Part B Pharmacy Policies
Navigate directly to a letter:
-
A
- ANIFRO~2.PDF
- Aglsidase Beta (Fabrazyme)
- Alemtuzumab (Lemtrada)
- Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme)
- Alpha 1 Anitrypsyin Therapy (Prolastin-C Aralast NP Glassia Zemaira)
- Anifrolumab-Fnia (Saphnelo)
- Anifrolumab-fnia_(Saphnelo)_2.pdf
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B
- Belimumab (Benlysta) for Intravenous Use
- Botulinum Toxin Agents
- Botulinum_Toxin_Agents_2.pdf
- Burosumab-Twza (Crysvita)
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C
- Canakinumab (llaris)
- Cerliponase alfa (Brineura®)
- Coagulation Factors
- Collagenase clostridium histolyticum (Xiaflex®), collagenase clostridium histolyticum-aaes
- Crizanlizumab-tmca (Adakveo®)
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D
- Denosumab (Prolia, Xgeva) Romosozumab-Appg (Evenity)
- Dofetilide (Tikosyn) Use in the Inpatient Setting
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E
- Eculizumab (Soliris) and Related Biosimilars, Ravulizumab-Cwvz (Ultomiris)
- Eculizumab_(Soliris)_and_Related_Biosimilars,_Ravulizumab-cwvz_(Ultomiris)_2.pdf
- Efgartigimod Alfa (Vyvgart) and Efgartigimod Alfa and Hyaluronidase Qvfc (Vyvgart Hytrulo)
- Emapalumab-lzsg (Gamifant)
- Enteral Nutritional Therapy
- Enteral_Nutritional_Therapy_2.pdf
- Enzyme Replacement Therapy for Mucopolysaccharidosis
- Enzyme Replacement for the Treatment of Gaucher's Disease
- Eptinezumab Jjmr (Vyepti)
- Erythropoeisis Stimulating Agents (ESA's)
- Evinacumab-Dgnb (Evkeeza)
- Evinacumab-dgnb_(Evkeeza)_2.pdf
- Exon Skipping for Duchenne Muscular Dystrophy (DMD)
- easset_upload_file20300_393078_e.pdf
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F
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G
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I
- Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
- Immune_Globulin_Intravenous_(IVIG),_Subcutaneous_(SCIG)_2.pdf
- Inclisiran (Leqvio)
- Inebilizumab-Cdon (Uplinza)
- Infliximab and Related Biosimilars
- Interleukin (IL-5) Antagonist (e.g Cinqair, Nucala) and IL-5 Receptor Antogonist (e.g. Faserna)
- Intravenous Ketamine (Ketalar) and Intranasal Esketamine (Spravato)
- Intravenous_Ketamine_(Ketalar)_and_Intranasal_Esketamine_(Spravato)_2.pdf
- Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related
-
L
- Lanreotide (Somatiuline Depot)
- Local Coverage Determination for Glucose Monitors
- Lumasiran (Oxlumo)
- Luspatercept-Aamt (Reblozyl)
-
M
- Medicare Part B vs. Part D Crossover Drugs
- Medicare_Part_B_vs_Part_D_Crossover_Drugs_2.pdf
- Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer Disease
- Monoclonal_Antibodies_Directed_Against_Amyloid_For_The_Treatment_of_Alzheimer_Disease_2.pdf
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N
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O
- Ocrelizumab (Ocrevus)
- Octreotide Acetate (Sandostatin LAR Depot)
- Octreotide_Acetate_(Sandostatin_LAR_Depot)_2.pdf
- Off-label Coverage for Prescription Drugs and/or Biologics
- Olipudase Alfa Rpcp Xenpozyme
- Omalizumab (Xolair)
-
P
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R
- Risankizumab-Rzaa (skyrizi) for intravenous Use
- Risankizumab-rzaa_(Skyrizi)_for_Intravenous_Use_2.pdf
- Rozanolixizumab-Noli (Rystiggo)
-
S
- Sebelipase Alfa (Kanuma)
- Spesolimab--sbzo (Spevigo)
- Spesolimab-sbzo_(Spevigo)_2.pdf
- Sutimlimab-jome (Enjaymo)
-
T
- Teplizumab-mzwv (Tzield)
- Teprotumumab (Tepezza)
- Tezepelumab-ekko (Tezspire)
- Tildrakizumab-Asmn (llumya)
- Tocilizumab (Actemra) for IV Infusion and SQ Injection
- Tofersen (Qalsody)
- Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN)
- Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous
- Treatments for Complex Regional Pain Syndrome (CRPS)
- Triamcinolone Acetonide Extended Release Injectable (Zilretta)
-
U
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V
- Vedolizumab (Entyvio) for intravenous Use
- Velmanase alfa (Lamzede)
- Voretigene Neparvovec-rzyl (Luxturna™)