Pharmacy benefit drug policy list
Part D drug list for Medicare plans
View Medicare formularies, prior authorization, and step therapy criteria by selecting the appropriate plan and county.
Pharmacy Benefit drug policies for Commercial plans
- Policy Name
- abaloparatide injection (Tymlos)
- abatacept (Orencia)
- abemaciclib (Verzenio)
- abiraterone (Zytiga)
- abiraterone acetate (Yonsa)
- abrocitinib (Cibinqo)
- acalabrutinib (Calquence)
- aceclidine (Vizz)
- aclidinium bromide inhaler (Tudorza Pressair)
- aclidinium-formoterol (Duaklir)
- acoltremon ophthalmic solution (Tryptyr)
- acoramidis hcl (Attruby)
- acyclovir cream, ointment (Zovirax)
- acyclovir-hydrocortisone cream ( Xerese)
- adagrasib (Krazati)
- adalimumab-aacf
- adalimumab-ryvk (Simlandi)
- adapalene (Plixda)
- adapalene cream, gel (Differin)
- adapalene solution
- adapalene-benzoyl peroxide (Epiduo and Epiduo Forte)
- afatinib (Gilotrif)
- albuterol sulfate (ProAir Respiclick)
- albuterol-budesonide (Airsupra)
- alectinib (Alecensa)
- alendronate effervescent tablet (Binosto)
- alirocumab (Praluent)
- aliskiren (Tekturna)
- alitretinoin (Panretin)
- almotriptan (Axert)
- alogliptin (Nesina)
- alogliptin-metformin (Kazano)
- alogliptin-pioglitazone (Oseni)
- alosetron (Lotronex)
- alpelisib (Piqray)
- alpelisib (Vijoice)
- alprostadil (Caverject, Edex)
- amantadine (Gocovri)
- ambrisarten (Letairis)
- amcinonide cream, ointment
- amifampridine phosphate (Firdapse)
- amikacin inhalation (Arikayce)
- amlodipine (Katerzia, Norliqva)
- amlodipine-atorvastatin (Caduet)
- amlodipine-celecoxib (Consensi)
- amlodipine-valsartan-HCTZ (Exforge HCTZ)
- amphetamine (Dyanavel XR)
- amphetamine extended-release (Adzenys XR ODT)
- amphetamine sulfate (Evekeo, Evekeo ODT)
- amphetamine-dexamphetamine capsule, extended-release (Adderall XR)
- amphetamine-dexamphetamine tablet (Adderall)
- amphetamine-dextroamphetamine (Mydayis)
- anakinra (Kineret)
- apalutamide (Erleada)
- apomorphine (Apokyn)
- apremilast (Otezla, Otezla XR)
- aprocitentan (Tryvio)
- arimoclomol (Miplyffa)
- aripiprazole (Opipza)
- asciminib (Scemblix)
- asenapine (Secuado)
- asfotase alfa (Strensiq)
- aspirin/omeprazole (Yosprala)
- atogepant (Qulipta)
- atorvastatin (Atorvaliq)
- atovaquone (Mepron)
- atrasentan (Vanrafia)
- avacopan (Tavneos)
- avanafil (Stendra)
- avatrombopag (Doptelet)
- avutometinib-defactinib (Avmapki Fakzynja Co-Pack)
- axitinib (Inlyta)
- ayvapritinib (Ayvakit)
- azacitidine (Onureg)
- azilsartan (Edarbi)
- azilsartan-chlorthalidone (Edarbyclor)
- aztreonam (Cayston)
- baclofen (Lyvispah)
- baclofen (Ozobax)
- baclofen suspension (Fleqsuvy)
- baricitinib (Olumiant)
- becaplermin (Regranex)
- beclomethasone (Qnasl)
- bedaquiline (Sirturo)
- belimumab (Benlysta)
- belumosudil (Rezurock)
- belzutifan (Welireg)
- bempedoic acid (Nexletol)
- bempedoic acid-ezetimibe (Nexlizet)
- benralizumab (Fasenra)
- benzgalantamine (Zunveyl)
- benzphetamine (Didrex)
- berdazimer topical gel (Zelsuvmi)
- berotralstat (Orladeyo)
- betamethasone foam (Luxiq Foam)
- betamethasone spray (Sernivo)
- bexagliflozin (Brenzavvy)
- bexarotene capsules and gel (Targretin)
- bimatoprost (Lumigan)
- bimekizumab (Bimzelx)
- binimetinib (Mektovi)
- birch triterpenes (Filsuvez)
- bismuth subcitrate potassium, metronidazole, tetracycline hydrochloride (Pylera)
- Blood Glucose Test Strips
- bosentan (Tracleer)
- bosutinib (Bosulif)
- bremelanotide injection (Vyleesi)
- brensocatib (Brinsupri)
- brexpiprazole (Rexulti)
- brigatinib (Alunbrig)
- brimonidine (Mirvaso)
- brinzolamide (Azopt)
- brivaracetam (Briviact)
- brodalumab (Siliq)
- bromfenac (Bromsite)
- bromfenac (Prolensa 0.7%)
- bromocriptine (Cycloset)
- budesonide (Entocort EC)
- budesonide (Tarpeyo)
- budesonide (Uceris)
- budesonide suspension (Eohilia)
