2022 - 4th quarter Form

1 Pharmacy Specialty Overview by Prior Authorization Approval or Denial 4th Quarter 2022 00122.03.04-0423 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 INTERNAL MEDICINE abiraterone 250 mg ANTINEOPLASTICS Approval 1 3963 UNSPECIFIED abiraterone 250 mg ANTINEOPLASTICS Approval 1 3951 HEMATOLOGY & ONCOLOGY abiraterone 500 mg ANTINEOPLASTICS Approval 1 3963 UNSPECIFIED abiraterone 500 mg ANTINEOPLASTICS Approval 1 3963 UNSPECIFIED abiraterone 500 mg ANTINEOPLASTICS No Response 1 3963 UNSPECIFIED Abiraterone Acetate 250MG OR TABS ANTINEOPLASTICS Approval 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Abiraterone Acetate 250MG OR TABS ANTINEOPLASTICS No Response 1 3963 RHEUMATOLOGY Actemra 162MG/0.9ML SC SOSY IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 UNSPECIFIED Actemra 400MG/20ML IV SOLN IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED Actemra SQ 162mg syringe/Actpen autoinjector IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 RHEUMATOLOGY Actemra SQ 162mg syringe/Actpen autoinjector IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 RHEUMATOLOGY Actemra SQ 162mg syringe/Actpen autoinjector IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 RHEUMATOLOGY Actemra SQ 162mg syringe/Actpen autoinjector IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 RHEUMATOLOGY Actemra SQ 162mg syringe/Actpen autoinjector IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 UNSPECIFIED Adempas OTHER ANTIHYPERTENSIVES Approval 1 3956 UNSPECIFIED Adempas PULMONARY ARTERIAL HYPERTENSION Approval 1 3956 PHYSICIAN, ONCOLOGY, MEDICAL Alecensa ANTINEOPLASTICS Approval 1 3956 PHYSICIAN, ONCOLOGY, MEDICAL Alecensa ANTINEOPLASTICS No Response 1 3956 PULMONARY DISEASES ambrisentan DERMATOLOGICAL AGENTS Approval 1 3963 UNSPECIFIED ambrisentan DERMATOLOGICAL AGENTS Approval 1 3963 INTERNAL MEDICINE ambrisentan DERMATOLOGICAL AGENTS Approval 1 3963 INTERNAL MEDICINE Ambrisentan 5MG OR TABS DERMATOLOGICAL AGENTS No Response 1 3951 UNSPECIFIED Aubagio MULTIPLE SCLEROSIS Approval 2 3956 UNSPECIFIED Aubagio MULTIPLE SCLEROSIS Approval 4 3956 UNSPECIFIED Aubagio MULTIPLE SCLEROSIS Denial 2 3956 UNSPECIFIED Aubagio MULTIPLE SCLEROSIS No Response 2 3956 FAMILY PRACTICE Aubagio MULTIPLE SCLEROSIS Approval 2 3956 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Approval 4 3956 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Denial 2

2 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3961 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Approval 2 3962 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Approval 2 3963 UNSPECIFIED Aubagio MULTIPLE SCLEROSIS Approval 8 3963 UNSPECIFIED Aubagio MULTIPLE SCLEROSIS No Response 4 3963 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Approval 12 3963 NEUROLOGY Aubagio MULTIPLE SCLEROSIS No Response 2 3963 NURSE PRACTITIONER, FAMILY HEALTH Aubagio MULTIPLE SCLEROSIS Denial 2 3964 NEUROLOGY Aubagio MULTIPLE SCLEROSIS Approval 2 3956 UNSPECIFIED Aubagio 14MG OR TABS MULTIPLE SCLEROSIS No Response 1 3963 NEUROLOGY Aubagio 14MG OR TABS MULTIPLE SCLEROSIS No Response 2 3956 UNSPECIFIED Aubagio 7MG OR TABS MULTIPLE SCLEROSIS No Response 1 3969 NEUROLOGY Austedo NEUROLOGICAL AGENTS Approval 1 3951 NEUROLOGY Avonex MISCELLANEOUS Approval 1 3951 NEUROLOGY Avonex MULTIPLE SCLEROSIS AGENT Approval 1 3951 UNSPECIFIED azacitidine ANTINEOPLASTICS Approval 1 3963 UNSPECIFIED Benlysta LUPUS THERAPY Approval 3 3963 UNSPECIFIED Benlysta LUPUS THERAPY No Response 1 3963 UNSPECIFIED Benlysta MISCELLANEOUS Approval 3 3963 UNSPECIFIED Benlysta MISCELLANEOUS No Response 1 3963 INTERNAL MEDICINE Benlysta LUPUS THERAPY Denial 1 3963 INTERNAL MEDICINE Benlysta LUPUS THERAPY No Response 1 3963 INTERNAL MEDICINE Benlysta MISCELLANEOUS Denial 1 3963 INTERNAL MEDICINE Benlysta MISCELLANEOUS No Response 1 3963 NURSE PRACTITIONER, UNSPECIFIED Benlysta LUPUS THERAPY Approval 1 3963 NURSE PRACTITIONER, UNSPECIFIED Benlysta MISCELLANEOUS Approval 1 3963 RHEUMATOLOGY Benlysta LUPUS THERAPY Approval 2 3963 RHEUMATOLOGY Benlysta LUPUS THERAPY No Response 1 3963 RHEUMATOLOGY Benlysta MISCELLANEOUS Approval 2 3963 RHEUMATOLOGY Benlysta MISCELLANEOUS No Response 1 3963 UNSPECIFIED Betaseron MISCELLANEOUS Approval 1 3956 UNSPECIFIED bexarotene ANTINEOPLASTICS Approval 1 3956 DERMATOLOGY bexarotene ANTINEOPLASTICS No Response 1 3963 DERMATOLOGY bexarotene ANTINEOPLASTICS No Response 1 3963 UNSPECIFIED Bexarotene 75MG OR CAPS ANTINEOPLASTICS Approval 1 3963 CARDIOLOGY bosentan 125 mg VASODILATORS Approval 1 3956 RHEUMATOLOGY bosentan 62.5 mg VASODILATORS Denial 1 3963 UNSPECIFIED bosentan 62.5 mg VASODILATORS No Response 1

3 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 HEMATOLOGY & ONCOLOGY Bosulif ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY & ONCOLOGY Bosulif ANTINEOPLASTICS No Response 2 3961 HEMATOLOGY & ONCOLOGY Bosulif ANTINEOPLASTICS Approval 2 3963 UNSPECIFIED Bosulif ANTINEOPLASTICS Approval 2 3963 UNSPECIFIED Bosulif ANTINEOPLASTICS Denial 2 3963 HEMATOLOGY & ONCOLOGY Braftovi ANTINEOPLASTICS Approval 1 3963 PHYSICIAN, ONCOLOGY, MEDICAL Braftovi ANTINEOPLASTICS Approval 1 3963 PHYSICIAN, ONCOLOGY, MEDICAL Braftovi ANTINEOPLASTICS No Response 1 3951 UNSPECIFIED Cabometyx ANTINEOPLASTICS Approval 2 3956 UNSPECIFIED Cabometyx ANTINEOPLASTICS Approval 8 3956 INTERNAL MEDICINE Cabometyx ANTINEOPLASTICS Approval 2 3963 HEMATOLOGY & ONCOLOGY Cabometyx ANTINEOPLASTICS Approval 6 3963 INTERNAL MEDICINE Cabometyx ANTINEOPLASTICS Approval 2 3951 UNSPECIFIED Cabometyx 40MG OR TABS ANINEOPLASTICS No Response 1 3956 INTERNAL MEDICINE Cabometyx 60MG OR TABS ANINEOPLASTICS No Response 1 3956 HEMATOLOGY & ONCOLOGY Calquence 100MG OR TABS ANTINEOPLASTICS No Response 1 3963 HEMATOLOGY & ONCOLOGY Calquence 100MG OR TABS ANTINEOPLASTICS No Response 1 3963 INTERNAL MEDICINE Calquence 100MG OR TABS ANTINEOPLASTICS Approval 1 3963 INTERNAL MEDICINE Calquence Capsule ANTINEOPLASTICS Approval 1 3963 INTERNAL MEDICINE Calquence Capsule ANTINEOPLASTICS No Response 1 3956 HEMATOLOGY & ONCOLOGY Calquence Tablet ANTINEOPLASTICS Approval 1 3961 HEMATOLOGY & ONCOLOGY Calquence Tablet ANTINEOPLASTICS Approval 1 3963 HEMATOLOGY & ONCOLOGY Calquence Tablet ANTINEOPLASTICS Approval 1 3963 PHYSICIAN, ONCOLOGY, MEDICAL Calquence Tablet ANTINEOPLASTICS Approval 1 3956 UNSPECIFIED capecitabine ANTINEOPLASTICS Approval 6 3956 UNSPECIFIED capecitabine ANTINEOPLASTICS No Response 2 3956 HEMATOLOGY capecitabine ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS Approval 12 3956 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS Denial 2 3956 INTERNAL MEDICINE capecitabine ANTINEOPLASTICS Approval 4 3956 INTERNAL MEDICINE capecitabine ANTINEOPLASTICS Denial 2 3956 PHYSICIAN, ONCOLOGY, MEDICAL capecitabine ANTINEOPLASTICS Approval 2 3963 UNSPECIFIED capecitabine ANTINEOPLASTICS Approval 6 3963 UNSPECIFIED capecitabine ANTINEOPLASTICS No Response 4 3963 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS Approval 8 3963 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS No Response 2 3963 INTERNAL MEDICINE capecitabine ANTINEOPLASTICS Approval 2

4 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3965 UNSPECIFIED capecitabine ANTINEOPLASTICS Approval 2 3969 HEMATOLOGY & ONCOLOGY capecitabine ANTINEOPLASTICS No Response 2 3969 INTERNAL MEDICINE capecitabine ANTINEOPLASTICS Approval 2 3969 UNSPECIFIED Capecitabine 500MG OR TABS ANTINEOPLASTICS Approval 1 3956 NEPHROLOGY / RENAL MEDICINE cinacalcet THYROID PRODUCT Approval 4 3956 NEPHROLOGY / RENAL MEDICINE cinacalcet THYROID PRODUCT Denial 1 3956 NEPHROLOGY / RENAL MEDICINE cinacalcet THYROID PRODUCT No Response 2 3956 PHYSICIAN, ENDOCRINOLOGY cinacalcet THYROID PRODUCT Denial 1 3956 RHEUMATOLOGY cinacalcet THYROID PRODUCT Denial 1 3961 UNSPECIFIED cinacalcet THYROID PRODUCT Approval 1 3961 NEPHROLOGY / RENAL MEDICINE cinacalcet THYROID PRODUCT Approval 1 3963 INTERNAL MEDICINE cinacalcet THYROID PRODUCT Approval 1 3963 NEPHROLOGY / RENAL MEDICINE cinacalcet THYROID PRODUCT Denial 2 3969 INTERNAL MEDICINE cinacalcet THYROID PRODUCT No Response 1 3956 NEUROLOGY Copaxone 40mg MULTIPLE SCLEROSIS Approval 1 3963 NEUROLOGY Copaxone 40mg MULTIPLE SCLEROSIS Approval 1 3964 NEUROLOGY Copaxone 40mg MULTIPLE SCLEROSIS Denial 1 3951 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3951 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Denial 4 3951 DERMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3951 DERMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3951 NURSE PRACTITIONER, FAMILY HEALTH Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 4 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS No Response 2 3951 RHEUMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS No Response 2 3956 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3956 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3956 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS No Response 6 3956 DERMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Denial 4 3956 NURSE PRACTITIONER, FAMILY HEALTH Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3956 NURSE PRACTITIONER, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3956 NURSE PRACTITIONER, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS No Response 2 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Denial 4 3956 RHEUMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3961 DERMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3963 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 8

5 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3963 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS No Response 4 3963 DERMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Approval 4 3963 DERMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3963 DERMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS No Response 2 3963 INTERNAL MEDICINE Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3963 NURSE PRACTITIONER, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 4 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3963 RHEUMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3963 RHEUMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS No Response 4 3964 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3964 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3964 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS No Response 2 3965 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3965 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS No Response 2 3965 DERMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS No Response 2 3965 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3965 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS No Response 2 3965 RHEUMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3969 UNSPECIFIED Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3969 DERMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Denial 2 3969 RHEUMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS Approval 2 3969 RHEUMATOLOGY Cosentyx ALL OTHER DERMATOLOGICALS No Response 2 3951 DERMATOLOGY Cosentyx Sensoready (300 MG) 150MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 2 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Cosentyx Sensoready (300 MG) 150MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 DERMATOLOGY Cosentyx Sensoready (300 MG) 150MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 DERMATOLOGY Cosentyx Sensoready (300 MG) 150MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3969 DERMATOLOGY Cosentyx Sensoready (300 MG) 150MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 NEUROLOGY dalfampridine ER MULTIPLE SCLEROSIS Approval 1 3956 UNSPECIFIED dalfampridine ER MULTIPLE SCLEROSIS Approval 4 3956 NEUROLOGY dalfampridine ER MULTIPLE SCLEROSIS Approval 1 3956 NEUROLOGY dalfampridine ER MULTIPLE SCLEROSIS Denial 2 3956 PHYSICIAN ASSISTANT, UNSPECIFIED dalfampridine ER MULTIPLE SCLEROSIS Approval 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED dalfampridine ER MULTIPLE SCLEROSIS No Response 1 3963 NEUROLOGY dalfampridine ER MULTIPLE SCLEROSIS Approval 1 3964 UNSPECIFIED dalfampridine ER MULTIPLE SCLEROSIS Approval 1

6 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3964 UNSPECIFIED dalfampridine ER MULTIPLE SCLEROSIS No Response 1 3965 UNSPECIFIED dalfampridine ER MULTIPLE SCLEROSIS Approval 2 3956 UNSPECIFIED Dalfampridine ER 10MG OR TB12 MULTIPLE SCLEROSIS Approval 1 3956 NEUROLOGY Dalfampridine ER 10MG OR TB12 MULTIPLE SCLEROSIS No Response 1 3956 UNSPECIFIED dimethyl fumarate Multiple Sclerosis Approval 1 3956 UNSPECIFIED dimethyl fumarate Multiple Sclerosis No Response 1 3956 FAMILY PRACTICE dimethyl fumarate Multiple Sclerosis Approval 1 3956 FAMILY PRACTICE dimethyl fumarate Multiple Sclerosis No Response 1 3963 UNSPECIFIED dimethyl fumarate Multiple Sclerosis Approval 2 3963 UNSPECIFIED dimethyl fumarate Multiple Sclerosis No Response 3 3963 NEUROLOGY dimethyl fumarate Multiple Sclerosis No Response 1 3964 UNSPECIFIED dimethyl fumarate Multiple Sclerosis Approval 1 3964 UNSPECIFIED dimethyl fumarate Multiple Sclerosis No Response 1 3951 NEUROLOGY Dimethyl Fumarate 240MG OR CPDR Multiple Sclerosis Approval 1 3956 UNSPECIFIED dofetilide CARDIOVASCULAR AGENTS Approval 3 3956 UNSPECIFIED dofetilide CARDIOVASCULAR AGENTS No Response 1 3956 UNSPECIFIED dofetilide OTHER CARDIOVASCULAR PREPS Approval 3 3956 UNSPECIFIED dofetilide OTHER CARDIOVASCULAR PREPS No Response 1 3956 CARDIOLOGY dofetilide CARDIOVASCULAR AGENTS Approval 4 3956 CARDIOLOGY dofetilide OTHER CARDIOVASCULAR PREPS Approval 4 3956 INTERNAL MEDICINE dofetilide CARDIOVASCULAR AGENTS Approval 1 3956 INTERNAL MEDICINE dofetilide CARDIOVASCULAR AGENTS No Response 1 3956 INTERNAL MEDICINE dofetilide OTHER CARDIOVASCULAR PREPS Approval 1 3956 INTERNAL MEDICINE dofetilide OTHER CARDIOVASCULAR PREPS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED dofetilide CARDIOVASCULAR AGENTS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED dofetilide OTHER CARDIOVASCULAR PREPS No Response 1 3956 PHYSICIAN, CARDIAC ELECTROPHYSIOLOGY dofetilide CARDIOVASCULAR AGENTS Approval 2 3956 PHYSICIAN, CARDIAC ELECTROPHYSIOLOGY dofetilide OTHER CARDIOVASCULAR PREPS Approval 2 3963 FAMILY PRACTICE dofetilide CARDIOVASCULAR AGENTS Approval 1 3963 FAMILY PRACTICE dofetilide OTHER CARDIOVASCULAR PREPS Approval 1 3963 NURSE PRACTITIONER, FAMILY HEALTH dofetilide CARDIOVASCULAR AGENTS Approval 1 3963 NURSE PRACTITIONER, FAMILY HEALTH dofetilide OTHER CARDIOVASCULAR PREPS Approval 1 3951 UNSPECIFIED Doptelet THROMBOPOIETIC AGENT Approval 1 3951 NEUROLOGY Duopa ANTIPARKINSON AGENT No Response 4 3951 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3951 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3951 ALLERGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1

7 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3951 ALLERGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3951 ALLERGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3951 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3951 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 3 3951 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 3 3951 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2 3951 GASTROENTEROLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2 3951 INTERNAL MEDICINE Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3951 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3951 PEDIATRICS Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 3 3951 PEDIATRICS Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2 3951 PEDIATRICS Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 4 3951 PULMONARY DISEASES Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3956 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 9 3956 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 7 3956 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 8 3956 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 5 3956 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 3 3956 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3956 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 10 3956 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 6 3956 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3956 INTERNAL MEDICINE Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3956 NURSE PRACTITIONER, ACUTE CARE Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 OTOLARYNGOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3956 OTOLARYNGOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3956 OTOLARYNGOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 PEDIATRICS Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3956 PEDIATRICS Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 13 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 18 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 4

8 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3956 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3956 PULMONARY DISEASES Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2 3961 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3961 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 2 3961 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3961 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3961 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3962 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3962 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3962 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3962 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3963 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 15 3963 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 10 3963 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 8 3963 ALLERGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2 3963 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 4 3963 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 5 3963 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3963 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 8 3963 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 11 3963 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 4 3963 GASTROENTEROLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2 3963 INTERNAL MEDICINE Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3963 INTERNAL MEDICINE Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3963 NEUROLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3963 NURSE PRACTITIONER, ADULT HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3963 NURSE PRACTITIONER, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3963 OTOLARYNGOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 8 3963 OTOLARYNGOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 2 3963 OTOLARYNGOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 4 3963 PEDIATRICS Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 12 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 5 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 5

9 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3963 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3963 PULMONARY DISEASES Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3963 PULMONARY DISEASES Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3964 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3964 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3964 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3964 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3964 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3964 PULMONARY DISEASES Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3965 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 5 3965 UNSPECIFIED Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3965 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3965 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3965 FAMILY PRACTICE Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3965 GASTROENTEROLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3965 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3965 NURSE PRACTITIONER, FAMILY HEALTH Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3965 OTOLARYNGOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 3 3965 OTOLARYNGOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3969 ALLERGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3969 ALLERGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3969 ALLERGY & IMMUNOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3969 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3969 DERMATOLOGY Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3969 PEDIATRICS Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3969 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Dupixent IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Approval 1 3963 UNSPECIFIED DUPIXENT 200MG/1.14ML PFS 2 PK IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 PULMONARY DISEASES Dupixent 200MG/1.14ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3963 OTOLARYNGOLOGY Dupixent 200MG/1.14ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 UNSPECIFIED DUPIXENT 300MG/2ML PEN 2X2ML IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 DERMATOLOGY DUPIXENT 300MG/2ML PEN 2X2ML IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED DUPIXENT 300MG/2ML PEN 2X2ML IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3963 UNSPECIFIED DUPIXENT 300MG/2ML PEN 2X2ML IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED DUPIXENT 300MG/2ML PEN 2X2ML IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3963 INTERNAL MEDICINE DUPIXENT 300MG/2ML PFS 2X2ML IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3969 DERMATOLOGY DUPIXENT 300MG/2ML PFS 2X2ML IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1

10 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3951 DERMATOLOGY Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3956 ALLERGY & IMMUNOLOGY Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3961 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3963 UNSPECIFIED Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3963 UNSPECIFIED Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 4 3963 ALLERGY & IMMUNOLOGY Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3963 DERMATOLOGY Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3963 OTOLARYNGOLOGY Dupixent 300MG/2ML SC SOPN IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3951 ALLERGY Dupixent 300MG/2ML SC SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 FAMILY PRACTICE Dupixent 300MG/2ML SC SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS Denial 1 3956 FAMILY PRACTICE Dupixent 300MG/2ML SC SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Dupixent 300MG/2ML SC SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3963 UNSPECIFIED Dupixent 300MG/2ML SC SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3965 NURSE PRACTITIONER, FAMILY HEALTH Dupixent 300MG/2ML SC SOSY IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3961 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC dupixent pen 300 mg/2 mLmg/ml pen injector IMMUNOGLOBULINS/DERMATOLOGICAL AGENTS No Response 1 3956 UNSPECIFIED Eligard 7.5mg ANTINEOPLASTICS Denial 1 3951 RHEUMATOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 3 3951 RHEUMATOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3956 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 CLINICAL NURSE SPECIALIST, FAMILY HEALTH Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 INTERNAL MEDICINE Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3956 INTERNAL MEDICINE Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 INTERNAL MEDICINE Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS No Response 4 3956 RHEUMATOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 13 3956 RHEUMATOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3956 RHEUMATOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS No Response 4 3961 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3961 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3963 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 9 3963 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS No Response 3 3963 ALLERGY & IMMUNOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 1

11 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 FAMILY PRACTICE Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 FAMILY PRACTICE Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 INTERNAL MEDICINE Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 INTERNAL MEDICINE Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 RHEUMATOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 10 3963 RHEUMATOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Denial 6 3963 RHEUMATOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS No Response 3 3964 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 UNSPECIFIED Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3969 RHEUMATOLOGY Enbrel 50mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3956 RHEUMATOLOGY Enbrel SureClick 50MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 UNSPECIFIED Enbrel SureClick 50MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 RHEUMATOLOGY Enbrel SureClick 50MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3962 UNSPECIFIED Epidiolex ANTICONVULSANTS Approval 2 3963 UNSPECIFIED Epidiolex ANTICONVULSANTS Approval 2 3963 UNSPECIFIED Epidiolex ANTICONVULSANTS Denial 2 3963 UNSPECIFIED Epidiolex ANTICONVULSANTS No Response 2 3963 NEUROLOGY Epidiolex ANTICONVULSANTS Approval 2 3963 NEUROLOGY Epidiolex ANTICONVULSANTS Denial 2 3963 NEUROLOGY Epidiolex ANTICONVULSANTS No Response 2 3963 NEUROLOGY, PEDIATRIC Epidiolex ANTICONVULSANTS Approval 6 3969 UNSPECIFIED Epidiolex ANTICONVULSANTS Denial 2 3963 DERMATOLOGY Erivedge ANTINEOPLASTICS Approval 2 3963 INTERNAL MEDICINE Erivedge ANTINEOPLASTICS No Response 2 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Erivedge ANTINEOPLASTICS Approval 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Erleada ANTINEOPLASTICS Approval 1 3956 UROLOGY Erleada ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY everolimus 10 mg ANTINEOPLASTICS Approval 1 3956 HEMATOLOGY & ONCOLOGY everolimus 10 mg ANTINEOPLASTICS Approval 1 3963 UNSPECIFIED everolimus 10 mg ANTINEOPLASTICS Approval 1 3963 HEMATOLOGY & ONCOLOGY everolimus 10 mg ANTINEOPLASTICS Approval 1 3956 UNSPECIFIED everolimus 5 mg ANTINEOPLASTICS Approval 1 3956 UNSPECIFIED Everolimus 5MG OR TABS ANTINEOPLASTICS No Response 1 3963 PHYSICIAN, ONCOLOGY, MEDICAL everolimus 7.5 mg ANTINEOPLASTICS Approval 1 3963 UNSPECIFIED Fasenra RESPIRATORY AGENTS Denial 2

12 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3969 UNSPECIFIED Fasenra RESPIRATORY AGENTS No Response 1 3969 INTERNAL MEDICINE Fasenra RESPIRATORY AGENTS Denial 1 3963 UNSPECIFIED Forteo MISCELLANEOUS Denial 1 3963 UNSPECIFIED Forteo OSTEOPOROSIS Denial 1 3951 UNSPECIFIED Genotropin GROWTH HORMONE THERAPY Denial 1 3951 UNSPECIFIED Genotropin OTHER HORMONES Denial 1 3963 UNSPECIFIED Genotropin GROWTH HORMONE THERAPY Approval 1 3963 UNSPECIFIED Genotropin OTHER HORMONES Approval 1 3963 ENDOCRINOLOGY, PEDIATRIC Genotropin GROWTH HORMONE THERAPY Approval 1 3963 ENDOCRINOLOGY, PEDIATRIC Genotropin OTHER HORMONES Approval 1 3963 ENDOCRINOLOGY, PEDIATRIC Genotropin 5MG SC CART OTHER HORMONES No Response 1 3956 UNSPECIFIED Gilenya MISCELLANEOUS No Response 1 3956 UNSPECIFIED Gilenya MULTIPLE SCLEROSIS No Response 1 3956 NEUROLOGY Gilenya MISCELLANEOUS Approval 1 3956 NEUROLOGY Gilenya MISCELLANEOUS No Response 2 3956 NEUROLOGY Gilenya MULTIPLE SCLEROSIS Approval 1 3956 NEUROLOGY Gilenya MULTIPLE SCLEROSIS No Response 2 3956 NURSE PRACTITIONER, GERONTOLOGY Gilenya MISCELLANEOUS Approval 1 3956 NURSE PRACTITIONER, GERONTOLOGY Gilenya MULTIPLE SCLEROSIS Approval 1 3961 FAMILY PRACTICE Gilenya MISCELLANEOUS Approval 1 3961 FAMILY PRACTICE Gilenya MULTIPLE SCLEROSIS Approval 1 3963 FAMILY PRACTICE Gilenya MISCELLANEOUS Denial 1 3963 FAMILY PRACTICE Gilenya MULTIPLE SCLEROSIS Denial 1 3956 NURSE PRACTITIONER, GERONTOLOGY Gilenya 0.5MG OR CAPS MULTIPLE SCLEROSIS No Response 1 3961 UNSPECIFIED Gilenya 0.5MG OR CAPS MULTIPLE SCLEROSIS Approval 1 3956 NEUROLOGY glatiramer acetate 20mg MULTIPLE SCLEROSIS No Response 1 3951 UNSPECIFIED glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 1 3951 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 1 3956 UNSPECIFIED glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 2 3956 UNSPECIFIED glatiramer acetate 40mg MULTIPLE SCLEROSIS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED glatiramer acetate 40mg MULTIPLE SCLEROSIS No Response 1 3962 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 1 3963 UNSPECIFIED glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 4 3963 UNSPECIFIED glatiramer acetate 40mg MULTIPLE SCLEROSIS No Response 1 3963 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS Approval 1 3963 NEUROLOGY glatiramer acetate 40mg MULTIPLE SCLEROSIS No Response 1

13 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 NURSE PRACTITIONER, FAMILY HEALTH glatiramer acetate 40mg MULTIPLE SCLEROSIS No Response 1 3951 NEUROLOGY Glatiramer Acetate 40MG/ML SC SOSY MULTIPLE SCLEROSIS No Response 1 3963 UNSPECIFIED Glatiramer Acetate 40MG/ML SC SOSY MULTIPLE SCLEROSIS No Response 1 3963 NEUROLOGY Glatopa MISCELLANEOUS Approval 1 3963 NEUROLOGY Glatopa MULTIPLE SCLEROSIS AGENT Approval 1 3956 UNSPECIFIED Gleevec ANTINEOPLASTICS Denial 1 3956 UNSPECIFIED Hemlibra HEMOPHILIA AGENT Denial 2 3956 UNSPECIFIED Hemlibra HEMOPHILIA AGENT No Response 1 3956 HEMATOLOGY & ONCOLOGY, PEDIATRIC Hemlibra HEMOPHILIA AGENT No Response 1 3951 NURSE PRACTITIONER, PSYCHIATRIC Hetlioz SEDATIVES/HYPNOTICS Denial 1 3956 UNSPECIFIED Hetlioz SEDATIVES/HYPNOTICS Denial 1 3956 PSYCHIATRY Hetlioz SEDATIVES/HYPNOTICS Denial 3 3951 UNSPECIFIED Hizentra BIOLOGICALS Approval 1 3951 UNSPECIFIED Hizentra BIOLOGICALS Denial 1 3951 UNSPECIFIED Hizentra IMMUNE GLOBULIN Approval 1 3951 UNSPECIFIED Hizentra IMMUNE GLOBULIN Denial 1 3963 UNSPECIFIED Hizentra BIOLOGICALS Denial 1 3963 UNSPECIFIED Hizentra IMMUNE GLOBULIN Denial 1 3963 PEDIATRICS Hizentra BIOLOGICALS Approval 1 3963 PEDIATRICS Hizentra BIOLOGICALS Denial 2 3963 PEDIATRICS Hizentra BIOLOGICALS No Response 1 3963 PEDIATRICS Hizentra IMMUNE GLOBULIN Approval 1 3963 PEDIATRICS Hizentra IMMUNE GLOBULIN Denial 2 3963 PEDIATRICS Hizentra IMMUNE GLOBULIN No Response 1 3969 ALLERGY & IMMUNOLOGY Hizentra BIOLOGICALS Approval 1 3969 ALLERGY & IMMUNOLOGY Hizentra IMMUNE GLOBULIN Approval 1 3963 PEDIATRICS Hizentra 10GM/50ML SC SOLN IMMUNOGLOBULINS No Response 1 3956 UNSPECIFIED Humira ANTIARTHRITICS Denial 2 3956 RHEUMATOLOGY Humira ANTIARTHRITICS Approval 2 3961 PHYSICIAN ASSISTANT, UNSPECIFIED Humira ANTIARTHRITICS Approval 2 3963 UNSPECIFIED Humira ANTIARTHRITICS Approval 4 3962 RHEUMATOLOGY Humira 20 mg ANTIRHEUMATIC Approval 1 3963 RHEUMATOLOGY Humira 20 mg ANTIRHEUMATIC Approval 2 3951 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 5 3951 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 6 3951 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3951 FAMILY PRACTICE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1

14 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3951 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3951 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 INTERNAL MEDICINE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3951 INTERNAL MEDICINE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3951 NURSE PRACTITIONER, FAMILY HEALTH Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 NURSE PRACTITIONER, FAMILY HEALTH Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3951 NURSE PRACTITIONER, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3951 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 7 3951 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 15 3956 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 4 3956 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 7 3956 DERMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 3 3956 DERMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 3 3956 DERMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 FAMILY PRACTICE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 FAMILY PRACTICE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3956 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 7 3956 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 6 3956 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 INTERNAL MEDICINE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3956 INTERNAL MEDICINE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 INTERNAL MEDICINE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3956 NURSE PRACTITIONER, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 17 3956 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 7 3956 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 6 3961 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3961 DERMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3961 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1

15 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3961 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3962 DERMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3962 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3962 NURSE PRACTITIONER, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3962 NURSE PRACTITIONER, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3962 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 14 3963 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 6 3963 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3963 DERMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 3 3963 DERMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 FAMILY PRACTICE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 FAMILY PRACTICE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 8 3963 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 6 3963 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 4 3963 INTERNAL MEDICINE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 INTERNAL MEDICINE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 INTERNAL MEDICINE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3963 NURSE PRACTITIONER, FAMILY HEALTH Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 3 3963 NURSE PRACTITIONER, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 19 3963 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 4 3963 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 4 3964 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3964 DERMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3964 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3964 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3965 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3965 FAMILY PRACTICE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3965 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 INTERNAL MEDICINE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3965 NURSE PRACTITIONER, ACUTE CARE Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3965 NURSE PRACTITIONER, FAMILY HEALTH Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1

16 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3965 NURSE PRACTITIONER, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 3 3965 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3969 UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3969 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3969 GASTROENTEROLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3969 NURSE PRACTITIONER, UNSPECIFIED Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3969 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3969 RHEUMATOLOGY Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 FAMILY PRACTICE Humira 40MG/0.4ML SC PSKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3951 DERMATOLOGY Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 3 3956 UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Denial 3 3956 DERMATOLOGY Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3963 UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3969 UNSPECIFIED Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3969 PEDIATRICS Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 UNSPECIFIED HUMIRA CD/UC/HS PACK CF 80MG IMMUNOSUPPRESSIVES/DMARDS No Response 2 3951 NURSE PRACTITIONER, FAMILY HEALTH Humira Crohn?s/UC/HS Starter Pack + Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 UNSPECIFIED Humira Crohn?s/UC/HS Starter Pack + Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 UNSPECIFIED Humira Crohn?s/UC/HS Starter Pack + Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3956 GASTROENTEROLOGY Humira Crohn?s/UC/HS Starter Pack + Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira Crohn?s/UC/HS Starter Pack + Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3961 INTERNAL MEDICINE Humira Crohn?s/UC/HS Starter Pack + Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 UNSPECIFIED Humira Crohn?s/UC/HS Starter Pack + Humira 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3951 UNSPECIFIED Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 DERMATOLOGY Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 DERMATOLOGY Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 UNSPECIFIED Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 2

17 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 UNSPECIFIED Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 GASTROENTEROLOGY Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3963 UNSPECIFIED Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 GASTROENTEROLOGY Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 GASTROENTEROLOGY Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 NURSE PRACTITIONER, ACUTE CARE Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 GASTROENTEROLOGY Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3969 PHYSICIAN ASSISTANT, UNSPECIFIED Humira Crohns/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 GASTROENTEROLOGY Humira Crohn’s/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3962 GASTROENTEROLOGY Humira Crohn’s/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 UNSPECIFIED Humira Crohn’s/UC/HS Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 DERMATOLOGY Humira Ped. Crohns Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3951 UNSPECIFIED Humira Ped. Crohn’s Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 3 3956 UNSPECIFIED Humira Ped. Crohn’s Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 3 3963 UNSPECIFIED Humira Ped. Crohn’s Starter Pack + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 UNSPECIFIED Humira Ped. UC Starter Pack + 80 mg IMMUNOSUPPRESSIVES/DMARDS No Response 5 3951 GASTROENTEROLOGY Humira Ped. UC Starter Pack + 80 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED Humira Ped. UC Starter Pack + 80 mg IMMUNOSUPPRESSIVES/DMARDS No Response 4 3961 UNSPECIFIED Humira Ped. UC Starter Pack + 80 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3962 UNSPECIFIED Humira Ped. UC Starter Pack + 80 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 UNSPECIFIED Humira Ped. UC Starter Pack + 80 mg IMMUNOSUPPRESSIVES/DMARDS No Response 6 3963 GASTROENTEROLOGY Humira Ped. UC Starter Pack + 80 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3969 UNSPECIFIED Humira Ped. UC Starter Pack + 80 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3964 UNSPECIFIED PHYSICIAN, INTERN/RESIDENT/FEL­ LOW, UNSPECIFIED Humira Pediatric Crohns Start 80MG/0.8ML SC PSKT AUTOIMMUNE AGENT No Response 1 3951 UNSPECIFIED Humira Pen 40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 DERMATOLOGY Humira Pen 40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 NURSE PRACTITIONER, FAMILY HEALTH Humira Pen 40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 GASTROENTEROLOGY Humira Pen 40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira Pen 40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 RHEUMATOLOGY Humira Pen 40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 2 3963 GASTROENTEROLOGY Humira Pen 40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 RHEUMATOLOGY Humira Pen 40MG/0.4ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 RHEUMATOLOGY HUMIRA PEN 40MG/0.8 INJ IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 DERMATOLOGY Humira Pen 40MG/0.8ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED HUMIRA PEN 80 MG/0.8ML NO CITR IMMUNOSUPPRESSIVES/DMARDS No Response 1

18 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira Pen 80MG/0.8ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 DERMATOLOGY Humira Pen-CD/UC/HS Starter 80MG/0.8ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED Humira Pen-CD/UC/HS Starter 80MG/0.8ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 DERMATOLOGY Humira Pen-CD/UC/HS Starter 80MG/0.8ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira Pen-CD/UC/HS Starter 80MG/0.8ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED HUMIRA PEN-CD/UC/HS STARTER CD/UC/HS KIT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 UNSPECIFIED Humira Pen-Ps/UV/Adol HS Start 40MG/0.8ML SC PNKT IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 DERMATOLOGY Humira PsO/UV/Adolescent HS + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Humira PsO/UV/Adolescent HS + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 DERMATOLOGY Humira PsO/UV/Adolescent HS + Humira 40 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 RHEUMATOLOGY Humira(CF) Pen 40 mg/0.4 mL subcutaneous kit IMMUNOSUPPRESSIVES/DMARDS No Response 1 3965 UNSPECIFIED humira(cf) pen 40 mg/0.4 mLmg/ml pen injector kit IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 ALLERGY & IMMUNOLOGY HyQvia BIOLOGICALS Approval 2 3956 ALLERGY & IMMUNOLOGY HyQvia BIOLOGICALS Denial 1 3956 ALLERGY & IMMUNOLOGY HyQvia BIOLOGICALS No Response 1 3956 ALLERGY & IMMUNOLOGY HyQvia IMMUNE GLOBULIN Approval 2 3956 ALLERGY & IMMUNOLOGY HyQvia IMMUNE GLOBULIN Denial 1 3956 ALLERGY & IMMUNOLOGY HyQvia IMMUNE GLOBULIN No Response 1 3956 PEDIATRICS HyQvia BIOLOGICALS No Response 1 3956 PEDIATRICS HyQvia IMMUNE GLOBULIN No Response 1 3963 UNSPECIFIED HyQvia BIOLOGICALS Approval 1 3963 UNSPECIFIED HyQvia BIOLOGICALS Denial 1 3963 UNSPECIFIED HyQvia IMMUNE GLOBULIN Approval 1 3963 UNSPECIFIED HyQvia IMMUNE GLOBULIN Denial 1 3963 ALLERGY & IMMUNOLOGY HyQvia BIOLOGICALS Approval 1 3963 ALLERGY & IMMUNOLOGY HyQvia IMMUNE GLOBULIN Approval 1 3964 UNSPECIFIED HyQvia BIOLOGICALS Approval 2 3964 UNSPECIFIED HyQvia BIOLOGICALS No Response 1 3964 UNSPECIFIED HyQvia IMMUNE GLOBULIN Approval 2 3964 UNSPECIFIED HyQvia IMMUNE GLOBULIN No Response 1 3964 ALLERGY & IMMUNOLOGY HyQvia BIOLOGICALS No Response 1 3964 ALLERGY & IMMUNOLOGY HyQvia IMMUNE GLOBULIN No Response 1 3964 UNSPECIFIED Hyqvia 30GM/300ML SC KIT IMMUNOGLOBULINS No Response 1 3951 HEMATOLOGY & ONCOLOGY Ibrance ANTINEOPLASTICS Approval 2 3956 UNSPECIFIED Ibrance ANTINEOPLASTICS Approval 2 3956 UNSPECIFIED Ibrance ANTINEOPLASTICS No Response 2

19 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 HEMATOLOGY & ONCOLOGY Ibrance ANTINEOPLASTICS Approval 6 3956 HEMATOLOGY & ONCOLOGY Ibrance ANTINEOPLASTICS Denial 2 3963 UNSPECIFIED Ibrance ANTINEOPLASTICS Approval 4 3963 UNSPECIFIED Ibrance ANTINEOPLASTICS No Response 4 3963 HEMATOLOGY & ONCOLOGY Ibrance ANTINEOPLASTICS Approval 4 3963 HEMATOLOGY & ONCOLOGY Ibrance ANTINEOPLASTICS No Response 2 3956 HEMATOLOGY & ONCOLOGY Ibrance 125MG OR TABS ANTINEOPLASTICS No Response 1 3951 UNSPECIFIED imatinib mesylate ANTINEOPLASTICS Approval 2 3951 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS Approval 2 3956 UNSPECIFIED imatinib mesylate ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS Denial 2 3961 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS Approval 2 3961 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS No Response 2 3963 UNSPECIFIED imatinib mesylate ANTINEOPLASTICS Approval 2 3963 HEMATOLOGY imatinib mesylate ANTINEOPLASTICS Approval 2 3963 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS Approval 4 3963 HEMATOLOGY & ONCOLOGY imatinib mesylate ANTINEOPLASTICS No Response 2 3963 MEDICAL ONCOLOGY imatinib mesylate ANTINEOPLASTICS Approval 2 3963 MEDICAL ONCOLOGY imatinib mesylate ANTINEOPLASTICS No Response 2 3956 MEDICAL ONCOLOGY Imbruvica ANTINEOPLASTICS Approval 2 3956 MEDICAL ONCOLOGY Imbruvica ANTINEOPLASTICS No Response 2 3963 FAMILY PRACTICE Ingrezza PSYCHOTHERAPEUTIC Approval 1 3963 NURSE PRACTITIONER, PSYCHIATRIC Ingrezza PSYCHOTHERAPEUTIC No Response 1 3963 PSYCHIATRY Ingrezza PSYCHOTHERAPEUTIC Approval 1 3963 NURSE PRACTITIONER, PSYCHIATRIC Ingrezza 40MG OR CAPS PSYCHOTHERAPEUTIC No Response 1 3963 PSYCHIATRY Ingrezza 40MG OR CAPS PSYCHOTHERAPEUTIC No Response 1 3963 FAMILY PRACTICE Ingrezza 80MG OR CAPS PSYCHOTHERAPEUTIC No Response 1 3963 HEMATOLOGY & ONCOLOGY Inlyta ANTINEOPLASTICS Approval 2 3963 MEDICAL ONCOLOGY Inlyta ANTINEOPLASTICS No Response 2 3963 PHYSICIAN, ONCOLOGY, MEDICAL Jakafi ANTINEOPLASTICS Approval 2 3963 PHYSICIAN, ONCOLOGY, MEDICAL Jakafi ANTINEOPLASTICS Denial 2 3963 PHYSICIAN, ONCOLOGY, MEDICAL Jakafi ANTINEOPLASTICS No Response 2 3965 NURSE PRACTITIONER, FAMILY HEALTH Jakafi ANTINEOPLASTICS Approval 2 3961 PHYSICIAN ASSISTANT, UNSPECIFIED Javygtor ENZYME COFACTOR Approval 1 3963 NEPHROLOGY / RENAL MEDICINE Jynarque KIDNEY AGENT Approval 1 3965 NEPHROLOGY / RENAL MEDICINE Jynarque KIDNEY AGENT Approval 1

20 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3965 NEPHROLOGY / RENAL MEDICINE Jynarque KIDNEY AGENT No Response 1 3956 NEUROLOGY Kesimpta MULTIPLE SCLEROSIS AGENT Approval 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Kesimpta MULTIPLE SCLEROSIS AGENT Denial 1 3963 UNSPECIFIED Kesimpta MULTIPLE SCLEROSIS AGENT Approval 2 3963 NEUROLOGY Kesimpta MULTIPLE SCLEROSIS AGENT Approval 1 3963 NURSE PRACTITIONER, UNSPECIFIED Kesimpta MULTIPLE SCLEROSIS AGENT No Response 1 3965 NEUROLOGY Kesimpta MULTIPLE SCLEROSIS AGENT Approval 1 3956 UNSPECIFIED Kesimpta 20MG/0.4ML SC SOAJ MULTIPLE SCLEROSIS AGENT No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Kesimpta 20MG/0.4ML SC SOAJ MULTIPLE SCLEROSIS AGENT No Response 1 3956 UNSPECIFIED Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 RHEUMATOLOGY Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval 3 3956 RHEUMATOLOGY Kevzara IMMUNOSUPPRESSIVES/DMARDS No Response 1 3961 UNSPECIFIED Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 UNSPECIFIED Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 INTERNAL MEDICINE Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 RHEUMATOLOGY Kevzara IMMUNOSUPPRESSIVES/DMARDS Approval 3 3963 RHEUMATOLOGY Kevzara IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 UNSPECIFIED KEVZARA 200 MG/1.14ML PEN 2PK IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 RHEUMATOLOGY Kevzara 200MG/1.14ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 2 3951 PHYSICIAN, ONCOLOGY, MEDICAL Kisqali ANTINEOPLASTICS Approval 1 3956 UNSPECIFIED Kisqali ANTINEOPLASTICS Denial 1 3951 PULMONARY DISEASES Kitabis Pak STREPTOMYCINS Approval 1 3956 HEMATOLOGY & ONCOLOGY lapatinib ANTINEOPLASTICS No Response 1 3963 HEMATOLOGY & ONCOLOGY, PEDIATRIC lapatinib ANTINEOPLASTICS No Response 1 3956 HEMATOLOGY & ONCOLOGY lenalidomide ANTINEOPLASTICS Denial 1 3956 HEMATOLOGY & ONCOLOGY lenalidomide ANTINEOPLASTICS No Response 2 3963 HEMATOLOGY & ONCOLOGY lenalidomide ANTINEOPLASTICS No Response 1 3956 HEMATOLOGY & ONCOLOGY Lenalidomide 15MG OR CAPS ANTINEOPLASTICS No Response 1 3956 UNSPECIFIED Lenalidomide 25MG OR CAPS ANTINEOPLASTICS No Response 1 3951 INTERNAL MEDICINE Lenvima ANTINEOPLASTICS No Response 2 3956 UNSPECIFIED Lenvima ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY & ONCOLOGY Lenvima ANTINEOPLASTICS Approval 2 3956 INTERNAL MEDICINE Lenvima ANTINEOPLASTICS Approval 2 3963 INTERNAL MEDICINE Lenvima ANTINEOPLASTICS Approval 2 3963 UNSPECIFIED Lenvima (24 MG Daily Dose) 2 x 10 MG &4 MG OR CPPK ANTINEOPLASTICS No Response 1 3956 UNSPECIFIED leuprolide kit HORMONES No Response 2

21 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3961 UNSPECIFIED leuprolide kit HORMONES No Response 3 3963 UNSPECIFIED leuprolide kit HORMONES No Response 5 3951 OBSTETRICS & GYNECOLOGY Lupron Depot (1-Month) 3.75MG IM KIT HORMONES/HORMONE MODIFIERS No Response 1 3951 OBSTETRICS & GYNECOLOGY Lupron Depot 3.75 mg HORMONES/HORMONE MODIFIERS Approval 1 3951 OBSTETRICS & GYNECOLOGY Lupron Depot 3.75 mg HORMONES/HORMONE MODIFIERS No Response 1 3956 UNSPECIFIED Lupron Depot 3.75 mg HORMONES/HORMONE MODIFIERS Denial 1 3956 HEMATOLOGY & ONCOLOGY Lynparza ANTINEOPLASTICS Approval 2 3956 INTERNAL MEDICINE Lynparza ANTINEOPLASTICS Approval 2 3963 HEMATOLOGY & ONCOLOGY Lynparza ANTINEOPLASTICS Denial 2 3963 OBSTETRICS & GYNECOLOGY Lynparza ANTINEOPLASTICS Approval 2 3965 HEMATOLOGY & ONCOLOGY Lynparza ANTINEOPLASTICS Denial 2 3951 HEMATOLOGY Lynparza 150MG OR TABS ANTINEOPLASTICS Denial 1 3951 NEUROLOGY Mavenclad MULTIPLE SCLEROSIS AGENT Denial 1 3963 UNSPECIFIED Mavenclad MULTIPLE SCLEROSIS AGENT Approval 2 3963 UNSPECIFIED Mavenclad MULTIPLE SCLEROSIS AGENT Denial 1 3956 UNSPECIFIED Mavenclad (10 Tabs) 10MG OR TBPK MULTIPLE SCLEROSIS AGENT No Response 1 3963 UNSPECIFIED Mavenclad (8 Tabs) 10MG OR TBPK MULTIPLE SCLEROSIS AGENT No Response 1 3963 PHYSICIAN, ONCOLOGY, MEDICAL Mektovi ANTINEOPLASTICS Approval 1 3963 PHYSICIAN, ONCOLOGY, MEDICAL Mektovi ANTINEOPLASTICS No Response 1 3969 UNSPECIFIED Nerlynx ANTINEOPLASTICS Approval 1 3956 GASTROENTEROLOGY Nivestym COLONY STIMULATING FACTORS Approval 1 3956 HEMATOLOGY & ONCOLOGY Nivestym COLONY STIMULATING FACTORS Approval 2 3963 UNSPECIFIED Norditropin GROWTH HORMONE THERAPY Approval 2 3963 UNSPECIFIED Norditropin GROWTH HORMONE THERAPY Denial 2 3963 UNSPECIFIED Norditropin GROWTH HORMONE THERAPY No Response 4 3963 UNSPECIFIED Norditropin OTHER HORMONES Approval 2 3963 UNSPECIFIED Norditropin OTHER HORMONES Denial 2 3963 UNSPECIFIED Norditropin OTHER HORMONES No Response 4 3963 ENDOCRINOLOGY, PEDIATRIC Norditropin GROWTH HORMONE THERAPY Denial 2 3963 ENDOCRINOLOGY, PEDIATRIC Norditropin OTHER HORMONES Denial 2 3963 FAMILY PRACTICE Norditropin GROWTH HORMONE THERAPY Approval 1 3963 FAMILY PRACTICE Norditropin OTHER HORMONES Approval 1 3963 PEDIATRICS Norditropin GROWTH HORMONE THERAPY Approval 3 3963 PEDIATRICS Norditropin GROWTH HORMONE THERAPY Denial 1 3963 PEDIATRICS Norditropin GROWTH HORMONE THERAPY No Response 1 3963 PEDIATRICS Norditropin OTHER HORMONES Approval 3 3963 PEDIATRICS Norditropin OTHER HORMONES Denial 1

22 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 PEDIATRICS Norditropin OTHER HORMONES No Response 1 3963 UNSPECIFIED Norditropin FlexPro 30MG/3ML SC SOPN HORMONES No Response 1 3951 PULMONARY DISEASES Nucala MISCELLANEOUS Denial 2 3956 UNSPECIFIED Nucala MISCELLANEOUS Approval 6 3956 UNSPECIFIED Nucala MISCELLANEOUS Denial 10 3956 UNSPECIFIED Nucala MISCELLANEOUS No Response 6 3956 PULMONARY DISEASES Nucala MISCELLANEOUS Denial 2 3961 UNSPECIFIED Nucala MISCELLANEOUS Approval 2 3963 UNSPECIFIED Nucala MISCELLANEOUS Approval 2 3963 UNSPECIFIED Nucala MISCELLANEOUS Denial 2 3963 INTERNAL MEDICINE Nucala MISCELLANEOUS Approval 2 3963 INTERNAL MEDICINE Nucala MISCELLANEOUS Denial 2 3963 NURSE PRACTITIONER, UNSPECIFIED Nucala MISCELLANEOUS Denial 2 3963 OTOLARYNGOLOGY Nucala MISCELLANEOUS Denial 8 3963 PULMONARY DISEASES Nucala MISCELLANEOUS Approval 2 3963 PULMONARY DISEASES Nucala MISCELLANEOUS Denial 2 3963 PULMONARY DISEASES Nucala MISCELLANEOUS No Response 2 3951 PULMONARY DISEASES Nucala 100MG/ML SC SOAJ RESPIRATORY AGENTS Denial 1 3956 UNSPECIFIED Nucala 100MG/ML SC SOAJ RESPIRATORY AGENTS No Response 2 3963 UNSPECIFIED Nutropin AQ GROWTH HORMONE Approval 1 3951 HEMATOLOGY & ONCOLOGY Nyvepria 6MG/0.6ML SC SOSY HEMATOPOIETIC AGENT No Response 1 3963 UNSPECIFIED Ocaliva BILE THERAPY Denial 1 3963 UNSPECIFIED Ocaliva PRIMARY BILIARY CHOLANGITIS Denial 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Ocaliva BILE THERAPY Approval 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Ocaliva PRIMARY BILIARY CHOLANGITIS Approval 1 3964 UNSPECIFIED Ocaliva BILE THERAPY Denial 1 3964 UNSPECIFIED Ocaliva PRIMARY BILIARY CHOLANGITIS Denial 1 3956 NURSE PRACTITIONER, FAMILY HEALTH octreotide acetate OTHER HORMONES Denial 1 3963 GASTROENTEROLOGY octreotide acetate OTHER HORMONES Denial 2 3963 GASTROENTEROLOGY Octreotide Acetate 100MCG/ML IJ SOLN OTHER HORMONES No Response 1 3951 UNSPECIFIED Ofev MISCELLANEOUS Denial 2 3951 UNSPECIFIED Ofev TYROSINE KINASE INHIBITOR Denial 2 3956 UNSPECIFIED Ofev MISCELLANEOUS Approval 2 3956 UNSPECIFIED Ofev TYROSINE KINASE INHIBITOR Approval 2 3956 PULMONARY DISEASES Ofev MISCELLANEOUS Approval 2 3956 PULMONARY DISEASES Ofev TYROSINE KINASE INHIBITOR Approval 2 3963 UNSPECIFIED Ofev MISCELLANEOUS Approval 2

23 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 UNSPECIFIED Ofev TYROSINE KINASE INHIBITOR Approval 2 3963 INTERNAL MEDICINE Ofev MISCELLANEOUS Denial 1 3963 INTERNAL MEDICINE Ofev TYROSINE KINASE INHIBITOR Denial 1 3963 PULMONARY DISEASES Ofev MISCELLANEOUS No Response 1 3963 PULMONARY DISEASES Ofev TYROSINE KINASE INHIBITOR No Response 1 3951 CARDIOLOGY Opsumit OTHER ANTIHYPERTENSIVES Approval 1 3951 CARDIOLOGY Opsumit PULMONARY ARTERIAL HYPERTENSION Approval 1 3956 UNSPECIFIED Opsumit OTHER ANTIHYPERTENSIVES No Response 1 3956 UNSPECIFIED Opsumit PULMONARY ARTERIAL HYPERTENSION No Response 1 3956 CARDIOLOGY Opsumit OTHER ANTIHYPERTENSIVES Approval 3 3956 CARDIOLOGY Opsumit PULMONARY ARTERIAL HYPERTENSION Approval 3 3956 INTERNAL MEDICINE Opsumit OTHER ANTIHYPERTENSIVES Approval 1 3956 INTERNAL MEDICINE Opsumit OTHER ANTIHYPERTENSIVES No Response 1 3956 INTERNAL MEDICINE Opsumit PULMONARY ARTERIAL HYPERTENSION Approval 1 3956 INTERNAL MEDICINE Opsumit PULMONARY ARTERIAL HYPERTENSION No Response 1 3961 UNSPECIFIED Opsumit OTHER ANTIHYPERTENSIVES Approval 1 3961 UNSPECIFIED Opsumit PULMONARY ARTERIAL HYPERTENSION Approval 1 3963 UNSPECIFIED Opsumit OTHER ANTIHYPERTENSIVES Approval 1 3963 UNSPECIFIED Opsumit PULMONARY ARTERIAL HYPERTENSION Approval 1 3963 INTERNAL MEDICINE Opsumit OTHER ANTIHYPERTENSIVES Approval 1 3963 INTERNAL MEDICINE Opsumit PULMONARY ARTERIAL HYPERTENSION Approval 1 3964 PULMONARY DISEASES Opsumit OTHER ANTIHYPERTENSIVES Approval 1 3964 PULMONARY DISEASES Opsumit PULMONARY ARTERIAL HYPERTENSION Approval 1 3961 NURSE PRACTITIONER, PEDIATRIC CARE Orkambi CYSTIC FIBROSIS AGENTS Approval 1 3961 NURSE PRACTITIONER, PEDIATRIC CARE Orkambi MISCELLANEOUS Approval 1 3956 UNSPECIFIED Otezla 10 & 20 & 30MG OR TBPK IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 DERMATOLOGY OTEZLA 30 MG TABLET 60 IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3951 DERMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3951 DERMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 3 3951 INTERNAL MEDICINE Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 NURSE PRACTITIONER, FAMILY HEALTH Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 3 3956 UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 8 3956 UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 DERMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 3 3956 DERMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 3

24 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 INTERNAL MEDICINE Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3956 INTERNAL MEDICINE Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3956 RHEUMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 RHEUMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3962 NURSE PRACTITIONER, FAMILY HEALTH Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 7 3963 UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 4 3963 DERMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3963 DERMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 3 3963 DERMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 FAMILY PRACTICE Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 INTERNAL MEDICINE Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 NURSE PRACTITIONER, FAMILY HEALTH Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 NURSE PRACTITIONER, UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 RHEUMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 3 3963 RHEUMATOLOGY Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3964 UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3964 UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3964 PHYSICIAN ASSISTANT, UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 UNSPECIFIED Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 UNSPECIFIED Otezla 30MG OR TABS IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 DERMATOLOGY Otezla 30MG OR TABS IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Otezla 30MG OR TABS IMMUNOSUPPRESSIVES/DMARDS No Response 2 3963 NURSE PRACTITIONER, FAMILY HEALTH Otezla 30MG OR TABS IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Otezla Starter Pack + Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Otezla Starter Pack + Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3961 INTERNAL MEDICINE Otezla Starter Pack + Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 UNSPECIFIED Otezla Starter Pack + Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 UNSPECIFIED Otezla Starter Pack + Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Otezla Starter Pack + Otezla 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 UNSPECIFIED pirfenidone ANTIFIBROTIC AGENT No Response 1

25 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 UNSPECIFIED pirfenidone IDIOPATHIC PULMONARY FIBROSIS No Response 1 3956 UNSPECIFIED Plegridy MISCELLANEOUS Denial 1 3956 UNSPECIFIED Plegridy MULTIPLE SCLEROSIS AGENT Denial 1 3956 UNSPECIFIED Plegridy Starter Pack 63 & 94MCG/0.5ML SC SOPN MULTIPLE SCLEROSIS AGENT No Response 1 3951 HEMATOLOGY Pomalyst ANTINEOPLASTICS Approval 2 3951 HEMATOLOGY & ONCOLOGY Pomalyst ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY Pomalyst ANTINEOPLASTICS Approval 2 3963 PHYSICIAN, ONCOLOGY, MEDICAL Pomalyst ANTINEOPLASTICS Approval 2 3951 UNSPECIFIED Praluent LIPOTROPICS Approval 2 3951 UNSPECIFIED Praluent LIPOTROPICS Denial 4 3951 CARDIOLOGY Praluent LIPOTROPICS Approval 4 3951 CARDIOLOGY Praluent LIPOTROPICS Denial 6 3951 FAMILY PRACTICE Praluent LIPOTROPICS Approval 2 3951 FAMILY PRACTICE Praluent LIPOTROPICS Denial 4 3956 UNSPECIFIED Praluent LIPOTROPICS Denial 12 3956 CARDIOLOGY Praluent LIPOTROPICS Approval 4 3956 CARDIOLOGY Praluent LIPOTROPICS Denial 16 3956 CARDIOLOGY Praluent LIPOTROPICS No Response 4 3956 CARDIOLOGY, INTERVENTIONAL Praluent LIPOTROPICS Denial 2 3956 FAMILY PRACTICE Praluent LIPOTROPICS Approval 4 3956 FAMILY PRACTICE Praluent LIPOTROPICS Denial 12 3956 HOSPITALIST Praluent LIPOTROPICS Denial 2 3956 INTERNAL MEDICINE Praluent LIPOTROPICS Approval 2 3956 INTERNAL MEDICINE Praluent LIPOTROPICS Denial 8 3956 NURSE PRACTITIONER, FAMILY HEALTH Praluent LIPOTROPICS Denial 4 3956 NURSE PRACTITIONER, UNSPECIFIED Praluent LIPOTROPICS Denial 2 3956 PHYSICIAN, ENDOCRINOLOGY Praluent LIPOTROPICS Denial 6 3961 CARDIOLOGY Praluent LIPOTROPICS Denial 2 3961 CARDIOLOGY, INTERVENTIONAL Praluent LIPOTROPICS Approval 2 3961 CARDIOLOGY, INTERVENTIONAL Praluent LIPOTROPICS Denial 6 3961 CARDIOLOGY, INTERVENTIONAL Praluent LIPOTROPICS No Response 2 3962 CARDIOLOGY, INTERVENTIONAL Praluent LIPOTROPICS Denial 4 3963 UNSPECIFIED Praluent LIPOTROPICS Approval 4 3963 UNSPECIFIED Praluent LIPOTROPICS Denial 22 3963 UNSPECIFIED Praluent LIPOTROPICS No Response 4 3963 CARDIOLOGY Praluent LIPOTROPICS Approval 8 3963 CARDIOLOGY Praluent LIPOTROPICS Denial 32

26 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 CARDIOLOGY Praluent LIPOTROPICS No Response 6 3963 FAMILY PRACTICE Praluent LIPOTROPICS Denial 6 3963 HOSPITALIST Praluent LIPOTROPICS Denial 2 3963 INTERNAL MEDICINE Praluent LIPOTROPICS Approval 2 3963 INTERNAL MEDICINE Praluent LIPOTROPICS Denial 8 3963 INTERNAL MEDICINE Praluent LIPOTROPICS No Response 2 3963 NURSE PRACTITIONER, FAMILY HEALTH Praluent LIPOTROPICS Approval 2 3963 NURSE PRACTITIONER, FAMILY HEALTH Praluent LIPOTROPICS No Response 2 3963 NURSE PRACTITIONER, UNSPECIFIED Praluent LIPOTROPICS Approval 2 3963 NURSE PRACTITIONER, UNSPECIFIED Praluent LIPOTROPICS Denial 4 3964 CARDIOLOGY Praluent LIPOTROPICS Approval 2 3964 CARDIOLOGY Praluent LIPOTROPICS Denial 2 3964 CARDIOLOGY, INTERVENTIONAL Praluent LIPOTROPICS Denial 2 3964 FAMILY PRACTICE Praluent LIPOTROPICS Denial 2 3965 UNSPECIFIED Praluent LIPOTROPICS Denial 2 3965 CARDIOLOGY Praluent LIPOTROPICS Denial 6 3965 INTERNAL MEDICINE Praluent LIPOTROPICS Denial 2 3965 NURSE PRACTITIONER, ACUTE CARE Praluent LIPOTROPICS Approval 2 3969 UNSPECIFIED Praluent LIPOTROPICS Denial 2 3963 UNSPECIFIED Praluent 150MG/ML SC SOAJ LIPOTROPICS Denial 1 3963 CARDIOLOGY Praluent 150MG/ML SC SOAJ LIPOTROPICS No Response 5 3963 FAMILY PRACTICE Praluent 150MG/ML SC SOAJ LIPOTROPICS No Response 1 3964 CARDIOLOGY Praluent 150MG/ML SC SOAJ LIPOTROPICS No Response 1 3965 UNSPECIFIED Praluent 150MG/ML SC SOAJ LIPOTROPICS No Response 1 3951 CARDIOLOGY Praluent 75MG/ML SC SOAJ LIPOTROPICS Denial 1 3951 CARDIOLOGY Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 2 3951 FAMILY PRACTICE Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 1 3956 UNSPECIFIED Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 3 3956 CARDIOLOGY Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 1 3956 FAMILY PRACTICE Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 1 3963 UNSPECIFIED Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 1 3963 CARDIOLOGY Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 2 3963 FAMILY PRACTICE Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 1 3963 INTERNAL MEDICINE Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 1 3965 UNSPECIFIED Praluent 75MG/ML SC SOAJ LIPOTROPICS Denial 1 3965 UNSPECIFIED Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 1

27 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3969 UNSPECIFIED Praluent 75MG/ML SC SOAJ LIPOTROPICS No Response 1 3956 UNSPECIFIED Prolia BONE-MODIFYING AGENT Approval 2 3956 UNSPECIFIED Prolia BONE-MODIFYING AGENT Denial 1 3956 UNSPECIFIED Prolia MISCELLANEOUS Approval 2 3956 UNSPECIFIED Prolia MISCELLANEOUS Denial 1 3956 CLINICAL NURSE SPECIALIST, ADULT HEALTH Prolia BONE-MODIFYING AGENT Approval 1 3956 CLINICAL NURSE SPECIALIST, ADULT HEALTH Prolia MISCELLANEOUS Approval 1 3956 FAMILY PRACTICE Prolia BONE-MODIFYING AGENT Approval 5 3956 FAMILY PRACTICE Prolia BONE-MODIFYING AGENT Denial 2 3956 FAMILY PRACTICE Prolia BONE-MODIFYING AGENT No Response 3 3956 FAMILY PRACTICE Prolia MISCELLANEOUS Approval 5 3956 FAMILY PRACTICE Prolia MISCELLANEOUS Denial 2 3956 FAMILY PRACTICE Prolia MISCELLANEOUS No Response 3 3956 INTERNAL MEDICINE Prolia BONE-MODIFYING AGENT No Response 1 3956 INTERNAL MEDICINE Prolia MISCELLANEOUS No Response 1 3956 OBSTETRICS & GYNECOLOGY Prolia BONE-MODIFYING AGENT Denial 1 3956 OBSTETRICS & GYNECOLOGY Prolia MISCELLANEOUS Denial 1 3956 PEDIATRICS Prolia BONE-MODIFYING AGENT Denial 1 3956 PEDIATRICS Prolia MISCELLANEOUS Denial 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Prolia BONE-MODIFYING AGENT Approval 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Prolia MISCELLANEOUS Approval 1 3956 PHYSICIAN, ENDOCRINOLOGY Prolia BONE-MODIFYING AGENT Approval 1 3956 PHYSICIAN, ENDOCRINOLOGY Prolia BONE-MODIFYING AGENT No Response 1 3956 PHYSICIAN, ENDOCRINOLOGY Prolia MISCELLANEOUS Approval 1 3956 PHYSICIAN, ENDOCRINOLOGY Prolia MISCELLANEOUS No Response 1 3963 UNSPECIFIED Prolia BONE-MODIFYING AGENT Approval 1 3963 UNSPECIFIED Prolia BONE-MODIFYING AGENT Denial 1 3963 UNSPECIFIED Prolia BONE-MODIFYING AGENT No Response 1 3963 UNSPECIFIED Prolia MISCELLANEOUS Approval 1 3963 UNSPECIFIED Prolia MISCELLANEOUS Denial 1 3963 UNSPECIFIED Prolia MISCELLANEOUS No Response 1 3963 FAMILY PRACTICE Prolia BONE-MODIFYING AGENT Approval 1 3963 FAMILY PRACTICE Prolia MISCELLANEOUS Approval 1 3963 INTERNAL MEDICINE Prolia BONE-MODIFYING AGENT Approval 1 3963 INTERNAL MEDICINE Prolia MISCELLANEOUS Approval 1 3963 NURSE PRACTITIONER, UNSPECIFIED Prolia BONE-MODIFYING AGENT Approval 1 3963 NURSE PRACTITIONER, UNSPECIFIED Prolia MISCELLANEOUS Approval 1

28 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 OBSTETRICS & GYNECOLOGY Prolia BONE-MODIFYING AGENT Approval 1 3963 OBSTETRICS & GYNECOLOGY Prolia MISCELLANEOUS Approval 1 3956 OBSTETRICS & GYNECOLOGY Prolia 60MG/ML SC SOSY OSTEOPOROSIS AGENTS No Response 2 3951 PHYSICIAN, ONCOLOGY, MEDICAL Promacta HEMOSTATICS Approval 2 3951 PHYSICIAN, ONCOLOGY, MEDICAL Promacta HEMOSTATICS Denial 2 3956 UNSPECIFIED Promacta HEMOSTATICS Approval 2 3956 UNSPECIFIED Promacta HEMOSTATICS Denial 4 3956 UNSPECIFIED Promacta HEMOSTATICS No Response 2 3956 HEMATOLOGY & ONCOLOGY Promacta HEMOSTATICS Approval 2 3956 HEMATOLOGY & ONCOLOGY Promacta HEMOSTATICS No Response 2 3956 INTERNAL MEDICINE Promacta HEMOSTATICS Approval 2 3956 INTERNAL MEDICINE Promacta HEMOSTATICS No Response 2 3963 HEMATOLOGY & ONCOLOGY Promacta HEMOSTATICS Denial 4 3963 MEDICAL ONCOLOGY Promacta HEMOSTATICS No Response 2 3963 PHYSICIAN, ONCOLOGY, MEDICAL Promacta HEMOSTATICS Denial 2 3964 UNSPECIFIED Promacta HEMOSTATICS Approval 4 3964 HEMATOLOGY & ONCOLOGY Promacta HEMOSTATICS No Response 2 3962 PEDIATRICS Pulmozyme MISCELLANEOUS Approval 1 3962 PEDIATRICS Pulmozyme MISCELLANEOUS No Response 2 3963 NURSE PRACTITIONER, PEDIATRIC CARE Pulmozyme MISCELLANEOUS Approval 1 3963 PULMONARY DISEASES Pulmozyme MISCELLANEOUS Approval 1 3963 PULMONARY DISEASES Pulmozyme MISCELLANEOUS No Response 1 3963 PULMONOLOGY, PEDIATRIC Pulmozyme MISCELLANEOUS Approval 2 3965 UNSPECIFIED Pulmozyme MISCELLANEOUS Approval 2 3969 PEDIATRICS Pulmozyme MISCELLANEOUS Approval 1 3963 NURSE PRACTITIONER, PEDIATRIC CARE Pulmozyme 2.5MG/2.5ML IN SOLN MISCELLANEOUS No Response 1 3963 UNSPECIFIED Rasuvo ANTIARTHRITICS Denial 4 3963 DERMATOLOGY Rasuvo ANTIARTHRITICS Denial 2 3951 UNSPECIFIED Rebif MISCELLANEOUS No Response 1 3951 UNSPECIFIED Rebif MULTIPLE SCLEROSIS AGENT No Response 1 3951 NEUROLOGY Rebif MISCELLANEOUS Approval 1 3951 NEUROLOGY Rebif MISCELLANEOUS No Response 1 3951 NEUROLOGY Rebif MULTIPLE SCLEROSIS AGENT Approval 1 3951 NEUROLOGY Rebif MULTIPLE SCLEROSIS AGENT No Response 1 3956 UNSPECIFIED Rebif MISCELLANEOUS Approval 1 3956 UNSPECIFIED Rebif MULTIPLE SCLEROSIS AGENT Approval 1 3963 NEUROLOGY Rebif MISCELLANEOUS Approval 1

29 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 NEUROLOGY Rebif MISCELLANEOUS Denial 1 3963 NEUROLOGY Rebif MULTIPLE SCLEROSIS AGENT Approval 1 3963 NEUROLOGY Rebif MULTIPLE SCLEROSIS AGENT Denial 1 3956 FAMILY PRACTICE REPATHA SURECLICK 140MG/ML INJ ANTILIPEMIC AGENT Denial 1 3951 UNSPECIFIED Retacrit HEMATOPOIETIC AGENT No Response 1 3951 NURSE PRACTITIONER, FAMILY HEALTH Retacrit HEMATOPOIETIC AGENT Approval 1 3956 FAMILY PRACTICE Retacrit HEMATOPOIETIC AGENT Denial 1 3965 UNSPECIFIED Retacrit HEMATOPOIETIC AGENT Approval 1 3965 UNSPECIFIED Retacrit HEMATOPOIETIC AGENT Denial 1 3956 FAMILY PRACTICE Retacrit 10000UNIT/ML IJ SOLN HEMATOPOIETIC AGENT No Response 1 3951 HEMATOLOGY & ONCOLOGY Revlimid ANTINEOPLASTICS Approval 4 3956 UNSPECIFIED Revlimid ANTINEOPLASTICS Approval 4 3956 HEMATOLOGY Revlimid ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY & ONCOLOGY Revlimid ANTINEOPLASTICS Approval 6 3963 UNSPECIFIED Revlimid ANTINEOPLASTICS Approval 4 3963 HEMATOLOGY & ONCOLOGY Revlimid ANTINEOPLASTICS Approval 2 3963 PHYSICIAN, ONCOLOGY, MEDICAL Revlimid ANTINEOPLASTICS Approval 2 3956 UNSPECIFIED RINVOQ 15 MG ER TABLET IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 7 3956 UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS No Response 3 3956 DERMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 DERMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3956 DERMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 GASTROENTEROLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 INTERNAL MEDICINE Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 INTERNAL MEDICINE Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3956 RHEUMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3956 RHEUMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3961 RHEUMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 6 3963 UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3963 GASTROENTEROLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 GASTROENTEROLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Denial 1

30 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 NURSE PRACTITIONER, UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 NURSE PRACTITIONER, UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 RHEUMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 6 3963 RHEUMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 RHEUMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3964 NURSE PRACTITIONER, UNSPECIFIED Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3964 RHEUMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 RHEUMATOLOGY Rinvoq 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Rinvoq 15MG OR TB24 IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 UNSPECIFIED Rinvoq 15MG OR TB24 IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 RHEUMATOLOGY Rinvoq 15MG OR TB24 IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 GASTROENTEROLOGY Rinvoq 15MG OR TB24 IMMUNOSUPPRESSIVES/DMARDS No Response 2 3964 NURSE PRACTITIONER, UNSPECIFIED Rinvoq 15MG OR TB24 IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 UNSPECIFIED Rinvoq 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 FAMILY PRACTICE Rinvoq 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 GASTROENTEROLOGY Rinvoq 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 UNSPECIFIED Rinvoq 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 UNSPECIFIED Rinvoq 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 GASTROENTEROLOGY Rinvoq 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 GASTROENTEROLOGY Rinvoq 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 GASTROENTEROLOGY Rinvoq 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 GASTROENTEROLOGY Rinvoq 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 GASTROENTEROLOGY Rinvoq 45mg + 15mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 GASTROENTEROLOGY Rinvoq 45mg + 15mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 GASTROENTEROLOGY Rinvoq 45mg + 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 UNSPECIFIED Rinvoq 45mg + 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 GASTROENTEROLOGY Rinvoq 45mg + 30mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 GASTROENTEROLOGY Rinvoq 45mg + 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Rinvoq 45mg + 30mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Rinvoq 45mg + 30mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3962 GASTROENTEROLOGY Rinvoq 45MG OR TB24 IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 NURSE PRACTITIONER, ACUTE CARE Rinvoq 45MG OR TB24 IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 MEDICAL ONCOLOGY Rydapt ANTINEOPLASTICS Approval 1 3961 UNSPECIFIED Rydapt ANTINEOPLASTICS Approval 1 3963 UNSPECIFIED Rydapt ANTINEOPLASTICS No Response 1 3963 HEMATOLOGY & ONCOLOGY Rydapt ANTINEOPLASTICS Approval 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED sapropterin ENZYME COFACTOR Denial 1

31 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 PHYSICIAN ASSISTANT, UNSPECIFIED sapropterin ENZYME COFACTOR Approval 1 3951 NEPHROLOGY / RENAL MEDICINE Sensipar CALCIMIMETIC Approval 1 3951 NEPHROLOGY / RENAL MEDICINE Sensipar MISCELLANEOUS Approval 1 3963 NEPHROLOGY / RENAL MEDICINE Sensipar CALCIMIMETIC Approval 1 3963 NEPHROLOGY / RENAL MEDICINE Sensipar MISCELLANEOUS Approval 1 3956 RHEUMATOLOGY Sensipar 30MG OR TABS HORMONES/HORMONE MODIFIERS No Response 1 3956 INTERNAL MEDICINE sildenafil (pulm.hypertension) 20 mg tablet VASODILATORS No Response 1 3964 UNSPECIFIED sildenafil (pulm.hypertension) 20 mg tablet VASODILATORS No Response 1 3956 FAMILY PRACTICE sildenafil (pulmonary hypertension) 20 mg tablet VASODILATORS No Response 2 3963 FAMILY PRACTICE sildenafil (pulmonary hypertension) 20 mg tablet VASODILATORS No Response 3 3963 PEDIATRICS sildenafil (pulmonary hypertension) 20 mg tablet VASODILATORS No Response 1 3963 UNSPECIFIED sildenafiL (pulmonary hypertension) 20 mg tablet (Revatio) VASODILATORS No Response 1 3963 PEDIATRICS sildenafiL (pulmonary hypertension) 20 mg tablet (Revatio) VASODILATORS No Response 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Sildenafil Citrate (Sildenafil Citrate (Pulmonary Hyper­ tension)) 20 MG Oral Tablet VASODILATORS No Response 1 3963 FAMILY PRACTICE Sildenafil Citrate (Sildenafil Citrate (Pulmonary Hyper­ tension)) 20 MG Oral Tablet VASODILATORS No Response 1 3963 UNSPECIFIED Sildenafil Citrate 20 MG Oral Tablet (REVATIO) VASODILATORS No Response 2 3951 UNSPECIFIED Sildenafil Citrate 20MG OR TABS VASODILATORS No Response 1 3956 CLINICAL NURSE SPECIALIST, FAMILY HEALTH Sildenafil Citrate 20MG OR TABS VASODILATORS No Response 1 3956 FAMILY PRACTICE Sildenafil Citrate 20MG OR TABS VASODILATORS Denial 1 3956 FAMILY PRACTICE Sildenafil Citrate 20MG OR TABS VASODILATORS No Response 2 3963 FAMILY PRACTICE Sildenafil Citrate 20MG OR TABS VASODILATORS Denial 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Sildenafil Citrate 20MG OR TABS VASODILATORS No Response 1 3965 UNSPECIFIED Sildenafil Citrate 20MG OR TABS VASODILATORS No Response 1 3951 FAMILY PRACTICE sildenafil tablets VASODILATORS Denial 1 3951 INTERNAL MEDICINE sildenafil tablets VASODILATORS Denial 1 3951 NURSE PRACTITIONER, FAMILY HEALTH sildenafil tablets VASODILATORS Denial 1 3956 UNSPECIFIED sildenafil tablets VASODILATORS Denial 2 3956 FAMILY PRACTICE sildenafil tablets VASODILATORS Approval 1 3956 FAMILY PRACTICE sildenafil tablets VASODILATORS Denial 3 3956 NURSE PRACTITIONER, FAMILY HEALTH sildenafil tablets VASODILATORS No Response 1 3956 REGISTERED NURSE, UNSPECIFIED sildenafil tablets VASODILATORS Denial 3 3956 RHEUMATOLOGY sildenafil tablets VASODILATORS Approval 1 3956 RHEUMATOLOGY sildenafil tablets VASODILATORS No Response 1 3961 FAMILY PRACTICE sildenafil tablets VASODILATORS Denial 1 3961 NURSE PRACTITIONER, FAMILY HEALTH sildenafil tablets VASODILATORS Denial 1

32 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 FAMILY PRACTICE sildenafil tablets VASODILATORS Denial 4 3963 INTERNAL MEDICINE sildenafil tablets VASODILATORS Denial 1 3963 NURSE PRACTITIONER, FAMILY HEALTH sildenafil tablets VASODILATORS Denial 1 3964 FAMILY PRACTICE sildenafil tablets VASODILATORS Denial 1 3965 FAMILY PRACTICE sildenafil tablets VASODILATORS Denial 1 3965 INTERNAL MEDICINE sildenafil tablets VASODILATORS Denial 1 3969 FAMILY PRACTICE sildenafil tablets VASODILATORS Denial 2 3956 GASTROENTEROLOGY Simponi 100mg ANTIARTHRITICS Denial 2 3956 INTERNAL MEDICINE Simponi 50mg ANTIARTHRITICS Approval 2 3956 INTERNAL MEDICINE Simponi 50mg ANTIARTHRITICS Denial 2 3956 INTERNAL MEDICINE Simponi Aria ANTIARTHRITICS Denial 1 3956 INTERNAL MEDICINE Simponi Aria 50MG/4ML IV SOLN ANTIARTHRITICS No Response 4 3963 UNSPECIFIED Skyrizi 150 mg/mL subcutaneous pen injector SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3951 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 2 3951 DERMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 2 3956 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 8 3956 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Denial 3 3956 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 3 3956 DERMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 7 3956 DERMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Denial 3 3956 INTERNAL MEDICINE Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3956 NURSE PRACTITIONER, ACUTE CARE Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 2 3956 NURSE PRACTITIONER, ACUTE CARE Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 5 3956 NURSE PRACTITIONER, FAMILY HEALTH Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Denial 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 8 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 2 3961 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 2 3961 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3961 DERMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3963 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 9 3963 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Denial 1 3963 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 3 3963 DERMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 6 3963 DERMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Denial 2 3963 DERMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 3

33 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 FAMILY PRACTICE Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 2 3963 FAMILY PRACTICE Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Denial 1 3963 GASTROENTEROLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3963 INTERNAL MEDICINE Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3963 NURSE PRACTITIONER, UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 3 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 4 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3963 REGISTERED NURSE, GENERAL PRACTICE Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3963 RHEUMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3965 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 3 3965 UNSPECIFIED Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3965 DERMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3969 DERMATOLOGY Skyrizi 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3963 INTERNAL MEDICINE SKYRIZI 150MG/ML PEN SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3956 UNSPECIFIED Skyrizi 150MG/ML SC SOSY SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Skyrizi 150MG/ML SC SOSY SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3951 GASTROENTEROLOGY Skyrizi 360mg + 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 2 3951 NURSE PRACTITIONER, UNSPECIFIED Skyrizi 360mg + 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3963 GASTROENTEROLOGY Skyrizi 360mg + 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Denial 1 3965 GASTROENTEROLOGY Skyrizi 360mg + 180mg + 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Denial 1 3951 UNSPECIFIED Skyrizi 600mg + 360mg + 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS No Response 2 3956 UNSPECIFIED Skyrizi 600mg + 360mg + 180mg + 150mg + 75mg SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3951 GASTROENTEROLOGY Skyrizi 600MG/10ML IV SOLN SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3951 NURSE PRACTITIONER, UNSPECIFIED Skyrizi Pen 150MG/ML SC SOAJ SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3956 UNSPECIFIED Skyrizi Pen 150MG/ML SC SOAJ SYSTEMIC ANTIPSORIASIS AGENTS No Response 3 3956 NURSE PRACTITIONER, FAMILY HEALTH Skyrizi Pen 150MG/ML SC SOAJ SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Skyrizi Pen 150MG/ML SC SOAJ SYSTEMIC ANTIPSORIASIS AGENTS No Response 1 3963 UNSPECIFIED Skyrizi Pen 150MG/ML SC SOAJ SYSTEMIC ANTIPSORIASIS AGENTS No Response 2 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Skyrizi Pen 150MG/ML SC SOAJ SYSTEMIC ANTIPSORIASIS AGENTS Approval 1 3956 HEMATOLOGY & ONCOLOGY Somatuline Depot HORMONE/HORMONE MODIFIER Approval 1 3956 HEMATOLOGY & ONCOLOGY Somatuline Depot SOMATOSTATIN ANALOG Approval 1 3963 ENDOCRINOLOGY, DIABETES & METABOLISM Somatuline Depot HORMONE/HORMONE MODIFIER Denial 1 3963 ENDOCRINOLOGY, DIABETES & METABOLISM Somatuline Depot SOMATOSTATIN ANALOG Denial 1 3951 INTERNAL MEDICINE sorafenib ANTINEOPLASTICS Approval 1 3963 HEMATOLOGY & ONCOLOGY SORAfenib Tosylate 200MG OR TABS ANTINEOPLASTICS Approval 1 3951 UNSPECIFIED Spravato ANTIDEPRESSANT Approval 12

34 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3951 UNSPECIFIED Spravato ANTIDEPRESSANT Denial 12 3951 INTERNAL MEDICINE Spravato ANTIDEPRESSANT Approval 12 3963 UNSPECIFIED Spravato ANTIDEPRESSANT Approval 24 3963 UNSPECIFIED Spravato ANTIDEPRESSANT Denial 48 3963 GENERAL PRACTICE Spravato ANTIDEPRESSANT Denial 12 3963 PSYCHIATRY Spravato ANTIDEPRESSANT Approval 12 3963 PSYCHIATRY Spravato ANTIDEPRESSANT Denial 24 3964 UNSPECIFIED Spravato ANTIDEPRESSANT Approval 24 3964 NURSE PRACTITIONER, PSYCHIATRIC Spravato ANTIDEPRESSANT Denial 12 3969 PSYCHIATRY Spravato ANTIDEPRESSANT Approval 12 3951 HEMATOLOGY & ONCOLOGY Sprycel ANTINEOPLASTICS Approval 2 3951 INTERNAL MEDICINE Sprycel ANTINEOPLASTICS Approval 2 3951 INTERNAL MEDICINE Sprycel ANTINEOPLASTICS Denial 6 3956 UNSPECIFIED Sprycel ANTINEOPLASTICS Approval 2 3956 UNSPECIFIED Sprycel ANTINEOPLASTICS No Response 4 3956 HEMATOLOGY & ONCOLOGY Sprycel ANTINEOPLASTICS Approval 2 3956 INTERNAL MEDICINE Sprycel ANTINEOPLASTICS Denial 2 3961 HEMATOLOGY & ONCOLOGY Sprycel ANTINEOPLASTICS Approval 2 3961 HEMATOLOGY & ONCOLOGY Sprycel ANTINEOPLASTICS No Response 2 3961 PHYSICIAN, ONCOLOGY, MEDICAL Sprycel ANTINEOPLASTICS Approval 2 3963 UNSPECIFIED Sprycel ANTINEOPLASTICS Approval 4 3963 HEMATOLOGY & ONCOLOGY Sprycel ANTINEOPLASTICS Approval 4 3963 HEMATOLOGY & ONCOLOGY Sprycel ANTINEOPLASTICS No Response 6 3969 HEMATOLOGY & ONCOLOGY Sprycel ANTINEOPLASTICS Approval 2 3961 HEMATOLOGY & ONCOLOGY Sprycel 70MG OR TABS ANTINEOPLASTICS No Response 1 3956 GASTROENTEROLOGY Stelara 130MG/26ML IV SOLN IMMUNOSUPPRESSIVES/DMARDS Denial 1 3951 DERMATOLOGY STELARA 45MG/0.5 INJ IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 UNSPECIFIED STELARA 45MG/0.5 INJ IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Stelara 45MG/0.5ML SC SOSY IMMUNOSUPPRESSIVES/DMARDS No Response 1 3961 NURSE PRACTITIONER, FAMILY HEALTH Stelara 90 mg/mL subcutaneous syringe IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 GASTROENTEROLOGY Stelara 90MG/ML SC SOSY IMMUNOSUPPRESSIVES/DMARDS No Response 4 3961 NURSE PRACTITIONER, FAMILY HEALTH Stelara 90MG/ML SC SOSY IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 UNSPECIFIED Stelara 90MG/ML SC SOSY IMMUNOSUPPRESSIVES/DMARDS No Response 2 3964 DERMATOLOGY Stelara IV + Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 RHEUMATOLOGY Stelara IV + Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 UNSPECIFIED Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 DERMATOLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 1

35 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 DERMATOLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 GASTROENTEROLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3956 GASTROENTEROLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3961 DERMATOLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3961 PHYSICIAN ASSISTANT, UNSPECIFIED Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 UNSPECIFIED Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 CLINICAL NURSE SPECIALIST, FAMILY HEALTH Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 DERMATOLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 3 3963 DERMATOLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 GASTROENTEROLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 GASTROENTEROLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 GASTROENTEROLOGY Stelara SQ 45mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 GASTROENTEROLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 GASTROENTEROLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3956 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 GASTROENTEROLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 6 3956 GASTROENTEROLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3956 GASTROENTEROLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 NURSE PRACTITIONER, ACUTE CARE Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 NURSE PRACTITIONER, UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 RHEUMATOLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3961 GASTROENTEROLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3961 NURSE PRACTITIONER, FAMILY HEALTH Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 3 3963 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Denial 3 3963 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS No Response 6 3963 DERMATOLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 GASTROENTEROLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 6 3963 GASTROENTEROLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Denial 7 3963 GASTROENTEROLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS No Response 4 3963 NURSE PRACTITIONER, ACUTE CARE Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Denial 1

