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USFHP Preauthorization Forms

A

Abilify Mycite
Absorica
Acanya
Aciphex Generics
Actemra
Acthar
Acticlate
Actoplus Met
Actos
Aczone
Adapalene 0.1 Topical Solution
Adapalene 0.1 External Pad/Swab
Addyi
Adempas
Adipex-P
Adlyxin
Adoxa
Aemcolo
Aerospan
Afrezza
Aimovig
AirDuo
Ajovy
Aklief
Alecensa
Almotriptan
Altoprev
Alunbrig
Alvesco
Amcinonide Ointment
Amitiza
Amrix
Amzeeq
Androderm
Androgel
Antara
Aplenzin
Arakoda
Arikayce
Arnuity Ellipta
Asmanex
Astepro
Austedo
Auvi-Q
Avandamet
Avandaryl
Avandia
Avidoxy Tablet
Avodart
Axiron
Ayvakit
Azelex (Azelaic Acid)
Azesco
Azor

B

Balversa
Basaglar
Beconase AQ
Belsomra
Belviq
BelviqXR
Benicar
Benicar HCT
Benlysta
Benzphetamine
Bepreve
Binosto
Bonjesta
Braftovi
Bravelle
Breo Ellipta
Brukinsa
Butrans
Bydureon
Bydureon Bcise
Byetta
Bystolic

C

Calquence
Caplyta
Carospir
Cequa
Chlorzoxazone 250mg Tablets
Cialis
Cimzia
Cinryze
Clindagel
Clobetasol propionate 0.05%
Compounded Medications
Contrave
Copiktra
Cordran Tape
Coremino ER
Corlanor
Cosentyx
Cotellic
Cotempla XR ODT
Crotan Lotion
Cyclobenzaprine 7.5mg
Cycloset

D

Dapsone Products
Daurismo
Denavir
Desoximetasone 0.05% Gel
Desvelafaxine ER
Detrol
Diclegis
Diclofenac Gel 3% (Solaraze)
Didrex
Diethylpropion
Diflorasone Diacetate 0.05% Cream
Diflorasone Diacetate 0.05% Ointment
Doptelet
Doryx MPC
Doryx/Doxycycline Hyclate
Doxycycline Monohydrate 40mg IR/DR
Drizalma Sprinkle
Duetact
Duexis
Dulera
Dupixent
Dymista

E

Edarbi
Edarbyclor
Edluar
Emadine
Emflaza
Emgality 100mg
Emgality 120mg
Enablex
Enbrel
Endari
Entresto
Epclusa
Epidiolex
Epiduo
Epiduo Forte
Erleada
Esbriet
Eucrisa
Eurax
Evekeo ODT
Ezallor Sprinkle

F

Farxiga
Farydak
Fasenra Pen
Fertility Agents
Fertinex
Fetzima
Fiasp
Fibric Acid Derivatives
Fibricor
Finacea
Firdapse
FloLipid
Fluticasone/Salmeterol (Generic Advair Diskus/Wixela)
Follistim
Fortamet
Forteo
Fortesta
Fosamax Plus D
Fravatriptan
Fycompa O/S

G

Galafold
Gelnique
Generess FE
Generic Insulin Aspart
Generic Sildenafil Tablets
Generic Tadalafil Tablets
Genotropin
Gilenya
Gloperba
Glucose Test Strips
Glyxambi
Gocovri
Gonal-F
Gralise

H

Haegarda
Harvoni
Hemlibra
Hetlioz
Horizant
Humatrope
Humegon
Humira

I

Ibrance
Idhifa
Ilumya
Imbruvica
Imvexxy
Inbrija
Increlex
Ingrezza
Inhaled Corticosteroids
Inrebic
Insulin Lispro Vial & KwikPen
Intermezzo
Intrarosa
Invokamet
Invokana

J

Jalyn
Janumet XR
Januvia
Jardiance
Jatenzo
Jentadueto
Jornay PM
Jublia
Jynarque

K

Kalydeco
Kapspargo Sprinkle
Kazano
Kerydin
Keveyis
Kevzara
Khedezla
Kineret
Kisqali
Kisqali Femara
Kombiglyze XR

L

Lastacaft
Lescol XL
Letairis
Levemir
Levitra
Lidocaine-Tetracaine 7%-7% Cream
Linzess
Lipofen
Livalo
Lomaira
Lonhala Magnair
Lorbrena
Lovaza
Lucemyra
Lynparza
Lyrica