- budesonide-glycopyrrolate-formoterol (Breztri)
- bumetanide nasal (Enbumyst)
- buprenorphine film (Belbuca)
- bupropion ER (Forfivo XL)
- butalbital-acetaminophen (Allzital)
- butalbital-acetaminophen-caffeine (Capacet, Fioricet, Phrenilin Forte, Vanatol LQ, Vanatol S)
- butalbital-acetaminophen-caffeine-codeine (Fioricet C)
- c1 esterase inhibitor (human) (Berinert)
- c1 esterase inhibitor (human) (Cinryze)
- c1 esterase inhibitor (Ruconest)
- cabozantinib (Cabometyx)
- cabozantinib (Cometriq)
- calcifediol (Rayaldee)
- calcipotriene foam (Sorilux)
- calcipotriene-betamethasone (Talconex)
- calcipotriene-betamethasone dipropionate cream (Wynzora)
- calcium-magnesium-potassium-sodium oxybates solution (Xywav)
- canagliflozin (Invokana)
- canagliflozin-metformin (Invokamet/Invokamet XR)
- cannabidiol cbd extract (Epidiolex)
- capivasertib (Truqap)
- caplacizumab (Cablivi)
- capmatinib (Tabrecta)
- carbamazepine 200mg chewable tablet
- carbidopa-levodopa (Rytary)
- carbidopa-levodopa er capsule (Crexont)
- carglumic acid (Carbaglu)
- cariprazine (Vraylar)
- carvedilol (Coreg CR)
- cedazuridine-decitabine tablet (Inqovi)
- celecoxib (Elyxyb)
- cenegermin (Oxervate)
- cenobamate (Xcopri)
- Cequr Simplicity 2U
- ceritinib (Zykadia)
- certolizumab (Cimzia)
- cetirizine solution (Zerviate)
- cetrorelix acetate (Cetrotide)
- chenodial (Chenodal)
- chlorpromazine oral solution
- chlorthalidone (Thalitone)
- chlorzoxazone (Lorzone, Parafon DSC)
- cholic acid (Cholbam)
- choriogonadotropin alfa (Ovidrel)
- chorionic gonadotropin (Pregnyl, Novarel)
- ciclesonide (Alvesco)
- ciclesonide (Omnaris, Zetonna)
- cinacalcet (Sensipar)
- ciprofloxacin-hydrocortisone otic (Cipro HC)
- citalopram 30 mg capsules (Celexa)
- CitraNatal Harmony
- CitraNatal Rx
- citric acid-glucono delta-lactone-magnesium carbonate (Renacidin)
- cladribine (Mavenclad)
- clascoterone cream (Winlevi)
- Clemastine syrup
- clindamycin phosphate foam (Evoclin)
- clindamycin phosphate-benzoyl peroxide gel (Acanya, Onexton)
- clindamycin phosphate-tretinoin gel (Veltin, Ziana)
- clobazam (Onfi)
- clobazam (Sympazan)
- clobetasol 0.05% ophthalmic suspension
- clobetasol foam (Olux-E, Tovet)
- clocortolone pivalate (Cloderm)
- clonidine (Onyda XR)
- clonidine extended release (Nexiclon XR)
- clozapine suspension (Versacloz)
- cobimetinib (Cotellic)
- codeine phosphate-chlorpheniramine (Tuxarin)
- colchicine (Gloperba)
- colchicine (Lodoco)
- corticotropin (Acthar, Cortrophin)
- crinecerfont (Crenessity)
- crisaborole (Eucrisa)
- crizotinib (Xalkori)
- crofelemer (Mytesi)
- crotamiton (Crotan)
- cyclobenzaprine (Amrix)
- cyclobenzaprine 7.5 mg (Fexmid)
- cyclosporine (Verkazia)
- cyclosporine ophthalmic solution 0.09% (Cequa)
- cysteamine (Procysbi)
- cysteamine eye drops (Cystadrops, Cystaran)
- dabigatran packet (Pradaxa)
- dabrafenib (Tafinlar)
- dacomitinib (Vizimpro)
- dalfampridine (Ampyra)
- danicopan (Voydeya)
- dapagliflozin (Farxiga)
- dapagliflozin propanediol
- dapagliflozin propanediol-metformin
- dapagliflozin-metformin (Xigduo XR)
- dapagliflozin-saxagliptin (Qtern)
- dapsone (Aczone)
- darbepoetin alfa (Aranesp)
- daridorexant (Quviviq)
- darolutamide (Nubeqa)
- dasatinib (Sprycel, Phyrago)
- dasiglucagon injection (Zegalogue)
- deferasirox sprinkle (Jadenu)
- deferiprone (Ferriprox)
- deflazacort (Emflaza, Jaythari, Kymbee, Pyqui)
- delafloxacin (Baxdela)
- delgocitinib (Anzupgo)
- desloratadine (Clarinex and Clarinex-D)
- desmopressin acetate (Nocdurna)
- desonide foam (Verdeso)
- desonide gel (Desonate)
- desoximetasone (Topicort)
- desvenlafaxine ER (Khedezla)
- deucravacitinib (Sotyktu)
- deuruxolitinib (Leqselvi)
- deutetrabenzine (Austedo)
- dexamethasone (Hemady)
- dexamethasone dose pack (Dexabliss, Dxevo, HiDex, Taperdex, Zcort)
