A

Allergen Immunotherapy - Grass Pollen Sublingual Products

Allergen Immunotherapy - Odactra

Allergen Immunotherapy - Palforzia

Allergen Immunotherapy - Ragwitek

Alpha1-Proteinase Inhibitor Products

Amifampridine Products 

Amyloidosis - Amvuttra

Amyloidosis - Attruby

Amyloidosis - Onpattro

Amyloidosis - Tafamidis Products

Amyloidosis - Tegsedi

Amyloidosis - Wainua

Antibiotics - Linezolid (Zyvox), Sivextro

Antibiotics - Vancomycin Capsules

Antibiotics - Xifaxan

Antibiotics (Inhaled) - Arikayce

Antibiotics (Inhaled) - Cayston

Antibiotics (Inhaled) - TOBI Podhaler

Antibiotics (Inhaled) - Tobramycin Inhalation Solution

Antibiotics (Injectable)

Anticoagulants - Dabigatran

Anticoagulants - Eliquis

Anticoagulants - Savaysa

Anticoagulants - Xarelto

Antifungals - Cresemba (Oral)

Antifungals - Flucytosine

Antifungals - Posaconazole (Oral)

Antifungals - Tolsura PA with Step Therapy

Antifungals - Vivjoa

Antifungals - Voriconazole (Oral) PA with Step Therapy

Antifungals (Azoles) - Intravenous Products

Antiseizure Medications - Clobazam Products

Antiseizure Medications - Diacomit

Antiseizure Medications - Epidiolex

Antiseizure Medications - Fintepla

Antiseizure Medications - Nayzilam

Antiseizure Medications - Rufinamide

Antiseizure Medications - Valtoco

Antiseizure Medications - Vigabatrin

Antiseizure Medications - Ztalmy

Antivirals - Ribavirin (Inhaled Products)

Antivirals - Ribavirin (Oral Products)

Attention Deficit Hyperactivity Disorder Non-Stimulant Medications

Attention Deficit Hyperactivity Disorder Stimulant Medications

B

Benign Prostatic Hyperplasia – Entadfi 

Bone Modifiers - Evenity

Bone Modifiers - Ibandronate Intravenous

Bone Modifiers - Prolia

Bone Modifiers - Teriparatide Products

Bone Modifiers - Tymlos

Bone Modifiers - Xgeva

Bone Modifiers - Zoledronic Acid (Reclast)

Bone Modifiers - Zoledronic Acid (Zometa)

Botulinum Toxins - Botox

Botulinum Toxins - Daxxify

Botulinum Toxins - Dysport

Botulinum Toxins - Myobloc

Botulinum Toxins - Xeomin

C

Cardiology - Camzyos

Cardiology - Ivabradine

Cardiology - Lodoco

Cardiology - Tryvio

Cardiology - Zontivity

Chelating Agents - Chemet

Chelating Agents - Iron Chelators (Oral)

