
- Hydroxyprogesterone Caproate (Makena/compound) (CP.PHAR.14) (PDF)
- Hydroxyurea (Siklos) (CP.PMN.193) (PDF)
- Ibalizumab-uiyk (Trogarzo) (CP.PHAR.378) (PDF)
- Ibandronate Injection (Boniva) (CP.PHAR.189) (PDF)
- Ibrutinib (Imbruvica) (CP.PHAR.126) (PDF)
- Ibuprofen/Famotidine (Duexis) (CP.PMN.120) (PDF)
- Icatibant (Firazyr) (CP.PHAR.178) (PDF)
- Icosapent Ethyl (Vascepa) (CP.PMN.187) (PDF)
- Idecabtagene Vicleucel (Abecma) (CP.PHAR.481) (PDF)
- Idelalisib (Zydelig) (CP.PHAR.133) (PDF)
- Idursulfase (Elaprase) (CP.PHAR.156) (PDF)
- Iloperidone (Fanapt) (CP.PMN.32) (PDF)
- Iloprost (Ventavis) (CP.PHAR.193) (PDF)
- Imatinib (Gleevec) (CP.PHAR.65) (PDF)
- Imetelstat (Rytelo) (CP.PHAR.690) (PDF)
- Imiglucerase (Cerezyme) (CP.PHAR.154) (PDF)
- Immune Globulins (CP.PHAR.103) (PDF)
- Inclisiran (Leqvio) (CP.PHAR.568) (PDF)
- IncobotulinumtoxinA (Xeomin) (CP.PHAR.231) (PDF)
- Inebilizumab-cdon (Uplizna) (CP.PHAR.458) (PDF)
- Infertility and Fertility Preservation (CP.PHAR.131) (PDF)
- Infigratinib (Truseltiq) (CP.PHAR.547) (PDF)
- Inhaled Agents for Asthma and COPD (HIM.PA.153) (PDF)
- Inotersen (Tegsedi) (CP.PHAR.405) (PDF)
- Inotuzumab Ozogamicin (Besponsa) (CP.PHAR.359) (PDF)
- Insulin Delivery Systems (V-Go, Omnipod, InPen) (CP.PHAR.534) (PDF)
- Insulin detemir (Levemir) (HIM.PA.171) (PDF)
- Insulin Glargine (Rezvoglar, Semglee, Toujeo) (HIM.PA.09) (PDF)
- Interferon Beta-1a (Avonex, Rebif) (CP.PHAR.255) (PDF)
- Interferon Beta-1b (Betaseron, Extavia) (CP.PCH.46) (PDF)
- Interferon Gamma- 1b (Actimmune) (CP.PHAR.52) (PDF)
- Iobenguane I-131 (Azedra) (CP.PHAR.459) (PDF)
- Ipilimumab (Yervoy) (CP.PHAR.319) (PDF)
- Iptacopan (Fabhalta) (CP.PHAR.656) (PDF)
- Irinotecan Liposome (Onivyde) (CP.PHAR.304) (PDF)
- Isatuximab-irfc (Sarclisa) (CP.PHAR.482) (PDF)
- Isavuconazonium (Cresemba) (CP.PMN.154) (PDF)
- Isotretinoin (Absorica, Absorica LD, Amnesteem, Claravis, Myorisan, Zenatane) (CP.PMN.143) (PDF)
- Istradefylline (Nourianz) (CP.PMN.217) (PDF)
- Itraconazole (Sporanox, Tolsura) (CP.PMN.124) (PDF)
- Ivabradine (Corlanor) (CP.PMN.70) (PDF)
- Ivacaftor (Kalydeco) (CP.PHAR.210) (PDF)
- Ivermectin (Stromectol, Sklice) (CP.PMN.269) (PDF)
- Ivosidenib (Tibsovo) (CP.PHAR.137) (PDF)
- Ixazomib (Ninlaro) (CP.PHAR.302) (PDF)
- Ketamine (Ketalar) (CP.PMN.296) (PDF)
- Ketorolac Nasal Spray (Sprix) (CP.PMN.282) (PDF)
- Lanadelumab-fylo (Takhzyro) (HIM.PA.172) (PDF)
- Lanreotide (Somatuline Depot and Unbranded) (CP.PHAR.391) (PDF)
- Lapatinib (Tykerb) (CP.PHAR.79) (PDF)
- Laronidase (Aldurazyme) (CP.PHAR.152) (PDF)
- Larotrectinib (Vitrakvi) (CP.PHAR.414) (PDF)
- Lasmiditan (Reyvow) (CP.PMN.218) (PDF)
- Lecanemab-irmb (Leqembi) (CP.PHAR.596) (PDF)
- Ledipasvir/Sofosbuvir (Harvoni) (HIM.PA.SP3) (PDF)
- Lefamulin (Xenleta) (CP.PMN.219) (PDF)
- Lenacapavir (Sunlenca) (CP.PHAR.622) (PDF)
- Lenalidomide (Revlimid) (CP.PHAR.71) (PDF)
