files.nhpri.org - /Wordpress/Nhpri_uploads/2023/12/
[To Parent Directory]
8/14/2025 1:59 PM 203134 2023.06.07-CMP-I-001-CategoryIIICodes.pdf
8/14/2025 1:59 PM 156548 2023.06.07-CMP-I-002-ChronicCareManagement.pdf
8/14/2025 1:59 PM 144650 2023.06.07-CMP-I-003-DentalExamIntegrity.pdf
8/14/2025 1:59 PM 182437 2023.06.07-CMP-I-004-Infertility-MMP.pdf
8/14/2025 1:59 PM 1316344 2024-Provider-Manual-Available.pdf
8/14/2025 1:59 PM 75157 abiraterone-Zytiga-1934-A-SGM-P2022.pdf
8/14/2025 1:59 PM 107677 Acamprosate-Calcium-PA-Policy-1975-A-12-2022.pdf
8/14/2025 1:59 PM 125241 Acne-Products-Combinations-Topical-Limit-Post-PA-Policy-4651-HJ-UDR-08-2023-v2.pdf
8/14/2025 1:59 PM 141684 Actemra-1959-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 25787 Actimmune-2375-A-SGM-P2022.pdf
8/14/2025 1:59 PM 106906 Adapalene-PA-with-Limit-Policy-351-C-08-2022.pdf
8/14/2025 1:59 PM 118034 Adapalene-PA-with-Limit-Policy-351-C-UDR-08-2023.pdf
8/14/2025 1:59 PM 195616 Adult-Day-Health-11.28.23.pdf
8/14/2025 1:59 PM 52694 Alecensa-2150-A-SGM-P2023.pdf
8/14/2025 1:59 PM 81991 Alpha1-Proteinase-Inhibitors-1877-A-SGM-P2023.pdf
8/14/2025 1:59 PM 94748 ambrisentan-Letairis-1646-A-SGM-P2023.pdf
8/14/2025 1:59 PM 204285 Anesthesia-Services-Payment-Policy-11.28.23.pdf
8/14/2025 1:59 PM 223448 Antidiabetic-Agents-ST-Post-PA-Policy-676-D-UDR-05-2023-v2.pdf
8/14/2025 1:59 PM 109064 Apokyn-Kynmobi-2258-A-SGM-P2022.pdf
8/14/2025 1:59 PM 172669 Appropriate-Use-of-Expedited-Prior-Authorization-Requests-.pdf
8/14/2025 1:59 PM 123168 Aranesp-1616-A-SGM-P2022.pdf
8/14/2025 1:59 PM 44235 Arcalyst-1800-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 227148 Atypical-Antipsychotics-ST-Post-PA-Policy-657-D-03-2023.pdf
8/14/2025 1:59 PM 23908 azacitidine-Vidaza-2280-A-SGM-P2023.pdf
8/14/2025 1:59 PM 28034 Betaseron-Extavia-1840-A-SGM-P2023.pdf
8/14/2025 1:59 PM 52880 bexarotene-Targretin-1795-A-SGM-P2023.pdf
8/14/2025 1:59 PM 95194 bosentan-Tracleer-1649-A-SGM-P2023.pdf
8/14/2025 1:59 PM 126946 BPH-Cialis-2.5mg-5mg-PA-with-Limit-Policy-865-C-UDR-05-2023.pdf
8/14/2025 1:59 PM 27522 Cabometyx-2212-A-SGM-P2023.pdf
8/14/2025 1:59 PM 23528 Calquence-2397-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 23549 Calquence-2397-A-SGM-P2023.pdf
8/14/2025 1:59 PM 18846 Caprelsa-1783-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 33793 Carbaglu-2122-A-SGM-P2023.pdf
8/14/2025 1:59 PM 27414 Cayston-1880-A-SGM-P2023.pdf
8/14/2025 1:59 PM 21546 Cerdelga-2050-A-SGM-P2023.pdf
8/14/2025 1:59 PM 75593 Cetrotide-Fyremadel-Ganirelix-1912-A-1913-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 75593 Cetrotide-Fyremadel-Ganirelix-1912-A-1913-A-SGM-P2023.pdf
8/14/2025 1:59 PM 83834 CGRP-Receptor-Antagonists-Inj-IV-ST-with-Limit-Post-PA-Policy-2761-E-3155-E-UDR-06-2023.pdf
8/14/2025 1:59 PM 104607 CGRP-Receptor-Antagonists-Oral-Nasal-ST-with-Limit-Post-PA-Policy-3481-E-UDR-07-2022-v3.pdf
8/14/2025 1:59 PM 162871 Change-in-Custodial-Level-Authorizations-for-Non-LTSS-Members.pdf
8/14/2025 1:59 PM 82720 cinacalcet-Sensipar-1624-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 189614 Claims-Corner.pdf
8/14/2025 1:59 PM 122720 Clindamycin-Erythromycin-Topical-Limit-Post-PA-Policy-3697-HJ-UDR-04-2023-v2.pdf
8/14/2025 1:59 PM 273193 CMP_Actemra_Non-ONC.20231207.pdf
8/14/2025 1:59 PM 149979 CMP_Apretude_20231214.pdf
8/14/2025 1:59 PM 195653 CMP_Benefit-Exclusion_20231207.pdf
8/14/2025 1:59 PM 188784 CMP_Beovu_20231207.pdf
8/14/2025 1:59 PM 193588 CMP_Berinert_20231214.pdf
8/14/2025 1:59 PM 135362 CMP_Cerezyme_Elelyso_VPRIV_20231207.pdf
8/14/2025 1:59 PM 181230 CMP_Cinqair_20231207.pdf
8/14/2025 1:59 PM 149292 CMP_Dimercaprol_Calcium-EDTA.20231214.pdf
8/14/2025 1:59 PM 173234 CMP_duopa_20231207.pdf
8/14/2025 1:59 PM 181229 CMP_Durysta_20231214.pdf
8/14/2025 1:59 PM 219696 CMP_ESA_agents_Aranesp_Epogen_Procrit_Retacrit_Non-Onc_20231214.pdf
8/14/2025 1:59 PM 250134 CMP_Evkeeza_20231214.pdf
8/14/2025 1:59 PM 178283 CMP_Eylea_20231207.pdf
8/14/2025 1:59 PM 157491 CMP_General_PA_without_specific_drug_criteria_20231101.medical.pdf
8/14/2025 1:59 PM 202328 CMP_HPActhar_20230928.medical.pdf
8/14/2025 1:59 PM 211660 CMP_Hyaluronicacids.20231214.pdf
8/14/2025 1:59 PM 172579 CMP_Ilumya_20231221.pdf
8/14/2025 1:59 PM 235522 CMP_Infliximab_Remicade_Renflexis_Inflectra_20231207.pdf
