Pharmacy & Specialty Drugs policy updates
Track new and updated Pharmacy & Specialty Drugs policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Clinical Policy: Gedatolisib (Revtorpyk) | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Dec 1, 2026 |
| Clinical Policy: Oveporexton (Orzeyful) | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Dec 1, 2026 |
| Centanafadine (Simtriyo) Coverage Criteria | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Dec 1, 2026 |
| Tebipenem Pivoxil (Utebzi) Coverage Criteria | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Dec 1, 2026 |
| Clinical Policy: Infusion Therapy Site of Care Optimization | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2025 |
| Fitusiran (Qfitlia) Coverage and Prior Authorization | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Mar 28, 2025 |
| Zenocutuzumab-zbco (Bizengri) Coverage Criteria | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Mar 1, 2025 |
| Clinical Policy: Tislelizumab-jsgr (Tevimbra) | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Sep 1, 2024 |
| Icosapent Ethyl (Vascepa) | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Mar 1, 2019 |
| 96-hour Emergency Supply Of Medication | Ambetter Nevada | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2017 |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
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Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.