Pharmacy Policies
These pharmacy policies are applicable to provider-administered drugs covered by TrueCare Mississippi Medicaid.
The below drugs may be reimbursable for properly prepared and submitted provider medical claims.
The following medications are managed under the Medical Benefit at TrueCare. For medications payable through Gainwell Technologies, the Single Pharmacy Benefit Manger, please visit here.
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
A
- Abecma (idecabtagene vicleucel)
- Acthar Gel (repository corticotropin injection)
- Adzynma (ADAMTS13, recombinant-krhn)
- Aflibercept (Eylea, Eylea HD, Pavblu)
- Aldurazyme (laronidase)
- Amvuttra (vutrisiran)
- Aucatzyl (obecabtagene autoleucel)
B
- Benlysta (belimumab)
- Beovu (brolucizumab)
- Bevacizumab (Alymsys, Avastin, Mvasi, Zirabev)
- Breyanzi (lisocabtagene maraleucel)
- Brineura (cerliponase alfa)
C
- Carvykti (ciltacabtagene autoleucel)
- Cortrophin Gel (corticotropin)
- Crysvita (burosumab-twza)
- Cytogam (cytomegalovirus immune globulin)
D
- Darzalex Faspro (daratumumab and hyaluronidase-fihj)
- Daxxify (DaxibotulinumtoxinA-lanm)
- Dysport (abobotulinumtoxinA)
E
- Elaprase (idursulfase)
- Encelto (revakinagene taroretcel-lwey)
- Enjaymo (sutimlimab)
- Enzyme Replacement Therapy (ERT) for Fabry Disease: Fabrazyme (agalsidase beta) and Elfabrio (pegunigalsidase alfa-iwxj)
F
G
H
- Hemgenix (etranacogene dezaparvovec)
- Hemophilia and Other Clotting Disorders
- Hyaluronic Acid Viscosupplements
I
- Iluvien (fluocinolone acetonide)
- Immune globulin (IVIG and SCIG): Intravenous (IVIG): Bivigam, Flebogamma DIF, Gammagard Liquid, Gammagard S/D, Gamunex-C, Panzyga, Privigen, Yimmugo Subcutaneous (SCIG): Hizentra, HyQvia, Xembify
- Izervay (avacincaptad pegol)
K
- Izervay (avacincaptad pegol)
- Kanuma (sebelipase alfa)
- Kebilidi (eladocagene exuparvovec-tneq)
- Kisunla (donanemab)
- Korsuva (difelikefalin)
- Krystexxa (pegloticase)
- Kymriah (tisagenlecleucel)
L
- Lemtrada (alemtuzumab)
- Lenmeldy (atidarsagene autotemcel)
- Leqembi (lecanemab)
- Lumizyme (alglucosidase alfa)
- Lupron Depot and Lupron Depot-PED (leuprolide acetate)
- Luxturna (voretigene neparvovec-rzyl)
M
- MACI (autologous cultured chondrocytes)
- Mepsevii (vestronidase alfa-vjbk)
- Myobloc (rimabotulinumtoxinB)
N
- Naglazyme (galsulfase)
- Nexviazyme (avalglucosidase alfa-ngp)
- Niktimvo (axatilimab)
- Novantrone (mitoxantrone)
- Nulibry (fosdenopterin)
O
P
- Panhematin (hemin for injection)
- PiaSky (crovalimab-akkz)
- Pombiliti (cipaglucosidase alfa-atga) and Opfolda (miglustat)
Q
R
- Radicava (edaravone injection); Radicava ORS (edaravone oral suspension)
- Ranibizumab (Lucentis, Byooviz, Cimerli)
- Reblozyl (luspatercept-aamt)
- Retisert (fluocinolone acetonide)
- Rituximab (Rituxan, Truxima, Ruxience, Riabni)
- Rivfloza (nedosiran)
- Roctavian (valoctocogene roxaparvovec)
- Ryplazim (plasminogen, human-tvmh)
- Rystiggo (rozanolixizumab-noli)
S
- Saphnelo (anifrolumab-fnia)
- Scenesse (afamelanotide)
- Signifor, Signifor LAR (pasireotide)
- Skysona (elivaldogene autotemcel)
- Soliris (eculizumab)
- Somatostatin analogs (Injectable; First generation): Sandostatin (octreotide), Sandostatin LAR (octreotide), Somatuline Depot (lanreotide)
- Spinraza (nusinersen)
- Spravato (esketamine)
- Supprelin LA (histrelin acetate)
- Susvimo (ranibizumab)
- Syfovre (pegcetacoplan)
- Synagis (palivizumab)
T
- Tecartus (brexucabtagene autoleucel)
- Tepezza (teprotumumab-trbw)
- Trastuzumab (Herceptin, Herzuma, Kanjinti, Ogivri, Ontruzant, Trazimera)
- Triptodur (triptorelin)
- Tzield (teplizumab-mzwv)
U
V
- Vabysmo (faricimab-svoa)
- Veopoz (Pozelimab)
- Vimizim (elosulfase alfa)
- Visudyne (verteporfin)
- Vyjuvek (beremagene geperpavec-svdt)
- Vyvgart (efgartigimod alfa-fcab) and Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)
X
Y
Z
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.