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(PA) Cross Reference

(PA) Cross Reference

Prior Authorization Drug Criteria Cross Reference PA Drug Name Generic Name PA Summary Name Epaned enalapril ACE Inhibitors and Combinations Perindopril perindopril ACE Inhibitors and Combinations Prestalia perindopril/ ACE Inhibitors and Combinations Qbrelis lisinopril ACE Inhibitors and Combinations Trandolapril/ ER by Greenstone trandolapril/verapamil ER ACE Inhibitors and Combinations Absorica/LD, Amnesteem, Claravis, Agents, Oral Isotretinoin, Myorisan, Zenatane Acanya / Acne and Rosacea Agents, Topical Aczone Acne and Rosacea Agents, Topical Aklief trifarotene Acne and Rosacea Agents, Topical Altreno, Avita, , Retin-A Micro tretinoin Acne and Rosacea Agents, Topical Amzeeq, Zilxi Acne and Rosacea Agents, Topical Arazlo, Fabior, Tazorac Acne and Rosacea Agents, Topical Azelex, Finacea azelaic Acne and Rosacea Agents, Topical Clindamycin, Clindacin, Evoclin clindamycin Acne and Rosacea Agents, Topical Clindamycin 1%/Benzoyl Peroxide 5%, clindamycin/benzoyl peroxide Acne and Rosacea Agents, Topical Neuac, Onexton Differin, adapalene Acne and Rosacea Agents, Topical Adapalene/Benzoyl Peroxide, Epidue Forte adapalene/benzoyl peroxide Acne and Rosacea Agents, Topical Ery Pad, pad erythromycin Acne and Rosacea Agents, Topical Erythromycin/Benzoyl Peroxide erythromycin/benzoyl peroxide Acne and Rosacea Agents, Topical Metrogel, , Noritate, Rosadan metronidazole Acne and Rosacea Agents, Topical Soolantra ivermectin Acne and Rosacea Agents, Topical Ziana tretinoin/clindamycin Acne and Rosacea Agents, Topical BP 10-1%, /, sodium sulfacetamide/sulfur Acne and Rosacea Agents, Topical Sumaxin Sulfacetamide sodium sulfacetamide sodium Acne and Rosacea Agents, Topical Tekturna aliskiren Aliskiren and Combinations Tekturna HCT aliskiren/HCTZ Aliskiren and Combinations 23 mg donepezil Alzheimer's Agents Memantine oral solution memantine Alzheimer's Agents Memantine ER, Namenda XR Titration Pak memantine extended-release Alzheimer's Agents Namzaric, Titration Pak memantine/donepezil Alzheimer's Agents Tiglutik Amyotrophic Lateral Sclerosis Agents Arymo ER, Kadian, Morphabond ER, ER , Narcotics Long Morphine ER capsules Belbuca Analgesics, Narcotics Long Patch 37.5, 62.5, 87.5 mcg/hour fentanyl Analgesics, Narcotics Long ER hydromorphone ER Analgesics, Narcotics Long Hysingla ER, Zohydro ER ER Analgesics, Narcotics Long levorphanol Analgesics, Narcotics Long Nucynta ER ER Analgesics, Narcotics Long OxyContin, Xtampza ER ER Analgesics, Narcotics Long ER oxymorphone ER Analgesics, Narcotics Long Acetaminophen/Caffeine/ acetaminophen/caffeine/dihydrocodeine Analgesics, Narcotics Short /Acetaminophen benzhydrocodone/acetaminophen Analgesics, Narcotics Short Butalbital/Acetaminophen/Caffeine/ butalbital/acetaminophen/caffeine/codeine Analgesics, Narcotics Short Butalbital//Caffeine/Codeine butalbital/aspirin/caffeine/codeine Analgesics, Narcotics Short Nasal Spray QLL butorphanol Analgesics, Narcotics Short Codeine codeine Analgesics, Narcotics Short Dilaudid Oral Liquid, Hydromorphone Rectal hydromorphone Analgesics, Narcotics Short Suppository Hydrocodone/, Ibudone hydrocodone/ibuprofen Analgesics, Narcotics Short Meperidine meperidine Analgesics, Narcotics Short Morphine Rectal Suppository morphine Analgesics, Narcotics Short Nalocet, Primlev oxycodone/acetaminophen Analgesics, Narcotics Short Nucynta tapentadol Analgesics, Narcotics Short Oxaydo, Oxycodone QLL, Oxycodone oxycodone Analgesics, Narcotics Short Concentrate Oral Solution Oxycodone/Aspirin oxycodone/aspirin Analgesics, Narcotics Short Oxycodone/Ibuprofen oxycodone/ibuprofen Analgesics, Narcotics Short Oxymorphone oxymorphone Analgesics, Narcotics Short diflunisal Analgesics, Salicylates Salsalate salsalate Analgesics, Salicylates Injection testosterone cypionate Androgenic Agents, Injectable Testosterone Injection, Xyosted testosterone enanthate Androgenic Agents, Injectable Anadrol-50 oxymetholone Androgenic Agents, Oral danazol Androgenic Agents, Oral Jatenzo testosterone undecanoate Androgenic Agents, Oral Methitest, Methyltestosterone methyltestosterone Androgenic Agents, Oral Oxandrolone oxandrolone Androgenic Agents, Oral