8/14/2025 1:59 PM 176634 CMP_kalbitor_20231214.pdf
8/14/2025 1:59 PM 328460 CMP_Krystexxa_20231207.pdf
8/14/2025 1:59 PM 148192 CMP_Lemtrada_20231214.pdf
8/14/2025 1:59 PM 190005 CMP_Leqvio_20231214.pdf
8/14/2025 1:59 PM 163590 CMP_Long-acting-CSF_-Non-Onc_20231207.pdf
8/14/2025 1:59 PM 206960 CMP_Lucentis_Byooviz_Cimerli_20231207.pdf
8/14/2025 1:59 PM 260363 CMP_M_Aldurazyme_20231207.pdf
8/14/2025 1:59 PM 249616 CMP_M_Alpha-1_PI_20231214.pdf
8/14/2025 1:59 PM 284975 CMP_M_Amondys45_20231207.pdf
8/14/2025 1:59 PM 251344 CMP_M_Amvuttra_20231207.pdf
8/14/2025 1:59 PM 205135 CMP_M_Brineura_20231207.pdf
8/14/2025 1:59 PM 298563 CMP_M_Briumvi_20231214.pdf
8/14/2025 1:59 PM 463584 CMP_M_Cimzia_20231221.pdf
8/14/2025 1:59 PM 257225 CMP_M_Cinryze_20231214.pdf
8/14/2025 1:59 PM 263183 CMP_M_Elaprase_20231207.pdf
8/14/2025 1:59 PM 271249 CMP_M_Elevidys_20231207.pdf
8/14/2025 1:59 PM 221446 CMP_M_Entyvio_20231214.pdf
8/14/2025 1:59 PM 257479 CMP_M_Evenity_20231214.pdf
8/14/2025 1:59 PM 283857 CMP_M_Exondys51_20231207.pdf
8/14/2025 1:59 PM 269382 CMP_M_Fabrazyme_20231207.pdf
8/14/2025 1:59 PM 281875 CMP_M_Factor_Anti-Inhibitor_Ab_Hemlibra_20231214.pdf
8/14/2025 1:59 PM 276510 CMP_M_Factor_Anti_inhibitor_Coagulant_Complex_20231214.pdf
8/14/2025 1:59 PM 408431 CMP_M_Factor_IX_20231214.pdf
8/14/2025 1:59 PM 328789 CMP_M_Factor_VIIa_20231214.pdf
8/14/2025 1:59 PM 471839 CMP_M_Factor_VIII_20231214.pdf
8/14/2025 1:59 PM 432744 CMP_M_Factor_VIII_VWF_20231214.pdf
8/14/2025 1:59 PM 354674 CMP_M_Factor_VWF_Vonvendi_20231214.pdf
8/14/2025 1:59 PM 295952 CMP_M_Factor_X_20231214.pdf
8/14/2025 1:59 PM 289168 CMP_M_Factor_XIII_20231214.pdf
8/14/2025 1:59 PM 266650 CMP_M_Factor_XIIIA_subunit_20231214.pdf
8/14/2025 1:59 PM 226643 CMP_M_Givlaari_20231207.pdf
8/14/2025 1:59 PM 302952 CMP_M_Hemgenix_20231207.pdf
8/14/2025 1:59 PM 357284 CMP_M_Ilaris_20231214.pdf
8/14/2025 1:59 PM 544330 CMP_M_IVIG_Non-Onc20231221.pdf
8/14/2025 1:59 PM 246117 CMP_M_Izervay_20231214.pdf
8/14/2025 1:59 PM 240408 CMP_M_Lantidra_20231221.pdf
8/14/2025 1:59 PM 292577 CMP_M_Leqembi_20231207.pdf
8/14/2025 1:59 PM 260117 CMP_M_Luxturna_20231207.pdf
8/14/2025 1:59 PM 260574 CMP_M_Mepsevii_20231207.pdf
8/14/2025 1:59 PM 246602 CMP_M_Monoferric_20230406.pdf
8/14/2025 1:59 PM 269427 CMP_M_Naglazyme_20231207.pdf
8/14/2025 1:59 PM 317905 CMP_M_Nucala_20231207.pdf
8/14/2025 1:59 PM 264402 CMP_M_Nulibry_20231214.pdf
8/14/2025 1:59 PM 447802 CMP_M_Orencia_IV_20231207.pdf
8/14/2025 1:59 PM 343717 CMP_M_Oxlumo_20231214.pdf
8/14/2025 1:59 PM 223651 CMP_M_Qalsody.20231214.pdf
8/14/2025 1:59 PM 284995 CMP_M_Revcovi_20231207.pdf
8/14/2025 1:59 PM 340011 CMP_M_Roctavian20231214.pdf
8/14/2025 1:59 PM 372550 CMP_M_SCIG_20231221.pdf
8/14/2025 1:59 PM 252925 CMP_M_Signifor_LAR_20231207.pdf
8/14/2025 1:59 PM 428268 CMP_M_Simponi_ARIA_20231207.pdf
8/14/2025 1:59 PM 308840 CMP_M_Skyrizi_IV_20231207.pdf
8/14/2025 1:59 PM 245119 CMP_M_Spevigo_20231214.pdf
8/14/2025 1:59 PM 201431 CMP_M_Syfovre_20231207.pdf
8/14/2025 1:59 PM 215622 CMP_M_Tepezza_20230914.cmp_.pdf
8/14/2025 1:59 PM 205677 CMP_M_Tepezza_20230914.medicaid.pdf
8/14/2025 1:59 PM 219328 CMP_M_Tepezza_20231221.pdf
8/14/2025 1:59 PM 238863 CMP_M_Tzield_20231207.pdf
8/14/2025 1:59 PM 296899 CMP_M_Viltepso_20231207.pdf
8/14/2025 1:59 PM 257812 CMP_M_Vimizim_20231207.pdf
8/14/2025 1:59 PM 283563 CMP_M_Vyepti_20231214.pdf
8/14/2025 1:59 PM 262095 CMP_M_Vyjuvek_20231207.pdf
8/14/2025 1:59 PM 291578 CMP_M_Vyondys53_20231207.pdf
8/14/2025 1:59 PM 303343 CMP_M_Xenpozyme_20231207.pdf
8/14/2025 1:59 PM 233821 CMP_M_Xiaflex_20231207.pdf
8/14/2025 1:59 PM 286866 CMP_M_Zolgensma_20231207.pdf
8/14/2025 1:59 PM 265233 CMP_M_Zynteglo_20231207.pdf
8/14/2025 1:59 PM 137623 CMP_Medicaid_Haegarda_20231214.pdf
8/14/2025 1:59 PM 110372 CMP_Medical-Benefit-Only-Policy_20231101.medical.pdf
8/14/2025 1:59 PM 157367 CMP_Miacalcin_20231214.pdf
8/14/2025 1:59 PM 142466 CMP_Nonc_Nipent_20231207.pdf
8/14/2025 1:59 PM 183233 CMP_Ocrevus_20231214.pdf
8/14/2025 1:59 PM 167999 CMP_Onpattro_20231207.pdf
8/14/2025 1:59 PM 139903 CMP_Parsabiv_20231207.pdf
8/14/2025 1:59 PM 165541 CMP_Probuphine_20231207.pdf
8/14/2025 1:59 PM 192619 CMP_Rebyota_20230914.pdf
8/14/2025 1:59 PM 330691 CMP_Rituxan_NonOnc_20231207.pdf
8/14/2025 1:59 PM 189435 CMP_Ruconest_20231214-1.pdf
