Drug authorization list
Drug authorization & quantity limits
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View opioid-related drugs
View Drugs for Weight Loss Management policy PDF File
Policies starting with A
- Abecma PDF File
- Acanya PDF File
- Aciphex PDF File
- Aciphex Sprinkles PDF File
- Actemra PDF File
- Aczone PDF File
- Adakveo PDF File
- Adapalene 0.3% PDF File
- Adapalene/Benzoyl Peroxide PDF File
- Adbry PDF File
- Adcirca PDF File
- Adderall XR PDF File
- Addyi PDF File
- Adempas PDF File
- Adlyxin PDF File
- Admelog PDF File
- Adzensys XR-ODT PDF File
- Afrezza PDF File
- Aimovig PDF File
- AirDuo (BRAND ONLY) PDF File
- Ajovy PDF File
- Aklief PDF File
- Aldurazyme PDF File
- Alinia PDF File
- Alkindi Sprinkles PDF File
- Almotriptan PDF File
- Alrex PDF File
- Altreno PDF File
- Alvesco PDF File
- Alyq PDF File
- Ambrisentan PDF File
- Amitiza (BRAND ONLY) PDF File
- Amjevita PDF File
- Amphetamine-Dextroamphetamine ER PDF File
- Amphetamine ER PDF File
- Amphetamine sulfate PDF File
- Amvuttra PDF File
- Amzeeq PDF File
- Anastrazole PDF File
- Androderm PDF File
- Androgel PDF File
- Androgel Pump PDF File
- Apidra PDF File
- Aptensio XR PDF File
- Aralast NP PDF File
- Arazlo PDF File
- Aripiprazole oral solution PDF File
- Armodafinil PDF File
- ArmonAir PDF File
- Asceniv PDF File
- Aspruzyo Sprinkle PDF File
- Atralin PDF File
- Aubagio PDF File
- Austedo PDF File
- Avastin PDF File
- Avita PDF File
- Avonex PDF File
- Avsola PDF File
- Axert PDF File
- Azelastine/fluticasone nasal spray PDF File
- Azelex PDF File
- Azstarys PDF File
Policies starting with B
- Baclofen oral solution PDF File
- Bafiertam PDF File
- Banzel PDF File
- Bavencio PDF File
- Beconase AQ PDF File
- Belsomra PDF File
- Benzaclin PDF File
- Benzoyl Peroxide/Clindamycin PDF File
- Berinert PDF File
- Besremi PDF File
- Betaseron PDF File
- Bevacizumab PDF File
- Bivigam PDF File
- Bosentan PDF File
- Botox PDF File
- Brenzavvy PDF File
- Breyanzi PDF File
- Breztri Aerosphere PDF File
- Brineura PDF File
- Briumvi PDF File
- Bronchitol PDF File
- Budesonide/Formoterol Fumarate Inhalation PDF File
- Bydureon BCise PDF File
- Byetta PDF File
- Bylvay PDF File
Policies starting with C
- Camzyos PDF File
- Caplyta PDF File
- Carac Cream PDF File
- Carimune NF PDF File
- Carospir PDF File
- Carvykti PDF File
- Cerdelga PDF File
- Cerezyme PDF File
- Cequa PDF File
- Cibinqo PDF File
- Cimzia PDF File
- Cinryze PDF File
- Cinqair PDF File
- Citalopram oral solution PDF File
- Clindamycin Foam PDF File
- Clindamycin phosphate/tretinoin topical PDF File
- Clobazam PDF File
- Compounded Drug Products PDF File
- Concerta PDF File
- Condylox Gel PDF File
- Copaxone PDF File
- Corlanor PDF File
- Cosentyx PDF File
- Cotempla XR PDF File
- Crysvita PDF File
- Cutaquig PDF File
- Cuvitru PDF File
- Cuvposa PDF File
Policies starting with D
- Dapsone topical gel PDF File
