Archived Pharmacy Policies
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A
- Abecma (idecabtagene vicleucel) - Archived 10/1/2022
- Actemra (tocilizumab) - Archived on 7/1/2022
- Acthar Gel (repository corticotropin injection)-archived on 1/1/23
- Adakveo (crizanlizumab-tmca) - Archived on 7/1/2022
- Aduhelm (aducanumab-avwa) - Archived on 7/1/2022
- Aimovig (erenumab-aooe)
- Aimovig (erenumab-aooe) - Archived 10/1/2022
- Ajovy (fremanezumab-vfrm) - Archived 01/17/2023
- Ajovy (fremanezumab-vfrm) - Archived 10/1/2022
- Amevive (alefacept)
- Amondys 45 (casimersen) - Archived on 7/1/2022
- Aralast NP, Glassia, Prolastin C, Zemaira (alpha1- proteinase inhibitor [human])
- Aralast NP, Glassia, Prolastin C, Zemaira (alpha1- proteinase inhibitor [human])
- Arcalyst (Rilonacept) - Archived on 7/1/2022
- Aubagio (teriflunomide)-archived on 1/1/23
- Austedo (deutetrabenazine) - Archived 10/1/2022
- Avonex (interferon beta-1a) archived on 1/1/23
B
- Bafiertam (monomethyl fumarate)-archived on 1/1/23
- Benlysta (belimumab)-archived on 1/1/23
- Beovu (brolucizumab)
- Beovu (brolucizumab)-archived on 1/1/23
- Berinert (C1 esterase inhibitor (human))-archived on 1/1/23
- Betaseron (interferon beta-1b) archived on 1/1/23
- Bethkis (tobramycin inhalation solution) - Archived 10/1/2022
- Bevacizumab (Alymsys, Avastin, Mvasi, Zirabev) - Archived 10/1/2022
- Bevacizumab (Alymsys, Avastin, Mvasi, Zirabev) Archived 01/01/2023
- Botox (onabotulinumtoxinA)
- Botox (onabotulinumtoxinA) - Archived on 7/1/2022
- Breyanzi (lisocabtagene maraleucel) archived on 1/1/23
- Brineura (cerliponase alfa) - Archived on 7/1/2022
- Bunavail (buprenorphine and naloxone) buccal film Archived on 09/14/2022
C
- Cabenuva (cabotegravir/rilpivirine)
- Cabenuva (cabotegravir/rilpivirine) - Archived 10/1/2022
- Cayston (aztreonam inhalation solution) - Archived 10/1/2022
- Cimzia (certolizumab pegol) - Archived on 7/1/2022
- Cinqair (reslizumab) - Archived on 7/1/2022
- Cinryze (C1 esterase inhibitor (human)) archived on 1/1/23
- Continuous Glucose Monitors - Archived on 7/1/22
- Cosentyx (secukinumab)
- Cosentyx (secukinumab)
- Crysvita (burosumab-twza) - Archived 10/1/2022
D
- Dalfampridine (generic for Ampyra)
- Dalfampridine (generic for Ampyra)-archived on 1/1/23
- Diacomit (stiripentol) - Archived 10/1/2022
- Dupixent (dupilumab)
- Dupixent (dupilumab) archived on 1/1/23
- Durolane (sodium hyaluronate) - Archived on 10/1/22
- Durysta (bimatoprost intracameral implant) - Archived on 7/1/2022
- Dysport (abobotulinumtoxinA)
- Dysport (abobotulinumtoxinA) - Archived on 7/1/2022
E
- Emflaza (deflazacort) - Archived on 7/1/2022
- Emgality (galcanezumab-gnlm)
- Emgality (galcanezumab-gnlm) - Archived 10/1/2022
- Emgality (galcanezumab-gnlm) archived on 1/1/23
- Enbrel (etanercept) - Archived on 7/1/2022
- Entyvio (vedolizumab) archived on 1/1/23
- Epclusa (Sofosbuvir/velpatasvir) - Archived on 7/1/2022
- Epidiolex (cannabidiol) - Archived 10/1/2022
- Esbriet (pirfenidone) - Archived 10/1/2022
- Euflexxa (sodium hyaluronate) - Archived on 10/1/22
- Evenity (romosozumab-aqqg) - Archived 10/1/2022
- Evkeeza (evinacumab-dgnb) - Archived on 7/1/2022
- Evrysdi (risdiplam) archived on 1/1/23
- Exondys 51 (eteplirsen) - Archived on 7/1/2022
- Extavia (interferon beta-1b) archived on 1/1/23
F
G
- Galafold (migalastat)
- Gel-One (sodium hyaluronate) - Archived on 10/1/22
- Gelsyn-3 (sodium hyaluronate) - Archived on 10/1/22
- Gender–Affirming Hormone Therapy - Archived 10/1/2022
- Genotropin (somatropin)
- GenVisc 850 (sodium hyaluronate) - Archived 02/07/2023
- Gilenya (fingolimod)
- Granix (tbo-filgrastim) - Archived on 09/14/2022
