Drug authorization list

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Drug authorization & quantity limits

Looking for a specific drug authorization list? Use Ctrl + F (Windows) or Command + F (Mac) to search by drug name. You can also browse the alphabetically organized accordions below.

Opioid Medication Management Program

Drugs for Weight Loss Management policy

A – M
A

Abecma

Acanya

Aciphex

Aciphex Sprinkles

Actemra

Acthar Gel

Aczone

Adalimumab-aacf

Adalimumab-adbm

Adakveo

Adapalene 0.3%

Adapalene/Benzoyl Peroxide

Adbry

Adcirca

Adderall XR

Addyi

Adempas

Admelog

Adstiladrin

Advair HFA (BRAND ONLY)

Advair Diskus (BRAND ONLY)

Adzensys XR-ODT

Adzynma

Afrezza

Agamree

Aimovig

AirDuo (BRAND ONLY)

Ajovy

Aklief

Aldurazyme

Alhemo

Alinia

Alkindi Sprinkles

Alrex

Altreno

Alvaiz

Alvesco

Alyftrek

Alyglo

Alymsys

Alyq

Ambrisentan

Amitiza (BRAND ONLY)

Amphetamine-Dextroamphetamine ER

Amphetamine ER

Amphetamine sulfate

Amtagvi

Amvuttra

Amzeeq

Anastrozole

Andembry

Androderm

Androgel

Androgel Pump

Anktiva

Anzupgo

Apidra

Aptensio XR

Aqneursa

Aqvesme

Aralast NP

Arazlo

Arbli

Aripiprazole oral solution

Armlupeg

Armodafinil

Arynta

Asceniv

Aspruzyo Sprinkle

Atmeksi

Atoncy

Atorvaliq

Atralin

Attruby

Aubagio

Augtyro

Austedo

Aucatzyl

Avastin

Avita

Avlayah

Avmapki Fakzynja Co-Pack

Avonex

Avsola

Avtozma

Axert

Azelastine/fluticasone nasal spray

Azelex

Azstarys

B

Baclofen oral solution

Bafiertam

Baraclude

Bavencio

Beconase AQ

Belsomra

Benzoyl Peroxide/Clindamycin

Beovu

Beqvez

Berinert

Besremi

Betaseron

Bevacizumab

Bexagliflozin

Bimzelx

Bivigam

Bizengri

Bkemv

Blenrep

Bomyntra

Boncresa

Bosentan

Botox

Brenzavvy

Breyanzi

Brineura

Brinsupri

Briumvi

Brynovin

Bydureon BCise

Byetta

Bylvay

Byooviz

C

Camzyos

Caplyta

Carac Cream

Carvykti

Casgevy

Cavhanza

Cerdelga

Cerezyme

Cequa

Cibinqo

Cimerli

Cimzia

Cinqair

Cinryze

Citalopram oral solution

Clindamycin Foam

Clindamycin phosphate/tretinoin topical

Clobazam

Cobenfy

Compounded Drug Products

Concerta

Condylox Gel

Conexxence

Copaxone

Corlanor

Cosentyx

Cotempla XR

Crenessity

Crysvita

Cutaquig

Cuvitru

Cuvposa

Cyclosporine Ophthalmic Emulsion

D

Danziten

Dapagliflozin

Dapagliflozin-Metformin

Dapsone topical gel

Dartisla ODT

Dawnzera

Daxxify

Daybue

Daytrana

Dayvigo

Denosumab

Desvenlafaxine ER

Desvenlafaxine Fumarate ER

Dexcom

Dexedrine

Dexilant

Dexlansoprazole

Dexmethylphenidate ER

Dextroamphetamine ER

Diacomit

Diclofenac epolamine patch

Differin 0.3%

Dificid Oral Suspension

Dimethyl Fumarate

Dojolvi

Doptelet

Doryx

Doxepin (generic Silenor)

