PDL Drug Class Review Announcement October 5, 2021

Drug Classes to be reviewed: Non-Steroidal Anti-Inflammatories (NSAIDs) (Oral & Non-Oral); Antibiotics, Inhaled; Anti-Herpetic Agents (Oral & Topical); Fluoroquinolones, Oral; Hepatitis C Virus Treatments (Direct Acting Antivirals & Ribavirin Products); Human Immunodeficiency Virus (HIV) Agents, Oral; Pulmonary Arterial Hypertension Therapies (Phosphodiesterase Inhibitors, Endothelin Antagonists, Prostanoids, Guanylate Cyclase Stimulator); Newer Generation Antidepressants; Monoamine Oxidase Inhibitors (MAOIs); Tricyclic Antidepressants (TCAs); Triptans and Other Migraine Agents (Oral & Non-Oral); Anti-Psoriatics (Oral & Topical); Topical Immunomodulators; Topical Steroids (Low, Medium, High, & Very High Potency); Antiemetics (Oral & Non-Oral); H. Pylori Treatments; Pancreatic Enzymes; Proton Pump Inhibitors; Non- Biologic Ulcerative Colitis Agents (Oral & Rectal); Immune Globulins; Newer Generation Antihistamines; Antihistamine/Decongestant Combinations; Intranasal Rhinitis Agents; Leukotriene Modifiers; Methotrexate Products; Targeted Immune Modulators; Epinephrine Products; Newer Hereditary Angioedema Agents; Antihyperuricemics; Respiratory Agents [Anticholinergics & Combinations, Beta-2 Agonists (Short & Long), Corticosteroids & Combinations, Phosphodiesterase Inhibitors].

These drug classes will be reviewed at the October 5th, 2021 P&T Committee meeting from 1‐5pm. The meeting will be held virtually. Dossiers and Supplemental Rebate offers are due to Magellan by September 7, 2021.

Interested parties who want to present at the meeting shall give advanced notice and provide a one-page summary of the clinical information no later than September 28, 2021 by 5pm MT. Please direct requests to Jessica Czechowski, Pharmacist Account Executive, [email protected] and carbon copy Brittany Schock, PDL & Clinical Strategy Pharmacist, at 303-866-6371 or by email at [email protected] to present at the meeting. Advance notice requests to present and/or written public comments can be submitted to and will be distributed to P&T Committee Members, once approved. Policies surrounding stakeholder comment can be found at: https://www.colorado.gov/pacific/hcpf/pharmacy-and-therapeutics-committee

NON-STEROIDAL ANTI-INFLAMMATORIES (NSAIDS) Brand Name Generic Name

Oral

Diclofenac sodium DR/EC tablet, ER tablet

Diclofenac potassium tablet

Diflunisal tablet Etodolac capsule, tablet, ER tablet

Flurbiprofen tablet

Ibuprofen tablet (Rx), suspension

Indomethacin capsule, ER capsule

Ketoprofen capsule, ER capsule

Ketorolac tablet

Meclofenamate capsule

Mefenamic acid capsule

Nabumetone tablet

Naproxen tablet, DR tablet, suspension

Naproxen sodium ER tablet, IR tablet

Sulindac tablet

Tolmetin tablet, capsule

Arthrotec Diclofenac/misoprostol tablet

Diclofenac/misoprostol tablet

Celebrex Celecoxib capsule

Celecoxib capsule

Daypro Oxaprozin tablet

Oxaprozin tablet

Duexis Ibuprofen/famotidine tablet

Ibuprofen/famotidine tablet

Feldene Piroxicam capsule

Piroxicam capsule

Indocin Indomethacin suspension Mobic Meloxicam tablet

Meloxicam tablet, suspension

Nalfon Fenoprofen capsule, tablet

Fenoprofen capsule, tablet

Naprelan CR Naproxen sodium CR tablet

Naproxen sodium CR tablet

Qmiiz Meloxicam ODT

Relafen DS Nabumetone tablet

Vimovo Naproxen/esomeprazole DR tablet

Naproxen/esomeprazole DR tablet

Vivlodex Meloxicam, submicronized capsule

Meloxicam, submicronized capsule

Zipsor Diclofenac potassium capsule

Zorvolex Diclofenac, submicronized capsule

Non-Oral

Diclofenac topical solution

Flector Diclofenac patch

Diclofenac patch

Licart Diclofenac patch

Pennsaid Diclofenac solution pump

Sprix Ketorolac nasal solution

Ketorolac nasal solution

Voltaren (Rx) Diclofenac gel (Rx)

