Prior Authorizations (PA)

The following list of Brand Name and Generic Drugs require a Prior Authorization (PA).

Brand Name	Generic Name
Adcirca	tadalafil
Aldurazyme	laronidase
Amitiza	lubiprostone
Aranesp	darbepoetin alfa
Avonex	interferon beta-1a
Betaseron	interferon beta-1b
Campral	acamprosate calcium
Celebrex	celecoxib
Cimzia	certolizumab pegol
Claravis	isotretinoin
Copaxone	glatiramer
Copegus	ribavirin
Eligard	leuprolide acetate
Enbrel	etanercept
Euflexxa	hyaluronate sodium
Exjade	deferasirox
Fabrazyme	agalsidase beta
Flector	diclofenac epolamine transdermal
Flolan	epoprostenol
Foreto	teriparatide
Humira	adalimumab
Hyalgan	hyaluronic acid
Infergen	interferon alfacon-1
Intron A	interferon alfa-2b
Letairis	ambrisentan
Leukine	sargramostim
Lindane	lindane
Lupron/Lupron Depot	leuprolide acetate
Neulasta	pegfilgrastim
Neupogen	filgrastim
Norditropin Nordiflex	somatropin
Novantrone	mitoxantrone HCl
Noxafil	posaconazole
Nplate	romiplostim
Orthovisc	hyaluronic acid
Oxycontin	oxycodone ext-rel
Pegasys	peginterferon alfa-2a
Pegintron	peginterferon alfa-2b
Procrit	epoetin alfa
Promacta	eltrombopag
Rebetol	ribavirin
Rebif	interferon beta-1a
Remodulin	treprostinil
Retin-A	tretinoin
Revatio	sildenafil
Sensipar	cinacalcet
Suboxone	buprenorphine/naloxone (1 fill, then PA)
Subutex	buprenorphine (1 fill, then PA)
Synagis	palivizumab
Synvisc	hyaluronic acid
Tev-Tropin	somatropin
Tikosyn	dofetilide
Tracleer	bosentan
Tykerb	lapatinib
Xenazine	tetrabenazine
Xolair	omalizumab
Zetia	ezetimibe
Zolinza	vorinostat