- dexchlopheniramine (Ryclora)
- Dexcom (CGM)
- dexlansoprazole (Dexilant)
- dexmethylphenidate extended-release (Focalin XR)
- dexmethylphenidate tablet (generic Focalin)
- dextroamphetamine (Procentra oral solution, Zenzedi)
- dextroamphetamine extended-release (Dexedrine Spansule)
- dextroamphetamine transdermal (Xelstrym)
- dextromethorphan-bupropion (Auvelity)
- dextromethorphan-quinidine (Nuedexta)
- diazepam buccal film (Libervant)
- diazepam nasal spray (Valtoco)
- diazoxide choline (Vykat XR)
- dichlorphenamide (Keveyis, Ormalvi)
- diclofenac patch (Flector, Licart)
- diclofenac potassium (Cambia)
- diclofenac sodium gel
- diclofenac topical gel (Solaraze)
- diclofenac topical solution (Pennsaid)
- diethylpropion (Tenuate)
- diflorasone (ApexiCon)
- dihydroergotamine (D.H.E. 45)
- dihydroergotamine nasal spray (Migranal)
- dihydroergotamine spray (Trudhesa)
- dimethyl fumarate (Tecfidera)
- diroximel fumarate (Vumerity)
- donepezil (Adlarity)
- donepezil (Aricept)
- donidalorsen (Dawnzera)
- dordaviprone (Modeyso)
- doxazosin extended release (Cardura XL)
- doxepin (Silenor)
- doxepin 5% cream (Prudoxin, Zonalon)
- doxycycline (Oracea)
- doxycycline hyclate (Acticlate, Doryx, Soloxide, Targadox)
- doxycycline monohydrate (Monodoxyne NL)
- doxylamine-pyridoxine (Bonjesta)
- dronabinol solution (Syndros)
- droxidopa (Northera)
- dulaglutide SQ (Trulicity)
- duloxetine delayed-release (Drizalma Sprinkle)
- dupilumab (Dupixent)
- dust mite mixed allergen extract (Odactra)
- dutasteride-tamsulosin (Jalyn)
- duvelisib (Copiktra)
- econazole (Ecoza)
- edaravone (Radicava ORS)
- edoxaban (Savaysa)
- efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)
- efinaconazole topical solution (Jublia)
- eflapegrastim-xnst (Rolvedon)
- eflornithine (Iwilfin)
- egvaliase-pqpz (Palynziq)
- elacestrant (Orserdu)
- elafibranor (Iqirvo)
- elagolix (Orilissa)
- elagolix-estradiol-norethisterone (Oriahnn)
- elamipretide (Forzinity)
- elapegademase-lvlr (Revcovi)
- elbasvir-grazoprevir (Zepatier)
- eletriptan (Relpax)
- elexacaftor-tezacaftor-ivacaftor (Trikafta)
- eliglustat (Cerdelga)
- eltrombopag (Alvaiz)
- eltrombopag (Promacta)
- eluxadoline (Viberzi)
- empagliflozin (Jardiance)
- empagliflozin-linagliptin (Glyxambi)
- empagliflozin-linagliptin-metformin (Trijardy XR)
- empagliflozin-metformin (Synjardy)
- enasidenib (Idhifa)
- encorafenib (Braftovi)
- ensartinib (Ensacove)
- ensifentrine (Ohtuvayre)
- entrectinib (Rozlytrek)
- enzalutamide (Xtandi)
- epinephrine nasal spray (Neffy)
- epinephrine, auto-injector pen (AuviQ)
- eplontersen (Wainua)
- epoetin alfa (Epogen)
- epoetin alfa-epbx (Retacrit)
- erdafitinib (Balversa)
- erenumab-aooe (Aimovig)
- erlotinib (Tarceva)
- ertugliflozin (Steglatro)
- ertugliflozin-metformin (Segluromet)
- ertugliflozin-sitagliptin (Steglujan)
- erythromycin capsule, suspension, tablet
- erythropoietin (Procrit)
- eslicarbazepine (Aptiom)
- esomeprazole (Nexium)
- estradiol (Imvexxy)
- etanercept (Enbrel)
- ethacrynic acid (Edecrin)
- etrasimod arginine (Velsipity)
- everolimus suspension (Afinitor Disperz)
- everolimus tablet (Afinitor)
- evolocumab (Repatha)
- exenatide SQ (Byetta)
- febuxostat (Uloric)
- fecal microbiota (Vowst)
- fedratinib (Inrebic)
- fenfluramine (Fintepla)
- fenofibrate (Antara, Fenoglide, Lipofen)
- fenofibrate micronized (Antara)
- fenofibric acid (Fibricor)
- fenoprofen (Nalfon)
- fentanyl patch (Duragesic)
- ferric citrate (Auryxia)
- ferric maltol (Accrufer)
- fezolinetant (Veozah)
- fidaxomicin (Dificid)
- filgrastim (Neupogen)
- filgrastim-aafi (Nivestym)
- filgrastim-ayow (Releuko)
- filgrastim-sndz (Zarxio)
- filgrastim-txid (Nypozi)
- finasteride-tadalafil (Entadfi)
- finerenone (Kerendia)
- fingolimod (Gilenya)
- fingolimod, ODT (Tascenso)