Chelating Agents - Penicillamine Products PA with Step Therapy

Chelating Agents - Trientine Products

Chenodal

Cholbam

Cinacalcet

Colony Stimulating Factors - Filgrastim Products

Colony Stimulating Factors - Granix

Colony Stimulating Factors - Leukine

Colony Stimulating Factors - Pegfilgrastim Products

Colony Stimulating Factors - Rolvedon

Colony Stimulating Factors - Ryzneuta

Complement Inhibitors - Empaveli

Complement Inhibitors - Fabhalta

Complement Inhibitors – PiaSky

Complement Inhibitors – Soliris

Complement Inhibitors – Ultomiris

Complement Inhibitors - Veopoz

Complement Inhibitors - Voydeya

Complement Inhibitors – Zilbrysq

Complement System Disorders - WHIM Syndrome - Xolremdi

Compounded Select Topical Medications

Contraceptives - Phexxi

Coronavirus Disease - Evusheld

Coronavirus Disease - Veklury

Corticosteroids (Intraarticular) - Zilretta

Crysvita

Cushing's - Isturisa

Cushing's - Mifepristone

Cushing's - Recorlev

Cushing's - Signifor

Cystic Fibrosis - Bronchitol

Cystic Fibrosis - Kalydeco

Cystic Fibrosis - Orkambi

Cystic Fibrosis - Pulmozyme

Cystic Fibrosis - Symdeko

Cystic Fibrosis - Trikafta

D

Dermatology - Filsuvez

Dermatology - Gene Therapy - Vyjuvek

Dermatology - Hyftor

Dermatology - Opzelura

Desmopressin Products - Nocdurna

Desmopressin Products - Noctiva PA with Step Therapy

Diabetes - Continuous Glucose Monitoring Systems

Diabetes - Glucagon-Like Peptide-1 Agonists (Optional)

