Ambetter Pharmacy Policy Updates

Date: 04/01/26

HIM Policy Updates

New policies effective 06/01/2026

Effective	Number	Title	Revision Log
6/1/2026	CP.PCH.61	Abaloparatide (Tymlos)	Policy created per March SDC [adapted from CP.PHAR.345].
6/1/2026	CP.PCH.62	Teriparatide (Forteo, Bonsity)	Policy created per March SDC [adapted from CP.PHAR.188].
6/1/2026	CP.PHAR.771_PEPP	Dalnacogene Ponparvovec (BBM-H901)_PEPP	Policy created pre-emptively.
6/1/2026	CP.PHAR.772_PEPP	Doruxapapogene Ralaplasmid (INO-3107)_PEPP	Policy created pre-emptively.
6/1/2026	CP.PHAR.773_PEPP	Veligrotug (VRDN-001)_PEPP	Policy created pre-emptively.
6/1/2026	CP.PHAR.774_PEPP	Vusolimogene Oderparepvec (RP1)_PEPP	Policy created pre-emptively.
6/1/2026	CP.PHAR.775	Sibeprenlimab-szsi (Voyxact)	Policy created
6/1/2026	CP.PHAR.776_PEPP	Gefurulimab (ALXN1720)_PEPP	Policy created pre-emptively
6/1/2026	CP.PMN.307	Tradipitant (Nereus)	Policy created.