Medical and Pharmacy Coverage Policies Home
Medical and Pharmacy Coverage Policies Home
»
Search Results
Pharmacy Coverage Policies
Search Results
Effective Date
Policy Name
Reviewed Date
7/15/2020
Tabrecta (capmatinib)
11/19/2025
1/1/2021
Tadalafil Products - PAH Indication Only
6/18/2025
1/1/2021
Tafinlar (dabrafenib)
7/17/2024
1/1/2026
Tafinlar (dabrafenib)
6/18/2025
1/1/2024
Tagrisso (osimertinib)
8/20/2025
1/1/2025
Takhzyro (lanadelumab-flyo)
8/20/2025
10/1/2025
Takhzyro (lanadelumab-flyo)
8/20/2025
1/1/2025
Taltz (ixekizumab)
6/18/2025
1/1/2026
Taltz (ixekizumab)
7/16/2025
1/1/2022
Taltz® (ixekizumab)
9/18/2024
1/1/2022
Taltz® (ixekizumab)
9/18/2024
11/22/2023
Talvey (talquetamab)
9/17/2025
11/1/2025
Talvey (talquetamab)
9/17/2025
11/1/2025
Talvey (talquetamab)
9/17/2025
1/1/2026
Talvey (talquetamab)
8/20/2025
12/12/2018
Talzenna (talazoparib)
4/16/2025
1/1/2026
Talzenna (talazoparib)
5/21/2025
1/1/2024
Tarceva (erlotinib)
3/19/2025
1/1/2026
Tarceva (erlotinib)
10/15/2025
2/23/2022
Tarpeyo™ (budesonide) delayed-release capsules
4/16/2025
1/1/2022
Tasigna (nilotinib)
4/16/2025
1/1/2022
Tasigna® (nilotinib)
5/15/2024
1/1/2024
Tasmar® (tolcapone)
4/16/2025
1/1/2021
Tavalisse® (fostamatinib)
4/16/2025
3/16/2022
Tavneos™ (avacopan)
12/10/2025
1/1/2021
Tazorac® (tazarotene cream and gel)
4/16/2025
7/15/2020
Tazverik™ (tazemetostat)
4/16/2025
1/1/2026
Tazverik™ (tazemetostat)
10/15/2025
9/16/2020
Tecartus™ (brexucabtagene autoleucel)
11/19/2025
1/1/2023
Tecartus™ (brexucabtagene autoleucel)
11/19/2025
7/1/2024
Tecartus™ (brexucabtagene autoleucel)
11/19/2025
4/21/2021
Tecartus™ (brexucabtagene autoleucel)
11/19/2025
11/1/2025
Tecvayli (teclistamab-cqyv)
9/17/2025
11/1/2025
Tecvayli (teclistamab-cqyv)
9/17/2025
11/1/2025
Tecvayli (teclistamab-cqyv)
9/17/2025
1/1/2023
Tecvayli (teclistamab-cqyv)
9/17/2025
1/1/2020
Temodar (temozolomide)
12/10/2025
1/1/2022
Tepezza® (teprotumumab)
4/16/2025
4/7/2021
Tepmetko (tepotinib)
11/19/2025
1/1/2021
Testosterone Products
4/17/2024
11/27/2024
Tevimbra® (tislelizumab-jsgr)
4/16/2025
5/28/2025
Tezruly™ (terazosin)
5/21/2025
6/22/2022
Tezspire™ (tezepelumab-ekko)
11/19/2025
7/15/2020
Thalomid® (thalidomide)
7/16/2025
1/1/2018
Thrombate III® [Antithrombin III (Human)]
8/20/2025
8/27/2025
Thrombate III® [Antithrombin III (Human)]
8/20/2025
8/27/2025
Thrombate III® [Antithrombin III (Human)]
8/20/2025
1/1/2024
Thymoglobulin (antithymocyte globulin [rabbit])
6/18/2025
1/1/2020
Tibsovo® (ivosidenib)
10/15/2025
12/12/2018
Tiglutik® (riluzole)
6/18/2025
1/1/2026
Tirosint SOL (levothyroxine sodium solution)
6/18/2025
12/24/2021
Tivdak (tisotumab vedotin-tftv)
8/20/2025
1/1/2024
Tivdak (tisotumab vedotin-tftv)
8/20/2025
10/1/2025
Tivdak (tisotumab vedotin-tftv)
8/20/2025
10/1/2025
Tivdak (tisotumab vedotin-tftv)
8/20/2025
1/1/2021
Tivorbex (indomethacin) capsule
1/17/2024
1/1/2024
Tobramycin for Inhalation
2/19/2025
1/16/2019
Tolsura (itraconazole)
10/15/2025
1/1/2023
Topical Acne Products
4/17/2024
1/1/2020
Topical Antifungals
7/16/2025
1/1/2025
Topical Antivirals
6/18/2025
1/1/2023
Topical Clindamycin (clindamycin gel, Clindagel®)
5/15/2024
1/1/2023
Topical Diflorasone
5/15/2024
