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Conditions / Drug List

Conditions / Drug List

Acromegaly

Sandostatin (Octreotide)
Sandostatin LAR (Octreotide)
Somatuline Depot (Lanreotide)
Somavert (Lanreotide) 

Allergic Asthma, Severe Eosinophilic Asthma

Nucala (Mepolizumab)
Xolair (Omalizumab)

Atopic Dermatitis

Dupixent (Dupilumab)

Botulinum Toxins

Botox (OnabotulinumtoxinA)
Dysport (AbobotulinumtoxinA)
Myobloc (RimabotulinumtoxinB)
Xeomin (IncobotulinumtoxinA)

Crohn’s Disease and Ulcerative Colitis

Cimizia (Certolizumab Pegol)
Humira (Adalimumab)
Entyvio (Vedolizumab)
Remicade (Infliximab)
Simponi (Golimumab)
Stelara (Ustekinumab)
Xeljanz (Tofacitinib)

Cystic Fibrosis

Bethkis (Tobramycin)
Pulmozyme (Dornase Alfa)
TOBI (Tobramycin)
TOBI Podhaler (Tobramycin)

Growth Hormone Deficiency and Related Disorders

Genotropin (Somatropin)
Humatrope (Somatropin)
Norditropin (Somatropin)
Nutropin AQ (Somatropin)
Omnitrope (Somatropin)
Saizen (Somatropin)
Serostim (Somatropin)
Zorbtive (Somatropin)

Hepatitis B

Baraclude (Entecavir)
Epivir HBV (Lamivudine)
Hepsera (Adefovir Dipivoxil)
Vemlidy (Tenofovir Alafenamide)

Hepatitis C

Daklinza (Daclatasvir)
Copegus (Ribavirin)
Epclusa (Sofosbuvir and Velpatasvir)
Harvoni (Ledipasvir and Sofosbuvir)
Mavyret (Glecaprevir and Pibrentasvir)
Moderiba (Ribavirin)
Pagasys (Peginterferon Alpha-2a)
Peg-Intron (Peginterferon Alpha-2a)
Rebetol (Ribavirin)
Ribasphere (Ribavirin)
Ribasphere RibaPak (Ribavirin) 
Sovaldi (Sofosbuvir)
Viekira Pak (Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir)
Vosevi (Sofosbuvir, Velpatasvir, and Voxilaprevir)
Zepatier (Elbasvir and Grazoprevir)

Hormonal Therapies

Eligard (Leuprolide)
Lupron Depot (Leuprolide)
Lupron Depot-Ped (Leuprolide)
Makena (Hydroxyprogesterone Caproate)
Supprelin LA (Histrelin)
Trelstar Mixjet (Triptorelin)
Vantas (Histrelin)
Zoladex (Goserelin)

Hemophilia and Related Bleeding Disorders

Afstyla (Antihemophilic Factor – Recombinant)
AlphaNin SD (Factor IX – Human)
Alprolix (Factor IX – Recombinant Fc Fusion Protein)
Benefix (Factor IX – Recombinant)
Corifact (Factor XIII Concentrate – Human)
Eloctate (Antihemophilic Factor – Recombinant Fc Fusion Protein)
Feiba (Anti-inhibitor Coagulant Complex – Human)
Helixate FS (Antihemophilic Factor – Recombinant)
Hemlibra (Emicizumab-kxwh)
Hemofil M (Antihemophilic Factor – Human)
Humate-P (Antihemophilic Factor/von Willebrand Factor Complex – Human)
Idelvion (Antihemophilic Factor – Recombinant Albumin Fusion Protein)
Ixinity (Factor IX – Recombinant)
Koate-DVI (Antihemophilic Factor – Human)
Kogenate FS (Antihemophilic Factor – Human)
Kovaltry (Antihemophilic Factor – Recombinant)
Monoclate-P (Antihemophilic Factor – Human)
Mononine (Factor IX – Human)
NovoEight (Antihemophilic Factor – Recombinant)
NovoSeven RT (Factor VIIa – Recombinant)
Nuwiq (Antihemophilic Factor – Recombinant)
Profilnine (Factor IX Complex – Human – Factors II, IX, X)
Recombinate (Antihemophilic Factor – Recombinant)
Riastap (Fibrinogen Concentrate – Human)
Rixubis (Factor IX – Recombinant)
Tretten (Factor XIII A-Subunit – Recombinant)
Vonvendi (von Willebrand Factor – Recombinant)
Wilate (Antihemophilic Factor/von Willebrand Factor Complex – Human)
Xyntha (Antihemophilic Factor – Recombinant)