Diclofenac gel (Rx) ANTIBIOTICS, INHALED Brand Name Generic Name

Arikayce Amikacin liposomal vial

Bethkis Tobramycin ampule

Tobramycin ampule

Cayston Aztreonam inhalation solution

Kitabis Tobramycin nebulizer Pak

Tobramycin nebulizer Pak

Tobi Tobramycin inhalation solution

Tobramycin inhalation solution

Tobi Podhaler Tobramycin inhalation capsule

ANTIHERPETIC AGENTS Brand Name Generic Name

Oral

Famciclovir tablet

Sitavig Acyclovir buccal tablet

Valtrex Valacyclovir tablet

Valacyclovir tablet

Zovirax Acyclovir suspension

Acyclovir tablet, capsule, suspension

Topical

Denavir Penciclovir cream

Xerese Acyclovir/hydrocortisone cream

Zovirax Acyclovir ointment, cream Acyclovir ointment, cream

FLUOROQUINOLONES, ORAL Brand Name Generic Name

Levofloxacin tablet, solution

Moxifloxacin tablet

Ofloxacin tablet

Baxdela Delafloxacin tablet

Cipro Ciprofloxacin tablet, suspension

Ciprofloxacin tablet, suspension

HEPATITIS C VIRUS TREATMENTS Brand Name Generic Name

Direct Acting Antivirals (DAAs)

Epclusa Velpatasvir/Sofosbuvir tablet

Velpatasvir/Sofosbuvir tablet

Harvoni Ledipasvir/Sofosbuvir tablet, pellet packet

Ledipasvir/Sofosbuvir tablet

Mavyret Glecaprevir/Pibrentasvir tablet

Sovaldi Sofosbuvir tablet, pellet packet

Viekira Pak Ombitasvir/Paritaprevir/Ritonavir/Dasabuvir tablet

Vosevi Velpatasvir/Sofosbuvir/Voxilaprevir tablet

Zepatier Elbasvir/Grazoprevir tablet

Ribavirin Products

Ribavirin capsule, tablet Ribasphere Ribavirin tablet

Ribasphere Ribapak Ribavirin dosepack

HUMAN IMMUNODEFICIENCY VIRUS (HIV) AGENTS, Oral Brand Name Generic Name

Didanosine DR capsule

Stavudine capsule

Aptivus Tipranavir capsule

Atripla Efavirenz/Emtricitabine/Tenofovir (TDF) tablet

Efavirenz/Emtricitabine/Tenofovir (TDF) tablet

Biktarvy Bictegravir/Emtricitabine/Tenofovir alafenamide (TAF) tablet Cimduo Lamivudine/Tenofovir (TDF) tablet

Combivir Lamivudine/Zidovudine tablet

Lamivudine/Zidovudine tablet

Complera Emtricitabine/Rilpivirine/Tenofovir (TDF) tablet

Crixivan Indinavir sulfate capsule

Delstrigo Doravirine/Lamivudine/Tenofovir (TDF) tablet

Descovy Emtricitabine/Tenofovir alafenamide (TAF) tablet

Dovato Dolutegravir sodium/Lamivudine tablet

Edurant Rilpivirine HCl tablet

Emtriva Emtricitabine capsule, solution

Emtricitabine capsule

Epivir Lamivudine solution, tablet

Lamivudine solution, tablet

Epzicom Abacavir sulfate/Lamivudine tablet Abacavir sulfate/Lamivudine tablet

Evotaz Atazanavir/Cobicistat tablet

Genvoya Elvitegravir/Cobicistat/Emtricitabine/Tenofovir alafenamide (TAF) tablet Intelence Etravirine tablet

Etravirine tablet

Invirase Saquinavir mesylate tablet

Isentress, Isentress HD Raltegravir potassium chewable, powder pack, tablet

Juluca Dolutegravir/Rilpivirine tablet

Kaletra Lopinavir/Ritonavir solution, tablet

Lopinavir/Ritonavir solution, tablet

Lexiva Fosamprenavir suspension, tablet

Fosamprenavir tablet

Norvir Ritonavir powder packet, solution, tablet

Ritonavir tablet

Odefsey Emtricitabine/Rilpivirine/Tenofovir alafenamide (TAF) tablet Pifeltro Doravirine tablet

