Welcome to the Clinical Criteria Page

This page provides the clinical criteria documents for all injectable, infused, or implanted prescription drugs and therapies covered under the medical benefit. The effective dates for using these documents for clinical reviews are communicated through the Provider notification process.
 
The clinical criteria information is alphabetized in the table below.

Development of clinical criteria

All clinical criteria are developed to help guide clinically appropriate use of drugs and therapies and are reviewed and approved by the Pharmacy and Therapeutics (P&T) Committee. The P&T Committee is an independent and external committee including practicing physicians, pharmacists, and clinicians from leading academic medical centers and clinical practices with expertise in evidence-based medicine. All major clinical specialties are represented.
 
If you have questions or feedback, please contact druglist@carelon.com.
 
 
Clinical Criteria
Associated Medications (as applicable) Document Number Coding
Abecma (idecabtagene vicleucel) CC-0195 C9081, J3490, J3590, J9999, Q2055
Abraxane (paclitaxel, protein bound) CC-0099 J9258, J9259, J9264
Actimmune (interferon gamma-1b) CC-0085 J9216
Adakveo (crizanlizumab) CC-0153 J0791
Aduhelm (aducanumab) CC-0200 J0172
Adzynma (ADAMTS13, recombinant-krhn) CC-0252 J7171
Aphexda (motixafortide) CC-0253 J2277
Givlaari (givosiran) CC-0154 J0223
Adcetris (brentuximab vedotin) CC-0092 J9042
Leqembi (lecanemab) CC-0228 J0174
Sunlenca (lenacapavir) CC-0229 J1961
Agents for Hemophilia A and von Willebrand Disease Antihemophilic Factor (Human) [Hemofil-M, Koate/Koate-DVI]. Antihemophilic Factor (Recombinant) [Advate, Afstyla, Kogenate FS, Kovaltry, Novoeight, Nuwiq, Recombinate, Xyntha/Xyntha Solofuse]. Antihemophilic Factor (Recombinat [Pegylated]) [Adynovate, Jivi]. Antihemophilic Factor (Recombinat Fc Fusion Protein) - Eloctate. Antihemophilic Factor (Recombinat Glycopegylated) - Esperoct. Antihemophilic Factor (Recominat Fc-VWF-XTEN Fusion Protein-ehtl) - Altuviiio. Antihemophilic Factor (bispecific) [Hemlibra (emicizumab-kxwh)]. Antihemophilic Factor (Recombinant [Porcine Sequence]) [Obizur]. Antihemophilic Factor/von Willebrand Factor Complex (Human) [Alphanate, Humate-P, Wilate]. von Willebrand factor (Recombinant) [Vonvendi]. CC-0065 J7190, J7182, J7185, J7192, J7204, J7209, J7210, J7211, J7205, J7207, J7208, J7214, J7188, J7191, J7183, J7186, J7187, J7179, J7170
Agents for Hemophilia B Factor IX (Human) [Alphanine SD, Mononine. Factor IX Complex (Human) [(Factors II, IX, X)] [Profilnine SD]. Factor IX (Recombinant) [Benefix, Ixinity, Rixubis]. Factor IX (Recombinant [Albumin Fusion Protein]) [Idelvion]. Factor IX (Recombinant [Fc Fusion Protein]) [Alprolix]. Factor IX (Recombinant [Glycopegylated]) [Rebinyn]. CC-0148 J7193, J7194, J7195, J7200 J7201, J7202, J7203, J7213
