Updated: May 20, 2021 Prior Authorization Drugs (NEW ADDITIONS HIGHLIGHTED)
A Abatacept (ORENCIA) Abemaciclib (VERZENIO) Abiraterone Acetate (ZYTIGA) Abiraterone Acetate (+ GENERIC FORMULATIONS) AbobotulinumtoxinA (DYSPORT) Abraxane (ABRAXANE) Acalabrutinib (CALQUENCE) Actemra (ACTEMRA) Adalimumab (AMGEVITA) Adalimumab (HADLIMA) Adalimumab (HULIO) Adalimumab (HUMIRA) Adalimumab (HYRIMOZ) Adalimumab (IDACIO) Adcetris (ADCETRIS) Adcirca (ADCIRCA) Adempas (ADEMPAS) Afatinib (GIOTRIF) Afinitor (AFINITOR) Aflibercept (EYLEA) Aflibercept (ZALTRAP) Afstyla (AFSTYLA) Agalsidase Alfa (REPLAGAL) Agalsidase Beta (FABRAZYM) Aimovig (AIMOVIG) Ajovy (FREMANEZUMAB) Aldesleukin (PROLEUKIN) Aldurazyme (ALDURAZYME) Alecensaro (ALECENSARO) Alectinib (ALECENSARO) Alefacept (AMEVIVE) Alemtuzumab (MABCAMPATH) Alemtuzumab (LEMTRADA) Alglucosidase Alfa (MYOZYME) Alimta (ALIMTA) Alirocumab (PRALUENT) Alpha-1-Proteinase Inhibitor (PROLASTIN - C) Alpha-1-Proteinase Inhibitor (ZEMAIRA) Alpelisib (PIQRAY) Alunbrig (ALUNBRIG) Ambrisentan (VOLIBRIS) Ambrisentan (Generic Formulations) Amevive (AMEVIVE) Amgevita (ADALIMUMAB) Amifampridine Phosphate (FIRDAPSE) Amifampridine Phosphate (RUZURGI) Anakinra (KINERET) Apalutamide (ERLEADA) Apomorphine (KYNMOBI) Apremilast (OTEZLA) Page 1 of 17
Updated: May 20, 2021 Arsenic Trioxide (TRISENOX) Arsenic Trioxide (Generic Formulations) Arzerra (ARZERRA) Asfotase Alfa (STRENSIQ) Asparaginase (ERWINASE) Asunaprevir (SUNVEPRA) Atezolizumab (TECENTRIQ) Atriance (ATRIANCE) Aubagio (AUBAGIO) Avastin (AVASTIN) Avelumab (BAVENCIO) Avonex (AVONEX) Avsola (INFLIXIMAB) Axicabtagene Ciloleucel (YESCARTA) Axitinib (INLYTA) Azacitidine (ONUREG) Azacitidine (VIDAZA) Azacitidine (Generic Formulations) Aztreonam (CAYSTON)
B Bacillus Calmette-Guerin (BCG) Substrain Connaught (IMMUCYST) Bacillus Calmette-Guerin (BCG) – Strain Russian BCG-I (VERITY-BCG) Balversa (BALVERSA) Baricitinib (OLUMIANT) Bavencio (BAVENCIO) Belimumab (BENLYSTA) Belkyra (BELKYRA) Bendamustine Hydrochloride (TREANDA) Bendamustine Hydrochloride (+ GENERIC FORMULATIONS) Benlysta (BENLYSTA) Berinert (BERINERT) Benralizumab (FASENRA) Beovu (BROLUCIZUMAB) Besponsa (BESPONSA) Betaseron (BETASERON) Bevacizumab (AVASTIN) Bevacizumab (MVASI) Bevacizumab (ZIRABEV) Binimetinib (MEKTOVI) Bicnu (BICNU) Bleomycin (Generic Formulations) Blinatumomab (BLINCYTO) Blincyto (BLINCYTO) Boceprevir (VICTRELIS) Boceprevir (VICTRELIS TRIPLE) Bortezomib (VELCADE) Bortezomib (Generic Formulations) Bosentan (TRACLEER) Bosentan (Generic Formulations) Bosulif (BOSULIF) Bosutinib (BOSULIF) Botox (BOTOX) Page 2 of 17
