Pharmacy Clinical Guidelines
The following criteria have changes going into effect on August 3, 2026:
- Cosentyx (secukinumab)
- Enhertu (fam-trastuzumab deruxtecan-nxki)
- Icotyde (icotrokinra)
- Imfinzi (durvalumab)
- Inqovi (decitabine and cedazuridine)
- Kresladi (marnetegragene autotemcel)
- Lynavoy (linerixibat)
- Neulasta and Pegfilgrastim Biosimilars
- Otarmeni (lunsotogene parvec-cwha)
- Reblozyl (luspatercept-ammt)
- States Fertility Preservation Exceptions - Georgia
- Vfend (voriconazole)
The following criteria have changes going into effect on September 1, 2026:
- Avastin and bevacizumab biosimilars
- Braftovi (encorafenib)
- Coagadex (coagulation Factor X)
- Corifact (coagulation Factor XIII concentrate)
- Cotellic (cobimetinib)
- Darzalex (daratumumab)
- Darzalex Faspro (daratumumab and hyaluronidase-fihj)
- Evenity (romosozumab-aqqg)
- Evkeeza (evinacumab-dgnb)
- Fibryga (fibrinogen)
- Forteo (teriparatide)
- Hemlibra (emicizumab-kxwh)
- Hympavzi (marstacimab-hncq)
- IIlygic (talimogene laherparepvec)
- Juxtapid (lomitapide)
- Jynarque (tolvaptan)
- Kyprolis (carfilzomib)
- Revlimid (lenalidomide)
- Libtayo (cemiplimab-rwlc)
- Mektovi (binimetinib)
- Mekinist (trametinib)
- Octreotide Products - Sandostatin
- Oxlumo (lumasiran)
- Parsabiv (etelcalcetide)
- Pomalyst (pomalidomide)
- RiaSTAP (fibrinogen concentrate)
- Rinvoq (upadacitinib)
- Rivfloza (nedosiran)
- Ryplazim (plasminogen, human-tvmh)
- Sensipar (cinacalcet)
- Serostim (somatropin)
- Stimate (desmopressin acetate nasal spray)
- Tafinlar (dabrafenib)
- Thalomid (thalidomide)
- Tretten (coagulation Factor XIII A-Subunit)
- Tryngolza (olezarsen)
- Tymlos (abaloparatide)
- Zelboraf (vemurafenib)
- Reclast (zoledronic acid)
- Zynyz (retifanlimab-dlwr)
The following criteria have changes going into effect on October 1, 2026:
- Aldurazyme (laronidase)
- Alyftrek (vanzacaftor/tezacaftor/deutivacaftor)
- Arikayce (amikacin liposome inhalation suspension)
- Bizengri (zenocutuzumab-zbco)
- Cerdelga (eliglustat)
- Cerezyme (imiglucerase)
- Cyramza (ramucirumab)
- Cystadane (betaine anhydrous)
- Cystagon (cysteamine bitartrate)
- Cystaran - Cystadrops (cysteamine ophthalmic solution)
- Datroway (datopotamab deruxtecan-dlnk)
- Daurismo (glasdegib)
- Elaprase (idursulfase)
- Elelyso (taliglucerase alfa)
- Esbriet (pirfenidone)
- Faslodex (fulvestrant)
- Gazyva (obinutuzumab)
- Halaven (eribulin mesylate)
- Hetlioz capsules - Hetlioz LQ oral suspension (tasimelteon)
- Ibrance (palbociclib)
- Imjudo (tremelimumab-actl)
- Increlex (mecasermin)
- Inluriyo (imlunestrant)
- Itovebi (inavolisib)
- Ixempra (ixabepilone)
- Keveyis - Ormalvi (dichlorphenamide)
- Keytruda (pembrolizumab)
- Keytruda Qlex (pembrolizumab and berahyaluronidase alfa-pmph)
- Kisqali (ribociclib)
- Kisqali Femara Co-Pack (ribociclib/letrozole tablets)
- Komzifti (ziftomenib)
- Korlym (mifepristone)
- Kuvan - Javygtor (sapropterin dihydrochloride)
- Lupkynis (voclosporin)
- Lynparza (olaparib)
- Mepsevii (vestronidase alfa-vjbk)
- Naglazyme (galsulfase)
- Nerlynx (neratinib)
- Ofev (nintedanib)
- Opdivo (nivolumab)
- Opdivo Qvantig (nivolumab and hyaluronidase-nvhy)
- Orserdu (elacestrant)
- Otezla/Otezla XR (apremilast/apremilast extended release)
- Perjeta (pertuzumab)
- Phesgo (pertuzumab, trastuzumab and hyaluronidase-zzxf)
- Piqray (alpelisib)
- Pombiliti (cipaglucosidase alfa-atga)
- Procysbi (cysteamine bitartrate delayed-release)
- Pulmozyme (dornase alfa)
- Reblozyl (luspatercept-ammt)
- Saphnelo (anifrolumab-fnia)
- Talzenna (talazoparib)
- Targretin (bexarotene)
- Tavneos (avacopan)
- Tecentriq (atezolizumab)
- Tecentriq Hybreza (atezollizumab and hyaluronidase-tqjs)
- Tibsovo (ivosidenib)
- Trikafta (elexacaftor-tezacaftor-ivacaftor)
- Trodelvy (sacituzumab govitecan-hziy)
- Truqap (capivasertib)
- Tukysa (tucatinib)
- Tykerb (lapatinib)
- Valchlor (mechlorethamine gel)
- Venclexta (venetoclax)
- Verzenio (abemaciclib)
- Vijoice (alpelisib)
- Vimizim (elosulfase alfa)
- Visudyne (verteporfin injection)
- VPRIV (velaglucerase alfa)
- Vykat XR (diazoxide choline)
- Xospata (gilteritinib)
- Yervoy (ipilimumab)
- Zavesca (miglustat)
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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