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Advantage MD Medical Injectable Drug Criteria

A

Actemra - Criteria | Non-Preferred Exception Criteria
Adakveo
Aduhelm
Advate
Adynovate
Afstyla

Aliqopa
Alphanate/VWF Complex/Human
Alphanine SD
Alprolix
Aralast NP - Criteria | Non-Preferred Exception Criteria
Avastin (Oncology)
Avastin (Other) - Criteria | Non-Preferred Exception Criteria
Avsola

B

Bavencio
Bebulin
Belrapzo
Bendeka
Benefix
Benlysta
Beovu - Criteria | Non-Preferred Exception Criteria
Berinert
Besponsa
Bivigam
Blincyto
Botox - Criteria | Non-Preferred Exception Criteria

C

Carimune NF
Cerezyme - Criteria | Non-Preferred Exception Criteria
Cimzia - Criteria | Non-Preferred Exception Criteria
Cinqair - Criteria | Non-Preferred Exception Criteria
Cinryze
Coagadex
Corifact
Crysvita
Cutaquig
Cuvitru
Cyramza
Cytogam

D

Darzalex
Durolane - Criteria | Non-Preferred Exception Criteria
Dysport

E

Elelyso
Eligard
Eloctate
Entyvio
Erbitux
Erwinaze
Esperoct
Euflexxa - Criteria | Non-Preferred Exception Criteria
Evenity
Exondys 51
Eylea - Criteria | Non-Preferred Exception Criteria

F

Fasenra
Feiba
Firazyr
Firmagon
Flebogamma DIF
Forteo
Fulphila
Fusilev

G

Gammagard
Gammagard S/D less IgA
Gammaked
Gammaplex
Gamunex-C
Gel-one - Criteria | Non-Preferred Exception Criteria
Gelsyn-3 - Criteria | Non-Preferred Exception Criteria
GenVisc 850 - Criteria | Non-Preferred Exception Criteria
Givlaari
Glassia - Criteria | Non-Preferred Exception Criteria
Granix - Criteria | Non-Preferred Exception Criteria

H

Helixate FS
Hemlibra
Hemofil M
Hepagam B
Herceptin - Criteria | Non-Preferred Exception Criteria
Herceptin Hylecta
Herzuma
Hizentra
Humate-P
Hyalgan - Criteria | Non-Preferred Exception Criteria
Hymovis - Criteria | Non-Preferred Exception Criteria
Hyqvia

I

Icatibant acetate
Idelvion
Ilaris
Ilumya - Criteria | Non-Preferred Exception Criteria
Imfinzi
Inflectra
Ixinity

J

Jivi

K

Kadcyla
Kalbitor
Kanjinti
Kanuma
Keytruda
Khapzory
Koate
Kogenate FS
Kogenate FS Bio-Set
Kovaltry
Krystexxa
Kymriah

L

Lartruvo
Lemtrada - Criteria | Non-Preferred Exception Criteria
Leukine - Criteria | Non-Preferred Exception Criteria
Levoleucovorin calcium
Libtayo
Lucentis - Criteria | Non-Preferred Exception Criteria
Lumizyme
Lupron Depot - Criteria | Non-Preferred Exception Criteria
Luxturna

M

Mepsevii
Monoclate-P
Mononine
Monovisc - Criteria | Non-Preferred Exception Criteria
Mvasi (Oncology)
Mvasi (Other) 
Myobloc - Criteria | Non-Preferred Exception Criteria

N

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

O

Obizur
Ocrevus
Octagam
Ogivri
Onpattro
Ontruzant
Opdivo
Orencia - Criteria | Non-Preferred Exception Criteria
Orthovisc

P

Panzyga
Perjeta
Privigen
Profilnine
Profilnine SD
Prolastin-C
Proleukin
Prolia
Provenge

Q

 

R

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

S

Sajazir
Sandostatin LAR Depot
Signifor LAR - Criteria | Non-Preferred Exception Criteria
Simponi Aria
Soliris
Somatuline Depot
Spinraza
Stelara IV - Criteria | Non-Preferred Exception Criteria
Supartz
Supartz FX
Supprelin LA
Synvisc
Synvisc One

T

Takhzyro
Tecartus
Tecentriq
Teriparatide
Trazimera
Treanda
Trelstar - Criteria | Non-Preferred Exception Criteria
Trelstar Mixject
Tretten
TriVisc - Criteria | Non-Preferred Exception Criteria
Truxima (Oncology)
Truxima (Other)
Tysabri

U

Udenyca
Ultomiris

V

Vantas
Vimizim
Visco-3 - Criteria | Non-Preferred Exception Criteria
Visudyne
Vonvendi
Vpriv - Criteria | Non-Preferred Exception Criteria

W

Wilate
WinRho SDF

X

Xembify
Xeomin
Xgeva
Xiaflex
Xolair
Xyntha
Xyntha Solofuse

Y

Yervoy
Yescarta

Z

Zarxio
Zemaira - Criteria | Non-Preferred Exception Criteria
Ziextenzo
Zirabev (Oncology)
Zirabev (Other)
Zoladex - Criteria | Non-Preferred Exception Criteria
Zoledronic acid
Zolgensma
Zometa