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Prescription Drug Polices

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Prescription Drug Polices - Top Content

The following is a list of our prescription drug policies. If you cannot find a policy for a specific medication, please select the link titled 'Clinical Review Prior Authorization' from the list below.

 

*Pharmacy benefit drugs - Univera Healthcare continues to manage the pharmacy benefit for Medicaid Managed Care and Child Health Plus members. Use the Univera Pharmacy Management Drug Policies below.

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We invite practitioners to review & comment on our policies.

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Showing 26– 50 of 57 Results
Title Last Updated
Enbrel Open a PDF 2/27/2020
Humira Open a PDF 2/27/2020
Stelara Open a PDF 2/27/2020
Safety Net – Oncology Clinical Review Prior Authorization Medical Drugs Open a PDF 2/3/2020
Ocrevus for Medicaid, Child Health Plus and Essential Plan Open a PDF 2/3/2020
Growth Hormone Open a PDF 2/3/2020
Tysabri Open a PDF 2/3/2020
Quantity Limit Open a PDF 2/5/2020
Rituxan, Rituxan Hycela Open a PDF 2/6/2020
IVIG/SCIG Open a PDF 3/10/2020
Anorexiants Open a PDF 3/11/2020
Medicaid Managed Care Step Therapy Policy Open a PDF 3/15/2020
Headache Disorders Open a PDF 3/20/2020
Oncology Clinical Review Prior Authorization Medical Drugs - (Adcetria, Aliqopa, Arzerra, Asparlas, Bavencio, Beleodaq, Besponsa, Blincyto, Cyramza, Darzalex, Elzonris, Empliciti, Enhertu, Erwinaze, Folotyn, Gazyva, Herceptin Hylecta, Imfinzi, Istodax & Romidepsin, Kadcyla, Keytruda, Kymriah, Kyprolis, Lartruvo, Libtayo, Lumoxiti, Marqibo, Mylotarg, Oncaspar, Onivyde, Opdivo, Padcev, Polivy, Portrazza, Poteligeo, Provenge, Synribo, Tecentriq, Torisel, Vyxeos, Xgeva, Yervoy, Yescarta, Yondelis, Zaltrap) Open a PDF 3/23/2020
Clinical Review Prior Authorization (CRPA) Medical Drugs Open a PDF 3/23/2020
Alpha-1 Antitrypsin Therapy (AAT) Open a PDF 3/25/2020
Step Therapy Policy for Commercial Open, Select Self-Funded Commercial Closed, Child Health Plus, Essential Plan, Small Employer Group and Direct Pay Metal Plans Open a PDF 3/25/2020
Antihemophilic Agents Open a PDF 3/29/2019
Botulinum Toxin (Medical Policy) Open a PDF 3/30/2020
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Open a PDF 3/5/2020
Inborn Errors of Metabolic Diseases (IEM) Open a PDF 4/1/2020
Clinical Review Prior Authorization Rx (CRPA) Open a PDF 4/1/2020
Opioid Management Health & Safety Program Open a PDF 4/1/2020
Inflammatory Conditions Clinical Review Prior Authorization (CRPA) Rx and Medical Drugs PDF Open a PDF 4/1/2020
Oncology Clinical Review Prior Authorization Rx Open a PDF 4/2/2020
Showing 26– 50 of 57 Results