A

Abraxane
Actemra - Criteria | Non-Preferred Product Exception Criteria
Acthar Gel
Actimmune
Adagen
Adakveo
Adcetris
Aduhelm
Advate
Adynovate
Afstyla
Ahzantive
Aldurazyme
Alimta
Aliqopa
Alphanate/VWF Complex/Human
Alphanine SD
Alprolix
Altuviiio 
Alyglo
Alymsys - Criteria | Non-Preferred Product Exception Criteria
Amondys
Amvuttra - Criteria | Non-Preferred Product Exception Criteria
Apokyn
Aralast NP - Criteria | Non-Preferred Exception Criteria
Aranesp
Arcalyst
Arzerra
Asceniv
Aukelso
Avastin - Criteria | Non-Preferred Product Exception Criteria
Aveed
Avgemsi
Avsola 
Avtozma
Avzivi
Axtle

B

Bavencio
Beleodaq
Belrapzo
Bendamustine HCI
Bendeka
Benefix - Criteria | Non-Preferred Exception Criteria
Benlysta
Beovu
Berinert - Criteria | Non-Preferred Exception Criteria
Besponsa
Bildyos
Bilprevda
Bivigam
Bkemv
Blenrep
Blincyto
Bomyntra
Bortezomib
Bosaya
Botox
Breyanzi
Brineura
Briumvi - Criteria | Non-Preferred Product Exception Criteria
Bynfezia Pen
Byooviz

C

Cabenuva
Cablivi
Camcevi - Criteria | Non-Preferred Product Exception Criteria
Carvykti
Cerezyme - Criteria | Non-Preferred Exception Criteria
Cimerli
Cimzia - Criteria | Non-Preferred Exception Criteria
Cinqair - Criteria | Non-Preferred Exception Criteria
Cinryze
Coagadex
Conexxence
Cosela
Cosentyx IV
Crysvita
Cutaquig
Cuvitru
Cyramza

D

Darzalex
Darzalex Faspro
Daxxify
Decitabine
Docefrez
Docetaxel
Docetaxel (non- alcohol)
Durolane - Criteria | Non-Preferred Exception Criteria
Dysport - Criteria | Non-Preferred Product Exception Criteria

E

Elaprase
Elelyso - Criteria | Non-Preferred Exception Criteria
Elevidys
Eligard
Eloctate
Elrexfio
Elzonris
Empliciti
Enhertu
Enoby
Entyvio
Enzeevu
Epogen - Criteria | Non-Preferred Product Exception Criteria
Epoprostenol sodium
Epysqli
Erbitux
Erwinaze
Esperoct - Criteria | Non-Preferred Product Exception Criteria
Euflexxa - Criteria | Non-Preferred Product Exception Criteria
Evenity
Evkeeza
Exondys 51
Eydenzelt
Eylea - Criteria | Non-Preferred Product Exception Criteria
Eylea HD

F

Fabrazyme - Criteria | Non-Preferred Product Exception Criteria
Fasenra
Feiba
Fensolvi
Fibryga
Firazyr
Firmagon - Criteria | Non-Preferred Product Exception Criteria
Flebogamma DIF
Flolan
Fulphila
Fyarro
Fylnetra - Criteria | Non-Preferred Product Exception Criteria

G

Gamifant
Gammagard
Gammagard S/D Less IgA
Gammaked
Gammaplex
Gamunex-C
Gazyva
Gel-one - Criteria | Non-Preferred Product Exception Criteria
Gelsyn-3 - Criteria | Non-Preferred Product Exception Criteria
Gemcitabine HCI
Gemzar
Genvisc 850 - Criteria | Non-Preferred Product Exception Criteria
Givlaari
Glassia - Criteria | Non-Preferred Product Exception Criteria
Granix - Criteria | Non-Preferred Product Exception Criteria

H

Haegarda
Halaven
Hemlibra
Hemofil M
Herceptin - Criteria | Non-Preferred Product Exception Criteria
Herceptin Hylecta - Criteria | Non-Preferred Product Exception Criteria
Herzuma - Criteria | Non-Preferred Product Exception Criteria
Hizentra
Humate-P
Hyalgan - Criteria | Non-Preferred Product Exception Criteria
Hymovis - Criteria | Non-Preferred Product Exception Criteria
Hyqvia

I

Icatibant Acetate
Idelvion
Ilaris
Ilumya
Imfinzi
Imlygic
Imuldosa
Inflectra
Infliximab - Criteria | Non-Preferred Product Exception Criteria
Intron A
Ixempra Kit
Ixinity - Criteria | Non-Preferred Product Exception Criteria

J

Jetrea
Jevtana
Jivi
Jobevne
Jubbonti

K

Kadcyla
Kalbitor
Kanjinti - Criteria | Non-Preferred Product Exception Criteria
Kanuma
Keytruda
Khapzory
Koate
Koate-DVI
Kogenate FS
Kogenate FS Bio-Set
Kovaltry
Krystexxa
Kymriah
Kyprolis - Criteria | Non-Preferred Product Exception Criteria

L

Lanreotide Acetate
Lemtrada Criteria | Non-Preferred Product Exception Criteria
Leukine Criteria | Non-Preferred Product Exception Criteria
Levoleucovorin
Libtayo
Lucentis Criteria | Non-Preferred Product Exception Criteria
Lumizyme
Lupron Depot (Endometriosis & Fibroids) - Criteria | Non-Preferred Product Exception Criteria
 Criteria | Non-Preferred Product Exception Criteria
Lupron Depot-PED
Luxturna
Lyfgenia

