Pharmacy Clinical Guidelines
The following criteria have changes going into effect on June 1, 2026:
- Aqvesme
- Bortezomib products
- Cholbam
- Cosentyx
- Ebglyss
- Empliciti
- Erivedge
- Fesilty
- Global Step Therapy Exemption Florida Mandate
- Imfinzi
- Infliximab-Remicade and Biosimilars
- Jascayd
- Lanreotide Injection-Somatuline Depot
- Lunsumio
- Nemluvio
- Neulasta and Pegfilgrastim Biosimilars
- Ninlaro
- Palynziq
- Palsonify
- Penpulimab
- Prolia and Biosimilars
- Qelbree (retiring)
- Sarclisa
- Signifor LAR
- Somavert
- Sotyktu
- Talvey
- Tecvayli
- Xgeva and Biosimilars
- Yartemlea
- Zycubo
The following criteria have completed the annual review process. No clinical changes.
- Alhemo
- Aphexda
- Cabenuva
- Carglumic acid-Carbaglu
- Dojolvi
- Egrifta
- Factor IX
- Factor IX Complex
- Factor VIII
- FEIBA
- Female Condoms Limit, Post PA
- Fuzeon
- Fyarro
- Global Formulary Exception Illinois Mandate
- Global Formulary Exception Virginia Mandate
- Krystexxa
- Male Condoms Limit, Post PA
- Nitisinone products
- NovoSeven RT
- Nulibry
- Obizur
- Odomzo
- Opdualag
- Plerixafor-Mozobil
- Qfitlia
- Sevenfact
- Unloxcyt
- Vivitrol
- Vonvendi
- Wilate
- Xenpozyme
- Zoledronic acid-Zometa
- Zulresso
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)
The following criteria have changes going into effect on August 3, 2026:
The following criteria have changes going into effect on September 1, 2026:
- Avastin and bevacizumab biosimilars
- Braftovi
- Cinacalcet-Sensipar
- Coagadex
- Corifact
- Cotellic
- Darzalex
- Darzalex Faspro
- Deferasirox-Exjade-Jadenu
- Evenity
- Evkeeza
- Fibryga
- Hemlibra
- Hympavzi
- Imlygic
- Juxtapid
- Kyprolis
- Lenalidomide-Revlimid
- Libtayo
- Mektovi
- Mekinist
- Octreotide products
- Oxlumo
- Parsabiv
- Pomalyst
- RiaSTAP
- Rinvoq
- Rivfloza
- Ryplazim
- Serostim
- Stimate
- Tafinlar
- Teriparatide-Forteo-Bonsity
- Thalomid
- Tolvaptan-Jynarque
- Tretten
- Tryngolza
- Tymlos
- Zelboraf
- Zoledronic acid-Reclast
- Zynyz
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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