- flibanserin (Addyi)
- flurandrenolide (Cordran)
- fluticasone (Flovent Diskus, and Flovent HFA)
- fluticasone furoate (Arnuity Ellipta)
- fluticasone lotion (Beser, Cutivate)
- fluticasone propionate spray (Xhance)
- fluticasone-salmeterol (Advair HFA)
- fluticasone-vilanterol (Breo Ellipta)
- fluvastatin extended-release (Lescol XL)
- fluvoxamine extended release (Luvox CR)
- follitropin (Gonal-f, Gonal-F RFF Rediject, Follistim AQ)
- foscarbidopa and foslevodopa (Vyalev)
- fostamatinib (Tavalisse)
- fostemsavir tromethamine (Rukobia)
- Freestyle Libre (CGM)
- fremanezumab-vfrm (Ajovy)
- frovatriptan (Frova)
- fruquintinib (Fruzaqla)
- furosemide on-body infusor (Furoscix)
- futibatinib (Lytgobi)
- gabapentin (Gralise)
- gabapentin enacarbil extended-release (Horizant)
- galcanezumab-gnlm (Emgality)
- ganaxolone suspension (Ztalmy)
- ganirelix acetate (Antagon, Fyremadel)
- garadacimab-gxii (Andembry)
- gefitinib (Iressa)
- gepirone (Exxua)
- gepotidacin (Blujepa)
- gilteritinib (Xospata)
- givinostat (Duvyzat)
- glasdegib (Daurismo)
- glatiramer acetate (Copaxone)
- glecaprevir-pibrentasvir (Mavyret)
- glutamine (Endari)
- glycerol phenylbutyrate (Ravicti)
- glycopyrrolate (Dartisla ODT)
- glycopyrrolate liquid (Cuvposa)
- glycopyrrolate-formoterol fumarate (Bevespi)
- glycopyrronium cloth (Qbrexza)
- golimumab (Simponi)
- granisetron patch (Sancuso)
- grass mixed pollens allergen extract (Oralair)
- guaifenesin-codeine (Guaiatussin AC, GuaiFENesin AC, Maxi-Tuss, Virtussin)
- Guardian (CGM)
- guselkumab injection (Tremfya)
- halcinonide (Halog)
- halobetasol (Lexette foam, Bryhali, Ultravate lotion)
- halobetasol-tazarotene (Duobrii)
- human c1-esterase inhibitor (Haegarda)
- hydrochlorothiazide (Inzirqo)
- hydrocodone bitartrate-homatropine methylbromide (Hycodan, Hydromet)
- hydrocodone extended release (Hysingla ER, Zohydro ER)
- hydrocodone-acetaminophen
- hydrocortisone (Alkindi)
- hydrocortisone (Khindivi)
- hydrocortisone acetate (Anusol HC)
- hydrocortisone butyrate (Locoid)
- hydrocortisone probutate (Pandel)
- hydromorphone extended release (Exalgo)
- hydroxyurea (Siklos)
- hydroxyurea (Xromi)
- ibaticant (Firazyr)
- ibrexafungerp (Brexafemme)
- ibrutinib (Imbruvica)
- icosapent ethyl (Vascepa)
- idelalisib (Zydelig)
- iloperidone (Fanapt)
- imatinib (Gleevec, Imkeldi)
- Imiquimod cream (Zyclara)
- imlunestrant (Inluriyo)
- inavolisib (Itovebi)
- indomethacin (Indocin)
- infliximab-dyyb (Zymfentra)
- Inpen (Fiasp, Humalog, Novolog)
- insulin aspart (Fiasp, Kirsty, Merilog, Novolog)
- insulin aspart (Novolog 70/30)
- insulin degludec
- insulin degludec-liraglutide injection (Xultophy)
- insulin glargine (Basaglar)
- insulin glargine-aglr (Rezvoglar)
- insulin glargine-lixisenatide injection (Soliqua)
- insulin glargine-yfgn
- insulin glulisine (Apidra)
- insulin human (Humulin 70/30)
- insulin human (Novolin N)
- insulin isophane and regular (Novolin 70/30)
- insulin lispro (Admelog, Humalog, Lyumjev)
- Insulin lispro (Humalog 75/25 Kwikpen)
- insulin regular (Afrezza)
- insulin regular (Novolin R)
- interferon beta-1a (Avonex)
- interferon beta-1a (Rebif, Rebif Rebidose)
- interferon beta-1b (Betaseron)
- interferon gamma-1b (Actimmune)
- iptacopan (Fabhalta)
- isavuconazonium (Cresemba)
- isotretinoin (Absorica LD)
- istradefylline (Nourianz)
- itraconazole (Tolsura)
- itraconazole solution (Sporanox)
- ivabradine (Corlanor)
- ivacaftor (Kalydeco)
- ivermectin cream (Soolantra)
- ivosidenib (Tibsovo)
- ixazomib (Ninlaro)
- ixekizumab (Taltz)
- ketoconazole (Extina, Ketodan, Xolegel)
- ketoprofen
- ketorolac nasal (Sprix)
- lacosamide (Motpoly XR)
- lamotrigine (Lamictal XR)
- lamotrigine orally disintegrating tablet (Lamictal ODT)
- lanadelumab-flyo (Takhzyro)
- lansoprazole ODT (Prevacid Solutab)
