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| Item Number | Policy/Procedure | Date Posted | Comment Period Closed | Status | Document Links |
|---|---|---|---|---|---|
| 2025-HUMANA-MED-129 | Pemetrexed, 10 mg – HCPCS codes J9292, J9294, J9305, J9322 and J9323 | 8/14/25 | 9/28/25 | Complete | Pemetrexed, 10 mg – HCPCS codes J9292, J9294, J9305, J9322 and J9323 |
| 2025-UHC-MED-251 | Encelto | 8/12/25 | 9/26/25 | Complete | Encelto |
| 2025-UHC-MED-252 | Denosumab-prolia-xgeva | 8/12/25 | 9/26/25 | Complete | Denosumab-prolia-xgeva |
| 2025-UHC-MED-253 | Reblozyl | 8/12/25 | 9/26/25 | Complete | Reblozyl |
| 2025-UHC-MED-254 | Rituxan-rituximab | 8/12/25 | 9/26/25 | Complete | Rituxan-rituximab |
| 2025-HB-MED-544 | Enhertu (fam-trastuzumab deruxtecan-nxki) | 8/12/25 | 9/26/25 | Complete | Enhertu (fam-trastuzumab deruxtecan-nxki) |
| 2025-LHCC-MED-852 | Nipocalimab-aahu (Imaavy) | 8/12/25 | 9/26/25 | Complete | Nipocalimab-aahu (Imaavy) |
| 2025-LHCC-MED-853 | Retifanlimab-dlwr (Zynyz) | 8/12/25 | 9/26/25 | Complete | Retifanlimab-dlwr (Zynyz) |
| 2025-HB-MED-545 | Imaavy (nipocalimab) | 8/12/25 | 9/26/25 | Complete | Imaavy (nipocalimab) |
| 2025-HB-MED-546 | Bevacizumab for Non-Ophthalmologic Indications | 8/12/25 | 9/26/25 | Complete | Bevacizumab for Non-Ophthalmologic Indications |
| 2025-HB-MED-547 | Denosumab | 8/12/25 | 9/26/25 | Complete | Denosumab |
| 2025-HB-MED-550 | Amvuttra (vutrisiran) | 8/12/25 | 9/26/25 | Complete | Amvuttra (vutrisiran) |
| 2025-HB-MED-551 | Vascular Endothelial Growth Factor (VEGF) Inhibitors | 8/12/25 | 9/26/25 | Complete | Vascular Endothelial Growth Factor (VEGF) Inhibitors |
| 2025-LHCC-MED-823 | Datopotamab deruxtecan-dlnk (Datroway) | 8/12/25 | 9/26/25 | Complete | Datopotamab deruxtecan-dlnk (Datroway) |
| 2025-LHCC-MED-845 | Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) | 8/12/25 | 9/26/25 | Complete | Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) |
| 2025-LHCC-MED-846 | Pegunigalsidase alfa-iwxj (Elfabrio) | 8/12/25 | 9/26/25 | Complete | Pegunigalsidase alfa-iwxj (Elfabrio) |
| 2025-LHCC-MED-847 | Denosumab (Xgeva and Biosimilars) | 8/12/25 | 9/26/25 | Complete | Denosumab (Xgeva and Biosimilars) |
| 2025-LHCC-MED-848 | Rituximab (Rituxan), Rituximab-Hyaluronidase (Rituxan Hycela), and Biosimilars | 8/12/25 | 9/26/25 | Complete | Rituximab (Rituxan), Rituximab-Hyaluronidase (Rituxan Hycela), and Biosimilars |
| 2025-LHCC-MED-849 | Letermovir (Prevymis) | 8/12/25 | 9/26/25 | Complete | Letermovir (Prevymis) |
| 2025-LHCC-MED-850 | Desmopressin Acetate (DDAVP) | 8/12/25 | 9/26/25 | Complete | Desmopressin Acetate (DDAVP) |
| 2025-LHCC-MED-851 | Treprostinil (Orenitram, Remodulin, Tyvaso, Yutrepia) | 8/12/25 | 9/26/25 | Complete | Treprostinil (Orenitram, Remodulin, Tyvaso, Yutrepia) |
| 2025-UHC-MED-247 | Testosterone replacement or supplementation therapy | 8/7/25 | 9/21/25 | Complete | Testosterone replacement or supplementation therapy |
| 2025-HUMANA-MED-125 | Prior Authorization List-State Submission | 8/7/25 | 9/21/25 | Complete | Prior Authorization List-State Submission |
| 2025-HUMANA-MED-126 | Collagenase clostridium histolyticum – HCPCS code J0775 (8419) | 8/7/25 | 9/21/25 | Complete | Collagenase clostridium histolyticum – HCPCS code J0775 (8419) |
| 2025-HUMANA-MED-127 | Golimumab, 1 mg – HCPCS code J1602 (8515) | 8/7/25 | 9/21/25 | Complete | Golimumab, 1 mg – HCPCS code J1602 (8515) |
| 2025-HUMANA-MED-128 | esketamine nasal spray – HCPCS code S0013 (8502) | 8/7/25 | 9/21/25 | Complete | esketamine nasal spray – HCPCS code S0013 (8502) |
| 2025-PHARM-119 | Palivizumab Criteria | 8/4/25 | 9/18/25 | Complete | Palivizumab Criteria |
| 2025-PHARM-120 | Palivizumab Request Form | 8/4/25 | 9/18/25 | Complete | Palivizumab Request Form |
| 2025-LHCC-MED-831 | Nivolumab (Opdivo), Nivolumab Hyaluronidase-nvhy (Opdivo Qvantig) | 7/28/25 | 9/11/25 | Complete | Nivolumab (Opdivo), Nivolumab Hyaluronidase-nvhy (Opdivo Qvantig) |
| 2025-LHCC-MED-824 | Avacincaptad pegol (Izervay) | 7/25/25 | 9/8/25 | Complete | Avacincaptad pegol (Izervay) |
| 2025-LHCC-MED-825 | Hyaluronate Derivatives | 7/25/25 | 9/8/25 | Complete | Hyaluronate Derivatives |
| 2025-LHCC-MED-826 | Furosemide (Furoscix) | 7/25/25 | 9/8/25 | Complete | Furosemide (Furoscix) |
| 2025-LHCC-MED-827 | Efgartigimod Alfa-fcab (Vyvgart) | 7/25/25 | 9/8/25 | Complete | Efgartigimod Alfa-fcab (Vyvgart) |
| 2025-LHCC-MED-828 | Iptacopan (Fabhalta) | 7/25/25 | 9/8/25 | Complete | Iptacopan (Fabhalta) |
| 2025-LHCC-MED-829 | Dostarlimab-gxly (Jemperli) | 7/25/25 | 9/8/25 | Complete | Dostarlimab-gxly (Jemperli) |
| 2025-LHCC-MED-830 | Daptomycin (Cubicin, Cubicin RF, Dapzura RT) | 7/25/25 | 9/8/25 | Complete | Daptomycin (Cubicin, Cubicin RF, Dapzura RT) |
| 2025-LHCC-MED-832 | Ciltacabtagene Autoleucel (Carvykti) | 7/25/25 | 9/8/25 | Complete | Ciltacabtagene Autoleucel (Carvykti) |
| 2025-LHCC-MED-833 | Vutrisiran (Amvuttra) | 7/25/25 | 9/8/25 | Complete | Vutrisiran (Amvuttra) |
| 2025-UHC-MED-249 | Kebilidi | 7/24/25 | 9/7/25 | Complete | Kebilidi |
| 2025-UHC-MED-250 | FcRn-blockers | 7/24/25 | 9/7/25 | Complete | FcRn-blockers |
| 2025-LHCC-MED-834 | Omacetaxine (Synribo) | 7/24/25 | 9/7/25 | Complete | Omacetaxine (Synribo) |
| 2025-LHCC-MED-835 | Isatuximab-irfc (Sarclisa) | 7/24/25 | 9/7/25 | Complete | Isatuximab-irfc (Sarclisa) |
| 2025-LHCC-MED-836 | Ramucirumab (Cyramza) | 7/24/25 | 9/7/25 | Complete | Ramucirumab (Cyramza) |
| 2025-LHCC-MED-837 | Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) | 7/24/25 | 9/7/25 | Complete | Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) |
| 2025-LHCC-MED-838 | Inotuzumab Ozogamicin (Besponsa) | 7/24/25 | 9/7/25 | Complete | Inotuzumab Ozogamicin (Besponsa) |