Diabetes - Glucagon-Like Peptide-1 Agonists

Diabetes - Kerendia

Diabetes - Symlin

Diabetes - Tzield

Dichlorphenamide

Dronabinol Products PA with Step Therapy

Droxidopa

E

Enspryng

Enzyme Replacement Therapy - Aldurazyme

Enzyme Replacement Therapy - Elaprase

Enzyme Replacement Therapy - Elfabrio

Enzyme Replacement Therapy - Fabrazyme

Enzyme Replacement Therapy - Kanuma

Enzyme Replacement Therapy - Lamzede

Enzyme Replacement Therapy - Mepsevii

Enzyme Replacement Therapy - Naglazyme

Enzyme Replacement Therapy - Revcovi

Enzyme Replacement Therapy - Strensiq

Enzyme Replacement Therapy - Sucraid

Enzyme Replacement Therapy - Vimizim

Enzyme Replacement Therapy - Xenpozyme

Erectile Dysfunction - Alprostadil Products

Erectile Dysfunction - Avanafil

Erectile Dysfunction - Sildenafil

Erectile Dysfunction - Tadalafil

Erectile Dysfunction - Vardenafil

Erythropoiesis-Stimulating Agents - Aranesp

Erythropoiesis-Stimulating Agents - Epoetin Alfa Products

Erythropoiesis-Stimulating Agents - Mircera

F

Fabry Disease - Galafold

G

Gamifant

Gastroenterology - Eohilia

Gastroenterology - Gattex

Gaucher Disease - Enzyme Replacement Therapy - Cerezyme

Gaucher Disease - Enzyme Replacement Therapy - Elelyso

Gaucher Disease - Enzyme Replacement Therapy - Vpriv

Gaucher Disease - Substrate Reduction Therapy - Cerdelga

Gaucher Disease - Substrate Reduction Therapy - Miglustat

Gonadotropin-Releasing Hormone Agonist - Synarel

Gonadotropin-Releasing Hormone Agonists - Central Precocious Puberty

Gonadotropin-Releasing Hormone Agonists - Implants

Gonadotropin-Releasing Hormone Agonists - Injectable Long-Acting Products

Gonadotropin-Releasing Hormone Antagonists - Myfembree

Gonadotropin-Releasing Hormone Antagonists - Oriahnn

Gonadotropin-Releasing Hormone Antagonists - Orilissa

Gout - Krystexxa

Growth Disorders - Growth Hormone

Growth Disorders - Increlex

Growth Disorders - Ngenla

Growth Disorders - Skytrofa

Growth Disorders - Sogroya

Growth Disorders - Voxzogo

H

Hemangeol PA with Step Therapy

Hematology - Adzynma

Hematology - Aphexda

Hematology - Cablivi

Hematology - Ceprotin

Hematology - Coagadex

Hematology - Corifact

Hematology - Enjaymo

Hematology - Fibrinogen Products

Hematology - Gene Therapy - Casgevy

Hematology - Gene Therapy - Lyfgenia

Hematology - Gene Therapy - Zynteglo

Hematology - Pyrukynd

Hematology - Reblozyl

Hematology - Ryplazim

Hematology - Rytelo

Hematology - Tretten

Hematology - Vonvendi

Hemophilia - Altuviiio

Hemophilia - Eptacog Products - NovoSeven RT

Hemophilia - Eptacog Products - Sevenfact

Hemophilia - Factor IX Products

Hemophilia - Factor VIII Products

Hemophilia - FEIBA

Hemophilia - Gene Therapy - Beqvez

Hemophilia - Gene Therapy - Hemgenix

Hemophilia - Gene Therapy - Roctavian

Hemophilia - Hemlibra

Hepatitis C - Epclusa

Hepatitis C - Harvoni

Hepatitis C - Mavyret

Hepatitis C - Sovaldi

Hepatitis C - Vosevi

Hepatitis C - Zepatier

Hepatology – Bylvay

Hepatology - Givlaari

Hepatology - Iqirvo

Hepatology - Livdelzi

Hepatology - Livmarli

Hepatology - Rezdiffra

Hereditary Angioedema - C1 Esterase Inhibitors (Intravenous)

Hereditary Angioedema - C1 Esterase Inhibitors (Subcutaneous)

Hereditary Angioedema - Icatibant

Hereditary Angioedema - Kalbitor

Hereditary Angioedema - Orladeyo

Hereditary Angioedema - Takhzyro

Homozygous Familial Hypercholesterolemia - Evkeeza

Homozygous Familial Hypercholesterolemia - Juxtapid

Human Immunodeficiency Virus - Apretude

Human Immunodeficiency Virus - Cabenuva

Human Immunodeficiency Virus - Rukobia

Human Immunodeficiency Virus - Sunlenca

Human Immunodeficiency Virus - Trogarzo

Hyaluronic Acid Derivatives (Intraarticular)

