| Effective Date | Policy Name | Reviewed Date |
| 1/1/2022 |
Balversa (erdafitinib)
| 2/18/2026 |
| 1/1/2026 |
Banzel® (rufinamide)
| 4/15/2026 |
| 1/1/2019 |
Bavencio® (avelumab)
| 7/15/2026 |
| 7/24/2014 |
Beleodaq® (belinostat)
| 11/19/2025 |
| 1/1/2026 |
Beleodaq® (belinostat)
| 11/19/2025 |
| 1/1/2026 |
Beleodaq® (belinostat)
| 11/19/2025 |
| 1/1/2026 |
Beleodaq® (belinostat)
| 11/19/2025 |
| 5/1/2021 |
Bempedoic Acid Products
| 2/18/2026 |
| 1/1/2023 |
Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta)
| 2/18/2026 |
| 1/1/2026 |
Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta)
| 2/18/2026 |
| 5/1/2026 |
Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta)
| 2/18/2026 |
| 5/1/2026 |
Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta)
| 2/18/2026 |
| 1/1/2026 |
Benlysta® (belimumab)
| 5/20/2026 |
| 7/1/2024 |
Benzodiazepine Limited Days Supply
| 6/4/2026 |
| 1/1/2019 |
Benzodiazepine Limited Days' Supply
| 4/24/2025 |
| 1/1/2023 |
Beovu® (brolucizumab)
| 1/21/2026 |
| 7/1/2024 |
Beovu® (brolucizumab)
| 1/21/2026 |
| 1/1/2025 |
Beovu® (brolucizumab)
| 1/21/2026 |
| 10/1/2025 |
Beovu® (brolucizumab)
| 1/21/2026 |
| 7/24/2024 |
Beqvez™ intravenous suspension
| 11/19/2025 |
| 1/1/2025 |
Berinert (C1 esterase inhibitor, human)
| 7/15/2026 |
| 10/1/2025 |
Berinert (C1 esterase inhibitor, human)
| 8/20/2025 |
| 10/1/2025 |
Berinert (C1 esterase inhibitor, human)
| 7/15/2026 |
| 1/1/2019 |
Besponsa™ (inotuzumab ozogamicin)
| 11/19/2025 |
| 1/1/2026 |
Besponsa™ (inotuzumab ozogamicin)
| 11/19/2025 |
| 1/1/2026 |
Besponsa™ (inotuzumab ozogamicin)
| 11/19/2025 |
| 2/16/2022 |
Besremi (ropeginterferon alfa-2b-njft)
| 11/19/2025 |
| 1/1/2026 |
Bevacizumab products
| 6/17/2026 |
| 1/1/2026 |
Bevacizumab products
| 6/17/2026 |
| 1/1/2026 |
Bevacizumab products
| 6/17/2026 |
| 1/1/2026 |
Bevacizumab products
| 6/17/2026 |
| 1/1/2021 |
Bexarotene products (Targretin capsules and gel, bexarotene capsules and gel)
| 7/15/2026 |
| 1/1/2022 |
BiDil® (isosorbide dinitrate/hydralazine)
| 4/15/2026 |
| 1/1/2019 |
Biguanide Agents
| 10/15/2025 |
| 1/1/2026 |
Bimzelx (bimekizumab-bkzx)
| 6/17/2026 |
| 1/1/2017 |
Bisphosphonates
| 2/18/2026 |
| 11/26/2025 |
Bizengri (zenocutuzumab-zbco)
| 8/19/2026 |
| 1/1/2026 |
Bizengri (zenocutuzumab-zbco)
| 11/19/2025 |
| 1/1/2026 |
Bizengri (zenocutuzumab-zbco)
| 11/19/2025 |
| 10/14/2020 |
Blenrep (belantamab mafodotin-blmf)
| 12/10/2025 |
| 1/1/2020 |
Blincyto® (blinatumomab)
| 7/15/2026 |
| 10/1/2025 |
Blincyto® (blinatumomab)
| 7/15/2026 |
| 10/1/2025 |
Blincyto® (blinatumomab)
| 7/15/2026 |
| 1/1/2022 |
Bortezomib products (Velcade and Bortezomib for injection)
| 2/18/2026 |
| 9/1/2025 |
Bortezomib products (Velcade and Bortezomib for injection)
| 2/18/2026 |
| 9/1/2025 |
Bortezomib products (Velcade and Bortezomib for injection)
| 2/18/2026 |
| 9/1/2025 |
Bortezomib products (Velcade and Bortezomib for injection)
| 2/18/2026 |
| 1/1/2022 |
Bosentan Products
| 5/20/2026 |
| 1/1/2022 |
Bosulif® (bosutinib)
| 4/15/2026 |
| 1/1/2024 |
Botox® (onabotulinumtoxinA)
| 6/17/2026 |
| 7/1/2024 |
Botox® (onabotulinumtoxinA)
| 6/17/2026 |
| 7/1/2024 |
Botox® (onabotulinumtoxinA)
| 6/17/2026 |
| 1/1/2025 |
Bowel Prep Agents
| 5/20/2026 |
| 1/1/2026 |
Braftovi (encorafenib)
| 4/15/2026 |
| 12/17/2025 |
Brekiya® (dihydroergotamine mesylate)
| 7/15/2026 |
| 3/17/2021 |
Breyanzi® (lisocabtagene maraleucel)
| 8/19/2026 |
| 1/1/2023 |
Breyanzi® (lisocabtagene maraleucel)
| 8/19/2026 |
| 7/1/2024 |
Breyanzi® (lisocabtagene maraleucel)
| 8/19/2026 |
| 4/21/2021 |
Breyanzi® (lisocabtagene maraleucel)
| 8/19/2026 |
| 7/19/2017 |
Brineura™ (cerliponase alfa)
| 3/18/2026 |
| 11/26/2025 |
Brinsupri™ (brensocatib)
| 11/19/2025 |
| 1/1/2026 |
Briumvi™ (ublituximab)
| 2/18/2026 |
| 1/1/2026 |
Briviact® (brivaracetam)
| 4/15/2026 |
| 5/19/2021 |
Bronchitol® (mannitol)
| 12/10/2025 |
| 1/1/2023 |
Brukinsa™ (zanubrutinib)
| 4/15/2026 |
| 1/1/2026 |
Buprenorphine weekly transdermal patch
| 3/18/2026 |
| 1/1/2026 |
Bupropion Containing Products (Aplenzin®, Forfivo XL®)
| 5/20/2026 |
| 1/1/2026 |
Bylvay® (odevixibat)
| 5/20/2026 |
| 11/26/2025 |
Bynfezia Pen® (octreotide acetate) injection
| 11/19/2025 |
| 8/19/2020 |
Bynfezia Pen™ (octreotide acetate) injection
| 2/21/2024 |
| 6/22/2022 |
Byooviz® (ranibizumab-nuna)
| 2/18/2026 |
| 1/1/2024 |
Byooviz® (ranibizumab-nuna)
| 2/18/2026 |
| 2/25/2026 |
Byooviz® (ranibizumab-nuna)
| 2/18/2026 |
| 5/1/2026 |
Byooviz® (ranibizumab-nuna)
| 2/18/2026 |
| 6/24/2026 |
Bysanti™ (milsaperidone)
| 6/17/2026 |