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| Item Number | Policy/Procedure | Date Posted | Comment Period Closed | Status | Document Links |
|---|---|---|---|---|---|
| 2024-HB-MED-486 | Botulinum Toxin | 12/13/24 | 1/27/25 | Complete | Botulinum Toxin |
| 2024-LHCC-MED-675 | Axatilimab-csfr (Niktimvo) | 12/13/24 | 1/27/25 | Complete | Axatilimab-csfr (Niktimvo) |
| 2024-LHCC-MED-676 | Denileukin Diftitox-cxdl (Lymphir) | 12/13/24 | 1/27/25 | Complete | Denileukin Diftitox-cxdl (Lymphir) |
| 2024-LHCC-MED-677 | Palopegteriparatide (Yorvipath) | 12/13/24 | 1/27/25 | Complete | Palopegteriparatide (Yorvipath) |
| 2024-LHCC-MED-665 | Mirvetuximab soravatansine-gynx (Elahere) | 12/13/24 | 1/27/25 | Complete | Mirvetuximab soravatansine-gynx (Elahere) |
| 2024-LHCC-MED-666 | Dornase Alfa (Pulmozyme) | 12/13/24 | 1/27/25 | Complete | Dornase Alfa (Pulmozyme) |
| 2024-LHCC-MED-667 | Ofatumumab (Arzerra) | 12/13/24 | 1/27/25 | Complete | Ofatumumab (Arzerra) |
| 2024-LHCC-MED-668 | Metreleptin (Myalept) | 12/13/24 | 1/27/25 | Complete | Metreleptin (Myalept) |
| 2024-LHCC-MED-669 | Bremelanotide (Vyleesi) | 12/13/24 | 1/27/25 | Complete | Bremelanotide (Vyleesi) |
| 2024-LHCC-MED-670 | Belantamab Mafodotin-blmf (Blenrep) | 12/13/24 | 1/27/25 | Complete | Belantamab Mafodotin-blmf (Blenrep) |
| 2024-LHCC-MED-671 | Mitomycin for Pyelocalyceal Solution (Jelmyto) | 12/13/24 | 1/27/25 | Complete | Mitomycin for Pyelocalyceal Solution (Jelmyto) |
| 2024-LHCC-MED-672 | Tebentafusp-tebn (Kimmtrak) | 12/13/24 | 1/27/25 | Complete | Tebentafusp-tebn (Kimmtrak) |
| 2024-LHCC-MED-673 | Fecal Microbiota, Live-jslm (Rebyota) | 12/13/24 | 1/27/25 | Complete | Fecal Microbiota, Live-jslm (Rebyota) |
| 2024-LHCC-MED-674 | Glycopyrronium (Qbrexza) | 12/13/24 | 1/27/25 | Complete | Glycopyrronium (Qbrexza) |
| 2024-LHCC-MED-661 | Teclistamab-cqyv (Tecvayli) | 12/13/24 | 1/27/25 | Complete | Teclistamab-cqyv (Tecvayli) |
| 2024-LHCC-MED-662 | Melphalan Flufenamide (Pepaxto) | 12/13/24 | 1/27/25 | Complete | Melphalan Flufenamide (Pepaxto) |
| 2024-LHCC-MED-663 | Levoleucovorin (Fusilev, Khapzory) | 12/13/24 | 1/27/25 | Complete | Levoleucovorin (Fusilev, Khapzory) |
| 2024-LHCC-MED-664 | Hyaluronate Derivatives | 12/13/24 | 1/27/25 | Complete | Hyaluronate Derivatives |
| 2024-LHCC-MED-653 | Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) | 12/13/24 | 1/27/25 | Complete | Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) |
| 2024-LHCC-MED-654 | Isatuximab-irfc (Sarclisa) | 12/13/24 | 1/27/25 | Complete | Isatuximab-irfc (Sarclisa) |
| 2024-LHCC-MED-655 | Baclofen (Fleqsuvy, Gablofen, Lioresal, Lyvispah, Ozobax) | 12/13/24 | 1/27/25 | Complete | Baclofen (Fleqsuvy, Gablofen, Lioresal, Lyvispah, Ozobax) |
| 2024-LHCC-MED-656 | Valrubicin (Valstar) | 12/13/24 | 1/27/25 | Complete | Valrubicin (Valstar) |
| 2024-LHCC-MED-657 | Tafasitamab-cxix (Monjuvi) | 12/13/24 | 1/27/25 | Complete | Tafasitamab-cxix (Monjuvi) |
| 2024-LHCC-MED-658 | Mogamulizumab-kpkc (Poteligeo) | 12/13/24 | 1/27/25 | Complete | Mogamulizumab-kpkc (Poteligeo) |
| 2024-LHCC-MED-659 | Desmopressin Acetate (DDAVP) | 12/13/24 | 1/27/25 | Complete | Desmopressin Acetate (DDAVP) |
| 2024-LHCC-MED-660 | Irinotecan Liposome (Onivyde) | 12/13/24 | 1/27/25 | Complete | Irinotecan Liposome (Onivyde) |
| 2024-UHC-MED-226 | Maximum Dosage | 12/13/24 | 1/27/25 | Complete | Maximum Dosage |
| 2024-UHC-MED-227 | Xiaflex | 12/13/24 | 1/27/25 | Complete | Xiaflex |
| 2024-ACLA-MED-91 | Complement inhibitors | 12/13/24 | 1/27/25 | Complete | Complement inhibitors |
| 2024-ACLA-MED-92 | Veopoz | 12/13/24 | 1/27/25 | Complete | Veopoz |
| 2024-ACLA-MED-93 | Rytelo | 12/13/24 | 1/27/25 | Complete | Rytelo |
| 2024-ACLA-MED-94 | Chronic Inflammatory Demyelinating Polyneuropathy | 12/13/24 | 1/27/25 | Complete | Chronic Inflammatory Demyelinating Polyneuropathy |
| 2024-ACLA-MED-95 | Tecelra | 12/13/24 | 1/27/25 | Complete | Tecelra |
| 2024-LHCC-MED-646 | Pembrolizumab (Keytruda) | 12/5/24 | 1/19/25 | Complete | Pembrolizumab (Keytruda) |
| 2024-LHCC-MED-647 | Fam-trastuzumab deruxtecan-nxki (Enhertu) | 12/5/24 | 1/19/25 | Complete | Fam-trastuzumab deruxtecan-nxki (Enhertu) |
| 2024-LHCC-MED-648 | Lutetium Lu 177 Dotatate (Lutathera) | 12/5/24 | 1/19/25 | Complete | Lutetium Lu 177 Dotatate (Lutathera) |
| 2024-LHCC-MED-649 | Daratumumab Daratumumab-Hyaluronidase-fihj (Darzalex, Darzalex, Faspro) | 12/5/24 | 1/19/25 | Complete | Daratumumab Daratumumab-Hyaluronidase-fihj (Darzalex, Darzalex, Faspro) |
| 2024-LHCC-MED-650 | Ciltacabtagene Autoleucel (Carvykti) | 12/5/24 | 1/19/25 | Complete | Ciltacabtagene Autoleucel (Carvykti) |
