Commercial Medical Policies for MedRx

Amyloidosis

• Amvuttra UM Medical De-IdentifiedDownload PDF

Botulinum Toxins

• Botox UM Medical De-IdentifiedDownload PDF

Complement Inhibitors

• PiaSky UM Medical De-IdentifiedDownload PDF
• Soliris UM Medical De-IdentifiedDownload PDF
• Ultomiris UM Medical De-IdentifiedDownload PDF
• Veopoz UM Medical De-IdentifiedDownload PDF

Erythropoiesis-Stimulating Agents (ESA)

• Aranesp UM Medical De-Identified Download PDF
• Epoetin Alfa Products UM Medical De-Identified Download PDF

Gaucher Disease

• Enzyme Replacement Therapy

  • Cerezyme UM Medical De-IdentifiedDownload PDF
  • Elelyso UM Medical De-IdentifiedDownload PDF
  • Vpriv UM Medical De-IdentifiedDownload PDF

Hematology

• Gene Therapy

  • Casgevy UM Medical De-IdentifiedDownload PDF
  • Zynteglo UM Medical De-IdentifiedDownload PDF

Hemophilia

Gene Therapy

• Roctavian UM Medical De-IdentifiedDownload PDF

Immune Globulin

• Intravenous UM Medical De-IdentifiedDownload PDF

Immunologicals

• Nucala UM Medical De-IdentifiedDownload PDF

Inflammatory Conditions

• Cimzia UM Medical De-IdentifiedDownload PDF
• Cosentyx Intravenous UM Medical De-IdentifiedDownload PDF
• Entyvio Intravenous UM Medical De-IdentifiedDownload PDF
• Etanercept Products PA Policy_de-identifiedDownload PDF
• Ilumya UM Medical De-IdentifiedDownload PDF
• Infliximab Intravenous Products UM Medical De-IdentifiedDownload PDF
• Omvoh Intravenous UM Medical De-IdentifiedDownload PDF
• Orencia Intravenous UM Medical De-IdentifiedDownload PDF
• Simponi Aria UM Medical De-IdentifiedDownload PDF
• Skyrizi Intravenous UM Medical PolicyDownload PDF
• Stelara Intravenous UM Medical PolicyDownload PDF
• Stelara Subcutaneous PA Policy with Dosing De-identifiedDownload PDF
• Tocilizumab Intravenous Products UM Medical De-Identified Download PDF
• Tocilizumab Subcutaneous Products PA Policy De-identified Download PDF
• Tremfya Intravenous UM Medical De Identified Download PDF
• Zymfentra PA Policy De-identified Download PDF

Multiple Sclerosis

• Ocrevus Zunovo UM Medical De-Identified Download PDF

Multiple Sclerosis and Crohn's Disease

• Tysabri UM Medical De-Identified Download PDF

Neurology

• Rystiggo UM Medical De-Identified Download PDF
• Vyvgart Hytrulo UM Medical De-Identified Download PDF
• Vyvgart Intravenous UM Medical De-Identified Download PDF

Oncology (Injectable)

• Phesgo UM Medical De-Identified Download PDF
• Trastuzumab Products UM Medical De-Identified Download PDF

Rituximab Intravenous Products UM Medical De-IdentifiedDownload PDF