Medical and Pharmacy Coverage Policies Home

Pharmacy Coverage Policies

Search Results

Effective DatePolicy NameReviewed Date
7/15/2020 Tabrecta (capmatinib)
11/19/2025
1/1/2021 Tadalafil Products - PAH Indication Only
5/20/2026
1/1/2026 Tafinlar (dabrafenib)
4/15/2026
1/1/2024 Tagrisso (osimertinib)
5/20/2026
1/1/2025 Takhzyro (lanadelumab-flyo)
8/20/2025
1/1/2026 Taltz (ixekizumab)
6/17/2026
11/22/2023 Talvey (talquetamab)
7/15/2026
11/1/2025 Talvey (talquetamab)
7/15/2026
11/1/2025 Talvey (talquetamab)
7/15/2026
1/1/2026 Talvey (talquetamab)
7/15/2026
1/1/2026 Talzenna (talazoparib)
5/20/2026
1/1/2026 Tarceva (erlotinib)
10/15/2025
2/23/2022 Tarpeyo™ (budesonide) delayed-release capsules
3/18/2026
1/1/2024 Tasmar® (tolcapone)
3/18/2026
1/1/2021 Tavalisse® (fostamatinib)
4/15/2026
3/16/2022 Tavneos™ (avacopan)
12/10/2025
1/1/2021 Tazorac® (tazarotene cream and gel)
2/18/2026
1/1/2026 Tazverik™ (tazemetostat)
5/20/2026
9/16/2020 Tecartus™ (brexucabtagene autoleucel)
2/18/2026
1/1/2023 Tecartus™ (brexucabtagene autoleucel)
2/18/2026
7/1/2024 Tecartus™ (brexucabtagene autoleucel)
2/18/2026
4/21/2021 Tecartus™ (brexucabtagene autoleucel)
2/18/2026
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)
7/15/2026
1/1/2020 Temodar (temozolomide)
12/10/2025
1/1/2022 Tepezza® (teprotumumab)
2/18/2026
5/1/2026 Tepezza® (teprotumumab)
2/18/2026
5/1/2026 Tepezza® (teprotumumab)
2/18/2026
5/1/2026 Tepezza® (teprotumumab)
2/18/2026
4/7/2021 Tepmetko (tepotinib)
11/19/2025
11/27/2024 Tevimbra® (tislelizumab-jsgr)
3/18/2026
6/1/2026 Tevimbra® (tislelizumab-jsgr)
3/18/2026
6/1/2026 Tevimbra® (tislelizumab-jsgr)
3/18/2026
6/1/2026 Tevimbra® (tislelizumab-jsgr)
3/18/2026
5/28/2025 Tezruly™ (terazosin)
4/15/2026
6/22/2022 Tezspire™ (tezepelumab-ekko)
11/19/2025
7/15/2020 Thalomid® (thalidomide)
2/18/2026
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])
6/17/2026
1/1/2020 Tibsovo® (ivosidenib)
10/15/2025
12/12/2018 Tiglutik® (riluzole)
6/17/2026
1/1/2026 Tirosint SOL (levothyroxine sodium solution)
5/20/2026
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
1/1/2024 Tobramycin for Inhalation
1/21/2026
1/16/2019 Tolsura (itraconazole)
10/15/2025
2/25/2026 Tonmya™ (cyclobenzaprine)
2/18/2026
1/1/2020 Topical Antifungals
7/15/2026
1/1/2025 Topical Antivirals
6/17/2026
1/1/2026 Topical Doxepin Products (doxepin, Prudoxin®, Zonalon®)
3/18/2026
1/1/2026 Topical Imidazole Antifungals (Econazole, Oxistat®)
3/18/2026
1/1/2026 Topical Nystatin Powder
12/10/2025
1/1/2023 Topical Onychomycotic Agents
2/18/2026
1/1/2021 Topical Psoriasis Agents
10/15/2025
1/1/2019 Topical Rosacea Products
12/10/2025
1/1/2023 Topical Tazarotene Products (Arazlo®, Fabior®)
2/18/2026
1/1/2021 Topical Tretinoin Containing Products
2/18/2026
1/1/2026 Topical Vitamin D Products
5/20/2026
1/1/2024 Torisel (temsirolimus)
5/20/2026
8/28/2024 Torpenz (everolimus)
4/15/2026
1/20/2016 Trabectedin Products
6/17/2026
1/1/2026 Tramadol extended-release products
3/18/2026
1/1/2026 Trastuzumab products
6/17/2026
1/1/2026 Trastuzumab products
6/17/2026
1/1/2026 Trastuzumab products
6/17/2026
1/1/2026 Trastuzumab products
6/17/2026
1/1/2026 Trelstar (triptorelin pamoate)
4/15/2026
1/1/2025 Tremfya (guselkumab)
7/15/2026
7/20/2017 Tretten® (Coagulation Factor XIII A-Subunit [Recombinant])
12/10/2025
2/1/2026 Tretten® (Coagulation Factor XIII A-Subunit [Recombinant])
12/10/2025
1/1/2022 Trintellix (vortioxetine)
6/17/2026
1/1/2019 Triptans
4/15/2026
1/1/2026 Triptodur™ (triptorelin)
5/20/2026
8/1/2026 Triptodur™ (triptorelin)
5/20/2026
1/1/2018 Trisenox® (arsenic trioxide)
1/21/2026
3/1/2026 Trisenox® (arsenic trioxide)
1/21/2026
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)
6/17/2026
1/1/2024 Trulance® (plecanatide)
6/17/2026
1/1/2025 Truqap (capivasertib)
9/17/2025
2/26/2025 Tryngolza ™ (olezarsen)
1/21/2026
7/24/2024 Tryvio™ (aprocitentan)
4/15/2026
6/17/2020 Tukysa (tucatinib)
10/15/2025
9/18/2019 Turalio® (pexidartinib)
12/10/2025
1/1/2026 Tyenne (tocilizumab) subcutaneous
7/15/2026
1/1/2026 Tyenne (tocilizumab) subcutaneous
7/15/2026
1/1/2023 Tykerb (lapatinib)
11/19/2025
1/1/2026 Tymlos® (abaloparatide) subcutaneous injection
2/18/2026
1/1/2025 Tyrvaya® (varenicline)
6/17/2026
1/1/2024 Tysabri® (natalizumab)
10/15/2025
12/1/2025 Tysabri® (natalizumab)
10/15/2025
1/1/2026 Tysabri® (natalizumab) and biosimilar
3/18/2026
1/1/2026 Tyvaso® (treprostinil)
5/20/2026
4/26/2023 Tzield (teplizumab) intravenous solution
5/20/2026
  • 1

Search by Keyword or Policy Number