Updated: May 20, 2021 Braftovi (ENCORAFENIB) Brentuximab Vedotin (ADCETRIS) Brenzys (BRENZYS) Brigatinib (ALUNBRIG) Brineura (BRINEURA) Brodalumab (SILIQ) Brolucizumab (BEOVU) Brukinsa (ZANUBRUTINIB) Burosumab (CRYSVITA)
C C1 Esterase Inhibitor (Human) (BERINERT) C1 Esterase Inhibitor (Human) (CINRYZE) C1 Esterase Inhibitor (Human) (HAEGARDA) Cabazitaxel (JEVTANA) Cabazitaxel (Generic Formulations) Cabenuva (CABOTEGRAVIR/RILPIVIRINE) Cablivi (CAPLACIZUMAB) Cabotegravir (VOCABRIA) Cabotegravir/Rilpivirine (CABENUVA) Cabometyx (CABOMETYX) Cabozantinib (CABOMETYX) Caelyx (CAELYX) Calcifediol (RAYALDEE) Calquence (CALQUENCE) Camptosar (CAMPTOSAR) Canakinumaab (ILARIS) Cannabidiol (SATIVEX) Capecitabine (XELODA) Caplacizumab (CABLIVI) Caprelsa (CAPRELSA) Carbaglu (CARBAGLU) Carfilzomib (KYPROLIS) Carglumic Acid (CARBAGLU) Carmustine (BICNU) Caripul (CARIPUL) Cayston (CAYSTON) Cedazuridine/Decitabine (INQOVI) Cemiplimab (LIBTAYO) Cenegermin (OXERVATE) Cerdelga (CERDELGA) Cerezyme (CEREZYME) Ceritinib (ZYKADIA) Cerliponase Alfa (BRINEURA) Certican (CERTICAN) Certolizumab Pegol (CIMZIA) Cetuximab (ERBITUX) Cimzia (CIMZIA) Cinacalet (SENSIPAR) Cinacalet (Generic Formulations) Cinqair (CINQAIR) Cinryze (CINRYZE)
Page 3 of 17
Updated: May 20, 2021 Cladribine (MAVENCLAD) Clofarabine (CLOLAR) Clolar (CLOLAR) Cobimetinib (COTELLIC) Copaxone (COPAXONE) Cosentyx (COSENTYX) Cotellic (COTELLIC) Crizotinib (XALKORI) Crysvita (CRYSVITA) Cubicin (CUBICIN) Cutaquig (CUTAQUIG) Cuvposa (CUVPOSA) Cyramza (CYRAMZA) Cystadrops (CYSTADROPS) Cysteamine (CYSTADROPS) Cysteamine (PROCYSBI) Cytarabine/Daunorubicin (VYXEOS)
D Dabrafenib (TAFINLAR) Daclatasvir (DAKLINZA) Dacogen (DACOGEN) Dacomitinib (VIZIMPRO) Daklinza (DAKLINZA) Daptomycin (CUBICIN) Daratumumab (DARZALEX) Darolutamide (NUBEQA) Darzalex (DARZALEX) Dasatinab (SPRYCEL) Dasatinab (Generic Formulations) Daurismo (GLASDEGIB) Decitabine (DACOGEN) Decitabine (DEMYLOCAN) Deferasirox (EXJADE) Deferasirox (JADENU) Deferasirox (Generic Formulations) Deferiprone (FERRIPROX) Defibrotide (DEFITELIO) Defitelio (DEFITELIO) Demylocan (DEMYLOCAN) Deoxycholic Acid (BELKYRA) Dimethyl Fumarate (TECFEDERA) Dinutuximab (UNITUXIN) Docataxel (TAXOTERE) Docataxel (Generic Formulations) Dojolvi (TRIHEPTANOIN) Dornase Alfa (PULMOZYME) Doxorubicin (CAELYX) Doxorubicin (MYOCET) Doxorubicin (Generic Formulations) Dupilumab (DUPIXENT) Dupixent (DUPIXENT) Durvalumab (IMFINZI) Page 4 of 17