Hyperhidrosis - Qbrexza

Hyperhidrosis - Sofdra

Hyperlipidemia - Nexletol

Hyperlipidemia - Nexlizet

Hyperlipidemia - Omega-3 Fatty Acid Products

Hypoactive Sexual Desire Disorder - Addyi

Hypoactive Sexual Desire Disorder - Vyleesi

Hypoparathyroidism - Natpara

Hypoparathyroidism - Yorvipath

I

Idiopathic Pulmonary Fibrosis and Related Lung Disease - Ofev

Idiopathic Pulmonary Fibrosis and Related Lung Disease - Pirfenidone

Immune Disorder - Joenja

Immune Globulin - Atgam

Immune Globulin – Cytogam

Immune Globulin - Intravenous

Immune Globulin - Subcutaneous

Immunologicals - Adbry

Immunologicals - Cinqair

Immunologicals - Dupixent

Immunologicals - Ebglyss

Immunologicals - Fasenra

Immunologicals - Nemluvio

Immunologicals - Nucala

Immunologicals - Tezspire

Immunologicals - Xolair

Immunosuppressive Agents - Rezurock

Infectious Disease - Impavido

Infectious Disease - Ivermectin Tablets

Infectious Disease - Livtencity

Infectious Disease - Pretomanid

Infectious Disease - Pyrimethamine

Infectious Disease - Sirturo

Inflammatory Conditions - Adalimumab Products

Inflammatory Conditions - Arcalyst

Inflammatory Conditions - Bimzelx

Inflammatory Conditions - Cibinqo

Inflammatory Conditions - Cimzia

Inflammatory Conditions - Cosentyx Intravenous

Inflammatory Conditions - Cosentyx Subcutaneous

Inflammatory Conditions - Entyvio Intravenous

Inflammatory Conditions - Entyvio Subcutaneous

Inflammatory Conditions - Etanercept Products

Inflammatory Conditions - Ilaris

Inflammatory Conditions - Ilumya

Inflammatory Conditions - Infliximab Intravenous Products

Inflammatory Conditions - Kevzara

Inflammatory Conditions - Kineret

Inflammatory Conditions - Entyvio Subcutaneous

Inflammatory Conditions - Entyvio Subcutaneous

Inflammatory Conditions - Etanercept Products

Inflammatory Conditions - Ilaris

Inflammatory Conditions - Ilumya

Inflammatory Conditions - Infliximab Intravenous Products

Inflammatory Conditions - Kevzara

Inflammatory Conditions - Kineret

Inflammatory Conditions - Leqselvi

Inflammatory Conditions - Litfulo

Inflammatory Conditions - Olumiant

Inflammatory Conditions - Omvoh Intravenous

Inflammatory Conditions - Omvoh Subcutaneous

Inflammatory Conditions - Orencia Intravenous

Inflammatory Conditions - Orencia Subcutaneous

Inflammatory Conditions - Otezla

Inflammatory Conditions - Rinvoq

Inflammatory Conditions - Siliq

Inflammatory Conditions - Simponi Aria

Inflammatory Conditions - Simponi Subcutaneous

Inflammatory Conditions - Skyrizi Intravenous

Inflammatory Conditions - Skyrizi Subcutaneous

Inflammatory Conditions - Sotyktu

Inflammatory Conditions - Spevigo Intravenous

Inflammatory Conditions - Spevigo Subcutaneous

Inflammatory Conditions - Taltz

Inflammatory Conditions - Tocilizumab Intravenous Products

Inflammatory Conditions - Tocilizumab Subcutaneous Products

Inflammatory Conditions - Tremfya Intravenous

Inflammatory Conditions - Tremfya Subcutaneous

Inflammatory Conditions - Ustekinumab Intravenous Products

Inflammatory Conditions - Ustekinumab Subcutaneous Products PA Policy with Dosing

