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Medications Limited to a 30-Day Supply This List Is Subject to Change at Any Time

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Medications Limited to a 30-Day Supply This List Is Subject to Change at Any Time Medications Limited to a 30-Day Supply This list is subject to change at any time Fertility Medications Medication Name Bravelle Cetrotide Clomiphene Crinone Endometrin Follistim AQ Ganirelix Gonal F/Gonal F RFF Human Chorionic Gonadotropin Leuprolide Acetate Lupron Depot Lupron Depot Ped Makena Menopur Novarel Ovidrel Pregnyl Serophene Injectable Medications Medication Name Abraxane Acetadote Actemra Acthar HP Actimmune Adriamycin Adrucil Alferon N Alkeran Apokyn Aranesp Arcalyst injection Arikayce Arzerra Aveed Avonex Bavencio Beleodaq Benlysta autoinject/syringe Berinert Besponsa Betaseron Bicillin BiCNu Bivigam Bleo 15K Bleomycin Sulfate Blincyto Boniva injection Bortezomib Botox Busulfex Cablivi Calcium Folinate Camptosar Carboplatin Carimune NF Carmustine Cerezyme Ceftazadime Cimzia Cinqair Cinryze Cisplatin Cladribine Copaxone Cosentyx Cosmegen Crysvita Cuvitru Cuvposa Cyclophosphamide Cyramza Cytarabine Cytogam Dacarbazine Dactinomycin Darzalex Daunorubicin HCL DDAVP Delestrogen Depocyt Depo-Estradiol Desferal Desferoxamine Desmopressin Acetate Dexrazoxane Docefrez Docetaxel Doxil Doxorubicin HCL Dupixent Dysport Egrifta Eligard Ellence Empliciti Enbrel Entyvio Epirubicin Epogen Ethyol Etopophos Etoposide Evomela Exondys Extavia Fasenra Faslodex Firazyr Firmagon Flebogamm Floxuridine Fludara Fludarabine Phosphate Fluorouracil Fortaz Forteo Fulphila Fusilev I.V. Fuzeon GamaSTAN Gamifant Gammagard Gammagard liquid Gammaked Gammaplex Gamunex Gattex Gazyva Gemcitabine Gemzar Genotropin Glatiramer Glatopa Granix Haegarda Herceptin Hizentra Humatrope Humira Hycamtin Hydroxyprogesterone HyQvia Ibandronate Idamycin PFS Idarubicin Ifex Ifosfamide Ifosfamide/Mesna Ilaris Ilumya Imfinzi Increlex Inflectra Intron A Irinotecan Istodax Kalbitor Kanuma Kenalog Kevzara Keytruda Khapzory Kineret Kynamro Lartruvo Lemtrada Leucovorin Calcium Leukine Leuprolide Acetate Levoleucovorin Libtayo Lipodox Lipodox 50 Lumoxiti Lupaneta Pack Lupron Depot Lupron Depot-Ped Makena Marqibo Mepsevii Mesna Mesnex Methotrexate Mitomycin Mitoxantrone Mozobil Mustargen Myobloc Nabi-HB Natpara Navelbine Neulasta Neulasta Onpro Neupogen Nipent Nivestym Norditropin Norditropin Flexpro Norditropin Nordiflex Nplate Nucala Nutropin AQ Nuspin Ocrevus Octagam Octreotide injection Omnitrope Oncaspar Onpattro Opdivo Orencia Otezla Otrexup Oxaliplatin Paclitaxel Palynziq Pamidronate Pamidronate Disodium Panzyga Pegasys Pegasys Proclick Peg-Intron Photofrin Poteligeo Portrazza Plegridy Praluent Privigen Procrit Proleukin Prolia Radicava Rebif Rebidose Remicade Renflexis Repatha Retacrit Revatio Revcovi Rimso-50 Rituxan Rocephin Roferon A Romidepsin Ruconest Saizen SaizenPrep Sandimmune Sandostatin Sandostatin-LAR Serostim Signifor Signifor Lar Sildenafil antihypertensive Siliq Simponi Simponi Aria Somatuline