Updated: May 20, 2021 Dysport Therapeutic (DYSPORT)
E Eculizumab (SOLIRIS) Edaravone (RADICAVA) Egrifta (EGRIFTA) Elaprase (ELAPRASE) Elbasvir (ZEPATIER) Elelyso (ELELYSO) Eliglustat (CERDELGA) Elosulfase Alfa (VIMIZIM) Elotuzumab (EMPLICITI) Eloxatin (ELOXATIN) Eltrombopag (REVOLADE) Emgality (EMGALITY) Emicizumab (HEMLIBRA) Empliciti (EMPLICITI) Enasidenib (IDHIFA) Encorafenib (BRAFTOVI) Enbrel (ENBREL) Enhurtu (TRASTUZUMAB DERUXTECAN) Enspryng (SATRALIZUMAB) Entrectinib (ROZLYTREK) Entyvio (ENTYVIO) Enzalutamide (XTANDI) Epclusa (EPCULSA) Epoprostenol (CARIPUL) Epoprostenol (FLOLAN) Epoprostenol (Generic Formulations) Eptinezumab (VYEPTI) Erbitux (ERBITUX) Erdafitinib (BALVERSA) Erelzi (ERELZI) Erenumab (AIMOVIG) Erivedge (ERIVEDGE) Erleada (ERLEADA) Erlotinib (TARCEVA) Erlotinib (Generic Formulations) Erwinase (ERWINASE) Esbriet (ESBRIET) Esketamine (SPRAVATO) Etanercept (BRENZYS) Etanercept (ENBREL) Etanercept (ERELZI) Evenity (EVENITY) Everolimus (AFINITOR) Everolimus (CERTICAN) Everolimus (Generic Formulations) Evolocumab (REPATHA) Evrysdi (RISDIPLAM) Exjade (EXJADE) Extavia (EXTAVIA) Eylea (EYLEA) Page 5 of 17
Updated: May 20, 2021
F Fabrazyme (FABRAZYME) Fampridine (FAMPYRA) Fampridine (Generic Formulations) Fampyra (FAMPYRA) Fasenra (FASENRA) Fasturtec (FASTURTEC) Fedratinib (INREBIC) Ferona (FERONA) Ferriprox (FERRIPROX) Filgrastim (NEUPOGEN) Filgrastim (GRASTOFIL) Filgrastim (NIVESTYM) Fingolimod (GILENYA) Fingolimod (Generic Formulations) Firazyr (FIRAZYR) Firdapse (AMIFAMPRIDINE PHOSPHATE) Flebogamma (FLEBOGAMMA) Flolan (FLOLAN) Fludara (FLUDARA) Fludarabine (FLUDARA) Fludarabine (Generic Formulations) Fluocinolone Acetonide (ILUVIEN) Folotyn (FOLOTYN) Fostamatinib (TAVALISSSE) Fremanezumab (AJOVY) Fulphila (FULPHILA)
G Galafold (GALAFOLD) Galexos (GALEXOS) Galsulfase (NAGLAZYME) Gazyva (GAZYVA) Gefitinib (IRESSA) Gefitinib (Generic Formulations) Galcanezumab (EMGALITY) Gemcitabine (GEMZAR) Gemcitabine (Generic Formulations) Gemtuzumab Ozogamicin (MYLOTARG) Gemzar (GEMZAR) Genotropin (GENOTROPIN) Gilenya (GILENYA) Giotrif (GIOTRIF) Gilteritinib (XOSPATA) Givlaari (GIVOSIRAN) Givosiran (GIVLAARI) Glasdegib (DAURISMO) Glatect (GLATECT) Glatiramer Acetate (COPAXONE) Glatiramer Acetate (GLATECT) Glatiramer Acetate (+Generic Formulations) Page 6 of 17