M

Macugen
Margenza - Criteria | Non-Preferred Product Exception Criteria
Mepsevii
Mircera - Criteria | Non-Preferred Product Exception Criteria
Mitoxantrone HCI
Monjuvi
Monovisc - Criteria | Non-Preferred Product Exception Criteria
Mozobil
Mvasi
Myobloc - Criteria | Non-Preferred Product Exception Criteria
Mycapssa

N

Naglazyme
Neulasta
Neulasta Onpro
Neupogen - Criteria | Non-Preferred Product Exception Criteria
Nexviazyme
Nivestym - Criteria | Non-Preferred Product Exception Criteria
Novoeight
NovoSeven RT
Nplate
Nucala
Nuwiq 
Nyvepria - Criteria | Non-Preferred Product Exception Criteria

O

Obizur
Ocrevus - Criteria | Non-Preferred Product Exception Criteria
Octagam
Octreotide Acetate
Ogivri - Criteria | Non-Preferred Product Exception Criteria
Omlyclo
Omvoh intravenous
Oncaspar
Onpattro
Ontruzant - Criteria | Non-Preferred Product Exception Criteria
Opdivo
Opfolda
Opuviz
Orencia - Criteria | Non-Preferred Product Exception Criteria
Orthovisc - Criteria | Non-Preferred Product Exception Criteria
Osenvelt
Ospomyv
Otulfi
Oxaliplatin

P

Padcev
Panzyga
Parsabiv
Pavblu
Pemetrexed
Pemfexy
Pemrydi RTU
Perjeta
Phesgo
Polivy
Pombiliti
Poteligeo
Purified Cortrophin Gel
Privigen
Procrit
Profilnine
Profilnine SD
Prolastin-C
Proleukin
Prolia
Pyzchiva

Q

 

R

Radicava
Rebinyn
Reblozyl
Reclast
Recombinate - Criteria | Non-Preferred Product Exception Criteria
Remicade - Criteria | Non-Preferred Product Exception Criteria
Remodulin
Renflexis - Criteria | Non-Preferred Product Exception Criteria
Retacrit - Criteria | Non-Preferred Product Exception Criteria
Riabni (Oncology)
Riabni (Other) - Criteria | Non-Preferred Product Exception Criteria
Riastap
Rituxan (Oncology)
Rituxan (Other) - Criteria | Non-Preferred Product Exception Criteria
Rituxan Hycela - Criteria | Non-Preferred Product Exception Criteria
Rixubis - Criteria | Non-Preferred Product Exception Criteria
Ruconest
Ruxience (Oncology)
Ruxience (Other) - Criteria | Non-Preferred Product Exception Criteria
Rylaze

S

Sajazir
Sandostatin
Sandostatin LAR Depot
Sarclisa
Scenesse
Selarsdi
Sevenfact
Signifor LAR - Criteria | Non-Preferred Product Exception Criteria
Simponi Aria
Skyrizi
Soliris
Somatuline Depot
Somavert - Criteria | Non-Preferred Product Exception Criteria
Spinraza
Starjemza
Stelara IV
Steqeyma
Stimufend - Criteria | Non-Preferred Product Exception Criteria
Stoboclo
Supartz
Supartz FX - Criteria | Non-Preferred Product Exception Criteria
Supprelin LA
Sylvant
SynoJoynt - Criteria | Non-Preferred Product Exception Criteria
Synvisc - Criteria | Non-Preferred Product Exception Criteria
Synvisc One - Criteria | Non-Preferred Product Exception Criteria

T

Takhzyro
Talvey
Taxotere
Tecartus
Tecelra
Tecentriq
Tecvayli
Tegsedi - Criteria | Non-Preferred Product Exception Criteria
Temodar
Temozolomide
Temsirolimus
Tepezza
Tezspire
Tivdak
Tofidence
Torisel
Trazimera - Criteria | Non-Preferred Product Exception Criteria
Treanda
Trelstar - Criteria | Non-Preferred Product Exception Criteria
Treprostinil
Tretten
Triluron - Criteria | Non-Preferred Product Exception Criteria
Triptodur
TriVisc - Criteria | Non-Preferred Product Exception Criteria
Trodelvy
Truxima (Oncology)
Truxima (Other)
Tyenne
Tyruko - Criteria | Non-Preferred Product Exception Criteria
Tysabri - Criteria | Non-Preferred Product Exception Criteria
Tzield

U

Udenyca, Udenyca Onbody - Criteria | Non-Preferred Product Exception Criteria
Ultomiris - Criteria | Non-Preferred Product Exception Criteria
Uplizna

V

Vabrinty
Vabysmo
Vantas
Vectibix
Vegzelma - Criteria | Non-Preferred Product Exception Criteria
Velcade - Criteria | Non-Preferred Product Exception Criteria
Veletri
Viltepso
Vimizim
Visco-3 - Criteria | Non-Preferred Product Exception Criteria
Vivimusta
Vonvendi
Vpriv - Criteria | Non-Preferred Product Exception Criteria
Vyondys

W

Wezlana
Wilate
Wyost

X

Xbryk
Xembify
Xeomin - Criteria | Non-Preferred Product Exception Criteria
Xgeva
Xiaflex
Xolair
Xtrenbo
Xyntha
Xyntha Solofuse

Y

Yargesa
Yervoy
Yesafili
Yescarta
Yesintek
Yimmugo

Z

Zaltrap
Zarxio
Zavesca
Zemaira - Criteria | Non-Preferred Product Exception Criteria
Zepzelca
Ziextenzo - Criteria | Non-Preferred Product Exception Criteria
Zirabev - Criteria | Non-Preferred Product Exception Criteria
Zoladex - Criteria | Non-Preferred Product Exception Criteria
Zolgensma
Zometa
Zymfentra
Zynteglo