Medical and Pharmacy Coverage Policies Home

Pharmacy Coverage Policies

Search Results

Effective DatePolicy NameReviewed Date
11/1/2025 Margenza (margetuximab-cmkb)
9/17/2025
11/1/2025 Margenza (margetuximab-cmkb)
9/17/2025
5/19/2021 Margenza (margetuximab-cmkb)
9/17/2025
1/1/2026 Mavenclad® (cladribine)
4/15/2026
1/1/2026 Mavyret™ (glecaprevir/pibrentasvir)
6/17/2026
6/19/2019 Medical Necessity Determinations
10/9/2025
1/1/2023 Medical Necessity Determinations
11/20/2025
12/1/2022 Medical Necessity Determinations
11/20/2025
7/1/2024 Medical Necessity Determinations
7/17/2025
7/1/2024 Medical Necessity Determinations
12/4/2025
12/11/2024 Medical Necessity Determinations
11/25/2025
7/1/2025 Medical Necessity Determinations
5/15/2025
3/11/2026 Medical Necessity Determinations
3/5/2026
3/11/2026 Medical Necessity Determinations
3/5/2026
5/6/2026 Medical Necessity Determinations
4/30/2026
4/1/2024 Medical Necessity Determinations
5/14/2026
1/1/2026 Mekinist (trametinib)
4/15/2026
1/1/2026 Mektovi (binimetinib)
4/15/2026
1/1/2019 Memantine Products
11/19/2025
12/13/2017 Mepsevii™ (vestronidase alfa-vjbk)
4/15/2026
11/23/2022 Methocarbamol Containing Products
10/15/2025
1/1/2023 Methotrexate Injection (Otrexup®, Reditrex®)
4/15/2026
3/26/2025 Miplyffa® (arimoclomol)
2/18/2026
1/1/2022 Mircera® (methoxy polyethylene glycol-epoetin beta)
7/15/2026
3/25/2026 MODD1 Insulin Delivery System
3/18/2026
10/22/2025 Modeyso (dordaviprone)
10/15/2025
10/22/2025 Modeyso (dordaviprone)
5/20/2026
10/14/2020 Monjuvi® (tafasitamab-cxix)
7/15/2026
10/1/2025 Monjuvi® (tafasitamab-cxix)
8/20/2025
10/1/2025 Monjuvi® (tafasitamab-cxix)
8/20/2025
10/1/2025 Monjuvi® (tafasitamab-cxix)
7/15/2026
10/1/2025 Monjuvi® (tafasitamab-cxix)
7/15/2026
10/1/2025 Monjuvi® (tafasitamab-cxix)
7/15/2026
1/1/2024 Motegrity® (prucalopride)
1/21/2026
11/22/2023 Motpoly XR (lacosamide extended release)
8/19/2026
10/17/2018 Mulpleta® (lusutrombopag)
4/15/2026
8/24/2007 Multi-Source Brands
12/10/2025
1/1/2020 Mupirocin Topical Cream
7/15/2026
1/1/2023 Muscle Relaxants
5/15/2024
1/1/2025 Muscle Relaxants
6/17/2026
1/1/2017 Myalept® (metreleptin)
7/15/2026
10/14/2020 Mycapssa® (octreotide) delayed-release capsules
11/19/2025
1/1/2020 Mylotarg® (gemtuzumab ozogamicin)
12/10/2025
2/1/2026 Mylotarg® (gemtuzumab ozogamicin)
12/10/2025
2/1/2026 Mylotarg® (gemtuzumab ozogamicin)
12/10/2025
2/1/2026 Mylotarg® (gemtuzumab ozogamicin)
12/10/2025
1/1/2024 Myobloc® (rimabotulinumtoxinB)
8/20/2025
7/1/2024 Myobloc® (rimabotulinumtoxinB)
8/20/2025
3/25/2026 Myqorzo™ (aficamten)
2/18/2026
  • 1

Search by Keyword or Policy Number