8/14/2025 1:59 PM 182272 CMP_Ruconest_20231214.pdf
8/14/2025 1:59 PM 168413 CMP_Ryplazim_20231214.pdf
8/14/2025 1:59 PM 163451 CMP_Saphnelo.20231207.pdf
8/14/2025 1:59 PM 145696 CMP_scenesse_20231214.pdf
8/14/2025 1:59 PM 193569 CMP_short-acting_CSF_Nivestym_Neupogen_Granix__Zarxio_Releuko.20231207.pdf
8/14/2025 1:59 PM 282485 CMP_Skysona_20231207.pdf
8/14/2025 1:59 PM 198336 CMP_Soliris_Ultomiris_NON_ONC_20231214.pdf
8/14/2025 1:59 PM 200912 CMP_Spinraza_20231207.pdf
8/14/2025 1:59 PM 360739 CMP_Stelara_IV_20231207.pdf
8/14/2025 1:59 PM 151226 CMP_Susvimo_20231207.pdf
8/14/2025 1:59 PM 182485 CMP_Tezspire_20231207.pdf
8/14/2025 1:59 PM 189659 CMP_Triptodur_20231214.pdf
8/14/2025 1:59 PM 196881 CMP_Trogarzo_20231214.pdf
8/14/2025 1:59 PM 177939 CMP_Tysabri_20231214.pdf
8/14/2025 1:59 PM 181870 CMP_Uplizna_20231214.pdf
8/14/2025 1:59 PM 177568 CMP_Vabysmo_20231207.pdf
8/14/2025 1:59 PM 174461 CMP_Vyvgart_Vyvgarthytrulo_20231214_.pdf
8/14/2025 1:59 PM 107385 CMP_Zulresso_20231101.pdf
8/14/2025 1:59 PM 22413 Cometriq-1854-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 141381 Commercial_Weight_Loss_Saxenda_Wegovy_20230824.pdf
8/14/2025 1:59 PM 119838 Commerical-Formulary-Changes-January-2024.pdf
8/14/2025 1:59 PM 188494 Compliance-Reminder-for-Nursing-Facilities.pdf
8/14/2025 1:59 PM 98369 Corticosteroid-Pulmicort-1mg-Post-Limit-PA-Policy-2495-J-10-2022.pdf
8/14/2025 1:59 PM 123093 Cosentyx-2017-A-SGM-2023.pdf
8/14/2025 1:59 PM 180238 Cost-Saver-Program-for-Commercial-Members-.pdf
8/14/2025 1:59 PM 210964 Criteria-for-Gender-Reassignment-Surgery.pdf
8/14/2025 1:59 PM 155486 Cross-Reference-Guide-for-Plan-ID_Group-ID-mod_Revised_December-2023.pdf
8/14/2025 1:59 PM 84483 Cystadane-2988-A-SGM-P2023.pdf
8/14/2025 1:59 PM 21411 Cystagon-2089-A-SGM-P2023.pdf
8/14/2025 1:59 PM 25132 Cystaran-Cystadrops-2090-A-SGM-P2023.pdf
8/14/2025 1:59 PM 23993 dalfampridine-Ampyra-1836-A-SGM-P2023.pdf
8/14/2025 1:59 PM 44220 Daliresp-PA-Policy-646-A-10-2022.pdf
8/14/2025 1:59 PM 48352 Daraprim-PA-Policy-1341-A-01-2023.pdf
8/14/2025 1:59 PM 76876 decitabine-Dacogen-2288-A-SGM-P2023.pdf
8/14/2025 1:59 PM 36396 deferiprone-Ferriprox-1621-A-SGM-P2023.pdf
8/14/2025 1:59 PM 31647 Desvenlafaxine-Fetzima-ST-with-Limit-Post-PA-Policy-1888-E-03-2023.pdf
8/14/2025 1:59 PM 218345 Diabetic-Supply-Policy20230503.pdf
8/14/2025 1:59 PM 45181 Dibenzyline-PA-with-Limit-Policy-3673-C-03-2023.pdf
8/14/2025 1:59 PM 22298 Dificid-PA-Policy-2753-A-12-2022.pdf
8/14/2025 1:59 PM 27874 dimethyl-fumarate-Tecfidera-1845-A-SGM-P2023.pdf
8/14/2025 1:59 PM 20524 Dipentum-PA-Policy-2967-A-02-2023.pdf
8/14/2025 1:59 PM 207565 Discontinuation-of-Alternative-Payment-Model-1.pdf
8/14/2025 1:59 PM 206130 Discontinuation-of-Alternative-Payment-Model.pdf
8/14/2025 1:59 PM 31878 Dofetilide-Tikosyn-1873-A-SGM-P2023.pdf
8/14/2025 1:59 PM 95469 Doptelet-3081-A-SGM-P2023.pdf
8/14/2025 1:59 PM 123590 DPP-4-Inhibitors-ST-Post-PA-Policy-1009-D-UDR-05-2023.pdf
8/14/2025 1:59 PM 185163 Dupixent-1690-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 207425 Durable-Medical-Equipment-Payment-Policy-11.28.23.pdf
8/14/2025 1:59 PM 72363 EFP-1-1-24.pdf
8/14/2025 1:59 PM 500565 Electronic-Payment-and-RA-Application-002.pdf
8/14/2025 1:59 PM 153724 Electronic-Prior-Authorization-for-the-Pharmacy-Benefit.pdf
8/14/2025 1:59 PM 74319 Elidel-PA-with-Logic-Policy-76-D-UDR-04-2023.pdf
8/14/2025 1:59 PM 88548 Eligard-1966-A-6043-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 80603 Emflaza-1636-A-SGM-P2023.pdf
8/14/2025 1:59 PM 41335 Emsam-PA-Policy-867-A-03-2023.pdf
8/14/2025 1:59 PM 200588 Enbrel-2003-A-SGM-P2022a-1.pdf
8/14/2025 1:59 PM 200614 Enbrel-2003-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 33674 entecavir-Baraclude-4779-A-Supplemental-Specialty-PA-P2023.pdf
8/14/2025 1:59 PM 122343 Epclusa-2137-A-2676-A-SGM-P2022.pdf
8/14/2025 1:59 PM 99559 Epogen-Procrit-Retacrit-1619-A-SGM-P2022-1.pdf
8/14/2025 1:59 PM 99559 Epogen-Procrit-Retacrit-1619-A-SGM-P2022.pdf
8/14/2025 1:59 PM 38145 Erbitux-1892-A-SGM-P2022.pdf
8/14/2025 1:59 PM 39683 Erbitux-1892-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 96197 Erivedge-1785-A-SGM-P2023.pdf
8/14/2025 1:59 PM 73052 Erleada-2498-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 73066 Erleada-2498-A-SGM-P2023.pdf