Iron Agents Feraheme (ferumoxytol), Ferrlecit (sodium ferric gluconate/sucrose complex), Infed (iron dextran), Injectafer (ferric carboxymaltose), Monoferric (ferric derisomaltose), Triferic/Triferic AVNU (ferric pyrophosphate citrate), Venofer (iron sucrose) CC-0182 J1443, J1445, J1437, Q0138, J2916, J1750, J1756, J1439
Akynzeo (fosnetupitant and palonosetron) for Iinjection CC-0074 J1454
Aldurazyme (laronidase) CC-0025 J1931, S9357
Aliqopa (copanlisib) CC-0133 J9057
Amtagvi (lifleucel) CC-0259 J3490, J3590
Amondys 45 (casimersen) CC-0189 J1426
Alpha-1 Proteinase Inhibitor Therapy Aralast, Glassia, Prolastin-C, Zemaira CC-0073 J0256, J0257
Aristada Initio (aripiprazole lauroxil) CC-0083 J1943
Arzerra (ofatumumab) CC-0122 J9302
Asparagine Specific Enzymes Asparlas (calaspargase pegol-mknl), Oncaspar (pegaspargase), Erwinaze (asparaginase [erwinia chrysanthemi]) , Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn) CC-0096 J9019, J9020, J9021, J9266, J9118
Bavencio (avelumab) CC-0129 J9023
Beleodaq (belinostat) CC-0176 J9032
Bendamustine Agents Belrapzo, Bendeka, Treanda, Vivimusta CC-0116 J9036, J9033, J9034, J9056, J9058, J9059
Benlysta (belimumab) CC-0028 J0490
Besponsa (inotuzumab ozogamicin) CC-0131 J9229
BESREMi (ropeginterferon alfa-2b-njft) CC-0206 J3490, J3590, J9999, C9399
Beta Interferons and Glatiramer Acetate for Treatment of Multiple Sclerosis Avonex (interferon beta-1a), Plegridy (peginterferon beta-1a), Rebif (interferon beta-1a), Betaseron (interferon beta-1b), Extavia (interferon beta-1b), Copaxone (glatiramer acetate), Glatopa (glatiramer acetate) CC-0014 C9399, J1595, J1826, J1830, J3490, Q3027, Q3028, S9559
Bevacizumab for Non-ophthalmologic Indications Avastin, Alymsys, Avzivi, Mvasi, Vegzelma, Zirabev CC-0107 J3490, J3590, J9035, Q5107, Q5118, Q5126, Q5129
Beyfortus (nirsevimab) CC-0247 90380, 90381, 96380, 96381
Blincyto (blinatumomab) CC-0126 J9039
Botulinum Toxin Botox (OnabotulinumtoxinA),Daxxify (daxibotulinumtoxinA-lanm), Xeomin (IncobotulinumtoxinA), Dysport (AbobotulinumtoxinA), Myobloc (RimabotulinumtoxinB) CC-0032 31573, 46505, 52287, 64647, 67345, 46505, 64611, 64612, 64615, 64616,
64617, 64642, 64643, 64644, 64645,
64646, 64647, 64650, 64653, J0585,
J0586, J0587, J0588, J0589, S2340, S2341
Breyanzi (lisocabtagene maraleucel) CC-0187 Q2054
Brineura (cerliponase alfa) CC-0012 J0567
Cabenuva (cabotegravir extended-release; rilpivirine extended-release) injection CC-0194 J0741
Cablivi (caplacizumab-yhdp) CC-0137 J3590, C9047
