Medical and Pharmacy Coverage Policies

Effective Date	Policy Name	Reviewed Date
3/25/2026	Yartemlea (narsoplimab-wuug)	3/18/2026
11/22/2023	Ycanth™ (cantharidin)	8/19/2026
1/1/2025	Yervoy® (ipilimumab)	6/17/2026
9/1/2026	Yervoy® (ipilimumab)	6/17/2026
9/1/2026	Yervoy® (ipilimumab)	6/17/2026
9/1/2026	Yervoy® (ipilimumab)	6/17/2026
12/13/2017	Yescarta™ (axicabtagene ciloleucel)	8/19/2026
7/1/2024	Yescarta™ (axicabtagene ciloleucel)	8/19/2026
4/21/2021	Yescarta™ (axicabtagene ciloleucel)	8/19/2026
1/1/2023	Yescarta™ (axicabtagene ciloleucel)	8/19/2026
1/1/2026	Yondelis® (trabectedin)	6/17/2026
1/1/2026	Yondelis® (trabectedin)	6/17/2026
1/1/2026	Yonsa (abiraterone acetate)	5/20/2026
12/18/2024	Yorvipath® (palopegteriparatide)	12/10/2025
7/22/2026	Yulithira (everolimus)	7/15/2026
1/1/2026	Yutrepia™ (treprostinil)	5/20/2026
4/22/2026	Yuviwel® (navepegritide) subcutaneous solution	4/15/2026

Pharmacy Coverage Policies