Updated: May 20, 2021 Glecaprevir (MAVIRET) Glycerol Phenylbutyrate (RAVICTI) Glycopyrrolate (CUVPOSA) Gleevec (GLEEVEC) Grastofil (GRASTOFIL) Grazoprevir (ZEPATIER) Golimumab (SIMPONI) Guselkumab (TREMFYA)
H Hadlima (HADLIMA) Haegarda (HAEGARDA) Harvoni (HARVONI) Hemlibra (HEMLIBRA) Herceptin (HERCEPTIN) Herzuma (HERZUMA) Hizentra (HIZENTRA) Holkira (HOLKIRA) Humatrope (HUMATROPE) Hulio (ADALIMUMAB) Humira (HUMIRA) Hycamtin (HYCAMTIN) Hyrimoz (ADALIMUMAB)
I Ibavyr (IBAVYR) Ibrance (IBRANCE) Ibrutinib (IMBRUVICA) Icatibant (FIRAZYR) Icosapent Ethyl (VASCEPA) Iclusig (ICLUSIG) Idacio (ADALIMUMAB) Idelalisib (ZYDELIG) Idhifa (IDHIFA) Idursulfate (ELAPRASE) Ilaris (ILARIS) Iluvien (ILUVIEN) Imatinib (GLEEVEC) Imatinib (Generic Formulations) Imbruvica (IMBRUVICA) Imfinzi (IMFINZI) Imiglucerase (CEREZYME) Immucyst (IMMUCYST) Immune Globulin (FLEBOGAMMA) Immune Globulin (HIZENTRA) Immune Globulin (XEMBIFY) Immunoglobin G (CUTAQUIG) IncobotulinumtoxinA (XEOMIN) Increlex (MECASERMIN) Inflectra (INFLECTRA) Infliximab (INFLECTRA) Infliximab (OMVYENCE) Page 7 of 17
Updated: May 20, 2021 Infliximab (REMICADE) Infliximab (RENFLEXIS) Infliximab (REMSIMA SC) Infliximab (AVSOLA) Inlyta (INLYTA) Inotersen (TEGSEDI) Inotuzumab Ozogamicin (BESPONSA) Inqovi (CEDAZURIDINE/DECITABINE) Inrebic (FEDRATINIB) Interferon Alfa-2B (INTRON A) Interferon Alpha-2A (ROFERON-A) Interferon Alpha-N1 (WELLFERON) Interferon Beta-1A (AVONEX) Interferon Beta-1A (REFIB) Interferon Beta-1B (BETASERON) Interferon Beta-1B (EXTAVIA) Interferon Beta-1B (FERONA) Intron A (INTRON A) Ipilimumab (YERVOY) Iressa (IRESSA) Irinotecan (CAMPTOSAR) Irinotecan (ONIVYDE) Irinotecan (Generic Formulations) Isatuximab (SARCLISA) Istodax (ISTODAX) Ivacaftor (KALYDECO) Ivacaftor (ORKAMBI) Ivacaftor (SYMDEKO) Ixazomib (NINLARO) Ixekizumab (TALTZ)
J Jadenu (DEFERASIROX) Jakavi (JAKAVI) Jetrea (JETREA) Jevtana (JEVTANA) Jinarc (JINARC) Juxtapid (JUXTAPID)
K Kadcyla (KADCYLA) Kalydeco (KALYDECO) Kanjinti (KANJINTI) Kanuma (KANUMA) Kepivance (KEPIVANCE) Kesimpta (OFATUMUMAB) Kevzara (KEVZARA) Keytruda (KEYTRUDA) Kineret (KINERET) Kisqali (KISQALI) Kuvan (KUVAN) Kymriah (KYMRIAH) Kynmobi (APOMORPHINE) Page 8 of 17