Colony Stimulating Factor Agents Elfapegrastim agents (Rolvedon). Elbemalenograstim agents (Ryzneuta). Filgrastim agents (Neupogen, Nivestym, Nypozi, Releuko, Zarxio, Granix). Pegfilgrastim agents (Neulasta/Neulasta Onpro, Fulphila, Fylnetra, Nyvepria, Stimufend, Udenyca/Udenyca Onbody, Ziextenzo). Sargramostim agents (Leukine, Prokine). CC-0002 96377, C9399, J3590, J1442, J1447, J1449, J2506, J2820, J9361, Q5101, Q5108, Q5110, Q5111, Q5120, Q5122, Q5125, Q5127, Q5130
Columvi (glofitamab-gxbm) CC-0244 J9286
Cosela (trilaciclib) CC-0192 J1448
Anktiva (nogapendekin alfa inbekicept-pmln) CC-0264 J9999, C9169
Imdelltra (tarlatamab-dlle) CC-0263 J9999, C9170
Complement C5 Inhibitors Piasky (crovalimab-akkz), Soliris (eculizumab), Ultomiris (ravulizumab-cwvz) CC-0041 J1300, J1303, J3590
Crysvita (burosumab-twza) CC-0081 J0584
Cyramza (ramucirumab) CC-0123 J9308
Danyelza (naxitamab-gqgk) CC-0184 J9348
Darzalex (daratumumab), Darzalex Faspro (daratumumab and hyaluronidase-fihj) Darzalex (daratumumab), Darzalex Faspro (daratumumab and hyaluronidase-fihj) CC-0127 J9145, J9144
Denosumab agents Prolia, Jubbonti, Xgeva, Wyost CC-0027 J0897, J3590, Q5136
Dihydroergotamine (DHE) injection CC-0052 J1110
Docetaxel Taxotere CC-0093 J9171, J9172
Doxorubicin liposome Doxil CC-0098 Q2050
Drug dosage, frequency, and route of administration CC-0136
Duopa (carbidopa and levodopa enteral suspension) CC-0035 J7340
Dupixent (dupilumab) CC-0029 C9399, J3590
Durysta (bimatoprost implant) CC-0163 J7351
Egrifta (tesamorelin) CC-0069 J3490, J3590
Elahere (mirvetuximab) CC-0226 J9063
Elaprase (idursulfase) CC-0024 J1743, S9357
Elzonris (tagraxofusp-erzs) CC-0088 J9269
Empaveli (pegcetacoplan) CC-0199 J3490, C9399
Empliciti (elotuzumab) CC-0117 J9176
Enhertu (fam-trastuzumab deruxtecan-nxki) CC-0158 J9358
Enjaymo (sutimlimab-jome) CC-0210 J1302
Enspryng (satralizumab-mwge) CC-0173 J3490, J3590, C9399
Entyvio (vedolizumab) CC-0071 J3380, J3590
Enzyme Replacement Therapy for Gaucher Disease Cerezyme (imiglucerase), Elelyso (taliglucerase), Vpriv (velaglucerase) CC-0051 J1786, J3060, J3385, S9357
Erbitux (cetuximab) CC-0106 J9055
Erythropoiesis Stimulating Agents Aranesp (darbepoetin alfa), Epogen (epoetin alfa), Mircera (methoxy polyethylene glycol-epoetin beta), Procrit (epoetin alfa), Retacrit (epoetin alfa-epbx) CC-0001 J0881, J0882, J0885, Q4081, J0887, J0888, Q4081, Q5105, Q5106 , EA, EB
EC
Spevigo (spesolimab-sbzo) CC-0221 J1747
Xenpozyme (olipudase alfa) CC-0220 J0218
Evenity (romosozumab-aqqg) CC-0139 J3111
Evkeeza (evinacumab) CC-0193 J1305
Exondys 51 (eteplirsen) CC-0044 J1428
Ethyol (amifostine) CC-0155 J0207
Fabrazyme (agalsidase beta) CC-0021 J0180, S9357
Faslodex (fulvestrant) CC-0103 J9393, J9394, J9395
Fuzeon (enfuvirtide) CC-0055 J1324
Fyarro (sirolimus albumin bound) CC-0205 J9331
GamaSTAN [(immune globulin (human)] GamaSTAN, GamaSTAN S/D CC-0039 90281, J1460, J1560,
Gamifant CC-0087 J9210
Gazyva (obinutuzumab) CC-0121 J9301
