Selective Treatment of HAE with Cinryze ™, Berinert ® & Ecallantide

Edurant Criteria

Effient® (prasugrel)

Egrifta (tesamorelin acetate)

Elahere (mirvetuximab)

Elaprase (idursulfase)

Elelyso (taliglucerase alfa)

Elepsia XR (levetiracetam)

Elestrin (estradiol gel)

Elevidys (moxeparvovec-rokl)

Elfabrio (pegunigalsidase alfa-iwxj)

Eligard (leuprolide acetate)

Elitek (rasburicase))

Elmiron Criteria

Oxaliplatin

(Eloxatin®)

Elzonris (tagraxofusp‐erzs)

Embeda

(morphine sulfate/naltrexone hydrochloride)

Emend IV (fosaprepitant)

Emend Oral (aprepitant)

Emflaza (deflazacort)

Empaveli (pegcetacoplan)

Empliciti (elotuzumab)

EMSAM (selegiline transdermal system)

Enbrel (etanercept)

Endari

(L-glutamine)

Enhertu

(fam-trastuzumab deruxtecan-nxki)

Enjaymo (sutimlimab-jome)

Enspryng (satralizumab-mwge)

Enstilar (calcipotriene  & betamethasone dipropionate)

Entadfi (finasteride & tadalafil)

Entocort (budesonide)

Entresto (sacubitril-valsartan)

Envarsus XR (tacrolimus extended release)

Entyvio (vedolizumab)

Epaned Criteria

Epclusa® (sofosbuvir & velpatasvir)

Differin (adapalene) & Epiduo (adapalene and benzoyl peroxide)

Epidiolex (cannabidiol)

Epirubicin Hydrochloride (Ellence™)

Epkinly (epcoritamab-bysp)

Epoetin alfa (Procrit®, Epogen®)

Epoprostenol Products (Flolan, Veletri, generic Flolan)

Eprontia (topiramate)

Eraxis (anidulafungin)

Erbitux (cetuximab)

Erectile Dysfunction Medications

Erivedge (vismodegib)

Erleada (apalutamide)

Erwinaze® (asparaginase Erwinia chrysanthemi)

Erythropoiesis Stimulating Agents (ESA)

Erythropoiesis Stimulating Agents (ESAS) in Cancer & Related Neoplastic Conditions

(NCD 110.21)

Esbriet® (pirfenidone)

Eskata™ (hydrogen peroxide) topical solution

Eteplirsen (Exondys 51)

Amifostine (Ethyol ®)

Etoposide (Etopophos®, Toposar®, Vepesid®, VP-16)

Eucrisa (crisaborole)

Evista (raloxifene)

Evkeeza (evinacumab-dgnb)

Evomela™ (melphalan)

Evrysdi (risdiplam) Oral Solution

Evzio (naloxone) injection, auto-injector

Exservan (riluzole)

Extavia (interferon beta-1b)

Eylea® (aflibercept injection)

Eysuvis (loteprednol etabonate)

Ezetimibe-Containing Products