We periodically update our pharmacy coverage guidelines to give you the most up-to-date drug 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)
• Hepatitis C Medications Coverage Guidelines (PDF)
• Humira Coverage Guidelines (PDF)
• Remicade Coverage Guidelines (PDF)
• Simponi Coverage Guidelines (PDF)
• Stelara Coverage Guidelines (PDF)
• Synagis Coverage Guidelines (PDF)
• Vivitrol Coverage Guidelines (PDF)

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