Prezcobix Darunavir/Cobicistat tablet

Prezista Darunavir ethanolate suspension, tablet

Retrovir Zidovudine capsule, syrup

Zidovudine capsule, syrup, tablet

Reyataz Atazanavir capsule, powder packet

Atazanavir capsule

Rukobia Fostemsavir tromethamine ER tablet

Selzentry Maraviroc solution, tablet Stribild Elvitegravir/Cobicistat/Emtricitabine/Tenofovir (TDF) tablet Sustiva Efavirenz capsule, tablet

Efavirenz capsule, tablet

Symfi, Symfi Lo Efavirenz/Lamivudine/Tenofovir (TDF) tablet

Efavirenz/Lamivudine/Tenofovir (TDF) tablet

Symtuza Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (TAF) tablet Temixys Lamivudine/Tenofovir (TDF) tablet

Tivicay Dolutegravir sodium tablet, tablet for suspension

Triumeq Abacavir/Dolutegravir/Lamivudine tablet

Trizivir Abacavir/Lamivudine/Zidovudine tablet

Abacavir/Lamivudine/Zidovudine tablet

Truvada Emtricitabine/Tenofovir (TDF) tablet

Emtricitabine/Tenofovir (TDF) tablet

Tybost Cobicistat tablet

Viracept Nelfinavir mesylate tablet

Viramune, Viramune XR Nevirapine suspension, ER tablet

Nevirapine suspension, ER tablet, IR tablet

Viread Tenofovir disoproxil fumarate (TDF) powder, tablet

Tenofovir disoproxil fumarate (TDF) tablet

Vocabria Cabotegravir sodium tablet

Ziagen Abacavir sulfate solution, tablet

Abacavir sulfate solution, tablet

PULMONARY ARTERIAL HYPERTENSION, Phosphodiesterase Inhibitors Brand Name Generic Name

Adcirca Tadalafil tablet

Tadalafil tablet

Alyq Tadalafil tablet

Revatio Sildenafil tablet, oral suspension

Sildenafil tablet, oral suspension

PULMONARY ARTERIAL HYPERTENSION, Endothelin Antagonists Brand Name Generic Name

Letairis Ambrisentan tablet

Ambrisentan tablet

Opsumit Macitentan tablet

Tracleer Bosentan tablet, tablet for suspension

Bosentan tablet

PULMONARY ARTERIAL HYPERTENSION, Prostanoids Brand Name Generic Name

Flolan Epoprostenol vial

Epoprostenol vial

Orenitram Treprostinil ER tablet

Remodulin Treprostinil vial

Treprostinil vial

Tyvaso Treprostinil inhalation solution

Uptravi Selexipag tablet, dosage pack Veletri Epoprostenol vial

Epoprostenol vial

Ventavis Iloprost inhalation solution

PULMONARY ARTERIAL HYPERTENSION, Guanylate Cyclase Stimulator Brand Name Generic Name

Adempas Riociguat tablet

NEWER GENERATION ANTIDEPRESSANTS Brand Name Generic Name

Bupropion IR Tablet

Desvenlafaxine fumarate ER tablet

Duloxetine 40mg capsule (generic Irenka)