- Dartisla ODT PDF File
- Daybue PDF File
- Daytrana PDF File
- Dayvigo PDF File
- Desvenlafaxine ER PDF File
- Desvenlafaxine Fumarate ER PDF File
- Dexedrine PDF File
- Dexilant PDF File
- Dexlansoprazole PDF File
- Dexmethylphenidate ER PDF File
- Dextroamphetamine ER PDF File
- Diacomit PDF File
- Diclofenac epolamine patch PDF File
- Differin 0.3% PDF File
- Dificid Oral Suspension PDF File
- Dimethyl Fumarate PDF File
- Dojolvi PDF File
- Doptelet PDF File
- Doryx PDF File
- Doxepin (generic Silenor) PDF File
- Doxycycline delayed release PDF File
- Doxycycline Hyclate delayed release tablet PDF File
- Drizalma Sprinkles PDF File
- Duac PDF File
- Dulera PDF File
- Dupixent PDF File
- Durolane PDF File
- Dyanavel XR PDF File
- Dymista PDF File
- Dysport PDF File
Policies starting with E
- Edluar PDF File
- Elaprase PDF File
- Elelyso PDF File
- Eletriptan PDF File
- Elyxyb PDF File
- Emflaza PDF File
- Emgality PDF File
- Empaveli PDF File
- Enalapril oral solution PDF File
- Enbrel PDF File
- Enjaymo PDF File
- Enspryng PDF File
- Entresto PDF File
- Entyvio PDF File
- Epaned PDF File
- Epclusa PDF File
- Epidiolex PDF File
- Epiduo Forte PDF File
- Epogen PDF File
- Epoprostenol PDF File
- Eprontia PDF File
- Esbriet PDF File
- Esomeprazole Strontium PDF File
- Eucrisa PDF File
- Euflexxa PDF File
- Evekeo PDF File
- Evekeo ODT PDF File
- Evenity PDF File
- Evkeeza PDF File
- Evoclin PDF File
- Evrysdi PDF File
- Exemestane PDF File
- Extavia PDF File
- Eysuvis PDF File
Policies starting with F
- Fabior PDF File
- Fabrazyme PDF File
- Fasenra PDF File
- Fetzima PDF File
- Filspari PDF File
- Finacea 15% foam PDF File
- Fintepla PDF File
- Firazyr/Sajazir PDF File
- Firdapse PDF File
- Firvanq PDF File
- Flebogamma PDF File
- Flector PDF File
- Fleqsuvy PDF File
- Flolan PDF File
- FloLipid PDF File
- Flovent PDF File
- Flunisolide Nasal Solution PDF File
- Fluorouracil 0.5% Cream PDF File
- Fluorouracil topical PDF File
- Fluvoxamine Maleate ER PDF File
- Focalin XR PDF File
- Forteo PDF File
- Fortesta PDF File
- Frova PDF File
- Frovatriptan PDF File
Policies starting with G
Policies starting with H
- Harvoni PDF File
- Haegarda PDF File
- Hemgenix PDF File
- Herceptin PDF File
- Hetlioz PDF File
- High dollar drug review policy PDF File
- Hizentra PDF File
- Humalog PDF File
- Humalog Mix 50/50 PDF File
- Humalog Mix 75/25 PDF File
- Humatrope PDF File
- Humira PDF File
- Humulin 70/30 PDF File
- Humulin N PDF File
- Humulin R-100 PDF File
- Hyalgan PDF File
- Hymovis PDF File
- HyQvia PDF File
Policies starting with I
- Icatibant PDF File
- Ilumya PDF File
- Imcivree PDF File
- Imitrex injection PDF File
- Imiquimod Pump 3.75% cream PDF File
- Inbrija PDF File
- Increlex PDF File
- Indocin oral suspension PDF File
- Inflectra PDF File
- Ingrezza PDF File
- Inpefa PDF File
- Interim Policy on New FDA Approvals PDF File
- Insulin Degludec PDF File
