Archived Pharmacy Policies
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
A
- Actemra (tocilizumab)
- Actemra (tocilizumab)
- Actemra (tocilizumab)
- Actemra (tocilizumab)
- Actemra (tocilizumab)
- Actemra (tocilizumab) - Archived 07/05/2023
- Actemra (tocilizumab) - Archived on 10/1/2022
- Adakveo (crizanlizumab-tmca)
- Adakveo (crizanlizumab-tmca)
- Aduhelm (aducanumab-avwa) - Archived 07/05/2023
- Aimovig (erenumab-aooe) archived on 01/09/23
- Aimovig (erenumab-aooe)
- Aimovig (erenumab-aooe)
- Aimovig (erenumab-aooe)
- Aimovig (erenumab-aooe)
- Aimovig (erenumab-aooe) - Archived 07/05/2023
- Aimovig (erenumab-aooe) Archived on 01/01/2023
- Ajovy (fremanezumab-vfrm)
- Ajovy (fremanezumab-vfrm)
- Ajovy (fremanezumab-vfrm)
- Ajovy (fremanezumab-vfrm) - Archived 07/05/2023
- Aldurazyme (laronidase) - Archived 08/01/2024
- Alpha 1-Proteinase Inhibitor Injection
- Alpha-1 Proteinase Inhibitors
- Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin C, Zemaira [human]) - Archived 01/01/2024
- Alunbrig (brigatinib)
- Amevive (alefacept)
- Amevive (alefacept)
- Ampyra (dalfampridin) archived on 1/1/23
- Ampyra (dalfampridine)
- Antihemophilic agents
- Antihemophilic Agents
- Antihemophilic Agents
- Apretude (cabotegravir extended-release) - archived 10/01/2023
- Apretude (cabotegravir extended-release) - Archived 01/01/2024
- Apretude (cabotegravir extended-release) - Archived 04/24/23
- Aranesp (darbepoetin alfa)
- Aranesp (darbepoetin alfa)
- Aranesp (darbepoetin alfa) - Archived 07/05/2023
- Arcalyst (Rilonacept) - Archived 07/05/2023
- Aubagio (teriflunomide)
- Austedo (deutetrabenazine)
- Austedo (deutetrabenazine)
- Austedo (deutetrabenazine) - Archived 07/05/2023
- Autoimmune Diseases: Biologic Therapies
- Avastin (bevacizumab) - Archived on 04/01/2024
- Avonex (interferon beta-1a)
- Avonex (interferon beta-1a) archived on 1/1/23
B
- Bafiertam (monomethyl fumarate) - Archived 07/05/2023
- Bafiertam (monomethyl fumarate) archived on 1/1/23
- Bavencio (avelumab)
- Bavencio (avelumab)
- Benlysta (belimumab)
- Benlysta (belimumab)
- Benlysta (belimumab)
- Benlysta (belimumab)
- Benlysta (belimumab) - Archived 08/01/2024
- Beovu (brolucizumab)
- Beovu (brolucizumab) archived on 1/1/23
- Berinert (C1 Esterase Inhibitor (Human))
- Berinert (C1 Esterase Inhibitor (Human))
- Betaseron (interferon beta-1b)
- Betaseron (interferon beta-1b) archived on 1/1/23
- Bethkis (tobramycin inhalation solution)
- Bethkis (tobramycin inhalation solution) - Archived on 10/1/2022
- Biologic and other Ophthalmologic Agents
- Biologic Cholesterol Agents
- Boniva (ibandronate) injection
- Botox (onabotulinumtoxinA)
- Botox (onabotulinumtoxinA)
- Botox (onabotulinumtoxinA)
- Botox (onabotulinumtoxinA)
- Botox (onabotulinumtoxinA)
- Botox (onabotulinumtoxinA) - Archived on 04/01/2024
- Botox (onabotulinumtoxinA) - Archived on 7/1/2022
- Botulinum Toxin Injection
- Brineura (cerliponase alfa)
- Brineura (cerliponase alfa) - Archived on 7/1/2022
- Bronchitol (mannitol) - Archived on 10/1/2022
- Bunavail (buprenorphine and naloxone) buccal film
- Bunavail (buprenorphine and naloxone) buccal film
- Bunavail (buprenorphine and naloxone) buccal film Archived on 09/14/2022
- Bylvay (odevixibat) - Archived 01/01/2024
C
- Cabenuva (cabotegravir/rilpivirine)
