Ampyra |
dalfampridine
|
01/01/2018 |
|
Multiple Sclerosis |
Anadrol-50 |
oxymetholone tablets
|
01/01/2017 |
|
Anabolic Steroids |
Androderm |
testosterone transdermal patch
|
01/01/2018 |
|
Testosterone Products |
Androgel |
testosterone topical gel
|
01/01/2018 |
|
Testosterone Products |
Android |
methyltestosterone capsules
|
01/01/2018 |
|
Testosterone Products |
Androxy |
fluoxymesterone, oral tablet
|
01/01/2018 |
|
Testosterone Products |
Anoro Ellipta |
umeclidinium/vilanterol
|
01/01/2018 |
- Subject to Quantity Limits
|
Long-Acting Beta Agonists (LABA) |
Anzemet |
dolasetron
|
01/01/2017 |
- Requires Prior Approval
- Subject to Quantity Limits
|
Antiemetics |
Apexicon E (Brand Only) |
diflorasone diacetate
|
01/01/2019 |
- Requires Prior Approval
- Subject to Quantity Limits
|
Corticosteroid |
Apokyn |
apomorphine
|
01/01/2018 |
|
Movement Disorders |
Aptensio XR |
methylphenidate extended-release
|
01/01/2018 |
- Requires Prior Approval
- Subject to Quantity Limits
|
ADHD-Narcolepsy Agents |
Aptivus |
tipranavir
|
01/01/2018 |
- Subject to Quantity Limits
|
HIV |
Aralast NP |
alpha1-proteinase inhibitor
|
01/01/2018 |
|
Alpha-1 Antitrypsin Deficiency |
Aranesp |
darbepoetin alfa
|
01/01/2018 |
|
Anemia |
Arcalyst |
rilonacept
|
01/01/2018 |
- Requires Prior Approval
- Subject to Quantity Limits
|
Cryopyrin Associated Periodic Synd (CAPS) |
Arcapta |
indacaterol capsule
|
01/01/2017 |
- Subject to Quantity Limits
|
Long-Acting Beta Agonists (LABA) |
Armonair Respiclick |
fluticasone propionate
|
01/01/2019 |
- Subject to Quantity Limits
|
Corticosteroid |
Arnuity Ellipta |
fluticasone furoate
|
01/01/2019 |
- Subject to Quantity Limits
|
Corticosteroid |
Arymo ER |
morphine sulfate extended-release tablets
|
03/01/2018 |
- Requires Excluded Exception Approval
|
Opioid Analgesics - Extended-Release |
Arzerra |
ofatumumab
|
01/01/2018 |
|
Oncology |
Asmanex |
mometasone furoate
|
01/01/2019 |
- Subject to Quantity Limits
|
Corticosteroid |
Asparlas |
calaspargase pegol - mknl
|
02/01/2019 |
- Requires Excluded Exception Approval
|
Oncology |
Aspirin/Caffeine/Dihydrocodeine |
aspirin/caffeine/dihydrocodeine
|
09/01/2017 |
- Requires Prior Approval
- Requires Step Therapy
- Subject to Quantity Limits
|
Opioid Analgesics |
Atralin |
tretinoin
|
10/01/2017 |
|
Retinoids |
Atripla |
efavirenz/emtricitabine/tenofovir
|
01/01/2018 |
- Subject to Quantity Limits
|
HIV |
Aubagio |
teriflunomide
|
01/01/2018 |
- Requires Prior Approval
- Subject to Quantity Limits
|
Multiple Sclerosis |
Austedo |
deutetrabenazine
|
01/01/2018 |
- Requires Prior Approval
- Subject to Quantity Limits
|
Movement Disorders |
Avar |
sulfacetamide sodium-sulfur
|
09/01/2017 |
- Requires Prior Approval
- Requires Step Therapy
|
Topical Acne Products |
Avastin |
bevacizumab
|
01/01/2018 |
|
Oncology |
Aveed |
testosterone undecanoate injection
|
01/01/2018 |
|
Hormonal Therapies |
Avinza |
morphine extended-release capsules
|
03/01/2018 |
- Requires Prior Approval
- Requires Step Therapy
- Subject to Quantity Limits
|
Opioid Analgesics - Extended-Release |
Avita |
tretinoin
|
10/01/2017 |
|
Retinoids |
Avonex |
interferon beta-1a
|
01/01/2018 |
|
Multiple Sclerosis |
Avsola |
infliximab
|
03/20/2020 |
- Requires Excluded Exception Approval
|
Autoimmune |
Axert |
almotriptan
|
01/01/2017 |
- Requires Prior Approval
- Subject to Quantity Limits
|
Antimigraine |
Axiron |
testosterone topical solution
|
01/01/2018 |
|
Testosterone Products |
Ayvakit |
avapritinib
|
03/07/2020 |
|
Oncology |
Azelex |
azelaic acid cream
|
09/01/2017 |
- Requires Prior Approval
- Requires Step Therapy
|
Topical Acne Products |
Bafiertam |
monomethyl fumarate
|
07/01/2020 |
|
Multiple Sclerosis |
Balversa |
erdafitinib
|
07/01/2019 |
|
Oncology |
Bavencio |
avelumab
|
01/01/2018 |
|
Oncology |
Bebulin |
factor IX complex [human]
|
01/01/2017 |
|
Hemophilia |
Belbuca |
buprenorphine buccal film
|
03/01/2018 |
- Requires Prior Approval
- Requires Step Therapy
- Subject to Quantity Limits
|
Opioid Analgesics |
Beleodaq |
belinostat solution reconstituted
|
01/01/2017 |
|
Oncology |
Belrapzo |
Bendamustine
|
01/01/2017 |
|
Oncology |
Belsomra |
suvorexant
|
01/01/2018 |
- Requires Prior Approval
- Requires Step Therapy
|
Sedative-Hypnotics |
Bendeka |
bendamustine
|
01/01/2018 |
|
Oncology |
Benefix |
coagulation factor IX [recombinant]
|
01/01/2017 |
|
Hemophilia |
Benlysta |
belimumab solution reconstituted
|
01/01/2017 |
|
Systemic Lupus Erythematosus |
Benzac |
benzoyl peroxide gel
|
09/01/2017 |
- Requires Prior Approval
- Requires Step Therapy
|
Topical Acne Products |