Somavert Spinraza Stelara Strensiq Sublocade Sylatron 4-pack Sylvant Synagis Synribo Takhzyro Taltz Taxotere Tazicef Tecentriq Tegsedi Temodar Teniposide Tepadina Testosterone Enanthate Tev-Tropin TheraCys Thiotepa Thyrogen Toposar Totect Trelstar Trelstar Depot Trelstar LA Tremfya Triptodur Tymlos Udenyca Unituxin Valstar Velcade Ventavis Vimizim VinBLAStine VinCRIStine Vinorelbine Vivitrol Vyxeos Xeomin Xgeva Xolair Yondelis Zaltrap Zanosar Zarxio Zilretta Zinecard Zoladex Zomacton Oral Medications Medication Name 8-Mop Abacavir Abacavir-Lamivudine Abacavir-Lamivudine-Zidovudine Abiraterone Adcirca Adempas Afinitor Afinitor Disperz Alecensa Alkeran Alunbrig Alyq Ampyra Aptivus Arikayce Atazanavir Sulfate Atripla Aubagio Austedo Balversa Bethkis Biktarvy Boniva 150mg Bosulif Cabometyx Calquence Capecitabine Carbaglu Cayston Cerdelga Chenodal Cholbam Cimduo Combivir Cometriq Complera Copegus Copiktra Cotellic Crixivan Cyclophosphamide Cystagon Daklinza Dalfampridine Daraprim Daurismo DDAVP Delstrigo Descovy Diacomit Didanosine Doptelet Duopa Edurant Efavirenz Emflaza Emtriva Epclusa Epivir Epzicom Erleada Erivedge Esbriet Etoposide Evotaz Exjade Farydak Firdpase Fosamprenavir Calcium Fuzeon Galafold Genvoya Gilenya Gilotrif Gleevec Gocovri ER Harvoni Hetlioz Hycamtin Ibrance Iclusig Idhifa Imatinib Imbruvica Inbrija Ingrezza Inlyta Intelence Invirase Iressa Isentress Isentress HD Jadenu Jakafi Juluca Juxtapid Jynarque Kaletra Kalydeco Keveyis Kisqali Kisqali Femara Kitabis PAK nebules Korlym Kuvan Lamivudine Lamivudine-Zidovudine Ledipasvir/Sofosbuvir Lenvima Letairis Lexiva Lobrena Lonsurf Lopinavir-Ritonavir Mavyret Mekinist Mesnex Miglustat Moderiba Mulpleta Nerlynx Nevirapine Nevirapine ER Nexavar Ninlaro Nityr Northera Norvir Nuplazid Ocaliva Odefsey Odomzo Ofev Olumiant Olysio Opsumit Orenitram Orfadin Orkambi Otezla Otezla starter pack Pifeltro Pomalyst Prezcobix Prezista Procysbi Promacta Pulmozyme Ravicti Rebetol Rescriptor Retrovir Revatio Revlimid Reyataz Ribasphere Ribasphere Ribapak Ribatab Ribavirin Rilutek Riluzole Ritonavir Rubraca Rydapt Sabril Samsca Selzentry Sildenafil antihypertensive Sofosbuvir/Velpatasvi Sovaldi Sprycel Stavudine Stivarga Stribild Sucraid Sustiva Sutent Symdeko Symfi Symfi Lo Symtuza Tadalafil Tafinlar Tagrisso Talzenna Tarceva Tasigna Tavalisse Tecfidera Technivie Temodar Temozolomide Tenofovir Disoproxil Fumarate Tetrabenazine Thalomid Thiola Tivicay Tiglutik TOBI ampules TOBI Podhaler Tobramycin nebules Tracleer Triumeq Trizivir Trogarzo Truvada Tykerb Tyvaso Uptravi Veltassa Venclexta Verzenio Videx Videx EC Viekira PAK Vigabatrin Viracept Viramune Viramune XR Viread Vistogard Vitekta Vitrakvi Vizimpro Vosevi Votrient Xalkori Xeljanz Xeljanz XR Xeloda Xenazine Xermelo Xospata Xtandi Xuriden Xyrem Yonsa Zavesca Zejula Zelboraf Zepatier Zerit Ziagen Zidovudine Zolinza Zydelig Zykadia Zytiga Topical Medications Medication Name Cystaran Mugard Oxervate Panretin Qutenza Synarel Valchlor Zecuity * This list is subject to change at any time.
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