- Cablivi (caplacizumab-yhdp) - Archived 01/01/2024
- Calcium Regulators (Reclast, Zometa, Boniva, Prolia, Forteo, Xgeva)
- Calquence (acalabrutinib)
- Cayston (aztreonam inhalation solution)
- Cayston (aztreonam inhalation solution) - Archived on 10/1/2022
- Cerdelga (eliglustat) - archived 10/01/2023
- Cimzia (certolizumab pegol)
- Cimzia (certolizumab pegol)
- Cimzia (certolizumab pegol)
- Cimzia (certolizumab pegol)
- Cimzia (certolizumab pegol)
- Cimzia (certolizumab pegol) - Archived 07/05/2023
- Cinqair (reslizumab)
- Cinqair (reslizumab) - Archived 07/05/2023
- Cinryze (C1 esterase inhibitor (human))
- Cinryze (C1 esterase inhibitor (human))
- Cinryze (C1 esterase inhibitor (human))
- Cinryze (C1 esterase inhibitor (human)) - Archived on 01/01/2023
- Colony Stimulating Factors
- Continuity of Care
- Copaxone (glatiramer acetate)
- Cosentyx (secukinumab)
- Cosentyx (secukinumab)
- Cosentyx (secukinumab)
- Cosentyx (secukinumab)
- Cosentyx (secukinumab) - Archived 07/05/2023
- Crysvita (burosumab-twza)
- Crysvita (burosumab-twza)
- Crysvita (burosumab-twza)
- Cysteamine (Procysbi, Cystagon, Cystaran, Cystadrops) - Archived 01/01/2024
- Cystic Fibrosis
- Cytomegalovirus Immune Globulin Intravenous (Cytogam) - Archived on 02/05/2024
D
- Dalfampridine (generic for Ampyra) - Archived 07/05/2023
- Diacomit (stiripentol)
- Diacomit (stiripentol) - Archived 07/05/2023
- Diacomit (stiripentol) - Archived on 09/14/2022
- Dispense as Written (DAW) Requests
- Dispense as Written (DAW) Requests
- Doptelet (avatrombopag)
- Doptelet (avatrombopag) - Archived 08/01/2023
- Dupixent (dupilumab)
- Dupixent (dupilumab)
- Dupixent (dupilumab)
- Dupixent (dupilumab)
- Dupixent (dupilumab)
- Dupixent (dupilumab) - Archived 07/05/2023
- Dupixent (dupilumab) archived on 01/09/23
- Dupixent (dupilumab) archived on 1/1/23
- Durolane (sodium hyaluronate)
- Durolane (sodium hyaluronate) - Archived on 10/1/22
- Durysta (bimatoprost intracameral implant) - Archived 08/01/2024
- Durysta (bimatoprost intracameral implant) - Archived on 08/16/2024
- Durysta (bimatoprost intracameral implant) - Archived on 7/1/2022
- Dysport (abobotulinumtoxinA)
- Dysport (abobotulinumtoxinA) - Archived on 04/01/2024
- Dysport (abobotulinumtoxinA) - Archived on 7/1/2022
E
- Elaprase (idursulfase) - Archived on 08/01/2024
- Emflaza (deflazacort)
- Emflaza (deflazacort)
- Emflaza (deflazacort)
- Emgality (galcanezumab-gnlm)
- Emgality (galcanezumab-gnlm)
- Emgality (galcanezumab-gnlm) - Archived 07/05/2023
- Emgality (galcanezumab-gnlm) Archived on 01/01/2023
- Empaveli (pegcetacoplan) - Archived 01/01/2024
- Empaveli (pegcetacoplan) - Archived on 04/01/2024
- Enbrel (etanercept)
- Enbrel (etanercept)
- Enbrel (etanercept)
- Enbrel (etanercept) - Archived 07/05/2023
- Enspryng (satralizumab-mwge) - Archived 01/01/2024
- Entyvio (vedolizumab)
- Entyvio (vedolizumab)
- Entyvio (vedolizumab)
- Entyvio (vedolizumab) - Archived 07/05/2023
- Entyvio (vedolizumab) archived on 1/1/23
- ENZYME REPLACEMENT THERAPY (ERT) FOR GAUCHER DISEASE: Cerezyme (imiglucerase), Elelyso (taliglucerase alfa), Vpriv (velaglucerase alfa) - Archived 01/01/2024
- ENZYME REPLACEMENT THERAPY (ERT) FOR GAUCHER DISEASE: Cerezyme (imiglucerase), Elelyso (taliglucerase alfa), Vpriv (velaglucerase alfa) - archived 10/01/2023
- Epidiolex (cannabidiol)
