Commercial Medical Policies for MedRx

Amyloidosis

• Amvuttra UM Medical Download PDF

Complement Inhibitors

• Eculizumab Products Utilization Management Medical Policy Download PDF

Dermatology

• Ycanth Utilization Management Medical Policy Download PDF

Gonadotropin-Releasing Hormone Agonists

• Implants Utilization Management Medical Policy Download PDF
• Lupron Depot Utilization Management Medical Policy Download PDF

Hematology

• Gene Therapy

  • Casgevy UM Medical Policy Download PDF
  • Lyfgenia UM Medical Policy Download PDF
  • Zynteglo Utilization Management Medical Policy Download PDF

Hemophilia

• Altuviiio UM Medical De-Identified Download PDF
• Factor VIII Products UM Medical De-Identified Download PDF

• Gene Therapy

  • Beqvez UM Medical De-Identified Download PDF
  • Hemgenix UM Medical De-Identified Download PDF

Immunologicals

• Tezspire UM Medical De-Identified Download PDF
• Xolair UM Medical De-Identified Download PDF

Inflammatory Conditions

• Cimzia UM Medical De-Identified Download PDF
• Omvoh Intravenous UM Medical De-Identified Download PDF
• Orencia Intravenous UM Medical De-Identified Download PDF
• Simponi Aria UM Medical De-Identified Download PDF
• Ustekinumab Intravenous Products UM Medical De-Identified Download PDF

Iron Replacement

• Feraheme UM Medical De-Identified Download PDF
• Ferrlecit UM Medical De-Identified Download PDF
• INFeD UM Medical De-Identified Download PDF
• Injectafer UM Medical De-Identified Download PDF
• Monoferric UM Medical De-Identified Download PDF
• Venofer UM Medical De-Identified Download PDF

Metabolic Disorders

• Primary Hyperoxaluria

  • Oxlumo UM Medical De-Identified Download PDF
  • Rivfloza UM Medical De-Identified Download PDF

Oncology (Injectable)

• Bevacizumab Products UM Medical De-Identified Download PDF
• Oncology (Injectable) – Gonadotropin-Releasing Hormone Analogs Download PDF
• Herceptin Hylecta UM Medical De-Identified Download PDF
• Rituxan Hycela UM Medical De-Identified Download PDF

Ophthalmology

• VEGF Inhibitors

  • Susvimo UM Medical De-Identified Download PDF