- Leniolisib (Joenja) (CP.PHAR.597) (PDF)
- Lenvatinib (Lenvima) (CP.PHAR.138) (PDF)
- Letermovir (Prevymis) (CP.PHAR.367) (PDF)
- Leucovorin Injection (CP.PHAR.393) (PDF)
- Leuprolide Acetate (Eligard, Fensolvi, Lupaneta Pack, Lupron Depot, Lupron Depot-Ped), Leuprolide mesylate (Camcevi) (CP.PHAR.173) (PDF)
- Levodopa Inhalation Powder (Inbrija) (CP.PMN.267) (PDF)
- Levoketoconazole (Recorlev) (CP.PMN.275) (PDF)
- Levoleucovorin (Fusilev, Khapzory) (CP.PHAR.151) (PDF)
- Levomilnacipran (Fetzima) (HIM.PA.125) (PDF)
- L-glutamine (Endari) (CP.PMN.116) (PDF)
- Lidocaine Transdermal (Lidoderm, ZTlido) (CP.PMN.08) (PDF)
- Lifileucel (Amtagvi) (CP.PHAR.598) (PDF)
- Lifitegrast (Xiidra) (CP.PMN.73) (PDF)
- Linezolid (Zyvox) (CP.PMN.27) (PDF)
- Lisocabtagene Maraleucel (Breyanzi) (CP.PHAR.483) (PDF)
- Lofexidine (Lucemyra) (CP.PMN.152) (PDF)
- Lomustine (Gleostine) (CP.PHAR.507) (PDF)
- Lonafarnib (Zokinvy) (CP.PHAR.499) (PDF)
- Loncastuximab Tesirine-lpyl (Zynlonta) (CP.PHAR.539) (PDF)
- Lorlatinib (Lorbrena) (CP.PHAR.406) (PDF)
- Loteprednol etabonate (Eysuvis) (CP.PMN.260) (PDF)
- Lotilaner (Xdemvy) (CP.PMN.291) (PDF)
- Lovotibeglogene Autotemcel (Lyfgenia) (PDF)
- Lubiprostone (Amitiza) (CP.PMN.142) (PDF)
- Luliconazole Cream (Luzu) (CP.PMN.166) (PDF)
- Lumacaftor/Ivacaftor (Orkambi) (CP.PHAR.213) (PDF)
- Lumasiran (Oxlumo) (CP.PHAR.473) (PDF)
- Lumateperone (Caplyta) (CP.PMN.232) (PDF)
- Lurbinectedin (Zepzelca) (CP.PHAR.500) (PDF)
- Luspatercept-aamt (Reblozyl) (CP.PHAR.450) (PDF)
- Lusutrombopag (Mulpleta) (CP.PHAR.407) (PDF)
- Lutetium Lu 177 Dotatate (Lutathera) (CP.PHAR.384) (PDF)
- Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) (CP.PHAR.582) (PDF)
- Macitentan (Opsumit) (CP.PHAR.194) (PDF)
- Mannitol (Bronchitol) (CP.PHAR.518) (PDF)
- Maralixibat (Livmarli) (CP.PHAR.543) (PDF)
- Margetuximab-cmkb (Margenza) (CP.PHAR.522) (PDF)
- Maribavir (Livtencity) (CP.PMN.271) (PDF)
- Mavacamten (Camzyos) (CP.PMN.272) (PDF)
- Mecamylamine (Vecamyl) (CP.PMN.136) (PDF)
- Mecasermin (Increlex) (CP.PHAR.150) (PDF)
- Mechlorethamine Gel (Valchlor) (CP.PHAR.381) (PDF)
- Megestrol Acetate (Megace ES) (CP.PMN.179) (PDF)
- Melphalan (Hepzato) (CP.PHAR.653) (PDF)
- Melphalan Flufenamide (Pepaxto) (CP.PHAR.535) (PDF)
- Memantine ER (Namenda XR), Memantine/Donepezil (Namzaric) (CP.PCH.30) (PDF)
- Mepolizumab (Nucala) (CP.PHAR.200) (PDF)
- Mercaptopurine (Purixan) (CP.PHAR.447) (PDF)
- Metformin ER (Fortamet, Glumetza) (CP.PMN.72) (PDF)
- Methotrexate (Otrexup, Rasuvo, Xatmep, Reditrex, Jylamvo (CP.PHAR.134) (PDF)
- Methoxsalen (Uvadex) (HIM.PA.17) (PDF)
- Methoxy Polyethylene Glycol-Epoetin Beta (Mircera) (CP.PHAR.238) (PDF)
- Methylnaltrexone Bromide (Relistor) (CP.PMN.169) (PDF)
- Metoclopramide (Gimoti) (CP.PMN.252) (PDF)
- Metreleptin (Myalept) (CP.PHAR.425) (PDF)
- Midazolam (Nayzilam) (CP.PMN.211) (PDF)
