Prescription Drugs  – UM Guidelines
CG-DRUG-01 Off-Label Drug and Approved Orphan Drug Use
CG-DRUG-03 Beta Interferons and Glatiramer Acetate for Treatment of Multiple Sclerosis
CG-DRUG-04 Use of Low Molecular Weight Heparin Therapy, Fondaparinux (Arixtra®) and Direct Thrombin Inhibitors in the Outpatient Setting
CG-DRUG-05 Recombinant Erythropoietin Products
CG-DRUG-07 Hepatitis C Pegylated Interferon Antiviral Therapy
CG-DRUG-08 Enzyme Replacement Therapy for Gaucher Disease
CG-DRUG-09 Immune Globulin (Ig) Therapy
CG-DRUG-11 Infertility Drugs
CG-DRUG-13 Hepatitis B Interferon Antiviral Therapy
CG-DRUG-14 Dihydroergotamine Mesylate (DHE) Injection for the Treatment of Migraine or Cluster Headaches in Adults
CG-DRUG-15 Gonadotropin Releasing Hormone (GnRH) Analogs
CG-DRUG-16 White Blood Cell Growth Factors
CG-DRUG-18 Nesiritide (Natrecor®)
CG-DRUG-19 Progesterone Therapy as a Technique to Prevent Preterm Delivery in High-Risk Women
CG-DRUG-20 Enfuvirtide (Fuzeon®)
CG-DRUG-21 Naltrexone (Vivitrol®) Injections for the Treatment of Alcohol and Opioid Dependence
CG-DRUG-24 Repository Corticotropin Injection (H.P. Acthar® Gel)
CG-DRUG-25 Intravenous versus Oral Drug Administration in the Outpatient and Home Setting
CG-DRUG-27 Clostridial Collagenase Histolyticum Injection
CG-DRUG-28 Alglucosidase alfa (Lumizyme®, Myozyme®)
CG-DRUG-29 Hyaluronan Injections in the Knee
CG-DRUG-30 Oprelvekin (Neumega®)
CG-DRUG-31 Oncology Drug Treatment Regimens for Adults **NOTE: At this time, this guideline is not implemented for medical benefit determinations
CG-DRUG-33 Palonosetron (Aloxi®)
CG-DRUG-34 Docetaxel (Taxotere®)
CG-DRUG-38 Pemetrexed Disodium (Alimta®)
CG-DRUG-40 Bortezomib (Velcade®)
CG-DRUG-41 Zoledronic acid
CG-DRUG-42 Asparagine Specific Enzymes (Asparaginase)
CG-DRUG-43 Natalizumab (Tysabri®)
CG-DRUG-44 Pegloticase (Krystexxa®)
CG-DRUG-45 Octreotide acetate (Sandostatin®; Sandostatin® LAR Depot)
CG-DRUG-46 Fosaprepitant (Emend®)
CG-DRUG-47 Level of Care: Specialty Pharmaceuticals

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