News
Effective May 1, 2025: Pharmacy and Biopharmacy Policies
Date: 02/25/25
Magnolia Health Plan has added, updated or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on May 1, 2025, at 12:00AM.
| POLICY | APPLICABLE PRODUCTS | NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS |
|---|---|---|
| Tafamidis (Vyndaqel, Vyndamax) (CP.PHAR.432) | Ambetter | Policy updates include:
|
| Sacituzumab govitecan-hziy (Trodelvy) (CP.PHAR.475) | Ambetter | Policy updates include:
|
| Delandistrogene moxeparvovec-rokl (Elevidys) (CP.PHAR.593) | Ambetter | Policy updates include:
|
| Encorafenib (Braftovi) (CP.PHAR.127) | Ambetter | Policy updates include:
|
| Durvalumab (Imfinzi) (CP.PHAR.339) | Ambetter | Policy updates include:
|
| Tislelizumab-jsgr (Tevimbra) (CP.PHAR.687) | Ambetter | Policy updates include:
|
| Tapinarof (Vtama) (CP.PMN.283) | Ambetter | Policy updates include:
|
| Hydroxyurea (Siklos, Xromi) (CP.PMN.193) | Ambetter | Policy updates include:
|
| Overactive Bladder Agents (CP.PMN.198) | Ambetter | Policy updates include:•
|
To review all policies, please visit Magnolia's Clinical & Payment Policies webpage.
Prior to updates, pharmacy and biopharmacy clinical policies are reviewed and approved by the Pharmacy and Therapeutics (P&T) Committee.
For questions or additional information, please contact Magnolia’s Pharmacy Department at 1-866-912-6285, ext. 66409.