| | Policy # | | | Policy Bulletin Title | |
|---|
 |  | | | | Abatacept (Orencia®) for injection for intravenous use | |
| | | | | Agalsidase beta (Fabrazyme®) | |
| | | | | Alglucosidase alfas, rhGAA (Myozyme®, Lumizyme®) | |
| | | | | Alpha 1-Proteinase Inhibitor Therapy (eg, Prolastin, Aralast, Aralast NP, Glassia, Zemaira) | |
| | | | | Belatacept (Nulojix®) | |
| | | | | Belimumab (Benlysta®) | |
| | | | | Bendamustine Hydrochloride (Treanda®) | |
|  | | | | Bevacizumab (Avastin®) | |
| | | | | Bortezomib (Velcade®) | |
| | | | | Botulinum Toxin Agents | |
| | | | | C1 Esterase Inhibitors (Human): Cinryze® and Berinert® | |
| | | | | Cabazitaxel (Jevtana®) | |
| | | | | Cetuximab (Erbitux®) | |
| | | | | Coagulation Factors for Hemophilia | |
| | | | | Complex Regional Pain Syndrome (CRPS) Parenteral Treatments | |
| | | | | Denosumab (Prolia™, Xgeva™) | |
| | | | | Dofetilide (Tikosyn®) Use in the Inpatient Setting | |
| | | | | Ecallantide (Kalbitor®) | |
| | | | | Eculizumab (Soliris®) | |
| | | | | Enzyme Replacement for the Treatment of Gaucher's Disease (eg, Alglucerase [Ceredase®], Imiglucerase [Cerezyme®], Velaglucerase Alpha [VPRIV™]). | |
| | | | | Epoprostenol (Flolan®) and Treprostinil (Remodulin®) | |
| | | | | Eribulin Mesylate (Halaven™) | |
| | | | | Erythropoiesis-Stimulating Agents (ESAs) | |
| | | | | Human Papillomavirus (HPV) Vaccine(s) | |
| | | | | Hydroxyprogesterone Caproate Injection as a Technique to Reduce the Risk of Preterm Birth in High-Risk Pregnancies | |
| | | | | Ibandronate Sodium (Boniva®) for Intravenous Injection | |
| | | | | Idursulfase (Elaprase™) | |
| | | | | Immune Globulin: Intravenous (IVIG), Subcutaneous (SCIG) | |
| | | | | Immune Prophylaxis for Respiratory Syncytial Virus (RSV) | |
| | | | | Infliximab (Remicade®) | |
| | | | | Inpatient Administration of Intravenous Dihydroergotamine Mesylate (D.H.E. 45®) | |
| | | | | Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (eg, ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], and aflibercept [Eylea®]) | |
| | | | | Ipilimumab (Yervoy®) | |
| | | | | Laronidase (Aldurazyme®) | |
| | | | | Medical Foods, Low-Protein Modified Food Products, Enteral Nutrition, and Nutritional Formulas | |
| | | | | Medicare Part B vs. Part D Crossover Drugs | |
| | | | | Natalizumab (Tysabri®) | |
| | | | | Nesiritide (Natrecor®) | |
| | | | | Ofatumumab (Arzerra™) | |
| | | | | Off-label Coverage for Prescription Drugs and Biologics | |
| | | | | Omalizumab (Xolair®) | |
| | | | | Oxaliplatin (Eloxatin®) | |
| | | | | Paclitaxel Protein-bound Particles for Injectable Suspension (Albumin-bound)/(Abraxane® for Injectable Suspension) | |
| | | | | Pamidronate Disodium (Aredia®) for Intravenous Infusion | |
| | | | | Pegloticase (Krystexxa®) | |
| | | | | Pemetrexed (Alimta®) | |
| | | | | Plerixafor Injection (Mozobil™) | |
| | | | | Pralatrexate (Folotyn®) for Injection | |
| | | | | Preventive Immunization | |
| | | | | Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) | |
| | | | | Radioimmunotherapy with Tositumomab and Iodine I-131 Tositumomab (the Bexxar® Therapeutic Regimen) | |
| | | | | Risperidone (Risperdal® Consta®) Injection | |
| | | | | Rituximab (Rituxan®) | |
| | | | | Romidepsin (Istodax®) | |
|  | | | | Self-Injectable Drugs | |
 | | | | | Attachment A | |
| | | | | Sipuleucel-T (Provenge®) | |
| | | | | Temozolomide (Temodar®) for Injection | |
| | | | | Tocilizumab (Actemra®) | |
| | | | | Total Parenteral Nutrition (TPN)/Intradialytic Parenteral Nutrition (IDPN) | |
| | | | | Trastuzumab (Herceptin®) | |
| | | | | Ustekinumab (Stelara™) for Subcutaneous Injection | |
| | | | | Zoledronic Acid (Zometa®, Reclast®) | |