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Effective January 1, 2026: Pharmacy and Biopharmacy Policies

Date: 10/16/25

Superior HealthPlan has added, updated or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on January 1, 2026, at 12:00AM.

Policy

Applicable Products

New Policy Overview or Updated Policy Revisions

Ferumoxytol (Feraheme) (CP.PHAR.165)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

  • Modified to redirect from brand Venofer to generic

Ferric Carboxymaltose (Injectafer) (CP.PHAR.234)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

  • Modified to redirect from brand Venofer to generic

Ferric Derisomaltose (Monoferric) (CP.PHAR.480)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

  • Modified to redirect from brand Venofer to generic

Concizumab-mtci (Alhemo) (CP.PHAR.625)

Ambetter

Policy updates include:

  • Added new indication for hemophilia A and B without inhibitors
  • Added continued therapy criterion for provider confirmation that member has discontinued any use of Hemlibra, bypassing agents, FVIII, or FIX products as prophylactic therapy while on Alhemo

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage .

Prior to updates, pharmacy and biopharmacy clinical policies are reviewed and approved by the Pharmacy and Therapeutics (P&T) Committee.

For questions or additional information, please contact Superior’s Pharmacy Department at 1-800-218-7453, ext. 22272.