Pharmacy Coverage Policies

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Effective DatePolicy NameReviewed 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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