8/14/2025 1:59 PM 79199 erlotinib-Tarceva-1664-A-SGM-P2023.pdf
8/14/2025 1:59 PM 127828 Eucrisa-ST-with-Limit-Post-PA-Aetna-SG-ACA-Aetna-IVL-MF-only-Policy-3199-E-UDR-04-2023.pdf
8/14/2025 1:59 PM 139742 everolimus-Afinitor-Products-2021-A-SGM-P2023.pdf
8/14/2025 1:59 PM 1080360 Evolent-Clinical-Guideline-7000-for-Radiation-Therapy-Services-2025.pdf
8/14/2025 1:59 PM 287362 Evolent-Clinical-Guideline-7001-for-Proton-Beam-Radiation-Therapy-and-Neutron-Beam-Radiation-Therapy-Services-2025.pdf
8/14/2025 1:59 PM 91291 Evrysdi-4074-A-SGM-P2023.pdf
8/14/2025 1:59 PM 109092 Exchange__Medical-Benefit-Only-Policy_20230209.pdf
8/14/2025 1:59 PM 74978 Exchange_Pharmacy_-Benefit_Only_20230209.pdf
8/14/2025 1:59 PM 97761 Exelon-PA-Policy-85-A-509-A-UDR-06-2023.pdf
8/14/2025 1:59 PM 946589 export-media-urls-171753.CSV
8/14/2025 1:59 PM 93932 Fasenra-2413-A-SGM-P2023.pdf
8/14/2025 1:59 PM 28455 fingolimod-Gilenya-Tascenso-ODT-1842-A-SGM-P2023.pdf
8/14/2025 1:59 PM 85845 Follitropins-1914-A-1915-A-SGM-P2023.pdf
8/14/2025 1:59 PM 23523 fulvestrant-Faslodex-2903-A-SGM-P2023.pdf
8/14/2025 1:59 PM 19769 Fuzeon-3099-A-SGM-P2023.pdf
8/14/2025 1:59 PM 130233 Gazyva-2075-A-SGM-P2023.pdf
8/14/2025 1:59 PM 30756 glatiramer-Copaxone-Glatopa-1841-A-SGM-P2023.pdf
8/14/2025 1:59 PM 153533 Growth-Hormone-Without-ISS-1742-A-SGM-P2023.pdf
8/14/2025 1:59 PM 23042 GSTP-Bisphosphonates-Policy-367-D-401-D-377-D-11-2022.pdf
8/14/2025 1:59 PM 22861 GSTP-Insomnia-Agents-Policy-372-D-406-D-382-D-UDR-04-2023-v2.pdf
8/14/2025 1:59 PM 22732 GSTP-Nasal-Steroids-w_OTCs-Policy-4589-D-4590-D-4591-D-02-2023.pdf
8/14/2025 1:59 PM 87902 Haegarda-2100-A-SGM-P2023.pdf
8/14/2025 1:59 PM 101767 Harvoni-2134-A-2677-A-SGM-P2022.pdf
8/14/2025 1:59 PM 85170 hCG-1925-A-1926-A-SGM-P2023.pdf
8/14/2025 1:59 PM 32309 Hemlibra-2417-A-3536-A-SGM-P2023.pdf
8/14/2025 1:59 PM 35920 Hetlioz-2426-A-SGM-P2023.pdf
8/14/2025 1:59 PM 147788 High-Risk-Medications-HRM-Long-List-PA-with-Age-Policy-698-B-02-2023.pdf
8/14/2025 1:59 PM 152898 Home-Care-Discharge-Communication-E-Form.pdf
8/14/2025 1:59 PM 247573 Home-Health-Agency-Services-Payment-Policy-01.01.24.pdf
8/14/2025 1:59 PM 227256 Home-Infusions-Payment-Policy-11.28.23.pdf
8/14/2025 1:59 PM 177839 Hospital-Readmission-Payment-Policy-11.28.23.pdf
8/14/2025 1:59 PM 168097 How-to-Bill-340B-Appropriately.pdf
8/14/2025 1:59 PM 220620 Humira-and-Biosimilars-2008-A-SGM-P2022d.pdf
8/14/2025 1:59 PM 89937 icatibant-Sajazir-Firazyr-1606-A-SGM-P2023.pdf
8/14/2025 1:59 PM 24638 Idhifa-2238-A-SGM-P2023.pdf
8/14/2025 1:59 PM 129286 imatinib-Gleevec-2172-A-SGM-P2023.pdf
8/14/2025 1:59 PM 155732 Imbruvica-1997-A-SGM-P2022.pdf
8/14/2025 1:59 PM 106882 Inbrija-2860-A-SGM-P2022.pdf
8/14/2025 1:59 PM 79787 Increlex-1740-A-SGM-P2023.pdf
8/14/2025 1:59 PM 215674 infliximab-Remicade-and-Biosimilars-2182-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 125018 Influenza-Treatment-and-Prevention-Post-Limit-PA-Policy-111-J-UDR-09-2022-v2.pdf
8/14/2025 1:59 PM 233593 Initiation-and-Engagement-of-Alcohol-and-Other-Drug-Dependence-Treatment.pdf
8/14/2025 1:59 PM 26645 Inlyta-2079-A-SGM-P2023.pdf
8/14/2025 1:59 PM 133412 Insomnia-Belsomra-Dayvigo-Quviviq-PA-with-Limit-Policy-1177-C-UDR-04-2023.pdf
8/14/2025 1:59 PM 223437 INTEGRITY-Formulary-Changes-January-2024.pdf
8/14/2025 1:59 PM 186857 Interpreter-Services-Payment-Policy-11.28.23.pdf
8/14/2025 1:59 PM 134547 Isotretinoins-PA-Policy-118-A-08-2021.pdf
8/14/2025 1:59 PM 41846 Itraconazole-Sporanox-Oral-Solution-PA-Policy-210-A-03-2023.pdf
8/14/2025 1:59 PM 37920 Jakafi-1999-A-SGM-P2023.pdf
8/14/2025 1:59 PM 80027 Jublia-PA-with-Limit-Policy-1160-C-10-2022.pdf
8/14/2025 1:59 PM 26069 Kadcyla-1906-A-SGM-P2023.pdf
8/14/2025 1:59 PM 102006 Kalydeco-1884-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 83682 Kerendia-PA-Policy-4871-A-11-2022.pdf
8/14/2025 1:59 PM 50733 Kevzara-1957-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 50730 Kevzara-1957-A-SGM-P2023.pdf
8/14/2025 1:59 PM 177910 Keytruda-1889-A-SGM-P2022g.pdf
8/14/2025 1:59 PM 21820 Kisqali-1639-A-SGM-P2023.pdf
8/14/2025 1:59 PM 88021 lanreotide-injection-Somatuline-Depot-2092-A-SGM-P2023.pdf
8/14/2025 1:59 PM 27846 lapatinib-Tykerb-1902-A-SGM-P2023.pdf
8/14/2025 1:59 PM 44735 lenalidomide-Revlimid-2232-A-SGM-P2022.pdf