| 2025-LHCC-MED-839 | Nadofaragene Firadenovec-vncg (Adstiladrin) | 7/24/25 | 9/7/25 | Complete | Nadofaragene Firadenovec-vncg (Adstiladrin) |
| 2025-LHCC-MED-840 | Amivantamab-vmjw (Rybrevant) | 7/24/25 | 9/7/25 | Complete | Amivantamab-vmjw (Rybrevant) |
| 2025-LHCC-MED-841 | Tremelimumab-actl (Imjudo) | 7/24/25 | 9/7/25 | Complete | Tremelimumab-actl (Imjudo) |
| 2025-LHCC-MED-842 | Paclitaxel, Protein-Bound (Abraxane) | 7/24/25 | 9/7/25 | Complete | Paclitaxel, Protein-Bound (Abraxane) |
| 2025-LHCC-MED-843 | Fam-Trastuzumab Deruxtecan-nxki (Enhertu) | 7/24/25 | 9/7/25 | Complete | Fam-Trastuzumab Deruxtecan-nxki (Enhertu) |
| 2025-LHCC-MED-844 | Pembrolizumab (Keytruda) | 7/24/25 | 9/7/25 | Complete | Pembrolizumab (Keytruda) |
| 2025-ACLA-MED-106 | Site of care medical-pharmacy | 7/9/25 | 8/23/25 | Complete | Site of care medical-pharmacy |
| 2025-PHARM-118 | Elevidys | 6/27/25 | N/A | Approved | Elevidys Met Imminent Peril Justification |
| 2025-HUMANA-MED-110 | Adstiladrin (nadofaragene firadenovec-vncg) | 6/27/25 | 8/11/25 | Complete | Adstiladrin (nadofaragene firadenovec-vncg) |
| 2025-HUMANA-MED-111 | Alpha-1 Proteinase Inhibitors (Prolastin-C®, Zemaira®) | 6/27/25 | 8/11/25 | Complete | Alpha-1 Proteinase Inhibitors (Prolastin-C®, Zemaira®) |
| 2025-HUMANA-MED-112 | Byooviz™ (ranibizumab-nuna) | 6/27/25 | 8/11/25 | Complete | Byooviz™ (ranibizumab-nuna) |
| 2025-HUMANA-MED-113 | Intravenous Iron Products | 6/27/25 | 8/11/25 | Complete | Intravenous Iron Products |
| 2025-HUMANA-MED-114 | Lucentis® (ranibizumab) | 6/27/25 | 8/11/25 | Complete | Lucentis® (ranibizumab) |
| 2025-HUMANA-MED-115 | Luxturna® (voretigene neparvovec-rzyl) | 6/27/25 | 8/11/25 | Complete | Luxturna® (voretigene neparvovec-rzyl) |
| 2025-HUMANA-MED-116 | Panhematin® (heme for injection) intravenous solution | 6/27/25 | 8/11/25 | Complete | Panhematin® (heme for injection) intravenous solution |
| 2025-HUMANA-MED-117 | Susvimo® (ranibizumab) | 6/27/25 | 8/11/25 | Complete | Susvimo® (ranibizumab) |
| 2025-HUMANA-MED-118 | Tivdak (tisotumab vedotin-tftv) | 6/27/25 | 8/11/25 | Complete | Tivdak (tisotumab vedotin-tftv) |
| 2025-HUMANA-MED-119 | Viscosupplements | 6/27/25 | 8/11/25 | Complete | Viscosupplements |
| 2025-HUMANA-MED-120 | Visudyne® (verteporfin) | 6/27/25 | 8/11/25 | Complete | Visudyne® (verteporfin) |
| 2025-HUMANA-MED-121 | Xgeva® (denosumab) | 6/27/25 | 8/11/25 | Complete | Xgeva® (denosumab) |
| 2025-HUMANA-MED-122 | Aflibercept Products (Eylea®, Eylea® HD, Pavblu™) | 6/27/25 | 8/11/25 | Complete | Aflibercept Products (Eylea®, Eylea® HD, Pavblu™) |
| 2025-HUMANA-MED-123 | Yescarta™ (axicabtagene ciloleucel) | 6/27/25 | 8/11/25 | Complete | Yescarta™ (axicabtagene ciloleucel) |
| 2025-HUMANA-MED-124 | Opdualag (nivolumab and relatlimab-rmbw) | 6/27/25 | 8/11/25 | Complete | Opdualag (nivolumab and relatlimab-rmbw) |
| 2025-LHCC-MED-807 | Pertuzumab (Perjeta) | 6/24/25 | 8/8/25 | Complete | Pertuzumab (Perjeta) |
| 2025-LHCC-MED-808 | Ado-Trastuzumab Emtansine (Kadcyla) | 6/24/25 | 8/8/25 | Complete | Ado-Trastuzumab Emtansine (Kadcyla) |
| 2025-LHCC-MED-809 | Cabazitaxel (Jevtana) | 6/24/25 | 8/8/25 | Complete | Cabazitaxel (Jevtana) |
| 2025-LHCC-MED-810 | Ipilimumab (Yervoy) | 6/24/25 | 8/8/25 | Complete | Ipilimumab (Yervoy) |
| 2025-LHCC-MED-811 | Patisiran (Onpattro) | 6/24/25 | 8/8/25 | Complete | Patisiran (Onpattro) |
| 2025-LHCC-MED-812 | Dexrazoxane (Zinecard, Totect) | 6/24/25 | 8/8/25 | Complete | Dexrazoxane (Zinecard, Totect) |
| 2025-LHCC-MED-813 | Edaravone (Radicava, Radivaca ORS) | 6/24/25 | 8/8/25 | Complete | Edaravone (Radicava, Radivaca ORS) |
| 2025-LHCC-MED-814 | Pozelimab-bbfg (Veopoz) | 6/24/25 | 8/8/25 | Complete | Pozelimab-bbfg (Veopoz) |
| 2025-LHCC-MED-815 | Lisocabtagene Maraleucel (Breyanzi) | 6/24/25 | 8/8/25 | Complete | Lisocabtagene Maraleucel (Breyanzi) |
| 2025-LHCC-MED-816 | Mitoxantrone | 6/24/25 | 8/8/25 | Complete | Mitoxantrone |
| 2025-LHCC-MED-817 | Denileukin Diftitox-cxdl (Lymphir) | 6/24/25 | 8/8/25 | Complete | Denileukin Diftitox-cxdl (Lymphir) |
| 2025-LHCC-MED-818 | Teclistamab-cqyv (Tecvayli) | 6/24/25 | 8/8/25 | Complete | Teclistamab-cqyv (Tecvayli) |
| 2025-LHCC-MED-819 | Mirvetuximab soravatansine-gynx (Elahere) | 6/24/25 | 8/8/25 | Complete | Mirvetuximab soravatansine-gynx (Elahere) |
| 2025-LHCC-MED-821 | Zolbetuximab-clzb (Vyloy) | 6/24/25 | 8/8/25 | Complete | Zolbetuximab-clzb (Vyloy) |
| 2025-LHCC-MED-822 | Zanidatamab-hrii (Ziihera) | 6/24/25 | 8/8/25 | Complete | Zanidatamab-hrii (Ziihera) |
| 2025-HB-MED-538 | Select Clotting Agents for Bleeding Disorders | 6/24/25 | 8/8/25 | Complete | Select Clotting Agents for Bleeding Disorders |
| 2025-UHC-MED-248 | Oncology medication clinical coverage policy | 6/24/25 | 8/8/25 | Complete | Oncology medication clinical coverage policy |
| 2025-ACLA-MED-107 | Myasthenia Gravis Agents | 6/24/25 | 8/8/25 | Complete | Myasthenia Gravis Agents |
| 2025-ACLA-MED-108 | Radicava | 6/24/25 | 8/8/25 | Complete | Radicava |
| 2025-ACLA-MED-109 | Specialty Drugs PA Criteria | 6/24/25 | 8/8/25 | Complete | Specialty Drugs PA Criteria |
| 2025-ACLA-MED-110 | Somatostatin Analogs | 6/24/25 | 8/8/25 | Complete | Somatostatin Analogs |
| 2025-HB-MED-527 | Rx Med PA Algn-SF 857 | 6/11/25 | 7/26/25 | Complete | Rx Med PA Algn-SF 857 |
| 2025-HB-MED-530 | Kanuma (sebelipase alfa) | 6/11/25 | 7/26/25 | Complete | Kanuma (sebelipase alfa) |
| 2025-HB-MED-531 | Scenesse (afamelanotide) | 6/11/25 | 7/26/25 | Complete | Scenesse (afamelanotide) |
| 2025-HB-MED-532 | Izervay (avacincaptad pegol) | 6/11/25 | 7/26/25 | Complete | Izervay (avacincaptad pegol) |