| 2024-LHCC-MED-651 | Cerliponase alfa (Brineura) | 12/5/24 | 1/19/25 | Complete | Cerliponase alfa (Brineura) |
| 2024-LHCC-MED-652 | Fibrinogen concentrate (human) (Fibryga, RiaSTAP) | 12/5/24 | 1/19/25 | Complete | Fibrinogen concentrate (human) (Fibryga, RiaSTAP) |
| 2024-LHCC-MED-634 | Ranibizumab (Lucentis, Susvimo), Lucentis Biosimilars | 12/5/24 | 1/19/25 | Complete | Ranibizumab (Lucentis, Susvimo), Lucentis Biosimilars |
| 2024-LHCC-MED-635 | Nivolumab and Relatlimab (Opdualag) | 12/5/24 | 1/19/25 | Complete | Nivolumab and Relatlimab (Opdualag) |
| 2024-LHCC-MED-636 | Amivantamab-vmjw (Rybrevant) | 12/5/24 | 1/19/25 | Complete | Amivantamab-vmjw (Rybrevant) |
| 2024-LHCC-MED-637 | Brentuximab Vedotin (Adcetris) | 12/5/24 | 1/19/25 | Complete | Brentuximab Vedotin (Adcetris) |
| 2024-LHCC-MED-638 | Furosemide (Furoscix) | 12/5/24 | 1/19/25 | Complete | Furosemide (Furoscix) |
| 2024-LHCC-MED-639 | Vutrisiran (Amvuttra) | 12/5/24 | 1/19/25 | Complete | Vutrisiran (Amvuttra) |
| 2024-LHCC-MED-640 | Aflibercept (Eylea) | 12/5/24 | 1/19/25 | Complete | Aflibercept (Eylea) |
| 2024-LHCC-MED-641 | Denosumab (Xgeva) | 12/5/24 | 1/19/25 | Complete | Denosumab (Xgeva) |
| 2024-LHCC-MED-642 | Paclitaxel protein-bound (Abraxane) | 12/5/24 | 1/19/25 | Complete | Paclitaxel protein-bound (Abraxane) |
| 2024-LHCC-MED-643 | Tremelimumab-actl (Imjudo) | 12/5/24 | 1/19/25 | Complete | Tremelimumab-actl (Imjudo) |
| 2024-LHCC-MED-644 | Nadofaragene Firadenovec-vncg (Adstiladrin) | 12/5/24 | 1/19/25 | Complete | Nadofaragene Firadenovec-vncg (Adstiladrin) |
| 2024-LHCC-MED-645 | Ophthalmic Riboflavin (Photrexa, Photrexa Viscous) | 12/5/24 | 1/19/25 | Complete | Ophthalmic Riboflavin (Photrexa, Photrexa Viscous) |
| 2024-UHC-MED-223 | Complement inhibitors | 12/5/24 | 1/19/25 | Complete | Complement inhibitors |
| 2024-UHC-MED-224 | Review at launch new to market medications | 12/5/24 | 1/19/25 | Complete | Review at launch new to market medications |
| 2024-HB-MED-475 | Tegsedi (inotersen) | 11/27/24 | 1/11/25 | Complete | Tegsedi (inotersen) |
| 2024-HB-MED-476 | Denosumab | 11/27/24 | 1/11/25 | Complete | Denosumab |
| 2024-HB-MED-478 | Vyvgart (efgartigimod alfa-fcab) and Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-gvfc) | 11/27/24 | 1/11/25 | Complete | Vyvgart (efgartigimod alfa-fcab) and Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-gvfc) |
| 2024-HB-MED-480 | Darzalex (daratumumab) and Darzalex Faspro (daratumumab and hyaluronidase-fihj) | 11/27/24 | 1/11/25 | Complete | Darzalex (daratumumab) and Darzalex Faspro (daratumumab and hyaluronidase-fihj) |
| 2024-HB-MED-481 | Epkinly (epcoritamab-bysp) | 11/27/24 | 1/11/25 | Complete | Epkinly (epcoritamab-bysp) |
| 2024-HB-MED-482 | Infertility and HCG Agents | 11/27/24 | 1/11/25 | Complete | Infertility and HCG Agents |
| 2024-HB-MED-484 | Sandostatin and Sandostatin LAR (Octreotide) / Octreotide Agents | 11/27/24 | 1/11/25 | Complete | Sandostatin and Sandostatin LAR (Octreotide) / Octreotide Agents |
| 2024-HB-MED-485 | Xenpozyme (olipudase alfa-rpcp) | 11/27/24 | 1/11/25 | Complete | Xenpozyme (olipudase alfa-rpcp) |
| 2024-HB-MED-465 | Rytelo (imetelstat) | 11/26/24 | 1/10/25 | Complete | Rytelo (imetelstat) |
| 2024-HB-MED-466 | Levoleucovorin Agents | 11/26/24 | 1/10/25 | Complete | Levoleucovorin Agents |
| 2024-HB-MED-467 | Istodax (romidepsin) | 11/26/24 | 1/10/25 | Complete | Istodax (romidepsin) |
| 2024-HB-MED-468 | Iron agents | 11/26/24 | 1/10/25 | Complete | Iron agents |
| 2024-HB-MED-469 | Monjuvi (tafasitamab-cxix) | 11/26/24 | 1/10/25 | Complete | Monjuvi (tafasitamab-cxix) |
| 2024-HB-MED-470 | Opdualag (nivolumab and relatlimab-rmbw) | 11/26/24 | 1/10/25 | Complete | Opdualag (nivolumab and relatlimab-rmbw) |
| 2024-HB-MED-471 | Jemperli (dostarlimab-gxly) | 11/26/24 | 1/10/25 | Complete | Jemperli (dostarlimab-gxly) |
| 2024-HB-MED-472 | Beyfortus (nirsevimab) | 11/26/24 | 1/10/25 | Complete | Beyfortus (nirsevimab) |
| 2024-HB-MED-473 | Onpattro (patisiran) | 11/26/24 | 1/10/25 | Complete | Onpattro (patisiran) |
| 2024-HB-MED-474 | Amvuttra (vulrisiran) | 11/26/24 | 1/10/25 | Complete | Amvuttra (vulrisiran) |
| 2024-PHARM-113 | POS Dermatology - Atopic Dermatitis, Immunomodulators | 11/20/24 | 1/4/25 | Complete | POS Dermatology - Atopic Dermatitis, Immunomodulators |
| 2024-PHARM-111 | Depression-Antidepressants, Other | 11/14/24 | 12/29/24 | Complete | Depression-Antidepressants, Other |
| 2024-PHARM-112 | PDL January 1, 2025 | 11/14/24 | 12/29/24 | Complete | PDL January 1, 2025 |
| 2024-PHARM-110 | Spinal Muscular Atrophy | 11/8/24 | 12/23/24 | Complete | Spinal Muscular Atrophy |
| 2024-PHARM-87 | Alyglo | 11/6/24 | 12/21/24 | Complete | Alyglo |
