Policy Bulletins
The Policy Bulletins on this website were developed to assist participating providers in administering and understanding the provisions of benefits.
To access a policy, select the corresponding link below:
- Abaloparatide/Teriparatide
- Actinic Keratosis agents and Zyclara®
- Acute Seizure Activity Agents
- Adjunctive Treatment for Parkinson’s Disease
- Allergen Specific Immunotherapy (SL)
- Alpelisib (Vijoice®)
- Amikacin Liposome Inhalation Suspension (Arikayce®)
- Amifampridine (Firdapse®)
- Androgens
- Antigout Agents
- Applicable Age Edits
- Avacopan (Tavneos™)
- Aztreonam (Cayston®)
- Becaplermin (Regranex®) Gel
- Belimumab (Benlysta®)/Voclosporin (Lupkynis™)
- Belumosudil (Rezurock™)
- Blood Modifier Agents
- Budesonide (Tarpeyo™)
- Carglumic Acid (Carbaglu®)
- Cenegermin-bkbj (Oxervate™)
- Chelation Agents
- Cholesterol Lowering Agents
- Cholic Acid (Cholbam®)
- Compounded Products
- Continuous Glucose Monitor
- Cushing’s Disease Agents
- Cyanocobalamin Inhalation (Nascobal®)
- Cyclosporine (Verkazia®)
- Cysteamine-Containing Products
- Cystic Fibrosis Agents (Kalydeco®, Orkambi®, Symdeko®)
- Dalfampridine (Ampyra®)
- Deflazacort (Emflaza®)
- Dextromethorphan Hydrobromide and Quinidine Sulfate (Nuedexta®)
- Dichlorphenamide (Keveyis®)
- Diclofenac Products
- Doxycycline IR/ER (Oracea®)
- Doxylamine/pyridoxine (Diclegis®, Bonjesta®)
- Droxidopa (Northera®)
- Drugs Exceeding Claim Dollar Limit Threshold
- Dupilumab (Dupixent®)
- Edaravone (Radicava® ORS)
- Elagolix, estradiol, and norethindrone acetate (Oriahnn®)/Relugolix, estradiol and norethindrone acetate (Myfembree®)
- Elagolix sodium (Orilissa™)
- Epinephrine Pen
- Fabry Disease Agents
- Finerenone (Kerendia®)
- Formulary Exception
- Fosdenopterin (Nulibry™)
- Fostemsavir (Rukobia), Enfuvirtide (Fuzeon)
- Gabapentin (Gralise/Horizant)/Pregabalin (Lyrica CR)
- Ganaxolone (Ztalmy®)
- Gaucher Disease Agents
- Glucagon-like Peptide-1 (GLP-1) Receptor Agonist
- Glycerol Phenylbutyrate (Ravicti®)
- Glycopyrrolate (Dartisla ODT™)
- Glycopyrronium Topical (Qbrexza™)
- Growth Hormones
- Heart Failure Agents
- Hemophilia Agents
- Hepatitis C
- Hereditary Angioedema Agents
- Hereditary Tyrosinemia Agents
- Hypoactive Sexual Desire Disorder (HSDD) Agents
- Icosapent ethyl (Vascepa®)
- Immune modulating therapies
- Insulin Human, Inhalation (Afrezza)
- Insulin Policy
- Interferon gamma-1b (Actimmune®)
- Interim Clinical Policy
- Interleukin-5 (IL-5) Antibody Agents
- Interstitial Lung Disease Agents
- Intranasal Corticosteroids
- Lonafarnib (Zokinvy™)
- Mannitol (Bronchitol®)
- Maralixibat (Livmarli®)
- Mavacamten (Camzyos™)
- Mecasermin (Increlex™)
- Metabolic Disorders Agents (Strensiq®, Xuriden®)
- Metreleptin (Myalept®)
- Migraine and Headache Agents
- Mitapivat (Pyrukynd®)
- New Jersey Formulary Exception
- New Jersey Infant Formula Mandate
- New Jersey Medications with Therapeutic Alternatives
- Obeticholic Acid (Ocaliva®)
- Octreotide products
- Odevixibat (Bylvay™)
- Off-Label Use
- Omalizumab (Xolair®)
- Oncology Agents
- Onychomycosis Agents
- Opioid Policy
- Oral Anti–infective
- Oteseconazole (Vivjoa™)
- Oxymetazoline (Upneeq™)
- Parathyroid Hormone (Natpara®)
- Peanut Immunotherapy (Palforzia®)
- Pegcetacoplan (Empaveli™)
- Pegvaliase-pqpz (Palynziq™)
- Pegvisomant (Somavert®)
- Pentosan Polysulfate (Elmiron®)
- Phenoxybenzamine (Dibenzyline®)
- Pilocarpine (Vuity™)
- Pimavanserin (Nuplazid®)
- Prior Authorization Requirements for Select Drugs
- Proton Pump Inhibitors
- Pulmonary Hypertension agents
- Quantity Level Limits for Pharmaceuticals Covered Under the Pharmacy Benefit
- Rifaximin (Xifaxan®)
- Risiplam (Evrysdi™)
- Ruxolitinib (Opzelua™)
- Sacrosidase (Sucraid®)
- Sapropterin dihydrochloride (Kuvan®, Javygtor®)
- Satralizumab (Enspryng®)
- Seizure Disorder Agents
- Setmelanotide (Imcivree™)
- Sickle Cell Agents
- Sinecatechins (Veregen®)
- Sirolimus (Hyftor™)
- Sleep Agents
- Sodium Oxybate (Xyrem®), Calcium, Magnesium, Potassium and Sodium Oxybate (Xywav™)
- Sodium Phenylbutyrate and Taurursodiol (Relyvrio™)
- Stimulant Policy
- Teduglutide (Gattex®)
- Telotristat Ethyl (Xermelo™)
- Tolvaptan (Samsca®, Jynarque®)
- Transthyretin Amyloidosis Agents
- Triheptanoin (Dojolvi®)
- VMAT2 Inhibitors
- Vosoritide (Voxzogo™)
- Wakefulness Promoting Agents
- Weight Loss Agents