| Medical Mutual | Ibandronate: Boniva® (Intravenous) | 2025-07-01 |
| Medical Mutual | Kepivance® (palifermin) (Intravenous) | 2025-07-01 |
| Medical Mutual | Pedmark® (sodium thiosulfate) (Intravenous) | 2025-07-01 |
| Medical Mutual | Phesgo® (pertuzumab, trastuzumab and hyaluronidasezzxf) (Subcutaneous) (EOV) | 2025-07-01 |
| Medical Mutual | Portrazza® (necitumumab) (Intravenous) (EOV) | 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 |
| 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 |