P24-22 Update: eviCore Healthcare Specialty Utilization Management (UM) Program – Medical Oncology Drug Prior Authorization Updates

2022 April Bulletins

Blue Plus 2022 Formulary

Tavneos (avacopan) - Commercial

Prior Authorization, Quantity Limit

Opzelura (ruxolitinib) - Commercial

Prior Authorization, Quantity Limit

Zeposia (ozanimod) - Medicaid

Prior Authorization, Quantity Limit

Zeposia (ozanimod) - Commercial

Prior Authorization, Quantity Limit

Xhance - Commercial

Prior Authorization, Quantity Limit

Vesicular Monoamine Transporter 2 (VMAT2) - Medicaid

Prior Authorization, Quantity Limit

Vesicular Monoamine Transporter 2 (VMAT2) - Commercial

Prior Authorization, Quantity Limit