US Family Health Plans Medical Injectable Drug Policies


A

MMDP064 Actemra IV
MMDP043 Abraxane
MMDP033 Adakveo
MMDP102 Adcetris
MMDP029 Ajovy (provider-administered)
MMDP050 Alymsys
MMDP103 Amondys 45
MMDP076 Aralast
MMDP050 Avastin

B

MMDP065 Belrapzo
MMDP065 Bendeka
MMDP012 Benlysta IV (provider-administered)
MMDP017 Beovu
MMDP077 Berinert
MMDP015 Bivigam
MMDP104 Blincyto
MMDP024 Botox
MMDP017 Byooviz

C

MMDP066 Cabenuva
MMDP015 Carimune
MMDP099 Carvykti
MMDP078 Cerezyme
MMDP017 Cimerli
MMDP002 Cimzia Lyophilized Powder (provider-administered)
MMDP088 Coagadex
MMDP098 Cosentyx IV
MMDP079 Crysvita
MMDP015 Cuvitru
MMDP067 Cyramza

D

MMDP105 Danyelza
MMDP045 Darzalex
MMDP068 Darzalex Faspro
MMDP024 Daxxify
MMDP001 Durolane
MMDP003 Dysport

E

MMDP046 Eligard
MMDP106 Elevidys
MMDP002 Entyvio
MMDP001 Euflexxa
MMDP080 Evkeeza
MMDP030 Evenity
MMDP013 Eylea, Eylea HD

F

MMDP091 FACTOR VIII Products: Advate, Afstyla Kogenate FS, Kovaltry, Novoeight, Nuwiq, Recombinate, Xyntha, Adynovate, Altuviio, Eloctate, Jivi, Esperoct, Hemofil M, Alphanate,Humate-P, Koate
MMDP092 FACTOR IX Products: Alphanine SD, Alprolix, Benefix, Idelvion, Ixinity, Rebinyn, Rixubis
MMDP004 Fasenra
MMDP015 Flebogamma
MMDP018 Fulphila
MMDP018 Fylnetra

G

MMDP015 Gammagard liquid
MMDP015 Gammagard S/D
MMDP015 Gammaked
MMDP015 Gammaplex
MMDP015 Gammunex-c
MMDP001 Gel-one
MMDP001 Gelsyn 3
MMDP001 Genvisc 850
MMDP076 Glassia

H

MMDP107 Haegarda
MMDP051 Herceptin
MMDP051 Herzuma
MMDP015 Hizentra
MMDP025 H.P. Acthar Gel
MMDP001 Hyalgan
MMDP001 Hymovis
MMDP015 Hyqvia

I

MMDP002 Ilumya
MMDP047 Imfinzi
MMDP002 Inflectra
MMDP002 Ixifi

J

K

MMDP048 Kadcyla
MMDP051 Kanjinti
MMDP052 Keytruda
MMDP108 Krystexxa
MMDP049 Kyprolis

L

MMDP016 Lemtrada
MMDP017 Lucentis
MMDP081 Lumizyme
MMDP072 Lupron Depot 3.75mg and Lupron Depot-3 Month 11.25mg
MMDP073 Lupron Depot 1-Month 7.5 mg, 3-Month 22.5 mg, 4-Month 30 mg, and 6-Month 45 mg
MMDP074 Lupron Depot-PED
MMDP023 Luxturna
MMDP100 Lyfgenia

M

MMDP001 Monovisc
MMDP024 Myobloc
MMDP050 Mvasi

N

MMDP018 Neulasta
MMDP109 Nexviazyme
MMDP027 Nplate
MMDP004 Nucala (provider-administered)

O

MMDP093 Obizur
MMDP019 Ocrevus
MMDP015 Octagam
MMDP069 Octreotide Acetate Injectable Products: Sandostatin, Sandostatin LAR Depot, Bynfezia Pen, generic octreotide acetate
MMDP051 Ogivri
MMDP082 Onpattro
MMDP051 Ontruzant
MMDP053 Opdivo
MMDP111 Opfolda
MMDP002 Orencia IV
MMDP001 Orthovisc
MMDP110 Oxlumo

P

MMDP015 Panglobulin NF
MMDP015 Panzyga
MMDP044 Pemetrexed products: Alimta, generic pemetrexed, and pemetrexed ditromethamine
MMDP054 Perjeta
MMDP112 Pombiliti
MMDP015 Privigen
MMDP094 Profilnine
MMDP076 Prolastin-C
MMDP055 Prolia
MMDP070 Provenge

R

MMDP083 Radicava
MMDP120 Reblozyl
MMDP002 Remicade
MMDP056 Remodulin generic treprostinil injection
MMDP002 Renflexis
MMDP057 Riabni (For Rheumatoid Arthritis and Other Conditions)
MMDP058 Riabni (For Oncologic and Hematologic Conditions)
MMDP058 Rituxan (For Oncologic and Hematologic Conditions)
MMDP057 Rituxan (For Rheumatoid Arthritis and Other Conditions)
MMDP114 Roctavian
MMDP057 Ruxience (For Rheumatoid Arthritis and Other Conditions)
MMDP058 Ruxience (For Oncologic and Hematologic Conditions)
MMDP113 Ryplazim

S

MMDP095 Sevenfact
MMDP002 Simponi Aria
PHARM061 Site Of Care Policy
MMDP097 Skyrizi IV
MMDP059 Somutaline Depot
MMDP002 Stelara IV
MMDP018 Stimufend
MMDP001 Supartz
MMDP028 Supprelin LA
MMDP008 Spinraza
MMDP001 SynoJoynt
MMDP001 Synvisc

T

MMDP115 Takhzyro
MMDP060 Tecentriq
MMDP061 Tepezza
MMDP051 Trazimera
MMDP065 Treanda
MMDP002 Tremfya
MMDP090 Tretten
MMDP001 Triluron
MMDP028 Triptodur
MMDP001 Trivisc
MMDP071 Trodelvy
MMDP087 Trogarzo
MMDP057 Truxima (For Rheumatoid Arthritis and Other Conditions)
MMDP057 Truxima (For Oncologic and Hematologic Conditions)
MMDP022 Tysabri

U

MMDP018 Udenyca

V

MMDP050 Vegzelma
MMDP062 Velcade
MMDP116 Veopoz
MMDP117 Viltepso
MMDP001 Visco 3
MMDP089 Vonvendi
MMDP118 Vyjuvek
MMDP034 Vyondys 53

W

MMDP096 Wilate

X

MMDP024 Xeomin
MMDP075 Xgeva
MMDP063 Xiaflex
MMDP004 Xolair

Y

MMDP119 Yervoy

 

Z

MMDP076 Zemaira
MMDP008 Zolgensma
MMDP050 Zirabev
MMDP101 Zynteglo