8/14/2025 1:59 PM 58249 Lenvima-1865-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 58222 Lenvima-1865-A-SGM-P2023.pdf
8/14/2025 1:59 PM 128650 Leuprolide-1989-A-1990-A-2117-A-SGM-P2023b.pdf
8/14/2025 1:59 PM 79513 Lidoderm-ZTLido-PA-with-Limit-Policy-125-C-10-2022.pdf
8/14/2025 1:59 PM 24641 Lorbrena-2787-A-SGM-P2022.pdf
8/14/2025 1:59 PM 23208 Lotronex-PA-129-A-690-A-Policy-10-2022.pdf
8/14/2025 1:59 PM 164849 LunaYou-Pilot-Program-Ending-1.pdf
8/14/2025 1:59 PM 163387 LunaYou-Pilot-Program-Ending.pdf
8/14/2025 1:59 PM 42973 Lynparza-1810-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 144024 Lyrica-Lyrica-CR-Gralise-Horizant-ST-Post-PA-Policy-656-D-UDR-06-2023.pdf
8/14/2025 1:59 PM 183318 Mandatory-Provider-Training.pdf
8/14/2025 1:59 PM 162501 Meal-Delivery-Benefit-for-New-Medicaid-Moms.pdf
8/14/2025 1:59 PM 340181 Medciaid_CMP_M_Myobloc_20231221.medical.pdf
8/14/2025 1:59 PM 194333 Medicaid-and-Commercial-Limited-Specialty-Pharmacy-Network.pdf
8/14/2025 1:59 PM 76993 Medicaid-Formulary-Changes-January-2024.pdf
8/14/2025 1:59 PM 179838 Medicaid-Redeterminations-for-Households-with-Kids-Underway-Help-Patients-Keep-Their-Coverage.pdf
8/14/2025 1:59 PM 259787 Medicaid.Commercial-Step_Therapy_11.30.23.pdf
8/14/2025 1:59 PM 263447 Medicaid.Commercial-Step_Therapy_12.15.23.pdf
8/14/2025 1:59 PM 174102 Medicaid_CMP_Benlysta_20231101.medical.pdf
8/14/2025 1:59 PM 163912 Medicaid_CMP_cinacalcet_20231101.medical.pdf
8/14/2025 1:59 PM 210937 Medicaid_CMP_Crysvita_20231101.medical.pdf
8/14/2025 1:59 PM 180529 Medicaid_CMP_Fasenra_20231207.medical.pdf
8/14/2025 1:59 PM 504906 Medicaid_CMP_M_Botox_2023121.medical.pdf
8/14/2025 1:59 PM 251496 Medicaid_CMP_M_Daxxify_20231221.medical.pdf
8/14/2025 1:59 PM 413831 Medicaid_CMP_M_Dysport_20231221.medical.pdf
8/14/2025 1:59 PM 240339 Medicaid_CMP_M_Kanuma_20231207.medical.pdf
8/14/2025 1:59 PM 244331 Medicaid_CMP_M_Lumizyme_20231207.medical.pdf
8/14/2025 1:59 PM 242226 Medicaid_CMP_M_Xolair_20231207.medical.pdf
8/14/2025 1:59 PM 135583 Medicaid_CMP_Nexviazyme_20231207.medical.pdf
8/14/2025 1:59 PM 157143 Medicaid_CMP_non-onc.Somatuline-Depot_20231207.medical.pdf
8/14/2025 1:59 PM 93656 Medicaid_CMP_Prevymis_20230914.medicaid.pdf
8/14/2025 1:59 PM 117342 Medicaid_CMP_Prevymis_20231214.medical-dont-post-redate-2024.pdf
8/14/2025 1:59 PM 117043 Medicaid_CMP_Prevymis_20231214.pdf
8/14/2025 1:59 PM 94490 Medicaid_CMP_Prevymis_20231214.rx_.pdf
8/14/2025 1:59 PM 137621 Medicaid_CMP_Serostim_20231207.medical.pdf
8/14/2025 1:59 PM 161644 Medicaid_CMP_Strensiq_20231207.medical.pdf
8/14/2025 1:59 PM 122519 Medicaid_CMP_Sublocade_Brixadi.20231102.medical.pdf
8/14/2025 1:59 PM 100962 Medicaid_CMP_Sublocade_Brixadi.20231102.mediciad.pdf
8/14/2025 1:59 PM 155146 Medicaid_CMP_Sunlenca_20231101.medical.pdf
8/14/2025 1:59 PM 189521 Medicaid_CMP_Synagis_20231207.medical.pdf
8/14/2025 1:59 PM 131292 Medicaid_CMP_Testopel_20231214.medical.pdf
8/14/2025 1:59 PM 138455 Medicaid_CMP_Xenleta_20231101.medical.pdf
8/14/2025 1:59 PM 375061 Medicaid_CMP_Xeomin_20231221.medical.pdf
8/14/2025 1:59 PM 85501 Medicaid_Commcercial_Quantity_Limit_Exception_20230105.pdf
8/14/2025 1:59 PM 91125 Medicaid_Dificid_ST_20230914.pdf
8/14/2025 1:59 PM 109996 Medicaid_Joenja_20230914.pdf
8/14/2025 1:59 PM 74253 Medicaid_Pharmacy_-Benefit_Only_20230914-1.pdf
8/14/2025 1:59 PM 74253 Medicaid_Pharmacy_-Benefit_Only_20230914.pdf
8/14/2025 1:59 PM 162368 Medicaid_Vowst_20230914.pdf
8/14/2025 1:59 PM 192348 Medical-Benefit-Prior-Authorization-Submission.pdf
8/14/2025 1:59 PM 67376 Mekinist-1681-A-SGM-P2023.pdf
8/14/2025 1:59 PM 32359 Metronidazole-Topical-Limit-Post-PA-Policy-4312-HJ-03-2023.pdf
8/14/2025 1:59 PM 48289 Mircera-1618-A-SGM-P2022.pdf
8/14/2025 1:59 PM 21603 Multaq-PA-Policy-532-A-UDR-05-2023.pdf
8/14/2025 1:59 PM 106468 Mupirocin-Limit-Post-PA-Policy-2940-HJ-10-2022.pdf
8/14/2025 1:59 PM 88400 Myalept-1674-A-SGM-P2023.pdf
8/14/2025 1:59 PM 100385 Namenda-PA-with-Age-Policy-511-B-UDR-06-2023.pdf
8/14/2025 1:59 PM 162933 Network-MED-Pharmacies-12.28.23.pdf
8/14/2025 1:59 PM 130709 Neulasta-and-pegfilgrastim-biosimilars-1931-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 152617 Neupogen-and-filgrastim-biosimilars-1930-A-SGM-P2022.pdf
8/14/2025 1:59 PM 219285 New-and-Updated-Neighborhood-Payment-Policies.pdf
8/14/2025 1:59 PM 2195032 NHP-HSA-Flyer-OE2024_PRESS_Adj.pdf
