A

Abraxane
Abecma
Actemra IV - Criteria | Non-Preferred Product Exception Criteria
Acthar Gel
Actimmune
Adakveo
Adcetris
Adstiladrin
Aduhelm
Advate
Adynovate
Afstyla
Ahzantive
Aldurazyme
Alhemo
Alimta, generic pemetrexed, and pemetrexed ditromethamine 
Aliqopa
Alphanate
AlphaNine SD
Alprolix
Altuviii
Alyglo
Alymsys - Criteria | Non-Preferred Product Exception Criteria
Amondys 45
Amvuttra
Anktiva
Apokyn
Aralast NP
Arcalyst
Arzerra
Asceniv - Criteria | Non-Preferred Product Exception Criteria
Aukelso
Avastin - Criteria | Non-Preferred Product Exception Criteria
Aveed
Avgemsi
Avolsa
Avtozma
Avzivi
Axtle
Azacitidine

B

Bavencio
Beizray
Belrapzo
Bendeka
BeneFIX
Benlysta
Beovu - Criteria | Non-Preferred Product Exception Criteria
Berinert - Criteria | Non-Preferred Product Exception Criteria
Besponsa
Beqvez
Bildyos
Bilprevda
Bivigam - Criteria | Non-Preferred Product Exception Criteria
Bkemv
Blenrep
Blincyto
Bomyntra
Bortezomib
Bosaya
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
Casgevy
Cerezyme
Cinqair
Cimerli - Criteria | Non-Preferred Product Exception Criteria
Cimzia
Cinryze
Coagadex
Columvi
Conexxence
Cosela
Cosentyx
Crysvita
Cutaquig - Criteria | Non-Preferred Product Exception Criteria
Cuvitru  - Criteria | Non-Preferred Product Exception Criteria
Cyramza

D

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

E

Elahere
Elaprase
Elevidys
Elelyso - Criteria | Non-Preferred Product Exception Criteria
Elfabrio
Eligard
Eloctate
Eloxatin
Elrexfio
Elzonris
Empliciti
Emrelis
Encelto
Enhertu
Enjaymo
Enoby
Entyvio
Enzeevu
Epkinly
Epysqli
Epoprostenol Sodium
Erbitux
Erwinaze
Esperoct
Euflexxa - Criteria | Non-Preferred Product Exception Criteria
Evenity
Evkeeza
Exondys 51
Eydenzelt
Eylea - Criteria | Non-Preferred Product Exception Criteria
Eylea HD - Criteria | Non-Preferred Product Exception Criteria

F

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

G

GamaSTAN
Gamifant
Gammagard
Gammagard S/D Less IgA
Gammaked
Gammaplex - Criteria | Non-Preferred Product Exception Criteria
Gammunex-c
Gazyva
Gel-one - Criteria | Non-Preferred Product Exception Criteria
Gelsyn 3 - Criteria | Non-Preferred Product Exception Criteria
Gemcitabine
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
Hympavzi
Hyqvia  - Criteria | Non-Preferred Product Exception Criteria

I

Icatibant Acetate
Idelvion
Ilaris
Ilumya
Imaavy
Imdelltra
Imfinzi
Imjudo
Imlygic
Imuldosa
Increlex
Inflectra
Intron A
Istodax
Ixempra Kit
Ixinity
Izervay

J

Jelmyto
Jemperli
Jevtana
Jivi
Jobevne
Jubbonti

K

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

L

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

M

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

N

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

O

Obizur
Ocrevus
Octagam
Octreotide Acetate
Ogivri - Criteria | Non-Preferred Product Exception Criteria
Omlyclo
Omvoh
Oncaspar
Onpattro
Ontruzant - Criteria | Non-Preferred Product Exception Criteria
Opdivo
Opdivo Qvantig
Opdualag
Opfolda
Opuviz
Orencia IV
Orthovisc - Criteria | Non-Preferred Product Exception Criteria
Osenvelt
Ospomyv
Otulfi
Oxaliplatin
Oxlumo

P

Padcev
Panzyga - Criteria | Non-Preferred Product Exception Criteria
Parsabiv
Pavblu
Pedmark
Pemetrexed
Pemfexy
Pemrydi RTU
Perjeta
Phesgo
Piasky
Polivy
Pombiliti
Poteligeo
Purified Cortrophin Gel
Privigen - Criteria | Non-Preferred Product Exception Criteria
Profilnine
Prolastin-C
Proleukin
Prolia
Pyzchiva

Q

Qalsody
Qfitlia

R

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

S

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

T

Takhzyro
Talvey
Taxotere
Tecartus
Tecelra
Tecentriq
Tecvayli
Temodar
Temozolomide
Temsirolimus
Tepezza
Tevimbra
Tezspire
Tivdak
Tofidence
Torisel
Trazimera - Criteria | Non-Preferred Product Exception Criteria
Treanda
Trelstar
Tremfya
Treprostinil
Tretten
Triluron
Triptodur
Trivisc - Criteria | Non-Preferred Product Exception Criteria
Trodelvy
Truxima (Oncology)
Truxima (Other) - Criteria | Non-Preferred Product Exception Criteria
Tyenne
Tyruko
Tysabri
Tzield

U

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

V

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

W

Wezlana
Wilate
Wyost

X

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

Y

Yargesa
Yervoy
Yesafili
Yescarta
Yesintek

Z

Zaltrap
Zarxio
Zavesca
Zemaira
Zepzelca
Zevaskyn
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
Zymfentra
Zynlonta
Zynteglo
Zynyz