- Midostaurin (Rydapt) (CP.PHAR.344) (PDF)
- Mifepristone (Korlym) (CP.PHAR.101) (PDF)
- Migalastat (Galafold) (CP.PHAR.394) (PDF)
- Miglustat (Zavesca) (CP.PHAR.164) (PDF)
- Milnacipran (Savella) (CP.PMN.125) (PDF)
- Minocycline ER (Solodyn, Ximino, Minolira), Microspheres (Arestin), Foam (Zilxi) (CP.PMN.80) (PDF)
- Mirvetuximab soravatansine-gynx (Elahere) (CP.PHAR.617) (PDF)
- Mitapivat (Pyrukynd) (CP.PHAR.558) (PDF)
- Mitomycin for Pyelocalyceal Solution (Jelmyto) (PDF)
- Mitoxantrone (CP.PHAR.258) (PDF)
- Mobocertinib (Exkivity) (CP.PHAR.559) (PDF)
- Modafinil (Provigil) (CP.PMN.39) (PDF)
- Mogamulizumab-kpkc (Poteligeo) (CP.PHAR.139) (PDF)
- Momelotinib (Ojjaara) (CP.PHAR.654) (PDF)
- Mometasone (Nasonex) (HIM.PA.93) (PDF)
- Mometasone Furoate (Sinuva) (CP.PHAR.448) (PDF)
- Mosunetuzumab-axgb (Lunsumio) (CP.PHAR.618) (PDF)
- Motixafortide (Aphexda) (CP.PHAR.655) (PDF)
- Moxetumomab pasudotox-tdfk (Lumoxiti) (PDF)
- Nabumetone Double-Strength (Relafen DS) (CP.PMN.287) (PDF)
- Nadofaragene Firadenovec-vncg (Adstiladrin) (CP.PHAR.461) (PDF)
- Nafarelin Acetate (Synarel) (CP.PHAR.174) (PDF)
- Naldemedine (Symproic) (CP.PMN.112) (PDF)
- Nalmefene (Opvee) (CP.PHAR.638) (PDF)
- Naloxegol (Movantik) (HIM.PA.167) (PDF)
- Naltrexone (Vivitrol) (CP.PHAR.96) (PDF)
- Naproxen Oral Suspension (Naprosyn) (HIM.PA.130) (PDF)
- Naproxen/Esomeprazole (Vimovo) (CP.PMN.117) (PDF)
- Natalizumab (Tysabri), Natalizumab-sztn (Tyruko) (CP.PHAR.259) (PDF)
- Naxitamab-gqgk (Danyelza) (CP.PHAR.523) (PDF)
- Necitumumab (Portrazza) (CP.PHAR.320) (PDF)
- Nedosiran (Rivfloza) (CP.PHAR.619) (PDF)
- Neomycin/Fluocinolone Cream (Neo-Synalar) (CP.PMN.167) (PDF)
- Neratinib (Nerlynx) (CP.PHAR.365) (PDF)
- Netupitant and Palonosetron (Akynzeo), Fosnetupitant and Palonosetron (Akynzeo IV) (CP.PMN.158) (PDF)
- Nifurtimox (Lampit) (CP.PMN.256) (PDF)
- Nilotinib (Tasigna) (CP.PHAR.76) (PDF)
- Nintedanib (Ofev) (CP.PHAR.285) (PDF)
- Niraparib (Zejula) (CP.PHAR.408) (PDF)
- Niraparib and Abiraterone Acetate (Akeega) (CP.PHAR.645) (PDF)
- Nirmatrelvir and Ritonavir (Paxlovid) (CP.PMN.288) (PDF)
- Nirogacestat (Ogsiveo) (CP.PHAR.671) (PDF)
- Nirsevimab-alip (Beyfortus) (CP.PHAR.614) (PDF)
- Nitazoxanide (Alinia) (HIM.PA.152) (PDF)
- Nitisinone (Nityr, Orfadin) (CP.PHAR.132) (PDF)
- Nivolumab (Opdivo) (CP.PHAR.121) (PDF)
- Nivolumab and Relatlimab-rmbw (Opdualag) (CP.PHAR.588) (PDF)
- No Coverage Criteria, Recent Label Changes Pending Clinical Policy Update (HIM.PA.33) (PDF)
- Nogapendekin alfa inbakicept-pmln (Anktiva) (CP.PHAR.684) (PDF)
- Non-Calcium Phosphate Binders (CP.PMN.04) (PDF)
- Non-Formulary and Formulary Contraceptives (HIM.PA.100) (PDF)
- Non-Formulary Test Strips (HIM.PA.34) (PDF)
- Nusinersen (Spinraza) (CP.PHAR.327) (PDF)
- Obeticholic Acid (Ocaliva) (CP.PHAR.287) (PDF)
- Obinutuzumab (Gazyva) (CP.PHAR.305) (PDF)