Inflammatory Conditions - Velsipity

Inflammatory Conditions - Xeljanz XR

Inflammatory Conditions - Zymfentra

Inpefa

Interferon - Actimmune

Iron Replacement – Feraheme

Iron Replacement – Ferrlecit

Iron Replacement – INFeD

Iron Replacement – Injectafer

Iron Replacement – Monoferric

Iron Replacement – Venofer

L

Lidocaine Patch Products

Lipodystrophy - Egrifta

Lipodystrophy - Myalept

Lofexidine

Lupus - Benlysta Intravenous

Lupus - Benlysta Subcutaneous

Lupus - Lupkynis

Lupus - Saphnelo

M

Metabolic Disorders - Betaine Anhydrous

Metabolic Disorders - Carbaglu

Metabolic Disorders – Cysteamine Ophthalmic Solution

Metabolic Disorders - Dojolvi

Metabolic Disorders - Imcivree

Metabolic Disorders - Nitisinone Products

Metabolic Disorders - Nulibry

Metabolic Disorders – Phenylbutyrate Products

Metabolic Disorders - Primary Hyperoxaluria - Oxlumo

Metabolic Disorders - Primary Hyperoxaluria - Rivfloza

Metabolic Disorders - Tiopronin Products

Metabolic Disorders - Xuriden

Methylergonovine

Migraine - Calcitonin Gene-Related Peptide Inhibitors - Aimovig

Migraine - Calcitonin Gene-Related Peptide Inhibitors - Ajovy

Migraine - Calcitonin Gene-Related Peptide Inhibitors - Emgality

Migraine - Calcitonin Gene-Related Peptide Inhibitors - Vyepti

Migraine - Elyxyb

Migraine - Nurtec ODT

Migraine - Qulipta

Migraine - Reyvow

Migraine - Ubrelvy

Migraine - Zavzpret

Multiple Sclerosis - Avonex

Multiple Sclerosis - Bafiertam

Multiple Sclerosis - Betaseron, Extavia

Multiple Sclerosis - Briumvi

Multiple Sclerosis - Dalfampridine

Multiple Sclerosis - Dimethyl Fumarate

Multiple Sclerosis - Fingolimod

Multiple Sclerosis - Glatiramer Products

Multiple Sclerosis - Kesimpta

Multiple Sclerosis - Lemtrada

Multiple Sclerosis - Mavenclad

Multiple Sclerosis - Mayzent

Multiple Sclerosis - Ocrevus

Multiple Sclerosis - Ocrevus Zunovo

Multiple Sclerosis - Plegridy

Multiple Sclerosis - Ponvory

Multiple Sclerosis - Rebif

Multiple Sclerosis - Tascenso ODT

Multiple Sclerosis - Teriflunomide

Multiple Sclerosis - Vumerity

Multiple Sclerosis and Crohn's Disease - Tysabri

Multiple Sclerosis and Ulcerative Colitis - Zeposia

Muscular Dystrophy - Agamree

Muscular Dystrophy - Amondys 45

Muscular Dystrophy - Deflazacort

Muscular Dystrophy - Duvyzat

Muscular Dystrophy - Exondys 51

Muscular Dystrophy - Gene Therapy - Elevidys

Muscular Dystrophy - Viltepso

Muscular Dystrophy - Vyondys 53

N

Nephrology - Filspari

Nephrology - Jesduvroq

Nephrology - Tarpeyo

Nephrology - Vafseo

Nephrology - Xphozah

Neurology - Aduhelm

Neurology - Brineura

Neurology - Daybue

Neurology - Gene Therapy - Lenmeldy

Neurology - Gene Therapy - Skysona

Neurology - Kisunla

Neurology - Leqembi

Neurology - Lyrica CR PA with Step Therapy

Neurology - Oxybate Products

Neurology - Qalsody

Neurology - Radicava Products

Neurology - Relyvrio

Neurology - Riluzole Products

Neurology - Rystiggo

Neurology - Skyclarys

Neurology - Vyvgart Hytrulo

Neurology - Vyvgart Intravenous

Niemann-Pick disease type C - Aqneursa

Niemann-Pick Disease Type C - Miplyffa

Niktimvo

Nuedexta

O

Oncology - Abiraterone Acetate

Oncology - Akeega

Oncology - Alecensa

Oncology - Alunbrig

Oncology - Augtyro

Oncology - Ayvakit

Oncology - Balversa

Oncology - Bexarotene (Oral)

Oncology - Bexarotene (Topical)