| 2024-PHARM-88 | Diabetes, Hypoglycemics - Insulins and Related Agents | 11/6/24 | 12/21/24 | Complete | Diabetes, Hypoglycemics - Insulins and Related Agents |
| 2024-PHARM-89 | Diabetes, Hypoglycemics - Meglitinides | 11/6/24 | 12/21/24 | Complete | Diabetes, Hypoglycemics - Meglitinides |
| 2024-PHARM-90 | Diabetes, Hypoglycemics - SGLT2 | 11/6/24 | 12/21/24 | Complete | Diabetes, Hypoglycemics - SGLT2 |
| 2024-PHARM-91 | Diabetes, Hypoglycemics - Sulfonylureas | 11/6/24 | 12/21/24 | Complete | Diabetes, Hypoglycemics - Sulfonylureas |
| 2024-PHARM-92 | Digestive Disorders Bile Acid Salts | 11/6/24 | 12/21/24 | Complete | Digestive Disorders Bile Acid Salts |
| 2024-PHARM-93 | Elevidys | 11/6/24 | 12/21/24 | Complete | Elevidys |
| 2024-PHARM-94 | GI Motility Chronic | 11/6/24 | 12/21/24 | Complete | GI Motility Chronic |
| 2024-PHARM-95 | H Pylori Treatment | 11/6/24 | 12/21/24 | Complete | H Pylori Treatment |
| 2024-PHARM-96 | Kisunla | 11/6/24 | 12/21/24 | Complete | Kisunla |
| 2024-PHARM-97 | Kisunla Form | 11/6/24 | 12/21/24 | Complete | Kisunla Form |
| 2024-PHARM-98 | Pain Management - Cytokine and CAM Antagonists | 11/6/24 | 12/21/24 | Complete | Pain Management - Cytokine and CAM Antagonists |
| 2024-PHARM-99 | POS ADD/ADHD - Stimulants and Related Agents | 11/6/24 | 12/21/24 | Complete | POS ADD/ADHD - Stimulants and Related Agents |
| 2024-PHARM-100 | POS Daxxify | 11/6/24 | 12/21/24 | Complete | POS Daxxify |
| 2024-PHARM-101 | POS Korlym | 11/6/24 | 12/21/24 | Complete | POS Korlym |
| 2024-PHARM-102 | POS Pain Management - Cytokine and CAM Antagonists | 11/6/24 | 12/21/24 | Complete | POS Pain Management - Cytokine and CAM Antagonists |
| 2024-PHARM-103 | POS PiaSky | 11/6/24 | 12/21/24 | Complete | POS PiaSky |
| 2024-PHARM-104 | POS Rextovy | 11/6/24 | 12/21/24 | Complete | POS Rextovy |
| 2024-PHARM-105 | Quantity Limit Override - Humira 80mg | 11/6/24 | 12/21/24 | Complete | Quantity Limit Override - Humira 80mg |
| 2024-PHARM-106 | Rezdiffra | 11/6/24 | 12/21/24 | Complete | Rezdiffra |
| 2024-PHARM-107 | Skyclarys | 11/6/24 | 12/21/24 | Complete | Skyclarys |
| 2024-PHARM-108 | Stimulants and Related Agents | 11/6/24 | 12/21/24 | Complete | Stimulants and Related Agents |
| 2024-PHARM-109 | Xolremdi | 11/6/24 | 12/21/24 | Complete | Xolremdi |
| 2024-LHCC-MED-616 | Ketamine (Ketalar) | 11/1/24 | 12/16/24 | Complete | Ketamine (Ketalar) |
| 2024-LHCC-MED-617 | Eculizumab (Soliris, Bkemv, Epysqli) | 11/1/24 | 12/16/24 | Complete | Eculizumab (Soliris, Bkemv, Epysqli) |
| 2024-LHCC-MED-618 | Burosumab-twza (Crysvita) | 11/1/24 | 12/16/24 | Complete | Burosumab-twza (Crysvita) |
| 2024-LHCC-MED-619 | Iptacopan (Fabhalta) | 11/1/24 | 12/16/24 | Complete | Iptacopan (Fabhalta) |
| 2024-LHCC-MED-620 | Inotuzumab Ozogamicin (Besponsa) | 11/1/24 | 12/16/24 | Complete | Inotuzumab Ozogamicin (Besponsa) |
| 2024-LHCC-MED-621 | Durvalumab (Imfinzi) | 11/1/24 | 12/16/24 | Complete | Durvalumab (Imfinzi) |
| 2024-LHCC-MED-622 | Tisotumab Vedotin-tftv (Tivdak) | 11/1/24 | 12/16/24 | Complete | Tisotumab Vedotin-tftv (Tivdak) |
| 2024-LHCC-MED-623 | Toripalimab (Loqtorzi) | 11/1/24 | 12/16/24 | Complete | Toripalimab (Loqtorzi) |
| 2024-LHCC-MED-624 | Avacincaptad pegol (Izervay) | 11/1/24 | 12/16/24 | Complete | Avacincaptad pegol (Izervay) |
| 2024-LHCC-MED-625 | Deferoxamine (Desferal) | 11/1/24 | 12/16/24 | Complete | Deferoxamine (Desferal) |
| 2024-LHCC-MED-626 | Ferumoxytol (Feraheme) | 11/1/24 | 12/16/24 | Complete | Ferumoxytol (Feraheme) |
| 2024-LHCC-MED-627 | Ferric Carboxymaltose (Injectafer) | 11/1/24 | 12/16/24 | Complete | Ferric Carboxymaltose (Injectafer) |
| 2024-LHCC-MED-628 | Lurbinectedin (Zepzelca) | 11/1/24 | 12/16/24 | Complete | Lurbinectedin (Zepzelca) |
| 2024-LHCC-MED-629 | Loncastuximab Tesirine-lpyl (Zynlonta) | 11/1/24 | 12/16/24 | Complete | Loncastuximab Tesirine-lpyl (Zynlonta) |
| 2024-LHCC-MED-630 | Dostarlimab-gxly (Jemperli) | 11/1/24 | 12/16/24 | Complete | Dostarlimab-gxly (Jemperli) |
| 2024-LHCC-MED-631 | Polatuzumab Vedotin-piiq (Polivy) | 11/1/24 | 12/16/24 | Complete | Polatuzumab Vedotin-piiq (Polivy) |
| 2024-UHC-MED-225 | Brineura | 10/31/24 | 12/15/24 | Complete | Brineura |
| 2024-MED-UHC-222 | Oncology Medications Clinical Coverage | 10/23/24 | 12/7/24 | Complete | Oncology Medications Clinical Coverage |
| 2024-MED-HB-458 | Breynazi | 10/23/24 | 12/7/24 | Complete | Breynazi |
| 2024-MED-HB-459 | Imdelitra | 10/23/24 | 12/7/24 | Complete | Imdelitra |
| 2024-MED-HB-460 | Anktiva | 10/23/24 | 12/7/24 | Complete | Anktiva |
| 2024-MED-HB-461 | Pemetrexed (Alimta, Pemfexy, Pemrydi) | 10/23/24 | 12/7/24 | Complete | Pemetrexed (Alimta, Pemfexy, Pemrydi) |