| 2025-HB-MED-533 | Jemperli (dostarlimab-gxly) | 6/11/25 | 7/26/25 | Complete | Jemperli (dostarlimab-gxly) |
| 2025-HB-MED-534 | Erbitux (cetuximab) | 6/11/25 | 7/26/25 | Complete | Erbitux (cetuximab) |
| 2025-HB-MED-535 | Denosumab | 6/11/25 | 7/26/25 | Complete | Denosumab |
| 2025-HB-MED-536 | Ketamine injection (Ketalar) | 6/11/25 | 7/26/25 | Complete | Ketamine injection (Ketalar) |
| 2025-PHARM-116 | Lyfgenia | 6/10/25 | 7/25/25 | Complete | Lyfgenia |
| 2025-PHARM-117 | PDL July 1, 2025 | 6/10/25 | 7/25/25 | Complete | PDL July 1, 2025 |
| 2025-PHARM-74 | Allergy - Nasal Rhinitis Agents | 6/4/25 | 7/19/25 | Complete | Allergy - Nasal Rhinitis Agents |
| 2025-PHARM-75 | Asthma-COPD, Inhaled Glucocorticoids | 6/4/25 | 7/19/25 | Complete | Asthma-COPD, Inhaled Glucocorticoids |
| 2025-PHARM-76 | Diabetes - Hypoglycemics, Incretin Mimetics/Enhancers | 6/4/25 | 7/19/25 | Complete | Diabetes - Hypoglycemics, Incretin Mimetics/Enhancers |
| 2025-PHARM-77 | Digestive Disorders - Bile Acid Salts | 6/4/25 | 7/19/25 | Complete | Digestive Disorders - Bile Acid Salts |
| 2025-PHARM-78 | GI Motility, Chronic | 6/4/25 | 7/19/25 | Complete | GI Motility, Chronic |
| 2025-PHARM-79 | Infectious Disorders - Oxazolidinones | 6/4/25 | 7/19/25 | Complete | Infectious Disorders - Oxazolidinones |
| 2025-PHARM-80 | Louisiana Medicaid ICD-10 Chart | 6/4/25 | 7/19/25 | Complete | Louisiana Medicaid ICD-10 Chart |
| 2025-PHARM-81 | Niktimvo | 6/4/25 | 7/19/25 | Complete | Niktimvo |
| 2025-PHARM-82 | Onapgo | 6/4/25 | 7/19/25 | Complete | Onapgo |
| 2025-PHARM-83 | Pain Management - Antimigraine Agents, CGRP Antagonists | 6/4/25 | 7/19/25 | Complete | Pain Management - Antimigraine Agents, CGRP Antagonists |
| 2025-PHARM-84 | Pain Management - Cytokine/CAM Antagonists | 6/4/25 | 7/19/25 | Complete | Pain Management - Cytokine/CAM Antagonists |
| 2025-PHARM-85 | Pain Management - Neuropathic Pain | 6/4/25 | 7/19/25 | Complete | Pain Management - Neuropathic Pain |
| 2025-PHARM-86 | Pain Management - Skeletal Muscle Relaxants | 6/4/25 | 7/19/25 | Complete | Pain Management - Skeletal Muscle Relaxants |
| 2025-PHARM-87 | POS ADD-ADHD Stimulants and Related Agents | 6/4/25 | 7/19/25 | Complete | POS ADD-ADHD Stimulants and Related Agents |
| 2025-PHARM-88 | POS Allergy - Antihistamines, Minimally Sedating | 6/4/25 | 7/19/25 | Complete | POS Allergy - Antihistamines, Minimally Sedating |
| 2025-PHARM-89 | POS Antipsychotic Agents, Oral/Transdermal | 6/4/25 | 7/19/25 | Complete | POS Antipsychotic Agents, Oral/Transdermal |
| 2025-PHARM-90 | POS Asthma/COPD - Glucocorticoids, Inhalation | 6/4/25 | 7/19/25 | Complete | POS Asthma/COPD - Glucocorticoids, Inhalation |
| 2025-PHARM-91 | POS Asthma/COPD - Immunomodulators | 6/4/25 | 7/19/25 | Complete | POS Asthma/COPD - Immunomodulators |
| 2025-PHARM-92 | POS Asthma/COPD - Leukotriene Modifiers | 6/4/25 | 7/19/25 | Complete | POS Asthma/COPD - Leukotriene Modifiers |
| 2025-PHARM-93 | POS Bkemv | 6/4/25 | 7/19/25 | Complete | POS Bkemv |
| 2025-PHARM-94 | POS Cystic Fibrosis, Oral | 6/4/25 | 7/19/25 | Complete | POS Cystic Fibrosis, Oral |
| 2025-PHARM-95 | POS. Dermatology - Atopic Dermatitis, Immunomodulators | 6/4/25 | 7/19/25 | Complete | POS. Dermatology - Atopic Dermatitis, Immunomodulators |
| 2025-PHARM-96 | POS Digestive Disorders - Bile Acid Salts | 6/4/25 | 7/19/25 | Complete | POS Digestive Disorders - Bile Acid Salts |
| 2025-PHARM-97 | POS GI Motility, Chronic | 6/4/25 | 7/19/25 | Complete | POS GI Motility, Chronic |
| 2025-PHARM-98 | POS Journavx | 6/4/25 | 7/19/25 | Complete | POS Journavx |
| 2025-PHARM-99 | POS Opiate Dependence Agents | 6/4/25 | 7/19/25 | Complete | POS Opiate Dependence Agents |
| 2025-PHARM-100 | POS Pain Management - Neuropathic Pain | 6/4/25 | 7/19/25 | Complete | POS Pain Management - Neuropathic Pain |
| 2025-PHARM-101 | POS Pain Management - Nonsteroidal Anti-Inflammatory Drugs | 6/4/25 | 7/19/25 | Complete | POS Pain Management - Nonsteroidal Anti-Inflammatory Drugs |
| 2025-PHARM-102 | POS Potassium Binders | 6/4/25 | 7/19/25 | Complete | POS Potassium Binders |
| 2025-PHARM-103 | POS Ryclora | 6/4/25 | 7/19/25 | Complete | POS Ryclora |
| 2025-PHARM-104 | POS Spinal Muscular Atrophy | 6/4/25 | 7/19/25 | Complete | POS Spinal Muscular Atrophy |
| 2025-PHARM-105 | POS Tryvio | 6/4/25 | 7/19/25 | Complete | POS Tryvio |
| 2025-PHARM-106 | POS Veozah | 6/4/25 | 7/19/25 | Complete | POS Veozah |
| 2025-PHARM-107 | POS Voydeya | 6/4/25 | 7/19/25 | Complete | POS Voydeya |
| 2025-PHARM-108 | POS Yorvipath | 6/4/25 | 7/19/25 | Complete | POS Yorvipath |
| 2025-PHARM-109 | Potassium Binders | 6/4/25 | 7/19/25 | Complete | Potassium Binders |
| 2025-PHARM-110 | Ryclora | 6/4/25 | 7/19/25 | Complete | Ryclora |
| 2025-PHARM-111 | Tryngolza | 6/4/25 | 7/19/25 | Complete | Tryngolza |
| 2025-PHARM-112 | Tryvio | 6/4/25 | 7/19/25 | Complete | Tryvio |
| 2025-PHARM-113 | Veozah | 6/4/25 | 7/19/25 | Complete | Veozah |
| 2025-PHARM-114 | Voydeya | 6/4/25 | 7/19/25 | Complete | Voydeya |
| 2025-PHARM-115 | Yorvipath | 6/4/25 | 7/19/25 | Complete | Yorvipath |
| 2025-HB-MED-528 | Rx Eylea Biosim Med | 5/23/25 | 7/7/25 | Complete | Rx Eylea Biosim Med |
| 2025-ACLA-MED-98 | Adzynma | 5/23/25 | 7/7/25 | Complete | Adzynma |
| 2025-ACLA-MED-99 | Amtagvi | 5/23/25 | 7/7/25 | Complete | Amtagvi |
| 2025-ACLA-MED-100 | Anti-CD19 CAT-T Immunotherapies | 5/23/25 | 7/7/25 | Complete | Anti-CD19 CAT-T Immunotherapies |
| 2025-ACLA-MED-101 | Blincyto | 5/23/25 | 7/7/25 | Complete | Blincyto |
| 2025-ACLA-MED-102 | Complement Inhibitors | 5/23/25 | 7/7/25 | Complete | Complement Inhibitors |