Oncology - Bosulif

Oncology - Braftovi

Oncology - Brukinsa

Oncology - Cabometyx

Oncology - Calquence

Oncology - Capecitabine

Oncology - Caprelsa

Oncology - Cometriq

Oncology - Copiktra

Oncology - Cotellic

Oncology - Dasatinib

Oncology - Daurismo

Oncology - Erivedge

Oncology - Erleada

Oncology - Erlotinib

Oncology - Everolimus Products

Oncology - Exkivity

Oncology - Farydak

Oncology - Fotivda

Oncology - Fruzaqla

Oncology - Gavreto

Oncology - Gefitinib

Oncology - Gilotrif

Oncology - Ibrance

Oncology - Iclusig

Oncology - Idhifa

Oncology - Imatinib

Oncology - Imbruvica

Oncology - Inlyta

Oncology - Inqovi

Oncology - Inrebic

Oncology - Itovebi

Oncology - Iwilfin

Oncology - Jakafi

Oncology - Jaypirca

Oncology - Kisqali and Kisqali Femara Co-Pack

Oncology - Koselugo

Oncology - Krazati

Oncology - Lapatinib

Oncology - Lazcluze

Oncology - Lenalidomide

Oncology - Lenvima

Oncology - Lonsurf

Oncology - Lorbrena

Oncology - Lumakras

Oncology - Lynparza

Oncology - Lytgobi

Oncology - Mekinist

Oncology - Mektovi

Oncology - Nerlynx

Oncology - Nilotinib Products

Oncology - Nilutamide

Oncology - Ninlaro

Oncology - Nubeqa

Oncology - Odomzo

Oncology - Ogsiveo

Oncology - Ojemda

Oncology - Ojjaara

Oncology - Onureg

Oncology - Orgovyx

Oncology - Orserdu

Oncology - Pazopanib

Oncology - Pemazyre

Oncology - Piqray

Oncology - Pomalyst

Oncology - Qinlock

Oncology - Retevmo

Oncology - Revuforj

Oncology - Rezlidhia

Oncology - Rozlytrek

Oncology - Rubraca

Oncology - Rydapt

Oncology - Scemblix

Oncology - Sorafenib

Oncology - Stivarga

Oncology - Sunitinib

Oncology - Tabrecta

Oncology - Tafinlar

Oncology - Tagrisso

Oncology - Talzenna

Oncology - Tazverik

Oncology - Temozolomide Capsules

Oncology - Tepmetko

Oncology - Thalomid

Oncology - Tibsovo

Oncology - Truqap

Oncology - Truseltiq

Oncology - Tukysa

Oncology - Turalio

Oncology - Valchlor

Oncology - Vanflyta

Oncology - Venclexta

Oncology - Verzenio

Oncology - Vistogard

Oncology - Vitrakvi

Oncology - Vizimpro

Oncology - Vonjo

Oncology - Voranigo

Oncology - Welireg

Oncology - Xalkori

Oncology - Xermelo

Oncology - Xospata

Oncology - Xpovio

Oncology - Xtandi

Oncology - Yonsa

Oncology - Zejula

Oncology - Zelboraf

Oncology - Zolinza

Oncology - Zydelig

Oncology - Zykadia

Oncology (Injectable - CAR-T) - Abecma

Oncology (Injectable - CAR-T) - Aucatzyl

Oncology (Injectable - CAR-T) - Breyanzi

Oncology (Injectable - CAR-T) - Carvykti

Oncology (Injectable - CAR-T) - Kymriah

Oncology (Injectable - CAR-T) - Tecartus

Oncology (Injectable - CAR-T) - Yescarta

Oncology (Injectable - Programmed Death Receptor-1) - Jemperli

Oncology (Injectable - Programmed Death Receptor-1) - Keytruda

Oncology (Injectable - Programmed Death Receptor-1) - Libtayo

Oncology (Injectable - Programmed Death Receptor-1) - Loqtorzi

Oncology (Injectable - Programmed Death Receptor-1) - Opdivo

Oncology (Injectable - Programmed Death Receptor-1) - Opdualag

Oncology (Injectable - Programmed Death Receptor-1) - Tevimbra

Oncology (Injectable - Programmed Death Receptor-1) - Zynyz

Oncology (Injectable - Programmed Death-Ligand 1) - Bavencio

Oncology (Injectable - Programmed Death-Ligand 1) - Imfinzi

Oncology (Injectable - Programmed Death-Ligand 1) - Tecentriq Hybreza

Oncology (Injectable - Programmed Death-Ligand 1) - Tecentriq

Oncology (Injectable) - Adcetris

Oncology (Injectable) - Aliqopa

Oncology (Injectable) - Amtagvi

Oncology (Injectable) - Arsenic Trioxide

Oncology (Injectable) - Asparlas

Oncology (Injectable) - Azedra

Oncology (Injectable) - Beleodaq

Oncology (Injectable) - Bendamustine Products

Oncology (Injectable) - Besponsa

Oncology (Injectable) - Besremi

Oncology (Injectable) - Bevacizumab Products

Oncology (Injectable) - Bizengri

Oncology (Injectable) - Blenrep

Oncology (Injectable) - Blincyto

Oncology (Injectable) - Bortezomib Products

Oncology (Injectable) - Carmustine Products

Oncology (Injectable) - Columvi

Oncology (Injectable) - Cosela

Oncology (Injectable) - Cyramza