| 2024-MED-HB-462 | Radioimmunotherapy | 10/23/24 | 12/7/24 | Complete | Radioimmunotherapy |
| 2024-MED-HB-463 | Trastuzumab Agents | 10/23/24 | 12/7/24 | Complete | Trastuzumab Agents |
| 2024-MED-HB-464 | Complement C5 Inhibitors | 10/23/24 | 12/7/24 | Complete | Complement C5 Inhibitors |
| 2024-HB-MED-446 | Keytruda | 10/17/24 | 12/1/24 | Complete | Keytruda |
| 2024-HB-MED-447 | Elrexfio, Ngenia, Pombiliti other requirements | 10/17/24 | 12/1/24 | Complete | Elrexfio, Ngenia, Pombiliti other requirements |
| 2024-HB-MED-448 | Tecentriq | 10/17/24 | 12/1/24 | Complete | Tecentriq |
| 2024-HB-MED-449 | Imfinzi | 10/17/24 | 12/1/24 | Complete | Imfinzi |
| 2024-HB-MED-450 | Polivy | 10/17/24 | 12/1/24 | Complete | Polivy |
| 2024-HB-MED-451 | Libtayo | 10/17/24 | 12/1/24 | Complete | Libtayo |
| 2024-HB-MED-452 | Enhertu | 10/17/24 | 12/1/24 | Complete | Enhertu |
| 2024-HB-MED-453 | Tepezza | 10/17/24 | 12/1/24 | Complete | Tepezza |
| 2024-HB-MED-454 | Trodelvy | 10/17/24 | 12/1/24 | Complete | Trodelvy |
| 2024-HB-MED-455 | Imcivree | 10/17/24 | 12/1/24 | Complete | Imcivree |
| 2024-HB-MED-456 | Rybrevant | 10/17/24 | 12/1/24 | Complete | Rybrevant |
| 2024-HB-MED-457 | Elahere | 10/17/24 | 12/1/24 | Complete | Elahere |
| 2024-HB-MED-433 | Winrevair | 9/26/24 | 11/10/24 | Complete | Winrevair |
| 2024-HB-MED-434 | Gazyva | 9/26/24 | 11/10/24 | Complete | Gazyva |
| 2024-HB-MED-435 | Opdivo | 9/26/24 | 11/10/24 | Complete | Opdivo |
| 2024-HB-MED-436 | Scenesse | 9/26/24 | 11/10/24 | Complete | Scenesse |
| 2024-HB-MED-437 | Revcovi | 9/26/24 | 11/10/24 | Complete | Revcovi |
| 2024-HB-MED-438 | Ycanth | 9/26/24 | 11/10/24 | Complete | Ycanth |
| 2024-HB-MED-439 | Tevimbra | 9/26/24 | 11/10/24 | Complete | Tevimbra |
| 2024-HB-MED-440 | Adcetris | 9/26/24 | 11/10/24 | Complete | Adcetris |
| 2024-HB-MED-441 | Doxorubicin | 9/26/24 | 11/10/24 | Complete | Doxorubicin |
| 2024-HB-MED-442 | Torisel | 9/26/24 | 11/10/24 | Complete | Torisel |
| 2024-HB-MED-443 | Vectibix | 9/26/24 | 11/10/24 | Complete | Vectibix |
| 2024-HB-MED-444 | Erbitux | 9/26/24 | 11/10/24 | Complete | Erbitux |
| 2024-HB-MED-445 | Cyramza | 9/26/24 | 11/10/24 | Complete | Cyramza |
| 2024-HB-MED-402 | iDose TR | 9/26/24 | 11/10/24 | Complete | iDose TR |
| 2024-HB-MED-403 | Amtagvi | 9/26/24 | 11/10/24 | Complete | Amtagvi |
| 2024-HB-MED-405 | Elzonris | 9/26/24 | 11/10/24 | Complete | Elzonris |
| 2024-HB-MED-406 | Mozobil | 9/26/24 | 11/10/24 | Complete | Mozobil |
| 2024-HB-MED-407 | Ixempra | 9/26/24 | 11/10/24 | Complete | Ixempra |
| 2024-HB-MED-408 | Docetaxel (Taxotere) | 9/26/24 | 11/10/24 | Complete | Docetaxel (Taxotere) |
| 2024-HB-MED-409 | Asparagine Specific Enzymes | 9/26/24 | 11/10/24 | Complete | Asparagine Specific Enzymes |
| 2024-HB-MED-410 | Vidaza | 9/26/24 | 11/10/24 | Complete | Vidaza |
| 2024-HB-MED-411 | Abraxane | 9/26/24 | 11/10/24 | Complete | Abraxane |
| 2024-HB-MED-412 | Halaven | 9/26/24 | 11/10/24 | Complete | Halaven |
| 2024-HB-MED-413 | Zaltrap | 9/26/24 | 11/10/24 | Complete | Zaltrap |
| 2024-HB-MED-414 | Perjeta | 9/26/24 | 11/10/24 | Complete | Perjeta |
| 2024-HB-MED-415 | Xofigo | 9/26/24 | 11/10/24 | Complete | Xofigo |
| 2024-HB-MED-416 | Sylvant | 9/26/24 | 11/10/24 | Complete | Sylvant |
| 2024-HB-MED-417 | Kadcyla | 9/26/24 | 11/10/24 | Complete | Kadcyla |
| 2024-HB-MED-418 | Bendamustine | 9/26/24 | 11/10/24 | Complete | Bendamustine |
| 2024-HB-MED-419 | Empliciti | 9/26/24 | 11/10/24 | Complete | Empliciti |
| 2024-HB-MED-420 | Yervoy | 9/26/24 | 11/10/24 | Complete | Yervoy |
| 2024-HB-MED-421 | Kyprolis | 9/26/24 | 11/10/24 | Complete | Kyprolis |
| 2024-HB-MED-422 | Arzerra | 9/26/24 | 11/10/24 | Complete | Arzerra |
| 2024-HB-MED-423 | Blincyto | 9/26/24 | 11/10/24 | Complete | Blincyto |
| 2024-HB-MED-424 | Bavencio | 9/26/24 | 11/10/24 | Complete | Bavencio |
| 2024-HB-MED-425 | Besponsa | 9/26/24 | 11/10/24 | Complete | Besponsa |
| 2024-HB-MED-426 | Mylotarg | 9/26/24 | 11/10/24 | Complete | Mylotarg |
| 2024-HB-MED-427 | Melanoma Vaccines | 9/26/24 | 11/10/24 | Complete | Melanoma Vaccines |
| 2024-HB-MED-428 | Padcev | 9/26/24 | 11/10/24 | Complete | Padcev |
| 2024-HB-MED-429 | Sarclisa | 9/26/24 | 11/10/24 | Complete | Sarclisa |
| 2024-HB-MED-430 | Adstiladrin | 9/26/24 | 11/10/24 | Complete | Adstiladrin |
| 2024-HB-MED-431 | Lunsumio | 9/26/24 | 11/10/24 | Complete | Lunsumio |
| 2024-HB-MED-432 | Nexobrid | 9/26/24 | 11/10/24 | Complete | Nexobrid |
| 2024-LHCC-MED-604 | Ferric Derisomaltose (Monoferric) | 9/17/24 | 11/1/24 | Complete | Ferric Derisomaltose (Monoferric) |
| 2024-LHCC-MED-605 | Idecabtagene vicleucel (Abecma) | 9/17/24 | 11/1/24 | Complete | Idecabtagene vicleucel (Abecma) |
