| Medical Mutual | Qalsody® (tofersen) (Intrathecal) | 2025-07-01 |
| Medical Mutual | Radicava® (edaravone) (Intravenous) | 2025-07-01 |
| Medical Mutual | Supprelin® LA (histrelin) (Subcutaneous Implant) | 2025-07-01 |
| Medical Mutual | Trelstar® (triptorelin) (Intramuscular) | 2025-07-01 |
| Medical Mutual | Triptodur® (triptorelin) (Intramuscular) | 2025-07-01 |
| Medical Mutual | Vabysmo® (faricimab-svoa) (Intravitreal) | 2025-07-01 |
| Wellcare North Carolina Medicaid Clinical | Sacroiliac Joint Interventions for Pain Management | 2025-07-01 |
| Wellcare North Carolina Medicaid Clinical | Selective Nerve Root Blocks and Transforaminal | 2025-07-01 |
| Paramount Healthcare | Experimental/Investigational
Procedures/Services | 2025-07-01 |
| Paramount Healthcare | Intraocular Lens Implant | 2025-07-01 |