8/14/2025 1:59 PM 2718440 NHPRI-OE2024-IF-PlanSummary_Spn_508-1.pdf
8/14/2025 1:59 PM 2718440 NHPRI-OE2024-IF-PlanSummary_Spn_508.pdf
8/14/2025 1:59 PM 2811268 NHPRI-OE2024-SHOP-PlanSummary_Spn_508-1.pdf
8/14/2025 1:59 PM 2811268 NHPRI-OE2024-SHOP-PlanSummary_Spn_508.pdf
8/14/2025 1:59 PM 1564235 NHPRI_6T_Formulary-12.1.23.pdf
8/14/2025 1:59 PM 1464257 NHPRI_6T_Formulary_OE.pdf
8/14/2025 1:59 PM 22857 nitisinone-Nityr-Orfadin-2120-A-SGM-P2023.pdf
8/14/2025 1:59 PM 1381337 Non-Covered-Services-11.28.23-CPT-HCPC.pdf
8/14/2025 1:59 PM 126552 Non-Covered-Services-11.28.23-ICD10.pdf
8/14/2025 1:59 PM 134114 Non-Covered-Services-11.28.23-Modifiers.pdf
8/14/2025 1:59 PM 330651 Non-Covered-Services-11.28.23.pdf
8/14/2025 1:59 PM 71540 Nubeqa-3147-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 71544 Nubeqa-3147-A-SGM-P2023.pdf
8/14/2025 1:59 PM 50703 Nuedexta-PA-Policy-870-A-599-A-UDR-04-2023.pdf
8/14/2025 1:59 PM 230473 Obstetrical-Services-11.28.23.pdf
8/14/2025 1:59 PM 143313 octreotide-products-1734-A-SGM-P2023.pdf
8/14/2025 1:59 PM 18080 Odomzo-1786-A-SGM-P2023.pdf
8/14/2025 1:59 PM 115855 Ofev-1882-A-SGM-P2023.pdf
8/14/2025 1:59 PM 22938 Oncaspar-2291-A-SGM-P2022.pdf
8/14/2025 1:59 PM 135754 Oncology_Hematology_Policy_20231101.medical.pdf
8/14/2025 1:59 PM 73821 Ongentys-PA-Policy-5464-A-09-2022.pdf
8/14/2025 1:59 PM 203191 Opioid-Containing-Cough-and-Cold-Products-Limit-Post-PA-Policy-4428-HJ-02-2023.pdf
8/14/2025 1:59 PM 193277 Opioid-Prescribing-and-Alternative-Therapies-for-Neighborhood-INTEGRITY-Members-.pdf
8/14/2025 1:59 PM 381829 Opioids-ER-Step-Therapy-with-MME-Limit-and-Post-Limit-Policy-2219-M-02-2023.pdf
8/14/2025 1:59 PM 282912 Opioids-IR-7-Day-Acute-Pain-Duration-Limit-with-MME-Limit-and-Post-Limit-Policy-2221-M-02-2023.pdf
8/14/2025 1:59 PM 178832 Opioids-IR-Combo-Products-Limit-Policy-1365-H-02-2023.pdf
8/14/2025 1:59 PM 94328 Opsumit-1647-A-SGM-P2023.pdf
8/14/2025 1:59 PM 106250 Oral-Fentanyl-Products-PA-with-Limit-Policy-288-C-02-2023.pdf
8/14/2025 1:59 PM 94354 Orenitram-1643-A-SGM-P2023.pdf
8/14/2025 1:59 PM 69653 Orkambi-1885-A-SGM-P2023.pdf
8/14/2025 1:59 PM 41457 Osphena-PA-Policy-961-A-01-2023.pdf
8/14/2025 1:59 PM 180687 Otezla-2002-A-SGM-P2023.pdf
8/14/2025 1:59 PM 24776 Ovide-ST-Post-PA-Policy-4831-D-03-2023.pdf
8/14/2025 1:59 PM 73697 Oxandrolone-PA-Policy-15-A-320-A-01-2023-1.pdf
8/14/2025 1:59 PM 24708 Pancrelipase-PA-Policy-3134-A-10-2022.pdf
8/14/2025 1:59 PM 94052 PCSK9i-2574-A-SGM-P2023.pdf
8/14/2025 1:59 PM 94957 Pegasys-2139-A-SGM-P2023.pdf
8/14/2025 1:59 PM 122683 Penicillamine-Trientine-PA-Policy-3079-A-UDR-04-2023.pdf
8/14/2025 1:59 PM 174419 Pharmacy-Benefit-Medicaid-Drug-Rebate-Program-MDRP.pdf
8/14/2025 1:59 PM 10497 Pharmacy_SpecialNetwork.csv
8/14/2025 1:59 PM 32191 pirfenidone-Esbriet-1881-A-SGM-P2023.pdf
8/14/2025 1:59 PM 217561 Policy-Update-for-Home-Health-Agencies.pdf
8/14/2025 1:59 PM 174709 Policy_Benefit-Exclusion_approved_8.24.23.pdf
8/14/2025 1:59 PM 84914 Polivy-3095-A-SGM-P2023.pdf
8/14/2025 1:59 PM 25437 Pomalyst-2234-A-SGM-P2022.pdf
8/14/2025 1:59 PM 174301 Prescription-Drug-Coverage-in-Assisted-Living-and-Long-Term-Care-Facilities.pdf
8/14/2025 1:59 PM 112967 Pretomanid-PA-Policy-3195-A-01-2023.pdf
8/14/2025 1:59 PM 79539 Preventive-Services-Zero-Copay-Exception-Policy-994-A-UDR-06-2023-1.pdf
8/14/2025 1:59 PM 108866 Prolia-2026-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 95569 Protopic-Logic-with-Age-Post-PA-Policy-1254-F-177-F-UDR-04-2023.pdf
8/14/2025 1:59 PM 182450 Provider-Preventable-Condition-Payment-Policy-11.28.23.pdf
8/14/2025 1:59 PM 72141 Provigil-PA-with-Limit-Policy-178-C-2814-C-UDR-04-2023.pdf
8/14/2025 1:59 PM 30855 Prudoxin-Zonalon-Limit-Post-PA-Policy-3765-HJ-UDR-07-2023.pdf
8/14/2025 1:59 PM 55513 Ranexa-ST-Post-PA-Policy-658-D-UDR-05-2023.pdf
8/14/2025 1:59 PM 26429 Regranex-PA-with-Limit-Policy-186-C-03-2023.pdf
8/14/2025 1:59 PM 131904 Reinstatement-of-PCP-Requirement-for-Select-Services.pdf
8/14/2025 1:59 PM 159143 Reminder-Specialty-Medication-Prior-Authorization-Criteria.pdf
8/14/2025 1:59 PM 147739 Request-for-Claim-Review-New-Terminology.pdf
8/14/2025 1:59 PM 181270 Respiratory-Syncytial-Virus-RSV-Prevention-Update.pdf
8/14/2025 1:59 PM 192246 Rhode-Island-Medicaid-Provider-Screening.pdf
