Policy # Policy Title Print View
VP-0004 Adcetris® (brentuximab vedotin) (Intravenous)
VP-0007 Alimta® (pemetrexed) (Intravenous)
VP-0008 Aloxi® (palonosetron) (Intravenous)
VP-0036 Emend® (fosaprepitant dimeglumine) (Intravenous)
VP-0038 Erbitux® (cetuximab) (Intravenous)
VP-0043 Faslodex® (fulvestrant) (Intramuscular)
VP-0057 Herceptin® (trastuzumab) (Intravenous)
VP-0071 Immune Globulins (immunoglobulin) (Intravenous)
VP-0092 Kadcyla® (ado-trastuzumab emtansine) (Intravenous)
VP-0096 Perjeta® (pertuzumab) (Intravenous)
VP-0100 Provenge® (sipuleucel-T) (Intravenous)
VP-0109 Rituxan® (rituximab) (Intravenous)
VP-0136 Vectibix® (panitumumab) (Intravenous)
VP-0157 Kyprolis® (carfilzomib) (Intravenous)
VP-0161 Zaltrap® (ziv-aflibercept) (Intravenous)
VP-0199 Cyramza™ (ramucirumab) (Intravenous)
VP-0208 Arzerra® (ofatumumab) (Intravenous)
VP-0234 Colony Stimulating Factors: Neulasta® (pegfilgrastim) (Subcutaneous)
VP-0235 Colony Stimulating Factors: Neupogen® (filgrastim) (Subcutaneous/Intravenous)
VP-0236 Colony Stimulating Factors: Granix® (tbo-filgrastim) (Subcutaneous/Intravenous)
VP-0237 Colony Stimulating Factors: Leukine® (sargramostim) (Subcutaneous/Intravenous)
VP-0245 Colony Stimulating Factors: Zarxio™ (filgrastim-sndz) (Subcutaneous/Intravenous)
VP-0268 Empliciti™ (elotuzumab) (Intravenous)
VP-0283 Sustol® (granisetron extended-release) (Subcutaneous)
VP-0301 Imfinzi™ (durvalumab) (Intravenous)
VP-0317 Besponsa (inotuzumab ozogamicin) (Intravenous)
VP-0319 Kymriah (tisagenlecleucel) (Intravenous)
VP-0320 Mylotarg (gemtuzumab ozogamicin) (Intravenous)
VP-0322 Rituxan Hycela™ (rituximab and hyaluronidase human) (Subcutaneous)
VP-0333 Yescarta™ (axicabtagene ciloleucel) (Intravenous)
VP-0336 Cinvanti™ (aprepitant) (Intravenous)
VP-0363 Akynzeo® (fosnetupitant/palonosetron) (Intravenous)
VP-0370 Colony Stimulating Factors: Fulphila™ (pegfilgrastim-jmdb) (Subcutaneous)
VP-0375 Colony Stimulating Factors: Nivestym™ (filgrastim-aafi) (Subcutaneous/Intravenous)
VP-0409 Colony Stimulating Factors: Udenyca™ (pegfilgrastim-cbqv) (Subcutaneous)
VP-0415 Truxima® (rituximab-abbs) (Intravenous)
VP-0431 Herzuma® (trastuzumab-pkrb) (Intravenous)
VP-0432 Ontruzant® (trastuzumab-dttb) (Intravenous)
VP-0449 Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) (Subcutaneous)
VP-0451 Trazimera™ (trastuzumab-qyyp) (Intravenous)
VP-0462 Ogivri™ (trastuzumab-dkst) (Intravenous)
VP-0482 Polivy™ (polatuzumab vedotin-piiq) (Intravenous)
VP-0483 Kanjinti™ (trastuzumab-anns) (Intravenous)
VP-0484 Zirabev™ (bevacizumab-bvzr) (Intravenous)
VP-0486 Ruxience® (rituximab-pvvr)