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Pharmacy Coverage Policies
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Effective Date
Policy Name
Reviewed Date
3/13/2024
Early Refill Edits on Topical Ophthalmic Products
1/26/2026
1/1/2026
Ebglyss™ (lebrikizumab-lbkx) subcutaneous
5/20/2026
12/16/2010
Egrifta® (tesamorelin acetate)
7/15/2026
8/27/2025
Ekterly® (sebetralstat)
7/15/2026
1/1/2023
Elahere (mirvetuximab soravtansine-gynx)
3/18/2026
1/1/2026
Elahere (mirvetuximab soravtansine-gynx)
3/18/2026
6/1/2026
Elahere (mirvetuximab soravtansine-gynx)
3/18/2026
9/29/2008
Elaprase® (idursulfase)
7/15/2026
10/1/2025
Elaprase® (idursulfase)
8/20/2025
10/1/2025
Elaprase® (idursulfase)
7/15/2026
5/22/2012
Elelyso® (taliglucerase alfa)
3/18/2026
6/1/2026
Elelyso® (taliglucerase alfa)
3/18/2026
9/27/2023
Elevidys (delandistrogene moxeparvovec-rokl)
12/10/2025
1/1/2024
Elidel® (pimecrolimus)
2/18/2026
1/1/2026
Eligard (leuprolide acetate)
4/15/2026
10/22/2025
Eliquis® (apixaban) Sprinkle & Tablet for Oral Suspension
10/15/2025
1/1/2012
Elitek® (rasburicase)
3/18/2026
10/1/2025
Elitek® (rasburicase)
8/20/2025
10/1/2025
Elitek® (rasburicase)
3/18/2026
10/1/2025
Elitek® (rasburicase)
3/18/2026
6/1/2026
Elitek® (rasburicase)
3/18/2026
11/15/2023
Elrexfio (elranatamab-bcmm)
7/15/2026
11/1/2025
Elrexfio (elranatamab-bcmm)
7/15/2026
1/1/2026
Elrexfio (elranatamab-bcmm)
7/15/2026
1/1/2023
Elzonris™ (tagraxofusp-erzs)
1/21/2026
3/1/2026
Elzonris™ (tagraxofusp-erzs)
1/21/2026
3/1/2026
Elzonris™ (tagraxofusp-erzs)
1/21/2026
1/1/2020
Emflaza® (deflazacort)
10/15/2025
1/1/2024
Empaveli (pegcetacoplan)
7/15/2026
1/1/2022
Empliciti (elotuzumab)
2/18/2026
9/1/2025
Empliciti (elotuzumab)
2/18/2026
10/1/2025
Empliciti (elotuzumab)
8/20/2025
10/1/2025
Empliciti (elotuzumab)
2/18/2026
10/1/2025
Empliciti (elotuzumab)
2/18/2026
7/23/2025
Emrelis (telisotuzumab vedotin-tllv)
5/20/2026
9/1/2025
Emrelis (telisotuzumab vedotin-tllv)
5/20/2026
9/1/2025
Emrelis (telisotuzumab vedotin-tllv)
5/20/2026
9/1/2025
Emrelis_(telisotuzumab_vedotin-tllv)
5/20/2026
7/23/2025
Emrosi™ (minocycline)
7/15/2026
1/1/2022
EMSAM® (selegiline transdermal system)
2/18/2026
1/1/2026
Enbrel (etanercept)
7/15/2026
1/28/2026
Enbumyst (bumetanide)
1/21/2026
5/28/2025
Encelto™ (revakinagene taroretcel-lwey) implant
8/19/2026
12/1/2025
Encelto™ (revakinagene taroretcel-lwey) Implant
8/19/2026
1/1/2023
Enhertu (fam-trastuzumab deruxtecan-nxki)
8/19/2026
6/1/2026
Enhertu (fam-trastuzumab deruxtecan-nxki)
3/18/2026
6/1/2026
Enhertu (fam-trastuzumab deruxtecan-nxki)
3/18/2026
7/27/2022
Enjaymo™ (sutimlimab-jome)
6/17/2026
10/1/2026
Enjaymo™ (sutimlimab-jome)
6/17/2026
7/23/2025
Enjaymo™ sutimlimab-jome
6/17/2026
2/25/2026
Ensacove (ensartinib)
1/29/2026
1/20/2021
Enspryng® (satralizumab-mwge)
5/20/2026
1/1/2026
Enspryng® (satralizumab-mwge)
5/20/2026
1/1/2026
Entresto® (sacubitril-valsartan)
6/18/2025
1/1/2025
Entyvio® (vedolizumab)
5/20/2026
1/1/2019
Envarsus XR® (tacrolimus extended-release)
2/18/2026
1/1/2026
Eohilia™ (budesonide oral suspension)
5/20/2026
1/1/2025
Epclusa® (sofosbuvir/velpatasvir)
4/15/2026
1/1/2024
Epidiolex® (cannabidiol)
3/18/2026
8/23/2023
Epkinly™ (epcoritamab-bysp)
2/18/2026
11/1/2025
Epkinly™ (epcoritamab-bysp)
2/18/2026
1/1/2026
Epkinly™ (epcoritamab-bysp)
2/18/2026
1/1/2025
Epoetin Alfa (Epogen, Procrit, Retacrit)
7/15/2026
1/1/2026
Epoprostenol Products
9/17/2025
1/1/2026
Eprontia® (topiramate) oral solution
5/21/2025
1/1/2026
Eprontia® (topiramate) oral solution
4/15/2026
1/1/2021
Equetro® (carbamazepine)
2/18/2026
1/1/2024
Erbitux (cetuximab)
12/10/2025
2/1/2026
Erbitux (cetuximab)
12/10/2025
2/1/2026
Erbitux (cetuximab)
12/10/2025
2/9/2012
Erivedge® (vismodegib)
4/15/2026
1/1/2026
Erleada (apalutamide)
5/20/2026
1/1/2019
Erwinase® (asparaginase Erwinia chrysanthemi)
7/15/2026
11/1/2025
Erwinase® (asparaginase Erwinia chrysanthemi)
7/15/2026
11/1/2025
Erwinase® (asparaginase Erwinia chrysanthemi)
7/15/2026
1/1/2023
Esbriet® (pirfenidone)
1/21/2026
1/1/2026
Eucrisa® (crisaborole)
5/20/2026
1/1/2023
Eulexin (Flutamide)
2/18/2026
1/1/2023
Evenity® (romosozumab-aqqg)
7/15/2026
1/1/2026
Evkeeza™ (evinacumab-dgnb)
6/17/2026
11/11/2020
Evrysdi® (risdiplam)
8/19/2026
3/25/2026
Exdensur™ (depemokimab-ulaa)
6/25/2026
7/1/2026
Exdensur™ (depemokimab-ulaa)
4/15/2026
7/1/2026
Exdensur™ (depemokimab-ulaa)
4/15/2026
11/17/2021
Exkivity (mobocertinib)
4/15/2026
1/1/2022
Exondys 51 (eteplirsen)
12/10/2025
8/18/2021
Exservan™ (riluzole)
6/17/2026
12/17/2025
Exxua (gepirone)
12/10/2025
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