Provider
Zoryve (roflumilast) - Commercial
Prior Authorization
Program effective Date: Jan 01, 2026
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Provider
Vtama (tapinarof) - Commercial
Prior Authorization
Program effective Date: Jan 01, 2026
Provider
Zeposia (ozanimod) - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Jan 01, 2026
Provider
Triptans - Commercial
Step Therapy, Quantity Limit
Program effective Date: Jan 01, 2026
Provider
Topical Corticosteroids - Commercial
Step Therapy, Quantity Limit
Program effective Date: Jan 01, 2026
Provider
Urea Cycle Disorders - Commercial
Prior Authorization
Program effective Date: Jan 01, 2026
Provider
Topical NSAID - Commercial
Step Therapy, Quantity Limit
Program effective Date: Jan 01, 2026
Provider
Topical Actinic Keratosis, Basal Cell Carcinoma, Genital Wart Agents - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Jan 01, 2026
Provider
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors and Combinations - Commercial
Step Therapy, Quantity Limit
Program effective Date: Jan 01, 2026
Provider
Corticotropin - Commercial
Prior Authorization
Program effective Date: Jan 01, 2026