- Epidiolex (cannabidiol) - Archived 07/05/2023
- Epidiolex (cannabidiol) - Archived on 09/14/2022
- Epogen (epoetin alfa)
- Epogen (epoetin alfa)
- Epogen (epoetin alfa) - Archived 07/05/2023
- Esbriet (pirfenidone) - Archived on 10/1/2022
- Euflexxa (sodium hyaluronate)
- Euflexxa (sodium hyaluronate) - Archived on 10/1/22
- Evenity (romosozumab-aqqg)
- Evenity (romosozumab-aqqg) - Archived 07/05/2023
- Evenity (romosozumab-aqqg) - Archived on 10/1/2022
- Evkeeza (evinacumab-dgnb) - Archived 07/05/2023
- Evkeeza (evinacumab-dgnb) - Archived on 7/1/2022
- Exondys 51 (eteplirsen)
- Extavia (interferon beta-1b)
- Extavia (interferon beta-1b) archived on 1/1/23
- Eylea (aflibercept) - archived 10/01/2023
- Eylea (aflibercept) - Archived on 04/01/2024
F
- Fabrazyme (agalsidase beta) Archived - 04/01/23
- Fasenra (benralizumab)
- Fasenra (benralizumab)
- Fasenra (benralizumab)
- Fasenra (benralizumab) - Archived 07/05/2023
- Filgrastim (Neupogen, Zarxio, Nivestym, Releuko) - Archived 07/05/2023
- Fintepla (fenfluramine) - Archived 07/05/2023
- Fintepla (fenfluramine) - Archived on 09/14/2022
- Firazyr (icatibant)
- Firazyr (icatibant)
- Firazyr (icatibant) archived on 1/1/23
- Firdapse (amifampridine)
- Firdapse (amifampridine) - Archived on 7/1/2022
- Forteo (teriparatide) - Archived 07/05/2023
- Forteo (teriparatide) - Archived on 10/1/2022
- Fulphila (pegfilgrastim-jmdb)
- Fulphila (pegfilgrastim-jmdb) - Archived 07/05/2023
G
- Galafold (migalastat)
- Galafold (migalastat) Archived - 04/01/23
- Gamifant (emapalumab-lzsg) - Archived on 04/01/2024
- Gattex (teduglutide)- Archived 01/01/2024
- Gel-One (sodium hyaluronate)
- Gel-One (sodium hyaluronate) - Archived on 10/1/22
- Gelsyn-3 (sodium hyaluronate)
- Gelsyn-3 (sodium hyaluronate) - Archived on 10/1/22
- Genotropin (somatropin)
- GenVisc 850 (sodium hyaluronate)
- GenVisc 850 (sodium hyaluronate) - Archived on 10/1/22
- Gilenya (fingolimod)
- Gilenya (fingolimod)
- Gilenya (fingolimod) - Archived 07/05/2023
- Givlaari (givosiran) - Archived 08/01/2023
- Givlaari (givosiran) - Archived on 08/01/2024
- Glatopa (glatiramer acetate)
- Granix (tbo-filgrastim)
- Granix (tbo-filgrastim) - Archived on 09/14/2022
H
- H.P. Acthar Gel (repository corticotropin injection)
- Haegarda (C1 esterase inhibitor (human)) archived on 1/1/23
- Haegarda (C1 inhibitor (human))
- Haegarda (C1 inhibitor (human))
- Haegarda (C1 inhibitor (human))
- Hematopoietic Growth Factors
- Hemophilic Agents
- Hereditary Angioedema and Pharmacotherapy
- Home Infusion Therapy
- Humatrope (somatropin)
- Humira (adalimumab)
- Humira (adalimumab)
- Humira (adalimumab)
- Humira (adalimumab)
- Humira (adalimumab) - Archived 07/05/2023
- Hyalgan (sodium hyaluronate)
- Hyalgan (sodium hyaluronate) - Archived on 10/1/22
- Hyaluronic Acid Derivative Injection
- Hyaluronic Acid Viscosupplements - Archived 04/01/23
- Hydroxyprogesterone caproate
- Hymovis (sodium hyaluronate)
- Hymovis (sodium hyaluronate) - Archived on 10/1/22
I
- Ibrance (palbociclib)
- Idiopathic Pulmonary Fibrosis
- Ilaris (canakinumab)
- Ilaris (canakinumab)
- Ilaris (canakinumab)
- Ilaris (canakinumab)
- Ilaris (canakinumab) - Archived 07/05/2023
- Ilumya (tildrakizumab-asmn)
- Ilumya (tildrakizumab-asmn)
- Ilumya (tildrakizumab-asmn) - Archived 07/05/2023
