Medical Benefit Updates Table

      Code Description PA Coverage Criteria J9144 INJECTION, DARATUMUMAB, 10MG AND HYALURONIDASE-FIHJ Approval is determined by medical necessity criteria Q5108 INJECTION, PEGFILGRASTIMJMDB, BIOSIMILAR, (FULPHILA), 0.5 MG   Q5110 INJECTION, FILGRASTIM-AAFI, BIOSIMILAR, (NIVESTYM), 1 MCG   Q5111 INJECTION, PEGFILGRASTIMCBQV, BIOSIMILAR, (UDENYCA), 0.5 MG   Q5101 INJECTION, FILGRASTIM-SNDZ, BIOSIMILAR, (ZARXIO), 1 MCG   J1447 INJECTION, […]

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Irbesartan & Irbesartan/Hctz Recall – IMMEDIATE ACTION NEEDED Table

        Product Lot No NDC Distribution Dates Irbesartan Tablets USP, 75mg H000843, H805727, H901579 68180-410-06(30’s 10/20/2018 12/03/2020   H000844, H000964, H804311, H805267, H805268, H805269, H805725, H805726, H901497, H901577, H901578, H902258 68180-410-09(90’s   Irbesartan Tablets USP, 150mg H804403, H805251, H805640, H901580 68180-411-06(30’s     H804492, H805252, H805253, H805641, H805642, H805643, H901581, H902139, H902140 […]

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