8/14/2025 1:59 PM 203536 Rinvoq-3173-A-SGM-P2023b-1.pdf
8/14/2025 1:59 PM 203480 Rinvoq-3173-A-SGM-P2023b.pdf
8/14/2025 1:59 PM 98592 riociguat-Adempas-1641-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 98592 riociguat-Adempas-1641-A-SGM-P2023.pdf
8/14/2025 1:59 PM 284566 Risk-Adjustment-Coding-Corner.pdf
8/14/2025 1:59 PM 66367 Rosacea-Products-PA-Policy-1486-A-BOG-4915-A-UDR-08-2023.pdf
8/14/2025 1:59 PM 28918 Rydapt-1817-A-SGM-P2023.pdf
8/14/2025 1:59 PM 78647 sapropterin-Javygtor-Kuvan-2012-A-SGM-P2023.pdf
8/14/2025 1:59 PM 71747 Savella-ST-Post-PA-Policy-2557-D-UDR-06-2023.pdf
8/14/2025 1:59 PM 236311 SCIG-2043-A-SGM-P2022.pdf
8/14/2025 1:59 PM 116776 Signifor-2124-A-SGM-P2023.pdf
8/14/2025 1:59 PM 143575 sildenafil-Liqrev-Revatio-1651-A-SGM-P2023.pdf
8/14/2025 1:59 PM 130317 Simponi-2014-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 130344 Simponi-2014-A-SGM-P2023.pdf
8/14/2025 1:59 PM 77743 Simponi-Aria-2015-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 77760 Simponi-Aria-2015-A-SGM-P2023.pdf
8/14/2025 1:59 PM 48125 Sirturo-PA-Policy-923-A-03-2023.pdf
8/14/2025 1:59 PM 144027 Skyrizi-3047-A-SGM-P2023.pdf
8/14/2025 1:59 PM 37175 sodium-oxybate-Lumryz-Xyrem-3677-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 30313 Sodium-phenylbutyrate-products-2121-A-SGM-P2023.pdf
8/14/2025 1:59 PM 72024 Somavert-2097-A-SGM-P2023.pdf
8/14/2025 1:59 PM 36070 sorafenib-Nexavar-2027-A-SGM-P2023.pdf
8/14/2025 1:59 PM 99150 Sovaldi-2141-A-2680-A-SGM-P2022.pdf
8/14/2025 1:59 PM 45775 Sprycel-1782-A-SGM-P2023.pdf
8/14/2025 1:59 PM 161048 Stelara-2010-A-SGM-P2023.pdf
8/14/2025 1:59 PM 240861 Step_Therapy_11.30.23.pdf
8/14/2025 1:59 PM 243897 Step_Therapy_12.15.13.pdf
8/14/2025 1:59 PM 160448 STI-Resources-from-RIDOH.pdf
8/14/2025 1:59 PM 32904 Stivarga-1809-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 38719 sunitinib-Sutent-2022-A-SGM-P2023.pdf
8/14/2025 1:59 PM 62743 Sunosi-PA-with-Limit-Policy-2915-C-UDR-04-2023.pdf
8/14/2025 1:59 PM 99653 Supprelin-LA-1973-A-6052-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 104196 Symdeko-2516-A-SGM-P2023.pdf
8/14/2025 1:59 PM 131704 Synarel-2984-A-3157-A-3158-A-Supplemental-Specialty-PA-P2023a.pdf
8/14/2025 1:59 PM 138641 Tadalafil-Products-1640-A-SGM-P2023.pdf
8/14/2025 1:59 PM 119652 Tafinlar-1683-A-SGM-P2023.pdf
8/14/2025 1:59 PM 114096 Taltz-2013-A-SGM-P2023.pdf
8/14/2025 1:59 PM 108664 Tazorac-PA-Policy-353-A-224-A-UDR-04-2023-1.pdf
8/14/2025 1:59 PM 110689 Tazorac-PA-Policy-353-A-224-A-UDR-04-2023-v2.pdf
8/14/2025 1:59 PM 30304 temozolomide-Temodar-1665-A-SGM-P2023.pdf
8/14/2025 1:59 PM 28463 teriflunomide-Aubagio-1808-A-SGM-P2023.pdf
8/14/2025 1:59 PM 168005 Testosterone-Products-TGC-PA-Policy-1210-A-03-2023.pdf
8/14/2025 1:59 PM 121383 tetrabenazine-Xenazine-2266-A-SGM-P2023.pdf
8/14/2025 1:59 PM 33682 Tetracycline-Capsules-Limit-Post-PA-Policy-4326-HJ-03-2023.pdf
8/14/2025 1:59 PM 114329 Thalomid-2368-A-SGM-P2022.pdf
8/14/2025 1:59 PM 33939 Tobramycin-Inhalation-1887-A-SGM-P2023.pdf
8/14/2025 1:59 PM 18343 tolvaptan-Samsca-2181-A-SGM-P2023.pdf
8/14/2025 1:59 PM 975278 Training_Provider-Mandatory-FINAL-2023.pdf
8/14/2025 1:59 PM 6572341 Training_Provider-Mandatory-FINAL-2023.pptx
8/14/2025 1:59 PM 206060 Transplant-Services-Payment-Policy-11.28.23.pdf
8/14/2025 1:59 PM 105175 Tremfya-2156-A-SGM-P2023.pdf
8/14/2025 1:59 PM 94844 treprostinil-Remodulin-1644-A-SGM-P2023.pdf
8/14/2025 1:59 PM 106219 Tretinoins-Topical-PA-Policy-355-A-237-A-08-2022.pdf
8/14/2025 1:59 PM 139163 Tretinoins-Topical-PA-Policy-355-A-237-A-UDR-08-2023.pdf
8/14/2025 1:59 PM 26860 Treximet-ST-Post-PA-Policy-3020-D-07-2022.pdf
8/14/2025 1:59 PM 76772 Trikafta-3374-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 99887 Triptodur-2504-A-6055-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 76030 Tukysa-3782-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 103746 Tymlos-1826-A-SGM-P2022b.pdf
8/14/2025 1:59 PM 127484 Tysabri-Tyruko-1846-A-SGM-P2023a-1.pdf
8/14/2025 1:59 PM 127490 Tysabri-Tyruko-1846-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 94867 Tyvaso-1650-A-SGM-P2023.pdf
8/14/2025 1:59 PM 140013 UM-ONC_1194-Nexavar-sorafenib_11272023.pdf
8/14/2025 1:59 PM 141612 UM-ONC_1219-Jevtana-cabazitaxel_11272023-.pdf
8/14/2025 1:59 PM 139497 UM-ONC_1222-Erivedge-vismodegib_11272023.pdf