Hereditary Angioedema

Firazyr (Icatibant)

HIV

Aptivus (Tipranavir)
Atripla (Efavirenz, Emtricitabine, Tenofovir Disoproxil Fumarate)
Biktarvy (Bictegravir, Emtricitabine, Tenofovir Alafenamide)
Cimduo (Lamivudine, Tenofovir Disoproxil Fumarate)
Combivir (Lamivudine, Zidovudine)
Complera (Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate)
Crixivan (Indinavir)
Descovy (Emtricitabine, Tenofovir Alafenamide)
Edurant (Rilpivirine)
Egrifta (Tesamorelin)
Emtriva (Emtricitabine)
Epivir (Lamivudine)
Epzicom (Abacavir, Lamivudine)
Evotaz (Atazanavir, Cobicistat)
Genvoya (Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Alafenamide)
Intelence (Etravirine)
Invirase (Saquinavir)
Isentress (Raltegravir)
Isentress HD (Raltegravir)
Juluca (Dolutegravir, Rilpivirine)
Kaletra (Lopinavir, Ritonavir)
Lexiva (Fosamprenavir)
Norvir (Ritonavir)
Odefsey (Emtricitabine, Rilpivirine, Tenofovir Alafenamide)
Prezcobix (Darunavir, Cobicistat)
Prezista (Darunavir)
Retrovir (Zidovudine)
Reyataz (Atazanavir)
Selzentry (Maraviroc)
Stribild (Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate)
Sustiva (Efavirenz)
Symfi (Efavirenz, Lamivudine, Tenofovir Disoproxil Fumarate)
Symfi Lo (Efavirenz, Lamivudine, Tenofovir Disoproxil Fumarate)
Symtuza (Darunavir, Cobicistat, Emtricitabine, Tenofovir Alafenamide)
Tivicay (Dolutegravir)
Triumeq (Abacavir, Dolutegravir, Lamivudine)
Trizivir (Abacavir, Lamivudine, Zidovudine)
Truvada (Emtricitabine, Tenofovir Disoproxil Fumarate)
Tybost (Cobicistat)
Videx (Didanosine)
Viracept (Nelfinavir)
Viramune (Nevirapine)
Viramune XR (Nevirapine)
Viread (Tenofovir Disoproxil Fumarate)
Vitekta (Elvitegravir)
Zerit (Stavudine)
Ziagen (Abacavir)

Immune Deficiency and Related Disorders

Carimune NF (Immune Globulin)
Cuvitru (Immune Globulin)
Flebogamma (Immune Globulin)
Gamastan S/D (Immune Globulin)
Gammagard (Immune Globulin)
Gammaked (Immune Globulin)
Gamunex-C (Immune Globulin)
Hizentra (Immune Globulin)
HyperRHO S/D (Rho (D) Immune Globulin)
Hyqvia (Immune Globulin)
Octagam (Immune Globulin)
Privigen (Immune Globulin)
Rhophylac (Rho (D) Immune Globulin)
WinRho SD (Rho (D) Immune Globulin)

Immune Thrombocytopenic Purpura

Promacta (Eltrombopag)

Migraine Headache Prevention

Botox (OnabotlinumtoxinA)
Aimovig (Erenumab-aooe)
Ajovy (Fremanezumab-vfrm)

Multiple Sclerosis

Ampyra (Dalfampridine)
Aubagio (Teriflunomide)
Avonex (Interferon Beta-1a)
Betaseron (Interferon Beta-1b)
Copaxone (Glatiramer Acetate)
Extavia (Interferon Beta-1b)
Gilenya (Fingolimod)
Glatopa (Glatiramer Acetate)
Ocrevus (Ocrelizumab)
Rebif (Interferon Beta-1a)

