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GLP-1 (glucagon-like peptide-1) Agonists - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Jul 01, 2026
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Cibinqo (abrocitinib) - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Jul 01, 2026
Provider
Erectile Dysfunction - Phosphodiesterase Type 5 Inhibitors, Topical Prostaglandin - Commercial
Quantity Limit
Program effective Date: Jul 01, 2026
Provider
Familial Chylomicronemia Syndrome - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Jul 01, 2026
Provider
Growth Hormone - Commercial
Prior Authorization
Program effective Date: Jul 01, 2026
Provider
Lyrica (pregabalin) Savella (milnacipran) - Commercial
Step Therapy, Quantity Limit
Program effective Date: Jul 01, 2026
Provider
Interstitial Lung Disease - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Jul 01, 2026
Provider
Interleukin-4 (IL-4) Inhibitors - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Jul 01, 2026
Provider
Jynarque - Commercial
Prior Authorization, Quantity Limit
Program effective Date: Jul 01, 2026
Provider
Insomnia Agents - Commercial
Step Therapy, Quantity Limit
Program effective Date: Jul 01, 2026