- Ocrelizumab (Ocrevus) (CP.PHAR.335) (PDF)
- Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Mycapssa) (PDF)
- Odevixibat (Bylvay) (CP.PHAR.528) (PDF)
- Ofatumumab (Arzerra, Kesimpta) (CP.PHAR.306) (PDF)
- Off-Label Drug Use (HIM.PA.154) (PDF)
- Olanzapine Long-Acting Injection (Zyprexa Relprevv) (CP.PHAR.292) (PDF)
- Olanzapine/Samidorphan (Lybalvi) (CP.PMN.265) (PDF)
- Olaparib (Lynparza) (CP.PHAR.360) (PDF)
- Olipudase Alfa-rpcp (Xenpozyme) (CP.PHAR.586) (PDF)
- Olutasidenib (Rezlidhia) (CP.PHAR.615) (PDF)
- Omacetaxine (Synribo) (CP.PHAR.108) (PDF)
- Omadacycline (Nuzyra) (CP.PMN.188) (PDF)
- Omalizumab (Xolair) (CP.PCH.49) (PDF)
- Omaveloxolone (Skyclarys) (CP.PHAR.590) (PDF)
- OnabotulinumtoxinA (Botox) (CP.PHAR.232) (PDF)
- Onasemnogene Abeparvovec (Zolgensma) (CP.PHAR.421) (PDF)
- Ophthalmic Corticosteroids (HIM.PA.03) (PDF)
- Ophthalmic Riboflavin (Photrexa, Photrexa Viscous) (CP.PHAR.536) (PDF)
- Opicapone (Ongentys) (CP.PMN.245) (PDF)
- Opioid Analgesics* (HIM.PA.139) (PDF)
- Osilodrostat (Isturisa) (CP.PHAR.487) (PDF)
- Osimertinib (Tagrisso) (CP.PHAR.294) (PDF)
- Ospemifene (Osphena) (CP.PMN.168) (PDF)
- Overactive Bladder Agents (CP.PMN.198) (PDF)
- Oxymetazoline (Rhofade, Upneeq) (CP.PMN.86) (PDF)
- Ozanimod (Zeposia) (CP.PHAR.462) (PDF)
- Ozenoxacin (Xepi) (CP.PMN.119) (PDF)
- Paclitaxel, Protein-Bound (Abraxane) (CP.PHAR.176) (PDF)
- Pacritinib (Vonjo) (CP.PHAR.583) (PDF)
- Palbociclib (Ibrance) (HIM.PA.173) (PDF)
- Paliperidone Long-Acting Injections (Invega Hafyera, Invega Sustenna, Invega Trinza) (CP.PHAR.291) (PDF)
- Palivizumab (Synagis) (CP.PHAR.16) (PDF)
- Palovarotene (Sohonos) (CP.PHAR.548) (PDF)
- Pancrelipase (Creon, Pancreaze, Pertzye, Viokace, Zenpep) (CP.PCH.44) (PDF)
- Panitumumab (Vectibix) (CP.PHAR.321) (PDF)
- Parathyroid Hormone (Natpara) (CP.PHAR.282) (PDF)
- Paricalcitol Injection (Zemplar) (CP.PHAR.270) (PDF)
- Pasireotide (Signifor, Signifor LAR) (PDF)
- Patiromer (Veltassa) (CP.PMN.205) (PDF)
- Patisiran (Onpattro) (CP.PHAR.395) (PDF)
- Pazopanib (Votrient) (CP.PHAR.81) (PDF)
- Peanut Allergen Powder-dnfp (Palforzia) (CP.PMN.220) (PDF)
- Pegaspargase (Oncaspar), Calaspargase Pegol-mknl (Asparlas) (CP.PHAR.353) (PDF)
- Pegcetacoplan (Empaveli, Syfovre) (CP.PHAR.524) (PDF)
- Pegfilgrastim (Neulasta, Neulasta Onpro), Pegfilgrastim-jmdb, Pegfilgrastim-pbbk, Pegfilgrastim-apgf, Eflapegrastim-xnst, Efbemalenograstim alfa-vuxw, Pegfilgrastim-fpgk, Pegfilgrastim-cbqv, Pegfilgrastim-bmez (CP.PHAR.296) (PDF)
- Peginterferon Alfa-2a (Pegasys) (CP.PHAR.89) (PDF)
- Peginterferon Beta-1a (Plegridy) (CP.PHAR.271) (PDF)
- Pegloticase (Krystexxa) (CP.PHAR.115) (PDF)
- Pegunigalsidase Alfa-iwxj (Elfabrio) (CP.PHAR.512) (PDF)
- Pegvaliase-pqpz (Palynziq) (CP.PHAR.140) (PDF)
- Pegvisomant (Somavert) (CP.PHAR.389) (PDF)
- Pembrolizumab (Keytruda) (CP.PHAR.322) (PDF)