| 2024-LHCC-MED-606 | Lisocabtagene maraleucel (Breyanzi) | 9/17/24 | 11/1/24 | Complete | Lisocabtagene maraleucel (Breyanzi) |
| 2024-LHCC-MED-607 | Ciltacabtagene Autoleucel (Carvykti) | 9/17/24 | 11/1/24 | Complete | Ciltacabtagene Autoleucel (Carvykti) |
| 2024-LHCC-MED-608 | Mitoxantrone | 9/17/24 | 11/1/24 | Complete | Mitoxantrone |
| 2024-LHCC-MED-609 | Daptomycin (Cubicin, Cubicin RF, Dapzura RT) | 9/17/24 | 11/1/24 | Complete | Daptomycin (Cubicin, Cubicin RF, Dapzura RT) |
| 2024-LHCC-MED-610 | Lanreotide (Somatuline Depot and Unbranded) | 9/17/24 | 11/1/24 | Complete | Lanreotide (Somatuline Depot and Unbranded) |
| 2024-LHCC-MED-611 | Aflibercept (Eylea, Eylea HD) | 9/17/24 | 11/1/24 | Complete | Aflibercept (Eylea, Eylea HD) |
| 2024-LHCC-MED-612 | Sodium Phenylbutyrate-Taurursodiol (Relyvrio) | 9/17/24 | 11/1/24 | Complete | Sodium Phenylbutyrate-Taurursodiol (Relyvrio) |
| 2024-LHCC-MED-602 | Glofitamab-gxbm (Columvi) | 9/17/24 | 11/1/24 | Complete | Glofitamab-gxbm (Columvi) |
| 2024-LHCC-MED-603 | Epcoritamab-bysp (Epkinly) | 9/17/24 | 11/1/24 | Complete | Epcoritamab-bysp (Epkinly) |
| 2024-LHCC-MED-598 | Tarlatamab-dlle (imdelltra) | 9/17/24 | 11/1/24 | Complete | Tarlatamab-dlle (imdelltra) |
| 2024-LHCC-MED-599 | Tislelizumab-jsgr (Tevimbra) | 9/17/24 | 11/1/24 | Complete | Tislelizumab-jsgr (Tevimbra) |
| 2024-LHCC-MED-600 | Imetelstat (Rytelo) | 9/17/24 | 11/1/24 | Complete | Imetelstat (Rytelo) |
| 2024-PHARM-86 | Diabetes - Hypoglycemics, Incretin Mimetics/Enhancers |
9/17/24 | N/A | Approved | Diabetes - Hypoglycemics, Incretin Mimetics/Enhancers Met Imminent Peril Justification |
| 2024-PHARM-84 | GLP-1/DPP-4 Therapeutic Duplication | 9/4/24 | N/A | Approved | GLP-1/DPP-4 Therapeutic Duplication Met Imminent Peril Justification |
| 2024-PHARM-85 | GLP-1 Maximum Dose/Quantity Limit | 9/4/24 | N/A | Approved | GLP-1 Maximum Dose/Quantity Limit Met Imminent Peril Justification |
| 2024-LHCC-MED-509 | No Coverage Criteria | 9/4/24 | 10/19/24 | Pending | No Coverage Criteria |
| 2024-LHCC-MED-508 | Off-label Use | 9/4/24 | 10/19/24 | Pending | Off-label Use |
| 2024-UHC-MED-220 | Neonatal receptor blockers | 9/4/24 | 10/19/24 | Pending | Neonatal receptor blockers |
| 2024-UHC-MED-221 | Provider administered drugs site of care | 9/4/24 | 10/19/24 | Pending | Provider administered drugs site of care |
| 2024-ACLA-MED-75 | Amtagvi | 9/4/24 | 10/19/24 | Pending | Amtagvi |
| 2024-ACLA-MED-85 | Anti-CD19 CAR-T Immunotherapies | 9/4/24 | 10/19/24 | Pending | Anti-CD19 CAR-T Immunotherapies |
| 2024-ACLA-MED-86 | BCMA Directed CART-T Therapy | 9/4/24 | 10/19/24 | Pending | BCMA Directed CART-T Therapy |
| 2024-ACLA-MED-87 | Brineura | 9/4/24 | 10/19/24 | Pending | Brineura |
| 2024-ACLA-MED-88 | Complement Inhibitors | 9/4/24 | 10/19/24 | Pending | Complement Inhibitors |
| 2024-ACLA-MED-89 | Omisirge | 9/4/24 | 10/19/24 | Pending | Omisirge |
| 2024-ACLA-MED-90 | Rituximab | 9/4/24 | 10/19/24 | Pending | Rituximab |
| 2024-PHARM-61 | Asthma Immunomodulators | 8/5/24 | 9/19/24 | Complete | Asthma Immunomodulators |
| 2024-PHARM-62 | Beqvez | 8/5/24 | 9/19/24 | Complete | Beqvez |
| 2024-PHARM-63 | Colony Stimulating Factors | 8/5/24 | 9/19/24 | Complete | Colony Stimulating Factors |
| 2024-PHARM-64 | Digestive Disorders - Bile Acid Salts | 8/5/24 | 9/19/24 | Complete | Digestive Disorders - Bile Acid Salts |
| 2024-PHARM-65 | Heart Disease/Hyperlipidemia - Lipotropics, Other | 8/5/24 | 9/19/24 | Complete | Heart Disease/Hyperlipidemia - Lipotropics, Other |
| 2024-PHARM-66 | Lenmeldy | 8/5/24 | 9/19/24 | Complete | Lenmeldy |
| 2024-PHARM-67 | Louisiana Medicaid ICD-10 Chart | 8/5/24 | 9/19/24 | Complete | Louisiana Medicaid ICD-10 Chart |
| 2024-PHARM-68 | Pain Management - Cytokine/CAM Antagonists | 8/5/24 | 9/19/24 | Complete | Pain Management - Cytokine/CAM Antagonists |
| 2024-PHARM-69 | POS Antipsychotic Agents, Injectable Agents | 8/5/24 | 9/19/24 | Complete | POS Antipsychotic Agents, Injectable Agents |
| 2024-PHARM-70 | POS Anxiolytics | 8/5/24 | 9/19/24 | Complete | POS Anxiolytics |
| 2024-PHARM-71 | POS Depression - Antidepressants, Other | 8/5/24 | 9/19/24 | Complete | POS Depression - Antidepressants, Other |
| 2024-PHARM-72 | POS Dermatology - Atopic Dermatitis, Immunomodulators | 8/5/24 | 9/19/24 | Complete | POS Dermatology - Atopic Dermatitis, Immunomodulators |
| 2024-PHARM-73 | POS Infectious Disorders - Hepatitis C Agents, Direct Acting Antiviral Agents | 8/5/24 | 9/19/24 | Complete | POS Infectious Disorders - Hepatitis C Agents, Direct Acting Antiviral Agents |
| 2024-PHARM-74 | POS Opiate Dependence Agents | 8/5/24 | 9/19/24 | Complete | POS Opiate Dependence Agents |