- Iluvien (fluocinolone acetonide) - Archived on 04/01/2024
- Imbruvica (ibrutinib) Archived - 04/01/23
- Imfinzi (durvalumab)
- Immune (Idiopathic) Thrombocytopenia Purpura (ITP)
- Immune globulin
- Immune globulin (IVIG and SCIG) - archived 10/01/2023
- Immune globulin (IVIG and SCIG): Intravenous (IVIG): Asceniv, Bivigam, Carimune NF, Flebogamma DIF, Gammagard Liquid, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Octagam, Panzyga, Privigen Subcutaneous (SCIG): Cutaquig, Cuvitru, Hizentra, HyQvia, Xembify) - Archived on 08/01/2024
- Immune globulin (IVIG)
- Immune globulin (IVIG)
- Immune globulin (IVIG)
- Inflammatory Bowel Disease: Biological Therapies
- Inflectra (infliximab-dyyb)
- Inflectra (infliximab-dyyb) - Archived 07/05/2023
- Ingrezza (valbenazine)
- Ingrezza (valbenazine)
- Ingrezza (valbenazine)
- Ingrezza (valbenazine) - Archived 07/05/2023
- Inhaled Prostacyclins for Pulmonary Arterial Hypertension: Tyvaso (treprostinil), Ventavis (iloprost) - Archived 07/05/2023
- Interferons for Multiple Sclerosis: Avonex (interferon beta-1a), Betaseron (interferon beta-1b), Extavia (interferon beta-1b), Plegridy (peginterferon beta-1a), Rebif (interferon beta-1a) - Archived 07/05/2023
- Isturisa (osilodrostat) - Archived on 10/1/2022
- IV Iron Products - Archived 01/01/2024
- IV Iron Products - Archived on 10/1/2024
J
K
- Kalbitor (ecallantide)
- Kalbitor (ecallantide)
- Kalbitor (ecallantide) archived on 1/1/23
- Kalydeco (ivacaftor)
- Kanuma (sebelipase alfa) - Archived on 7/1/2022
- Kesimpta (ofatumumab) - Archived 07/05/2023
- Kesimpta (ofatumumab) archived on 1/1/23
- Kevzara (sarilumab)
- Kevzara (sarilumab)
- Kevzara (sarilumab)
- Kevzara (sarilumab) - Archived 07/05/2023
- Keytruda (pembrolizumab)
- Kineret (anakinra)
- Kineret (anakinra)
- Kineret (anakinra)
- Kineret (anakinra) - Archived 07/05/2023
- Kisqali (ribociclib)
- Kitabis Pak (tobramycin inhalation solution)
- Kitabis Pak (tobramycin inhalation solution) - Archived on 10/1/2022
- Korlym (mifepristone) - Archived on 10/1/2022
- Korsuva (difelikefalin) - Archived on 08/16/2024
- Korsuva (difelikefalin) - Archived on 10/1/2022
- Koselugo (selumetinib) - Archived on 04/01/2024
- Krystexxa (pegloticase) archived on 1/1/23
- Kuvan (sapropterin) Archived - 04/01/23
- Kymriah (tisagenlecleucel)
- Kymriah (tisagenlecleucel)
- Kyriah (tisagenlecleucel)
L
- Lemtrada (alemtuzumab)
- Lemtrada (alemtuzumab)
- Lemtrada (alemtuzumab) - Archived 07/05/2023
- Lemtrada (alemtuzumab) archived on 1/1/23
- Leqembi (lecanemab) - Archived 08/28/2023
- Leqvio (inclisiran) - Archived 07/05/2023
- Leukine (sargramostim)
- Leukine (sargramostim)
- Leukine (sargramostim) - Archived on 09/14/2022
- Litfulo (ritlecitinib)
- Lucentis (ranibizumab) - archived 10/01/2023
- Lumizyme (alglucosidase alfa) - Archived on 04/01/2024
- Lumizyme (alglucosidase alfa) Archived - 04/01/23
- Lupkynis (voclosporin) - Archived 08/01/2024
- Lupkynis (voclosporin) archived on 1/1/23
- Lupron Depot and Lupron Depot-PED (leuprolide acetate)
- Luxturna (voretigene neparvovec-rzyl) intraocular suspension for subretinal injection
M
- MACI (autologous cultured chondrocytes) - Archived on 10/1/2022
- Macrilen (macimorelin) - Archived on 08/16/2024
- Macrilen (macimorelin) - Archived on 04/01/2024
- Macrilen (macimorelin) Archived - 04/01/23