Updated: May 20, 2021 Kyprolis (KYPROLIS)
L Lanadelumab (TAKHZYRO) Lanreotide (SOMATULINE AUTOGEL) Lapatinib (TYKERB) Lapelga (LAPELGA) Laronidase (ALDURAZYME) Larotrectinib (VITRAKVI) Lartruvo (LARTRUVO) Ledipasvir (HARVONI) Lemtrada (LEMTRADA) Lenalidomide (REVLIMID) Lenvatinib (LENVIMA) Lenvima (LENVIMA) Letermovir (PREVYMIS) Leukine (LEUKINE) Levofloxacin (QUINSAIR) Libtayo (LIBTAYO) Lokelma (LOKELMA) Lomitapide (JUXTAPID) Lonoctocog Alfa (AFSTYLA) Lonsurf (LONSURF) Lorbrena (LORBRENA) Lorlatinib (LORBRENA) Lucentis (LUCENTIS) Lumacaftor (ORKAMBI) Luspatercept (REBLOZYL) Luxturna (VORETIGENE NEPARVOVEC) Lynparza (LYNPARZA)
M Mabcampath (MABCAMPATH) Macitentan (OPSUMIT) Matulane (MATULANE) Mavenclad (MAVENCLAD) Maviret (MAVIRET) Mayzent (MAYZENT) Mecasermin (INCRELEX) Mekinist (MEKINIST) Mektovi (BINIMETINIB) Mepolizumab (NUCALA) Midostaurin (RYDAPT) Migalastat (GALAFOLD) Miglustat (ZAVESCA) Miglustat (Generic Formulations) Mitomycin (Generic Formulations) Moderiba (MODERIBA) Mozobil (MOZOBIL) Mvasi (MVASI) Mylotarg (MYLOTARG) Myobloc (MYOBLOC) Myocet (MYOCET) Page 9 of 17
Updated: May 20, 2021 Myozyme (MYOZYME)
N Naglazyme (NAGLAZYME) Natalizumab (TYSABRI) Necitumumab (PORTRAZZA) Nelarabine (ATRIANCE) Neratinib (NERLYNX) Nerlynx (NERLYNX) Neulasta (NEULASTA) Neupogen (NEUPOGEN) Nexavar (NEXAVAR) Nilotinib (TASIGNA) Ninlaro (NINLARO) Nintedanib (OFEV) Niraparib (ZEJULA) Nitisinone (ORFADIN) Nitisinone (Generic Formulations) Nivestym (FILGRASTIM) Nivolumab (OPDIVO) Norditropin (NORDITROPIN) Nplate (NPLATE) Nucala (NUCALA) Nuceiva (NUCEIVA) Nubeqa (NUBEQA) Nusinersen (SPINRAZA) Nutropin (NUTROPIN) Nyvepria (PEGFILGRATIM)
O Obeticholic Acid (OCALIVA) Obinutuzumab (GAZYVA) Ocaliva (OCALIVA) Ocrelizumab (OCREVUS) Ocrevus (OCREVUS) Ocriplasmin (JETREA) Octreotide (OCTREOTIDE) Odomzo (SONIDEGIB) Ofatumumab (KESIMPTA) Ofev (OFEV) Ogivri (OGIVRI) Olaparib (LYNPARZA) Olaratumab (LARTRUVO) Olumiant (OLUMIANT) Omalizumab (XOLAIR) Omnitrope (OMNITROPE) Omvyence (INFLIXIMAB) OnabotulinumtoxinA (BOTOX) Onasemnogene Abeparvovec (ZOLGENSMA) Oncaspar (ONCASPAR) Onivyde (ONIVYDE) Onpattro (ONPATTRO) Onureg (AZACITIDINE) Page 10 of 17
Updated: May 20, 2021 Opdivo (OPDIVO) Opsumit (OPSUMIT) Orencia (ORENCIA) Orfadin (ORFADIN) Orkambi (ORKAMBI) Osimertinib (TAGRISSO) Otezla (OTEZLA) Ozanimod (ZEPOSIA) Oxaliplatin (ELOXATIN) Oxaliplatin (Generic Formulations) Oxervate (OXERVATE)