| 2025-ACLA-MED-103 | Dendritic Cell Tumor Peptide Immunotherapy | 5/23/25 | 7/7/25 | Complete | Dendritic Cell Tumor Peptide Immunotherapy |
| 2025-ACLA-MED-104 | Hydroxyprogesterone | 5/23/25 | 7/7/25 | Complete | Hydroxyprogesterone |
| 2025-ACLA-MED-105 | Kebilidi | 5/23/25 | 7/7/25 | Complete | Kebilidi |
| 2025-UHC-MED-244 | Medical therapies for enzyme deficiencies | 5/22/25 | 7/6/25 | Complete | Medical therapies for enzyme deficiencies |
| 2025-UHC-MED-245 | Maximum dosage and frequency | 5/22/25 | 7/6/25 | Complete | Maximum dosage and frequency |
| 2025-UHC-MED-246 | RNA-targeted therapies (Amvuttra, Onpattro) | 5/22/25 | 7/6/25 | Complete | RNA-targeted therapies (Amvuttra, Onpattro) |
| 2025-LHCC-MED-802 | Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo) | 5/22/25 | 7/6/25 | Complete | Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo) |
| 2025-LHCC-MED-803 | Brentuximab Vedotin (Adcetris) | 5/22/25 | 7/6/25 | Complete | Brentuximab Vedotin (Adcetris) |
| 2025-LHCC-MED-804 | Durvalumab (Imfinzi) | 5/22/25 | 7/6/25 | Complete | Durvalumab (Imfinzi) |
| 2025-LHCC-MED-805 | Eculizumab (Soliris) | 5/22/25 | 7/6/25 | Complete | Eculizumab (Soliris) |
| 2025-LHCC-MED-806 | Aflibercept (Eylea) | 5/22/25 | 7/6/25 | Complete | Aflibercept (Eylea) |
| 2025-LHCC-MED-790 | Eteclacalcetide (Parsabiv) | 5/21/25 | 7/5/25 | Complete | Eteclacalcetide (Parsabiv) |
| 2025-LHCC-MED-791 | Chloramphenicol Sodium Succinate | 5/21/25 | 7/5/25 | Complete | Chloramphenicol Sodium Succinate |
| 2025-LHCC-MED-792 | Olipudase Alfa-rpcp (Xenpozyme) | 5/21/25 | 7/5/25 | Complete | Olipudase Alfa-rpcp (Xenpozyme) |
| 2025-LHCC-MED-793 | Idecabtagene Vicleucel (Abecma) | 5/21/25 | 7/5/25 | Complete | Idecabtagene Vicleucel (Abecma) |
| 2025-LHCC-MED-794 | Collagenase Clostridium Histolyticum (Xiaflex) | 5/21/25 | 7/5/25 | Complete | Collagenase Clostridium Histolyticum (Xiaflex) |
| 2025-LHCC-MED-795 | Paricalcitol Injection (Zemplar) | 5/21/25 | 7/5/25 | Complete | Paricalcitol Injection (Zemplar) |
| 2025-LHCC-MED-796 | Lifileucel (Amtagvi) | 5/21/25 | 7/5/25 | Complete | Lifileucel (Amtagvi) |
| 2025-LHCC-MED-797 | Ferric Carboxymaltose (Injectafer) | 5/21/25 | 7/5/25 | Complete | Ferric Carboxymaltose (Injectafer) |
| 2025-LHCC-MED-798 | Toripalimab-tpzi (Loqtorzi) | 5/21/25 | 7/5/25 | Complete | Toripalimab-tpzi (Loqtorzi) |
| 2025-LHCC-MED-799 | Ferumoxytol (Feraheme) | 5/21/25 | 7/5/25 | Complete | Ferumoxytol (Feraheme) |
| 2025-LHCC-MED-800 | Siltuximab (Sylvant) | 5/21/25 | 7/5/25 | Complete | Siltuximab (Sylvant) |
| 2025-LHCC-MED-801 | Panitumumab (Vectibix) | 5/21/25 | 7/5/25 | Complete | Panitumumab (Vectibix) |
| 2025-HB-MED-523 | Unloxcyt (cosibelimab-ipdl) | 5/21/25 | 7/5/25 | Complete | Unloxcyt (cosibelimab-ipdl) |
| 2025-HB-MED-524 | Datroway (datopotamab deruxtecan-dlnk) | 5/21/25 | 7/5/25 | Complete | Datroway (datopotamab deruxtecan-dlnk) |
| 2025-HB-MED-525 | Grafapex (treosulfan) | 5/21/25 | 7/5/25 | Complete | Grafapex (treosulfan) |
| 2025-HB-MED-526 | Opdivo Qvantig (nivolumab hyaluronidase-nvhy) | 5/21/25 | 7/5/25 | Complete | Opdivo Qvantig (nivolumab hyaluronidase-nvhy) |
| 2025-HB-MED-488 | Alyglo, Simlandi, Winrevair | 4/21/25 | 6/5/25 | Complete | Alyglo, Simlandi, Winrevair |
| 2025-HB-MED-521 | Givlaari | 4/17/25 | 6/1/25 | Complete | Givlaari |
| 2025-HB-MED-522 | Anktiva, Hercessi, Imdelltra | 4/17/25 | 6/1/25 | Complete | Anktiva, Hercessi, Imdelltra |
| 2025-UHC-MED-243 | Oncology Medication Clinical Coverage | 4/17/25 | 6/1/25 | Complete | Oncology Medication Clinical Coverage |
| 2025-UHC-MED-239 | Qalsody | 4/14/25 | 5/29/25 | Complete | Qalsody |
| 2025-UHC-MED-240 | Reblozyl | 4/14/25 | 5/29/25 | Complete | Reblozyl |
| 2025-UHC-MED-241 | Veopoz | 4/14/25 | 5/29/25 | Complete | Veopoz |
| 2025-LHCC-MED-777 | Cipaglucosidase alfa-atga--miglustat (Pombiliti-Opfolda) | 4/2/25 | 5/17/25 | Complete | Cipaglucosidase alfa-atga--miglustat (Pombiliti-Opfolda) |
| 2025-LHCC-MED-778 | Letermovir (Prevymis) | 4/2/25 | 5/17/25 | Complete | Letermovir (Prevymis) |
| 2025-LHCC-MED-779 | Cosyntropin (Cortrosyn) | 4/2/25 | 5/17/25 | Complete | Cosyntropin (Cortrosyn) |
| 2025-LHCC-MED-780 | Alglucosidase Alfa (Lumizyme) | 4/2/25 | 5/17/25 | Complete | Alglucosidase Alfa (Lumizyme) |
| 2025-LHCC-MED-781 | Triamcinolone ER Injection (Zilretta) | 4/2/25 | 5/17/25 | Complete | Triamcinolone ER Injection (Zilretta) |
| 2025-LHCC-MED-782 | Verteporfin (Visudyne) | 4/2/25 | 5/17/25 | Complete | Verteporfin (Visudyne) |
| 2025-LHCC-MED-783 | Trabectedin (Yondelis) | 4/2/25 | 5/17/25 | Complete | Trabectedin (Yondelis) |
| 2025-LHCC-MED-784 | Epoprostenol (Flolan, Veletri) | 4/2/25 | 5/17/25 | Complete | Epoprostenol (Flolan, Veletri) |
| 2025-LHCC-MED-785 | Tarlatamab-dlle (Imdelltra) | 4/2/25 | 5/17/25 | Complete | Tarlatamab-dlle (Imdelltra) |
| 2025-LHCC-MED-786 | Imetelstat (Rytelo) | 4/2/25 | 5/17/25 | Complete | Imetelstat (Rytelo) |
| 2025-LHCC-MED-787 | Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia, Mycapssa) | 4/2/25 | 5/17/25 | Complete | Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia, Mycapssa) |
| 2025-LHCC-MED-788 | Tislelizumab-jsgr (Tevimbra) | 4/2/25 | 5/17/25 | Complete | Tislelizumab-jsgr (Tevimbra) |
| 2025-LHCC-MED-789 | Immunization Coverage | 4/2/25 | 5/17/25 | Complete | Immunization Coverage |
| 2025-LHCC-MED-771 | Elotuzumab (Empliciti) | 4/2/25 | 5/17/25 | Complete | Elotuzumab (Empliciti) |
| 2025-LHCC-MED-772 | Ramucirumab (Cyramza) | 4/2/25 | 5/17/25 | Complete | Ramucirumab (Cyramza) |
| 2025-LHCC-MED-773 | Avelumab (Bavencio) | 4/2/25 | 5/17/25 | Complete | Avelumab (Bavencio) |
| 2025-LHCC-MED-774 | Bortezomib (Velcade) | 4/2/25 | 5/17/25 | Complete | Bortezomib (Velcade) |