Oncology (Injectable) - Danyelza

Oncology (Injectable) - Darzalex Faspro

Oncology (Injectable) - Darzalex Intravenous

Oncology (Injectable) - Decitabine Products

Oncology (Injectable) - Elahere

Oncology (Injectable) - Elrexfio

Oncology (Injectable) - Elzonris

Oncology (Injectable) - Empliciti

Oncology (Injectable) - Enhertu

Oncology (Injectable) - Epkinly

Oncology (Injectable) - Erbitux

Oncology (Injectable) - Fulvestrant

Oncology (Injectable) - Fyarro

Oncology (Injectable) - Gazyva

Oncology (Injectable) - Gonadotropin-Releasing Hormone Analogs

Oncology (Injectable) - Halaven

Oncology (Injectable) - Herceptin Hylecta

Oncology (Injectable) - Imdelltra

Oncology (Injectable) - Imjudo

Oncology (Injectable) - Imlygic

Oncology (Injectable) - Ixempra

Oncology (Injectable) - Jevtana

Oncology (Injectable) - Kadcyla

Oncology (Injectable) - Kimmtrak

Oncology (Injectable) - Kyprolis

Oncology (Injectable) - Levoleucovorin Products

Oncology (Injectable) - Lunsumio

Oncology (Injectable) - Lymphir

Oncology (Injectable) - Margenza

Oncology (Injectable) - Monjuvi

Oncology (Injectable) - Mylotarg

Oncology (Injectable) - Oncaspar

Oncology (Injectable) - Onivyde

Oncology (Injectable) - Padcev

Oncology (Injectable) - Perjeta

Oncology (Injectable) - Phesgo

Oncology (Injectable) - Polivy

Oncology (Injectable) - Portrazza

Oncology (Injectable) - Poteligeo

Oncology (Injectable) - Pralatrexate Products

Oncology (Injectable) - Proleukin

Oncology (Injectable) - Rituxan Hycela

Oncology (Injectable) - Romidepsin Products

Oncology (Injectable) - Rybrevant

Oncology (Injectable) - Rylaze

Oncology (Injectable) - Sarclisa

Oncology (Injectable) - Sylvant

Oncology (Injectable) - Talvey

Oncology (Injectable) - Tecelra

Oncology (Injectable) - Tecvayli

Oncology (Injectable) - Thiotepa Products

Oncology (Injectable) - Tivdak

Oncology (Injectable) - Topotecan Products

Oncology (Injectable) - Torisel

Oncology (Injectable) - Trastuzumab Products

Oncology (Injectable) - Trodelvy

Oncology (Injectable) - Unituxin

Oncology (Injectable) - Vectibix

Oncology (Injectable) - Vyloy

Oncology (Injectable) - Vyxeos

Oncology (Injectable) - Yervoy

Oncology (Injectable) - Zaltrap

Oncology (Injectable) - Zepzelca

Oncology (Injectable) - Ziihera

Oncology (Injectable) - Zynlonta

Oncology (Other) - Adstiladrin

Oncology (Other) - Anktiva

Oncology (Other) - Jelmyto

Oncology (Other) - Valrubicin Products

Ophthalmic - Glaucoma - Prostaglandins

Ophthalmology - Dry Eye Disease - Cyclosporine Products

Ophthalmology - Dry Eye Disease - Eysuvis

Ophthalmology - Dry Eye Disease - Lacrisert

Ophthalmology - Dry Eye Disease - Miebo

Ophthalmology - Dry Eye Disease - Tyrvaya

Ophthalmology - Dry Eye Disease - Xiidra

Ophthalmology - Durysta

Ophthalmology - Gene Therapy - Luxturna

Ophthalmology - iDose TR

Ophthalmology - Izervay

Ophthalmology – Oxervate

Ophthalmology - Syfovre

Ophthalmology - Tepezza

Ophthalmology - Upneeq

Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Aflibercept Products

Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Beovu

Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Ranibizumab Products

Ophthalmology - Vascular Endothelial Growth Factor Inhibitors - Susvimo

Ophthalmology – Vascular Endothelial Growth Factor Inhibitors – Vabysmo

Ophthalmology - Verkazia

Opioids - Fentanyl Transmucosal Drugs

Opioids - Long-Acting Products

Opioids - Methadone

Opioids - Tramadol Extended-Release Products

P

Parkinson’s Disease - Amantadine Extended-Release Drugs PA with Step Therapy

Parkinson’s Disease – Apomorphine Subcutaneous

Parkinson’s Disease - Carbidopa

Parkinson’s Disease - Duopa

Parkinson’s Disease - Inbrija

Parkinson’s Disease - Nourianz

Parkinson’s Disease - Nuplazid

Parkinson’s Disease - Tolcapone

Parkinson’s Disease - Vyalev

Parkinson’s Disease - Zelapar

Parkinson's Disease - Kynmobi

Parkinson's Disease - Ongentys

Phenylketonuria - Palynziq

Phenylketonuria - Sapropterin

Pheochromocytoma - Metyrosine and Phenoxybenzamine (Oral)

