Pharmacy Clinical Guidelines
The following criteria have changes going into effect on July 1, 2026:
- Actemra and Tocilizumab Biosimilars
- Apokyn, Kynmobi (apomorphine hydrochloride)
- Aranesp (darbepoetin alfa)
- Arcalyst (rilonacept)
- Besremi (ropeginterferon alfa-2b-njft)
- Bimzelx (bimekizum ab-bkzx)
- Cosentyx (secukinumab)
- Crenessity (crinecerfont)
- Crysvita - Burosumab-twza
- Dacogen (decitabine)
- Duopa (carbidopa/levodopa enteral suspension)
- Empaveli (pegcetacoplan)
- Enbrel (etanercept)
- Enhertu (fam-trastuzumab deruxtecan-nxki)
- Epkinly (epcoritamab- bysp)
- Epogen - Procrit - Retacrit
- Fabhalta (iptacopan)
- Filspari (sparsentan tablets)
- Givlaari (givosiran)
- Humira and Adalimumab Biosimilars
- Idhifa (enasidenib)
- Ilumya (tildrakizumab-asmn)
- Imfinzi (durvalumab)
- Inbrija (levodopa)
- Jakafi (ruxolitinib)
- Jemperli (dostarlimab-gxly)
- Jesduvroq (daprodustat)
- Juxtapid (lomitapide)
- Kalydeco (ivacaftor)
- Kevzara (sarilumab)
- Kineret (anakinra)
- Leqselvi (deuruxolitinib)
- Leuprolide Acetate Injection
- Litfulo (ritlecitinib)
- Lupron Depot-PED (leuprolide acetate for depot suspension)
- Mekinist (trametinib)
- Mircera (methoxy polyethylene glycol-epoetin beta)
- Ojjaara (momelotinib)
- Olumiant (baricitinib)
- Onapgo (apomorphine hydrochloride)
- Onureg (azacitidine)
- Orkambi (lumacaftor/ivacaftor)
- Poteligeo (mogamulizumab-kpkc)
- Remicade and Infliximab Biosimilars
- Rinvoq (upadacitinib)
- Rytelo (imetelstat)
- Siliq (brodalumab)
- Sotyktu (deucravacitinib)
- Strensiq (asfotase alfa)
- Supprelin LA (histrelin acetate)
- Sylvant (siltuximab)
- Symdeko (tezacaftor-ivacaftor)
- Synarel (nafarelin acetate) (Supplemental Specialty PA)
- Tafinlar (dabrafenib)
- Taltz (ixekizumab)
- Temodar (temozolomide)
- Triptodur (triptorelin)
- Vafseo (vadadustat)
- Vanflyta (quizartinib)
- Vanrafia (atrasentan)
- Vidaza (azacitidine)
- Vonjo (pacritinib)
- Voxzogo (vosoritide)
- Vyalev (foscarbidopa/foslevodopa)
- Xeljanz-Xeljanz XR (tofacitinib)
- Yorvipath (palopegteriparatide)
- Zejula (niraparib)
- Zolinza (vorinostat)
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
- 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
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View Oscar's Custom Exceptions Criteria for Autoimmune Conditions