Fluoxetine tablet

Fluvoxamine IR tablet, ER capsule

Nefazodone tablet

Trazodone tablet

Venlafaxine IR tablet, ER tablet

Aplenzin Bupropion ER tablet

Celexa Citalopram tablet

Citalopram solution, tablet

Cymbalta Duloxetine DR capsule

Duloxetine DR capsule

Drizalma Duloxetine sprinkle capsule

Effexor XR Venlafaxine ER capsule

Venlafaxine ER capsule Fetzima ER Levomilnacipran ER capsule, titration pak

Forfivo XL Bupropion XL tablet

Bupropion XL tablet

Lexapro Escitalopram tablet

Escitalopram tablet, oral solution

Paxil Paroxetine tablet, oral suspension

Paroxetine tablet

Paxil CR Paroxetine CR tablet

Paroxetine CR/ER tablet

Pexeva Paroxetine mesylate tablet

Pristiq Desvenlafaxine succinate ER tablet

Desvenlafaxine succinate ER tablet

Prozac Fluoxetine pulvule

Fluoxetine capsule, DR capsule, oral solution

Remeron Mirtazapine tablet, ODT Soltab

Mirtazapine tablet, ODT

Trintellix Vortioxetine tablet

Viibryd Vilazodone tablet, Starter Pack

Wellbutrin SR, XL Bupropion ER/SR, XL tablet

Bupropion ER/SR, XL tablet

Zoloft Sertraline tablet, oral concentrate

Sertraline tablet, oral concentrate

MONOAMINE OXIDASE INHIBITORS (MAOIs) Brand Name Generic Name

Tranylcypromine tablet

Emsam Selegiline patch

Marplan Isocarboxazid tablet

Nardil Phenelzine tablet

Phenelzine tablet

TRICYCLIC ANTIDEPRESSANTS (TCAs) Brand Name Generic Name

Amitriptyline tablet

Amoxapine tablet

Doxepin capsule 10mg, 25mg, 50mg, 75mg, 100mg, 150mg, concentrate Imipramine tablet