| 2024-PHARM-75 | POS Opsynvi | 8/5/24 | 9/19/24 | Complete | POS Opsynvi |
| 2024-PHARM-76 | POS Progestational Agents | 8/5/24 | 9/19/24 | Complete | POS Progestational Agents |
| 2024-PHARM-77 | POS Voydeya | 8/5/24 | 9/19/24 | Complete | POS Voydeya |
| 2024-PHARM-78 | POS Wegovy | 8/5/24 | 9/19/24 | Complete | POS Wegovy |
| 2024-PHARM-79 | POS Winrevair | 8/5/24 | 9/19/24 | Complete | POS Winrevair |
| 2024-PHARM-80 | Rezdiffra | 8/5/24 | 9/19/24 | Complete | Rezdiffra |
| 2024-PHARM-81 | Simlandi | 8/5/24 | 9/19/24 | Complete | Simlandi |
| 2024-PHARM-82 | Tofidence | 8/5/24 | 9/19/24 | Complete | Tofidence |
| 2024-PHARM-83 | Tyenne | 8/5/24 | 9/19/24 | Complete | Tyenne |
| 2024-ACLA-MED-73 | Adzynma | 8/5/24 | 9/19/24 | Complete | Adzynma |
| 2024-ACLA-MED-74 | Alpha 1 Proteinase Inhibitors | 8/5/24 | 9/19/24 | Complete | Alpha 1 Proteinase Inhibitors |
| 2024-ACLA-MED-76 | Hydroxyprogesterone | 8/5/24 | 9/19/24 | Complete | Hydroxyprogesterone |
| 2024-ACLA-MED-77 | Ketamine | 8/5/24 | 9/19/24 | Complete | Ketamine |
| 2024-ACLA-MED-78 | Lamzede | 8/5/24 | 9/19/24 | Complete | Lamzede |
| 2024-ACLA-MED-79 | Myasthenia Gravis Agents | 8/5/24 | 9/19/24 | Complete | Myasthenia Gravis Agents |
| 2024-ACLA-MED-80 | Oncology Drugs | 8/5/24 | 9/19/24 | Complete | Oncology Drugs |
| 2024-ACLA-MED-81 | Radicava | 8/5/24 | 9/19/24 | Complete | Radicava |
| 2024-ACLA-MED-82 | Somatostatin Analogs | 8/5/24 | 9/19/24 | Complete | Somatostatin Analogs |
| 2024-ACLA-MED-83 | Specialty Drugs | 8/5/24 | 9/19/24 | Complete | Specialty Drugs |
| 2024-ACLA-MED-84 | Transthyretin-mediated Amyloidosis | 8/5/24 | 9/19/24 | Complete | Transthyretin-mediated Amyloidosis |
| 2024-LHCC-MED-590 | Dornase alfa (Pulmozyme) | 8/5/24 | 9/19/24 | Complete | Dornase alfa (Pulmozyme) |
| 2024-LHCC-MED-591 | Motixafortide (Aphexda) | 8/5/24 | 9/19/24 | Complete | Motixafortide (Aphexda) |
| 2024-LHCC-MED-592 | Lifileucel (Amtagvi) | 8/5/24 | 9/19/24 | Complete | Lifileucel (Amtagvi) |
| 2024-LHCC-MED-593 | Sodium thiosulfate (Pedmark) | 8/5/24 | 9/19/24 | Complete | Sodium thiosulfate (Pedmark) |
| 2024-LHCC-MED-594 | Pozelimab-bbfg (Veopoz) | 8/5/24 | 9/19/24 | Complete | Pozelimab-bbfg (Veopoz) |
| 2024-LHCC-MED-595 | Talquetamab-tgvs (Talvey) | 8/5/24 | 9/19/24 | Complete | Talquetamab-tgvs (Talvey) |
| 2024-LHCC-MED-596 | DaxibotulinumtoxinA-lanm (Daxxify) | 8/5/24 | 9/19/24 | Complete | DaxibotulinumtoxinA-lanm (Daxxify) |
| 2024-LHCC-MED-597 | Elranatamab-bcmm (Elrexfio) | 8/5/24 | 9/19/24 | Complete | Elranatamab-bcmm (Elrexfio) |
| 2024-HUMANA-MED-108 | LA PAL State review | 8/5/24 | 9/19/24 | Complete | LA PAL State review |
| 2024-HUMANA-MED-109 | HCPCS J7202 Indelvion | 8/5/24 | 9/19/24 | Complete | HCPCS J7202 Indelvion |
| 2024-HB-MED-366 | Elfabrio, Epkinly, Vyjuvek, Zynyz | 8/5/24 | 9/19/24 | Complete | Elfabrio, Epkinly, Vyjuvek, Zynyz |
| 2024-UHC-MED-218 | Self-administered medications | 8/5/24 | 9/19/24 | Complete | Self-administered medications |
| 2024-UHC-MED-219 | Complement inhibitors (Soliris, Ultomiris) | 8/5/24 | 9/19/24 | Complete | Complement inhibitors (Soliris, Ultomiris) |
| 2024-PHARM-60 | Wegovy | 8/1/24 | 9/15/24 | Complete | Wegovy |
| 2024-HUMANA-MED-97 | 7417_Vedolizumab | 7/12/24 | 8/26/24 | Complete | 7417_Vedolizumab |
| 2024-HUMANA-MED-98 | 7426, 7428, 7429, 7432_Pemetrexed | 7/12/24 | 8/26/24 | Complete | 7426, 7428, 7429, 7432_Pemetrexed |
| 2024-HUMANA-MED-99 | 7477, 7479, 7481, 7483_Tocilizumab | 7/12/24 | 8/26/24 | Complete | 7477, 7479, 7481, 7483_Tocilizumab |
| 2024-HUMANA-MED-100 | 7412, 7415_Aflibercept | 7/12/24 | 8/26/24 | Complete | 7412, 7415_Aflibercept |
| 2024-HUMANA-MED-101 | 7407_Irinotecan | 7/12/24 | 8/26/24 | Complete | 7407_Irinotecan |
| 2024-HUMANA-MED-102 | 7424_Omalizumab | 7/12/24 | 8/26/24 | Complete | 7424_Omalizumab |
| 2024-HUMANA-MED-103 | 7443_Adalimumab | 7/12/24 | 8/26/24 | Complete | 7443_Adalimumab |
| 2024-HUMANA-MED-104 | 7462_Pegfilgrastim | 7/12/24 | 8/26/24 | Complete | 7462_Pegfilgrastim |
| 2024-HUMANA-MED-105 | 7410_Nivolumab | 7/12/24 | 8/26/24 | Complete | 7410_Nivolumab |
| 2024-HUMANA-MED-106 | 7445_Ipilimumab | 7/12/24 | 8/26/24 | Complete | 7445_Ipilimumab |
| 2024-HUMANA-MED-107 | 7501_Ritiliximab | 7/12/24 | 8/26/24 | Complete | 7501_Ritiliximab |
| 2024-LHCC-MED-575 | Sipuleucel-T (Provenge) | 7/8/24 | 8/22/24 | Complete | Sipuleucel-T (Provenge) |
| 2024-LHCC-MED-576 | Pertuzumab (Perjeta) | 7/8/24 | 8/22/24 | Complete | Pertuzumab (Perjeta) |
| 2024-LHCC-MED-577 | Cabazitaxel (Jevtana) | 7/8/24 | 8/22/24 | Complete | Cabazitaxel (Jevtana) |
| 2024-LHCC-MED-578 | Ipilimumab (Yervoy) | 7/8/24 | 8/22/24 | Complete | Ipilimumab (Yervoy) |