- Pemetrexed (Alimta, Pemfexy) (CP.PHAR.368) (PDF)
- Pemigatinib (Pemazyre) (CP.PHAR.496) (PDF)
- Penicillamine (Cuprimine) (CP.PCH.09) (PDF)
- Perampanel (Fycompa) (CP.PMN.156) (PDF)
- Perfluorohexyloctane (Miebo) (CP.PMN.290) (PDF)
- Pertuzumab (Perjeta) (CP.PHAR.227) (PDF)
- Pertuzumab/Trastuzumab/Hyaluronidase-zzxf (Phesgo) (CP.PHAR.501) (PDF)
- Pexidartinib (Turalio) (CP.PHAR.436) (PDF)
- Phendimetrazine (CP.PCH.47) (PDF)
- Phentermine (Adipex-P, Lomaira) (CP.PCH.13) (PDF)
- Pilocarpine (Qlosi, Vuity) (CP.PMN.270) (PDF)
- Pimavanserin (Nuplazid) (CP.PMN.140) (PDF)
- Pirfenidone (Esbriet) (CP.PHAR.286) (PDF)
- Pirtobrutinib (Jaypirca) (CP.PHAR.620) (PDF)
- Pitolisant (Wakix) (CP.PMN.221) (PDF)
- Plasminogen, Human-tvmh (Ryplazim) (PDF)
- Plecanatide (Trulance) (CP.PMN.87) (PDF)
- Plerixafor (Mozobil) (CP.PHAR.323) (PDF)
- Polatuzumab Vedotin-piiq (Polivy) (CP.PHAR.433) (PDF)
- Pomalidomide (Pomalyst) (CP.PHAR.116) (PDF)
- Ponatinib (Iclusig) (CP.PHAR.112) (PDF)
- Ponesimod (Ponvory) (CP.PHAR.537) (PDF)
- Potassium Chloride for Oral Solution (Klor-Con Powder) (HIM.PA.143) (PDF)
- Pozelimab-bbfg (Veopoz) (CP.PHAR.626) (PDF)
- Pralatrexate (Folotyn) (CP.PHAR.313) (PDF)
- Pramlintide (Symlin) (CP.PMN.129) (PDF)
- Prasterone (Intrarosa) (CP.PMN.99) (PDF)
- Pregabalin (Lyrica, Lyrica CR) (CP.PMN.33) (PDF)
- Pretomanid (CP.PMN.222) (PDF)
- Progesterone (Crinone, Endometrin, Milprosa) (CP.PMN.243) (PDF)
- Propranolol HCl Oral Solution (Hemangeol) (CP.PCH.51) (PDF)
- Protein C Concentrate, Human (Ceprotin) (CP.PHAR.330) (PDF)
- Prucalopride (Motegrity) (HIM.PA.159) (PDF)
- Pyrimethamine (Daraprim) (CP.PMN.44) (PDF)
- Quantity Limit Override and Dose Optimization (CP.PMN.59) (PDF)
- Quetiapine Extended-Release (Seroquel XR) (PDF)
- Quinine Sulfate (Qualaquin) (CP.PMN.262) (PDF)
- Quizartinib (Vanflyta) (CP.PHAR.646) (PDF)
- Ramucirumab (Cyramza) (CP.PHAR.119) (PDF)
- Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo) (CP.PHAR.186) (PDF)
- Rasagiline (Azilect) (HIM.PA.89) (PDF)
- Ravulizumab-cwvz (Ultomiris) (CP.PHAR.415) (PDF)
- Regorafenib (Stivarga) (CP.PHAR.107) (PDF)
- Relugolix (Orgovyx), Relugolix/Estradiol/Norethinedrone (Myfembree) (CP.PHAR.529) (PDF)
- Repository Corticotropin Injection (H.P. Acthar Gel, Purified Cortrophin Gel) (HIM.PA.168) (PDF)
- Repotrectinib (Augtyro) (CP.PHAR.667) (PDF)
- Reslizumab (Cinqair) (CP.PHAR.223) (PDF)
- Resmetirom (Rezdiffra) (CP.PHAR.647) (PDF)
- Respiratory syncytial virus vaccine (Abrysvo) (CP.PHAR.658) (PDF)
- Retifanlimab-dlwr (Zynyz) (CP.PHAR.629) (PDF)
- Ribavirin (Rebetol, Ribasphere) (CP.PHAR.141) (PDF)
- Ribociclib (Kisqali), Ribociclib/Letrozole (Kisqali Femara) (CP.PHAR.334) (PDF)
- Rifabutin (Mycobutin) (CP.PMN.223) (PDF)
- ifamycin (Aemcolo) (CP.PMN.196) (PDF)
- Rifaximin (Xifaxan) (CP.PMN.47) (PDF)
- Rilonacept (Arcalyst) (CP.PHAR.266) (PDF)