Imipramine pamoate capsule

Maprotiline tablet

Protriptyline tablet

Trimipramine capsule

Anafranil Clomipramine capsule

Clomipramine capsule

Norpramin Desipramine tablet

Desipramine tablet

Pamelor Nortriptyline capsule

Nortriptyline capsule, solution

TRIPTANS AND OTHER MIGRAINE AGENTS Brand Name Generic Name

Oral

Almotriptan tablet

Amerge Naratriptan tablet

Naratriptan tablet

Frova Frovatriptan tablet

Frovatriptan tablet

Imitrex Sumatriptan tablet

Sumatriptan tablet

Maxalt, Maxalt MLT Rizatriptan tablets, ODT

Rizatriptan tablets, ODT

Relpax Eletriptan tablet

Eletriptan tablet

Reyvow Lasmitidan tablet

Treximet Sumatriptan/naproxen tablet

Sumatriptan/naproxen tablet

Zomig, Zomig ZMT Zolmitriptan tablet, ODT

Zolmitriptan tablet, ODT

Non-Oral

Imitrex Sumatriptan nasal spray, cartridge, pen injector

Sumatriptan nasal spray, cartridge, pen injector, vial

Onzentra Xsail Sumatriptan nasal powder

Tosymra Sumatriptan nasal spray Zembrace Symtouch Sumatriptan SC auto-injector

Zomig Zolmitriptan nasal spray

Zolmitriptan nasal spray

ANTIPSORIATICS Brand Name Generic Name

Oral

Oxsoralen-Ultra Methoxsalen capsule

Methoxsalen capsule

Soriatane Acitretin capsule

Acitretin capsule

Topical

Dovonex Calcipotriene cream

Calcipotriene cream, ointment, solution

Duobrii Halobetasol/Tazarotene lotion

Enstilar Calcipotriene/Betamethasone DP foam

Sorilux Calcipotriene foam

Calcipotriene foam

Taclonex Calcipotriene/Betamethasone DP ointment, suspension

Calcipotriene/Betamethasone DP ointment, suspension

Vectical Calcitriol ointment

Calcitriol ointment

IMMUNOMODULATORS, TOPICAL Brand Name Generic Name

Elidel Pimecrolimus cream

Pimecrolimus cream

Protopic Tacrolimus ointment

Tacrolimus ointment

TOPICAL STEROIDS Brand Name Generic Name

Low Potency Alclometasone 0.05% cream, 0.05% ointment

Desonide 0.05% cream, 0.05% lotion, 0.05% ointment

Fluocinolone 0.01% cream

Hydrocortisone (Rx) cream, lotion, ointment

Capex Fluocinolone 0.01% shampoo

Derma-Smoothe-FS/ Scalp Fluocinolone 0.01% body oil/ 0.01% scalp oil

Fluocinolone 0.01% body oil/ 0.01% scalp oil

Desonate Desonide 0.05% gel

Synalar Fluocinolone 0.01% solution

Fluocinolone 0.01% solution

Synalar TS Fluocinolone 0.01%/Skin Cleanser Kit

Texacort Hydrocortisone 2.5% solution

Medium Potency Betamethasone Dipropionate 0.05% cream, 0.05% lotion

Betamethasone Valerate 0.1% cream, 0.1% lotion, 0.1% ointment

Fluocinonide-E 0.05% cream

Flurandrenolide 0.05% cream, 0.05% lotion, 0.05% ointment

Hydrocortisone valerate 0.2% cream, 0.2% ointment

Mometasone 0.1% cream, 0.1% ointment, 0.1% solution

Triamcinolone 0.025% cream, 0.1% cream, 0.025% lotion, 0.1% lotion, 0.025% ointment, 0.5% ointment, 1% ointment

Beser Fluticasone 0.05% lotion; 0.05% emollient Kit

Fluticasone 0.05% lotion

Cloderm Clocortolone 0.1% cream, 0.1% cream pump

Clocortolone 0.1% cream, 0.1% cream pump

Cutivate Fluticasone 0.05% cream, 0.05% lotion

Fluticasone 0.05% cream, 0.05%, lotion, 0.005% ointment

Dermatop Prednicarbate 0.1% ointment

Prednicarbate 0.1% ointment, 0.1% cream

Kenalog Triamcinolone 0.147 mg/g spray

Triamcinolone 0.147 mg/g spray

Locoid/Locoid Lipocream Hydrocortisone butyrate 0.1% lotion, hydrocortisone- emollient 0.1% cream

Hydrocortisone butyrate 0.1% cream, 0.1% ointment, 0.1% lotion, 0.1% solution, hydrocortisone-emollient 0.1% cream

Luxiq Betamethasone 0.12% foam Betamethasone 0.12% foam

Pandel Hydrocortisone probutate 0.1% cream

Psorcon Diflorasone 0.05% cream

Diflorasone 0.05% cream

Synalar Fluocinolone 0.025% cream, 0.025% ointment

Fluocinolone 0.025% cream, 0.025% ointment

Synalar Fluocinolone/emollient 0.025% cream, 0.025% ointment Kit

High Potency

Amcinonide 0.1% cream, 0.1% lotion

Betamethasone dipropionate 0.05% ointment

Betamethasone dipropionate/propylene glycol, (augmented) 0.05% cream

Diflorasone 0.05% ointment

Fluocinonide 0.05% cream, 0.05% gel, 0.05% ointment, 0.05% solution

Triamcinolone 0.5% cream, 0.5% ointment

Apexicon-E Diflorasone/emollient 0.05% cream

Halog Halcinonide 0.1% cream, 0.1% ointment, 0.1% solution

Halcinonide 0.1% cream

Topicort Desoximetasone 0.05% cream, 0.25% cream, 0.05% gel, 0.05% ointment, 0.25% ointment

Desoximetasone 0.05% cream, 0.25% cream, 0.05% gel, 0.05% ointment, 0.25% ointment

Very High Potency

Clobetasol emollient 0.05% cream

Halobetasol 0.05% cream, 0.05% ointment

Bryhali Halobetasol 0.01% lotion Clobex Clobetasol 0.05% shampoo, 0.05% spray

Clobetasol 0.05% lotion, 0.05% shampoo, 0.05% spray, 0.05% gel

Clodan Clobetasol 0.05% shampoo

Clobetasol 0.05% shampoo

Diprolene Betamethasone dipropionate/propylene glycol, (augmented) 0.05% ointment

Betamethasone dipropionate/propylene glycol, (augmented) 0.05% ointment, 0.05% lotion, 0.05% gel

