Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Recorded changes
82,180 on record
Recorded policy changes, newest first| Recorded | Payer | Policy | Change |
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| Sep 30, 2026 | Oscar Health | Eohilia (budesonide) (PG216, Ver. 3)PayerPolicy · OSCAR-PG216-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Direct Acting Antiviral Agents for Hepatitis C (PG045, Ver. 8)PayerPolicy · OSCAR-PG045-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Dexlansoprazole (Dexilant) (PG047, Ver. 9)PayerPolicy · OSCAR-PG047-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Dapsone 7.5% Topical Gel (Aczone) (PG214, Ver. 3)PayerPolicy · OSCAR-PG214-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | CeQur Simplicity Insulin Delivery System (PG192, Ver. 5)PayerPolicy · OSCAR-PG192-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Benzodiazepines for Acute Repetitive Seizures or Seizure Clusters (PG254, Ver. 6)PayerPolicy · OSCAR-PG254-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Azstarys (serdexmethylphenidate and dexmethylphenidate) (PG130, Ver. 4)PayerPolicy · OSCAR-PG130-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Auvelity (dextromethorphan and bupropion) (PG128, Ver. 5)PayerPolicy · OSCAR-PG128-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Autoimmune Conditions Exceptions Criteria For Certain States (FL, GA, IA, NJ, OH, TN, TX) (PG286, Ver. 8)PayerPolicy · OSCAR-PG286-PHARMACY | New policy |
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| Sep 30, 2026 | Oscar Health | Autoimmune Conditions Exceptions Criteria For All Other States (PG287, Ver. 1)PayerPolicy · OSCAR-PG287-PHARMACY | New policy |
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| Sep 30, 2026 | Oscar Health | Adbry (tralokinumab) (PG110, Ver. 8)PayerPolicy · OSCAR-PG110-PHARMACY | Metadata changed |
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| Sep 30, 2026 | Oscar Health | iDose TR (travoprost intracameral implant) (CG115, Ver. 5)PayerPolicy · OSCAR-CG115-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Vyvgart (efgartigimod alfa-fcab) and Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) (PG191, Ver. 5)PayerPolicy · OSCAR-PG191-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Vascular Endothelial Growth Factor (VEGF) Inhibitor Ophthalmic Agents - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG099, Ver. 7)PayerPolicy · OSCAR-CG099-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Somatostatin Analogs - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG078, Ver. 5)PayerPolicy · OSCAR-CG078-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Short-Acting Granulocyte Colony-Stimulating Factors - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG080, Ver. 4)PayerPolicy · OSCAR-CG080-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Rystiggo (rozanolixizumab-noli) (PG190, Ver. 4)PayerPolicy · OSCAR-PG190-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Prostacyclin Analogs/Receptor Agonists for Pulmonary Hypertension (PAH) - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG097, Ver. 3)PayerPolicy · OSCAR-CG097-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | PiaSky (crovalimab-akkz) (PG262, Ver. 2)PayerPolicy · OSCAR-PG262-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Outpatient Physical Therapy (PT) and Occupational Therapy (OT) (CG044, Ver. 10)PayerPolicy · OSCAR-CG044-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Onasemnogene abeparvovec (Zolgensma [-xioi]; Itvisma, [-brve]) (CG061, Ver. 8)PayerPolicy · OSCAR-CG061-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Niktimvo (axatilimab) (PG252, Ver. 3)PayerPolicy · OSCAR-PG252-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Medical Nutrition Therapy (Dietary Evaluation and Counseling) (CG010, Ver. 12)PayerPolicy · OSCAR-CG010-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Lyfgenia (lovotibeglogene autotemcel) (CG114, Ver. 4)PayerPolicy · OSCAR-CG114-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Lenmeldy (atidarsagene autotemcel) (CG117, Ver. 4)PayerPolicy · OSCAR-CG117-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Kebilidi (eladocagene exuparvovec-tneq) (PG259, Ver. 2)PayerPolicy · OSCAR-PG259-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Intraoperative Neuromonitoring (CG045, Ver. 10)PayerPolicy · OSCAR-CG045-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Injectable Iron Supplements - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG107, Ver. 4)PayerPolicy · OSCAR-CG107-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Infertility Injectable Agents (PG119, Ver. 5)PayerPolicy · OSCAR-PG119-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Immunomodulating Agents - Biologics for Autoimmune and Inflammatory Conditions - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG086, Ver. 10)PayerPolicy · OSCAR-CG086-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Home Care - Skilled Nursing Care (RN, LVN/LPN) (CG020, Ver. 12)PayerPolicy · OSCAR-CG020-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Home Care - Physical Therapy (PT) and Occupational Therapy (OT) (CG021, Ver. 12)PayerPolicy · OSCAR-CG021-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Home Care - Home Health Aides (HHA) (CG022, Ver. 12)PayerPolicy · OSCAR-CG022-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Gonadotropin-Releasing Hormone Agonists for Prostate Cancer - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG085, Ver. 3)PayerPolicy · OSCAR-CG085-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Gender-Affirming Services-REG (CG017-REG, Ver. 1)PayerPolicy · OSCAR-CG017-REG-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Gender-Affirming Services (CG017, Ver. 17)PayerPolicy · OSCAR-CG017-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Factor VIII Antihemophilic Agents - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG091, Ver. 4)PayerPolicy · OSCAR-CG091-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Factor VIII (Long-Acting) Antihemophilic Agents - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG090, Ver. 4)PayerPolicy · OSCAR-CG090-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Erythropoiesis-Stimulating Agent (ESA) - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG084, Ver. 4)PayerPolicy · OSCAR-CG084-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Diagnosis and Treatment of Infertility (CG016, Ver. 14)PayerPolicy · OSCAR-CG016-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Deep Brain Stimulation (DBS) and Responsive Neurostimulation (RNS) (CG050, Ver. 10)PayerPolicy · OSCAR-CG050-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Concomitant (Concurrent) use of Biologics (Biologic Response Modifiers Therapies) and targeted synthetic Disease-Modifying Antirheumatic Drugs (tsDMARDs) (CG064, Ver. 7)PayerPolicy · OSCAR-CG064-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Complement Inhibitors - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG098, Ver. 7)PayerPolicy · OSCAR-CG098-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Collagenase Ointment (Santyl) (PG141, Ver. 4)PayerPolicy · OSCAR-PG141-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Biologics for Chronic Respiratory and Allergic Conditions - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG100, Ver. 5)PayerPolicy · OSCAR-CG100-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Benlysta (belimumab) (PG014, Ver. 9)PayerPolicy · OSCAR-PG014-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Bariatric Surgery and Revision of Bariatric Surgery (Adults) (CG008, Ver. 12)PayerPolicy · OSCAR-CG008-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Bariatric Surgery and Revision of Bariatric Surgery (Adolescents: Ages 13-17) (CG009, Ver. 12)PayerPolicy · OSCAR-CG009-MEDICAL | Metadata changed |
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| Sep 30, 2026 | Oscar Health | Antineoplastics - Pemetrexed Products - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG105, Ver. 5)PayerPolicy · OSCAR-CG105-MEDICAL | New policy |
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| Sep 30, 2026 | Oscar Health | Antineoplastics - HER2-Targeted Agents - Medical Benefit Preferred Physician-Administered Drug Exceptions Criteria (CG101, Ver. 3)PayerPolicy · OSCAR-CG101-MEDICAL | New policy |
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