| 2024-LHCC-MED-579 | Patisiran (Onpattro) | 7/8/24 | 8/22/24 | Complete | Patisiran (Onpattro) |
| 2024-LHCC-MED-580 | Dexrazoxane (Totect) | 7/8/24 | 8/22/24 | Complete | Dexrazoxane (Totect) |
| 2024-LHCC-MED-581 | Sacituzumab govitecan-hziy (Trodelvy) | 7/8/24 | 8/22/24 | Complete | Sacituzumab govitecan-hziy (Trodelvy) |
| 2024-LHCC-MED-582 | Letermovir (Prevymis) | 7/8/24 | 8/22/24 | Complete | Letermovir (Prevymis) |
| 2024-LHCC-MED-583 | Bezlotoxumab (Zinplava) | 7/8/24 | 8/22/24 | Complete | Bezlotoxumab (Zinplava) |
| 2024-LHCC-MED-584 | Pembrolizumab (Keytruda) | 7/8/24 | 8/22/24 | Complete | Pembrolizumab (Keytruda) |
| 2024-LHCC-MED-585 | Blinatumomab (Blincyto) | 7/8/24 | 8/22/24 | Complete | Blinatumomab (Blincyto) |
| 2024-LHCC-MED-586 | Omecetaxine (Synribo) | 7/8/24 | 8/22/24 | Complete | Omecetaxine (Synribo) |
| 2024-LHCC-MED-587 | Sebelipase alfa (Kanuma) | 7/8/24 | 8/22/24 | Complete | Sebelipase alfa (Kanuma) |
| 2024-LHCC-MED-588 | Ado-trastuzumab (Kadcyla) | 7/8/24 | 8/22/24 | Complete | Ado-trastuzumab (Kadcyla) |
| 2024-LHCC-MED-589 | Elapegademase-lvlr (Revcovi) | 7/8/24 | 8/22/24 | Complete | Elapegademase-lvlr (Revcovi) |
| 2024-UHC-MED-214 | Maximum dosage and frequency | 7/8/24 | 8/22/24 | Complete | Maximum dosage and frequency |
| 2024-UHC-MED-215 | Oncology medication clinical coverage | 7/8/24 | 8/22/24 | Complete | Oncology medication clinical coverage |
| 2024-UHC-MED-216 | RNA-targeted therapies | 7/8/24 | 8/22/24 | Complete | RNA-targeted therapies |
| 2024-UHC-MED-217 | Rituxan-rituximab | 7/8/24 | 8/22/24 | Complete | Rituxan-rituximab |
| 2024-LHCC-MED-534 | Alglucosidase (Lumizyme) | 6/24/24 | 8/8/24 | Complete | Alglucosidase (Lumizyme) |
| 2024-LHCC-MED-535 | Trabectedin (Yondelis) | 6/24/24 | 8/8/24 | Complete | Trabectedin (Yondelis) |
| 2024-LHCC-MED-536 | Paricalcitol Injection (Zemplar) | 6/24/24 | 8/8/24 | Complete | Paricalcitol Injection (Zemplar) |
| 2024-LHCC-MED-537 | Brentuximab Vedotin (Adcetris) | 6/24/24 | 8/8/24 | Complete | Brentuximab Vedotin (Adcetris) |
| 2024-LHCC-MED-538 | Elotuzumab (Empliciti) | 6/24/24 | 8/8/24 | Complete | Elotuzumab (Empliciti) |
| 2024-LHCC-MED-539 | Carfilzomib (Kyprolis) | 6/24/24 | 8/8/24 | Complete | Carfilzomib (Kyprolis) |
| 2024-LHCC-MED-540 | Daratumumab Daratumumab-Hyaluronidase-fihj (Darzalex, Darzalex, Faspro) | 6/24/24 | 8/8/24 | Complete | Daratumumab Daratumumab-Hyaluronidase-fihj (Darzalex, Darzalex, Faspro) |
| 2024-LHCC-MED-541 | Cetuximab (Erbitux) | 6/24/24 | 8/8/24 | Complete | Cetuximab (Erbitux) |
| 2024-LHCC-MED-542 | Siltuximab (Sylvant) | 6/24/24 | 8/8/24 | Complete | Siltuximab (Sylvant) |
| 2024-LHCC-MED-543 | Avelumab (Bavencio) | 6/24/24 | 8/8/24 | Complete | Avelumab (Bavencio) |
| 2024-LHCC-MED-544 | Lutetium Lu 177 Dotatate (Lutathera) | 6/24/24 | 8/8/24 | Complete | Lutetium Lu 177 Dotatate (Lutathera) |
| 2024-LHCC-MED-545 | Azacitidine (Onureg, Vidaza) | 6/24/24 | 8/8/24 | Complete | Azacitidine (Onureg, Vidaza) |
| 2024-LHCC-MED-546 | Moxetumomab pasudotox-tdfk (Lumoxiti) | 6/24/24 | 8/8/24 | Complete | Moxetumomab pasudotox-tdfk (Lumoxiti) |
| 2024-LHCC-MED-547 | Denosumab (Xgeva) | 6/24/24 | 8/8/24 | Complete | Denosumab (Xgeva) |
| 2024-LHCC-MED-548 | Paclitaxel protein-bound (Abraxane) | 6/24/24 | 8/8/24 | Complete | Paclitaxel protein-bound (Abraxane) |
| 2024-LHCC-MED-549 | Atezolizumab (Tecentriq) | 6/24/24 | 8/8/24 | Complete | Atezolizumab (Tecentriq) |
| 2024-LHCC-MED-550 | Erwinia Asparaginase (Erwinaze, Rylaze) | 6/24/24 | 8/8/24 | Complete | Erwinia Asparaginase (Erwinaze, Rylaze) |
| 2024-LHCC-MED-551 | Cerliponase alfa (Brineura) | 6/24/24 | 8/8/24 | Complete | Cerliponase alfa (Brineura) |
| 2024-LHCC-MED-552 | Tisagenlecleucel (Kymriah) | 6/24/24 | 8/8/24 | Complete | Tisagenlecleucel (Kymriah) |
| 2024-LHCC-MED-553 | Axicabtagene ciloleucel (Yescarta) | 6/24/24 | 8/8/24 | Complete | Axicabtagene ciloleucel (Yescarta) |
| 2024-LHCC-MED-554 | Octreotide Acetate (Sandostatin, Sandostatin LAR, Bynfezia, Mycapssa) | 6/24/24 | 8/8/24 | Complete | Octreotide Acetate (Sandostatin, Sandostatin LAR, Bynfezia, Mycapssa) |
| 2024-LHCC-MED-555 | Emapalumab-lzsg (Gamifant) | 6/24/24 | 8/8/24 | Complete | Emapalumab-lzsg (Gamifant) |
| 2024-LHCC-MED-556 | Fam-trastuzumab deruxtecan-nxki (Enhertu) | 6/24/24 | 8/8/24 | Complete | Fam-trastuzumab deruxtecan-nxki (Enhertu) |
| 2024-LHCC-MED-557 | Teprotumumab (Tepezza) | 6/24/24 | 8/8/24 | Complete | Teprotumumab (Tepezza) |
| 2024-LHCC-MED-558 | Ramucirumab (Cyramza) | 6/6/24 | 7/21/24 | Complete | Ramucirumab (Cyramza) |
| 2024-LHCC-MED-559 | Nivolumab (Opdivo) | 6/6/24 | 7/21/24 | Complete | Nivolumab (Opdivo) |