Impeklo Clobetasol 0.05% lotion

Lexette Halobetasol 0.05% foam

Halobetasol 0.05% foam

Olux/Olux-E Clobetasol 0.05% foam, Clobetasol-emollient 0.05% foam

Clobetasol 0.05% foam, Clobetasol-emollient 0.05% foam

Temovate Clobetasol 0.05% cream, 0.05% ointment

Clobetasol 0.05% cream, 0.05% ointment, 0.05% solution, 0.05% lotion, 0.05% gel

Topicort Desoximetasone 0.25% spray

Desoximetasone 0.25% spray

Tovet Clobetasol emollient 0.05% foam, 0.05% emollient foam kit

Clobetasol emollient 0.05% foam

Ultravate Halobetasol 0.05% lotion

Vanos Fluocinonide 0.1% cream

Fluocinonide 0.1% cream

ANTIEMETICS Brand Name Generic Name

Oral

Granisetron tablet

Prochlorperazine tablet

Promethazine solution/syrup, tablet

Akynzeo Netupitant/Palonosetron capsule

Antivert Meclizine 50 mg tablet

Meclizine (Rx) 12.5 mg, 25 mg tablet

Bonjesta ER Doxylamine/pyridoxine tablet

Diclegis Doxylamine/pyridoxine tablet

Doxylamine/pyridoxine tablet

Emend Aprepitant capsule, powder pack, tripack

Aprepitant capsule, capsule pack

Marinol Dronabinol capsule

Dronabinol capsule

Reglan Metoclopramide tablet

Metoclopramide ODT, solution, tablet

Tigan Trimethobenzamide capsule

Trimethobenzamide capsule

Varubi Rolapitant tablet

Zofran Ondansetron tablet

Ondansetron tablet, ODT, oral solution/suspension

Zuplenz Ondansetron film Non-Oral

Compro Prochlorperazine 25 mg suppository

Prochlorperazine 25 mg suppository

Promethegan Promethazine 50 mg suppository

Promethazine 12.5 mg, 25 mg suppository

Sancuso Granisetron patch

Transderm-Scop Scopolamine patch

Scopolamine patch

H. PYLORI TREATMENTS Brand Name Generic Name

Amoxicillin/Lansoprazole/Clarithromycin pack

OMECLAMOX-PAK Amoxicillin/Omeprazole/Carithromycin pack

PYLERA Bismuth subcitrate/Metronidazole /Tetracycline tablet

TALICIA Omeprazole/Amoxicillin/Rifabutin tablet

PANCREATIC ENZYMES Brand Name Generic Name

Creon Lipase/Protease/Amylase capsule

Pancreaze Lipase/Protease/Amylase capsule

Pertzye Lipase/Protease/Amylase capsule

Viokace Lipase/Protease/Amylase capsule

Zenpep Lipase/Protease/Amylase capsule

PROTON PUMP INHIBITORS Brand Name Generic Name

Omeprazole DR capsule (Rx)

Omeprazole DR tablet (OTC), ODT (OTC)

Aciphex Rabeprazole tablet, sprinkles

Rabeprazole tablet

Dexilant Dexlansoprazole capsule

Nexium Esomeprazole DR capsule (Rx), oral suspension packet

Esomeprazole DR capsule (Rx/OTC), oral suspension packet Prilosec DR Omeprazole suspension

Prevacid Lansoprazole DR capsule (Rx), Solutab, suspension

Lansoprazole DR capsule (Rx), DR capsule (OTC), ODT (Rx) Protonix DR Pantoprazole DR tablet, oral suspension packet

Pantoprazole DR tablet, oral suspension packet

Zegerid Omeprazole/Na Bicarb capsule, oral suspension packet

Omeprazole/Na Bicarb capsule, oral suspension packet

NON-BIOLOGIC ULCERATIVE COLITIS AGENTS Brand Name Generic Name

Oral

Apriso Mesalamine ER capsule

Mesalamine ER capsule

Asacol HD Mesalamine DR tablet

Mesalamine DR tablet

Azulfidine, Azulfidine Entab Sulfasalazine tablet, DR tablet Sulfasalazine tablet, DR tablet

Colazal Balsalazide capsule

Balsalazide capsule

Delzicol Mesalamine DR capsule

Mesalamine DR capsule

Dipentum Olsalazine capsule

Lialda Mesalamine DR tablet

Mesalamine DR tablet

Pentasa Mesalamine capsule

Uceris Budesonide tablet

Budesonide tablet

Rectal

Canasa Mesalamine suppository

Mesalamine suppository

Rowasa, SFRowasa Mesalamine enema, kit

Mesalamine enema, kit

Uceris Budesonide rectal foam

IMMUNE GLOBULINS Brand Name Generic Name Bivigam Immune Globulin IV solution

Cutaquig Immune Globulin-hipp SC solution

Cuvitru Immune Globulin SC solution

Flebogamma Dif Immune Globulin IV solution

Gammagard Immune Globulin SC solution Gammagard S/D Immune Globulin IV powder vial

