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Pharmacy Coverage Policies

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Effective DatePolicy NameReviewed Date
1/1/2020 Kadcyla (ado-trastuzumab emtansine)
11/19/2025
1/1/2026 Kadcyla (ado-trastuzumab emtansine)
11/19/2025
1/1/2026 Kadcyla (ado-trastuzumab emtansine)
11/19/2025
1/1/2025 Kalbitor (ecallantide)
7/15/2026
10/1/2025 Kalbitor (ecallantide)
8/20/2025
10/1/2025 Kalbitor (ecallantide)
7/15/2026
11/1/2025 Kanuma® (sebelipase alfa)
8/19/2026
1/20/2016 Kanuma® (sebelipase alfa)
8/19/2026
8/15/2018 Kapspargo™ Sprinkle (metoprolol succinate)
11/19/2025
11/17/2021 Kerendia® (finerenone)
11/19/2025
1/1/2021 Ketoconazole tablet
4/15/2026
1/1/2026 Kevzara (sarilumab)
6/17/2026
3/23/2022 Kimmtrak (tebentafusp-tebn)
7/15/2026
10/22/2025 Kimmtrak (tebentafusp-tebn)
10/15/2025
12/1/2025 Kimmtrak (tebentafusp-tebn)
7/15/2026
12/1/2025 Kimmtrak (tebentafusp-tebn)
7/15/2026
10/22/2025 Kimmtrak (tebentafusp-tebn)
7/15/2026
1/1/2026 Kineret (anakinra)
6/17/2026
1/1/2024 Kisqali (ribociclib)
1/21/2026
9/25/2024 Kisunla™ (donanemab-azbt)
10/15/2025
3/25/2026 Komzifti™ (ziftomenib)
3/18/2026
4/12/2012 Korlym® (mifepristone)
12/10/2025
7/27/2022 Korsuva™ (difelikefalin)
5/20/2026
5/27/2026 Korsuva™ (difelikefalin)
5/20/2026
5/27/2026 Korsuva™ (difelikefalin)
5/20/2026
8/1/2026 Korsuva™ (difelikefalin)
5/20/2026
1/1/2022 Koselugo (selumetinib)
3/18/2026
3/22/2023 Krazati (adagrasib)
2/18/2026
1/1/2020 Krystexxa® (pegloticase)
1/21/2026
3/1/2026 Krystexxa® (pegloticase)
1/21/2026
1/1/2022 Kuvan® (sapropterin)
7/15/2026
4/22/2026 Kygevvi® (doxecitine and doxribtimine) oral powder packet
4/15/2026
10/18/2017 Kymriah™ (tisagenlecleucel)
8/19/2026
1/1/2023 Kymriah™ (tisagenlecleucel)
8/19/2026
7/1/2024 Kymriah™ (tisagenlecleucel)
8/19/2026
4/21/2021 Kymriah™ (tisagenlecleucel)
8/19/2026
1/1/2022 Kyprolis® (carfilzomib)
5/20/2026
12/1/2025 Kyprolis® (carfilzomib)
5/20/2026
12/1/2025 Kyprolis® (carfilzomib)
5/20/2026
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