| Policy |
Policy Name |
Date Posted |
Date Removed |
| ID_CHS_56782026_1026 |
Teplizumab-mzwv (Tzield™) |
08/27/26 |
10/13/26 |
| ID_CHS_24132026a_0926 |
Benralizumab (Fasenra®) |
08/27/26 |
10/13/26 |
| ID_CHS_17002025_1026 |
Brentuximab Vedotin (Adcetris®) |
08/27/26 |
10/13/26 |
| ID_CHS_20042026_1026 |
Vedolizumab (Entyvio®) |
08/27/26 |
10/13/26 |
| ID_CHS_19762026a_1026 |
Ranibizumab (Lucentis®); Ranibizumab-nuna [Byooviz™]; Ranibizumab-eqrn [Cimerli™]; Ranibizumab-leyk [Nufymco™]; Ranibizumab-hkdz [Ranluspec®] |
08/27/26 |
10/13/26 |
| ID_CHS_20242026_1026 |
Aflibercept Products (Eylea®; Eylea®HD, Ahzantive™ [aflibercept-mrbb], Enzeevu™ [Aflibercept-abzv], Eydenzelt® [Aflibercept-boav], Opuviz™ [Aflibercept-yszy], Pavblu™ [Aflibercept-ayyh], and Yesafili™ [Aflibercept-jbvf]) |
08/27/26 |
10/13/26 |
| ID_CHS_18202026c_1026 |
Durvalumab (Imfinzi®) |
08/27/26 |
10/13/26 |
| ID_CHS_18942026b_1026 |
Nivolumab (Opdivo®) |
09/04/26 |
10/13/26 |
| ID_CHS_17962026a_1026 |
Ipilimumab (Yervoy®) |
08/27/26 |
10/13/26 |
| ID_CHS_67952026a_1026 |
Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™) |
08/27/26 |
10/13/26 |
| ID_CHS_75422026_1026 |
Gedatolisib (Revtorpyk™) |
08/27/26 |
10/13/26 |
| ID_CHS_17662026_1026 |
Atezolizumab (Tecentriq®) |
09/04/26 |
10/13/26 |
| ID_CHS_66652026_1026 |
Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza™) |
09/04/26 |
10/13/26 |
| ID_CHS_62902025a_1026 |
Exagamglogene Autotemcel (Casgevy™) |
09/04/26 |
10/13/26 |
| ID_CHS_71362025_1026 |
Multiple Sclerosis Products:(Ocrelizumab [Ocrevus™], Ocrelizumab and Hyaluronidase-ocsq [Ocrevus Zunovo™], Ublituximab-xiiy [Briumvi™]) |
09/04/26 |
10/13/26 |
| ID_CHS_19312025b_1026 |
Pegfilgrastim (Neulasta®); Pegfilgrastim-unne ( Armlupeg® ); Pegfilgrastim-pccg (Ennumo™); Pegfilgrastim-jmdb (Fulphila®); Pegfilgrastim-pbbk (Fylnetra®); Pegfilgrastim-apgf (Nyvepria™); Pegfilgrastim-fpgk (Stimufend®); Pegfilgrastim-cbqv (Udenyca®); Pegfilgrastim-bmez (Ziextenzo™) |
09/04/26 |
10/13/26 |
| ID_CHS_71972026a_1026 |
Pembrolizumab and Berahyaluronidase alfa-pmph (Keytruda Qlex™) |
09/04/26 |
10/13/26 |
| ID_CHS_19002025_1026 |
Pemetrexed (Alimta®; Pemfexy™, Pemetrexed™, Pemrydi RTU, Axtle™) |
09/04/26 |
10/13/26 |
| ID_CHS_18992026a_1026 |
Pertuzumab (Perjeta®); Pertuzumab-dpzb (Poherdy®) |
09/04/26 |
10/13/26 |
| ID_CHS_17042026a_1026 |
Rituximab Oncology Products (Rituxan®, Rituximab-abbs [Truxima®], Rituximab-arrx [Riabni™] and Rituximab-pvvr [Ruxience®]) |
10/02/26 |
10/13/26 |
| ID_CHS_19592026a_1026 |