Oncology Oral

Afinitor (Everolimus)
Alkeran (Melphalan)
Bosulif (Bosutinib)
Cabometyx (Cabozantinib)
Cometriq (Cabozantinib)
Cyclophosphamide
Daurismo (Glasdegib)
Farydak (Panobinostat)
Gleevec (Imatinib)
Gleostine (Lomustine)
Ibrance (Palbociclib)
Inlyta (Axitinib)
Iressa (Gefitinib)
Kisqali (Ribociclib)
Kisqali Femara Co-Pack (Ribociclib & Letrozole)
Leukeran (Chlorambucil)
Lorbrena (Lorlatinib)
Lynparza (Olaparib)
Mekinist (Trametinib)
Nerlynx (Neratinib)
Nilandron (Nilutamide)
Ninlaro (Ixazomib)
Odomzo (Sonidegib)
Purixan (Mercaptopurine)
Sprycel (Dasatinib)
Sutent (Sunitinib)
Tafinlar (Dabrafenib)
Tagrisso (Osimertinib)
Talzenna (Talazoparib)
Tarceva (Erlotinib) 
Targretin (Bexarotene)
Tasigna (Nilotinib)
Temodar (Temozolomide)
Tretinoin 
Tykerb (Lapatinib)
Verzenio (Ademaciclib)
Vizimpro (Dacomitinib)
Votrient (Pazopanib)
Xalkori (Crizotinib)
Xeloda (Capecitabine)
Xgeva (Denosumab)
Zejula (Niraparib)
Zolinza (Vorinostat)
Zykadia (Ceritinib)
Zytiga (Abiraterone Acetate)

Oncology Supportive Care

Xgeva (Denosumab)

Osteoarthritis

Durolane (Hyaluronate and Derivatives)
Euflexxa (Hyaluronate and Derivatives)
Gel-One (Hyaluronate and Derivatives)
GelSyn-3 (Hyaluronate and Derivatives)
Hyalgan (Hyaluronate and Derivatives)
Hymovis (Hyaluronate and Derivatives)
Monovisc (Hyaluronate and Derivatives)
Orthovisc (Hyaluronate and Derivatives)
Supartz FX (Hyaluronate and Derivatives)
Synvisc (Hyaluronate and Derivatives)
Synvisc One (Hyaluronate and Derivatives)

Plaque Psoriasis

Cimzia (Certolizumab Pegol)
Cosentyx (Secukinumab)
Enbrel (Etanercept)
Humira (Adalimumab) 
Inflectra (Infliximab) 
Otezla (Apremilast)
Remicade (Infliximab)
Stelara (ustekinumab)
Taltz (Ixekizumab) 
Tremfya (Guselkumab)

Psoriatic Arthritis

Cimzia (Certolizumab Pegol)
Cosentyx (Secukinumab)
Enbrel (Etanercept)
Humira (Adalimumab) 
Inflectra (Infliximab) 
Orencia (Abatacept)
Otezla (Apremilast)
Remicade (infliximab)
Simponi (Golimumab)
Simponi Aria (Golimumab)
Stelara (Ustekinumab)
Taltz (Ixekizumab)
Xeljanz (Tofacitinib)

Pulmonary Arterial Hypertension

Adcirca (Tadalafil)
Revatio (Sildenafil)

Respiratory Syncytial Virus

Synagis (Palivizumab)

Rheumatoid Arthritis

Actemra (Tocilizumab)
Cimzia (Certolizumab Pegol)
Enbrel (Etanercept)
Humira (Adalimumab)
Inflectra (Infliximab) 
Kevzara (Sarilumab)
Olumiant (Baricitinib)
Orencia (Abatacept)
Remicade (Inliximab) 
Simponi (Golimumab)
Simponi Aria (Golimumab)
Xeljanz (Tofacitinib)
Xeljanz XR (Tofacitinib)

Transplant

Astagraf XL (Tacrolimus)
Cellcept (Mycophenolate)
Envarsus XR (Tacrolimus)
Gengraf (Cylosporine Modified) 
Myfortic (Mycophenolate)
Neoral (Cylosporine Modified)
Prograf (Tacrolimus)
Rapamune (Sirolimus)
Sandimmune (Cylosporine) 
Zortress (Everolimus)