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EHP Medical Injectable Drug Criteria

Medical Injectable Drug Criteria

A

Abraxane
Actemra
Actimmune
Adagen
Adcetris
Advate
Adynovate
Afstyla
Aldurazyme
Alimta
Aliqopa
Alphanate/VWF Complex/Human
Alphanine SD
Alprolix
Apokyn
Aralast NP
Aranesp (albumin free)
Arcalyst
Asceniv
Avastin
Aveed
Avsola

B

Bavencio
Bebulin
Beleodaq
Belrapzo
Bendamustine HCI
Bendeka
Benefix
Benlysta
Beovu
Berinert
Besponsa
Bivigam
Blincyto
Bortezomib
Botox
Brineura
Bynfezia Pen

C

Carimune NF
Cerezyme
Cimzia
Cinqair
Cinryze
Coagadex
Crysvita
Cuvitru
Cyramza

D

Darzalex
Decitabine
Docefrez
Docetaxel
Docetaxel (non- alcohol)
Durolane
Dysport

E

Elaprase
Elelyso
Eloctate
Elzonris
Empliciti
Entyvio
Epogen
Epoprostenol sodium
Erbitux
Erwinaze
Esperoct
Euflexxa
Evenity
Exondys 51
Eylea

F

Fabrazyme
Fasenra
Feiba
Fibryga
Firazyr
Flebogamma DIF
Flolan
Fulphila
Fusilev

G

Gamifant
Gammagard
Gammagard S/D Less IgA
Gammaked
Gammaplex
Gamunex-C
Gazyva
Gel-one
Gelsyn-3
Gemcitabine HCI
Gemzar
Genvisc 850
Glassia

H

H.P. Acthar Gel
Haegarda
Halaven
Helixate FS
Hemlibra
Hemofil M
Herceptin
Herceptin Hylecta
Herzuma
Hizentra
Humate-P
Hyalgan
Hymovis
Hyqvia

I

Icatibant Acetate
Idelvion
Ilaris
Ilumya
Imfinzi
Imlygic
Inflectra
Intron A
Ixempra Kit
Ixinity

J

Jetrea
Jevtana
Jivi

K

Kadcyla
Kalbitor
Kanjinti
Kanuma
Keytruda
Koate
Koate-DVI
Kogenate FS
Kogenate FS Bio-Set
Kovaltry
Krystexxa
Kyprolis

L

Lemtrada
Libtayo
Lucentis
Lumizyme
Luxturna

M

Macugen
Mepsevii
Mircera
Mitoxantrone HCI
Monoclate-P
Mononine
Monovisc
Mvasi
Myobloc

N

Naglazyme
Neulasta
Neulasta Onpro
Neupogen
Nivestym
Novoeight
NovoSeven RT
Nplate
Nucala
Nuwiq
Nyvepria

O

Obizur
Ocrevus
Octagam
Octreotide Acetate
Ogivri
Oncaspar
Oncology
Onpattro
Ontruzant
Opdivo
Orencia
Orthovisc
Oxaliplatin

P

Panzyga
Parsabiv
Perjeta
Polivy
Poteligeo
Privigen
Procrit
Profilnine
Profilnine SD
Prolastin-C
Proleukin
Prolia

Q

 

R

Radicava
Rebinyn
Recombinate
Remicade
Remodulin
Renflexis
Retacrit
Riastap
Rituxan (Oncology)
Rituxan (Other)
Rituxan hycela
Rixubis
Ruconest
Ruxience (Oncology)
Ruxience (Other)

S

Sandostatin
Sandostatin LAR Depot
Signifor LAR
Simponi Aria
Soliris
Somatuline Depot
Spinraza
Stelara IV
Stelara Subcutaneous
Supartz
Supartz FX
Supprelin LA
Sylvant
Synvisc
Synvisc One

T

Takhzyro
Taxotere
Tecentriq
Temodar
Temsirolimus
Torisel
Trazimera
Treanda
Treprostinil
Tretten
Triluron
Triptodur
Trivisc
Truxima (Oncology)
Truxima (Other)
Tysabri

U

Udenyca
Ultomiris

V

Vantas
Vectibix
Velcade
Veletri
Vimizim
Visco-3
Vonvendi
Vpriv

W

Wilate

X

Xembify
Xeomin
Xgeva
Xiaflex
Xolair
Xyntha
Xyntha Solofuse

Y

Yervoy
Yescarta

Z

Zaltrap
Zemaira
Zepzelca
Ziextenzo
Zirabev
Zolgensma