Pompe Disease - Enzyme Replacement Therapy - Lumizyme

Pompe Disease - Enzyme Replacement Therapy - Nexviazyme

Pompe Disease - Enzyme Replacement Therapy - Pombiliti

Pompe Disease - Enzyme Stabilization Therapy - Opfolda

Proprotein Convertase Subtilisin Kexin Type 9 Inhibitors - Praluent

Proprotein Convertase Subtilisin Kexin Type 9 Inhibitors - Repatha

Proprotein Convertase Subtilisin Kexin Type 9 Related Products - Leqvio

Psychiatry - Spravato

Psychiatry - Zulresso

Psychiatry - Zurzuvae

Pulmonary - Corticosteroid Long-Acting Beta2-Agonist Combination Inhalers

Pulmonary - Roflumilast PA with Step Therapy

Pulmonary Arterial Hypertension - Adempas

Pulmonary Arterial Hypertension - Endothelin Receptor Antagonists

Pulmonary Arterial Hypertension - Epoprostenol Products

Pulmonary Arterial Hypertension - Orenitram

Pulmonary Arterial Hypertension - Phosphodiesterase Type 5 Inhibitors

Pulmonary Arterial Hypertension - Treprostinil Injection

Pulmonary Arterial Hypertension - Uptravi

Pulmonary Arterial Hypertension - Winrevair

Pulmonary Arterial Hypertension and Related Lung Disease - Inhaled Prostacyclin Products

R

Repository Corticotropin - Acthar Gel

Repository Corticotropin - Cortrophin Gel

Rituximab Intravenous Products

S

Scenesse

Sedative Hypnotics Medications PA Policy for the InMynd Program

Sickle Cell Disease - Adakveo

Sickle Cell Disease - L-glutamine

Sickle Cell Disease - Oxbryta

Sohonos

Somatostatin Analogs – Lanreotide Products

Somatostatin Analogs - Mycapssa

Somatostatin Analogs – Octreotide Immediate-Release Products

Somatostatin Analogs – Octreotide Long-Acting Products

Somatostatin Analogs – Signifor LAR

Somavert

Spinal Muscular Atrophy - Evrysdi

Spinal Muscular Atrophy - Gene Therapy - Zolgensma

Spinal Muscular Atrophy - Spinraza

Synagis

T

Tasimelteon Products

Testosterone (injectable) Products

Testosterone (Oral, Topical, and Nasal) Products

Thrombocytopenia - Doptelet

Thrombocytopenia - Eltrombopag Products

Thrombocytopenia - Mulpleta

Thrombocytopenia - Nplate

Thrombocytopenia - Tavalisse

Tolvaptan Products - Jynarque

Tolvaptan Products - Tolvaptan (Samsca)

Topical Acne - Winlevi

Topical Acyclovir Products

Topical Alpha-Adrenergic Agonists for Rosacea - Brimonidine

Topical Alpha-Adrenergic Agonists for Rosacea - Rhofade

Topical Anesthetic - Lidocaine, Tetracaine Products PA with Step Therapy Policy

Topical Diclofenac Sodium 3 percent Gel PA Policy

Topical Retinoids - Aklief

Topical Retinoids - Panretin

Topical Retinoids - Tazarotene Products

U

Uplizna

V

Vasculitis - Tavneos

Vecamyl

Veregen

Vesicular Monoamine Transporter Type 2 Inhibitors - Austedo

Vesicular Monoamine Transporter Type 2 Inhibitors - Ingrezza Products

Vesicular Monoamine Transporter Type 2 Inhibitors - Tetrabenazine

Vijoice

W

Wakefulness-Promoting Agents - Armodafinil, Modafinil PA with Step Therapy Policy

Wakefulness-Promoting Agents - Sunosi PA with Step Therapy Policy

Wakefulness-Promoting Agents - Wakix PA with Step Therapy Policy

Weight Loss - Glucagon-Like Peptide-1 Agonists

Weight Loss - Other Appetite Suppressants and Orlistat

X

Xiaflex

Z

Zokinvy