Gonadotropin Releasing Hormone Analogs for oncologic indications Camcevi (leuprolide mesylate), Firmagon (degarelix), Zoladex (goserelin acetate), Eligard (leuprolide acetate), Lupron Depot (leuprolide acetate), and Trelstar, Trelstar LA (triptorelin pamoate) CC-0102 J1950, J9202, J9218, S9560, J3315, J9155, J9217, J9225, J1675, J1950, J3315, J9155, J9202, J1952
Gonadotropin Releasing Hormone Analogs for the treatment of non-oncologic indications Fensolvi (leuprolide acetate), Zoladex (goserelin acetate), Supprelin LA (histrelin acetate), Lupron Depot/Depot-Ped (leuprolide acetate), Synarel Nasal Spray (nafarelin acetate), Triptodur (triptorelin pamoate extended-release) CC-0061 J1675, J3316, J9202, J9226, S9560, J1950, J1951, J9217, J9218, J1954
Growth hormone Somatropin: Genotropin, Humatrope, Norditropin, Nutropin AQ, Omnitrope, Saizen, Serostim, Zomacton,Zorbtive; Somapacitan-beco: Sogroya; Somatrogon-ghla: NGENLA. Lonapegsomatropin-tcgd: Skytrofa CC-0068 J2940, J2941, S9558, J3490, J3590, C9399
Repository Corticotropin Injection Acthar Gel, Purified Cortrophin Gel CC-0004 J0800 ,J0801, J0802
Halaven (eribulin) CC-0108 J9179
Hereditary Angioedema Agents Cinryze, Haegarda, Berinert: [C1 Inhibitor (Human)], Ruconest [C1 Inhibitor (Recombinant)], Takhzyro (lanadelumab-flyo), Icatibant (Firazyr, Sajazir), Kalbitor (ecallantide) CC-0034 J0593, J0596, J0597, J0598, J1290, J1744, J0599
Human Parathyroid Hormone Bonsity, (teriparatide), Forteo (teriparatide),Tymlos (abaloparatide) CC-0038 J3490, C9399, J3110
Hyaluronan Injections Durolane, Euflexxa, Gel-One, Gel-Syn, GenVisc, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz/FX, Synojoynt, Synvisc/-One, Triluron, TriVisc, Visco-3 CC-0006 J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332
Hyaluronan Injections - Step Therapy and Quantity Limit - MEDICARE ONLY Durolane, Euflexxa, Gel-One, Gen-Syn, GenVisc, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz/FX, Sodium hyaluronate , Synvisc/-One, Triluron, TriVisc, Visco-3 CC-0005 J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329 , J7331, J7332
iDoseTR (travoprost implant) CC-0258 J7355
Imcivree (setmelanotide) CC-0188 J3590, C9399
Imfinzi (durvalumab) CC-0130 J9173
Imjudo (tremelimumab-actl) CC-0223 J9347
Immunoglobulins Immune Globulin: Asceniv, Alyglo, Bivigam, Carimune NF, Cutaquig, Cuvitru, Flebogamma DIF. Gammagard, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Hizentra, Hyqvia, Octagam, Panzyga, Privigen, Xembify, Yimmugo CC-0003
90283, 90284, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1576, J1599, J3590, S9338
Rytelo (imetelstat) CC-0266 C9399, J9999
Increlex (mecasermin) CC-0045 J2170
