Lumaktaw papuntang pangunahing content


Parmasya

The management of outpatient prescription drugs is an integral part of the medical management program to improve the health and well-being of our members.

Search for a drug using our online tool. You can also view or print the PDL.

Printed Preferred Drug Lists

Coverage Determination Requests

Request a coverage decision and/or exception or file an appeal of a drug coverage decision.

Maximum Allowable Cost prices

Mga Form ng Parmasya

This is a prior authorization form for Zubsolv treatment.

Pharmacy Clinical Policies

Hydroxyprogesterone caproate (Makena®/compound) is a progestin.

Eculizumab (Soliris®) is a complement inhibitor.

Mogamulizumab-kpkc (Poteligeo®) is a CC chemokine receptor type 4 (CCR4)-directed monoclonal antibody.

The following are factor VIII products requiring prior authorization: human – Hemofil M®, Koate-DVI®; recombinant – Advate®, Adynovate®, Afstyla®, Eloctate®, Esperoct®, Helixate FS®, Jivi®, Kogenate FS®, Kogenate FS with Vial Adapter®, Kogenate FS with Bio-Set®, Kovaltry®, NovoEight®, Nuwiq®, Obizur®, Recombinate®, ReFacto®, Xyntha®, and Xyntha® Solofuse™.

Factor VIIa, recombinant (NovoSeven® RT) and coagulation factor VIIa (recombinant)-jncw (SevenFact®) are coagulation factors.

AbobotulinumtoxinA (Dysport®) is an acetylcholine release inhibitor and a neuromuscular blocking agent.

IncobotulinumtoxinA (Xeomin®) is an acetylcholine release inhibitor and a neuromuscular blocking agent.

OnabotulinumtoxinA (Botox®) is an acetylcholine release inhibitor and a neuromuscular blocking agent.

RimabotulinumtoxinB (Myobloc®) is an acetylcholine release inhibitor and a neuromuscular blocking agent.

Eteplirsen (Exondys 51™) is an antisense oligonucleotide.

Ocrelizumab (Ocrevus™) is a CD20-directed cytolytic antibody.

Cerliponase alfa (Brineura®) is a hydrolytic lysosomal N-terminal tripeptidyl peptidase.

Edaravone (Radicava™) is a member of the substituted 2-pyrazolin-5-one class that acts as a free-radical scavenger of peroxyl radicals and peroxynitrite.

Testosterone pellet (Testopel®) is an implantable androgen. Testosterone undecanoate (Jatenzo®) is an oral androgen.

Tisagenlecleucel (Kymriah™) is a CD19-directed, genetically modified, autologous T-cell immunotherapy.

Axicabtagene ciloleucel (Yescarta™) is a CD19-directed, genetically modified, autologous T-cell immunotherapy.

Voretigene neparvovec-rzyl (Luxturna™) is an adeno-associated virus vector-based gene therapy.

Ibalizumab-uiyk (Trogarzo™) is a CD4-directed post-attachment human immunodeficiency virus type 1 (HIV-1) inhibitor.

Patisiran (Onpattro™) is a double-stranded small interfering ribonucleic acid, formulated as a lipid complex for delivery to hepatocytes.

Ravulizuamb-cwvz (Ultomiris®) is a complement inhibitor.

Caplacizumab-yhdp (Cablivi®) is a von Willebrand factor (vWF)-directed antibody fragment.

Elapegademase-lvlr (Revcovi®) is a recombinant adenosine deaminase.

Onasemnogene abeparvovec (Zolgensma®) is an adeno-associated virus (AAV) vector-based gene therapy.

Trientine (Syprine®) is a chelating agent.

Crizanlizumab-tmca (Adakveo®) is a selectin blocker.

Golodirsen (Vyondys 53TM) is an antisense oligonucleotide.

Inebilizumab-cdon (Uplizna ™ ) is an anti-CD19 monoclonal antibody.

Belantamab mafodotin (Blenrep®/™ ) is an anti-B-cell maturation antigen (BCMA) monoclonal antibody and microtubule inhibitor conjugate.

Icon ng Makipag-ugnayan sa Amin

Kailangan ng tulong? Narito kami para sa iyo.

Makipag-ugnayan sa Amin
Last Updated On: 5/11/2021
Medicare Members: Your materials are on the way! We realize you may be waiting to receive some plan materials and we apologize for any delays. Did you know you can go online to our member portal to view Member materials, review your benefits, request or download an ID card, or choose a physician (when applicable)? Log in or register today!
×