P Paclitaxel (ABRAXANE) Paclitaxel (Generic Formulations) Palbociclib (IBRANCE) Palifermin (KEPIVANCE) Palivizumab (SYNAGIS) Panitumumab (VECTIBIX) Pasireotide (SIGNIFOR) Pasireotide (SIGNIFOR LAR) Patiromer (VELTASSA) Patisiran (ONPATTRO) Pazopanib (VOTRIENT) Pegaspargase (ONCASPAR) Pegetron (PEGETRON) Pegfilgrastim (FULPHILA) Pegfilgrastim (LAPELGA) Pegfilgrastim (NEULASTA) Pegfilgrastim (NYVEPRIA) Pegfilgrastim (ZIEXTENZO) Peginterferon Beta-1A (PLEGRIDY) Pegvisomant (SOMAVERT) Pembrolizumab (KEYTRUDA) Pemetrexed (ALIMTA) Pemetrexed (Generic Formulations) Perjeta (PERJETA) Pertuzumab (PERJETA) Pheburane (PHEBURANE) Phesgo (TRASTUZUMAB/PERTUZUMAB) Pibrentasvir (MAVIRET) Piqray (ALPELISIB) Pirfenidone (ESBRIET) Pirfenidone ( +Generic Formulations) Plegridy (PLEGRIDY) Plerixafor (MOZOBIL) Polatuzumab Vedotin (POLIVY) Polivy (POLATUZUMAB VEDOTIN) Pomalidomide (POMALYST) Pomalyst (POMALYST) Ponatinib (ICLUSIG) Ponesimod (PONVORY) Portrazza (PORTRAZZA) Page 11 of 17
Updated: May 20, 2021 Prabotulinumatoxina (NUCEIVA) Pralatrexate (FOLOTYN) Praluent (PRALUENT) Prevymis (PREVYMIS) Procarbazine (MATULANE) Procysbi (PROCYSBI) Prolastin - C (PROLASTIN - C) Proleukin (PROLEUKIN) Pulmozyme (PULMOZYME)
Q Qinlock (RIPRETINIB) Quinsair (QUINSAIR)
R Radicava (RADICAVA) Ramucirumab (CYRAMZA) Ranibizumab (LUCENTIS) Rasburicase (FASTURTEC) Ravicti (RAVICTI) Ravulizumab (ULTOMIRIS) Rayaldee (RAYALDEE) Rebif (REBIF) Reblozyl (LUSPATERCEPT) Regorafenib (STIVARGA) Remicade (REMICADE) Remodulin (REMODULN) Removab (REMOVAB) Remsima SC (INFLIXIMAB) Renflexis (RENFLEXIS) Repatha (REPATHA) Replagal (REPLAGAL) Reslizumab (CINQAIR) Respigam (RESPIGAM) Respiratory Syncytial Virus Immune Globulin (RESPIGAM) Revatio (REVATIO) Revestive (REVESTIVE) Revlimid (REVLIMID) Revolade (REVOLADE) Riabni (RITUXIMAB) Ribavirin (IBAVYR) Ribavirin (VICTRELIS TRIPLE) Ribociclib (KISQALI) Rilutek (RILUTEK) Riluzole (RILUTEK) Riluzole (Generic Formulations) RimabotulinumtoxinB (MYOBLOC) Rinvoq (RINVOQ) Riociguat (ADEMPAS) Ripretinib (QINLOCK) Risankizumab (SKYRIZI) Risdiplam (EVRYSDI) Ritonavir (TECHNIVIE) Page 12 of 17
Updated: May 20, 2021 Rituxan (RITUXAN) Rituximab (RITUXAN) Rituximab (TRUXIMA) Rituximab (RIXIMYO) Rituximab (RUXIENCE) Rituximab (RIABNI) Riximyo (RITUXIMAB) Roferon-A (ROFERON-A) Romidepsin (ISTODAX) Romiplostim (NPLATE) Romosozumab (EVENITY) Rozlytrek (ROZLYTREK) Ruxience (RITUXIMAB) Ruxolitinib (JAKAVI) Rydapt (RYDAPT) Ruzurgi (AMIFAMPRIDINE PHOSPHATE)
