Medical and Pharmacy Coverage Policies Home

Pharmacy Coverage Policies

Search Results

Effective DatePolicy NameReviewed Date
2/17/2021 Danyelza® (naxitamab-gqgk)
6/17/2026
1/1/2026 Danyelza® (naxitamab-gqgk)
6/17/2026
1/1/2026 Danyelza® (naxitamab-gqgk)
6/17/2026
2/23/2022 Dartisla ODT (glycopyrrolate)
8/19/2026
6/1/2026 Darzalex Faspro™ (daratumumab and hyaluronidase- fihj)
3/18/2026
6/1/2026 Darzalex Faspro™ (daratumumab and hyaluronidase- fihj)
3/18/2026
1/1/2022 Darzalex Faspro™ (daratumumab and hyaluronidase-fihj)
3/18/2026
1/1/2022 Darzalex® (daratumumab)
1/21/2026
3/1/2026 Darzalex® (daratumumab)
1/21/2026
3/1/2026 Darzalex® (daratumumab)
1/21/2026
3/1/2026 Darzalex® (daratumumab)
1/21/2026
1/1/2026 Dasatinib products
4/15/2026
3/26/2025 Datroway (datopotamab deruxtecan-dlnk)
8/19/2026
11/1/2025 Datroway (datopotamab deruxtecan-dlnk)
9/17/2025
11/1/2025 Datroway (datopotamab deruxtecan-dlnk)
9/17/2025
1/1/2026 Daurismo™ (glasdegib)
3/18/2026
10/22/2025 Dawnzera™ (donidalorsen)
10/15/2025
10/22/2025 Dawnzera™ (donidalorsen)
8/19/2026
1/1/2024 Daxxify® (daxibotulinumtoxinA-lanm)
3/18/2026
7/1/2024 Daxxify® (daxibotulinumtoxinA-lanm)
3/18/2026
5/24/2023 Daybue™ (trofinetide)
2/18/2026
1/1/2022 Dayvigo™ (lemborexant)
12/10/2025
1/1/2026 Deferasirox Products
6/17/2026
1/1/2022 Defitelio® (defibrotide sodium)
3/18/2026
1/1/2026 Defitelio® (defibrotide sodium)
3/18/2026
6/1/2026 Defitelio® (defibrotide sodium)
3/18/2026
1/1/2022 Desmopressin Nasal Spray
4/17/2024
1/1/2025 Desmopressin Products
4/15/2026
1/1/2023 Dexilant® (dexlansoprazole)
2/21/2024
1/1/2017 Diabetic Test Strips and Meters
6/17/2026
1/1/2023 Diacomit® (stiripentol)
10/15/2025
10/15/2015 Dichlorphenamide Products
9/17/2025
1/1/2022 Dihydroergotamine Products
7/15/2026
9/2/2020 Dojolvi™ (triheptanoin) Oral Liquid
1/21/2026
1/1/2023 Dopamine Agonists
11/19/2025
1/1/2025 Doptelet® (Avatrombopag) Products
4/15/2026
1/1/2021 Doxycycline Antibiotics
7/15/2026
1/1/2026 DPP-IV inhibitors
6/17/2026
1/1/2026 DPP-IV, SGLT2 Combination Products
6/17/2026
1/24/2019 Drug Management Program-Opioid Program
7/15/2026
8/28/2010 Drug Utilization Management and Clinical Edits Tools
11/19/2025
10/1/2025 Drug Utilization Management and Clinical Edits Tools
9/18/2025
1/1/2024 Duavee® (conjugated estrogens/bazedoxifene tablet)
4/15/2026
1/1/2026 Duexis (ibuprofen-famotidine)
3/18/2026
10/16/2019 Duloxetine Containing Products
8/19/2026
1/1/2021 Duobrii® (halobetasol propionate and tazarotene)
2/18/2026
1/1/2024 Duopa® (carbidopa and levodopa)
1/21/2026
7/1/2024 Duopa® (carbidopa and levodopa)
1/21/2026
1/1/2026 Dupixent® (dupilumab) injection
5/28/2026
8/19/2020 Durysta® (bimatoprost implant)
5/20/2026
1/1/2026 Durysta® (bimatoprost implant)
8/19/2026
9/25/2024 Duvyzat (givinostat)
7/15/2026
1/1/2024 Dysport® (abobotulinumtoxinA)
6/17/2026
7/1/2024 Dysport® (abobotulinumtoxinA)
6/17/2026
  • 1

Search by Keyword or Policy Number