- Intermezzo PDF File
- Invokamet PDF File
- Invokamet XR PDF File
- Invokana PDF File
- Isturisa PDF File
- Itraconazole PDF File
- Ivermectin PDF File
Policies starting with J
Policies starting with K
- Kalbitor PDF File
- Kalydeco PDF File
- Kanuma PDF File
- Katerzia PDF File
- Kazano PDF File
- Kerendia PDF File
- Kerydin PDF File
- Kesimpta PDF File
- Kevzara PDF File
- Keytruda PDF File
- Khedezla PDF File
- Kineret PDF File
- Klisyri PDF File
- Kombiglyze ER PDF File
- Korlym PDF File
- Koselugo PDF File
- Krystexxa PDF File
- Kymriah PDF File
- Kynmobi PDF File
Policies starting with L
- Lamzede PDF File
- Lanreotide PDF File
- Lansoprazole PDF File
- Lantus PDF File
- Ledipasvir/sofosbuvir PDF File
- Lemtrada PDF File
- Leqvio PDF File
- Letairis PDF File
- Leukine PDF File
- Liqrev PDF File
- Livmarli PDF File
- Lucemyra PDF File
- Lumizyme PDF File
- Lupkynis PDF File
- Luvox CR PDF File
- Luxturna PDF File
- Lybalvi PDF File
- Lyrica solution PDF File
- Lyumjev PDF File
- Lyvispah PDF File
Policies starting with M
- Mavenclad PDF File
- Mavyret PDF File
- Mayzent PDF File
- Memantine oral solution PDF File
- Mepsevii PDF File
- Metadate CD PDF File
- Metadate ER PDF File
- Metformin oral solution PDF File
- Methitest PDF File
- Methylphenidate CD PDF File
- Methylphenidate ER PDF File
- Methyltestosterone PDF File
- Miebo PDF File
- Miglustat PDF File
- Minocycline ER PDF File
- Mirapex ER PDF File
- Mircera PDF File
- Mirvaso PDF File
- Modafinil PDF File
- Mometasone Nasal Spray PDF File
- Monovisc PDF File
- Motegrity PDF File
- Mounjaro PDF File
- Movantik PDF File
- Mulpleta PDF File
- Mycapssa PDF File
- Mydayis PDF File
- Myfembree PDF File
- Myobloc PDF File
- Myrbetriq granules PDF File
Policies starting with N
- Naglazyme PDF File
- Namenda oral solution PDF File
- Naprosyn suspension PDF File
- Naproxen suspension PDF File
- Natesto PDF File
- Nayzilam PDF File
- Nesina PDF File
- Neuac PDF File
- Neulasta PDF File
- Neulasta Onpro PDF File
- Neupogen PDF File
- Neupro PDF File
- Nexium Capsules PDF File
- Nexium Packets PDF File
- Nexletol PDF File
- Nexlizet PDF File
- Nexviazyme PDF File
- Norditropin PDF File
- Norliqva PDF File
- Nortriptyline oral solution PDF File
- Nourianz PDF File
- Nucala PDF File
- Nulibry PDF File
- Nurtec PDF File
- Nutropin PDF File
- Nutropin AQ PDF File
- Nuvigil PDF File
Policies starting with O
- Ocaliva PDF File
- Ocrevus PDF File
- Octagam PDF File
- Odactra PDF File
- Ofev PDF File
- Off-label policy PDF File
- Olpruva PDF File
- Olumiant PDF File
- Omeprazole PDF File
- Omisirge PDF File
- Omnaris PDF File
- Omnipod PDF File
- Omnitrope PDF File
- Onexton PDF File
- Onfi PDF File
- Ongentys PDF File
- Onglyza PDF File
- Onmel PDF File
- Onpattro PDF File
- Opdivo PDF File
- Opdualag PDF File
- Opsumit PDF File
- Opzelura PDF File
- Oraceav PDF File
- Oralair PDF File
- Orencia PDF File
- Orenitram PDF File