| 2025-LHCC-MED-775 | Tisagenlecleucel (Kymriah) | 4/2/25 | 5/17/25 | Complete | Tisagenlecleucel (Kymriah) |
| 2025-LHCC-MED-776 | Axicabtagene ciloleucel (Yescarta) | 4/2/25 | 5/17/25 | Complete | Axicabtagene ciloleucel (Yescarta) |
| 2025-LHCC-MED-760 | Bezlotoxumab (Zinplava) | 4/2/25 | 5/17/25 | Complete | Bezlotoxumab (Zinplava) |
| 2025-LHCC-MED-761 | Allogenic Processed Thymus Tissue-agdc (Rethymic) | 4/2/25 | 5/17/25 | Complete | Allogenic Processed Thymus Tissue-agdc (Rethymic) |
| 2025-LHCC-MED-762 | Enfortumab Vedotin-ejfv (Padcev) | 4/2/25 | 5/17/25 | Complete | Enfortumab Vedotin-ejfv (Padcev) |
| 2025-LHCC-MED-763 | Protein C Concentrate, Human (Ceprotin) | 4/2/25 | 5/17/25 | Complete | Protein C Concentrate, Human (Ceprotin) |
| 2025-LHCC-MED-764 | Ibandronate Injection (Boniva) | 4/2/25 | 5/17/25 | Complete | Ibandronate Injection (Boniva) |
| 2025-LHCC-MED-765 | Voretigene Neparvovec-rzyl (Luxturna) | 4/2/25 | 5/17/25 | Complete | Voretigene Neparvovec-rzyl (Luxturna) |
| 2025-LHCC-MED-766 | Emapalumab-lzsg (Gamifant) | 4/2/25 | 5/17/25 | Complete | Emapalumab-lzsg (Gamifant) |
| 2025-LHCC-MED-767 | Teprotumumab (Tepezza) | 4/2/25 | 5/17/25 | Complete | Teprotumumab (Tepezza) |
| 2025-LHCC-MED-768 | Treprostinil (Remodulin) | 4/2/25 | 5/17/25 | Complete | Treprostinil (Remodulin) |
| 2025-LHCC-MED-769 | Sodium thiosulfate (Pedmark) | 4/2/25 | 5/17/25 | Complete | Sodium thiosulfate (Pedmark) |
| 2025-LHCC-MED-770 | Erwinia Asparaginase (Erwinaze, Rylaze) | 4/2/25 | 5/17/25 | Complete | Erwinia Asparaginase (Erwinaze, Rylaze) |
| 2025-LHCC-MED-756 | Obecabtagene autoleucel (Aucatzyl) | 4/2/25 | 5/17/25 | Complete | Obecabtagene autoleucel (Aucatzyl) |
| 2025-LHCC-MED-757 | Cosibelimab-Ipdl (Unloxcyt) | 4/2/25 | 5/17/25 | Complete | Cosibelimab-Ipdl (Unloxcyt) |
| 2025-LHCC-MED-758 | Zenocutuzumab-zbco (Bizengri) | 4/2/25 | 5/17/25 | Complete | Zenocutuzumab-zbco (Bizengri) |
| 2025-LHCC-MED-759 | Eladocagene Exuparvovec-tneq (Kebilidi) | 4/2/25 | 5/17/25 | Complete | Eladocagene Exuparvovec-tneq (Kebilidi) |
| 2025-LHCC-MED-731 | Agalsidase Beta (Fabrazyme) | 3/26/25 | 5/10/25 | Complete | Agalsidase Beta (Fabrazyme) |
| 2025-LHCC-MED-732 | Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) | 3/26/25 | 5/10/25 | Complete | Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) |
| 2025-LHCC-MED-733 | Iobenguane I-131 (Azedra) | 3/26/25 | 5/10/25 | Complete | Iobenguane I-131 (Azedra) |
| 2025-LHCC-MED-734 | Pertuzumab/Trastuzumab/Hyaluronidase-zzxf (Phesgo) | 3/26/25 | 5/10/25 | Complete | Pertuzumab/Trastuzumab/Hyaluronidase-zzxf (Phesgo) |
| 2025-LHCC-MED-735 | Interferon Gamma-1b (Actimmune) | 3/26/25 | 5/10/25 | Complete | Interferon Gamma-1b (Actimmune) |
| 2025-LHCC-MED-736 | Sirolimus Protein-Bound Particles (Fyarro) | 3/26/25 | 5/10/25 | Complete | Sirolimus Protein-Bound Particles (Fyarro) |
| 2025-LHCC-MED-737 | Thyrotropin Alfa (Thyrogen) | 3/26/25 | 5/10/25 | Complete | Thyrotropin Alfa (Thyrogen) |
| 2025-LHCC-MED-738 | Zilucoplan (Zilbrysq) | 3/26/25 | 5/10/25 | Complete | Zilucoplan (Zilbrysq) |
| 2025-LHCC-MED-739 | Parathyroid Hormone (Natpara) | 3/26/25 | 5/10/25 | Complete | Parathyroid Hormone (Natpara) |
| 2025-LHCC-MED-740 | Hemin (Panhematin) | 3/26/25 | 5/10/25 | Complete | Hemin (Panhematin) |
| 2025-LHCC-MED-741 | Mosunetuzumab-axgb (Lunsumio) | 3/26/25 | 5/10/25 | Complete | Mosunetuzumab-axgb (Lunsumio) |
| 2025-LHCC-MED-742 | Naxitamab-gqgk (Danyelza) | 3/26/25 | 5/10/25 | Complete | Naxitamab-gqgk (Danyelza) |
| 2025-LHCC-MED-730 | Afamitresgene autoleucel (Tecelra) | 3/26/25 | 5/10/25 | Complete | Afamitresgene autoleucel (Tecelra) |
| 2025-LHCC-MED-743 | Rituximab (Rituxan), Rituximab-arrx (Riabni), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), Rituximab-Hyaluronidase (Rituxan Hycela) | 3/26/25 | 5/10/25 | Complete | Rituximab (Rituxan), Rituximab-arrx (Riabni), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), Rituximab-Hyaluronidase (Rituxan Hycela) |
| 2025-LHCC-MED-744 | Blinatumomab (Blincyto) | 3/26/25 | 5/10/25 | Complete | Blinatumomab (Blincyto) |
| 2025-LHCC-MED-745 | Sacituzumab Govitecan-hziy (Trodelvy) | 3/26/25 | 5/10/25 | Complete | Sacituzumab Govitecan-hziy (Trodelvy) |
| 2025-LHCC-MED-746 | Margetuximab-cmkb (Margenza) | 3/26/25 | 5/10/25 | Complete | Margetuximab-cmkb (Margenza) |
| 2025-LHCC-MED-747 | Talimogene laherepvec (Imlygic) | 3/26/25 | 5/10/25 | Complete | Talimogene laherepvec (Imlygic) |
| 2025-LHCC-MED-748 | Ropeginterferon Alfa-2b-njft (Besremi) | 3/26/25 | 5/10/25 | Complete | Ropeginterferon Alfa-2b-njft (Besremi) |
| 2025-LHCC-MED-749 | Inotersen (Tegsedi) | 3/25/25 | 5/9/25 | Complete | Inotersen (Tegsedi) |
| 2025-LHCC-MED-750 | Faricimab-svoa (Vabysmo) | 3/25/25 | 5/9/25 | Complete | Faricimab-svoa (Vabysmo) |
| 2025-LHCC-MED-751 | Plerixafor (Mozobil) | 3/25/25 | 5/9/25 | Complete | Plerixafor (Mozobil) |
| 2025-LHCC-MED-752 | Ravulizumab-cwvz (Ultomiris) | 3/25/25 | 5/9/25 | Complete | Ravulizumab-cwvz (Ultomiris) |
| 2025-LHCC-MED-753 | Avalglucosidase Alfa-ngpt (Nexviazyme) | 3/25/25 | 5/9/25 | Complete | Avalglucosidase Alfa-ngpt (Nexviazyme) |
| 2025-LHCC-MED-754 | Afamelanotide (Scenesse) | 3/25/25 | 5/9/25 | Complete | Afamelanotide (Scenesse) |
| 2025-LHCC-MED-755 | Brolucizumab-dbll (Beovu) | 3/25/25 | 5/9/25 | Complete | Brolucizumab-dbll (Beovu) |
| 2025-HB-MED-506 | Jemperli | 3/25/25 | 5/9/25 | Complete | Jemperli |
| 2025-HB-MED-507 | Kyprolis | 3/25/25 | 5/9/25 | Complete | Kyprolis |
| 2025-HB-MED-508 | Loqtorzi | 3/25/25 | 5/9/25 | Complete | Loqtorzi |
| 2025-HB-MED-509 | Rybrevant | 3/25/25 | 5/9/25 | Complete | Rybrevant |