Gammaked Immune Globulin IV/SC solution

Gammaplex Immune Globulin IV solution

Gamunex-C Immune Globulin IV/SC solution

Hizentra Immune Globulin SC solution syringe, vial

Hyqvia Immune Globulin-Hyaluronidase SC kit/pack

Octagam Immune Globulin IV solution

Panzyga Immune Globulin-ifas IV solution

Privigen Immune Globulin IV solution

Xembify Immune Globulin-klhw SC solution

NEWER GENERATION ANTIHISTAMINES Brand Name Generic Name

Single Ingredient

Cetirizine (OTC) tablet, chewable tablet (OTC), softgel (OTC), solution/syrup (OTC/Rx) Clarinex Desloratadine tablet

Desloratadine tablet, ODT

Fexofenadine (OTC) tablet, (OTC) suspension

Levocetirizine (OTC/Rx) tablet, solution

Loratadine (OTC) chewable, (OTC) ODT, (OTC) solution/syrup, (OTC) tablet

Antihistamine/Decongestant Combinations

Cetirizine/Pseudoephedrine tablet

Fexofenadine/Pseudoephedrine (OTC) tablet

Loratadine/Pseudoephedrine (OTC) tablet

Clarinex-D Desloratadine/Pseudoephedrine tablet

INTRANASAL RHINITIS AGENTS Brand Name Generic Name

Azelastine 0.1% (137 mcg), 0.15% spray

Budesonide (generic Rhinocort Aqua) spray (OTC)

Flunisolide (generic Nasarel) spray

Fluticasone spray (RX/OTC)

Ipratropium (generic Atrovent) spray

Triamcinolone (generic Nasacort AQ) spray (OTC)

Beconase AQ Beclomethasone spray

Dymista Azelastine/Fluticasone spray

Azelastine/Fluticasone spray

Nasonex Mometasone spray

Mometasone spray

Omnaris Ciclesonide spray

Patanase Olopatadine spray

Olopatadine spray

Qnasl/Qnasl Children’s Beclomethasone spray

Xhance Fluticasone spray

Zetonna Ciclesonide spray

LEUKOTRIENE MODIFIERS Brand Name Generic Name

Zileuton ER tablet

Accolate Zafirlukast tablet

Zafirlukast tablet

Singulair Montelukast tablet, chewable tablet, granules Montelukast tablet, chewable tablet, granules

Zyflo Zileuton tablet

METHOTREXATE PRODUCTS Brand Name Generic Name

Methotrexate Vial

Otrexup Methotrexate auto-injector

Rasuvo Methotrexate auto-injector

Reditrex Methotrexate syringe

Trexall Methotrexate oral tablet

Methotrexate oral tablet

Xatmep Methotrexate oral solution

TARGETED IMMUNE MODULATORS Brand Name Generic Name

Actemra Tocilizumab SC syringe, Actpen

Arcalyst Rilonacept SC vial

Cimzia Certolizumab SC kit, vial

Cosentyx Secukinumab SC pen, syringe

Enbrel Etanercept SC kit, mini cartridge, Sureclick, syringe, vial

Humira Adalimumab SC syringe, pen, kit

Ilaris Canakinumab SC vial

Kevzara Sarilumab SC pen, syringe

Kineret Anakinra SC syringe

Olumiant Baricitinib oral tablet Orencia Abatacept SC clickject, syringe

Otezla Apremilast oral tablet, starter pack

Rinvoq Upadacitinib ER oral tablet

Siliq Brodalumab SC syringe

Simponi Golimumab SC pen injector, syringe

Skyrizi Risankizumab-rzaa SC pen, syringe

Stelara Ustekinumab SC syringe

Taltz Ixekizumab SC autoinjector, syringe

Tremfya Guselkumab SC injector, syringe

Xeljanz Tofacitinib oral tablet, solution

Xeljanz XR Tofacitinib ER oral tablet

EPINEPHRINE PRODUCTS, SELF-ADMINISTERED Brand Name Generic Name

Epinephrine auto-injector (generic Adrenaclick)