1/1/2018
Topical Doxepin Products (doxepin, Prudoxin®, Zonalon®)
5/21/2025
1/1/2026
Topical Doxepin Products (doxepin, Prudoxin®, Zonalon®)
5/21/2025
1/1/2024
Topical Estradiol Products
7/17/2024
1/1/2026
Topical Imidazole Antifungals (Econazole, Oxistat®)
5/21/2025
1/1/2021
Topical Imidazole Antifungals (Econazole, Oxistat®)
5/21/2025
1/1/2026
Topical Nystatin Powder
12/10/2025
1/1/2023
Topical Onychomycotic Agents
4/16/2025
1/1/2021
Topical Psoriasis Agents
10/15/2025
1/1/2023
Topical Retinoid Products
5/15/2024
1/1/2019
Topical Rosacea Products
2/21/2024
1/1/2019
Topical Rosacea Products
12/10/2025
1/1/2019
Topical Seborrheic Dermatitis Agents
2/21/2024
1/1/2023
Topical Tazarotene Products (Arazlo®, Fabior®)
4/16/2025
1/1/2021
Topical Tretinoin Containing Products
4/16/2025
1/1/2023
Topical Vitamin D Products
5/21/2025
1/1/2026
Topical Vitamin D Products
5/21/2025
1/1/2024
Torisel (temsirolimus)
8/20/2025
8/28/2024
Torpenz (everolimus)
6/18/2025
1/1/2025
Tramadol extended release products
6/18/2025
1/1/2026
Tramadol extended-release capsule (Conzip)
6/18/2025
1/1/2024
Trastuzumab Products
1/15/2025
1/1/2026
Trastuzumab products
8/20/2025
1/1/2026
Trastuzumab products
8/20/2025
1/1/2026
Trastuzumab products
8/20/2025
1/1/2026
Trastuzumab products
8/20/2025
1/1/2024
Trelstar (triptorelin pamoate)
4/16/2025
1/1/2026
Trelstar (triptorelin pamoate)
5/21/2025
1/1/2020
Trelstar(triptorelin pamoate)
6/19/2024
1/1/2025
Tremfya (guselkumab)
10/15/2025
7/20/2017
Tretten® (Coagulation Factor XIII A-Subunit [Recombinant])
12/10/2025
1/1/2022
Trintellix (vortioxetine)
6/18/2025
1/1/2019
Triptans
4/16/2025
10/18/2017
Triptodur™ (triptorelin)
6/19/2024
1/1/2025
Triptodur™ (triptorelin)
4/16/2025
1/1/2026
Triptodur™ (triptorelin)
6/18/2025
1/1/2018
Trisenox® (arsenic trioxide)
3/19/2025
6/17/2020
Trodelvy (sacituzumab govitecan-hziy)
11/19/2025
1/1/2026
Trodelvy (sacituzumab govitecan-hziy)
11/19/2025
1/1/2026
Trodelvy (sacituzumab govitecan-hziy)
11/19/2025
1/1/2026
Trodelvy (sacituzumab govitecan-hziy)
11/19/2025
1/1/2025
Trudhesa (dihydroergotamine mesylate)
6/18/2025
10/21/2021
Trudhesa™ (dihydroergotamine mesylate)
6/19/2024
1/1/2024
Trulance® (plecanatide)
7/16/2025
1/1/2025
Truqap (capivasertib)
9/17/2025
8/18/2021
Truseltiq (infigratinib)
5/15/2024
2/26/2025
Tryngolza ™ (olezarsen)
2/19/2025
9/24/2025
Tryptyr® (acoltremon ophthalmic solution)
9/17/2025
7/24/2024
Tryvio™ (aprocitentan)
5/21/2025
1/1/2021
Tudorza® (aclidinium) Pressair
1/17/2024
6/17/2020
Tukysa (tucatinib)
10/15/2025
9/18/2019
Turalio® (pexidartinib)
12/10/2025
1/1/2026
Tyenne (tocilizumab) subcutaneous
8/20/2025
1/1/2026
Tyenne (tocilizumab) subcutaneous
8/20/2025
1/1/2023
Tykerb (lapatinib)
11/19/2025
1/1/2026
Tymlos® (abaloparatide) subcutaneous injection
10/15/2025
1/1/2025
Tyrvaya® (varenicline)
6/18/2025
1/1/2024
Tysabri® (natalizumab)
10/15/2025
1/1/2025
Tysabri® (natalizumab) and biosimilar
6/18/2025
1/1/2026
Tysabri® (natalizumab) and biosimilar
6/18/2025
1/1/2024
Tyvaso® (treprostinil)
4/16/2025
1/1/2026
Tyvaso® (treprostinil)
8/20/2025
4/26/2023
Tzield© (teplizumab) intravenous solution
10/15/2025
1
Search by Keyword or Policy Number