- lanthanum carbonate (Fosrenol)
- lapatinib (Tykerb)
- larotrectinib (Vitrakvi)
- lasmiditan (Reyvow)
- latanoprost (Iyuzeh, Xelpros)
- latanoprostene (Vyzulta)
- lazertinib (Lazcluze)
- lebrikizumab-lbkz (Ebglyss)
- lecanemab (Leqembi Iqlik)
- ledipasvir-sofosbuvir tablet (Harvoni)
- lemborexant (Dayvigo)
- lenacapavir (Sunlenca)
- lenalidomide (Revlimid)
- leniolisib (Joenja)
- lenvatinib (Lenvima)
- letermovir (Prevymis)
- leuprolide acetate (Lupron, Eligard)
- levacetylleucine (Aqneursa)
- levamlodipine (Conjupri)
- levetiracetam (Elepsia XR)
- levetiracetam (Spritam)
- levodopa (Inbrija)
- levomilnacipran (Fetzima)
- levorphanol
- levothyroxine (Ermeza)
- lidocaine patch (ZTLido)
- lidocaine topical ointment
- linaclotide (Linzess)
- linagliptin (Tradjenta)
- linagliptin-metformin (Jentadueto/Jentadueto XR)
- linezolid (Zyvox)
- liraglutide (Saxenda)
- liraglutide SQ (Victoza)
- lisdexamfetamine (Vyvanse)
- lisinopril solution (Qbrelis)
- lofexidine (Lucemyra)
- lomitapide (Juxtapid)
- lonafarnib (Zokinvy)
- lonapegsomatropin (Skytrofa)
- lorazepam extended-release (Loreev XR)
- lorlatinib (Lorbrena)
- losartan suspension (Arbli)
- loteprednol etabonate (Eysuvis)
- loteprednol preservative-free (Inveltys)
- lotilaner (Xdemvy)
- lubiprostone (Amitiza)
- luliconazole (Luzu)
- lumacaftor-ivacaftor (Orkambi)
- lumateperone (Caplyta)
- lusutrombopag (Mulpleta)
- macitentan (Opsumit)
- macitentan-tadalafil (Opsynvi)
- mannitol (Bronchitol)
- maralixibat (Livmarli)
- maribavir (Livtencity)
- mavacamten (Camzyos)
- mavorixafor (Xolremdi)
- mebendazole (Emverm)
- mecasermin (Increlex)
- mechlorethamine hcl (Valchlor)
- meclofenamate
- mefenamic acid (Ponstel)
- meloxicam (Vivlodex)
- meloxicam oral suspension
- menotropins (Menopur)
- mepolizumab (Nucala)
- mercaptopurine suspension (Purixan)
- mesalamine (Asacol HD, Delzicol, Dipentum, Pentasa)
- metformin (Fortamet, Riomet)
- methadone (Dolophine)
- methamphetamine (Desoxyn)
- methotrexate (Jylamvo)
- methotrexate (Rasuvo)
- methotrexate solution (Xatmep)
- methoxy polyethylene glycol-epoetin beta (Mircera)
- methylnaltrexone bromide (Relistor)
- methylphenidate (Methylin, Ritalin)
- Methylphenidate capsule, long-acting (Ritalin LA)
- methylphenidate controlled-delivery (Metadate CD)
- methylphenidate extended-release (Aptensio XR, Metadate ER)
- methylphenidate extended-release (Jornay, Relexxii)
- methylphenidate extended-release, chewable (Quillichew ER)
- methylphenidate oral solution (Methylin)
- methylphenidate orally disintegrating tablet (Cotempla XR ODT)
- methylphenidate patch (Daytrana)
- methylphenidate suspension, extended release (Quillivant XR)
- methylphenidate tablet, extended-release (Concerta ER)
- methyltestosterone capsule (Methitest)
- methyltrexate (Jylamvo)
- metoclopramide (Gimoti)
- metoclopramide orally disintegrating tablet (Metozolv ODT)
- metreleptin (Myalept)
- metronidazole suspension (Likmez)
- miconazole (Oravig)
- miconazole nitrate-zinc oxide-white petrolatum ointment (Vusion)
- midazolam spray (Nayzilam)
- midostaurin (Rydapt)
- mifepristone (Korlym)
- migalastat (Galafold)
- miglustat (Opfolda)
- miglustat (Yargesa, Zavesca)
- milnacipran (Savella)
- miltefosine (Impavido)
- minocycline aerosol, foam (Zilxi)
- minocycline extended-release (Solodyn)
- minocycline foam (Amzeeq)
- mirabegron (Myrbetriq)
- mirdametinib (Gomekli)
- mirikizumab-mrkz (Omvoh)
- mitapivat (Pyrukynd)
- MODD1 Kit
- momelotinib (Ojjaara)
- mometasone-formoterol (Dulera)
- monomethyl fumarate (Bafiertam)
- morphine ER (Avinza, Kadian)
- mupirocin cream (Bactroban)
- mycophenolate mofetil (Myhibbin)
- nafarelin (Synarel)
- naftifine cream, gel (Naftin)
- naldemedine (Symproic)
- naloxone (Kloxxado nasal spray, Zimhi injection)
