Skip to Main Content

Important Updates to Pharmacy Policies – Please Review

Date: 12/26/25

Ambetter from Arkansas Health & Wellness is amending or implementing new policies. Please see the table below for a list of these policies and their effective dates. 

Policy Policy Name Revision Effective Date 
CP.PMN.154 Isavuconazonium (Cresemba) Per SDC, added redirection to posaconazole for mucormycosis and aspergillosis if member is age ≥ 13 years and had prior inadequate response (i.e., refractory or progressive aspergillosis) to voriconazole 3/1/2026 
HIM.PA.SP60 Biologic and Non-biologic DMARDs Per August SDC: for PsO, PsA, CD, and UC initial approval criteria, added redirection to additional preferred ustekinumab products (Pyzchiva, Steqeyma, and Yesintek) and applied to continuation of therapy requests, and for members initiating therapy with Stelara added a single step through preferred agents; for RA, pJIA, PsA, AS, CD, UC, PsO, HS, UV initial therapy, added redirection to preferred adalimumab products (adalimumab-aaty, adalimumab-adaz, adalimumab-adbm, Simlandi) and removed redirection to Cyltezo; for members initiating therapy with Humira initial approval criteria, added single step through preferred agents; extended initial approval durations from 6 months to 12 months for chronic indications. 3/1/2026 
HIM.PA.53 Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists RT4: updated policy to reflect Rybelsus’s new FDA indication for reduction of major adverse cardiovascular events in diabetic patients at high risk. 3/1/2026 

 

Ambetter’s clinical, payment, and pharmacy policies can be found on our website at AmbetterHealth.com/en/ar/provider-resources/clinical-payment-policies.html. New or amended policies are available here as well. To easily search for a policy: 

  • Expand the accordions at the bottom of the page to view all available policies. 

  • Use the Ctrl+F (or Command+F on Mac) function on your keyboard to search by keyword, policy number, or effective date. 

New or amended policies are also available on the Arkansas Health & Wellness Provider News page. To view recent updates: 

  • Select the For Providers tab at the top of the screen. 

  • Select Provider News from the drop-down menu. 

  • Select the policy update you are interested in to view the details.