We periodically update our coverage guidelines to give you the most up-to-date medical and pharmacy benefit coverage criteria. 

• Amevive Coverage Guidelines (PDF)
• Botox, Dysport and Myobloc Coverage Guidelines (PDF)
• Cimzia Coverage Guidelines (PDF)
• Enbrel Coverage Guidelines (PDF)
• Gilenya Coverage Guidelines (PDF)
• Humira Coverage Guidelines (PDF)
• Proton Pump Inhibitor Coverage Guidelines (PDF)
• Remicade Coverage Guidelines (PDF)
• Selective Serotonin Reuptake Inhibitors Coverage Guidelines (PDF)
• Simponi Coverage Guidelines (PDF)
• Stelara Coverage Guidelines (PDF)
• Synagis Coverage Guidelines (PDF)
• Vivitrol Coverage Guidelines (PDF)

Adherence to our coverage guidelines does not guarantee coverage if the medical or pharmacy benefit is not part of a member’s benefit plan. Please verify a member's eligibility and if we cover a medical or pharmacy benefit under the member's benefit plan.