- naltrexone-bupropion (Contrave)
- naproxen suspension (Naprosyn)
- naratriptan (Amerge)
- nedosiran (Rivfloza)
- nemolizumab-ilto (Nemluvio)
- neomycin-fluocinolone (Neo-Synalar)
- nepafenac (Ilevro 0.3%)
- neratinib (Nerlynx)
- netarsudil (Rhopressa)
- netarsudil-latanoprost (Rocklatan)
- nilotinib (Tasigna)
- nilotinib tartrate (Danziten)
- nimodipine (Nymalize)
- nintedanib (Ofev)
- niraparib (Zejula)
- niraparib tosylate monohydrate-abiraterone acetate (Akeega)
- nirogacestat (Ogsiveo)
- nitazoxanide (Alinia)
- nitisinone (Harliku)
- nitisinone (Orfadin)
- nitroglycerin ointment (Rectiv)
- Novopen Echo insulin delivery device
- Obstetrix One
- ocreotide (Mycapssa)
- octreotide (Sandostatin)
- odevixibat (Bylvay)
- ofatumumab (Kesimpta)
- olanzapine-samidorphan (Lybalvi)
- olaparib (Lynparza)
- olezarsen (Tryngolza)
- olopatadine-mometasone (Ryaltris)
- olsalazine (Dipentum)
- olutasidenib (Rezlidhia)
- omadacycline (Nuzyra)
- omalizumab (Xolair)
- omaveloxolone (Skyclarys)
- omeprazole magnesium, amoxicillin and rifabutin (Talicia)
- omeprazole packet (Prilosec)
- omeprazole-bicarbonate (Konvomep)
- Omnipod
- ondansetron 16 mg ODT
- opicapone (Ongentys)
- orlistat (Xenical)
- orphenadrine-spirin-caffeine (Norgesic Forte, Orphengesic Forte)
- osilodrostat (Isturisa)
- osimertinib (Tagrisso)
- ospemifene (Osphena)
- oteseconazole (Vivjoa)
- oxcarbazepine (Oxtellar XR)
- oxiconazole (Oxistat)
- oxybutynin chloride 2.5 mg
- oxybutynin gel, patch (Gelnique, Oxytrol)
- oxycodone (Roxybond)
- oxycodone extended release (Oxycontin)
- oxycodone extended release (Xtampza ER)
- oxymetazoline hcl cream (Rhofade)
- oxymetazoline hcl ophthalmic solution (Upneeq)
- oxymorphone extended release (Opana ER)
- oxymorphone immediate release (Opana)
- ozanimod hcl capsule (Zeposia)
- pacritinib (Vonjo)
- palbociclib (Ibrance)
- palopegteriparatide (Yorvipath)
- palovarotene (Sohonos)
- paltusotine hcl (Palsonify)
- pancrelipase (Viokace, Pancreaze, Pertzye)
- paromomycin sulfate (Humatin)
- pasireotide (Signifor)
- patiromer powder (Veltassa)
- pazopanib (Votrient)
- peanut allergen powder (Palforzia)
- PEG 3350 (Clenpiq, Moviprep, Plenvu)
- PEG 3350 (Suflave)
- pegcetacoplan (Empaveli)
- pegfilgrastim (Neulasta)
- pegfilgrastim-apgf (Nyvepria)
- pegfilgrastim-bmez (Ziextenzo)
- pegfilgrastim-cbqv (Udenyca)
- pegfilgrastim-fpgk (Stimufend)
- pegfilgrastim-jmdb (Fulphila)
- pegfilgrastim-pbbk (Fylnetra)
- peginterferon alfa-2a (Pegasys)
- peg-interferon beta-1a (Plegridy)
- pegvisomant (Somavert)
- pemigatinib (Pemazyre)
- penciclovir cream (Denavir)
- penicillamine (Cuprimine)
- penicillamine (Depen)
- perampanel (Fycompa)
- perfluorohyxyloctane (Miebo)
- perindopril-amlodipine (Prestalia)
- pexidartinib (Turalio)
- phendimetrazine (Bontril PDM)
- phenoxybenzamine (Dibenzyline)
- phentermine (Adipex-P, Lomaira)
- phentermine-topiramate (Qsymia)
- phospholine iodide ophthalmic drops
- pilocarpine eye drops (Qlosi)
- pilocarpine hcl solution (Vuity)
- pimavanserin tartrate (Nuplazid)
- pioglitazone-glimepiride (Duetact)
- pirfenidone (Esbriet)
- pirtobrutinib (Jaypirca)
- pitavastatin (Livalo)
- pitavastatin magnesium (Zypitamag)
- pitolisant (Wakix)
- plecanatide (Trulance)
- plerixafor (Mozobil)
- PNV-DHA+Docusate
- podofilox (Condylox)
- pomalidomide (Pomalyst)
- ponatinib (Iclusig)
- ponesimod (Ponvory)
- posaconazole (Noxafil)
- pralsetinib (Gavreto)
- pramlintide (SymlinPen)
- prasterone (Intrarosa)
- prednisolone (Millipred, Millipred Dose Pack, Orapred ODT, Pediapred solution)
- pregabalin (Lyrica CR)
- PreGen DHA
- Prenara
- progesterone (Crinone 4)
- progesterone (Crinone 8)
- progesterone (Endometrin)
- propranolol (Hemangeol)
- propranolol SR (Inderal XL, Innopran XL)
- prucalopride (Motegrity)
- pyrimethamine (Daraprim)
