Archived Pharmacy Policies
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
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- Macrilen (macimorelin) - Archived on 04/01/2024
- Macrilen (macimorelin) - Archived on 08/16/2024
- Macugen (pegaptanib)
- Macugen (pegaptanib) - Archived on 09/10/2024
- Medical Necessity – Off Label - Archived on 10/01/2024
- Medical Necessity for DAW - Archived on 10/01/2024
- Medical Necessity for Non-Formulary Medications - Archived on 10/01/2024
- Myobloc (rimabotulinumtoxinB)
- Myobloc (rimabotulinumtoxinB) - Archived on 1/13/2023
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- Reblozyl (luspatercept-aamt) - Archived on 07/01/2024
- Retisert (fluocinolone acetonide) - Archived on 04/01/2024
- Rituxan (rituximab) - Archived on 1/13/2023
- Rituxumab (Rituxan*, Truxima, Ruxience, Riabni) - Archived on 04/01/2024
- Rivfloza (nedosiran) - Archived on 10/01/2024
- Ruzurgi (amifampridine) - Archived on 09/10/2024