Doxycycline delayed release

Doxycycline Hyclate delayed release tablet

Duac

Dulera

Dupixent

Durolane

Duvyzat

Dyanavel XR

Dysport

E

Ebglyss

Eculizumab

Edluar

Ekterly

Elaprase

Elelyso

Elfabrio

Elrexfio

Elyxyb

Emflaza

Emgality

Empaveli

Emrelis

Enalapril oral solution

Enbrel

Encelto

Enjaymo

Ennumo

Enoby

Enspryng

Entyvio

Epaned

Epclusa

Epidiolex

Epiduo Forte

Epogen

Epoprostenol

Eprontia

Epysqli

Esbriet

Eucrisa

Euflexxa

Evekeo

Evekeo ODT

Evenity

Evkeeza

Evoclin

Evrysdi

Exdensur

Exemestane

Extavia

Eydenzelt

Eylea/Eylea HD

Eysuvis

F

Fabhalta

Fabior

Fabrazyme

Fasenra

Feraheme

Ferrlecit

Fetzima

Filkri

Filspari

Filsuvez

Finacea 15% foam

Fintepla

Firazyr/Sajazir

Firdapse

Firvanq

Flebogamma

Flector

Fleqsuvy

Flolan

FloLipid

Flovent

Flunisolide Nasal Solution

Fluorouracil 0.5% Cream

Fluorouracil topical

Fluvoxamine Maleate ER

Focalin XR

Forteo

Fortesta

Forzinity

Foundayo

Freestyle Libre

Fulphila

Fylnetra

G

Galafold

Gamifant

Gammagard

Gammaked

Gammaplex

Gamunex C

Gel-One

Gelsyn-3

Genotropin

Genvisc 850

Gilenya

Givlaari

Glassia

Glatiramer

Glatopa

Gloperba

Glucose Test Strips

Glycopyrrolate oral solution

Gocovri

Gomekli

Granix

Guardian

H

Hadlima

Haegarda

Harvoni

Hemgenix

Hepcludex

Hepzato Kit

Herceptin

Hercessi

Hernexeos

Herzuma

Hetlioz

High dollar drug review policy

Hizentra

Humalog

Humalog Mix 50/50

Humalog Mix 75/25

Humatrope

Humira 10mg/20mg

Humulin 70/30

Humulin N

Humulin R-100

Hyalgan

Hymovis

Hympavzi

HyQvia

Hyrnuo

I

Ibsrela

Ibtrozi

Icatibant

Icotyde

Ilumya

Imaavy

Imcivree

Imiquimod Pump 3.75% cream

Imitrex injection

Imuldosa

Inbrija

Increlex

Indocin oral suspension

Infed

Inflectra

Ingrezza

Injectafer

Inlexzo

Inpefa

Inrebic

Instinct

Insulin Degludec

Insulin Glargine U-300

Intermezzo

Invokamet

Invokamet XR

Invokana

Inzirqo oral suspension

Iqirvo

Isturisa

Itovebi

Itraconazole

Itvisma

Ivermectin

Izervay

J

Jascayd

Jatenzo

Jaythari

Jentadueto

Jesduvroq

Jobevne

Joenja

Jubbonti

Jublia

Juxtapid

Jylamvo

Jynarque

K

Kalbitor

Kalydeco

Kanjinti

Kanuma

Katerzia

Kazano

Kebilidi

Keratolytics Other Topical Dermatological Agents

Kerendia

Kerydin

Kesimpta

Kevzara

Keytruda

Keytruda Qlex

Khindivi

Kineret

Kirsty

Kisunla

Klisyri

Kombiglyze ER

Komzifti

Konvomep

Korlym

Koselugo

Krystexxa

Kygevvi

Kymbee

Kymriah

Kynmobi

L

Lamzede

Lanreotide

Lansoprazole

Lantidra

Lantus

Latuda

Lazcluze

Ledipasvir/sofosbuvir

Lemtrada

Lenmeldy

Leqembi

Leqembi Iqlk

Leqselvi

Leqvio

Lerochol

Letairis

Leukine

Lifyorli

Likmez

Liqrev

Liraglutide

lisdexamfetamine

Litfulo

Livdelzi

Livmarli

Loargys

Lopressor

Lucentis

Lumizyme

Lumvoa

Lupkynis

Luvox CR

Luxturna

Lybalvi

Lyfgenia

Lymphir

Lynavoy

Lynozyfic

Lyrica solution

Lyumjev

Lyvispah

M

Mavenclad

Mavyret

Mayzent

Meloxicam Oral Suspension

Memantine oral solution

Mepsevii

Merilog

Metadate CD

Metadate ER

Metformin oral solution

Methitest

Methylphenidate CD

Methylphenidate ER

Methyltestosterone

Miebo

Miglustat

Minocycline ER

Miplyffa

Mirapex ER

Mircera

Mirvaso

Modafinil

Modeyso

Mometasone Nasal Spray

Monoferric

Monovisc

Motegrity

Mounjaro

Movantik

Mulpleta

Mycapssa

Mydayis

Myfembree

Myobloc

Myqorzo

Myrbetriq granules

N – Z
N

Naglazyme

Namenda oral solution

Naprosyn suspension

Naproxen suspension

Natesto

Nemluvio

Nesina

Neuac

Neulasta

Neulasta Onpro

Neupogen

Neupro

Nexium Capsules

Nexium Packets

Nexletol

Nexlizet

Nexviazyme

Ngenla

Niktimvo

Nivestym

Non-Formulary Exception

Norditropin

Noritate

Norliqva

Nortriptyline oral solution

Nourianz

Noxafil PowderMix

Nucala

Nufymco

Nulibry

Nurtec

Nutropin

Nutropin AQ

Nuvigil

Nypozi

Nyvepria

O

Ocaliva

Ocrevus

Octagam

Ofev

Ogivri

Ogsiveo

Ojjaara

Olpruva

Olumiant

Omeprazole

Omisirge

Omnaris

Omnipod

Omnitrope

Omvoh

Onexton

Ongentys

Onglyza

Onpattro

Ontruzant

Onyda

Opdivo

Opdivo Qvantig

Opdualag

Opfolda

Opsumit

Opsynvi

Opzelura

Oracea

Orencia

Orenitram

Orfadin (generic Nitisinone)

