Zoryve (roflumilast) - Commercial

Prior Authorization

GLP-1 (glucagon-like peptide-1) Agonists - Commercial

Prior Authorization, Quantity Limit

Empaveli (pegcetacoplan) - Commercial

Prior Authorization, Quantity Limit

Biologic Immunomodulators PAQL (For Pharmacy Benefits Only) - Medicaid

Prior Authorization, Quantity Limit

Empaveli (pegcetacoplan) - Medicaid

Prior Authorization, Quantity Limit

Accrufer (ferric maltol) - Medicaid

Prior Authorization, Quantity Limit

Calcitonin Gene-Related Peptide (CGRP) - Commercial

Prior Authorization, Quantity Limit

Glucagon-like Peptide-1 (GLP-1) Agonists - Medicaid

Step Therapy, Quantity Limit

Korlym (mifepristone) - Commercial

Prior Authorization, Quantity Limit

P8-26 New and Updated Reimbursement Policies