- Oriahnn PDF File
- Orilissa PDF File
- Orkambi PDF File
- Orladeyo PDF File
- Orthovisc PDF File
- Oseni PDF File
- Osmolex ER PDF File
- Otezla PDF File
- Oxbryta PDF File
- Oxervate PDF File
- Oxlumo PDF File
- Ozempic PDF File
- Ozobax PDF File
Policies starting with P
- Palforzia PDF File
- Palynziq PDF File
- Pantoprazole PDF File
- Panzyga PDF File
- Paroxetine Suspension PDF File
- Paxil Suspension PDF File
- Pegasys PDF File
- Pennsaid 2% solution PDF File
- Pexeva PDF File
- Pheburane PDF File
- Picato PDF File
- Pirfenidone PDF File
- Plegridy PDF File
- Ponvory PDF File
- Pradaxa PDF File
- Praluent PDF File
- Pramipexole ER PDF File
- Pregabalin oral solution PDF File
- Prevacid Solutabs PDF File
- Prilosec Packets PDF File
- Privigen PDF File
- Procrit PDF File
- Prolastin-C PDF File
- Promacta PDF File
- Protonix Packets PDF File
- Provenge PDF File
- Provigil PDF File
- Pulmicort Flexhaler PDF File
- Purixan PDF File
- Pyrukynd PDF File
Policies starting with Q
Policies starting with R
- Rabeprazole PDF File
- Radicava PDF File
- Ragwitek PDF File
- Raloxifene PDF File
- Ramelteon PDF File
- Rapamune oral solution PDF File
- Ravicti PDF File
- Rebif PDF File
- Reblozyl PDF File
- Recorlev PDF File
- Relistor PDF File
- Relpax PDF File
- Relyvrio PDF File
- Remicade PDF File
- Remodulin PDF File
- Renflexis PDF File
- Repatha PDF File
- Requip XL PDF File
- Respository Corticotropin Injection PDF File
- Retin A Micro PDF File
- Retin-A PDF File
- Revatio PDF File
- Revcovi PDF File
- Rexulti PDF File
- Reyvow PDF File
- Rezurock PDF File
- Rezvoglar PDF File
- Rhofade PDF File
- Riabni PDF File
- Rinvoq PDF File
- Riomet PDF File
- Riomet ER PDF File
- Risperidal oral disintegrating tablet PDF File
- Risperdal oral solution PDF File
- Risperidone oral disintegrating tablet PDF File
- Risperidone oral solution PDF File
- Ritalin LA PDF File
- Rituxan PDF File
- Rituxan Hycela PDF File
- Rolvedon PDF File
- Ropinirole ER PDF File
- Rozerem PDF File
- Ruconest PDF File
- Rufinamide PDF File
- Ruxience PDF File
- Ruzurgi PDF File
- Ryaltris PDF File
- Ryplazim PDF File
- Rytary PDF File
Policies starting with S
- Saizen PDF File
- Samsca PDF File
- Sandostatin LAR Depot PDF File
- Saphnelo PDF File
- Savaysa PDF File
- Scemblix PDF File
- Scenesse PDF File
- Secuado PDF File
- Segluromet PDF File
- Semglee PDF File
- Serostim PDF File
- Seysara PDF File
- Signifor LAR PDF File
- Sildenafil PDF File
- Silenor PDF File
- Siliq PDF File
- Simponi PDF File
- Simponi Aria PDF File
- Simvastatin oral suspension PDF File
- Sirolimus oral solution PDF File
- Skyclarys PDF File
- Skyrizi PDF File
- Skysona PDF File
- Skytrofa PDF File
- Sodium Hyaluronate PDF File
- Sofosbuvir/velpatasvir PDF File
- Sogroya PDF File
- Soliris PDF File
- Solodyn PDF File
- Soltamox PDF File
- Somatuline Depot PDF File
- Somavert PDF File
- Soolantra PDF File
- Sotyktu PDF File