| 2025-HB-MED-510 | Abecma | 3/25/25 | 5/9/25 | Complete | Abecma |
| 2025-HB-MED-511 | Akynzeo for injection | 3/25/25 | 5/9/25 | Complete | Akynzeo for injection |
| 2025-HB-MED-512 | Alpha-1 Proteinase inhibitor | 3/25/25 | 5/9/25 | Complete | Alpha-1 Proteinase inhibitor |
| 2025-HB-MED-513 | Amtagvi | 3/25/25 | 5/9/25 | Complete | Amtagvi |
| 2025-HB-MED-514 | Aucatzyl | 3/25/25 | 5/9/25 | Complete | Aucatzyl |
| 2025-HB-MED-515 | Bendamustine | 3/25/25 | 5/9/25 | Complete | Bendamustine |
| 2025-HB-MED-516 | Imfinzi | 3/25/25 | 5/9/25 | Complete | Imfinzi |
| 2025-HB-MED-518 | Octreotide Agents | 3/25/25 | 5/9/25 | Complete | Octreotide Agents |
| 2025-HB-MED-519 | Strensiq | 3/25/25 | 5/9/25 | Complete | Strensiq |
| 2025-HB-MED-505 | Piasky | 3/25/25 | 5/9/25 | Complete | Piasky |
| 2025-UHC-MED-236 | Edaravone | 3/25/25 | 5/9/25 | Complete | Edaravone |
| 2025-UHC-MED-237 | Enjaymo | 3/25/25 | 5/9/25 | Complete | Enjaymo |
| 2025-PHARM-72 | Louisiana Medicaid ICD-10 Chart May1 | 3/14/25 | 4/28/25 | Complete | Louisiana Medicaid ICD-10 Chart May1 |
| 2025-PHARM-73 | POS Oncology - Oral Prostate | 3/14/25 | 4/28/25 | Complete | POS Oncology - Oral Prostate |
| 2025-PHARM-65 | POS Androgenic Agents | 3/12/25 | 4/26/25 | Complete | POS Androgenic Agents |
| 2025-PHARM-66 | POS Estrogenic Agents and Combos | 3/12/25 | 4/26/25 | Complete | POS Estrogenic Agents and Combos |
| 2025-PHARM-67 | POS Progestational Agents | 3/12/25 | 4/26/25 | Complete | POS Progestational Agents |
| 2025-PHARM-68 | POS Progestational Agents, Other | 3/12/25 | 4/26/25 | Complete | POS Progestational Agents, Other |
| 2025-PHARM-69 | POS Prostate - BPH Treatment | 3/12/25 | 4/26/25 | Complete | POS Prostate - BPH Treatment |
| 2025-PHARM-70 | POS Spironolactone | 3/12/25 | 4/26/25 | Complete | POS Spironolactone |
| 2025-PHARM-71 | POS Testosterone, Oral/Injectable | 3/12/25 | 4/26/25 | Complete | POS Testosterone, Oral/Injectable |
| 2025-PHARM-33 | Alyftrek | 3/10/25 | 4/24/25 | Complete | Alyftrek |
| 2025-PHARM-34 | Attruby | 3/10/25 | 4/24/25 | Complete | Attruby |
| 2025-PHARM-35 | Crenessity | 3/10/25 | 4/24/25 | Complete | Crenessity |
| 2025-PHARM-36 | Davimet | 3/10/25 | 4/24/25 | Complete | Davimet |
| 2025-PHARM-37 | Depression-Antidepressants, Other | 3/10/25 | 4/24/25 | Complete | Depression-Antidepressants, Other |
| 2025-PHARM-38 | Lidotral | 3/10/25 | 4/24/25 | Complete | Lidotral |
| 2025-PHARM-39 | Louisiana Medicaid ICD-10 Chart | 3/10/25 | 4/24/25 | Complete | Louisiana Medicaid ICD-10 Chart |
| 2025-PHARM-40 | Multitam | 3/10/25 | 4/24/25 | Complete | Multitam |
| 2025-PHARM-41 | Oxervate | 3/10/25 | 4/24/25 | Complete | Oxervate |
| 2025-PHARM-42 | Pain Management - Cytokine/CAM Antagonists | 3/10/25 | 4/24/25 | Complete | Pain Management - Cytokine/CAM Antagonists |
| 2025-PHARM-43 | POS ADD-ADHD Stimulants and Related Agents | 3/10/25 | 4/24/25 | Complete | POS ADD-ADHD Stimulants and Related Agents |
| 2025-PHARM-44 | POS Alhemo | 3/10/25 | 4/24/25 | Complete | POS Alhemo |
| 2025-PHARM-45 | POS Allergy - Rhinitis Agents, Nasal | 3/10/25 | 4/24/25 | Complete | POS Allergy - Rhinitis Agents, Nasal |
| 2025-PHARM-46 | POS Antipsychotic Agents, Oral/Transdermal | 3/10/25 | 4/24/25 | Complete | POS Antipsychotic Agents, Oral/Transdermal |
| 2025-PHARM-47 | POS Asthma/COPD Bronchodilator, Beta Adrenergic Agents | 3/10/25 | 4/24/25 | Complete | POS Asthma/COPD Bronchodilator, Beta Adrenergic Agents |
| 2025-PHARM-48 | POS Attruby | 3/10/25 | 4/24/25 | Complete | POS Attruby |
| 2025-PHARM-49 | POS Butalbital-Containing Agents | 3/10/25 | 4/24/25 | Complete | POS Butalbital-Containing Agents |
| 2025-PHARM-50 | POS Davimet | 3/10/25 | 4/24/25 | Complete | POS Davimet |
| 2025-PHARM-51 | POS Dermatology - Antipsoriatics, Topical | 3/10/25 | 4/24/25 | Complete | POS Dermatology - Antipsoriatics, Topical |
| 2025-PHARM-52 | POS Diabetes - Glucagon Agents | 3/10/25 | 4/24/25 | Complete | POS Diabetes - Glucagon Agents |
| 2025-PHARM-53 | POS Diabetes - Hypoglycemics, SGLT2 Inhibitors | 3/10/25 | 4/24/25 | Complete | POS Diabetes - Hypoglycemics, SGLT2 Inhibitors |
| 2025-PHARM-54 | POS Hympavzi | 3/10/25 | 4/24/25 | Complete | POS Hympavzi |
| 2025-PHARM-55 | POS Inhaler Spacers | 3/10/25 | 4/24/25 | Complete | POS Inhaler Spacers |
| 2025-PHARM-56 | POS Lidocaine/Prilocaine | 3/10/25 | 4/24/25 | Complete | POS Lidocaine/Prilocaine |
| 2025-PHARM-57 | POS Multitam | 3/10/25 | 4/24/25 | Complete | POS Multitam |
| 2025-PHARM-58 | POS Ryvent | 3/10/25 | 4/24/25 | Complete | POS Ryvent |
| 2025-PHARM-59 | POS Smoking Cessation Products | 3/10/25 | 4/24/25 | Complete | POS Smoking Cessation Products |
| 2025-PHARM-60 | POS Sofdra | 3/10/25 | 4/24/25 | Complete | POS Sofdra |
| 2025-PHARM-61 | POS Urology - Incontinence Bladder Relaxant Preparations | 3/10/25 | 4/24/25 | Complete | POS Urology - Incontinence Bladder Relaxant Preparations |
| 2025-PHARM-62 | Sofdra | 3/10/25 | 4/24/25 | Complete | Sofdra |
| 2025-PHARM-63 | Vyalev | 3/10/25 | 4/24/25 | Complete | Vyalev |
| 2025-PHARM-64 | Yesintek | 3/10/25 | 4/24/25 | Complete | Yesintek |
| 2025-UHC-MED-233 | Maximum dosage and frequency | 2/24/25 | 4/10/25 | Complete | Maximum dosage and frequency |
| 2025-UHC-MED-234 | Denosumab-Prolia-Xgeva | 2/24/25 | 4/10/25 | Complete | Denosumab-Prolia-Xgeva |
| 2025-UHC-MED-235 | Somatostatin analogs | 2/24/25 | 4/10/25 | Complete | Somatostatin analogs |
| 2025-ACLA-MED-96 | Enzyme replacement therapy for ASMD (Xenpozyme) | 2/24/25 | 4/10/25 | Complete | Enzyme replacement therapy for ASMD (Xenpozyme) |
| 2025-ACLA-MED-97 | Pompe Disease agents | 2/24/25 | 4/10/25 | Complete | Pompe Disease agents |