- Macugen (pegaptanib) - archived 10/01/2023
- Macugen (pegaptanib) - Archived on 09/10/2024
- Makena (hydroxyprogesterone caproate)
- Mavenclad (cladribine) - Archived 07/05/2023
- Mavenclad (cladribine) archived on 1/1/23
- Mayzent (siponimod)
- Mayzent (siponimod) - Archived 07/05/2023
- Medical Necessity for Physician Dispense as Written (DAW) Requests
- Medication Assisted Therapy (buprenorphine containing agents)
- Mepsevii (vestronidase alfa-vjbk)
- Mepsevii (vestronidase alfa-vjbk)
- Mepsevii (vestronidase alfa-vjbk) - Archived on 08/01/2024
- Monovisc (sodium hyaluronate)
- Monovisc (sodium hyaluronate) - Archived on 10/1/22
- Mulpleta (lusutrombopag) - Archived 08/01/2023
- Multi-ingredient Compound Policy
- Multiple Sclerosis
- Mycapssa (octreotide) - Archived on 10/1/2022
- Myfembree (relugolix, estradiol, and norethindrone acetate) - Archived 07/05/2023
- Myfembree (relugolix, estradiol, and norethindrone acetate) archived on 1/1/23
- Myobloc (rimabotulinumtoxinB)
- Myobloc (rimabotulinumtoxinB)
- Myobloc (rimabotulinumtoxinB)
- Myobloc (rimabotulinumtoxinB) - Archived on 04/01/2024
- Myobloc (rimabotulinumtoxinB) - Archived on 7/1/2022
N
- Naglazyme (galsulfase) - Archived on 08/01/2024
- Neulasta (Pegfilgrastim), Neulasta Onpro (Pegfilgrastim on-body injector)
- Neulasta (Pegfilgrastim), Neulasta Onpro (Pegfilgrastim on-body injector)
- Neulasta (Pegfilgrastim), Neulasta Onpro (Pegfilgrastim on-body injector) - Archived 07/05/2023
- Neulasta (Pegfilgrastim), Neulasta Onpro (Pegfilgrastim on-body injector) - Archived on 9/14/2022
- Neupogen (filgrastim)
- Neupogen (filgrastim)
- Neupogen (filgrastim)
- Neupogen (Filgrastim) - Archived 07/05/2023
- Nexviazyme (avalglucosidase alfa-ngp) - Archived on 04/01/2024
- Nexviazyme (avalglucosidase alfa-ngp) - Archived on 10/1/2022
- Ngenla (somatrogon-ghla)
- Nivestym (filgrastim-aafi) - Archived 07/05/2023
- Noctiva (desmopressin acetate) intranasal-archived on 12/13/22
- Norditropin (somatropin)
- Novantrone (mitoxantrone)
- Novantrone (mitoxantrone) archived on 1/1/23
- NPlate (romiplostim) - Archived 08/01/2023
- Nucala (mepolizumab)
- Nucala (mepolizumab)
- Nucala (mepolizumab)
- Nucala (mepolizumab)
- Nucala (mepolizumab) - Archived 07/05/2023
- Nulibry (fosdenopterin) - archived 10/01/2023
- Nutropin AQ (somatropin)
O
- Ocrevus (ocrelizumab)
- Ocrevus (ocrelizumab)
- Ocrevus (ocrelizumab) - Archived 07/05/2023
- Ocrevus (ocrelizumab) archived on 1/1/23
- Ofev (nintedanib) - Archived on 10/1/2022
- Olumiant (baricitinib)
- Olumiant (baricitinib)
- Olumiant (baricitinib)
- Olumiant (baricitinib) - Archived 07/05/2023
- Olumiant (baricitinib) archived on 1/1/23
- Omnitrope (somatropin)
- Omnitrope (somatropin)
- Oncology Medications
- Onpattro (patisiran)
- Onpattro (patisiran) - archived 10/01/2023
- Orencia (abatacept)
- Orencia (abatacept)
- Orencia (abatacept)
- Orencia (abatacept) - Archived 07/05/2023
- Orencia (abatacept) - Archived on 7/1/2022
- Orfadin (nitisinone) - Archived on 10/01/2024
- Oriahnn (elagolix, estradiol, and norethindrone acetate; elagolix) - Archived 07/05/2023
- Orilissa (elagolix)
- Orilissa (elagolix)
- Orilissa (elagolix) - Archived 07/05/2023
- Orilissa (elagolix) archived on 1/1/23
- Orkambi (lumacaftor/ivacaftor)
- Orkambi (lumacaftor/ivacaftor) - Archived on 08/08/2032
- Orladeyo (berotralstat) archived on 1/1/23
- Orthovisc (sodium hyaluronate)
- Orthovisc (sodium hyaluronate) - Archived on 10/1/22
- Otezla (apremilast)
- Otezla (apremilast)
- Otezla (apremilast)
- Otezla (apremilast)
- Otezla (apremilast) - Archived 07/05/2023
- Otezla (apremilast) - Archived on 7/1/2022
- Oxervate (cenegermin-bkbj)
- Oxervate (cenegermin-bkbj) - Archived 07/05/2023
- Oxervate (cenegermin-bkbj) - Archived on 7/1/2022
- Oxlumo (lumasiran) - Archived on 04/01/2024
- Oxlumo (lumasiran) - Archived on 08/01/2024
- Oxlumo (lumasiran) - Archived on 9/14/2022
- Oxlumo (lumasiran) Archived - 04/01/23
- Ozurdex (dexamethasone) - Archived on 04/01/2024
P
- Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp]
- Palynziq (pegvaliase-pqpz)
- Palynziq (pegvaliase-pqpz) Archived - 04/01/23
- Panhematin (hemin for injection) - Archived on 08/01/2024
- Pegasys (peginterferon alfa-2a) - Archived 07/05/2023
- Pegylated and Non-Pegylated Interferon
- Plegridy (peginterferon beta-1a)
- Plegridy (peginterferon beta-1a) archived on 1/1/23
- Ponvory (ponesimod)
- Ponvory (ponesimod) - Archived 07/05/2023
- Praluent (alirocumab)
- Praluent (alirocumab)
- Praluent (alirocumab) - Archived 07/05/2023
- Prevymis (letermovir) - Archived 01/01/2024
- Probuphine (buprenorphine subdermal implant) - Archived on 09/14/2022
- Procrit (epoetin alfa)
- Procrit (epoetin alfa)
- Procrit (epoetin alfa) - Archived 07/05/2023
- Prolia (denosumab)
- Prolia (denosumab) - Archived 07/05/2023
- Prolia (denosumab) - Archived on 10/1/2022
- Promacta (eltrombopag) - Archived 08/01/2023
- Provenge (sipuleucel-T)
- Psoriasis Biological Therapies
- Pulmonary Arterial Hypertension
- Pulmozyme (dornase alfa inhalation solution)
- Pulmozyme (dornase alfa inhalation solution)
- Pulmozyme (dornase alfa inhalation solution) - Archived on 10/1/2022
Q
R
- Radicava (edaravone injection)
- Radicava (edaravone injection) Archived - 04/01/23
- Ravicti (glycerol phenylbuytyrate) - Archived 08/01/2023
- Rebif (interferon beta-1a)
- Rebif (interferon beta-1a) archived on 1/1/23
- Reblozyl (luspatercept-aamt)
- Reblozyl (luspatercept-aamt) - Archived 07/05/2023
- Rebyota (fecal microbiota, live - jslm) - archived 10/01/2023
- Relistor (methylnaltrexone) - Archived 07/05/2023
- Remicade (infliximab)
- Remicade (infliximab)
- Remicade (infliximab)
- Remicade (infliximab) - Archived 07/05/2023
- Renflexis (infliximab-abda)
- Renflexis (infliximab-abda) - Archived 07/05/2023
- Repatha (evolocumab)
- Repatha (evolocumab)
- Repatha (evolocumab)
- Repatha (evolocumab) - Archived 07/05/2023
- Retacrit (epoetin alfa-epbx) - Archived 07/05/2023
- Retisert (fluocinolone acetonide) - Archived on 04/01/2024
- Rinvoq (upadacitinib)
- Rinvoq (upadacitinib) - Archived 07/05/2023
- Rinvoq (upadacitinib) - Archived on 10/1/2022
- Rituxan (rituximab)
- Rituxan (rituximab)
- Rituxan (rituximab)
- Rituxan (rituximab) - Archived on 7/1/2022
- Rituxan (rituximab) archived on 1/1/23
- Rituxan (rituximab)- Archived 01/01/2024
- Rituxumab (Rituxan*, Truxima, Ruxience, Riabni) - Archived on 04/01/2024
- Rivfloza (nedosiran) - Archived on 08/01/2024
- Ruconest (C1 esterase inhibitor (rabbit-derived))
- Ruconest (C1 esterase inhibitor (rabbit-derived))
- Ruconest (C1 esterase inhibitor (recombinant)) archived on 1/1/23
- Rukobia (fostemsavir) - Archived on 08/01/2024
- Ruzurgi (amifampridine)
- Ruzurgi (amifampridine) - Archived on 09/10/2024
- Rydapt (midostaurin)
S
- Sabril (vigabatrin)
- Saizen (somatropin)
- Saphnelo (anifrolumab-fnia) - Archived on 08/01/2024
- Saphnelo (anifrolumab-fnia) archived on 1/1/23
- Scenesse (Afamelanotide)
- Scenesse (Afamelanotide) Archived - 04/01/23
- Seizure Disorders (H.P. Acthar Gel (repository corticotropin injection) and Sabril (vigabatrin) oral solution and tablets)
- Serostim (somatropin) - Archived 07/05/2023
- Short Bowel Syndrome (Gattex, Zorbtive)
- Signifor, Signifor LAR (pasireotide) - Archived on 10/1/2022
- Siliq (brodalumab)
- Siliq (brodalumab)
- Siliq (brodalumab)
- Siliq (brodalumab) - Archived 07/05/2023
- Simponi (golimumab)
- Simponi (golimumab)
- Simponi (golimumab) - Archived 07/05/2023
- Simponi Aria (golimumab)
- Simponi Aria (golimumab)
- Simponi Aria (golimumab)
- Simponi Aria (golimumab) - Archived on Aug 18, 2023
- Skyrizi (risankizumab-rzaa)
- Skyrizi (risankizumab-rzaa) - Archived 07/05/2023
- Skyrizi (risankizumab-rzaa) archived on 1/1/23
- Skytrofa (lonapegsomatropin) - Archived 07/05/2023
- Sogroya (somapacitan-beco) - Archived 07/05/2023
- Soliris (eculizumab)
- Soliris (eculizumab)
- Soliris (eculizumab)
- Soliris (eculizumab)
- Soliris (eculizumab)
- Soliris (eculizumab) - Archived 01/01/2024
- Somatostatin analogs (Injectable; First generation): Sandostatin (octreotide), Sandostatin LAR (octreotide), Somatuline Depot (lanreotide), Bynfezia Pen (octreotide)
- Somatropin Agents - Archived 07/05/2023
- Somatropin Injection
- Somatuline depot (lanreotide), Bynfezia Pen (octreotide)
- Somavert (pegvisomant) - Archived on 10/1/2022
- Spinraza (nusinersen)
- Stelara (ustekinumab)
- Stelara (ustekinumab)
- Stelara (ustekinumab)
- Stelara (ustekinumab)
- Stelara (ustekinumab) - Archived 07/05/2023
- Stelara (ustekinumab) archived on 1/1/23
- Strensiq (asfotase alfa)
- Strensiq (asfotase alfa)
- Sublocade (buprenorphine extended-release) injection
- Sublocade (buprenorphine extended-release) injection, for subcutaneous use - Archived 07/05/2023
- Suboxone (buprenorphine and naloxone)
- Suboxone (buprenorphine and naloxone) sublingual film, for sublingual or buccal use - Archived 07/05/2023
- Sunlenca (lenacapavir) - Archived on 08/01/2024
- Supartz FX (sodium hyaluronate)
- Supartz FX (sodium hyaluronate) - Archived on 10/1/22
- Synagis (palivizumab)
- Synagis (palivizumab)
- Synagis (palivizumab)
- Synagis (palivizumab)
- Synagis (palivizumab)
- Synagis (palivizumab) - Archived 07/05/2023
- Synagis (palivizumab) - Archived on 9/20/2022
- Synagis (palivizumab) archived on 1/1/23
- Synvisc (sodium hyaluronate)
- Synvisc (sodium hyaluronate) - Archived on 10/1/22
- Synvisc-One (sodium hyaluronate)
- Synvisc-One (sodium hyaluronate) - Archived on 10/1/22
T
- Takhzyro (lanadelumab-flyo)
- Takhzyro (lanadelumab-flyo) - Archived 08/01/2023
- Takhzyro (lanadelumab-flyo) archived on 01/01/23
- Taltz (ixekizumab)
- Taltz (ixekizumab)
- Taltz (ixekizumab)
- Taltz (ixekizumab) - Archived 07/05/2023
- Tavalisse (fostamatinib disodium hexahydrate) - Archived 08/01/2023
- Tecentriq (atezolizumab)
- Tecfidera (dimethyl fumarate)
- Tecfidera (dimethyl fumarate) - Archived 07/21/2023
- Tegsedi (inotersen)
- Tegsedi (inotersen) - Archived on 08/01/2024