Epipen, Epipen Jr. Epinephrine auto-injector

Epinephrine auto-injector

Symjepi Epinephrine syringe

Epinephrine syringe

NEWER HEREDITARY ANGIOEDEMA (HAE) AGENTS Brand Name Generic Name

Berinert C1 Esterase Inhibitor kit, vial

Cinryze C1 Esterase Inhibitor vial

Firazyr Icatibant syringe Icatibant syringe

Haegarda C1 Esterase Inhibitor vial

Orladeyo Berotralstat capsule

Ruconest C1 Esterase Inhibitor, recombinant vial

Takhzyro Lanadelumab-flyo vial

ANTIHYPERURICEMICS Brand Name Generic Name

Probenecid tablet

Probenecid-Colchicine tablet

Colcrys Colchicine tablet

Colchicine tablet

Gloperba Colchicine solution

Mitigare Colchicine capsule

Colchicine capsule

Uloric Febuxostat tablet

Febuxostat tablet

Zyloprim Allopurinol tablet

Allopurinol tablet

RESPIRATORY AGENTS, Inhaled Anticholinergics & Anticholinergic Combinations Brand Name Generic Name

Solutions

Ipratropium/Albuterol nebulizer solution

Ipratropium nebulizer solution Lonhala Magnair Glycopyrrolate nebulizer set

Yupelri Revafenacin nebulizer solution

Short-Acting Inhalers

Atrovent HFA Ipratropium inhaler

Combivent Respimat Ipratropium/Albuterol inhaler

Long-Acting Inhalers

Anoro Ellipta Umeclidinium/Vilanterol inhaler

Bevespi Aerosphere Glycopyrrolate/Formoterol fumarate inhaler

Breztri Aerosphere Budesonide/Glycopyrrolate/Formoterol inhaler

Duaklir Pressair Aclidinium/Formoterol inhaler

Incruse Ellipta Umeclidinium inhaler

Seebri Neohaler Glycopyrrolate inhaler

Spiriva Handihaler Tiotropium capsules

Spiriva Respimat Tiotropium inhaler

Stiolto Respimat Tiotropium/olodaterol inhaler

Tudorza Pressair Aclidinium inhaler

Utibron Neohaler Glycopyrrolate/indacaterol inhaler

RESPIRATORY AGENTS, Inhaled Beta2 Agonists, Short-Acting Brand Name Generic Name

Solutions

Albuterol nebulizer solution

Xopenex Levalbuterol nebulizer solution

Levalbuterol nebulizer solution Inhalers

Albuterol HFA Inhaler

Proair Digihaler, HFA, Respiclick Albuterol HFA Inhaler

Proventil HFA Albuterol HFA Inhaler

Ventolin HFA Albuterol HFA Inhaler

Xopenex HFA Levalbuterol HFA Inhaler

Levalbuterol HFA Inhaler

RESPIRATORY AGENTS, Inhaled Beta2 Agonists, Long-Acting Brand Name Generic Name

Solutions

Brovana Arformoterol nebulizer solution

Arformoterol nebulizer solution

Perforomist Formoterol nebulizer solution

Formoterol nebulizer solution

Inhalers

Serevent Diskus Salmeterol Inhaler

Striverdi Respimat Olodaterol Inhaler

RESPIRATORY AGENTS, Inhaled Corticosteroids Brand Name Generic Name

Solutions

Pulmicort Budesonide nebules

Budesonide nebules Inhalers

Alvesco Ciclesonide

Armonair Digihaler Fluticasone propionate

Arnuity Ellipta Fluticasone furoate

Asmanex HFA, Twisthaler Mometasone

Flovent Diskus, HFA Fluticasone propionate

Pulmicort Flexhaler Budesonide

Qvar Redihaler Beclomethasone

RESPIRATORY AGENTS, Inhaled Corticosteroid Combinations Brand Name Generic Name

Advair Diskus, HFA Fluticasone/salmeterol

Fluticasone/salmeterol

Airduo Digihaler, Respiclick Fluticasone/salmeterol

Fluticasone/salmeterol

Breo Ellipta Fluticasone/vilanterol

Dulera Mometasone/formoterol

Symbicort Budesonide/formoterol

Budesonide/formoterol

Trelegy Ellipta Fluticasone/Umeclindinium/Vilanterol

RESPIRATORY AGENTS, Phosphodiesterase Inhibitors (PDEIs) Brand Name Generic Name

DALIRESP Roflumilast tablet