S Saizen (SAIZEN) Samsca (SAMSCA) Sapropterin (KUVAN) Sarclisa (ISATUXIMAB) Sargramostim (LEUKINE) Sarilumab (KEVZARA) Sativex (SATIVEX) Satralizumab (ENSPRYNG) Sebelipase Alfa (KANUMA) Secukinumab (COSENTYX) Selexipag (UPTRAVI) Sensipar (SENSIPAR) Serostim (SEROSTIM) Signifor (SIGNIFOR) Signifor Lar (SIGNIFOR LAR) Sildenafil (REVATIO) Sildenafil (Generic Formulations) Siliq (SILIQ) Siltuximab (SYLVANT) Simponi (SIMPONI) Siponimod (MAYZENT) Skyrizi (SKYRIZI) Sodium Oxybate (XYREM) Sodium Phenylbutyrate (PHEBURANE) Sodium Zirconium Cyclosilicate (LOKELMA) Sofosbuvir (EPCLUSA) Sofosbuvir (HARVONI) Sofosbuvir (SOVALDI) Sofosbuvir (VOSEVI) Soliris (SOLIRIS) Somatropin (GENOTROP) Somatropin (HUMATROP) Somatropin (NORDITROPIN) Somatropin (NUTROPIN) Somatropin (OMNITROP) Page 13 of 17
Updated: May 20, 2021 Somatropin (SAIZEN) Somatropin (SEROSTIM) Somatuline Autogel (SOMATULINE AUTOGEL) Somavert (SOMAVERT) Sonidegib (ODOMZO) Sorafenib (NEXAVAR) Sovaldi (SOVALDI) Spinraza (SPINRAZA) Spravato (ESKETAMINE) Sprycel (SPRYCEL) Stelara (STELARA) Stivarga (STIVARGA) Strensiq (STRENSIQ) Sunitinib (SUTENT) Sunvepra (SUNVEPRA) Sutent (SUTENT) Sylvant (SYLVANT) Symdeko (SYMDEKO) Synagis (SYNAGIS)
T Tadalafil (ADCIRCA) Tadalafil (Generic Formulations) Tafamidis (VYNDAQEL) Tafinlar (TAFINLAR) Tagrisso (TAGRISSO) Takhzyro (TAKHZYRO) Talazoparib (TALZENNA) Taliglucerase Alfa (ELELYSO) Taltz (TALTZ) Talzenna (TALZENNA) Tarceva (TARCEVA) Tasigna (TASIGNA) Tavalisse (FOSTAMATINIB) Taxotere (TAXOTERE) Tecentriq (TECENTRIQ) Tecfidera (TECFIDERA) Technivie (TECHNIVIE) Teduglutide (REVESTIVE) Tegsedi (TEGSEDI) Telotristat Ethyl (XERMELO) Temodal (TEMODAL) Temozolomide (TEMODAL) Temozolomide (Generic Formulations) Temsirolimus (TORISEL) Temsirolimus (Generic Formulations) Tenofovir Alafenamide (VEMLIDY) Tepadina (TEPADINA) Teriflunomide (AUBAGIO) Tesamorelin (EGRIFTA) Tezacaftor (SYMDEKO) Thalidomide (THALOMID) Thalomid (THALOMID) Page 14 of 17