| 2024-LHCC-MED-560 | Deferoxamine (Desferal) | 6/6/24 | 7/21/24 | Complete | Deferoxamine (Desferal) |
| 2024-LHCC-MED-561 | Trastuzumab Biosimilars Trastuzumab-Hyaluronidase | 6/6/24 | 7/21/24 | Complete | Trastuzumab Biosimilars Trastuzumab-Hyaluronidase |
| 2024-LHCC-MED-562 | Rituximab (Rituxan, Riabni, Ruxience, Truxima, Rituxan Hycela) | 6/6/24 | 7/21/24 | Complete | Rituximab (Rituxan, Riabni, Ruxience, Truxima, Rituxan Hycela) |
| 2024-LHCC-MED-563 | Durvalumab (Imfinzi) | 6/6/24 | 7/21/24 | Complete | Durvalumab (Imfinzi) |
| 2024-LHCC-MED-564 | Cemiplimab-rwlc (Libtayo) | 6/6/24 | 7/21/24 | Complete | Cemiplimab-rwlc (Libtayo) |
| 2024-LHCC-MED-565 | Enfortumab Vedotin-ejfv (Padcev) | 6/6/24 | 7/21/24 | Complete | Enfortumab Vedotin-ejfv (Padcev) |
| 2024-LHCC-MED-566 | Faricimab (Vabysmo) | 6/6/24 | 7/21/24 | Complete | Faricimab (Vabysmo) |
| 2024-LHCC-MED-567 | Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) | 6/6/24 | 7/21/24 | Complete | Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) |
| 2024-LHCC-MED-568 | Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) | 6/6/24 | 7/21/24 | Complete | Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) |
| 2024-LHCC-MED-569 | Ravulizumab-cwvz (Ultomiris) | 6/6/24 | 7/21/24 | Complete | Ravulizumab-cwvz (Ultomiris) |
| 2024-LHCC-MED-570 | Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta) | 6/6/24 | 7/21/24 | Complete | Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta) |
| 2024-LHCC-MED-571 | Daptomycin (Cubicin, Cubicin RF, Dapzura RT) | 6/6/24 | 7/21/24 | Complete | Daptomycin (Cubicin, Cubicin RF, Dapzura RT) |
| 2024-LHCC-MED-572 | Bortezomib (Velcade) | 6/6/24 | 7/21/24 | Complete | Bortezomib (Velcade) |
| 2024-LHCC-MED-573 | Efgartigimod Alfa-fcab (Vyvgart) | 6/6/24 | 7/21/24 | Complete | Efgartigimod Alfa-fcab (Vyvgart) |
| 2024-LHCC-MED-574 | Pemetrexed (Alimta, Pemfexy) | 6/6/24 | 7/21/24 | Complete | Pemetrexed (Alimta, Pemfexy) |
| 2024-LHCC-MED-531 | Ferumoxytol (Feraheme) | 6/4/24 | 7/19/24 | Complete | Ferumoxytol (Feraheme) |
| 2024-LHCC-MED-532 | Ibandronate injection (Boniva) | 6/4/24 | 7/19/24 | Complete | Ibandronate injection (Boniva) |
| 2024-LHCC-MED-533 | Ferric Carboxymaltose (Injectafer) | 6/4/24 | 7/19/24 | Complete | Ferric Carboxymaltose (Injectafer) |
| 2024-LHCC-MED-511 | Iptacopan (Fabhalta) | 6/4/24 | 7/19/24 | Complete | Iptacopan (Fabhalta) |
| 2024-LHCC-MED-512 | Toripalimab-tpzi (Loqtorzi) | 6/4/24 | 7/19/24 | Complete | Toripalimab-tpzi (Loqtorzi) |
| 2024-LHCC-MED-513 | Aprocitentan (Tryvio) | 6/4/24 | 7/19/24 | Complete | Aprocitentan (Tryvio) |
| 2024-LHCC-MED-514 | Vadadustat (Vafseo) | 6/4/24 | 7/19/24 | Complete | Vadadustat (Vafseo) |
| 2024-LHCC-MED-515 | Edaravone (Radicava) | 6/4/24 | 7/19/24 | Complete | Edaravone (Radicava) |
| 2024-LHCC-MED-516 | Triamcinolone ER Injection (Zilretta) | 6/4/24 | 7/19/24 | Complete | Triamcinolone ER Injection (Zilretta) |
| 2024-LHCC-MED-517 | Epoprostenol (Flolan, Veletri) | 6/4/24 | 7/19/24 | Complete | Epoprostenol (Flolan, Veletri) |
| 2024-LHCC-MED-518 | Hemin (Panhematin) | 6/4/24 | 7/19/24 | Complete | Hemin (Panhematin) |
| 2024-LHCC-MED-519 | Verteporfin (Visudyne) | 6/4/24 | 7/19/24 | Complete | Verteporfin (Visudyne) |
| 2024-LHCC-MED-520 | Cosyntropin (Cortrosyn) | 6/4/24 | 7/19/24 | Complete | Cosyntropin (Cortrosyn) |
| 2024-LHCC-MED-521 | Asfotase Alfa (Strensiq) | 6/4/24 | 7/19/24 | Complete | Asfotase Alfa (Strensiq) |
| 2024-LHCC-MED-522 | Protein C Concentrate Human (Ceprotin) | 6/4/24 | 7/19/24 | Complete | Protein C Concentrate Human (Ceprotin) |
| 2024-LHCC-MED-523 | Voretigene Neparvovec-rzyl (Luxturna) | 6/4/24 | 7/19/24 | Complete | Voretigene Neparvovec-rzyl (Luxturna) |
| 2024-LHCC-MED-524 | Inotersen (Tegsedi) | 6/4/24 | 7/19/24 | Complete | Inotersen (Tegsedi) |
| 2024-LHCC-MED-525 | Trofinetide (Daybue) | 6/4/24 | 7/19/24 | Complete | Trofinetide (Daybue) |
| 2024-LHCC-MED-526 | Eculizumab (Soliris) | 6/4/24 | 7/19/24 | Complete | Eculizumab (Soliris) |
| 2024-LHCC-MED-527 | Agalsidase beta (Fabrazyme) | 6/4/24 | 7/19/24 | Complete | Agalsidase beta (Fabrazyme) |
| 2024-LHCC-MED-528 | Interferon Gamma-1b (Actimmune) | 6/4/24 | 7/19/24 | Complete | Interferon Gamma-1b (Actimmune) |
| 2024-LHCC-MED-529 | Ranibizumab (Lucentis, Susvimo), Lucentis Biosimilars | 6/4/24 | 7/19/24 | Complete | Ranibizumab (Lucentis, Susvimo), Lucentis Biosimilars |
| 2024-LHCC-MED-530 | Sutimlimab-jome (Enjaymo) | 6/4/24 | 7/19/24 | Complete | Sutimlimab-jome (Enjaymo) |
Managed Care Pharmacy and Medical Drug Policies Archive (2024)
"Policy or procedure" shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.
Below are items previously posted for public comment: