Self-Administered Drug Exclusion List - R18

This coverage article has been revised and published for notice under contract numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

Effective Date: 05/03/2020
Summary of Changes: The following drugs are being added to the SAD list with an effective date of 05/03/2020.

J1628 - Injection, Guselkumba, 1mg, (Tremfya®)

J3357 - Ustekinumab, for subcutaneous injection, 1 mg (Stelara®)

Visit the Self-Administered Drugs (SADs) webpage to view the locally hosted Self-Administered Drug Exclusion List.

To view the complete listing of locally hosted coverage articles and/or access the Active, Future, or Retired articles available in the CMS MCD, visit the Medicare Coverage Articles webpage.

Last Updated Mar 19, 2020