- quizartinib (Vanflyta)
- ramelteon (Rozerem)
- ranolazine ER (Aspruzyo)
- regorafenib (Stivarga)
- relugolix (Orgovyx)
- relugolix-estradiol hemihydrate-norethindrone acetate (Myfembree)
- remibrutinib (Rhapsido)
- repotrectinib (Augtyro)
- resmetirom (Rezdiffra)
- revefenacin (Yupelri)
- revumenib citrate (Revuforj)
- ribociclib (Kisqali)
- ribociclib-letrozole (Kisqali Femara CoPack)
- rifamyin (Aemcolo)
- rifaximin (Xifaxan)
- rilonacept (Arcalyst)
- riluzole (Tiglutik)
- rilzabrutinib (Wayrilz)
- rimegepant sulfate (Nurtec)
- riociguat (Adempas)
- ripretinib (Qinlock)
- risankizumab-rzaa (Skyrizi)
- risdiplam (Evrysdi)
- risedronate (Actonel 30 mg)
- ritlecitinib (Litfulo)
- rizatriptan (Maxalt)
- roflumilast (Daliresp)
- roflumilast aerosol foam (Zoryve)
- roflumilast cream (Zoryve)
- ropeginterferon alfa-2b (Besremi)
- rucaparib (Rubraca)
- rufinamide (Banzel)
- ruxolitinib (Jakafi)
- ruxolitinib (Opzelura)
- sacrosidase (Sucraid)
- sacubitril-valsartan (Entresto Sprinkle)
- safinamide mesylate (Xadago)
- sapropterin (Kuvan)
- sarecycline (Seysara)
- sargramostim (Leukine)
- sarilumab (Kevzara)
- satralizumab (Enspryng)
- saxagliptin (Onglyza)
- saxagliptin-metformin (Kombiglyze XR)
- sebetralstat (Ekterly)
- secnidazole (Solosec)
- secukinumab (Cosentyx)
- seladelpar (Livdelzi)
- selexipag (Uptravi)
- selinexor (Xpovio)
- selpercatinib (Retevmo)
- selumetinib (Koselugo)
- semaglutide (Wegovy)
- semaglutide SQ (Ozempic)
- semaglutide tablet (Rybelsus)
- sepiapterin (Sephience)
- serdexmethylphenidate-dexmethylphenidate (Azstarys)
- sertaconazole (Ertaczo)
- setmelanotide (Imcivree)
- sevelamer carbonate, oral packet (Renvela)
- short ragweed pollen allergen extract (Ragwitek)
- sildenafil (Viagra)
- sildenafil 20mg (Revatio)
- sildenafil suspension (Liqrev)
- Simplera (CGM)
- simvastatin suspension (FloLipid)
- sinecatechins ointment (Veregen)
- siponimod (Mayzent)
- sirolimus gel (Hyftor)
- sitagliptin (Januvia)
- sitagliptin (Zituvio, Brynovin)
- sitagliptin-metformin (Janumet, Janumet XR)
- sitagliptin-metformin (Zituvimet, Zituvimet XR)
- sodium oxybate (Xyrem)
- sodium oxybate ER (Lumryz)
- sodium phenylbutyrate (Buphenyl, Olpruva, Pheburane)
- sodium sulfate-magnesium sulfate-potassium chloride (Sutab)
- sofosbuvir (Sovaldi)
- sofosbuvir-velpatasvir-voxilaprevir (Vosevi)
- sofpironium topical gel (Sofdra)
- solifenacin (Vesicare LS)
- solriamfetol (Sunosi)
- somatropin (Genotropin, Humatrope, Ngenla, Norditropin, Omnitrope, Saizen, Sogroya, Zomacton)
- somatropin (Serostim)
- sonidegib (Odomzo)
- sorafenib (Nexavar)
- sotagliflozin (Inpefa)
- sotalol (Sotylize)
- sotatercept-csrk (Winrevair)
- sotorasib (Lumakras)
- sparsentan (Filspari)
- spesolimab-sbzo (Spevigo)
- spironolactone (Carospir)
- stiripentol (Diacomit)
- sucroferric oxyhydroxide (Velphoro)
- sulfacetamide sodium-sulfur (cleanser, cream, gel, lotion, pad)
- sulopenem etzadroxil-probenecid (Orlynvah)
- sumatriptan (Imitrex)
- sumatriptan injection (Zembrace)
- sumatriptan nasal spray (Onzetra Xsail)
- sumatriptan spray (Tosymra)
- sumatriptan-naproxen (Treximet)
- sunitinib (Sutent)
- suvorexant (Belsomra)
- suzetrigine (Journavx)
- tacrolimus (Envarsus XR)
- tacrolimus (Prograf Packet)
- tadalafil (Cialis)
- tadalafil 20mg (Adcirca, Alyq, Tadliq)
- tafamidis capsule (Vyndamax, Vyndaqel)
- tafenoquine (Arakoda)
- tafluprost (Zioptan)
- talazoparib (Talzenna)
- taletrectinib (Ibtrozi)
- tapentadol (Nucynta ER)
- tapentadol (Nucynta)
- tapinarof cream (Vtama)
- tasimelteon (Hetlioz LQ)
- tasimelteon (Hetlioz)
- tavaborole topical solution (Kerydin)
- tazarotene (Arazlo)
- tazarotene aerosol foam (Fabior)
- tazemetostat (Tazverik)
- tbo-filgrastim (Granix)
- tedizolid (Sivextro)
- teglutide (Gattex)
- telmisartan-amlodipine
