Priority Partners Medical Injectable Drug Forms and Criteria

• A
• B
• C
• D
• E
• F
• G
• H
• I
• J
• K
• L
• M
• N
• O
• P
• Q
• R
• S
• T
• U
• V
• W
• X
• Y
• Z

A

Actemra IV - Form | Criteria
Actimmune - Form | Criteria
Adakveo - Form | Criteria
Ajovy - Form | Criteria
Alimta - Form | Criteria
Asceniv - Form | Criteria
Avastin - Form | Criteria
Avsola - Form | Criteria

B

Benlysta IV - Form | Criteria
Beovu - Form | Criteria
Bivigam - Form | Criteria
Botox - Form | Criteria

C

Carimune - Form | Criteria
Cimzia Lyophilized Powder - Form | Criteria
Cinryze - Form | Criteria
Cuvitru - Form | Criteria

D

Durolane - Form | Criteria
Dysport - Form | Criteria

E

Eligard - Form | Criteria
Entyvio - Form | Criteria
Euflexxa - Form | Criteria
Evenity - Form | Criteria
Eylea - Form | Criteria

F

Fasenra - Form | Criteria
Flebogamma - Form | Criteria
Fulphila - Form | Criteria

G

Gammagard - Form | Criteria
Gammagard S/D Less IgA - Form | Criteria
Gammaked - Form | Criteria
Gammaplex - Form | Criteria
Gammunex-c- Form | Criteria
Gel-one - Form | Criteria
Gelsyn 3 - Form | Criteria
GenVisc - Form | Criteria
Givlaari - Form | Criteria

H

H.P. Acthar Gel - Form | Criteria
Herceptin - Form | Criteria
Herceptin Hylecta - Form | Criteria
Herzuma - Form | Criteria
Hizentra - Form | Criteria
Hyalgan - Form | Criteria
Hymovis - Form | Criteria
Hyqvia - Form | Criteria

I

Ilumya - Form | Criteria
Inflectra - Form | Criteria

J

K

Kanjinti - Form | Criteria
Kymriah - Form | Criteria

L

Lemtrada - Form | Criteria
Leuprolide Acetate - Form | Criteria
Lucentis - Form | Criteria
Lupron Depot (Endometriosis & Fibroids) - Form | Criteria
Lupron Depot (Prostate Cancer, Ovarian Cancer, Gender Dysphoria & Salivary Gland Tumors) - Form | Criteria
Lupron Depot-PED - Form | Criteria
Luxturna - Form | Criteria

M

Monovisc - Form | Criteria
Mvasi - Form | Criteria
Myobloc - Form | Criteria

N

Neulasta - Form | Criteria
Neulasta Onpro - Form | Criteria
NovoSeven RT - Form | Criteria
Nplate - Form | Criteria
Nucala - Form | Criteria
Nyvepria - Form | Criteria

O

Ocrevus - Form | Criteria
Octagam - Form | Criteria
Ogivri - Form | Criteria
Ontruzant - Form | Criteria
Opdivo - Form | Criteria
Orencia IV - Form | Criteria
Orthovisc - Form | Criteria

P

Panzyga - Form | Criteria
Polivy - Form | Criteria
Privigen - Form | Criteria
Prolia - Form | Criteria

Q

R

Remicade - Form | Criteria
Renflexis - Form | Criteria
Rituxan (Oncology) - Form | Criteria
Rituxan (Other) - Form | Criteria
Rituxan Hycela - Form | Criteria
Ruxience (Oncology) - Form | Criteria
Ruxience (Other) - Form | Criteria

S

Simponi Aria - Form | Criteria
Soliris - Form | Criteria
Spinraza - Form | Criteria
Stelara IV - Form | Criteria
Supartz - Form | Criteria
Supartz FX - Form | Criteria
Supprelin LA - Form | Criteria
Synagis - Form | Criteria
SynoJoynt - Form | Criteria
Synvisc - Form | Criteria
Synvisc One - Form | Criteria

T

Trazimera - Form | Criteria
Tremfya - Form | Criteria
Triluron - Form | Criteria
Triptodur - Form | Criteria
TriVisc - Form | Criteria
Truxima (Oncology) - Form | Criteria
Truxima (Other) - Form | Criteria
Tysabri - Form | Criteria

U

Udenyca - Form | Criteria
Ultomiris - Form | Criteria

V

Vimizim - Form | Criteria
Visco-3 - Form | Criteria
Vyepti - Form | Criteria
Vyondys 53 - Form | Criteria

W

X

Xembify - Form | Criteria
Xeomin - Form | Criteria
Xgeva - Form | Criteria
Xolair - Form | Criteria

Y

Yescarta - Form | Criteria

Z

Ziextenzo - Form | Criteria
Zirabev - Form | Criteria
Zolgensma - Form | Criteria

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