Policy # Policy Title Print View
VP-0008 Aloxi® (palonosetron) (Intravenous)
VP-0014 Bevacizumab: Avastin®; Mvasi™; Zirabev™ (Intravenous)
VP-0036 Emend® (fosaprepitant dimeglumine) (Intravenous)
VP-0043 Faslodex® (fulvestrant) (Intramuscular)
VP-0057 Trastuzumab: Herceptin®; Ogivri™; Kanjinti™; Trazimera™; Herzuma™; Ontruzant™ (Intravenous)
VP-0071 Immune Globulins (immunoglobulin) (Intravenous)
VP-0089 Nplate™ (romiplostim) (Subcutaneous)
VP-0100 Provenge® (sipuleucel-T) (Intravenous)
VP-0109 Rituximab: Rituxan®, Truxima®, Ruxience® (Intravenous)
VP-0208 Arzerra® (ofatumumab) (Intravenous)
VP-0235 Colony Stimulating Factors: Filgrastim (Neupogen®); Filgrastim-aafi (Nivestym™); Filgrastim-sndz (Zarxio™); Tbo-Filgrastim (Granix®) (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-0257 Yondelis® (trabectedin) (Intravenous)
VP-0283 Sustol® (granisetron extended-release) (Subcutaneous)
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-0375 Colony Stimulating Factors: Nivestym™ (filgrastim-aafi) (Subcutaneous/Intravenous)
VP-0422 Bendamustine (bendamustine ready-to-dilute) (Intravenous) (Belrapzo™)
VP-0449 Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) (Subcutaneous)
VP-0482 Polivy™ (polatuzumab vedotin-piiq) (Intravenous)
VP-0521 Padcev™ (enfortumab vedotin-ejfv) (Intravenous)