Infertility Agents and HCG Agents Menopur (menotropins), Follistim AQ (follitropin beta), Gonal-f/RFF (follitropin beta), Pregnyl, Novarel: Chorionic Gonadotropin (Human), Ovidrel (Chorionic Gonadotropin (Recombinant), Cetrotide (cetrorelix), Ganirelix, Lupron Depot (leuprolide acetate), Crinone 8% gel, Endometrin vaginal insert, progesterone CC-0015 J9217, J0725, J1950, J3490, J8499, S0122, S0126, S0128, S0132
Hydroxyprogesterone caproate CC-0238 J1729
Qalsody (tofersen) CC-0237 J1304
Interleukin-1 Inhibitors Arcalyst (rilonacept), Ilaris (canakinumab,; Kineret (anakinra) CC-0064 J2793, J0638, J3490, J3590
Intravitreal Corticosteroid Implants Iluvien (fluocinolone acetonide intravitreal), Retisert (fluocinolone acetonide intravitreal), Yutiq (fluocinolone acetonide intravitreal), Ozurdex (dexamethasone intravitreal implant) CC-0031 J7314, 67027, J7311, 08H033Z, 08H133Z, 67028, J7313, 67028, J7312
Istodax (romidepsin) Istodax CC-0100 J9318, J9319
Ixempra (ixabepilone) CC-0090 J9207
Izervay (avacincaptad pegol) CC-0245 J2782
Jelmyto (mitomycin) CC-0164 J9281
Jemperli (dostarlimab-gxly) CC-0197 J9272
Jevtana (cabazitaxel) CC-0114 J9043, J9064
Kadcyla (ado-trastuzumab) CC-0115 J9354
Kanuma (sebelipase alfa) CC-0037 J2840
Revcovi (elapegademase-lvlr) CC-0235 J3590, C9399
Signifor LAR (pasireotide) CC-0236 J2502
Kesimpta (ofatumumab) CC-0174 J3490, J3590, C9399
Keytruda (pembrolizumab) CC-0124 J9271
Kimmtrak (tebentafusp-tebn) CC-0211 J9274
Krystexxa (pegloticase) CC-0057 J2507
Kymriah (tisagenlecleucel) CC-0150 0537T, 0538T, 0539T, 0540T, Q2042
Kyprolis (carfilzomib) CC-0120 J9047
Lemtrada (alemtuzumab) for Treatment of Multiple Sclerosis CC-0009 J0202
Levoleucovorin Agents Fusilev, Khapzory CC-0104 J0641, J0642
Libtayo (cemiplimab-rwlc) CC-0145 J9119
Loqtorzi (toripalimab-tpzi) CC-0255 J3263
Lumoxiti (moxetumomab pasudotox-tdfk) CC-0144 J9313
Margenza (margetuximab-cmkb) CC-0186 J9353
Melanoma Vaccines Imlygic (talimogene laherparepvec), other melanoma vaccines CC-0135 J9325, J3590
Mepsevii (vestronidase alfa) CC-0013 J3397
Monjuvi (tafasitamab-cxix) CC-0180 J9349
Monoclonal Antibodies to Interleukin-17 Bimzelx (bimekizumab-bkzx), Cosentyx (secukinumab), Siliq (brodalumab), Taltz (ixekizumab) CC-0042 C9399, J3490, J3590, J3247
Monoclonal Antibodies to Interleukin-23 Ilumya (tildrakizumab-asmn), Omvoh (mirikizumab-mrkz), Skyrizi (risankizumab-rzaa), Tremfya (guselkumab) CC-0050 J1628, J3245, J2327, J2267
Monoclonal Antibodies to Interleukin-5 Cinqair (reslizumba), Fasenra (benralizumab), Nucala (mepolizumab) CC-0043 J0517, J2182, J2786
Monoclonal Antibodies to Interleukin-6 Actemra (tocilizumab), Tofidence (tocilizumab-bavi), Tyenne (tocilizumab-aazg), Kevzara (sarilumab) CC-0066 J3262, C9399, J3490, J3590, Q5133, Q0249
Mozobil (plerixafor) CC-0089 J2562
Mylotarg (gemtuzumab ozogamicin) CC-0132 J9203
Naglazyme (galsulfase) CC-0023 J1458, S9357
Naltrexone Implantable Pellets CC-0036 11981, 11983, 17999, 22999, 49999, J3490, J7999