Tocilizumab (Actemra®); Tocilizumab-anoh (Avtozma®); Tocilizumab-bavi (Tofidence™); Tocilizumab-aazg (Tyenne®), tocilizumab-aazg, tocilizumab-anoh |
09/04/26 |
10/13/26 |
| ID_CHS_20102026_1026 |
Ustekinumab Products: Ustekinumab (Stelara®); Ustekinumab-auub (Wezlana™); Ustekinumab-srlf (Imuldosa™); Ustekinumab-aauz (Otulfi™); Ustenkinumab-ttwe (Pyzchiva™), Ustekinumab-aekn (Selarsdi™); Ustenkinumab-stba (Steqeyma™); Ustenkinumba-kfce (Yesintek™); ustekinumab; ustekinumab-aauz, ustekinumab-stba, ustekinumab-aekn ; ustekinumab-auub; ustenkinumab-ttwe, Ustekinumab-hmny (Starjemza) |
09/04/26 |
10/13/26 |
| ID_CHS_51022026a_1026 |
Efgartigimod Alfa-fcab (Vyvgart®); Efgartigimod Alfa-fcab and Hyaluronidase-qvfc (Vyvgart®Hytrulo) |
09/04/26 |
10/13/26 |
| ID_CHS_36432025a_1026 |
Isatuximab-irfc (Sarclisa®; Sarclisa EscenaTM) |
09/04/26 |
10/13/26 |
| ID_CHS_73342026_1026 |
Etuvetidigene autotemcel (Waskyra®) |
09/04/26 |
10/13/26 |
| DMP0926-01 |
Facet Joint Injections |
09/17/26 |
10/05/26 |
| DMP0926-02 |
Facet Joint Neurotomy |
09/17/26 |
10/05/26 |
| ID_CHS_17042026a_1026 |
Rituximab Products (Rituxan®, Rituximab-abbs [Truxima®], Rituximab-arrx [Riabni™] and Rituximab-pvvr [Ruxience®]), Rituximab-cdxx [Zimrixby™] (Non-Oncology Indications) |
10/02/26 |
10/13/26 |
| ID_CHS_17052026_1126 |
Bendamustine Products (Treanda®, Belrapzo®, Bendeka®, Vivimusta™, Bendamustine) |
10/02/26 |
11/10/26 |
| ID_CHS_60222026_1126 |
Glofitamab-gxbm (Columvi™) |
10/02/26 |
11/10/26 |
| ID_CHS_16752026_1126 |
Avelumab (Bavencio®) |
10/02/26 |
11/10/26 |
| ID_CHS_23852026_1126 |
Axicabtagene Ciloleucel (Yescarta®) |
10/02/26 |
11/10/26 |
| ID_CHS_64762026_1126 |
Nogapendekin alfa inbakicept-pmln (Anktiva ®) |
10/02/26 |
11/10/26 |
| ID_CHS_26592026_1126 |
Patisiran Lipid Complex (Onpattro®) |
10/02/26 |
11/10/26 |
| ID_CHS_17022026_1126 |
Pralatrexate (Folotyn®); Pralatrexate |
10/02/26 |
11/10/26 |
| ID_CHS_60402026_1126 |
Rozanolixizumab‐noli (Rystiggo®) |
10/02/26 |
11/10/26 |
| ID_CHS_22942026_1126 |
Tisagenlecleucel (Kymriah®) |
10/02/26 |
11/10/26 |
| ID_CHS_73182026_1126 |
Onasemnogene Abeparvovec-brve (Itvisma ®) |
10/02/26 |
11/10/26 |
| ID_CHS_17002025_1126 |
Brentuximab Vedotin (Adcetris®) |
10/02/26 |
11/10/26 |
| ID_CHS_66652026a_1126 |
Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza™) |
10/02/26 |
11/10/26 |
| ID_CHS_71972026b_1126 |
Pembrolizumab and Berahyaluronidase alfa-pmph (Keytruda Qlex™) |
10/02/26 |
11/10/26 |
| ID_CHS_69842026_1126 |
Nipocalimab-aahu (Imaavy™) |
10/02/26 |
11/10/26 |
| ID_CHS_39682026a_1126 |
Inebilizumab-cdon (Uplizna™) |
10/02/26 |
11/10/26 |