36 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 RHEUMATOLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 RHEUMATOLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3964 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3964 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3964 DERMATOLOGY Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 UNSPECIFIED Stelara SQ 90mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 HEMATOLOGY & ONCOLOGY Stivarga ANTINEOPLASTICS Approval 4 3956 HEMATOLOGY & ONCOLOGY Sutent ANTINEOPLASTICS Approval 2 BCBSAR UNSPECIFIED Synagis RESPIRATORY AGENT Approval 1 BCBSAR FAMILY MEDICINE Synagis RESPIRATORY AGENT Approval 2 BCBSAR FAMILY PRACTICE Synagis RESPIRATORY AGENT Approval 2 BCBSAR INTERNAL MEDICINE Synagis RESPIRATORY AGENT Approval 2 BCBSAR PEDIATRICS Synagis RESPIRATORY AGENT Approval 5 BCBSAR PEDIATRICS Synagis RESPIRATORY AGENT Denial 7 3956 CARDIOLOGY tadalafil 20mg VASODILATORS Approval 1 3956 INTERNAL MEDICINE tadalafil 20mg VASODILATORS Approval 1 3963 UNSPECIFIED tadalafil 20mg VASODILATORS Approval 1 3963 UNSPECIFIED tadalafil 20mg VASODILATORS Denial 1 3963 NURSE PRACTITIONER, FAMILY HEALTH tadalafil 20mg VASODILATORS Approval 1 3965 HEMATOLOGY & ONCOLOGY Tagrisso ANTINEOPLASTICS No Response 2 3951 UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Approval 4 3951 UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS No Response 2 3951 DERMATOLOGY Taltz ALL OTHER DERMATOLOGICALS Approval 2 3951 INTERNAL MEDICINE Taltz ALL OTHER DERMATOLOGICALS Approval 2 3951 INTERNAL MEDICINE Taltz ALL OTHER DERMATOLOGICALS Denial 2 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Approval 6 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Denial 2 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS No Response 2 3956 UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Approval 24 3956 UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Denial 10 3956 UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS No Response 18 3956 DERMATOLOGY Taltz ALL OTHER DERMATOLOGICALS Approval 28 3956 DERMATOLOGY Taltz ALL OTHER DERMATOLOGICALS Denial 2 3956 DERMATOLOGY Taltz ALL OTHER DERMATOLOGICALS No Response 8 3956 FAMILY PRACTICE Taltz ALL OTHER DERMATOLOGICALS Approval 2 3956 INTERNAL MEDICINE Taltz ALL OTHER DERMATOLOGICALS Approval 2 3956 INTERNAL MEDICINE Taltz ALL OTHER DERMATOLOGICALS Denial 2

37 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 NURSE PRACTITIONER, FAMILY HEALTH Taltz ALL OTHER DERMATOLOGICALS Approval 4 3956 NURSE PRACTITIONER, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Approval 2 3956 NURSE PRACTITIONER, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS No Response 2 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Approval 26 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Denial 10 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS No Response 6 3956 RHEUMATOLOGY Taltz ALL OTHER DERMATOLOGICALS Denial 2 3956 RHEUMATOLOGY Taltz ALL OTHER DERMATOLOGICALS No Response 2 3963 UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Approval 2 3963 DERMATOLOGY Taltz ALL OTHER DERMATOLOGICALS Approval 12 3963 DERMATOLOGY Taltz ALL OTHER DERMATOLOGICALS Denial 6 3963 DERMATOLOGY Taltz ALL OTHER DERMATOLOGICALS No Response 2 3963 INTERNAL MEDICINE Taltz ALL OTHER DERMATOLOGICALS Approval 2 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS Approval 2 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz ALL OTHER DERMATOLOGICALS No Response 2 3956 UNSPECIFIED TALTZ 80MG/ML CF AUTO INJ 1ML IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 DERMATOLOGY TALTZ 80MG/ML CF AUTO INJ 1ML IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 DERMATOLOGY TALTZ 80MG/ML CF AUTO INJ 1ML IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED TALTZ 80MG/ML CF PFS 1ML IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED TALTZ 80MG/ML INJ IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz 80MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED Taltz 80MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 UNSPECIFIED Taltz 80MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 DERMATOLOGY Taltz 80MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz 80MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 2 3963 DERMATOLOGY Taltz 80MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz 80MG/ML SC SOAJ IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 DERMATOLOGY Taltz 80MG/ML SC SOSY IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Taltz Autoinjector 80 mg/mL subcutaneous IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 UNSPECIFIED temozolomide ANTINEOPLASTICS Denial 2 3956 UNSPECIFIED temozolomide ANTINEOPLASTICS Approval 4 3956 HEMATOLOGY & ONCOLOGY temozolomide ANTINEOPLASTICS Approval 10 3956 INTERNAL MEDICINE temozolomide ANTINEOPLASTICS Approval 2 3956 MEDICAL ONCOLOGY temozolomide ANTINEOPLASTICS Approval 2 3961 UNSPECIFIED temozolomide ANTINEOPLASTICS Approval 2 3963 UNSPECIFIED temozolomide ANTINEOPLASTICS Approval 4 3963 HEMATOLOGY & ONCOLOGY temozolomide ANTINEOPLASTICS Approval 2

38 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 UNSPECIFIED Temozolomide 180MG OR CAPS ANTINEOPLASTICS Approval 1 3951 UNSPECIFIED tetrabenazine MISCELLANEOUS Approval 1 3951 UNSPECIFIED tetrabenazine VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR Approval 1 3956 UNSPECIFIED tetrabenazine MISCELLANEOUS Approval 1 3956 UNSPECIFIED tetrabenazine MISCELLANEOUS Denial 1 3956 UNSPECIFIED tetrabenazine MISCELLANEOUS No Response 2 3956 UNSPECIFIED tetrabenazine VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR Approval 1 3956 UNSPECIFIED tetrabenazine VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR Denial 1 3956 UNSPECIFIED tetrabenazine VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR No Response 2 3956 INTERNAL MEDICINE tetrabenazine MISCELLANEOUS Denial 1 3956 INTERNAL MEDICINE tetrabenazine VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR Denial 1 3956 NEUROLOGY tetrabenazine MISCELLANEOUS Approval 3 3956 NEUROLOGY tetrabenazine MISCELLANEOUS Denial 2 3956 NEUROLOGY tetrabenazine MISCELLANEOUS No Response 1 3956 NEUROLOGY tetrabenazine VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR Approval 3 3956 NEUROLOGY tetrabenazine VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR Denial 2 3956 NEUROLOGY tetrabenazine VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR No Response 1 3956 PSYCHIATRY tetrabenazine MISCELLANEOUS Denial 1 3956 PSYCHIATRY tetrabenazine VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR Denial 1 3956 PSYCHIATRY tetrabenazine 12.5 mg tablet VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR No Response 2 3956 NEUROLOGY Tetrabenazine 12.5MG OR TABS VESICULAR MONOAMINE TRANSPORTER 2 INHIB­ ITOR No Response 1 3956 UNSPECIFIED Thalomid ANTINEOPLASTICS No Response 1 3956 UNSPECIFIED Thalomid OTHER ANTIBIOTICS No Response 1 3963 UNSPECIFIED Thalomid ANTINEOPLASTICS Approval 1 3963 UNSPECIFIED Thalomid OTHER ANTIBIOTICS Approval 1 3963 DERMATOLOGY Thalomid ANTINEOPLASTICS Denial 1 3963 DERMATOLOGY Thalomid OTHER ANTIBIOTICS Denial 1 3963 HEMATOLOGY & ONCOLOGY Thalomid ANTINEOPLASTICS Approval 1 3963 HEMATOLOGY & ONCOLOGY Thalomid OTHER ANTIBIOTICS Approval 1 3951 UNSPECIFIED Tobramycin inhalation solution RESPIRATORY AGENTS No Response 1

39 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 FAMILY PRACTICE Tobramycin inhalation solution RESPIRATORY AGENTS Approval 1 3961 FAMILY PRACTICE Tobramycin inhalation solution RESPIRATORY AGENTS Denial 1 3951 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1 3951 DERMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 2 3951 FAMILY PRACTICE Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 INTERNAL MEDICINE Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 2 3951 INTERNAL MEDICINE Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 9 3956 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Denial 3 3956 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 DERMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 10 3956 DERMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 DERMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 5 3956 NURSE PRACTITIONER, FAMILY HEALTH Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 3 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 7 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 3 3956 RHEUMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1 3961 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1 3961 DERMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3961 EMERGENCY MEDICINE Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1 3961 EMERGENCY MEDICINE Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3962 PHYSICIAN ASSISTANT, UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 8 3963 DERMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 5 3963 DERMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 2 3963 NURSE PRACTITIONER, FAMILY HEALTH Tremfya IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 NURSE PRACTITIONER, FAMILY HEALTH Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 8 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Denial 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 RHEUMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 2 3964 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1 3964 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3964 INTERNAL MEDICINE Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1

40 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3965 UNSPECIFIED Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3965 DERMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 DERMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3965 RHEUMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 RHEUMATOLOGY Tremfya IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 DERMATOLOGY TREMFYA 100 MG/ML ONE-PRESS IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 DERMATOLOGY TREMFYA 100 MG/ML ONE-PRESS IMMUNOSUPPRESSIVES/DMARDS No Response 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Tremfya 100 mg/mL subcutaneous auto-injector IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 UNSPECIFIED Tremfya 100 mg/mL subcutaneous auto-injector IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Tremfya 100MG/ML SC SOPN IMMUNOSUPPRESSIVES/DMARDS No Response 4 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Tremfya 100MG/ML SC SOPN IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 UNSPECIFIED Tremfya 100MG/ML SC SOSY IMMUNOSUPPRESSIVES/DMARDS No Response 4 3956 UNSPECIFIED Trikafta CYSTIC FIBROSIS AGENTS Approval 1 3956 PULMONARY DISEASES Trikafta CYSTIC FIBROSIS AGENTS Approval 2 3956 PULMONARY DISEASES Trikafta CYSTIC FIBROSIS AGENTS No Response 1 3962 PEDIATRICS Trikafta CYSTIC FIBROSIS AGENTS Approval 1 3963 UNSPECIFIED Trikafta CYSTIC FIBROSIS AGENTS Approval 3 3963 PULMONARY DISEASES Trikafta CYSTIC FIBROSIS AGENTS Approval 4 3963 PULMONARY DISEASES Trikafta CYSTIC FIBROSIS AGENTS No Response 2 3963 PULMONOLOGY, PEDIATRIC Trikafta CYSTIC FIBROSIS AGENTS Approval 1 3965 UNSPECIFIED Trikafta CYSTIC FIBROSIS AGENTS Approval 1 3956 HEMATOLOGY Tukysa ANTINEOPLASTICS Approval 1 3956 HEMATOLOGY Tukysa ANTINEOPLASTICS Denial 1 3951 UNSPECIFIED Tymlos OSTEOPOROSIS AGENTS Approval 1 3956 UNSPECIFIED Tymlos OSTEOPOROSIS AGENTS No Response 2 3956 CLINICAL NURSE SPECIALIST, FAMILY HEALTH Tymlos OSTEOPOROSIS AGENTS Approval 1 3956 INTERNAL MEDICINE Tymlos OSTEOPOROSIS AGENTS Approval 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Tymlos OSTEOPOROSIS AGENTS Approval 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Tymlos OSTEOPOROSIS AGENTS Denial 1 3956 NURSE PRACTITIONER, UNSPECIFIED Tymlos OSTEOPOROSIS AGENTS Approval 1 3956 PHYSICIAN, ENDOCRINOLOGY Tymlos OSTEOPOROSIS AGENTS Approval 1 3956 RHEUMATOLOGY Tymlos OSTEOPOROSIS AGENTS Approval 2 3963 UNSPECIFIED Tymlos OSTEOPOROSIS AGENTS Approval 2 3963 UNSPECIFIED Tymlos OSTEOPOROSIS AGENTS No Response 2 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Tymlos OSTEOPOROSIS AGENTS Approval 1 3967 INTERNAL MEDICINE Tymlos OSTEOPOROSIS AGENTS Denial 1 3956 NURSE PRACTITIONER, UNSPECIFIED Tymlos 3120MCG/1.56ML SC SOPN OSTEOPOROSIS AGENTS No Response 2

41 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 UNSPECIFIED Tymlos 80 mcg/dose (3,120 mcg/1.56 mL) subcutane­ ous pen injector PARATHYROID HORMONE ANALOG No Response 1 3951 CARDIOLOGY Tyvaso DPI Maintenance Kit 32MCG IN POWD VASODILATORS No Response 1 3956 PULMONARY DISEASES Tyvaso DPI Maintenance Kit 64MCG IN POWD VASODILATORS No Response 1 3956 CARDIOLOGY Tyvaso DPI Titration Kit 112 x 16MCG &84 x 32MCG IN POWD VASODILATORS No Response 1 3956 CARDIOLOGY Tyvaso DPI Titration Kit 16 & 32 & 48MCG IN POWD VASODILATORS No Response 1 3951 CARDIOLOGY Tyvaso Dry Powder Inhaler (DPI) VASODILATORS Approval 2 3951 CARDIOLOGY Uptravi OTHER ANTIHYPERTENSIVES Approval 1 3951 CARDIOLOGY Uptravi PULMONARY ARTERIAL HYPERTENSION Approval 1 3961 UNSPECIFIED Uptravi OTHER ANTIHYPERTENSIVES Approval 1 3961 UNSPECIFIED Uptravi PULMONARY ARTERIAL HYPERTENSION Approval 1 3956 UNSPECIFIED valganciclovir ANTIVIRALS Approval 2 3956 INTERNAL MEDICINE valganciclovir ANTIVIRALS Approval 2 3961 UNSPECIFIED valganciclovir ANTIVIRALS Approval 2 3963 NURSE PRACTITIONER, ACUTE CARE valganciclovir ANTIVIRALS Approval 2 3956 UNSPECIFIED valGANciclovir HCl 450MG OR TABS ANTIVIRALS Approval 1 3956 UNSPECIFIED Vemlidy Antivirals Denial 1 3956 FAMILY PRACTICE Vemlidy Antivirals Denial 1 3963 UNSPECIFIED Vemlidy Antivirals Approval 1 3963 UNSPECIFIED Vemlidy Antivirals Denial 1 3951 UNSPECIFIED Vemlidy 25MG OR TABS Antivirals Approval 1 3951 UNSPECIFIED Vemlidy 25MG OR TABS Antivirals No Response 4 3963 UNSPECIFIED Vemlidy 25MG OR TABS Antivirals No Response 1 3951 UNSPECIFIED Venclexta ANTINEOPLASTICS No Response 2 3956 HEMATOLOGY & ONCOLOGY Venclexta ANTINEOPLASTICS Approval 6 3956 HEMATOLOGY & ONCOLOGY Venclexta ANTINEOPLASTICS Denial 2 3956 HEMATOLOGY & ONCOLOGY Venclexta ANTINEOPLASTICS No Response 2 3956 INTERNAL MEDICINE Venclexta ANTINEOPLASTICS Approval 4 3956 MEDICAL ONCOLOGY Venclexta ANTINEOPLASTICS Approval 2 3961 UNSPECIFIED Venclexta ANTINEOPLASTICS Approval 2 3961 UNSPECIFIED Venclexta ANTINEOPLASTICS Denial 2 3963 UNSPECIFIED Venclexta ANTINEOPLASTICS Approval 2 3969 HEMATOLOGY & ONCOLOGY Venclexta ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY & ONCOLOGY Venclexta 100MG OR TABS ANTINEOPLASTICS No Response 2 3956 MEDICAL ONCOLOGY Venclexta Starting Pack 10 & 50 & 100MG OR TBPK ANTINEOPLASTICS No Response 1 3963 INTERNAL MEDICINE Verzenio ANTINEOPLASTICS Approval 1 3963 MEDICAL ONCOLOGY Verzenio ANTINEOPLASTICS Approval 1

