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Pharmacy clinical coverage policies adopted by Humana Healthy Horizons in Ohio

Clinical coverage policies are resources for physicians and other Humana-contracted healthcare professionals providing care to our members enrolled in Humana Healthy Horizons® in Ohio. Humana Healthy Horizons in Ohio has adopted the following pharmacy clinical coverage policies:

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HU-P1001-Abraxane (nab-paclitaxel) 03-13-2024, PDF

HU-P1002-Aduhelm (aducanumab) 03-13-2024, PDF

HU-P1003-Aloxi (palonosetron) 03-13-2024, PDF

HU-P1004-Alpha‐1 Proteinase Inhibitors (Aralast NP, Glassia) 03-13-2024, PDF

HU-P1005-Alpha‐1 Proteinase Inhibitors (Prolastin‐C, Zemaira) 03-13-2024, PDF

HU-P1006-Amvuttra (vutrisiran) 03-13-2024, PDF

HU-P1008-Beovu (brolucizumab) 03-13-2024, PDF

HU-P1009-Bevacizumab products 03-13-2024, PDF

HU-P1010-Bortezomib products (Velcade and Bortezomib for injection) Coversheet 03-13-2024, PDF

HU-P1011-Byooviz (ranibizumab‐nuna) 03-14-2024, PDF

HU-P1012-Carvykti (ciltacabtagene autoleucel) 03-14-2024, PDF

HU-P1013-Corticotropin Products 03-14-2024, PDF

HU-P1015-Enjaymo (sutimlimab‐jome) 03-14-2024, PDF

HU-P1016-Entyvio (vedolizumab) 03-14-2024, PDF

HU-P1019-Fyarro (sirolimus protein‐bound particles) 03-14-2024, PDF

HU-P1021-Inflectra (infliximab‐dyyb) 03-18-2024, PDF

HU-P1022-IVIG Immune Globulin 03-14-2024, PDF

HU-P1024-Kimmtrak (tebentafusp‐tebn) 03-14-2024, PDF

HU-P1025-Korsuva (difelikefalin) 03-14-2024, PDF

HU-P1026-Leqvio (inclisiran) 03-14-2024, PDF

HU-P1027-Levoleucovorin products (Fusilev, Khapzory) 03-14-2024, PDF

HU-P1028-Liposomal doxorubicin 03-14-2024, PDF

HU-P1029-Lucentis (ranibizumab) 03-13-2024, PDF

HU-P1031-Nexviazyme (avalglucosidase‐alfa) 03-18-2024, PDF

HU-P1033-Opdualag (nivolumab and relatlimab‐rmbw) 03-18-2024, PDF

HU-1034-Parsabiv (etelcalcetide) 03-18-2024, PDF

HU-P1035-Pemetrexed Products 03-18-24, PDF

HU-P1036-Pluvicto (lutetium Lu 177 vipivotide tetraxetan) 03-18-2024, PDF

HU-P1039-Rituxan Hycela (rituximab-hyaluronidase) 03-18-2024, PDF

HU-P1040-Rituximab products 03-18-2024, PDF

HU-P1041-Rybrevant (amivantamab) 03-13-2024, PDF

HU-P1042-Rylaze (asparaginase Erwinia chrysanthemi recombinant‐rywn) 03-18-2024, PDF

HU-P1043-Ryplazim (plasminogen, human‐tvmh) 03-18-2024, PDF

HU-P1044-Saphnelo (anifrolumab-fnia) 03-18-2024, PDF

HU-P1046-Somatuline Depot (lanreotide) 03-13-2024, PDF

HU-P1047-Sustol (granisetron) 03-18-2024, PDF

HU-P1048-Susvimo (ranibizumab) 03-18-2024, PDF

HU-P1050-Tivdak (tisotumab vedotin-tftv) 03-18-2024, PDF

HU-P1051-Vabysmo (faricimab‐svoa) 03-18-2024, PDF

HU-P1052-Viscosupplements Coversheet 03-18-2024, PDF

HU-P1054-Vyvgart (efgartigimod alfa‐fcab) 03-18-2024, PDF

HU-P1055-Xipere (triamcinolone acetonide) 03-18-2024, PDF

HU-P1057- Non Preferred Infliximab Products 03-18-2024, PDF

Access Humana Healthy Horizons in Ohio behavioral and physical health clinical coverage policies