- RimabotulinumtoxinB (Myobloc) (CP.PHAR.233) (PDF)
- Rimegepant (Nurtec ODT) (CP.PHAR.490) (PDF)
- Riociguat (Adempas) (CP.PHAR.195) (PDF)
- Ripretinib (Qinlock) (CP.PHAR.502) (PDF)
- Risdiplam (Evrysdi) (CP.PHAR.477) (PDF)
- Risedronate (Actonel, Atelvia) (CP.PMN.100) (PDF)
- Risperidone Long-Acting Injection (Perseris, Risperdal Consta, Rykindo, Uzedy) (CP.PHAR.293) (PDF)
- Rituximab (Rituxan), Rituximab-arrx (Riabni), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), Rituximab-Hyaluronidase (Rituxan Hycela) (CP.PHAR.260) (PDF)
- Roflumilast (Daliresp, Zoryve) (CP.PMN.46) (PDF)
- Rolapitant (Varubi) (CP.PMN.102) (PDF)
- Romidepsin (Istodax) (CP.PHAR.314) (PDF)
- Romiplostim (Nplate) (CP.PHAR.179) (PDF)
- Romosozumab-aqqg (Evenity) (CP.PHAR.428) (PDF)
- Ropeginterferon Alfa-2b-njft (BESREMi) (CP.PHAR.570) (PDF)
- Rozanolixizumab-noli (Rystiggo) (CP.PHAR.648) (PDF)
- Rucaparib (Rubraca) (CP.PHAR.350) (PDF)
- Rufinamide (Banzel) (CP.PMN.157) (PDF)
- Ruxolitinib (Jakafi, Opzelura) (CP.PHAR.98) (PDF)
- Sacituzumab Govitecan-hziy (Trodelvy) (CP.PHAR.475) (PDF)
- Sacubitril/Valsartan (Entresto) (CP.PCH.52) (PDF)
- Safinamide (Xadago) (CP.PMN.113) (PDF)
- Sapropterin Dihydrochloride (Kuvan) (CP.PHAR.43) (PDF)
- Sarecycline (Seysara) (CP.PMN.189) (PDF)
- Sargramostim (Leukine) (CP.PHAR.295) (PDF)
- Satralizumab-mwge (Enspryng) (CP.PHAR.463) (PDF)
- Sebelipase Alfa (Kanuma) (CP.PHAR.159) (PDF)
- Secnidazole (Solosec) (CP.PMN.103) (PDF)
- Selexipag (Uptravi) (CP.PHAR.196) (PDF)
- Selinexor (Xpovio) (CP.PHAR.431) (PDF)
- Selpercatinib (Retevmo) (CP.PHAR.478) (PDF)
- Selumetinib (Koselugo) (CP.PHAR.464) (PDF)
- Semaglutide (Wegovy) (CP.PMN.295) (PDF)
- Setmelanotide (Imcivree) (CP.PHAR.491) (PDF)
- Short Ragweed Pollen Allergen Extract (Ragwitek) (CP.PMN.83) (PDF)
- Sildenafil (Revatio, Liqrev) (CP.PHAR.197) (PDF)
- Sildenafil for ED (Viagra) (CP.PCH.07) (PDF)
- Siltuximab (Sylvant) (CP.PHAR.329) (PDF)
- Siponimod (Mayzent) (CP.PHAR.427) (PDF)
- Sirolimus Protein-Bound Particles (Fyarro), Topical Gel (Hyftor) (CP.PHAR.574) (PDF)
- Sodium Oxybate (Xyrem, Lumryz) and Calcium, Magnesium, Potassium, and Sodium Oxybate (Xywav) (CP.PMN.42) (PDF)
- Sodium Phenylbutyrate (Buphenyl, Pheburane, Olpruva) (CP.PHAR.208) (PDF)
- Sodium Phenylbutyrate/Taurursodiol (Relyvrio) (CP.PHAR.584) (PDF)
- Sodium Thiosulfate (Pedmark) (CP.PHAR.610) (PDF)
- Sodium Zirconium Cyclosilicate (Lokelma) (CP.PMN.163) (PDF)
- Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors (HIM.PA.91) (PDF)
- Sofosbuvir (Sovaldi) (HIM.PA.SP2) (PDF)
- Sofosbuvir/Velpatasvir (Epclusa) (HIM.PA.SP1) (PDF)
- Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) (HIM.PA.SP63) (PDF)
- Solriamfetol (Sunosi) (CP.PMN.209) (PDF)
- Sonidegib (Odomzo) (CP.PHAR.272) (PDF)
- Sorafenib (Nexavar) (CP.PHAR.69) (PDF)
- Sotatercept (Winrevair) (CP.PHAR.657) (PDF)