Updated: May 20, 2021 Thiotepa (TEPADINA) Tisagenlecleucel (KYMRIAH) Tobi Podhaler (TOBI PODHALER) Tobramycin (TOBI PODHALER) Tobramycin (Generic Formulations) Tocilizumab (ACTEMRA) Tofacitinib (XELJANZ) Tofacitinib (XELJANZ XR) Tolvaptan (JINARC) Tolvaptan (SAMSCA) Topotecan (HYCAMTIN) Topotecan (Generic Formulations) Torisel (TORISEL) Trabectedin (YONDELIS) Tracleer (TRACLEER) Trametinib (MEKINIST) Trastuzumab (HERCEPTIN) Trastuzumab (HERZUMA) Trastuzumab (KADCYLA) Trastuzumab (KANJINTI) Trastuzumab (OGIVRI) Trastuzumab (PERJETA) Trastuzumab/Pertuzumab (PHESGO) Trastuzumab Deruxtecan (ENHURTU) Trastuzumab (TRAZIMERA) Trazimera (TRAZIMERA) Treanda (TREANDA) Trelstar (TRELSTAR) Tremfya (TREMFYA) Treprostinil (REMODULN) Tretinoin (VESANOID) Trientine (TRIENTINE) Trifluridine (LONSURF) Triheptanoin (DOJOLVI) Triptorelin (TRELSTAR) Trisenox (TRISENOX) Truxima (TRUXIMA) Tucatinib (TUKYSA) Tukysa (TUCATINIB) Tykerb (TYKERB) Tysabri (TYSABRI)
U Ultomiris (ULTOMIRIS) Unituxin (UNITUXIN) Upadacitinib (RINVOQ) Uptravi (UPTRAVI) Ustekinumab (STELARA)
V Vandetanib (CAPRELSA) Vascepa (ICOSAPENT ETHYL) Vectibix (VECTIBIX) Page 15 of 17
Updated: May 20, 2021 Vedolizumab (ENTYVIO) Velaglucerase alfa (VPRIV) Velcade (VELCADE) Velpatasvir (EPCLUSA) Velpatasvir (VOSEVI) Veltassa (PATIROMER) Vemlidy (VEMLIDY) Vemurafenib (ZELBORAF) Venclexta (VENCLEXTA) Venetoclax (VENCLEXTA) Vesanoid (VESANOID) Verity – BCG (BACILLUS CALMETTE-GUERIN (BCG)- STRAIN RUSSIAN BCG-1 Verzenio (VERZENIO) Victrelis (VICTRELIS) Victrelis Triple (VICTRELIS TRIPLE) Vidaza (VIDAZA) Vimizim (VIMIZIM) Vismodegib (ERIVEDGE) Vitrakvi (VITRAKVI) Vizimpro (VIZIMPRO) Vocabria (CABOTEGRAVIR) Volibris (VOLIBRIS) Voretigene Neparvovec (LUXTURNA) Vorinostat (ZOLINZA) Vosevi (VOSEVI) Votrient (VOTRIENT) Voxilaprevir (VOSEVI) Vpriv (VPRIV) Vumon (VUMON) Vyepti (EPTINEZUMAB) Vyxeos (CYTARABINE/DAUNORUBICIN) Vyndaqel (TAFAMIDIS)
W Wellferon (WELLFERON)
X Xalkori (XALKORI) Xeljanz (XELJANZ) Xeljanz XR (XELJANZ XR) Xeloda (XELODA) Xembify (XEMBIFY) Xeomin (XEOMIN) Xermelo (XERMELO) Xolair (XOLAIR) Xospata (XOSPATA) Xtandi (XTANDI) Xyrem (XYREM)
Y Yervoy (YERVOY) Yescarta (YESCARTA) Yondelis (YONDELIS) Page 16 of 17
Updated: May 20, 2021
Z Zaltrap (ZALTRAP) Zanubrutinib (BRUKINSA) Zavesca (ZAVESCA) Zejula (ZEJULA) Zelboraf (ZELBORAF) Zemaira (ZEMAIRA) Zepatier (ELBASVIR) Zepatier (GRAZOPREVIR) Ziextenzo (PEGFILGRASTIM) Zinbryta (ZINBRYTA) Zeposia (OZANIMOD) Zirabev (ZIRABEV) Zolgensma (ONASEMNOGENE ABEPARVOVEC) Zolinza (ZOLINZA) Zydelig (ZYDELIG) Zykadia (ZYKADIA) Zytiga (ZYTIGA)
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