Pharmacy Clinical Guidelines
The following criteria have changes going into effect on April 1, 2026:
- Actimmune (interferon gamma-1b)
- Alhemo
- Avmapki Fakzynja Co-Pack (avutometinib and defactinib)
- Cimzia (certolizumab pegol)
- Continuity of Care (AZ, CT)
- Continuity of Care (CO, IL, MS, TN, VT, WY)
- Daliresp (roflumilast)
- Elahere (mirvetuximab soravtansine-gynx)
- Emflaza, Jaythari (deflazacort)
- Enbrel (etanercept)
- Exdensur
- Herceptin and Trastuzumab Biosimilars
- Herceptin Hylecta (trastuzumab and hyaluronidase-oysk)
- Humira and Adalimumab Biosimilars
- Itvisma
- Kadcyla (ado-trastuzumab emtansine)
- Lotronex - Alosetron
- Nail Antifungal Topical (Jublia - Kerydin)
- Nuplazid (pimavanserin)
- Nutritional Supplements - Infant Formulas
- Nutritional Supplements - Malabsorption Products
- Nutritional Supplements - Renal Dysfunction Products
- Nutritional Supplements - Tube Feeding Products
- Osteoporosis - Exceptions Criteria
- Oxervate (cenegermin-bkbj)
- Padcev (enfortumab vedotin-ejfv)
- Relistor (methylnaltrexone bromide)
- Remicade and Infliximab Biosimilars
- Rituxan and Rituximab Biosimilars (RA and Other Conditions)
- Rybrevant Faspro
- States Global Step Therapy Mississippi Mandate
- Stelara and Ustekinumab Biosimilars
- Sucraid - Sacrosidase
- Tretinoins (Topical)
- Uplizna (inebilizumab-cdon)
- Veklury (remdesivir)
The following criteria have changes going into effect on May 1, 2026:
- Akeega (niraparid and abiraterone acetate)
- Arzerra (ofatumumab)
- Besponsa (inotuzumab ozogamicin)
- Blincyto (blinatumomab)
- Cometriq (cabozantinib)
- Elrexfio (elranatamab-bcmm)
- Firdapse (mifampridine)
- Gazyva (obinutuzumab)
- Imbruvica (ibrutinib)
- Imfinzi (durvalumab)
- Imjudo (tremelimumab-actl)
- Lenvima (lenvatinib)
- Leukine (sargramostim)
- Lorbrena (lorlatinib)
- Lunsumio (mosunetuzumab-axgb)
- Lynparza (olaparib)
- Neulasta and Pegfilgrastim Biosimilars
- Neupogen and Filgrastim Biosimilars
- Nplate (romiplostim)
- Promacta - Alvaiz (eltrombobag olamin/choline)
- Pyrukynd (mitapivat)
- Reblozyl (luspatercept-ammt)
- Revuforj (revumenib)
- Rolvedon (eflapegrastim-xnst)
- Ryzneuta (efbemalenograstim alfa-vuxw)
- Stivarga (regorafenib)
- Strontium Chloride Sr-89 (Metastron)
- Talvey (talquetamab-tgvs)
- Talzenna (talazoparib)
- Tecvayli (teclistamab-cqyv)
- Voranigo (vorasidenib)
- Xeloda (capecitabine)
- Zytiga (abiraterone)
The following criteria have changes going into effect on June 1, 2026:
The following criteria have changes going into effect on July 1, 2026:
- Apokyn, Kynmobi (apomorphine hydrochloride)
- Aranesp (darbepoetin alfa)
- Crysvita - Burosumab-twza
- Duopa (carbidopa/levodopa enteral suspension)
- Empaveli (pegcetacoplan)
- Enhertu (fam-trastuzumab deruxtecan-nxki)
- Epogen - Procrit - Retacrit
- Fabhalta (iptacopan)
- Filspari (sparsentan tablets)
- Givlaari (givosiran)
- Inbrija (levodopa)
- Jemperli (dostarlimab-gxly)
- Jesduvroq (daprodustat)
- Leqselvi (deuruxolitinib)
- Litfulo (ritlecitinib)
- Mircera (methoxy polyethylene glycol-epoetin beta)
- Olumiant (baricitinib)
- Onapgo (apomorphine hydrochloride)
- Rinvoq (upadacitinib)
- Strensiq (asfotase alfa)
- Vafseo (vadadustat)
- Vanrafia (atrasentan)
- Vyalev (foscarbidopa/foslevodopa)
- Xeljanz-Xeljanz XR (tofacitinib)
- Yorvipath (palopegteriparatide)
- Zejula (niraparib)
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Pharmacy Clinical Guidelines
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Exceptions
Select the starting letter of the medication or condition to find the desired form.
View Oscar's Custom Exceptions Criteria for Autoimmune Conditions