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Draft Provider-Administered Drug Policies

There are currently no policies in draft status.

Comment on Draft Policies 

To ensure that the development of medical policies occurs through an open, collaborative process, we welcome comments about medical policies that are in the draft stage. 

Participating providers are invited to submit scientific, evidence-based information, professional consensus opinions, and other information supported by medical literature relevant to these draft policies for consideration. Comments are accepted for 45 days from the posting date listed on the draft policy.

Make sure your voice is heard by providing feedback directly to us through one of the following methods:

Patrius Health
Attn: Health Management - Medical Policy
P.O. Box 12364
Birmingham, AL 35202-2364
Fax: 205-220-0878

Policy # Policy Title Print View
PH-90310 Tremfya® (guselkumab)
VP-90278 Tecentriq® (atezolizumab)
VP-90378 Poteligeo® (mogamulizumab-kpkc)
VP-90226 Opdivo® (nivolumab)
VP-90209 Keytruda® (pembrolizumab)
PH-90002 Tocilizumab: Actemra®; Tofidence™; Tyenne®; Avtozma®; Tocilizumab-anoh§
VP-90780 Unloxcyt® (cosibelimab-ipdl)
VP-90301 Imfinzi™ (durvalumab) (Intravenous)
VP-90295 Bavencio® (avelumab) (Intravenous)
VP-90363 Akynzeo® (fosnetupitant/palonosetron)
VP-90700 Zynyz™ (retifanlimab-dlwr) (Intravenous)
VP-90778 Ziihera® (zanidatamab-hrii)
VP-90148 Yervoy™ (ipilimumab) (Intravenous)
VP-90314 Vyxeos® (daunorubicin and cytarabine – liposome)
VP-90750 Tevimbra™ (tislelizumab-jsgr)
VP-90320 Mylotarg™ (gemtuzumab ozogamicin)
VP-90735 Loqtorzi™ (toripalimab-tpzi) (Intravenous)
VP-90398 Libtayo® (cemiplimab-rwlc) (Intravenous)
VP-90599 Jemperli® (dostarlimab-gxly)
VP-90683 Imjudo® (tremelimumab-actl) (Intravenous)
VP-90336 Cinvanti® (aprepitant)
PH-90036 Fosaprepitant: Emend®; Fosaprepitant Ψ; Focinvez Ψ
PH-90673 Xenpozyme® (olipudase alfa)
PH-90141 VPRIV® (velaglucerase alfa)
PH-90190 Vimizim (elosulfase alfa)
PH-90034 Elaprase® (idursulfase)
PH-90114 Eculizumab: Soliris®; Bkemv™; Epysqli®
PH-90027 Cerezyme® (imiglucerase)
PH-90299 Brineura (cerliponase alfa)
PH-90006 Aldurazyme® (laronidase)
PH-90594 Nulibry™ (fosdenopterin)
PH-90767 Niktimvo™ (axatilimab-csfr)
PH-90696 Lamzede® (velmanase alfa-tycv)
PH-90277 Kanuma® (sebelipase alfa)
PH-90708 Elfabrio® (pegunigalsidase alfa-iwxj)
PH-90052 Alpha-1-Proteinase Inhibitors: Aralast NP®; Glassia®; Prolastin®-C; Zemaira®
PH-90736 Adzynma® (ADAMTS13, recombinant-krhn)
PH-90017 Benlysta® (belimumab)
PH-90463 Sublocade (buprenorphine ER injection)
PH-90793 Encelto™ (revakinagene taroretcel-lwey)
PH-90614 Saphnelo® (anifrolumab-fnia)
PH-90731 Pombiliti® (cipaglucosidase alfa-atga)
PH-90615 Nexviazyme® (avalglucosidase alfa-ngpt)
PH-90084 Naglazyme® (galsulfase)
PH-90346 Mepsevii® (vestronidase alfa-vjbk)
PH-90079 Lumizyme® (alglucosidase alfa)
PH-90042 Fabrazyme® (agalsidase beta)
PH-90105 Elelyso™ (taliglucerase alfa)
PH-90751 Lenmeldy™ (atidarsagene autotemcel)
PH-90298 Ocrevus™ (ocrelizumab)
PH-90694 Leqembi™ (lecanemab-irmb)
PH-90117 Ustekinumab: Stelara®; Wezlana™; Selarsdi™; Pyzchiva®; Otulfi™; Imuldosa®; Yesintek™; Steqeyma®; Ustekinumab-aekn§
PH-90713 Elevidys® (delandistrogene moxeparvovec-rokl)
VP-90200 Sylvant® (siltuximab) (Intravenous)
VP-0612 Rylaze® (asparaginase Erwinia chrysanthemi (recombinant)-rywn)
VP-90100 Provenge® (sipuleucel-T)
VP-90001 Paclitaxel Albumin-Bound: Abraxane®; Paclitaxel Albumin-Bound Ψ
VP-90522 Enhertu® (fam-trastuzumab deruxtecan-nxki)
VP-90074 Cabazitaxel: Jevtana®; Cabazitaxel§
VP-90014 Bevacizumab: Avastin®; Mvasi®; Zirabev®; Alymsys®; Vegzelma®; Avzivi®
VP-0785 Datroway® (datopotamab deruxtecan-dlnk)
VP-90766 Lymphir™ (denileukin diftitox-cxdl)
VP-90007 Pemetrexed: Alimta®; Pemfexy™; Pemrydi RTU®; Pemetrexed Ψ
VP-90057 Trastuzumab: Herceptin®; Ogivri®; Kanjinti®; Trazimera™; Herzuma®; Ontruzant®
PH-90634 Susvimo™ (ranibizumab)
PH-90176 Simponi ARIA® (golimumab)
PH-90714 Rystiggo® (rozanolixizumab-noli)
PH-90091 Orencia® (abatacept)
PH-90721 Izervay™ (avacincaptad pegol)
PH-90104 Infliximab: Remicade®; Inflectra™; Renflexis™; Avsola™, Infliximab*
PH-90421 Gamifant™ (emapalumab-lzsg)
PH-90202 Entyvio® (vedolizumab)
PH-90229 Cosentyx® (secukinumab)
PH-90028 Cimzia® (certolizumab pegol)
PH-90649 Vyvgart™ (efgartigimod alfa-fcab)
PH-90137 Velcade (bortezomib)
PH-90674 Spevigo® (spesolimab)
PH-90671 Skyrizi® (risankizumab-rzaa)
PH-90712 Vyvgart® Hytrulo (efgartigimod alfa-fcab and hyaluronidase-qvfc)
PH-90659 Vabysmo™ (faricimab-svoa)
PH-90358 Ilumya™ (tildrakizumab-asmn)
PH-90688 Hemgenix® (etranacogene dezaparvovec-drlb)
PH-90481 Spravato® (esketamine)
PH-90579 Oxlumo® (lumasiran)
PH-90514 Givlaari (givosiran)
PH-90598 Abecma® (idecabtagene vicleucel)