Natalizumab Agents Tysabri (natalizumab), Tyruko (natalizumab-sztn) CC-0020 J2323, Q5134
Nexobrid (anacaulase-bcdb) CC-0260 J7353
Nplate (romiplostim) CC-0111 J2796
Nulibry (fosdenopterin) CC-0190 J3490, J3590, C9399
Nulojix (belatacept) CC-0076 J0485
Ocrevus (ocrelizumab), Ocrevus Zunovo (ocrelizumab/hyaluronidase-ocsq) Ocrevus (ocrelizumab), Ocrevus Zunovo (ocrelizumab/hyaluronidase-ocsq) CC-0011 J2350, J3590
Octreotide Agents Sandostatin, Sandostatin LAR Depot CC-0058 J2353, J2354
Off Label Drug and Approved Orphan Drug Use CC-0141
Onpattro (patisiran) CC-0082 J0222
Opdivo (nivolumab) CC-0125 J9299
Orencia (abatacept) CC-0078 J0129
Oxlumo (lumasiran) CC-0185 J0224
Padcev (enfortumab vedotin-ejfv) CC-0157 J9177
Palynziq (pegvaliase-pqpz) CC-0077 C9399, J3590
Pedmark (sodium thiosulfate injection) CC-0224 J0208
Pemetrexed Agents Alimta, Pemfexy, Pemrydi CC-0094 J9304, J9305, J9314, J9322, J9323, J9324, J9294, J9296, J9297
Perjeta (pertuzumab) CC-0110 J9306
Phesgo (pertuzumab/trastuzumab/hyaluronidase-zzxf) CC-0169 J9316
Polivy (polatuzumab vedotin-piiq) CC-0143 J9309
Pompe Disease Lumizyme (alglucosidase alfa), Nexviazyme (avalglucosidase alfa-ngpt), Pombiliti (cipaglucosidase alfa-atga) CC-0018 J0219, J0221, J1203, S9357
Prialt (ziconotide) CC-0040 J2278
Proleukin (aldesleukin) CC-0175 J9015
Proprotein Convertase Subtilisin Kexin 9 (PCSK9) Inhibitors Praluent (alirocumab), Repatha (evolocumab) CC-0010 C9399, J3490, J3590
Prostacyclin Infusion and Inhalation Therapy Flolan (epoprostenol), Remodulin (treprostinil), Tyvaso (treprostinil), Veletri (epoprostenol), Ventavis (iloprost) CC-0067 J1325, J3285, J7686, K0455, Q4074, S0155, S9347
Provenge (sipuleucel-T) CC-0134 Q2043
Radicava (edaravone) CC-0049 J1301
Radioimmunotherapy and Somatostatin Receptor Targeted Radiotherapy Azedra (iobenguane I 131), Lutathera (lutetium Lu 177 dotatate), Pluvicto (lutetium Lu 177), Zevalin (ibritumomab tiuxetan) CC-0118 A9543, 79403, 79101, A9513, A9590, A9607
Reblozyl (luspatercept) CC-0156 J0896
Relizorb (immobilized lipase) cartridge CC-0198 B4105
Rituximab agents for Non-Oncologic Indications Rituxan, Riabni, Ruxience, Truxima CC-0075 J9312, Q5115, Q5119, Q5123
Rituximab agents for Oncologic Indications Rituxan, Riabni, Ruxience, Truxima CC-0167 J9312, Q5115, Q5119, Q5123
Rivfloza (nedosiran) CC-0256 J3490
Sarclisa (isatuximab-irfc) CC-0161 J9227
Selected Injectable 5HT3 Antiemetic Agents Aloxi injection (palonosetron) CC-0056 J2469
Selected Injectable NK-1 Antiemetic Agents Cinvanti injection (aprepitant), Emend injection (fosaprepitant), Focinvez (fosaprepitant) CC-0059 J1453, J1456, J0185, C9145, J1434
