April 2024 Pharmacy Policy Updates
Explore April 2024 pharmacy policy updates for MVP Medicare Advantage and Medicaid plans. Review changes to drug coverage, new policies, and updated guidelines for specialty and Part B medications.
EFFECTIVE December 1, 2023
|
Pharmaceutical Policy Name |
Status |
|---|---|
|
Entyvio |
Reviewed |
|
Risankizumab (Skyrizi) |
Updated |
|
Ustekinumab (Stelara) |
Updated |
|
Proton Pump Inhibitor Therapy |
Updated |
|
Hemophilia Factor |
Reviewed |
|
Colony Stimulating Factor |
Updated |
|
Erythropoiesus Stimulating Agents |
Reviewed |
|
Hereditary Angioedema |
Reviewed |
|
Gaucher Disease Type 1 Treatment |
Reviewed |
|
Select Chelating Agents |
Updated |
|
Enteral Therapy VT |
Reviewed |
|
Irritable Bowel Syndrome |
Updated |
|
Biosimilars, Select Medical |
Reviewed |
|
Intestinal Antibiotics |
Reviewed |
|
Mulpleta/Doptelet |
Reviewed |
|
Dojolvi |
Reviewed |
|
Ozanimod (Zeposia) |
Reviewed |
|
Etancercept (Enbrel) |
Reviewed |
|
Tofacitinib (Xeljanz) |
Reviewed |
|
Guzelkumab (Tremfya) |
Reviewed |
|
Tepezza |
Updated |
|
Adakveo |
Updated |
|
Upadacitinib (Rinvoq) |
Updated |
|
Secukinumab (Cosentyx) |
Updated |
|
Adalimumab (Humira) |
Updated |
|
Apremilast (Otezla) |
Updated |
|
Soliris |
New |
|
Ultomiris |
New |
|
Pharmacy Program Management |
Updated |
EFFECTIVE January 1, 2024
|
Pharmaceutical Policy Name |
Status |
|---|---|
|
Multiple Sclerosis Agents |
Updated |
|
GABA Receptor Modulators |
Updated |
|
Duchenne Muscular Dystrophy |
Reviewed |
|
Duchenne Muscular Dystrophy Medicaid |
Reviewed |
|
Movement Disorder |
Updated |
|
Botulinum Toxin Treatment |
Reviewed |
|
Radicava |
Reviewed |
|
Respiratory Syncytial Virus/Synagis (palivizumab) |
Updated |
|
Spravato |
Reviewed |
|
Gabapentin ER |
Reviewed |
|
Nuedexta |
Reviewed |
|
Agents for female sexual dysfunction |
Updated |
|
Adalimumab |
Updated |
|
Monoclonal Antibodies for Alzheimer's Disease (formerly Aduhelm) |
Updated |
|
CAR-T Cell Therapy |
Updated |
|
Daybue |
New |
|
GLP-1 Receptor Agonist Retrospective |
Archived |
|
Select Oral Antipsychotics |
Updated |
|
MVP Medicare Part D Drug Management |
Updated |
|
Oral Allergen Immunotherapy Medications |
Updated |
|
Palforzia |
Reviewed |
|
Pharmacy Programs Administration Internal |
Updated |
|
Prostate Cancer |
Reviewed |
|
Spinal Muscular Atrophy |
Reviewed |
|
Zoladex-Medicaid |
Reviewed |
|
Herceptin (trastuzumab)- Medicaid |
Reviewed |
|
Perjeta (pertuzumab)- Medicaid |
Reviewed |
|
Avastin (bevacizumab)- Medicaid |
Reviewed |
|
Cancer Guidance Program Oncology Medication Coverage and Review |
New |
|
Densoumab (Prolia and Xgeva) |
New |
|
Dose Rounding for Systemic therapy |
New |
|
Entyvio (vedolizumab) Medicare Part B |
Updated |
|
Infliximab Medicare Part B |
Updated |
|
Drug Utilization Review & Monitoring Program |
Updated |
|
Zinplava Medicare Part B |
Updated |
|
Zynteglo Medicare Part B |
Updated |
|
Syfovre |
Updated |
|
Syfovre Medicare Part B |
Updated |
|
Immunoglobulin Therapy Medicare Part B |
Updated |
|
Medicare Part B vs. Part D Determination |
Updated |
|
Medicare Part B Drug Therapy |
Updated |
|
Eylea |
Archived |
|
Skysona Medicare Part B |
Updated |
|
Botulinum Toxin Treatment |
Archived |
|
Botulinum Toxin Treatment Part B |
Archived |
|
Weight Loss Medications |
New |
EFFECTIVE February 1, 2024
|
Pharmaceutical Policy Name |
Status |
|---|---|
|
Entyvio (vedolizumab) |
Updated |
|
Infliximab |
Updated |
|
Certolizumab (Cimzia) |
Updated |
|
Adalimumab (Humira) |
Updated |
|
Risankizumab (Skyrizi) |
Updated |
|
Ustekinumab (Stelara) |
Updated |
|
Antibiotic/Antiviral (oral) Prophylaxis |
Reviewed |
|
Zinplava |
Updated |
|
Government Programs OTC Drug Coverage |
Reviewed |
|
Compounded (Extemporaneous) Medications |
Updated |
|
Skysona |
Updated |
|
D-SNP Over-the-Counter (OTC) and Prescription Drug Coverage |
New |
|
Secukinumab |
Updated |
|
Secukinumab Part B |
New Policy |
|
Omidubicel |
New Policy |
|
Omidubicel Part B |
New Policy |
|
Donislecel |
New Policy |
|
Donislecel Part B |
New Policy |
|
Pulmonary Hypertension (Advanced Agents) Part B |
Archived |
|
Hemophilia Gene Therapy Part B |
New Policy |
|
Vascular Endothelial Growth Factor (VEGF) Inhibitor |
Updated |
|
Vascular Endothelial Growth Factor (VEGF) Inhibitor Part B |
Updated |
|
Syfovre |
Updated |
|
Syfovre Part B |
Updated |
EFFECTIVE April 1, 2024
|
Pharmaceutical Policy Name |
Status |
|---|---|
|
Ganaxolone |
No changes |
|
Teplizumab-mzwv |
No changes |
|
Teplizumab-mzwv Part B |
No changes |
|
Tocilizumab |
Updated |
|
Tocilizumab Part B |
Updated |
|
Golimumab |
Updated |
|
Golimumab Part B |
Updated |
|
Abatacept |
Updated |
|
Abatacept Part B |
Updated |
|
Mail Order |
No changes |
|
Prescribers Treating Self or Family Members |
No changes |
|
Physician Prescription Eligibility |
No changes |
|
Transgender Hormone Therapy (COMM/EXCH/CHP) |
No changes |
|
Transgender Hormone Therapy (Medicaid/HARP) |
No changes |
|
Phenylketonuria Agents |
No changes |
|
Acthar |
No changes |
|
Certolizumab |
Updated |
|
Certolizumab Part B |
Updated |
|
Etanercept |
Updated |
|
Growth Hormone |
No changes |
|
Infertility Drug Therapy (Commercial/Marketplace) |
Updated |
|
Jynarque |
Updated |
|
Male Hypogonadism |
Updated |
|
Metformin ER |
Updated |
|
Vascular Endothelial Growth Factor (VEGF) Inhibitor Effective November 1, 2023 |
New |
|
Zynteglo Effective October 27, 2023 |
Updated |
|
Hemophilia Gene Therapy Effective October 1, 2023 |
New |
Policy Updates
Review other articles in this issue regarding formulary, pharmacy policy, and medical policy updates.