List of drugs requiring prior authorization by La Capitale
GENERIC ORIGINAL NAME GENERIC ORIGINAL NAME
TOCILIZUMAB Actemra FLUDARABINE Fludara TADALAFIL Adcirca TERIPARATIDE Forteo RIOCIGUAT Adempas ENFUVIRTIDE Fuzeon EVEROLIMUS Afi nitor SIMEPREVIR Galexos ALECTINIB Alecensaro FINGOLIMOD Gilenya ESLICARBAZEPINE Aptiom AFATINIB Giotrif TERIFLUNOMIDE Aubagio GLATIRAMER Glatect INTERFERON BETA-1A Avonex Pen IMATINIB Gleevec BELIMUMAB Benlysta FOLLITROPIN ALPHA Gonal-F INTERFERON BETA-1B Betaseron LEDIPASVIR/SOFOSBUVIR Harvoni BOSUTINIB Bosulif OMBITASVIR/PARITAPREVIR/RITONAVIR AND Holkira Pak ONABOTULINUMTOXIN A Botox DASABUVIR UROFOLLITROPIN Bravelle ADALIMUMAB Humira ETANERCEPT Brenzys RIBAVIRIN Ibavyr VANDETANIB Caprelsa PALBOCICLIB Ibrance CETRORELIX Cetrotide PONATINIB Iclusig CERTOLIZUMAB PEGOL Cimzia IBRUTINIB Imbruvica RESLIZUMAB Cinqair INFLIXIMAB Infl ectra GLATIRAMER Copaxone AXITINIB Inlyta SECUKINUMAB Cosentyx GEFITINIB Iressa COBIMETINIB Cotellic DEFERASIROX Jadenu PROGESTERONE Crinone RUXOLITINIB Jakavi DACLATASVIR Daklinza LOMITAPIDE Juxtapid STIRIPENTOL Diacomit SARILUMAB Kevzara LEVODOPIA - CARBIDOPA INTESTINAL GEL Duodopa ANAKINRA Kineret LYOPHILIZED ABOBOTULINUMTOXIN A Dysport SAPROPTERIN DIHYDROCHLORIDE Kuvan ETANERCEPT Enbrel ALEMTUZUMAB Lemtrada PROGESTERONE Endometrin LENVATINIB Lenvima VEDOLIZUMAB Entyvio RANIBIZUMAB Lucentis SOFOSBUVIR / VELPATASVIR Epclusa GONADORELIN Lutrepulse ETANERCEPT Erelzi OLAPARIB Lynparza VISMODEGIB Erivedge GLECAPREVIR/PIBRENTASVIR Maviret PIRFENIDONE Esbriet TRAMETINIB Mekinist DEFERASIROX Exjade MENOTROPINS Menopur INTERFERON BETA-1B Extavia SORAFENIB Nexavar AFLIBERCEPT Eylea ROMIPLOSTIM Nplate DÉFÉRIPRONE Ferriprox MEPOLIZUMAB Nucala ICATIBANT Firazyr OBETICHOLIC ACID Ocaliva EPOPROSTENOL Flolan OCRELIZUMAB Ocrevus List of drugs requiring prior authorization by La Capitale
GENERIC ORIGINAL NAME GENERIC ORIGINAL NAME
NINTEDANIB OFEV BOSENTAN Tracleer MACITENTAN Opsumit LAPATINIB Tykerb ABATACEPT Orencia NATALIZUMAB Tysabri GANIRELIX Orgalutran SELEXIPAG Uptravi APREMILAST Otezla AMBRISENTAN Volibris CHORIOGONADOTROPIN ALPHA Ovidrel PAZOPANIB Votrient FOLLITROPIN ALPHA / LUTROPIN ALFA Pergoveris CRIZOTINIB Xalkori PEGINTERFERON BETA-1A Plegridy TOFACITINIB Xeljanz POMALIDOMIDE Pomalyst CAPECITABINE Xeloda ALIROCUMAB Praluent INCOBOTULINUMTOXIN A Xeomin CHORIONIC GONADOTROPIN Pregnyl DENOSUMAB Xgeva FOLLITROPIN BETA Puregon OMALIZUMAB Xolair LEVOFLOXACIN INHALATION Quinsair ENZALUTAMIDE Xtandi INTERFERON BETA-1A Rebif SODIUM OXYBATE Xyrem INFLIXIMAB Remicade VEMURAFENIB Zelboraf TREPROSTINIL Remodulin ELBASVIR / GRAZOPREVIR Zepatier EVOLOCUMAB Repatha DACLIZUMAB Zinbryta MENOTROPINS Repronex ZOLEDRONIC ACID Zometa SILDENAFIL Revatio IDELALISIB Zydelig LENALIDOMIDE Revlimid CERITINIB Zykadia ELTROMBOPAG Revolade ABIRATERONE Zytiga RILUZOLE Rilutek RITUXIMAB Rituxan GOLIMUMAB Simponi SOFOSBUVIR Sovaldi DASATINIB Sprycel USTEKINUMAB Stelara REGORAFENIB Stivarga SUNITINIB Sutent DABRAFENIB Tafi nlar OSIMERTINIB Tagrisso IXEKIZUMAB Taltz ERLOTINIB Tarceva NILOTINIB Tasigna DIMETHYL FUMARATE Tecfi dera OMBITASVIR/PARITAPREVIR/RITONAVIR Technivie TEMOZOLOMIDE Temodal THALIDOMIDE Thalomid (01-2018)
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