Vascular Endothelial Growth Factor (VEGF) Inhibitors Avastin, Alymsys, Mvasi, Vegzelma, Zirabev (bevacizumab, bevacizumab-maly, bevacizumab-awwb, bevacizumab-bvzr, bevacizumab-adcd), Lucentis (ranibizumab), Byooviz (ranibizumab-nuna), Cimerli (ranibizumab-cqrn), Eylea (aflibercept), Eylea HD (aflibercept), Beovu (brolucizumab-dbll), Vabysmo (faricimab-svoa) CC-0072 Q5118, C9257, J9035, Q5107, J2778, J0177, J0178, J0179, Q5124, J2777, Q5126, Q5128, Q5129
Scenesse (afamelanotide) CC-0159 J7352
Spinraza (nusinersen) CC-0048 96450, J2326
Spravato (esketamine) CC-0086 G2082, G2083, S0013
Ustekinumab Stelara (ustekinumab), Selarsdi (ustekinumab-aekn), Wezlana (ustekinumab-auub) CC-0063 J3357, J3358, Q5137, Q5138
Strensiq (asfotase alfa) CC-0079 J3490
Sylvant (siltuximab) CC-0113 J2860
Synagis (palivizumab) CC-0007 90378, S9562
Synribo (omacetaxine mepesuccinate) CC-0178 J9262
Talvey (talquetamab-tgvs) CC-0249 J3055
Tecartus (brexucabtagene autoleucel) CC-0168 Q2053
Tecentriq (atezolizumab) CC-0128 J9022
Tecvayli (teclistamab-cqyv) CC-0222 J9380
Select Clotting Agents for Bleeding Disorders FEIBA [Anti-inhibitor Coagulant Complex (Human)], Coagadex [Factor X (Human)], Novoseven RT, SevenFact [Factor VIIa (Recombinant)], Corifact [Factor XIII Concentrate (Human)], Tretten [Factor XIII A-Subunit (Recombinant)], RiaSTAP, Fibryga: [Fibrinogen Concentrate (Human)] CC-0149 J7198, J7189, J7175, J7180 , J7181, J7177, J7178, J7189, J7212
Tegsedi (inotersen) CC-0084 J3490, C9399
Tepezza (teprotumumab-trbw) CC-0162 J3241
Tezspire (tezepelumab-ekko) CC-0212 J2356
Somatuline Depot (lanreotide) CC-0142 J1930, J1932
Subcutaneous Hormonal Implants Testopel (testosterone), estrogen containing implants CC-0008 11980, S0189, J3490
Testosterone, Injectable Depo-Testosterone (testosterone cypionate), Xyosted (testosterone enanthate), Aveed (testosterone undecanoate) CC-0026 J1071, J3121, J3145
Tevimbra (tislelizumab-jsgr) CC-0262 J9329
Torisel (temsirolimus) CC-0101 J9330
Trastuzumab Agents Herceptin (trastuzumab), Hercessi (trastuzumab-strf), Herzuma (trastuzumab-pkrb), Kanjinti (trastuzumab-anns), Ogivri (trastuzumab-dkst), Ontruzant (trastuzumab-dttb), Trazimera (trastuzumab-qyyp), Herceptin Hylecta (trastuzumab; hyaluronidase-oysk) CC-0166 J9356, J9355, J3590, Q5113, Q5117 Q5114, Q5112, Q5116
Trodelvy (sacituzumab govitecan) CC-0165 J9317
Trogarzo (ibalizumab-uiyk) CC-0047 J1746
Tumor Necrosis Factor Antagonists Adalimumab agents (Humira, Adalimumab unbranded, Abrilada, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Simlandi, Yuflyma, Yusimry), Certolizumab pegol (Cimzia), Etanercept agents (Enbrel, Erelzi, Eticovo), Golimumab (Simponi, Simponi Aria), Infliximab agents (Remicade, Infliximab unbranded, Avsola, Inflectra, Ixifi, Renflexis, Zymfentra) CC-0062 J0135, J0717, J1438, J1602, J1745, J1748, J3590, Q5103, Q5104, Q5109, Q5121, Q5131, Q5132, S9359 , J3490
Tzield (teplizumab-mzwv) CC-0225 J9381
