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

Abraxane - Form | Criteria
Actemra IV - Form | Criteria
Acthar Gel - Form | Criteria
Actimmune - Form | Criteria
Adakveo - Form | Criteria
Adcetris - Form | Criteria
Aduhelm - Form | Criteria
Advate - Form | Criteria
Adynovate - Form | Criteria
Afstyla - Form | Criteria
Aldurazyme - Form | Criteria
Alimta - Form | Criteria
Aliqopa - Form | Criteria
Alphanate - Form | Criteria
AlphaNine SD - Form | Criteria
Alprolix - Form | Criteria
Amondys 45 - Form | Criteria
Apokyn - Form | Criteria
Aralast NP - Form | Criteria
Arcalyst - Form | Criteria
Arzerra - Form | Criteria
Asceniv - Form | Criteria
Avastin - Form | Criteria
Aveed - Form | Criteria
Avsola - Form | Criteria
Azacitidine - Form | Criteria

B

Bavencio - Form | Criteria
Belrapzo - Form | Criteria
Bendeka - Form | Criteria
BeneFIX - Form | Criteria
Benlysta IV - Form | Criteria
Beovu - Form | Criteria
Berinert - Form | Criteria
Besponsa - Form | Criteria
Bivigam - Form | Criteria
Blenrep - Form | Criteria
Blincyto - Form | Criteria
Bortezomib - Form | Criteria
Botox - Form | Criteria
Breyanzi - Form | Criteria
Brineura - Form | Criteria
 

C

Cabenuva - Form | Criteria
Carimune - Form | Criteria
Cerezyme - Form | Criteria
Cinqair - Form | Criteria
Cimzia Lyophilized Powder - Form | Criteria
Cinryze - Form | Criteria
Coagadex - Form | Criteria
Cosela - Form | Criteria
Crysvita - Form | Criteria
Cuvitru - Form | Criteria
Cyramza - Form | Criteria

D

Dacogen - Form | Criteria
Darzalex - Form | Criteria
Darzalex Faspro - Form | Criteria
Decitabine - Form | Criteria
Deferoxamine Mesylate - Form | Criteria
Desferal - Form | Criteria
Docetaxel - Form | Criteria
Duopa - Form | Criteria
Durolane - Form | Criteria
Dysport - Form | Criteria

E

Elaprase - Form | Criteria
Elelyso - Form | Criteria
Eligard - Form | Criteria
Eloctate - Form | Criteria
Elzonris - Form | Criteria
Empliciti - Form | Criteria
Enhertu - Form | Criteria
Entyvio - Form | Criteria
Epoprostenol Sodium - Form | Criteria
Erbitux - Form | Criteria
Erwinaze - Form | Criteria
Esperoct - Form | Criteria
Euflexxa - Form | Criteria
Evenity - Form | Criteria
Evkeeza - Form | Criteria
Exondys 51 - Form | Criteria
Eylea - Form | Criteria

F

Fabrazyme - Form | Criteria
Fasenra - Form | Criteria
Faslodex - Form | Criteria
Feiba - Form | Criteria
Fensolvi (6 Month) - Form | Criteria
Fibryga - Form | Criteria
Firazyr - Form | Criteria
Firmagon - Form | Criteria
Flebogamma - Form | Criteria
Flolan - Form | Criteria
Folotyn - Form | Criteria
Fulphila - Form | Criteria
Fulvestrant - Form | Criteria

G

Gamastan - Form | Criteria
Gamastan S/D - Form | Criteria
Gamifant - Form | Criteria
Gammagard - Form | Criteria
Gammagard S/D Less IgA - Form | Criteria
Gammaked - Form | Criteria
Gammaplex - Form | Criteria
Gammunex-c- Form | Criteria
Gazyva - Form | Criteria
Gel-one - Form | Criteria
Gelsyn 3 - Form | Criteria
Gemcitabine HCl - Form | Criteria
Genvisc - Form | Criteria
Givlaari - Form | Criteria
Glassia - Form | Criteria
Granix - Form | Criteria

H

Haegarda - Form | Criteria
Halaven - Form | Criteria
Hemlibra - Form | Criteria
Hemofil M - Form | Criteria
Herceptin - Form | Criteria
Herceptin Hylecta - Form | Criteria
Herzuma - Form | Criteria
Hizentra - Form | Criteria
Humate-P - Form | Criteria
Hyalgan - Form | Criteria
Hymovis - Form | Criteria
Hyqvia - Form | Criteria

I

Icatibant Acetate - Form | Criteria
Idelvion - Form | Criteria
Ilaris - Form | Criteria
Ilumya - Form | Criteria
Imfinzi - Form | Criteria
Imlygic - Form | Criteria
Inflectra - Form | Criteria
Intron A - Form | Criteria
Istodax - Form | Criteria
Ixempra Kit - Form | Criteria
Ixinity - Form | Criteria

J

Jevtana - Form | Criteria
Jivi - Form | Criteria

K

Kadcyla - Form | Criteria
Kalbitor - Form | Criteria
Kanjinti - Form | Criteria
Kanuma - Form | Criteria
Keytruda - Form | Criteria
Khapzory - Form | Criteria
Koate - Form | Criteria
Koate-DVI - Form | Criteria
Kogenate FS - Form | Criteria
Kovaltry - Form | Criteria
Krystexxa - Form | Criteria
Kymriah - Form | Criteria
Kyprolis - Form | Criteria