- Sotorasib (Lumakras) (CP.PHAR.549) (PDF)
- Sparsentan (Filspari) (CP.PHAR.631) (PDF)
- Spesolimab-sbzo (Spevigo) (CP.PHAR.606) (PDF)
- Spinosad (Natroba) (HIM.PA.134) (PDF)
- Step Therapy (HIM.PA.109) (PDF)
- Stiripentol (Diacomit) (CP.PMN.184) (PDF)
- Sunitinib (Sutent) (CP.PHAR.73) (PDF)
- Sutimlimab-jome (Enjaymo) (CP.PHAR.503) (PDF)
- Suvorexant (Belsomra) (CP.PMN.109) (PDF)
- Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens Allergen Extract (Oralair) (CP.PMN.85) (PDF)
- Tadalafil (Adcirca, Alyq, Tadliq) (CP.PHAR.198) (PDF)
- Tadalafil BPH - ED (Cialis) (CP.PMN.132) (PDF)
- Tafamidis (Vyndaqel, Vyndamax) (CP.PHAR.432) (PDF)
- Tafasitamab-cxix (Monjuvi) (CP.PHAR.508) (PDF)
- Talazoparib (Talzenna) (CP.PHAR.409) (PDF)
- Taliglucerase Alfa (Elelyso) (CP.PHAR.157) (PDF)
- Talimogene laherepvec (Imlygic) (CP.PHAR.542) (PDF)
- Talquetamab-tgvs (Talvey) (CP.PHAR.649) (PDF)
- Tapinarof (Vtama) (CP.PMN.283) (PDF)
- Tarlatamab-dlle (Imdelltra) (CP.PHAR.685) (PDF)
- Tasimelteon (Hetlioz, Hetlioz LQ) (CP.PMN.104) (PDF)
- Tavaborole (Kerydin) (CP.PMN.105) (PDF)
- Tazarotene (Arazlo, Fabior, Tazorac) (CP.PMN.244) (PDF)
- Tazemetostat (Tazverik) (CP.PHAR.452) (PDF)
- Tebentafusp-tebn (Kimmtrak) (CP.PHAR.575) (PDF)
- Teclistamab-cqyv (Tecvayli) (CP.PHAR.611) (PDF)
- Tedizolid (Sivextro) (CP.PMN.62) (PDF)
- Teduglutide (Gattex) (CP.PHAR.114) (PDF)
- Tegaserod (Zelnorm) (HIM.PA.160) (PDF)
- Telotristat Ethyl (Xermelo) (CP.PHAR.337) (PDF)
- Temozolomide (Temodar) (CP.PHAR.77) (PDF)
- Temsirolimus (Torisel) (CP.PHAR.324) (PDF)
- Tenapanor (Ibsrela, Xphozah) (HIM.PA.174) (PDF)
- Tenofovir Alafenamide Fumarate (Vemlidy) (CP.PMN.268) (PDF)
- Teplizumab-mzwv (Tzield) (CP.PHAR.492) (PDF)
- Tepotinib (Tepmetko) (CP.PHAR.530) (PDF)
- Teprotumumab (Tepezza) (CP.PHAR.465) (PDF)
- Teriflunomide (Aubagio) (CP.PCH.40) (PDF)
- Teriparatide (Forteo, Bonsity) (CP.PHAR.188) (PDF)
- Tesamorelin (Egrifta SV) (CP.PHAR.109) (PDF)
- Testosterone (Androderm) (HIM.PA.87) (PDF)
- Testosterone (Testopel, Jatenzo, Kyzatrex, Tlando) (CP.PHAR.354) (PDF)
- Tetrabenazine (Xenazine) (CP.PHAR.92) (PDF)
- Tezacaftor/Ivacaftor; Ivacaftor (Symdeko) (CP.PHAR.377) (PDF)
- Tezepelumab-ekko (Tezspire) (CP.PHAR.576) (PDF)
- Thalidomide (Thalomid) (CP.PHAR.78) (PDF)
- Thioguanine (Tabloid) (CP.PHAR.437) (PDF)
- Thyrotropin Alfa (Thyrogen) (CP.PHAR.95) (PDF)
- Timothy Grass Pollen Allergen Extract (Grastek) (CP.PMN.84)(PDF)
- Tiopronin Delayed-Release (Thiola EC) (CP.PCH.50) (PDF)
- Tisagenlecleucel (Kymriah) (CP.PHAR.361) (PDF)
- Tislelizumab-jsgr (Tevimbra) (CP.PHAR.686) (PDF)
- Tisotumab Vedotin-tftv (Tivdak) (CP.PHAR.561) (PDF)
- Tivozanib (Fotivda) (CP.PHAR.538) (PDF)
- Tobramycin (Bethkis, Kitabis Pak, TOBI, TOBI Podhaler) (CP.PHAR.211) (PDF)
- Tofersen (Qalsody) (CP.PHAR.591) (PDF)
- Tolvaptan (Jynarque, Samsca) (CP.PHAR.27) (PDF)