Oriahnn

Orilissa

Orkambi

Orladeyo

Orthovisc

Oseni

Osenvelt

Osmolex ER

Osvyrti

Otezla

Otulfi

Oxervate

Oxlumo

Ozempic

Oziltus

Ozobax

Ozobax DS

P

Palsonify

Palynziq

Panhematin

Pantoprazole

Panzyga

Papzimeos

Paroxetine Suspension

Paxil Suspension

Pegasys

Pennsaid 2% solution

Pexeva

Pheburane

PiaSky

Picato

Pirfenidone

Pizensy

Plegridy

Pombiliti

Ponvory

Pradaxa

Praluent

Pramipexole ER

Pregabalin oral solution

Prevacid Solutabs

Prilosec Packets

Privigen

Procrit

Prolastin-C

Prolia

Promacta

Protonix Packets

Provenge

Provigil

Pulmicort Flexhaler

Purixan

Pyquvi

Pyrukynd

Pyzchiva

Q

Qalsody

Qbrelis

Qelbree

Qfitlia

Qivigy

Qnasl

Qnasl Children

Qtern

QuilliChew ER

Quillivant XR

Qulipta

Quviviq

R

Rabeprazole

Radicava

Raldesy

Raloxifene

Ramelteon

Rapamune oral solution

Ravicti

Rebif

Reblozyl

Recorlev

Redemplo

Releuko

Relistor

Remicade

Remodulin

Renflexis

Repatha

Requip XL

Respository Corticotropin Injection

Retacrit

Retin A Micro

Retin-A

Revatio

Revcovi

Revuforj

Rexulti

Reyvow

Rezdiffra

Rezurock

Rezvoglar

Rhapsido

Rhofade

Riabni

Rinvoq

Riomet

Riomet ER

Risperdal oral disintegrating tablet

Risperdal oral solution

Risperidone oral disintegrating tablet

Risperidone oral solution

Ritalin LA

Rituxan

Rituxan Hycela

Rituximab

Rivfloza

Roctavian

Rolvedon

Romvimza

Ropinirole ER

Rozerem

Ruconest

Rufinamide

Ruxience

Ryaltris

Rybelsus

Ryoncil

Ryplazim

Rystiggo

Rytary

Rytelo

Ryzneuta

S

Saizen

Samsca

Sandostatin LAR Depot

Saphnelo

Savaysa

Saxagliptin

Saxagliptin/Metformin XR

Scenesse

Secuado

Segluromet

Selarsdi

Semglee

Sephience

Serostim

Seysara

Signifor LAR

Sildenafil

Silenor

Siliq

Simplera

Simponi

Simponi Aria

Simvastatin oral suspension

Sirolimus oral solution

Skyclarys

Skyrizi

Skysona

Skytrofa

Sodium Hyaluronate

Sofosbuvir/velpatasvir

Sogroya

Sohonos

Soliris

Solodyn

Soltamox

Somatuline Depot

Somavert

Soolantra

Sotyktu

Sotylize

Sovaldi

Spevigo

Spinraza

Sporanox

Spravato

Starjemza

Steglatro

Steglujan

Stelara

Steqeyma

Stimufend

Strensiq

Striant

Subvenite

Sumatriptan injection

Sumatriptan/naproxen

Sumavel Dosepro

Sunosi

Supartz

Susvimo

Syfovre

Symbicort (BRAND ONLY)

Symdeko

Symproic

Syndros

Synojoynt

Synvisc