Uplizna (inebilizumab-cdon) CC-0170 J1823
Vectibix (panitumumab) CC-0105 J9303
Velcade (bortezomib) CC-0095 J9041, J9044, J9046, J9048, J9049, J9051
Veopoz (pozelimab-bbfg) CC-0250 J9376
Vidaza (azacitidine) CC-0097 J9025
Viltepso (viltolarsen) CC-0172 J1427
Vimizim (elosulfase alfa) CC-0022 J1322, S9357
Voxzogo (vosoritide) CC-0213 J3490, C9399
Vyepti (eptinezumab) CC-0160 J3032
Vyondys 53 (golodirsen) CC-0152 J1429
Xiaflex (clostridial collagenase histolyticum) injection CC-0017 20527, 26341, J0775
Xofigo (Radium Ra 223 Dichloride) CC-0112 A9606, 79101
Xolair (omalizumab) CC-0033 J2357
Ycanth (cantharidin) CC-0251 J7354
Yervoy (ipilimumab) CC-0119 J9228
Yescarta (axicabtagene ciloleucel) CC-0151 0537T, 0538T, 0539T, 0540T, Q2041
Zaltrap (ziv-aflibercept) CC-0109 J9400
Zepzelca (lurbinectedin) CC-0171 J9223
Zilretta (triamcinolone acetonide extended-release) CC-0177 J3304
Zilbrysq (zilucoplan) CC-0254 J3490
Zinplava (bezlotoxumab) CC-0046 J0565, 96413, 96365
Adstiladrin (nadofaragene firadenovec-vncg) CC-0230 J9029
Lamzede (velmanase alfa-tycv) CC-0231 J0217
Lunsumio (mosunetuzumab-axgb) CC-0232 J9350
Rebyota (fecal microbiota, live – jslm) CC-0233 J1440
Syfovre (pegcetacoplan) CC-0234 J2781
Zoledronic Acid Reclast, Zoledronic acid 4mg CC-0019 J3489
Zulresso (brexanolone) CC-0140 J1632
Zynlonta (loncastuximab tesirine-lpyl) CC-0196 J9359
Rybrevant (amivantamab-vmjw) CC-0201 J9061
Ryplazim (plasminogen, human-tvmh) CC-0203 J2998
Rystiggo (rozanolixizumab-noli) CC-0246 J9333
Saphnelo (anifrolumab-fnia) CC-0202 J0491
Tivdak (tisotumab vedotin-tftv) CC-0204 J9273
Adbry (tralokinumab) CC-0208 J3490, J3590, C9399
Leqvio (inclisiran) CC-0209 J1306
Vyvgart (efgartigimod alfa-fcab), Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) Vyvgart (efgartigimod alfa-fcab), Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) CC-0207 J9332, J9334
Carvykti (ciltacabtagene autoleucel) CC-0214 Q2056
Opdualag (nivolumab and relatlimab-rmbw) CC-0216 J9298
Ketamine injection (Ketalar) CC-0215 J3490
Amvuttra (vutrisiran) CC-0217 J0225
Xipere (triamcinolone acetonide injectable suspension) CC-0218 67516, J3299
Korsuva (difelikefalin acetate) CC-0219 J0879
Briumvi (ublituximab) CC-0227 J2329
Zynyz (retifanlimab-dlwr) CC-0240 J9345
Elfabrio (pegunigalsidase alfa-iwxj) CC-0241 J2508
Elrexfio (elranatamab-bcmm) CC-0248 J1323
Epkinly (epcoritamab-bysp) CC-0242 J9321
Vyjuvek (beremagene geperpavec) CC-0243 J3401
Wainua (eplontersen) CC-0257 J3490, C9399
Winrevair (sotatercept-csrk) CC-0261 J3590, C9399
Kisunla (donanemab-azbt) CC-0265 J0175
Ebglyss (lebrikizumab-lbkz) CC-0267 C9399, J3590
Lymphir (denileukin diftitox-cxdl) CC-0268 C9399, J9999
Nemluvio (nemolizumab-ilto) CC-0269 C9399, J3590
Niktimvo (axatilmab-csfr) CC-0270 C9399, J3590
Tecelra (afamitresgene autoleucel) CC-0271 C9399, J9999