- Sotylize PDF File
- Sovaldi PDF File
- Spevigo PDF File
- Spinraza PDF File
- Sporanox PDF File
- Spravato PDF File
- Steglatro PDF File
- Steglujan PDF File
- Stelara PDF File
- Stimufend PDF File
- Strensiq PDF File
- Striant PDF File
- Sumatriptan injection PDF File
- Sumatriptan/naproxen PDF File
- Sumavel Dosepro PDF File
- Sunosi PDF File
- Supartz PDF File
- Susvimo PDF File
- Syfovre PDF File
- Symdeko PDF File
- Sympazan PDF File
- Symproic PDF File
- Synagis PDF File
- Syndros PDF File
- Synojoynt PDF File
- Synvisc PDF File
- Synvisc-One PDF File
Policies starting with T
- Tadalafil PDF File
- Tadliq PDF File
- Takhzyro PDF File
- Taltz PDF File
- Tamoxifen PDF File
- Tarpeyo PDF File
- Tascenso PDF File
- Tasmar PDF File
- Tavaborole topical PDF File
- Tavalisse PDF File
- Tavneos PDF File
- Tazarotene 0.1% foam PDF File
- Tecartus PDF File
- Tecfidera PDF File
- Tegsedi PDF File
- Tepezza PDF File
- Teriflunomide PDF File
- Teriparatide PDF File
- Testim PDF File
- Testopel PDF File
- Testosterone Gel 1% PDF File
- Testosterone Gel Pump 1% PDF File
- Tezspire PDF File
- Tlando PDF File
- Tolcapone PDF File
- Tolsura PDF File
- Tolvaptan PDF File
- Tosymra PDF File
- Tracleer PDF File
- Tradjenta PDF File
- Trastuzumab PDF File
- Tremfya PDF File
- Treprostinil PDF File
- Tretin-X PDF File
- Tretinoin Micronized topical PDF File
- Tretinoin topical PDF File
- Treximet PDF File
- Trikafta PDF File
- Triluron PDF File
- Trintellix PDF File
- Trivisc PDF File
- Trulicity PDF File
- Truxima PDF File
- Turalio PDF File
- Tymlos PDF File
- Tyrvaya PDF File
- Tysabri PDF File
- Tyvaso PDF File
- Tyvaso DPI PDF File
- Tzield PDF File
Policies starting with U
Policies starting with V
- Valtoco PDF File
- Vancocin PDF File
- Vancomycin PDF File
- Vascepa PDF File
- Veletri PDF File
- Veltin PDF File
- Ventavis PDF File
- Veramyst PDF File
- Veregen Ointment PDF File
- Verquvo PDF File
- Vesicare PDF File
- Vevye PDF File
- Victoza PDF File
- Viekira Pak PDF File
- Viibryd PDF File
- Vijoice PDF File
- Visco-3 PDF File
- Vogelxo PDF File
- Vonjo PDF File
- Vosevi PDF File
- Vowst PDF File
- Voxzogo PDF File
- VPRIV PDF File
- Vraylar PDF File
- Vtama PDF File
- Vyepti PDF File
- Vyleesi PDF File
- Vyndamax PDF File
- Vyndaqel PDF File
- Vyvgart PDF File
Policies starting with W
Policies starting with X
Policies starting with Y
Policies starting with Z
- Zavesca PDF File
- Zavzpret PDF File
- Zecuity PDF File
- Zelapar PDF File
- Zemaira PDF File
- Zepatier PDF File
- Zeposia PDF File
- Zetonna PDF File
- Ziana PDF File
- Zilxi PDF File
- Zokinvy PDF File
- Zolgensma PDF File
- Zolmitriptan nasal spray PDF File
- Zolpidem sublingual tablet PDF File
- Zolpimist PDF File
- Zomacton PDF File
- Zomig Nasal Spray PDF File
- Zonisade PDF File
- Zorbtive PDF File
- Zoryve PDF File
- Zulresso PDF File
- Ztalmy PDF File
- Zyclara PDF File
- Zynteglo PDF File
- Zynyz PDF File