42 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3963 PHYSICIAN, ONCOLOGY, MEDICAL Verzenio ANTINEOPLASTICS Approval 1 3962 UNSPECIFIED vigabatrin powder ANTICONVULSANTS Approval 4 3962 UNSPECIFIED vigabatrin powder ANTICONVULSANTS No Response 4 3951 UNSPECIFIED Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 1 3951 UNSPECIFIED Vivitrol SUBSTANCE ABUSE AGENTS Approval 1 3956 UNSPECIFIED Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 23 3956 UNSPECIFIED Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS No Response 2 3956 UNSPECIFIED Vivitrol SUBSTANCE ABUSE AGENTS Approval 23 3956 UNSPECIFIED Vivitrol SUBSTANCE ABUSE AGENTS No Response 2 3956 FAMILY PRACTICE Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 6 3956 FAMILY PRACTICE Vivitrol SUBSTANCE ABUSE AGENTS Approval 6 3956 GENERAL PRACTICE Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 1 3956 GENERAL PRACTICE Vivitrol SUBSTANCE ABUSE AGENTS Approval 1 3956 INTERNAL MEDICINE Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 1 3956 INTERNAL MEDICINE Vivitrol SUBSTANCE ABUSE AGENTS Approval 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 4 3956 NURSE PRACTITIONER, FAMILY HEALTH Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS No Response 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Vivitrol SUBSTANCE ABUSE AGENTS Approval 4 3956 NURSE PRACTITIONER, FAMILY HEALTH Vivitrol SUBSTANCE ABUSE AGENTS No Response 1 3956 NURSE PRACTITIONER, PSYCHIATRIC Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 6 3956 NURSE PRACTITIONER, PSYCHIATRIC Vivitrol SUBSTANCE ABUSE AGENTS Approval 6 3956 NURSE PRACTITIONER, UNSPECIFIED Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 1 3956 NURSE PRACTITIONER, UNSPECIFIED Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS No Response 1 3956 NURSE PRACTITIONER, UNSPECIFIED Vivitrol SUBSTANCE ABUSE AGENTS Approval 1 3956 NURSE PRACTITIONER, UNSPECIFIED Vivitrol SUBSTANCE ABUSE AGENTS No Response 1 3956 PSYCHIATRY Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 2 3956 PSYCHIATRY Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Denial 1 3956 PSYCHIATRY Vivitrol SUBSTANCE ABUSE AGENTS Approval 2 3956 PSYCHIATRY Vivitrol SUBSTANCE ABUSE AGENTS Denial 1 3956 PSYCHIATRY, ADDICTION Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS Approval 1 3956 PSYCHIATRY, ADDICTION Vivitrol SUBSTANCE ABUSE AGENTS Approval 1 3956 PSYCHIATRY, CHILD & ADOLESCENT Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS No Response 1 3956 PSYCHIATRY, CHILD & ADOLESCENT Vivitrol SUBSTANCE ABUSE AGENTS No Response 1 3961 UNSPECIFIED Vivitrol ELECTROLYTES & MISCELLANEOUS NUTRIENTS No Response 1 3961 UNSPECIFIED Vivitrol SUBSTANCE ABUSE AGENTS No Response 1 3956 UNSPECIFIED Vivitrol 380MG IM SUSR SUBSTANCE ABUSE AGENTS No Response 2 3956 NURSE PRACTITIONER, PSYCHIATRIC Vivitrol 380MG IM SUSR SUBSTANCE ABUSE AGENTS No Response 3

43 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 PSYCHIATRY Vivitrol 380MG IM SUSR SUBSTANCE ABUSE AGENTS Approval 1 3962 NEUROLOGY Vumerity MULTIPLE SCLEROSIS Approval 1 3963 UNSPECIFIED Vumerity MULTIPLE SCLEROSIS Approval 2 3963 NEUROLOGY Vumerity MULTIPLE SCLEROSIS Approval 1 3963 NURSE PRACTITIONER, GERONTOLOGY Vumerity MULTIPLE SCLEROSIS Approval 1 3956 UNSPECIFIED Vumerity 231MG OR CPDR MULTIPLE SCLEROSIS No Response 2 3963 UNSPECIFIED Vumerity 231MG OR CPDR MULTIPLE SCLEROSIS No Response 1 3963 NURSE PRACTITIONER, GERONTOLOGY Vumerity 231MG OR CPDR MULTIPLE SCLEROSIS No Response 2 3956 INTERNAL MEDICINE Xeljanz 5 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3962 RHEUMATOLOGY Xeljanz 5 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 UNSPECIFIED Xeljanz 5 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3963 GASTROENTEROLOGY Xeljanz 5 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3965 UNSPECIFIED Xeljanz 5 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3965 UNSPECIFIED Xeljanz 5 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3962 RHEUMATOLOGY Xeljanz 5MG OR TABS IMMUNOSUPPRESSIVES/DMARDS No Response 1 3951 DERMATOLOGY Xeljanz XR 11 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 UNSPECIFIED Xeljanz XR 11 mg IMMUNOSUPPRESSIVES/DMARDS Approval 2 3956 UNSPECIFIED Xeljanz XR 11 mg IMMUNOSUPPRESSIVES/DMARDS Denial 1 3956 RHEUMATOLOGY Xeljanz XR 11 mg IMMUNOSUPPRESSIVES/DMARDS No Response 2 3961 RHEUMATOLOGY Xeljanz XR 11 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 UNSPECIFIED Xeljanz XR 11 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3963 RHEUMATOLOGY Xeljanz XR 11 mg IMMUNOSUPPRESSIVES/DMARDS Approval 4 3963 RHEUMATOLOGY Xeljanz XR 11 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3965 RHEUMATOLOGY Xeljanz XR 11 mg IMMUNOSUPPRESSIVES/DMARDS Approval 1 3956 GASTROENTEROLOGY Xeljanz XR 22 mg IMMUNOSUPPRESSIVES/DMARDS Denial 2 3956 RHEUMATOLOGY Xeljanz XR 22 mg IMMUNOSUPPRESSIVES/DMARDS No Response 1 3956 HEMATOLOGY Xeloda 500MG OR TABS ANTINEOPLASTICS No Response 1 3956 NEUROLOGY Xenazine 12.5MG OR TABS MISCELLANEOUS No Response 1 3963 HEMATOLOGY & ONCOLOGY Xermelo TRYPTOPHAN HYDROXYLASE INHIBITOR Approval 2 3963 HEMATOLOGY & ONCOLOGY Xermelo TRYPTOPHAN HYDROXYLASE INHIBITOR No Response 2 3963 INTERNAL MEDICINE Xermelo TRYPTOPHAN HYDROXYLASE INHIBITOR Approval 2 3951 UNSPECIFIED Xolair MISCELLANEOUS No Response 1 3951 UNSPECIFIED Xolair RESPIRATORY AGENTS No Response 1 3951 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS Approval 1 3951 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS Denial 1 3951 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS No Response 1 3951 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS Approval 1

44 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3951 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS Denial 1 3951 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS No Response 1 3956 UNSPECIFIED Xolair MISCELLANEOUS Approval 3 3956 UNSPECIFIED Xolair MISCELLANEOUS Denial 2 3956 UNSPECIFIED Xolair MISCELLANEOUS No Response 4 3956 UNSPECIFIED Xolair RESPIRATORY AGENTS Approval 3 3956 UNSPECIFIED Xolair RESPIRATORY AGENTS Denial 2 3956 UNSPECIFIED Xolair RESPIRATORY AGENTS No Response 4 3956 ALLERGY Xolair MISCELLANEOUS Approval 1 3956 ALLERGY Xolair MISCELLANEOUS No Response 1 3956 ALLERGY Xolair RESPIRATORY AGENTS Approval 1 3956 ALLERGY Xolair RESPIRATORY AGENTS No Response 1 3956 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS Approval 10 3956 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS Denial 1 3956 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS No Response 2 3956 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS Approval 10 3956 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS Denial 1 3956 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS No Response 2 3956 DERMATOLOGY Xolair MISCELLANEOUS No Response 1 3956 DERMATOLOGY Xolair RESPIRATORY AGENTS No Response 1 3956 FAMILY MEDICINE Xolair MISCELLANEOUS Approval 1 3956 FAMILY MEDICINE Xolair MISCELLANEOUS Denial 1 3956 FAMILY MEDICINE Xolair RESPIRATORY AGENTS Approval 1 3956 FAMILY MEDICINE Xolair RESPIRATORY AGENTS Denial 1 3956 FAMILY PRACTICE Xolair MISCELLANEOUS Approval 1 3956 FAMILY PRACTICE Xolair MISCELLANEOUS Denial 1 3956 FAMILY PRACTICE Xolair RESPIRATORY AGENTS Approval 1 3956 FAMILY PRACTICE Xolair RESPIRATORY AGENTS Denial 1 3956 INTERNAL MEDICINE Xolair MISCELLANEOUS Approval 1 3956 INTERNAL MEDICINE Xolair RESPIRATORY AGENTS Approval 1 3956 NEUROLOGY Xolair MISCELLANEOUS Approval 1 3956 NEUROLOGY Xolair RESPIRATORY AGENTS Approval 1 3956 NURSE PRACTITIONER, ADULT HEALTH Xolair MISCELLANEOUS Approval 1 3956 NURSE PRACTITIONER, ADULT HEALTH Xolair MISCELLANEOUS No Response 1 3956 NURSE PRACTITIONER, ADULT HEALTH Xolair RESPIRATORY AGENTS Approval 1 3956 NURSE PRACTITIONER, ADULT HEALTH Xolair RESPIRATORY AGENTS No Response 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Xolair MISCELLANEOUS Approval 1

45 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 NURSE PRACTITIONER, FAMILY HEALTH Xolair MISCELLANEOUS Denial 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Xolair RESPIRATORY AGENTS Approval 1 3956 NURSE PRACTITIONER, FAMILY HEALTH Xolair RESPIRATORY AGENTS Denial 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Xolair MISCELLANEOUS Approval 2 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Xolair MISCELLANEOUS Denial 1 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Xolair RESPIRATORY AGENTS Approval 2 3956 PHYSICIAN ASSISTANT, UNSPECIFIED Xolair RESPIRATORY AGENTS Denial 1 3956 PULMONARY DISEASES Xolair MISCELLANEOUS Approval 1 3956 PULMONARY DISEASES Xolair RESPIRATORY AGENTS Approval 1 3961 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS Approval 1 3961 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS Approval 1 3963 UNSPECIFIED Xolair MISCELLANEOUS Approval 4 3963 UNSPECIFIED Xolair MISCELLANEOUS Denial 2 3963 UNSPECIFIED Xolair MISCELLANEOUS No Response 1 3963 UNSPECIFIED Xolair RESPIRATORY AGENTS Approval 4 3963 UNSPECIFIED Xolair RESPIRATORY AGENTS Denial 2 3963 UNSPECIFIED Xolair RESPIRATORY AGENTS No Response 1 3963 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS Approval 8 3963 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS Denial 3 3963 ALLERGY & IMMUNOLOGY Xolair MISCELLANEOUS No Response 3 3963 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS Approval 8 3963 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS Denial 3 3963 ALLERGY & IMMUNOLOGY Xolair RESPIRATORY AGENTS No Response 3 3963 FAMILY PRACTICE Xolair MISCELLANEOUS Approval 1 3963 FAMILY PRACTICE Xolair RESPIRATORY AGENTS Approval 1 3963 PEDIATRICS Xolair MISCELLANEOUS Approval 1 3963 PEDIATRICS Xolair RESPIRATORY AGENTS Approval 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Xolair MISCELLANEOUS Denial 1 3963 PHYSICIAN ASSISTANT, UNSPECIFIED Xolair RESPIRATORY AGENTS Denial 1 3963 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Xolair MISCELLANEOUS Approval 1 3963 PHYSICIAN, ALLERGY & IMMUNOLOGY, PEDIATRIC Xolair RESPIRATORY AGENTS Approval 1 3963 REGISTERED NURSE, UNSPECIFIED Xolair MISCELLANEOUS Approval 1 3963 REGISTERED NURSE, UNSPECIFIED Xolair RESPIRATORY AGENTS Approval 1 3965 UNSPECIFIED Xolair MISCELLANEOUS Approval 1 3965 UNSPECIFIED Xolair RESPIRATORY AGENTS Approval 1 3969 UNSPECIFIED Xolair MISCELLANEOUS Approval 1 3969 UNSPECIFIED Xolair RESPIRATORY AGENTS Approval 1

46 Carrier Prescriber Primary Specialty Description Drug Standard Code Description Decision Count 3956 PHYSICIAN ASSISTANT, UNSPECIFIED XOLAIR 150 MG/ML SYRINGE RESPIRATORY AGENTS No Response 1 3963 ALLERGY & IMMUNOLOGY xolair 150 mg/mLmg/ml syringe RESPIRATORY AGENTS No Response 2 3951 ALLERGY & IMMUNOLOGY Xolair 150MG/ML SC SOSY RESPIRATORY AGENTS No Response 2 3956 FAMILY PRACTICE Xolair 150MG/ML SC SOSY RESPIRATORY AGENTS No Response 3 3963 UNSPECIFIED Xolair 150MG/ML SC SOSY RESPIRATORY AGENTS Denial 1 3963 ALLERGY & IMMUNOLOGY Xolair 150MG/ML SC SOSY RESPIRATORY AGENTS No Response 1 3963 ALLERGY & IMMUNOLOGY xolair 75 mg/0.5 mLmg/ml syringe RESPIRATORY AGENTS No Response 1 3951 HEMATOLOGY & ONCOLOGY Xtandi ANTINEOPLASTICS Approval 2 3956 HEMATOLOGY & ONCOLOGY Xtandi ANTINEOPLASTICS Approval 2 3956 NURSE PRACTITIONER, FAMILY HEALTH Xtandi ANTINEOPLASTICS Approval 2 3956 PHYSICIAN, ONCOLOGY, MEDICAL Xtandi ANTINEOPLASTICS Approval 2 3956 UROLOGY Xtandi ANTINEOPLASTICS Approval 2 3969 HEMATOLOGY & ONCOLOGY Xtandi ANTINEOPLASTICS Approval 2 3963 GASTROENTEROLOGY Zeposia MULTIPLE SCLEROSIS AGENT Approval 1 3951 HEMATOLOGY Ziextenzo HEMATINICS & BLOOD CELL STIMULATORS Approval 1 3956 HEMATOLOGY & ONCOLOGY Ziextenzo HEMATINICS & BLOOD CELL STIMULATORS Approval 3 3961 HEMATOLOGY & ONCOLOGY Ziextenzo HEMATINICS & BLOOD CELL STIMULATORS Approval 1 3963 HEMATOLOGY & ONCOLOGY Ziextenzo HEMATINICS & BLOOD CELL STIMULATORS Approval 2 3963 INTERNAL MEDICINE Ziextenzo HEMATINICS & BLOOD CELL STIMULATORS Approval 1 3956 UNSPECIFIED Zoledronic Acid 4MG/100ML IV SOLN BISPHOSPHONATE No Response 1 3963 PHYSICIAN, ENDOCRINOLOGY Zoledronic Acid 5MG/100ML IV SOLN BISPHOSPHONATE No Response 1