L

Lemtrada - Form | Criteria
Leukine - Form | Criteria
Leuprolide Acetate - Form | Criteria
Libtayo - Form | Criteria
Lucentis - Form | Criteria
Lumizyme - Form | Criteria
Lumoxiti - 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

Mepsevii - Form | Criteria
Monjuvi - Form | Criteria
Mononine - Form | Criteria 
Monovisc - Form | Criteria
Mvasi - Form | Criteria
Myobloc - Form | Criteria

N

Naglazyme - Form | Criteria
Neulasta - Form | Criteria
Neulasta Onpro - Form | Criteria
Neupogen - Form | Criteria
Nivestym - Form | Criteria
Novoeight - Form | Criteria
NovoSeven RT - Form | Criteria
Nplate - Form | Criteria
Nucala - Form | Criteria
Nuwiq - Form | Criteria
Nyvepria - Form | Criteria

O

Obizur - Form | Criteria
Ocrevus - Form | Criteria
Octagam - Form | Criteria
Octreotide Acetate - Form | Criteria
Ogivri - Form | Criteria
Oncaspar - Form | Criteria
Onpattro - Form | Criteria
Ontruzant - Form | Criteria
Opdivo - Form | Criteria
Orencia IV - Form | Criteria
Orthovisc - Form | Criteria
Oxaliplatin - Form | Criteria
Oxlumo - Form | Criteria

P

Padcev - Form | Criteria
Panzyga - Form | Criteria
Parsabiv - Form | Criteria
Perjeta - Form | Criteria
Polivy - Form | Criteria
Poteligeo - Form | Criteria
Privigen - Form | Criteria
Profilnine - Form | Criteria
Prolastin-C - Form | Criteria
Proleukin - Form | Criteria
Prolia - Form | Criteria

Q

R

Radicava - Form | Criteria
Rebinyn - Form | Criteria
Reclast - Form | Criteria
Recombinate - Form | Criteria
Remicade - Form | Criteria
Remodulin - Form | Criteria
Renflexis - Form | Criteria
Revcovi - Form | Criteria
Riabni - Form | Criteria
RiaSTAP - Form | Criteria
Rixubis - Form | Criteria
Rituxan (Oncology) - Form | Criteria
Rituxan (Other) - Form | Criteria
Rituxan Hycela - Form | Criteria
Romidepsin - Form | Criteria
Ruconest - Form | Criteria
Ruxience (Oncology) - Form | Criteria
Ruxience (Other) - Form | Criteria

S

Sajazir - Form | Criteria
Sandostatin - Form | Criteria
Sandostatin Lar Depot - Form | Criteria
Sarclisa - Form | Criteria
Scenesse - Form | Criteria
Sevenfact - Form | Criteria
Signifor Lar - Form | Criteria
Simponi Aria - Form | Criteria
Soliris - Form | Criteria
Somatuline Depot - Form | Criteria
Spinraza - Form | Criteria
Stelara IV - Form | Criteria
Supartz FX - Form | Criteria
Supprelin LA - Form | Criteria
Sylvant - Form | Criteria
Synagis - Form | Criteria
Synojoynt - Form | Criteria
Synribo - Form | Criteria
Synvisc - Form | Criteria
Synvisc One - Form | Criteria

T

Takhzyro - Form | Criteria
Tecartus - Form | Criteria
Tecentriq - Form | Criteria
Temsirolimus - Form | Criteria
Tepezza - Form | Criteria
Torisel - Form | Criteria
Trazimera - Form | Criteria
Treanda - Form | Criteria
Trelstar Mixject - Form | Criteria
Tremfya - Form | Criteria
Treprostinil - Form | Criteria
Tretten - Form | Criteria
Triluron - Form | Criteria
Triptodur - Form | Criteria
TriVisc - Form | Criteria
Trodelvy - Form | Criteria
Truxima (Oncology) - Form | Criteria
Truxima (Other) - Form | Criteria
Tysabri - Form | Criteria

U

Udenyca - Form | Criteria
Ultomiris - Form | Criteria
Uplizna - Form | Criteria

V

Vectibix - Form | Criteria
Velcade - Form | Criteria
Veletri - Form | Criteria
Ventavis - Form | Criteria
Vidaza - Form | Criteria
Viltepso - Form | Criteria
Vimizim - Form | Criteria
Visco-3 - Form | Criteria
Visudyne - Form | Criteria
Vonvendi - Form | Criteria
Vpriv - Form | Criteria
Vyepti - Form | Criteria
Vyondys 53 - Form | Criteria

W

Wilate - Form | Criteria

X

Xembify - Form | Criteria
Xeomin - Form | Criteria
Xgeva - Form | Criteria
Xiaflex - Form | Criteria
Xolair - Form | Criteria
Xyntha - Form | Criteria
Xyntha Solofuse - Form | Criteria

Y

Yervoy - Form | Criteria
Yescarta - Form | Criteria

Z

Zaltrap - Form | Criteria
Zarxio - Form | Criteria
Zemaira - Form | Criteria
Zepzelca - Form | Criteria
Ziextenzo - Form | Criteria
Zirabev - Form | Criteria
Zoladex - Form | Criteria
Zoledronic Acid (Generic of Reclast) - Form | Criteria
Zoledronic Acid (Generic of Zometa) - Form | Criteria
Zolgensma - Form | Criteria


 

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