Archived Pharmacy Policies
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
A
B
- Benlysta (belimumab) - Archived on 11/15/2024
- Bimzelx (bimekizumab-bkzx) - Archived on 03/03/2025
- Bleeding Disorder Agents - Archived on 03/07/2025
- Botox (onabotulinumtoxinA) - Archived on 11/15/2024
- Brineura (cerliponase alfa) - Archived on 11/15/2024
- Briumvi (ublituximab-xiiy) - Archived on 11/15/2024
C
D
E
F
G
I
- Immune globulin (IVIG and SCIG): Intravenous (IVIG): Alyglo, Asceniv, Bivigam, Flebogamma DIF, Gammagard Liquid, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Octagam, Panzyga, Privigen Subcutaneous (SCIG): Cutaquig, Cuvitru, Hizentra, HyQvia, Xembify - Archived on 11/15/2024
- Infliximab (Avsola, Inflectra, Remicade, Renflexis, Zymfentra) - Archived on 11/15/2024
- IV Iron Products - Archived on 03/07/2025
K
L
M
N
O
R
S
- Scenesse (Afamelanotide) - Archived on 11/15/2024
- Simponi (golimumab) - Archived on 11/15/2024
- Simponi Aria (golimumab) - Archived on 11/15/2024
- Soluble Guanylate Cyclase Stimulator for Pulmonary Arterial Hypertension: Adempas (riociguat) - Archived on 03/07/2025
- Spravato (esketamine) - Archived on 11/15/2024
- Stelara (ustekinumab) - Archived on 11/15/2024