| 2025-HB-MED-401 | Q423 Med PA Notice | 2/21/25 | 4/7/25 | Complete | Q423 Med PA Notice |
| 2025-HB-MED-503 | Drug and Biologic | 2/19/25 | 4/5/25 | Complete | Drug and Biologic |
| 2025-LHCC-MED-717 | Talquetamab-tgvs (Talvey) | 2/12/25 | 3/29/25 | Complete | Talquetamab-tgvs (Talvey) |
| 2025-LHCC-MED-718 | Off-Label Use | 2/12/25 | 3/29/25 | Complete | Off-Label Use |
| 2025-LHCC-MED-719 | Cemiplimab-rwlc (Libtayo) | 2/12/25 | 3/29/25 | Complete | Cemiplimab-rwlc (Libtayo) |
| 2025-LHCC-MED-720 | Carfilzomib (Kyprolis) | 2/12/25 | 3/29/25 | Complete | Carfilzomib (Kyprolis) |
| 2025-LHCC-MED-721 | Cetuximab (Erbitux) | 2/12/25 | 3/29/25 | Complete | Cetuximab (Erbitux) |
| 2025-LHCC-MED-722 | Brexucabtagene Autoleucel (Tecartus) | 2/12/25 | 3/29/25 | Complete | Brexucabtagene Autoleucel (Tecartus) |
| 2025-LHCC-MED-723 | Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase | 2/12/25 | 3/29/25 | Complete | Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase |
| 2025-LHCC-MED-724 | Azacitidine (Vidaza) | 2/12/25 | 3/29/25 | Complete | Azacitidine (Vidaza) |
| 2025-LHCC-MED-725 | Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta) | 2/12/25 | 3/29/25 | Complete | Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta) |
| 2025-LHCC-MED-726 | Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) | 2/12/25 | 3/29/25 | Complete | Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) |
| 2025-LHCC-MED-727 | Eplontersen (Wainua) | 2/12/25 | 3/29/25 | Complete | Eplontersen (Wainua) |
| 2025-LHCC-MED-728 | Atezolizumab (Tecentriq) | 2/12/25 | 3/29/25 | Complete | Atezolizumab (Tecentriq) |
| 2025-LHCC-MED-729 | Rozanolixizumab-noli (Rystiggo) | 2/12/25 | 3/29/25 | Complete | Rozanolixizumab-noli (Rystiggo) |
| 2025-LHCC-MED-710 | ADAMTS13, recombinant-krhn (Adzynma) | 2/10/25 | 3/27/25 | Complete | ADAMTS13, recombinant-krhn (Adzynma) |
| 2025-LHCC-MED-711 | Pemetrexed (Alimta, Pemfexy) | 2/10/25 | 3/27/25 | Complete | Pemetrexed (Alimta, Pemfexy) |
| 2025-LHCC-MED-712 | Melphalan (Hepzato) | 2/10/25 | 3/27/25 | Complete | Melphalan (Hepzato) |
| 2025-LHCC-MED-713 | Elranatamab-bcmm (Elrexfio) | 2/10/25 | 3/27/25 | Complete | Elranatamab-bcmm (Elrexfio) |
| 2025-LHCC-MED-714 | Vadadustat (Vafseo) | 2/10/25 | 3/27/25 | Complete | Vadadustat (Vafseo) |
| 2025-LHCC-MED-715 | Nivolumab (Opdivo) | 2/10/25 | 3/27/25 | Complete | Nivolumab (Opdivo) |
| 2025-LHCC-MED-716 | Efgartigimod Alfa-fcab (Vyvgart) | 2/10/25 | 3/27/25 | Complete | Efgartigimod Alfa-fcab (Vyvgart) |
| 2025-LHCC-MED-704 | Asfotase Alfa (Strensiq) | 1/30/25 | 3/16/25 | Complete | Asfotase Alfa (Strensiq) |
| 2025-LHCC-MED-705 | Moxetumomab pasudotox-tdfk (Lumoxiti) | 1/30/25 | 3/16/25 | Complete | Moxetumomab pasudotox-tdfk (Lumoxiti) |
| 2025-LHCC-MED-706 | No Coverage Criteria | 1/30/25 | 3/16/25 | Complete | No Coverage Criteria |
| 2025-LHCC-MED-707 | Antithrombin III (ATryn, Thrombate III) | 1/30/25 | 3/16/25 | Complete | Antithrombin III (ATryn, Thrombate III) |
| 2025-LHCC-MED-708 | DaxibotulinumtoxinA-lanm (Daxxify) | 1/30/25 | 3/16/25 | Complete | DaxibotulinumtoxinA-lanm (Daxxify) |
| 2025-LHCC-MED-709 | Motixafortide (Aphexda) | 1/30/25 | 3/16/25 | Complete | Motixafortide (Aphexda) |
| 2025-HB-MED-494 | Brineura (cerliponase alfa) | 1/29/25 | 3/15/25 | Complete | Brineura (cerliponase alfa) |
| 2025-HB-MED-495 | Veopoz (pozelimab-bbfg) | 1/29/25 | 3/15/25 | Complete | Veopoz (pozelimab-bbfg) |
| 2025-HB-MED-496 | Vascular Endothelial Growth Factor (VEGF) Inhibitors | 1/29/25 | 3/15/25 | Complete | Vascular Endothelial Growth Factor (VEGF) Inhibitors |
| 2025-HB-MED-497 | Erbitux (cetuximab) | 1/29/25 | 3/15/25 | Complete | Erbitux (cetuximab) |
| 2025-HB-MED-498 | Rybrevant (amivantamab-ymjw) | 1/29/25 | 3/15/25 | Complete | Rybrevant (amivantamab-ymjw) |
| 2025-HB-MED-499 | Imfinzi (durvalumab) | 1/29/25 | 3/15/25 | Complete | Imfinzi (durvalumab) |
| 2025-LHCC-MED-695 | Obinutuzumab (Gazyva) | 1/24/25 | 3/10/25 | Complete | Obinutuzumab (Gazyva) |
| 2025-LHCC-MED-696 | Belinostat (Beleodaq) | 1/24/25 | 3/10/25 | Complete | Belinostat (Beleodaq) |
| 2025-LHCC-MED-697 | Pralatrexate (Folotyn) | 1/24/25 | 3/10/25 | Complete | Pralatrexate (Folotyn) |
| 2025-LHCC-MED-698 | Romidepsin (Istodax) | 1/24/25 | 3/10/25 | Complete | Romidepsin (Istodax) |
| 2025-LHCC-MED-699 | Panitumumab (Vectibix) | 1/24/25 | 3/10/25 | Complete | Panitumumab (Vectibix) |
| 2025-LHCC-MED-700 | Temsirolimus (Torisel) | 1/24/25 | 3/10/25 | Complete | Temsirolimus (Torisel) |
| 2025-LHCC-MED-701 | Pegaspargase (Oncaspar), Calaspargase Pegol-mknl | 1/24/25 | 3/10/25 | Complete | Pegaspargase (Oncaspar), Calaspargase Pegol-mknl |
| 2025-LHCC-MED-702 | Gemtuzumab Ozogamicin (Mylotarg) | 1/24/25 | 3/10/25 | Complete | Gemtuzumab Ozogamicin (Mylotarg) |
| 2025-LHCC-MED-703 | Antithymocyte Globulin (Atgam, Thymoglobulin) | 1/24/25 | 3/10/25 | Complete | Antithymocyte Globulin (Atgam, Thymoglobulin) |
| 2024-LHCC-MED-683 | Degarelix Acetate (Firmagon) | 1/9/25 | 2/23/25 | Complete | Degarelix Acetate (Firmagon) |
| 2024-LHCC-MED-684 | Belatacept (Nulojix) | 1/9/25 | 2/23/25 | Complete | Belatacept (Nulojix) |
| 2024-LHCC-MED-685 | Immunization coverage | 1/9/25 | 2/23/25 | Complete | Immunization coverage |
| 2024-LHCC-MED-686 | Eribulin Mesylate (Halaven) | 1/9/25 | 2/23/25 | Complete | Eribulin Mesylate (Halaven) |
| 2024-LHCC-MED-687 | Necitumumab (Portrazza) | 1/9/25 | 2/23/25 | Complete | Necitumumab (Portrazza) |
| 2024-LHCC-MED-688 | Ziv-aflibercept (Zaltrap) | 1/9/25 | 2/23/25 | Complete | Ziv-aflibercept (Zaltrap) |
| 2024-LHCC-MED-689 | Daunorubicin/Cytarabine (Vyxeos) | 1/9/25 | 2/23/25 | Complete | Daunorubicin/Cytarabine (Vyxeos) |