M

Mavenclad
Mavyret
Mayzent
Mefloquine
Mekinist
Mektovi
Menopur
Mesalamine (Generic Lialda)
Minastrin FE Chewable
Minocin
Minocycline ER Generic
Minolira ER
Mirvaso
Monodoxyne NL
Monodox
Morgidox
Motegrity
Movantik
Mulpleta
Mydayis
Myrbetriq

N

Namenda XR
Namzaric
Naprelan/Generics
Naratriptan
Nasal Allergy Drugs
Nasonex
Natesto
Nerlynx
Nesina
Neupro Patch
Nexium/Generics
Nexletol
Nilandron
Ninlaro
Nocdurna
Noctiva
Noritate
Northera
Nourianz
Nubeqa
Nucala
Nuplazid
Nurtec ODT
Nutropin AQ

O

Ocaliva
Odactra
Ofev
Okebo
Olumiant
Olysio
Omnaris
Omnitrope
Onextron
Onglyza
Opsumit
Oracea
Oral Bisphosphonates
Oral Triptans
Orencia SC
Orenitram ER
Orilissa
Orkambi
Oseni
Osmolex ER
Otezla
Otrexup
Oxbryta
Oxervate
Oxytrol
Ozempic
Ozobax

P

Palforzia
Palynziq
Pancreaze
Pataday
Patanase
Pennsaid
Pergonal
Pertzye
Phendimetrazine IR & SR
Phentermine
Piqray
Pomalyst
Praluent
Prestalia
Prevacid
Pristiq
Prograf Granule Packet
Pulmicort Flexhaler

Q

Qbrexza
Qmiiz ODT
Qnasl
Qsymia
Qtern
Qualaquin
Qudexy XR
Qvar

R

Rapaflo
Rasuvo
Rayos
Relistor
Repatha
Repronex
Restasis
Retin A Micro
Revlimid
Rexulti
Reyvow
Rhinocort Aqua
Rhofade
Rhopressa
Rinvoq ER
Rocklatan
Rozerem
Rozlytrek
Rubraca
Ruzurgi
Rybelsus
Rydapt
Rytary

S

Saizen
Sanctura XR
Savella
Saxenda
Segluromet
Serostim
Seysara
Siklos
Silenor
Siliq
Simponi
Sitavig
Skyrizi
Soliqua
Solodyn ER
Somatropin
Soolantra
Sovaldi
Staxyn
Steglatro
Steglujan
Stelara
Stendra
Strensiq
Striant
Sunosi
Symbicort
Symdeko
Symlin
Symproic
Syndros
Synjardy

T

Tafinlar
Takhzyro
Taltz
Talzenna
Targadox
Tavalisse
Tazverik
Tecfidera
Technivie
Tegsedi
Tekturna
Tekturna HCT
Testim
Testosterone 1% & 1.62% Gel
Thiazolidinediones (TZDs)
Thiola
Thiola EC
Tibsovo
Tiglutik
Tirosint-SOL
Tivorbex
Tolsura
Topical Antibiotics and Combinations
Topical Metronidazole Products
Topical Retinoids and Combinations
Toujeo
Toviaz
Tracleer/Generic
Tradjenta
Tremfya
Tresiba
Treximet
Tribenzor
Triglide
Trijardy XR
Trikafta
Trilipix
Trintellix
Trokendi XR
Trulance
Trulicity
Turalio
Tymlos
Tyvaso

U

Ubrelvy
Uloric
Uptravi

V

Vascepa
Veltin
Venclexta
Ventavis
Verzenio
Vesicare
V-Go
Viagra
Viberzi
Vibramycin
Victoza
Viekira Pak
Viekira XR
Viokace
Vitrakvi
Vivlodex
Vizimpro
Vogelxo
Vosevi
Vumerity
Vyleesi
Vyndamax
Vyndaqel
Vytorin
Vyzulta

W

Wakix
Wixela

X

Xadago
Xalkori
Xatmep
Xatmep Oral Solution
Xeljanz
Xeljanz XR
Xenical
Xepi
Xerese
Xermelo
Xhance
Xifaxan 200mg
Xifaxan 550mg
Xigduo XR
Xiidra
Ximino ER
Xospata
Xpovio
Xtandi
Xultophy
Xuriden
Xyosted
Xyrem

Y

Yonsa
Yupelri

Z

Zalvit
Zegerid
Zejula
Zelboraf
Zembrace Injection
Zenpep
Zepatier
Zerviate
Zetonna
Ziana
Zipsor
Zolpimist
Zomacton
Zomig Nasal
Zorbtive
Zorvolex
ZTLido
Zypitamag
Zytiga 250mg
Zytiga 500mg