- Topical Acne Treatment (HIM.PA.71) (PDF)
- Topical Immunomodulators (CP.PMN.107) (PDF)
- Topiramate Extended-Release (Qudexy XR, Trokendi XR) (CP.PMN.281) (PDF)
- Topotecan (Hycamtin) (CP.PHAR.64) (PDF)
- Toripalimab-tpzi (Loqtorzi) (CP.PHAR.668) (PDF)
- Tovorafenib (Ojemda) (CP.PHAR.687) (PDF)
- Trabectedin (Yondelis) (CP.PHAR.204) (PDF)
- Tralokinumab-ldrm (Adbry) (CP.PHAR.577) (PDF)
- Trametinib (Mekinist) (CP.PHAR.240) (PDF)
- Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase (CP.PHAR.228) (PDF)
- Travoprost Implant (iDose TR) (CP.PHAR.672) (PDF)
- Tremelimumab-actl (Imjudo) (CP.PHAR.612) (PDF)
- Treprostinil (Orenitram, Remodulin, Tyvaso, Tyvaso DPI) (CP.PHAR.199) (PDF)
- Triamcinolone ER Injection (Zilretta) (CP.PHAR.371) (PDF)
- Triclabendazole (Egaten) (CP.PMN.207) (PDF)
- Trientine (Cuvrior, Syprine) (CP.PHAR.438) (PDF)
- Trifarotene (Aklief) (CP.PMN.225) (PDF)
- Trifluridine/Tipiracil (Lonsurf) (CP.PHAR.383) (PDF)
- Triheptanoin (Dojolvi) (CP.PHAR.509) (PDF)
- Triptorelin Pamoate (Trelstar, Triptodur) (CP.PHAR.175) (PDF)
- Trofinetide (Daybue) (CP.PHAR.600) (PDF)
- Tucatinib (Tukysa) (CP.PHAR.497) (PDF)
- Ublituximab-xiiy (Briumvi) (CP.PHAR.621) (PDF)
- Ulcer Therapy Products (CP.PMN.277) (PDF)
- Umbralisib (Ukoniq) (CP.PHAR.531) (PDF)
- Uridine Triacetate (Vistogard) (HIM.PA.SP55) (PDF)
- Vadadustat (Vafseo) (CP.PHAR.677) (PDF)
- Valbenazine (Ingrezza) (CP.PCH.48) (PDF)
- Valganciclovir (Valcyte) (CP.PCH.06) (PDF)
- Valoctocogene Roxaparvovec-rvox (Roctavian) (CP.PHAR.466) (PDF)
- Valrubicin (Valstar) (CP.PHAR.439) (PDF)
- Vamorolone (Agamree) (CP.PHAR.659) (PDF)
- Vandetanib (Caprelsa) (CP.PHAR.80) (PDF)
- Varenicline (Tyrvaya) (CP.PMN.273) (PDF)
- Velaglucerase Alfa (VPRIV) (CP.PHAR.163) (PDF)
- Velmanase Alfa-tycv (Lamzede) (CP.PHAR.601) (PDF)
- Vemurafenib (Zelboraf) (CP.PHAR.91) (PDF)
- Venetoclax (Venclexta) (CP.PHAR.129) (PDF)
- Verteporfin (Visudyne) (CP.PHAR.187) (PDF)
- Vestronidase Alfa-vjbk (Mepsevii) (CP.PHAR.374) (PDF)
- Vigabatrin (Sabril) (CP.PHAR.169) (PDF)
- Viloxazine (Qelbree) (CP.PMN.264) (PDF)
- Viltolarsen (Viltepso) (CP.PHAR.484) (PDF)
- Vincristine Sulfate Liposome Injection (Marqibo) (CP.PHAR.315) (PDF)
- Vismodegib (Erivedge) (CP.PHAR.273) (PDF)
- Voclosporin (Lupkynis) (CP.PHAR.504) (PDF)
- Vorapaxar (Zontivity) (HIM.PA.146) (PDF)
- Voretigene Neparvovec-rzyl (Luxturna) (CP.PHAR.372) (PDF)
- Vorinostat (Zolinza) (CP.PHAR.83) (PDF)
- Vortioxetine (Trintellix) (CP.PMN.65) (PDF)
- Vosoritide (Voxzogo) (CP.PHAR.525) (PDF)
- Voxelotor (Oxbryta) (CP.PHAR.451) (PDF)
- Vutrisiran (Amvuttra) (CP.PHAR.550) (PDF)
- Zanubrutinib (Brukinsa) (CP.PHAR.467) (PDF)
- Zavegepant (Zavzpret) (CP.PHAR.630) (PDF)
- Zilucoplan (Zilbrysq) (CP.PHAR.616) (PDF)
- Ziv-aflibercept (Zaltrap) (CP.PHAR.325) (PDF)
- Zoledronic Acid (Reclast) (CP.PHAR.59) (PDF)
- Zuranolone (Zurzuvae) (CP.PHAR.650) (PDF)