Medical and Pharmacy Coverage Policies Home

Pharmacy Coverage Policies

Search Results

Effective DatePolicy NameReviewed Date
7/19/2017 Xadago® (safinamide)
10/15/2025
1/1/2026 Xalkori (crizotinib)
2/18/2026
1/1/2026 Xarelto® (rivaroxaban) oral suspension
10/15/2025
1/1/2025 Xatmep™ (methotrexate) oral solution
10/15/2025
1/1/2025 Xcopri® (cenobamate)
5/20/2026
1/1/2026 Xdemvy® (lotilaner)
5/20/2026
1/1/2026 Xeljanz and Xeljanz XR (tofacitinib)
6/17/2026
1/1/2022 Xeloda (capecitabine)
12/10/2025
1/1/2022 Xenazine® (tetrabenazine)
6/17/2026
11/30/2022 Xenpozyme™ (olipudase alfa) intravenous solution
5/20/2026
8/1/2026 Xenpozyme™ (olipudase alfa) intravenous solution
5/20/2026
1/1/2024 Xeomin® (incobotulinumtoxinA)
6/17/2026
7/1/2024 Xeomin® (incobotulinumtoxinA)
6/17/2026
1/1/2026 Xeomin® (incobotulinumtoxinA)
6/17/2026
4/5/2017 Xermelo™ (telotristat ethyl)
10/15/2025
1/1/2024 Xgeva® (denosumab) and biosimilars
2/18/2026
5/1/2026 Xgeva® (denosumab) and biosimilars
2/18/2026
1/1/2026 Xgeva® (denosumab) and biosimiliars
6/17/2026
11/8/2017 XHANCE® (fluticasone propionate)
4/15/2026
1/1/2024 Xifaxan® (rifaximin)
6/17/2026
1/1/2025 Xiidra® (lifitegrast ophthalmic solution)
6/17/2026
2/23/2022 Xipere® (triamcinolone acetonide)
7/15/2026
7/1/2026 Xofigo® (radium Ra 223 dichloride)
4/15/2026
7/1/2026 Xofigo® (radium Ra 223 dichloride)
4/15/2026
7/1/2026 Xofigo® (radium Ra 223 dichloride)
4/15/2026
1/1/2023 Xofigo® (radium Ra 223 dichloride)
4/15/2026
1/1/2024 Xolair® (omalizumab)
3/18/2026
9/25/2024 Xolremdi (mavorixafor)
5/20/2026
1/1/2026 Xospata® (gilteritinib)
5/20/2026
1/1/2022 Xpovio® (selinexor)
1/21/2026
4/23/2025 Xromi oral solution
3/18/2026
1/1/2026 Xtandi (enzalutamide)
5/20/2026
1/1/2025 Xultophy® (insulin degludec and liraglutide)
4/15/2026
1/1/2025 Xyrem® (sodium oxybate)
3/18/2026
1/1/2025 Xywav® (calcium, magnesium, potassium, and sodium oxybates)
3/18/2026
  • 1

Search by Keyword or Policy Number