| 2024-LHCC-MED-690 | Leucovorin Injection | 1/9/25 | 2/23/25 | Complete | Leucovorin Injection |
| 2024-LHCC-MED-691 | Pegunigalsidase alfa-iwxj (Elfabrio) | 1/9/25 | 2/23/25 | Complete | Pegunigalsidase alfa-iwxj (Elfabrio) |
| 2024-LHCC-MED-692 | Plasminogen, Human-tvmh (Ryplazim) | 1/9/25 | 2/23/25 | Complete | Plasminogen, Human-tvmh (Ryplazim) |
| 2024-LHCC-MED-693 | Tofersen (Qalsody) | 1/9/25 | 2/23/25 | Complete | Tofersen (Qalsody) |
| 2024-LHCC-MED-694 | Velmanase Alfa-tycv (Lamzede) | 1/9/25 | 2/23/25 | Complete | Velmanase Alfa-tycv (Lamzede) |
| 2024-LHCC-MED-678 | Pasireotide (Signifor, Signifor LAR) | 1/9/25 | 2/23/25 | Complete | Pasireotide (Signifor, Signifor LAR) |
| 2024-LHCC-MED-679 | Copanlisib (Aliqopa) | 1/9/25 | 2/23/25 | Complete | Copanlisib (Aliqopa) |
| 2024-LHCC-MED-680 | Pegvisomant (Somavert) | 1/9/25 | 2/23/25 | Complete | Pegvisomant (Somavert) |
| 2024-LHCC-MED-681 | Lanreotide (Somatuline Depot) | 1/9/25 | 2/23/25 | Complete | Lanreotide (Somatuline Depot) |
| 2024-LHCC-MED-682 | Pegcetacoplan (Empaveli, Syfovre) | 1/9/25 | 2/23/25 | Complete | Pegcetacoplan (Empaveli, Syfovre) |
| 2025-UHC-MED-228 | Oncology medication clinical coverage | 1/8/25 | 2/22/25 | Complete | Oncology medication clinical coverage |
| 2025-UHC-MED-229 | Provider administered drugs site of care | 1/8/25 | 2/22/25 | Complete | Provider administered drugs site of care |
| 2025-UHC-MED-230 | Botulinum toxins a and b | 1/8/25 | 2/22/25 | Complete | Botulinum toxins a and b |
| 2025-UHC-MED-231 | Iron replacement therapy | 1/8/25 | 2/22/25 | Complete | Iron replacement therapy |
| 2025-UHC-MED-232 | Tepezza | 1/8/25 | 2/22/25 | Complete | Tepezza |
| 2025-HB-MED-490 | Tecelra | 1/8/25 | 2/22/25 | Complete | Tecelra |
| 2025-HB-MED-491 | Niktimvo | 1/8/25 | 2/22/25 | Complete | Niktimvo |
| 2025-HB-MED-493 | Lymphir | 1/8/25 | 2/22/25 | Complete | Lymphir |
| 2025-LHCC-MED-632 | Sotatercept (Winrevair) | 1/8/25 | 2/22/25 | Complete | Sotatercept (Winrevair) |
| 2025-PHARM-1 | Aqneursa | 1/8/25 | 2/22/25 | Complete | Aqneursa |
| 2025-PHARM-2 | Asthma, Immunomodulators | 1/8/25 | 2/22/25 | Complete | Asthma, Immunomodulators |
| 2025-PHARM-3 | Colony Stimulating Factors | 1/8/25 | 2/22/25 | Complete | Colony Stimulating Factors |
| 2025-PHARM-4 | Dermatology - Atopic Dermatitis, Immunomodulators | 1/8/25 | 2/22/25 | Complete | Dermatology - Atopic Dermatitis, Immunomodulators |
| 2025-PHARM-5 | Duvyzat | 1/8/25 | 2/22/25 | Complete | Duvyzat |
| 2025-PHARM-6 | Ebglyss | 1/8/25 | 2/22/25 | Complete | Ebglyss |
| 2025-PHARM-7 | Lodoco | 1/8/25 | 2/22/25 | Complete | Lodoco |
| 2025-PHARM-8 | Louisiana Medicaid ICD-10 Chart | 1/8/25 | 2/22/25 | Complete | Louisiana Medicaid ICD-10 Chart |
| 2025-PHARM-9 | Max Dose Override Buprenorphine | 1/8/25 | 2/22/25 | Complete | Max Dose Override Buprenorphine |
| 2025-PHARM-10 | Miplyffa | 1/8/25 | 2/22/25 | Complete | Miplyffa |
| 2025-PHARM-11 | Narcotics Quantity Limit and MME Override | 1/8/25 | 2/22/25 | Complete | Narcotics Quantity Limit and MME Override |
| 2025-PHARM-12 | Nemluvio | 1/8/25 | 2/22/25 | Complete | Nemluvio |
| 2025-PHARM-13 | Ocrevus Zunovo | 1/8/25 | 2/22/25 | Complete | Ocrevus Zunovo |
| 2025-PHARM-14 | Pain Management, Cytokine and CAM Antagonists | 1/8/25 | 2/22/25 | Complete | Pain Management, Cytokine and CAM Antagonists |
| 2025-PHARM-15 | Pain Management, LA Narcotic Analgesics | 1/8/25 | 2/22/25 | Complete | Pain Management, LA Narcotic Analgesics |
| 2025-PHARM-16 | Pain Management, SA Narcotic Analgesics | 1/8/25 | 2/22/25 | Complete | Pain Management, SA Narcotic Analgesics |
| 2025-PHARM-17 | POS ADD-ADHD Stimulants and Related Agents | 1/8/25 | 2/22/25 | Complete | POS ADD-ADHD Stimulants and Related Agents |
| 2025-PHARM-18 | POS Anticonvulsants | 1/8/25 | 2/22/25 | Complete | POS Anticonvulsants |
| 2025-PHARM-19 | POS Asthma - COPD, Glucocorticoids Inhalation | 1/8/25 | 2/22/25 | Complete | POS Asthma - COPD, Glucocorticoids Inhalation |
| 2025-PHARM-20 | POS Cobenfy | 1/8/25 | 2/22/25 | Complete | POS Cobenfy |
| 2025-PHARM-21 | POS Dermatology - Antibiotics, Topical | 1/8/25 | 2/22/25 | Complete | POS Dermatology - Antibiotics, Topical |
| 2025-PHARM-22 | POS Dermatology - Atopic Dermatitis, Immunomodulators | 1/8/25 | 2/22/25 | Complete | POS Dermatology - Atopic Dermatitis, Immunomodulators |
| 2025-PHARM-23 | POS Diabetes - Hypoglycemics, Incretin Mimetics/Enhancers | 1/8/25 | 2/22/25 | Complete | POS Diabetes - Hypoglycemics, Incretin Mimetics/Enhancers |
| 2025-PHARM-24 | POS Diabetes - Hypoglycemics, Insulins and Related Agents | 1/8/25 | 2/22/25 | Complete | POS Diabetes - Hypoglycemics, Insulins and Related Agents |
| 2025-PHARM-25 | POS Erzofri | 1/8/25 | 2/22/25 | Complete | POS Erzofri |
| 2025-PHARM-26 | POS GI Motility Chronic | 1/8/25 | 2/22/25 | Complete | POS GI Motility Chronic |
| 2025-PHARM-27 | POS Lodoco | 1/8/25 | 2/22/25 | Complete | POS Lodoco |
| 2025-PHARM-28 | POS Neffy | 1/8/25 | 2/22/25 | Complete | POS Neffy |
| 2025-PHARM-29 | POS Ophthalmic Disorders, Anti-Inflammatory Immunomodulators | 1/8/25 | 2/22/25 | Complete | POS Ophthalmic Disorders, Anti-Inflammatory Immunomodulators |
| 2025-PHARM-30 | POS Opiate Dependence Agents | 1/8/25 | 2/22/25 | Complete | POS Opiate Dependence Agents |
| 2025-PHARM-31 | POS Pain Management - Antimigraine Agents, CGRP Antagonists | 1/8/25 | 2/22/25 | Complete | POS Pain Management - Antimigraine Agents, CGRP Antagonists |
| 2025-PHARM-32 | Vyondys | 1/8/25 | 2/22/25 | Complete | Vyondys |
Medicaid Managed Care Policies & Procedures Archive - Pharmacy (2025)
"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:
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