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Humana December 2017 Pharmacy Policy Updates

Click here to view the Humana Pharmacy Policy Updates »

December 2017 Pharmacy Policy Updates

Policy Name Reviewed Date
Naftin® Gel (naftifine) 12/28/2017
Hemlibra® (emicizumab-kxwh) 12/21/2017
GLP-1 Analogs 12/14/2017
GLP-1 Analogs 12/14/2017
Nuedexta® (dextromethorphan and quinidine) 12/14/2017
Nuedexta® (dextromethorphan and quinidine) 12/14/2017
Opioid Utilization Program – Morphine equivalent dose (MED) edits 12/14/2017
Opioid Utilization Program – Morphine equivalent dose (MED) edits 12/14/2017
Afrezza® (insulin human) Inhalation Powder 12/13/2017
Aliqopa™ (copanlisib) 12/13/2017
Alpha-1 Proteinase Inhibitors (Aralast NP®, Glassia®) 12/13/2017
Alpha-1 Proteinase Inhibitors (Prolastin-C®, Zemaira®) 12/13/2017
Anzemet® (dolasetron) 12/13/2017
Arcalyst® (rilonacept) 12/13/2017
Atgam® (antithymocyte immune globulin, equine) 12/13/2017
Auvi-Q® (epinephrine injection) 12/13/2017
Azopt® (brinzolamide ophthalmic suspension) 1% 12/13/2017
Biguanide Agents 12/13/2017
Cayston® (aztreonam inhalation solution) 12/13/2017
Cytogam® (cytomegalovirus immune globulin, human) 12/13/2017
Darzalex® (daratumumab) 12/13/2017
Fusilev® (levoleucovorin) 12/13/2017
Fycompa® (perampanel) 12/13/2017
Gocovri™ (amantadine) 12/13/2017
High Risk Medications (HRM) in the Elderly 12/13/2017
Idiopathic Pulmonary Fibrosis Products (Ofev, Esbriet) 12/13/2017
Ilaris® (canakinumab) 12/13/2017
Iluvien® (fluocinolone acetonide intravitreal implant) 12/13/2017
Intron A® (interferon alfa-2b) 12/13/2017
Istodax® (romidepsin) 12/13/2017
Jakafi® (ruxolitinib) 12/13/2017
Lartruvo™ (olaratumab) 12/13/2017
Minocycline Extended Release 12/13/2017
Movantik® (naloxegol) 12/13/2017
Namenda® (memantine HCl) and Namenda XR® (memantine HCl extended-release) 12/13/2017
Nplate® (romiplostim) 12/13/2017
Oral Acne Antibiotics 12/13/2017
Osphena® (ospemifene) 12/13/2017
Otrexup ™ (methotrexate injection) 12/13/2017
Pomalyst® (pomalidomide) 12/13/2017
Prestalia® (perindopril-amlodipine) 12/13/2017
Promacta® (eltrombopag) 12/13/2017
Rapid-Acting Fentanyl (Abstral®, Actiq®, Fentora®, Lazanda®, Subsys®) 12/13/2017
Rayaldee® (calcifediol) 12/13/2017
Sandostatin® S.C., Sandostatin LAR® Depot (octreotide acetate for injection) 12/13/2017
Sandostatin® S.C., Sandostatin LAR® Depot (octreotide acetate for injection) 12/13/2017
Savaysa® (edoxaban) 12/13/2017
Sernivo™ (betamethasone dipropionate) Spray 12/13/2017
Sernivo™ (betamethasone dipropionate) Spray 12/13/2017
Signifor® LAR (pasireotide) 12/13/2017
Simbrinza™ (brinzolamide/brimonidine ophthalmic suspension) 12/13/2017
Simponi® (golimumab) 12/13/2017
Simponi® (golimumab) 12/13/2017
Soliqua™ 100/33 (insulin glargine and lixisenatide) 12/13/2017
Soliris® (eculizumab) 12/13/2017
Somatuline Depot® (lanreotide) 12/13/2017
Somavert® (pegvisomant) 12/13/2017
Soolantra® (ivermectin 1% topical cream) 12/13/2017
Supprelin® LA (histrelin acetate implant) 12/13/2017
Supprelin® LA (histrelin acetate implant) 12/13/2017
Symproic® (naldemedine) 12/13/2017
Taclonex® (calcipotriene and betamethasone dipropionate) 12/13/2017
Thymoglobulin® (anti-thymocyte globulin [rabbit]) 12/13/2017
Topical Rosacea Products 12/13/2017
Topical Tretinoin Containing Products 12/13/2017
Tracleer (bosentan) tablet for oral suspension 12/13/2017
Trelegy Ellipta® (fluticasone furoate, umeclidinium, vilanterol) 12/13/2017
Trulance™(plecanatide) 12/13/2017
Uceris® Tablet and Rectal Foam (budesonide) 12/13/2017
Varizig® (varicella zoster immune globulin) 12/13/2017
Varubi® (rolapitant) 12/13/2017
Venclexta™ (venetoclax) 12/13/2017
Verzenio™ (abemaciclib) 12/13/2017
Vimpat® (lacosamide) 12/13/2017
Xultophy® 100/3.6 (insulin degludec and liraglutide) 12/13/2017
Yescarta™ (axicabtagene ciloleucel) 12/13/2017
Yondelis® (trabectedin) 12/13/2017
Zilretta™ (triamcinolone acetonide extended-release injectable suspension) 12/13/2017
Zometa® (zoledronic acid) 12/13/2017
Zontivity® (vorapaxar) 12/13/2017
Mepsevii™ (vestronidase alfa-vjbk) 12/7/2017
Ophthalmic Prostaglandins 12/7/2017
Ophthalmic Prostaglandins 12/7/2017
Actimmune® (interferon gamma-1b)

 

Click here to view the Humana Pharmacy Policy Updates »

 

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