Medical Drug Policies

• MDB001 - Aldurazyme® (laronidase)
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• MDB002 - Elaprase® (idursulfase)
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• MDB003 - Elfabrio® (pegunigalsidase alfa)
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• MDB004 - Fabrazyme® (agalsidase)
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• MDB005 - Kanuma® (sebelipase alfa)
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• MDB006 - Lamzede® (velmanase alfa-tycv)
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• MDB007 - Lumizyme® (alglucosidase)
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• MDB008 - Mepsevii® (vestronidase alfa-vjbk)
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• MDB009 - Naglazyme® (galsulfase)
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• MDB010 - Nexviazyme® (avalglucosidase alfa-ngpt)
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• MDB011 - Revcovi® (elapegademase-lvlr)
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• MDB012 - Vimizim® (elosulfase alfa)
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• MDB013 - Xenpozyme™ (olipudase alfa-rpcp)
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• MDB014 - Cerezyme® (imiglucerase)
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• MDB015 - Elelyso® (taliglucerase)
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• MDB016 - Vpriv® (velaglucerase)
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• MDB017 - Cablivi® (caplacizumab-yhdp)
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• MDB018 - Ceprotin® (protein C concentrate [human]
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• MDB019 - Coagadex® (coagulation Factor X [human]
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• MDB020 - Corifact® (Factor XIII Concentrate [human]
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• MDB021 - Enjaymo® (sutimlimab-jome)
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• MDB022 - RiaSTAP® (fibrinogen concentrate [human]
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• MDB023 - Zynteglo™ (betibeglogene autotemcel)
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• MDB024 - Reblozyl® (luspatercept-aamt)
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• MDB025 - Ryplazim® (plasminogen, human-tvmh)
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• MDB026 - Tretten® (coagulation Factor XIII A-Subunit)
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• MDB027 - Vonvendi® (von Willebrand factor)
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• MDB028 - Givlaari™ (givosiran)
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• MDB029 - Panhematin® (hemin)
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• MDB030 - Berinert® (C1 esterase inhibitor )
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• MDB030 - Cinryze® (C1 esterase inhibitor )
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• MDB031 - Haegarda® (C1 esterase inhibitor )
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• MDB030 - Ruconest® (C1 esterase inhibitor )
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• MDB032 - Firazyr® (icatibant )
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• MDV032 - Sajazir™ (icatibant )
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• MDB033 - Kalbitor® (ecallantide )
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• MDB034 - Takhzyro® (lanadelumab-flyo)
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• MDB036 - Sunlenca® (lenacapavir )
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• MDB037 - Trogarzo® (ibalizumab-uiyk )
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• MDB038 - Cinqair® (reslizumab )
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• MDB039 - Fasenra® (benralizumab )
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• MDB040 - Nucala® (mepolizumab)
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• MDB041 - Tezspire® (tezepelumab-ekko)
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• MDB042 - Xolair® (omalizumab)
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• MDB043 - Actemra® (tocilizumab)
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• MDB044 - Cimzia® (certolizumab pegol )
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• MDB045 - Entyvio® (vedolizumab )
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• MDB046 - Ilaris® (canakinumab )
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• MDB047 - Ilumya® (tildrakizumab-asmn )
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• MDB048 - Orencia® (abatacept )
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• MDB049 - Simponi Aria® (golimumab )
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• MDB050 - Skyrizi® (risankizumab-rzaa )
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• MDB051 - Spevigo® (spesolimab-sbzo )
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• MDB052 - Stelara® (ustekinumab )
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• MDB053 - Feraheme® (ferumoxytol)
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• MDB054 - Injectafer® (ferric carboxymaltose )
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• MDB055 - Monoferric® (ferric derisomaltose )
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• MDB056 - Benlysta® (belimumab )
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• MDB057 - Saphnelo™ (anifrolumab-fnia )
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• MDB058 - Imcivree® (setmelanotide subcutaneous )
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• MDB059 - Nulibry™ (fosdenopterin )
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• MDB060 - Oxlumo™ (lumasiran subcutaneous injection )
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• MDB061 - Briumvi™ (ublituximab-xiiy )
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• MDB062 - Lemtrada® (alemtuzumab )
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• MDB063 - Ocrevus® (ocrelizumab )
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• MDB064 - Tysabri® (natalizumab )
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• MDB065 - Amondys 45™ (casimersen )
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• MDB066 - Exondys 51™ (eteplirsen )
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• MDB067 - Viltepso™ (viltolarsen )
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• MDB068 - Vyondys 53™ (golodirsen )
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• MDB070 - Brineura® (cerliponase alfa )
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• MDB071 - Skysona® (elivaldogene autotemcel )
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• MDB072 - Leqembi™ (lecanemab-irmb )
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• MDB074 - Radicava® (edaravone )
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• MDB075 - Vyvgart™ (efgartigimod alfa-fcab )
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• MDB076 - Durysta® (bimatoprost implant)
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• MDB077 - Luxturna® (voretigene neparvovec-rzyl )
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• MDB078 - Izervay™ (avacincaptad pegol intravitreal )
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• MDB079 - Syfovre™ (pegcetacoplan intravitreal injection)
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• MDB080 - Tepezza™ (teprotumumab )
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• MDB081 - Beovu® (brolucizumab intravitreal injection )
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• MDB082 - Eylea® (aflibercept intravitreal injection )
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• MDB083 - Byooviz™ (ranibizumab-nuna intravitreal)
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• MDB084 - Susvimo™ (ranibizumab intravitreal injection)
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• MDB085 - Vabysmo™ (faricimab-svoa intravitreal )
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• MDB086 - Spravato® (esketamine nasal spray)
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• MDB087 - Zulresso® (brexanolone )
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• MDB088 - Flolan® (epoprostenol )
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• MDB088 - Veletri® (epoprostenol )
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• MDB089 - Remodulin® (treprostinil)
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• MDB090 - Acthar® Gel (repository corticotropin)
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• MDB091 - Purified Cortrophin™ Gel (repository corticotropin )
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• MDB092 - Lanreotide subcutaneous injection – Cipla
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• MDB092 - Somatuline® Depot (lanreotide )
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• MDB093 - Lutathera® (lutetium Lu 177 dotatate )
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• MDB094 - Sandostatin® LAR Depot (octreotide acetate )
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• MDB095 - Signifor® LAR (pasireotide )
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• MDB096 - Zolgensma® (onasemnogene abeparvovec-xioi )
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• MDB097 - Spinraza® (nusinersen intrathecal injection )
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• MDB098 - Nulojix® (belatacept )
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• MDB099 - Omisirge® (omidubicel-onlv)
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• MDB100 - Evenity® (romosozumab-aqqg subcutaneous)
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• MDB101 - Boniva® (ibandronate intravenous infusion)
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• MDB102 - Prolia® (denosumab subcutaneous)
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• MDB103 - Xgeva® (denosumab subcutaneous
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• MDB104 - Reclast® (zoledronic acid intravenous infusion
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• MDB105 - Zometa® (zoledronic acid intravenous infusion)
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• MDB106 - Atgam® (lymphocyte immune globulin)
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• MDB107 - Cytogam® (human cytomegalovirus immune globulin intravenous)
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• MDB108 - Immune Globulin - Intravenous
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• MDB109 - Immune Globulin - Subcutaneous
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• MDB110 - Soliris (eculizumab intravenous infusion)
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• MDB111 - Leqvio® (inclisiran subcutaneous injection – Novartis)
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• MDB112 - Xiaflex® (collagenase clostridium histolyticum intralesional injection)
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• MDB113 - Tocilizumab Intravenous Products UM Medical Policy
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