H
- Haegarda (C1 esterase inhibitor (human)) archived on 1/1/23
- Harvoni (ledipasvir/sofosbuvir) - Archived on 7/1/2022
- Humatrope (somatropin)
- Humira (adalimumab)
- Humira (adalimumab) - Archived on 7/1/2022
- Humira (adalimumab) - Archived on 7/1/22
- Hyalgan (sodium hyaluronate) - Archived on 10/1/22
- Hymovis (sodium hyaluronate) - Archived on 10/1/22
I
- Ilaris (canakinumab)
- Ilaris (canakinumab) - Archived on 7/1/2022
- Ilumya (tildrakizumab-asmn)
- Imcivree (setmelanotide) archived on 1/1/23
- Inflectra (infliximab-dyyb)
- Infliximab (Avsola, Inflectra, Remicade, Renflexis) - Archived 10/1/2022
- Ingrezza (valbenazine) - Archived 10/1/2022
- Inhaled Prostacyclins for Pulmonary Arterial Hypertension: Tyvaso (treprostinil), Ventavis (iloprost) archived on 1/1/23
- Injectable somatostatin analogs (First generation): Sandostatin (octreotide), Sandostatin LAR (octreotide), Somatuline depot (lanreotide), Bynfezia Pen (octreotide)
- Isturisa (osilodrostat) - Archived 10/1/2022
J
K
- Kalbitor (ecallantide) archived on 1/1/23
- Kalydeco (ivacaftor) - Archived 10/1/2022
- Kanuma (sebelipase alfa) - Archived on 7/1/2022
- Kesimpta (ofatumumab) archived on 1/1/23
- Kevzara (sarilumab) - Archived on 7/1/2022
- Kineret (anakinra)
- Kineret (anakinra) - Archived on 7/1/2022
- Kitabis Pak (tobramycin inhalation solution) - Archived 10/1/2022
- Korlym (mifepristone) - Archived 10/1/2022
- Korsuva (difelikefalin) - Archived 10/1/2022
- Krystexxa (pegloticase) archived on 1/1/23
- Kymriah (tisagenlecleucel) archived on 1/1/23
L
- Lemtrada (alemtuzumab) archived on 1/1/23
- Leukine (sargramostim) - Archived on 09/14/2022
- Lupaneta Pack (leuprolide acetate, norethindrone acetate) - Archived on 09/14/2022
- Lupkynis (voclosporin) archived on 1/1/23
- Luxturna (voretigene neparvovec-rzyl) intraocular suspension for subretinal injection - Archived on 7/1/2022
M
- MACI (autologous cultured chondrocytes) - Archived 10/1/2022
- Mavenclad (cladribine) archived on 1/1/23
- Mavyret (glecaprevir and pibrentasvir) - Archived on 7/1/2022
- Mayzent (siponimod)
- Mepsevii (vestronidase alfa-vjbk)
- Monovisc (sodium hyaluronate) - Archived on 10/1/22
- Mycapssa (octreotide) - Archived 10/1/2022
- Myfembree (relugolix, estradiol, and norethindrone acetate) archived on 1/1/23
- Myobloc (rimabotulinumtoxinB)
- Myobloc (rimabotulinumtoxinB) - Archived on 7/1/2022
N
- Neulasta (Pegfilgrastim), Neulasta Onpro (Pegfilgrastim on-body injector)
- Nexviazyme (avalglucosidase alfa-ngp) - Archived 10/1/2022
- Noctiva (desmopressin acetate) intranasal 0.83 mcg/0.1 mL and 1.66 mcg/0.1 mL-archived on 12/13/22
- Norditropin (somatropin)
- Novantrone (mitoxantrone) archived on 1/1/23
- NPlate (romiplostim)
- Nutropin AQ (somatropin)
O
- Ocrevus (ocrelizumab)
- Ocrevus (ocrelizumab) archived on 1/1/23
- Ofev (nintedanib) - Archived 10/1/2022
- Olumiant (baricitinib)
- Olumiant (baricitinib) - Archived on 7/1/2022
- Olumiant (baricitinib) archived on 1/1/23
- Omnitrope (somatropin) cartridge 5 mg/1.5 mL and 10 mg/1.5 mL, Omnitrope (somatropin) for injection 5.8 mg/vial
- Onpattro (patisiran) archived on 1/1/23
- Orencia (abatacept) - Archived on 7/1/2022
- Orilissa (elagolix) archived on 1/1/23
- Orkambi (lumacaftor/ivacaftor) - Archived 10/1/2022
- Orladeyo (berotralstat) archived on 1/1/23
- Orthovisc (sodium hyaluronate) - Archived on 10/1/22
- Otezla (apremilast) - Archived on 7/1/2022
- Oxbryta (voxelotor) - Archived on 7/1/2022
- Oxervate (cenegermin-bkbj) - Archived on 7/1/2022
- Oxlumo (lumasiran) - Archived 10/1/2022
P
- Pegasys (peginterferon alfa-2a) archived on 1/1/23
- Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, Ziextenzo) - Archived 10/1/2022
- Plegridy (peginterferon beta-1a)
- Plegridy (peginterferon beta-1a) archived on 1/1/23
- Ponvory (ponesimod)
- Praluent (alirocumab) - Archived on 7/1/2022
- Probuphine (buprenorphine subdermal implant) - Archived on 09/14/2022
- Prolia (denosumab) - Archived 10/1/2022
- Pulmozyme (dornase alfa inhalation solution) - Archived 10/1/2022
R
- Rebif (interferon beta-1a) archived on 1/1/23
- Remicade (infliximab)
- Remicade (infliximab) - Archived on 7/1/2022
- Renflexis (infliximab-abda)
- Rinvoq (upadacitinib)
- Rinvoq (upadacitinib)
- Rinvoq (upadacitinib) - Archived on 7/1/2022
- Rituxan (rituximab)
- Rituxan (rituximab) - Archived on 7/1/2022
- Rituximab (Riabni, Rituxan, Rituxan Hycela, Ruxience, Truxima) - Archived 10/1/2022
- Rituximab (Rituxan, Ruxience, Truxima) archived on 1/1/23
- Ruconest (C1 esterase inhibitor (recombinant)) archived on 1/1/23
- Rukobia (fostemsavir) - Archived 10/1/2022
S
- Saphnelo (anifrolumab-fnia) archived on 1/1/23
- Siliq (brodalumab)
- Simponi Aria (golimumab) - Archived on 7/1/2022
- Skyrizi (risankizumab-rzaa)
- Skyrizi (risankizumab-rzaa) - Archived on 7/1/2022
- Skyrizi (risankizumab-rzaa) archived on 1/1/23
- Sofosbuvir/velpatasvir (generic for Epclusa) - Archived on 11/18/2022
- Soliris (eculizumab)
- Somatostatin Analogs - Archived 10/1/2022
- Spinraza (nusinersen) archived on 1/1/23
- Stelara (ustekinumab)
- Stelara (ustekinumab)
- Stelara (ustekinumab) - Archived on 7/1/2022
- Stelara (ustekinumab) archived on 1/1/23
- Strensiq (asfotase alfa) - Archived on 9/30/2022
- Sublocade (buprenorphine extended-release) injection, for subcutaneous use archived on 1/1/23
- Suboxone (buprenorphine and naloxone) sublingual film, for sublingual or buccal use archived on 1/1/23
- Supartz FX (sodium hyaluronate) - Archived on 10/1/22
- Symdeko (tezacaftor/ivacaftor) - Archived on 9/30/2022
- Synagis (palivizumab)
- Synagis (palivizumab) - Archived on 9/20/2022
- Synvisc-One (sodium hyaluronate)
- Synvisc-One (sodium hyaluronate) - Archived on 10/1/22
T
- Takhzyro (lanadelumab-flyo) archived on 1/1/23
- Taltz (ixekizumab)
- Taltz (ixekizumab) - Archived on 7/1/2022
- Tecartus (Brexucabtagene Autoleucel) - Archived on 7/1/2022
- Tecfidera (dimethyl fumarate) archived on 1/1/23
- Tegsedi (inotersen) archived on 1/1/23
- Tepezza (teprotumumab-trbw) - Archived on 7/1/2022
- Tobi (tobramycin inhalation solution), Tobi Podhaler - Archived 10/1/2022
- Trastuzumab (Herceptin, Herzuma, Kanjinti, Ogivri, Ontruzant, Trazimera) - Archived 10/1/2022
- Tremfya (guselkumab)
- Tremfya (guselkumab) - Archived on 7/1/2022
- Tremfya (guselkumab) - Archived on 7/1/22
- Trikafta (elexacaftor, tezacaftor and ivacaftor tablets; ivacaftor tablets) - Archived 10/1/2022
- Trogarzo (ibalizumab-uiyk) - Archived 10/1/2022
- Tysabri (natalizumab) archived on 1/1/23
U
V
- Varubi (rolapitant) - Archived on 8/24/2022
- Vigabatrin (generic for Sabril), Vigadrone archived on 1/1/23
- Viltepso (viltolarsen) - Archived on 7/1/2022
- Vosevi (sofosbuvir/velpatasvir/voxilaprevir) - Archived on 7/1/2022
- Vumerity (diroximel fumarate) archived on 1/1/23
- Vyepti (eptinezumab-jjmr) - Archived 10/1/2022
- Vyndaqel (tafamidis meglumine) and Vyndamax (tafamidis) archived on 1/1/23
- Vyondys 53 (golodirsen) - Archived on 7/1/2022
X
Y
Z
- Zavesca (miglustat)
- Zepatier (grazoprevir/elbasvir) - Archived on 7/1/2022
- Zeposia (ozanimod)
- Zolgensma (onasemnogene abeparvovec-xioi) archived on 1/1/23
- Zubsolv (buprenorphine and naloxone) sublingual tablets for sublingual administration archived on 1/1/23
- Zulresso (brexanolone) - Archived 10/1/2022