| Effective Date | Policy Name | Reviewed Date |
| 1/1/2025 |
Radicava® and Radicava ORS® (edaravone)
| 11/19/2025 |
| 1/1/2023 |
Rasuvo® (methotrexate injection)
| 4/15/2026 |
| 3/7/2013 |
Ravicti® (glycerol phenylbutyrate)
| 11/19/2025 |
| 1/1/2022 |
Rayos® (prednisone delayed-release)
| 2/18/2026 |
| 1/1/2025 |
Reblozyl® (luspatercept-aamt)
| 6/17/2026 |
| 9/1/2026 |
Reblozyl® (luspatercept-aamt)
| 6/17/2026 |
| 1/25/2023 |
Rebyota™ (fecal microbiota, live-jslm)
| 8/19/2026 |
| 1/1/2026 |
Reclast® (zoledronic acid)
| 2/18/2026 |
| 4/27/2022 |
Recorlev® (levoketoconazole) Tablet
| 11/19/2025 |
| 2/25/2026 |
Redemplo® (plozasiran)
| 2/18/2026 |
| 1/1/2021 |
Regranex® (becaplermin)
| 5/20/2026 |
| 1/1/2024 |
Relistor® (methylnaltrexone)
| 1/21/2026 |
| 1/1/2026 |
Remodulin® (treprostinil)
| 5/20/2026 |
| 8/1/2026 |
Remodulin® (treprostinil)
| 5/20/2026 |
| 1/1/2026 |
Repatha® (evolocumab)
| 12/10/2025 |
| 7/8/2020 |
Retevmo (selpercatinib)
| 1/29/2026 |
| 1/1/2021 |
Revatio® (sildenafil) oral tab
| 12/10/2025 |
| 1/1/2021 |
Revatio® (sildenafil) suspension
| 12/10/2025 |
| 1/1/2026 |
Revcovi (elapegademase-lvlr)
| 8/20/2025 |
| 1/1/2026 |
Revcovi (elapegademase-lvlr)
| 8/19/2026 |
| 1/1/2026 |
Revlimid (lenalidomide)
| 2/18/2026 |
| 2/26/2025 |
Revuforj® (revumenib)
| 1/21/2026 |
| 1/1/2025 |
Rexulti® (brexpiprazole)
| 8/19/2026 |
| 1/1/2024 |
Reyvow™ (lasmiditan)
| 1/21/2026 |
| 1/1/2026 |
Rezdiffra™ (resmetirom)
| 8/19/2026 |
| 2/22/2023 |
Rezlidhia (olutasidenib)
| 11/19/2025 |
| 10/8/2021 |
Rezurock (belumosudil)
| 8/19/2026 |
| 8/23/2023 |
Rezzayo Intravenous Solution
| 3/18/2026 |
| 2/25/2026 |
Rhapsido® (remibrutinib)
| 2/18/2026 |
| 10/14/2020 |
Rhopressa® (netarsudil), Rocklatan® (netarsudil and latanoprost)
| 5/20/2026 |
| 1/1/2022 |
Ridaura® (auranofin)
| 1/21/2026 |
| 1/1/2026 |
Rinvoq (upadacitinib) Extended Release Tablet
| 7/15/2026 |
| 1/1/2026 |
Rinvoq (upadacitinib) LQ Oral Solution
| 7/15/2026 |
| 1/1/2023 |
Risperidone Orally Disintegrating Tablets
| 2/18/2026 |
| 1/1/2021 |
Rituxan Hycela™ (rituximab/hyaluronidase)
| 6/17/2026 |
| 1/1/2023 |
Rituxan Hycela™ (rituximab/hyaluronidase)
| 6/17/2026 |
| 7/1/2024 |
Rituxan Hycela™ (rituximab/hyaluronidase)
| 6/17/2026 |
| 1/1/2023 |
Rituximab Products
| 6/17/2026 |
| 1/1/2026 |
Rituximab products
| 6/17/2026 |
| 1/1/2026 |
Rituximab products
| 6/17/2026 |
| 1/1/2026 |
Rituximab products
| 6/17/2026 |
| 1/1/2026 |
Rituximab products
| 6/17/2026 |
| 5/22/2024 |
Rivfloza® (nedosiran)
| 4/16/2025 |
| 8/31/2023 |
Roctavian™ (valoctocogene roxaparvovec-rvox)
| 4/15/2026 |
| 1/1/2026 |
Rolvedon (eflapegrastim-xnst)
| 2/18/2026 |
| 1/1/2026 |
Rolvedon (eflapegrastim-xnst)
| 2/18/2026 |
| 1/1/2026 |
Rolvedon (eflapegrastim-xnst)
| 2/18/2026 |
| 5/28/2025 |
Romvimza (vimseltinib)
| 1/21/2026 |
| 1/1/2020 |
Rozerem® (ramelteon)
| 3/18/2026 |
| 11/1/2019 |
Rozlytrek™ (entrectinib)
| 5/20/2026 |
| 1/1/2026 |
Rubraca (rucaparib)
| 2/18/2026 |
| 1/1/2025 |
Ruconest (C1 esterase inhibitor, recombinant)
| 7/15/2026 |
| 10/1/2025 |
Ruconest (C1 esterase inhibitor, recombinant)
| 8/20/2025 |
| 10/1/2025 |
Ruconest (C1 esterase inhibitor, recombinant)
| 7/15/2026 |
| 1/1/2020 |
Ruxolitinib products (Jakafi, Jakafi XR)
| 6/17/2026 |
| 1/1/2026 |
Rydapt® (midostaurin)
| 5/20/2026 |
| 9/15/2021 |
Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn)
| 7/15/2026 |
| 7/22/2026 |
Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn)
| 7/15/2026 |
| 4/27/2022 |
Ryplazim (plasminogen, human-tvmh)
| 8/19/2026 |
| 2/1/2026 |
Ryplazim (plasminogen, human-tvmh)
| 8/19/2026 |
| 2/1/2026 |
Ryplazim (plasminogen, human-tvmh)
| 8/19/2026 |
| 2/1/2026 |
Ryplazim (plasminogen, human-tvmh).
| 8/19/2026 |
| 1/1/2025 |
Rystiggo (rozanolixizumab-noli)
| 5/20/2026 |
| 8/1/2026 |
Rystiggo (rozanolixizumab-noli)
| 5/20/2026 |
| 10/23/2024 |
Rytelo (imetelstat)
| 8/19/2026 |
| 12/1/2025 |
Rytelo (imetelstat)
| 8/19/2026 |
| 12/1/2025 |
Rytelo (imetelstat)
| 8/19/2026 |
| 6/25/2025 |
Ryzneuta (efbemalenograstim alfa-vuxw)
| 2/18/2026 |
| 1/1/2026 |
Ryzneuta (efbemalenograstim alfa-vuxw)
| 2/18/2026 |
| 1/1/2026 |
Ryzneuta (efbemalenograstim alfa-vuxw)
| 2/18/2026 |