Clinical pharmacy policies

Drug coverage policies linked below are based on medical necessity considerations subject to applicable benefits. The documents linked below assist with medical necessity coverage decisions, may include state-specific guidance regarding coverage and do not constitute medical advice. Benefit determination is based on the applicable contract language and/or state requirements.

These policies are not a guarantee of coverage. Contract language or state requirements will prevail when there are conflicts with any medication coverage policy. In all cases, Medicaid contracts or CMS requirements supersede policy criteria.