- telotristat etiprate (Xermelo)
- tenapanor (Xphozah)
- tenapanor hydrochloride (Ibsrela)
- tenofovir-alafenamide (Vemlidy)
- tepotinib (Tepmetko)
- terazosin (Tezruly)
- teriflunomide (Aubagio)
- teriparatide SQ (Forteo, Bonsity)
- tesamorelin (Egrifta)
- testosterone enanthate injection (Xyosted)
- testosterone gel, packet, patch, pump (Androgel, Fortesta, Testim, Vogelxo)
- testosterone nasal (Natesto)
- testosterone undecanoate capsule (Jatenzo, Kyzatrex, Tlando)
- tetrabenazine (Xenazine)
- tezacaftor-ivacaftor (Symdeko)
- tezepelumab-ekko autoinjector pen (Tezspire)
- thalidomide (Thalomid)
- Timolol preservative-free (Timoptic Ocudose)
- timothy grass pollen allergen extract tablet (Grastek)
- tiopronin (Thiola, Thiola EC)
- tiotropium bromide (Spiriva HandiHaler)
- tiotropium-olodaterol (Stiolto Respimat)
- tirbanibulin (Klisyri)
- tirzepatide (Mounjaro)
- tirzepatide SQ (Zepbound)
- tivozanib (Fotivda)
- tobramycin inhalation solution (Bethkis, Kitabis, Tobi)
- tocilizumab-aazg syringe (Tyenne)
- tofacitinib (Xeljanz/Xeljanz XR, Xeljanz solution)
- tolcapone (Tasmar)
- tolmetin (Tolectin)
- tolvaptan (Jynarque)
- tolvaptan (Samsca)
- topiramate (Eprontia)
- topiramate er (Trokendi XR)
- topiramate extended release capsule (Qudexy XR)
- topiramate sprinkle capsule 50 mg
- tovorafenib (Ojemda)
- tralokinumab-ldrm (Adbry)
- tramadol (tramadol tablet, Qdolo)
- tramadol extended-release (Conzip)
- trametinib (Mekinist)
- travoprost (Travatan Z)
- trazodone oral solution (Raldesy)
- treprostinil (Orenitram ER)
- treprostinil (Tyvaso DPI, Yutrepia)
- tretinoin cream, gel (Retin-A, Avita)
- tretinoin gel (Atralin)
- tretinoin lotion (Altreno)
- tretinoin microsphere (Retin-A Micro)
- tretinoin-benzoyl peroxide cream (Twyneo)
- triamcinolone (Kenalog Spray)
- triamcinolone ointment (Trianex)
- triameterene (Dyrenium)
- trientine (Syprine)
- trientine tetrahydrochloride (Cuvrior)
- trifarotene (Aklief)
- trifluridine-tipiracil (Lonsurf)
- triheptanoin (Dojolvi)
- Trinaz
- trofinetide (Daybue)
- tucatinib (Tukysa)
- ubrogepant (Ubrelvy)
- umeclidinium-vilanterol (Anoro Ellipta)
- upadacitinib (Rinvoq)
- uridine triacetate granule (Xuriden)
- ustekinumab products (Stelara, Selarsdi, Steqeyma, Yesintek)
- valbenazine (Ingrezza)
- valsartan oral solution
- vamorolone (Agamree)
- vancomycin solution (Firvanq)
- vandetanib (Caprelsa)
- vanzacaftor-tezacaftor-deutivacaftor (Alyftrek)
- vardenafil (Levitra, Staxyn ODT)
- varenicline spray (Tyrvaya)
- vedolizumab (Entyvio SQ)
- velpatasvir-sofosbuvir (Epclusa)
- vemurafenib (Zelboraf)
- venetoclax (Venclexta)
- vericiguat (Verquvo)
- V-Go
- vibegron (Gemtesa)
- vigabatrin (Sabril)
- vigabatrin (Vigafyde)
- vilazodone (Viibryd)
- viloxazine hcl (Qelbree)
- vimseltinib (Romvimza)
- vismodegib (Erivedge)
- voclosporin (Lupkynis)
- vonopazan (Voquezna)
- vorasidenib (Voranigo)
- voriconazole (Vfend)
- vorinostat (Zolinza)
- vortioxetine (Trintellix)
- vosoritide (Voxzogo)
- xanomeline-trospium (Cobenfy)
- zanubrutinib (Brukinsa)
- zavegepant (Zavzpret)
- zileuton (Zyflo)
- zileuton controlled release (Zyflo CR)
- zilucoplan injection (Zilbrysq)
- zolmitriptan nasal spray (Zomig)
- zolmitriptan tablets (Zomig)
- zolpidem (Edular, Intermezzo)
- zongertinib (Hernexeos)
- zonisamide (Zonisade)
- zuranolone (Zurzuvae)
Medication policy user guide
This brief user guide describes our medication policy, explains terms used, and includes contact info for more information
About medication policy
Find out how our medication policy, which determines if a service will be covered by a plan, is reviewed and updated.
Drug formulary, policy and forms
Search our drug formulary database, get prior authorization forms, and find information on oral and topical drugs, home-injectable drugs and more.