8/14/2025 1:59 PM 145439 UM-ONC_1223-Inlyta-axitinib_11272023.pdf
8/14/2025 1:59 PM 143822 UM-ONC_1224-Kyprolis-carfilzomib_11272023.pdf
8/14/2025 1:59 PM 178023 UM-ONC_1261-Cyramza-ramucirumab_10272023.pdf
8/14/2025 1:59 PM 140996 UM-ONC_1265-Zykadia-ceritinib_11272023.pdf
8/14/2025 1:59 PM 140457 UM-ONC_1276-Onivyde-irinotecan-liposome_11272023.pdf
8/14/2025 1:59 PM 147598 UM-ONC_1280-Darzalex-and-Darzalex-Faspro_11272023.pdf
8/14/2025 1:59 PM 140752 UM-ONC_1281-Empliciti-elotuzumab_11272023.pdf
8/14/2025 1:59 PM 140135 UM-ONC_1335-Braftovi-encorafenib_11272023.pdf
8/14/2025 1:59 PM 141418 UM-ONC_1344-Poteligeo-mogamulizumab-kpkc_11272023.pdf
8/14/2025 1:59 PM 149304 UM-ONC_1379-Enhertu-fam-trastuzumab-deruxtecan-nxki_11272023.pdf
8/14/2025 1:59 PM 138791 UM-ONC_1384-Targretin-bexarotene_11272023.pdf
8/14/2025 1:59 PM 114869 UM-ONC_1391-Thalomid-thalidomide_11272023-.pdf
8/14/2025 1:59 PM 83696 UM-ONC_1394-Genomic-Genetic-Biomarker-Testing_03312023.pdf
8/14/2025 1:59 PM 140346 UM-ONC_1397-Mektovi-binimetinib_11272023.pdf
8/14/2025 1:59 PM 142086 UM-ONC_1405-Retevmo-selpercatinib_11272023.pdf
8/14/2025 1:59 PM 218000 UM-ONC_1419-Danyelza-naxitamab-gqgk_11272023-.pdf
8/14/2025 1:59 PM 141571 UM-ONC_1454-Besremi-ropeginterferon-alfa-2b-nijft_11272023.pdf
8/14/2025 1:59 PM 139506 UM-ONC_1466-Lytgobi-futibatinib_11272023.pdf
8/14/2025 1:59 PM 140104 UM-ONC_1467-Pedmark-sodium-thiosulfate_11272023-.pdf
8/14/2025 1:59 PM 141202 UM-ONC_1487-Aphexda-motixafortide_11272023.pdf
8/14/2025 1:59 PM 149286 UM-ONC_1488-Ojjaara-momelotinib_11272023.pdf
8/14/2025 1:59 PM 182366 Unlisted-Unspecified-Procedure-Code-Billing-Guidelines-11.28.23.pdf
8/14/2025 1:59 PM 184921 Upcoming-Medicaid-Pharmacy-Benefit-Preferred-Therapy-Changes.pdf
8/14/2025 1:59 PM 187700 Upcoming-Pharmacy-Benefit-Changes-for-Inhaler-and-Insulin-Products.pdf
8/14/2025 1:59 PM 186435 Update-to-Neighborhoods-Telemedicine-Telephone-Services-Policy.pdf
8/14/2025 1:59 PM 145029 Updated-Electronic-Payment-and-Remittance-Application-Now-Online.pdf
8/14/2025 1:59 PM 92965 Uptravi-1645-A-SGM-P2023.pdf
8/14/2025 1:59 PM 220424 Valcyte-3100-A-Supplemental-Specialty-PA-P2022.pdf
8/14/2025 1:59 PM 26579 Vecamyl-2992-A-Supplemental-Specialty-PA-P2023.pdf
8/14/2025 1:59 PM 86772 Vemlidy-2901-A-Supplemental-Specialty-PA-P2023.pdf
8/14/2025 1:59 PM 32009 Venclexta-2374-A-SGM-P2023.pdf
8/14/2025 1:59 PM 94073 Ventavis-1648-A-SGM-P2023.pdf
8/14/2025 1:59 PM 28431 Verzenio-2342-A-SGM-P2023a.pdf
8/14/2025 1:59 PM 50033 Vfend-PA-Policy-241-A-01-2023.pdf
8/14/2025 1:59 PM 21246 Viberzi-PA-Policy-1271-A-1287-A-10-2022.pdf
8/14/2025 1:59 PM 34507 vigabatrin-Sabril-Vigadrone-1770-A-SGM-P2023-.pdf
8/14/2025 1:59 PM 18032 Vitrakvi-2799-A-SGM-P2023.pdf
8/14/2025 1:59 PM 23290 Voltaren-Gel-Post-Limit-PA-Policy-1729-J-07-2022.pdf
8/14/2025 1:59 PM 55399 Voltaren-Gel-Post-Limit-PA-Policy-1729-J-UDR-06-2023.pdf
8/14/2025 1:59 PM 91995 Vosevi-2176-A-2683-A-SGM-P2022.pdf
8/14/2025 1:59 PM 34416 Votrient-2009-A-SGM-P2023.pdf
8/14/2025 1:59 PM 50172 Vytorin-10-80-Zocor-80-PA-with-Logic-Policy-981-D-12-2022.pdf
8/14/2025 1:59 PM 32652 Xalkori-1666-A-SGM-P2023.pdf
8/14/2025 1:59 PM 71544 Xeljanz-Xeljanz-XR-2011-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 71567 Xeljanz-Xeljanz-XR-2011-A-SGM-P2023.pdf
8/14/2025 1:59 PM 98806 Xeloda-1993-A-SGM-P2022-1.pdf
8/14/2025 1:59 PM 98806 Xeloda-1993-A-SGM-P2022.pdf
8/14/2025 1:59 PM 95944 Xepi-PA-with-Limit-5466-C-Policy-10-2022.pdf
8/14/2025 1:59 PM 121387 Xolair-1656-A-SGM-P2023.pdf
8/14/2025 1:59 PM 70415 Xtandi-1933-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 70416 Xtandi-1933-A-SGM-P2023.pdf
8/14/2025 1:59 PM 68936 Yonsa-2596-A-SGM-P2023-1.pdf
8/14/2025 1:59 PM 68946 Yonsa-2596-A-SGM-P2023.pdf
8/14/2025 1:59 PM 73765 Zejula-1687-A-SGM-P2022b.pdf
8/14/2025 1:59 PM 61757 Zelboraf-1685-A-SGM-P2023.pdf
8/14/2025 1:59 PM 113003 Zepatier-2145-A-2684-A-SGM-P2022.pdf
8/14/2025 1:59 PM 26736 Zileuton-PA-Policy-4836-A-UDR-04-2023.pdf
8/14/2025 1:59 PM 137927 zoledronic-acid-Reclast-2380-A-SGM-P2022a.pdf
8/14/2025 1:59 PM 87726 zoledronic-acid-Zometa-2382-A-SGM-P2022.pdf
8/14/2025 1:59 PM 17196 Zolinza-1863-A-SGM-P2023.pdf
8/14/2025 1:59 PM 22117 Zydelig-1706-A-SGM-P2022-.pdf
8/14/2025 1:59 PM 25521 Zykadia-1668-A-SGM-P2023.pdf