Procedure Codes Not Applicable to Commercial Products Code List
Natiijooyinka Raadinta
Soo bandhiga 4151 - 4160 ee natiijooyinka 4226
Bixiye
Saxenda Wegovy Zepbound - Commercial
Coverage Exception, Formulary Exception
Taariikhda uu dhaqangalayo Barnaamijka: : Abr 01, 2026
Bixiye
Tezspire (tezepelumab-ekko) - Commercial
Prior Authorization, Quantity Limit
Taariikhda uu dhaqangalayo Barnaamijka: : Abr 01, 2026
Bixiye
Topical Corticosteroids - Commercial
Step Therapy, Quantity Limit
Taariikhda uu dhaqangalayo Barnaamijka: : Abr 01, 2026
Bixiye
Self-Administered Oncology Agents - Commercial
Prior Authorization, Quantity Limit
Taariikhda uu dhaqangalayo Barnaamijka: : Abr 01, 2026
Bixiye
Sunosi (solriamfetol) - Commercial
Prior Authorization, Quantity Limit
Taariikhda uu dhaqangalayo Barnaamijka: : Abr 01, 2026
Bixiye
GLP-1 (glucagon-like peptide-1) Agonists - Commercial
Prior Authorization, Quantity Limit
Taariikhda uu dhaqangalayo Barnaamijka: : Abr 01, 2026
Bixiye
Interleukin-5 (IL-5) Inhibitors - Commercial
Prior Authorization, Quantity Limit
Taariikhda uu dhaqangalayo Barnaamijka: : Abr 01, 2026
Bixiye
Interleukin-4 (IL-4) Inhibitors - Commercial
Prior Authorization, Quantity Limit
Taariikhda uu dhaqangalayo Barnaamijka: : Abr 01, 2026
Bixiye
Immune Globulins - Commercial
Oggolaanshaha Hore
Taariikhda uu dhaqangalayo Barnaamijka: : Abr 01, 2026