| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Aceclidine | 2025-11-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Acyclovir Buccal Tablet | 2025-11-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Adefovir | 2025-11-01 |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Afamitresgene Autoleucel | 2025-11-01 |
| Ambetter Health Iowa Clinical | Skin and Soft Tissue Substitutes for Diabetic Foot Ulcers and Venous Leg Ulcers | 2025-11-01 |
| Sunshine Health Clinical Policy | Proton and Neutron Beam Therapies | 2025-11-01 |
| BCBS Iowa Medical Policies | Ablative Procedures for the Peripheral Nerves to Treat Pain* | 2025-11-01 |
| BCBS Iowa Medical Policies | Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) | 2025-11-01 |
| BCBS Massachusetts | Adoptive Immunotherapy | 2025-11-01 |
| BCBS Massachusetts | Allogeneic Pancreas Transplant | 2025-11-01 |