A

Abraxane
Abecma
Actemra IV
Acthar Gel
Actimmune
Adakveo
Adcetris
Aduhelm
Advate
Adynovate
Afstyla
Aldurazyme
Alimta
Aliqopa
Alphanate
AlphaNine SD
Alprolix
Altuviii
Alymsys - Criteria | Non-Preferred Product Exception Criteria
Amondys 45
Amvuttra
Apokyn
Aralast NP
Arcalyst
Arzerra
Asceniv
Avastin - Criteria | Non-Preferred Product Exception Criteria
Aveed
Avolsa
Azacitidine

B

Bavencio
Belrapzo
Bendeka
BeneFIX
Benlysta IV
Beovu - Criteria | Non-Preferred Product Exception Criteria
Berinert - Criteria | Non-Preferred Product Exception Criteria
Besponsa
Bivigam
Blenrep
Blincyto
Bortezomib
Botox - Criteria | Non-Preferred Product Exception Criteria
Breyanzi
Brineura
Briumvi - Criteria | Non-Preferred Product Exception Criteria
Bynfezia
Byooviz - Criteria | Non-Preferred Product Exception Criteria

C

Cabenuva
Cablivi
Camcevi
Carvykti
Cerezyme
Cinqair
Cimerli - Criteria | Non-Preferred Product Exception Criteria
Cimzia Lyophilized Powder
Cinryze
Coagadex
Cosela
Crysvita
Cuvitru
Cyramza

D

Dacogen
Danyelza
Darzalex
Darzalex Faspro
Decitabine
Deferoxamine Mesylate
Desferal
Docetaxel
Duopa
Durolane
Dysport

E

Elahere
Elaprase
Elevidys
Elelyso - Criteria | Non-Preferred Product Exception Criteria
Eligard
Eloctate
Eloxatin
Elzonris
Empliciti
Enhertu
Entyvio
Epoprostenol Sodium
Erbitux
Erwinaze
Esperoct
Euflexxa
Evenity
Evkeeza
Exondys 51
Eylea

F

Fabrazyme
Fasenra
Faslodex
Feiba
Fensolvi
Fibryga
Firazyr
Firmagon
Flebogamma
Flolan
Folotyn
Fulphila
Fulvestrant
Fusilev
Fyarro
Fylnetra - Criteria | Non-Preferred Product Exception Criteria

G

Gamastan
Gamifant
Gammagard
Gammagard S/D Less IgA
Gammaked
Gammaplex
Gammunex-c
Gazyva
Gel-one - Criteria | Non-Preferred Product Exception Criteria
Gelsyn 3 - Criteria | Non-Preferred Product Exception Criteria
Gemzar
GenVisc - Criteria | Non-Preferred Product Exception Criteria
Givlaari
Glassia
Granix

H

Haegarda
Halaven
Hemgenix
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
Inflectra
Intron A
Istodax
Ixempra Kit
Ixinity

J

Jevtana
Jivi

K

Kadcyla
Kalbitor
Kanjinti
Kanuma
Keytruda
Khapzory
Kimmtrak
Koate
Koate-DVI
Kogenate FS
Kovaltry
Krystexxa
Kymriah
Kyprolis

L

Lamzede
Lemtrada - Criteria | Non-Preferred Product Exception Criteria
Leukine
Leuprolide Acetate
Levoleucovorin solution
Libtayo
Lucentis - Criteria | Non-Preferred Product Exception Criteria
Lumizyme
Lumoxiti
Lupron Depot (Endometriosis & Fibroids)
Lupron Depot (Prostate Cancer, Ovarian Cancer, Gender Dysphoria & Salivary Gland Tumors)
Lupron Depot-PED
Luxturna

M

Mepsevii
Monjuvi
Mononine
Monovisc - Criteria | Non-Preferred Product Exception Criteria
Mvasi
Mycapssa
Myobloc - Criteria | Non-Preferred Product Exception Criteria

N

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

O

Obizur
Ocrevus
Octagam
Octreotide Acetate
Ogivri - Criteria | Non-Preferred Product Exception Criteria
Oncaspar
Onpattro
Ontruzant - Criteria | Non-Preferred Product Exception Criteria
Opdivo
Orencia IV
Orthovisc - Criteria | Non-Preferred Product Exception Criteria
Oxaliplatin
Oxlumo

P

Padcev
Panzyga
Parsabiv
Perjeta
Polivy
Poteligeo
Purified Cortrophin Gel
Privigen
Profilnine
Prolastin-C
Proleukin
Prolia

Q

 

R

Radicava
Rebinyn
Reclast
Recombinate
Releuko
Remicade - Criteria | Non-Preferred Product Exception Criteria
Remodulin
Renflexis - Criteria | Non-Preferred Product Exception Criteria
Riabni
Riabni (Oncology)
RiaSTAP
Rixubis
Rituxan (Oncology)
Rituxan (Other)
Rituxan Hycela
Romidepsin
Ruconest
Ruxience (Oncology)
Ruxience (Other)
Ryplazim

S

Sajazir
Sandostatin
Sandostatin Lar Depot
Sarclisa
Scenesse
Sevenfact
Signifor Lar
Simponi Aria
Site of Care Policy
Skyrizi
Soliris
Somatuline Depot
Spinraza
Stelara IV
Stimufend - Criteria | Non-Preferred Product Exception Criteria
Supartz
Supartz FX - Criteria | Non-Preferred Product Exception Criteria
Supprelin LA
Sylvant
Synagis
Synojoynt
Synribo
Synvisc - Criteria | Non-Preferred Product Exception Criteria
Synvisc One - Criteria | Non-Preferred Product Exception Criteria

T

Takhzyro
Tecartus
Tecentriq
Tecvayli
Temsirolimus
Tepezza
Tezspire
Tofidence
Torisel
Trazimera - Criteria | Non-Preferred Product Exception Criteria
Treanda
Trelstar Mixject
Tremfya
Treprostinil
Tretten
Triluron
Triptodur
Trivisc - Criteria | Non-Preferred Product Exception Criteria
Trodelvy
Truxima (Oncology)
Truxima (Other)
Tysabri

U

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

V

Vabysmo - Criteria | Non-Preferred Product Exception Criteria
Vectibix
Vegzelma - Criteria | Non-Preferred Product Exception Criteria
Velcade
Veletri
Ventavis
Vidaza
Viltepso
Vimizim
Visco-3 - Criteria | Non-Preferred Product Exception Criteria
Visudyne
Vivimusta
Vonvendi
Vpriv - Criteria | Non-Preferred Product Exception Criteria
Vyepti
Vyondys 53

W

Wilate

X

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

Y

Yervoy
Yescarta

Z

Zaltrap
Zarxio
Zemaira
Zepzelca
Ziextenzo - Criteria | Non-Preferred Product Exception Criteria
Zirabev - Criteria | Non-Preferred Product Exception Criteria
Zoladex
Zoledronic Acid (Generic of Reclast)
Zoledronic Acid (Generic of Zometa)
Zolgensma