Synvisc One

T

Tadalafil

Tadliq

Takhzyro

Taltz

Talvey

Tamoxifen

Tapentadol Oral Solution

Tarpeyo

Tascenso

Tasmar

Tavaborole topical

Tavalisse

Tavneos

Tazarotene 0.1% foam

Tecartus

Tecelra

Tecfidera

Tepezza

Teriflunomide

Teriparatide

Testim

Testopel

Testosterone Gel 1%

Testosterone Gel Pump 1%

Tevimbra

Tezruly

Tezspire

Tlando

Tofidence

Tolcapone

Tolvaptan

Tosymra

Tracleer

Tradjenta

Trastuzumab

Trazimera

Tremfya

Treprostinil

Tretin-X

Tretinoin Micronized topical

Tretinoin topical

Treximet

Trikafta

Triluron

Trintellix

Trivisc

Trulicity

Truqap

Truxima

Tryngolza

Tryptyr

Turalio

Twiist

Twyneo

Tyenne

Tymlos

Tyruko

Tyrvaya

Tysabri

Tyvaso

Tyvaso DPI

Tzield

U

Ubrelvy

Udenyca

Udenyca Onbody

Ultomiris

Unloxcyt

Uplizna

Uptravi

V

Vabysmo

Vafseo

Valsartan Oral Solution

Vancocin

Vancomycin

Vanrafia (atrasentan)

Vascepa

Vegzelma

Veletri

Velsipity

Veltin

Ventavis

Venofer

Veopoz

Veramyst

Veregen Ointment

Verquvo

Vesicare

Vevye

Victoza

Viekira Pak

Vigafyde

Viibryd

Vijoice

Vimizim

Visco-3

Vivitrol

Vogelxo

Vonjo

Voranigo

Vosevi

Vostally

Vowst

Voxzogo

Voydeya

Voyxact

VPRIV

Vraylar

Vtama

Vumerity

Vyaley

Vyepti

Vyjuvek

Vykat XR

Vyleesi

Vyndamax

Vyndaqel

Vyscoxa

Vyvanse

Vyvgart

Vyvgart Hytrulo

W

Wainua

Wakix

Waskyra

Wayrilz

Wegovy (Supplemental Indications)

Wezlana

Winlevi

Winrevair

Wyost

X

Xadago

Xatmep

Xeljanz

Xeljanz Oral Solution

Xeljanz XR

Xelstyrm

Xembify

Xenpozyme

Xeomin

Xermelo

Xgeva

Xiaflex

Ximino

Xolair

Xolremdi

Xromi

Xyosted

Xyrem

Xywav

Y

Yartemlea

Yervoy

Yescarta

Yesintek

Yimmugo

Yutrepia

Yuviwel

Yorvipath

Z

Zarxio

Zavesca

Zavzpret

Zecuity

Zegfrovy

Zelapar

Zemaira

Zepatier

Zeposia

Zerviate

Zetonna

Zevaskyn

Ziana

Ziextenzo

Ziihera

Zilbrysq

Zilxi

Zokinvy

Zolgensma

Zolmitriptan nasal spray

Zolpidem sublingual tablet

Zolpimist

Zomacton

Zomig Nasal Spray

Zonisade

Zoryve

Ztalmy

Zusduri

Zunovo

Zurzuvae

Zyclara

Zycubo

Zymfentra

Zynteglo

Zynyz

Wellmark does not require prior authorization for the preferred product(s) within this drug policy. Please review the drug policy for additional information. This does not apply to Wellmark Advantage Health Plan or Federal Employee Program (FEP) members.