- Tepezza (teprotumumab-trbw)
- Tepezza (teprotumumab-trbw) - archived 10/01/2023
- Tepezza (teprotumumab-trbw) - Archived on 7/1/2022
- Tobi (tobramycin inhalation solution)
- Tobi (tobramycin inhalation solution), Tobi Podhaler - Archived on 10/1/2022
- Tremfya (guselkumab)
- Tremfya (guselkumab)
- Tremfya (guselkumab)
- Tremfya (guselkumab) - Archived 07/05/2023
- Triptodur (triptorelin)
- Trogarzo (ibalizumab-uiyk) - Archived 08/01/2023
- Trogarzo (ibalizumab-uiyk) - Archived 08/01/2024
- Tymlos (abaloparatide) - Archived 07/05/2023
- Tymlos (abaloparatide) - Archived on 10/1/2022
- Tysabri (natalizumab)
- Tysabri (natalizumab)
- Tysabri (natalizumab)
- Tysabri (natalizumab) - Archived 07/05/2023
- Tysabri (natalizumab) archived on 1/1/23
U
- Udenyca (pegfilgrastim-cbqv) - Archived 07/05/2023
- Ultomiris (ravulizumab-cwvz)
- Ultomiris (ravulizumab-cwvz)
- Ultomiris (ravulizumab-cwvz)
- Ultomiris (ravulizumab-cwvz) - Archived on 10/1/2022
- Ultomiris (ravulizumab-cwvz) archived on 01/01/2023
- Ultomiris (ravulizumab-cwvz)- Archived 01/01/2024
- Uplizna (inebilizumab-cdon) - Archived 01/01/2024
V
- Vabysmo (faricimab-svoa) - archived 10/01/2023
- Vabysmo (faricimab-svoa) - Archived on 04/01/2024
- Varubi (rolapitant)
- Vigabatrin (generic for Sabril), Vigadrone - Archived 07/05/2023
- Vigabatrin (generic for Sabril), Vigadrone archived on 1/1/23
- Vimizim (elosulfase alfa) - Archived 08/01/2024
- VOXZOGO (vosoritide) - Archived 07/05/2023
- Vumerity (diroximel fumarate) - Archived 07/05/2023
- Vumerity (diroximel fumarate) archived on 1/1/23
- Vyepti (eptinezumab-jjmr)
- Vyepti (eptinezumab-jjmr) - Archived 07/05/2023
- Vyjuvek (beremagene geperpavec-svdt)
- Vyndaqel (tafamidis meglumine) and Vyndamax (tafamidis)
- Vyndaqel (tafamidis meglumine) and Vyndamax (tafamidis)
- Vyndaqel (tafamidis meglumine) and Vyndamax (tafamidis) - Archived 07/05/2023
- Vyvgart (efgartigimod alfa-fcab) - Archived 01/01/2024
X
- Xeljanz/Xeljanz XR (tofacitinib)
- Xeljanz/Xeljanz XR (tofacitinib)
- Xeljanz/Xeljanz XR (tofacitinib)
- Xeljanz/Xeljanz XR (tofacitinib)
- Xeljanz/Xeljanz XR (tofacitinib) - Archived 07/05/2023
- Xenleta (lefamulin) - Archived on 08/16/2024
- Xenleta (lefamulin) - Archived on 10/1/2022
- Xeomin (incobotulinumtoxinA)
- Xeomin (incobotulinumtoxinA)
- Xeomin (incobotulinumtoxinA)
- Xeomin (incobotulinumtoxinA)
- Xeomin (incobotulinumtoxinA) - Archived on 04/01/2024
- Xeomin (incobotulinumtoxinA) - Archived on 7/1/2022
- Xermelo (telotristat ethyl) - Archived on 10/1/2022
- Xgeva (denosumab) - Archived 07/05/2023
- Xipere (triamcinolone) - Archived on 04/01/2024
- Xolair (omalizumab) - Archived 07/05/2023
- Xolair (omalizumab) inmed
- Xolair/Nucala/Cinqair
Y
Z
- Zarxio (filgrastim-sndz) - Archived on 9/14/2022
- Zavesca (miglustat)
- Zejula (niraparib)
- Zeposia (ozanimod)
- Zeposia (ozanimod) - Archived 07/05/2023
- Zinbryta (daclizumab)
- Zomacton (somatropin)
- Ztalmy (ganaxolone) - Archived 07/05/2023
- Zubsolv (buprenorphine and naloxone)
- Zubsolv (buprenorphine and naloxone) sublingual tablets for sublingual administration
- Zubsolv (buprenorphine and naloxone) sublingual tablets for sublingual administration archived on 1/1/23
- Zulresso (brexanolone) - Archived 04/12/23
- Zulresso (brexanolone) - Archived on 10/1/2022