Androderm, Striant, Testosterone testosterone Androgenic Agents, Topical Trandermal Candesartan candesartan Angiotensin Receptor Blockers and Combinations Edarbi azilsartan Angiotensin Receptor Blockers and Combinations Eprosartan eprosartan Angiotensin Receptor Blockers and Combinations Micardis, telmisartan Angiotensin Receptor Blockers and Combinations Amlodipine/Valsartan amlodipine/valsartan Angiotensin Receptor Blockers and Combinations Amlodipine/Valsartan/HCTZ amlodipine/valsartan/HCTZ Angiotensin Receptor Blockers and Combinations Amlodipine/olmesartan amlodipine/olmesartan Angiotensin Receptor Blockers and Combinations Entresto sacubitril/valsartan Angiotensin Receptor Blockers and Combinations Tribenzor olmesartan/amlodipine/HCTZ Angiotensin Receptor Blockers and Combinations Candesartan/HCTZ candesartan/HCTZ Angiotensin Receptor Blockers and Combinations Edarbyclor azilsartan/HCTZ Angiotensin Receptor Blockers and Combinations Micardis, Telmisartan/HCTZ telmisartan/HCTZ Angiotensin Receptor Blockers and Combinations Telmisartan/Amlodipine, Twynsta telmisartan/amlodipine Angiotensin Receptor Blockers and Combinations Albendazole albendazole Anthelmintics Emverm mebendazole Anthelmintics Stromectol ivermectin Anthelmintics Oralair mixed grass pollen allergen extract Antiallergens, Oral peanut [Arachis hypogaea] allergen powder- Palforzia Antiallergens, Oral dnfp Multaq Antiarrhythmics, Oral Dificid fidaxomicin , GI Paromomycin paromomycin Antibiotics, GI Xifaxan rifamixin Antibiotics, GI Tobi Podhaler, Tobramycin Nebulized tobramycin Antibiotics, Inhaled Mupirocin Cream mupirocin Antibiotics, Topical Neo-Synalar / Antibiotics, Topical Neo-Synalar Kit neomycin/fluocinolone/emollient cream Antibiotics, Topical Xepi ozenoxacin Antibiotics, Topical Cleocin Ovules, Clindamycin Vaginal Cream clindamycin Antibiotics, Vaginal (7-day) Solosec secnidazole Antibiotics, Vaginal Chlordiazepoxide/Clidinium chlordiazepoxide/clidinium - Cuvposa, Glycate, Glycopyrrolate Injection glycopyrrolate Anticholinergics-Antispasmodics Methscopolamine methscopolamine Anticholinergics-Antispasmodics Proprantheline proprantheline Anticholinergics-Antispasmodics Bevyxxa betrixaban Anticoagulants Savaysa edoxaban Anticoagulants Fondaparinux fondaparinux Anticoagulants Fragmin Syringes dalteparin Anticoagulants Aptiom eslicarbazepine Anticonvulsants Banzel Anticonvulsants Briviact brivaracetam Anticonvulsants Clobazam oral suspension, Sympazan clobazam Anticonvulsants Rectal, Valtoco Nasal Spray diazepam Anticonvulsants Diacomit stiripentol Anticonvulsants Epidiolex Anticonvulsants Equetro extended-release Anticonvulsants Felbamate felbamate Anticonvulsants Fintepla fenfluramine Anticonvulsants Fycompa perampanel Anticonvulsants Gabitril, Tiagabine tiagabine Anticonvulsants Lamictal Kits/ODT, ER/ODT/kits lamotrigine Anticonvulsants ER levetiracetam extended-release Anticonvulsants Lyrica CR extended-release Anticonvulsants Nayzilam midazolam Anticonvulsants Oxtellar XR Anticonvulsants Qudexy XR, ER, Trokendi XR topiramate extended-release Anticonvulsants Sabril vigabatrin Anticonvulsants Stavzor, Valproic Acid Capsules valproic acid Anticonvulsants Vimpat Injection Anticonvulsants Xcopri Anticonvulsants Brisdelle, Paxil Suspension, Pexeva paroxetine Antidepressants Escitalopram Oral Solution escitalopram Antidepressants 10 mg, 20 mg Tablets fluoxetine Antidepressants Fluoxetine 90 mg Delayed-Release fluoxetine DR Antidepressants Fluoxetine [PMDD], Sarafem fluoxetine [PMDD] Antidepressants Fluvoxamine ER fluvoxamine extended-release Antidepressants Paroxetine ER paroxetine extended-release Antidepressants Desvenlafaxine ER desvenlafaxine extended-release Antidepressants Drizalma, Duloxetine 40 mg duloxetine Antidepressants Fetzima levomilnacipran Antidepressants Savella milnacipran Antidepressants Trintellix (previously Brintellix) vortioxetine Antidepressants Venlafaxine ER Tablets venlafaxine extended-release Antidepressants nefazodone Antidepressants Trazodone 300 mg trazodone Antidepressants Viibryd viladazone Antidepressants Emsam Antidepressants Marplan isocarboxazid Antidepressants Phenylzine phenylzine Antidepressants Tranylcypromine tranylcypromine Antidepressants Imipramine Capsules imipramine pamoate Antidepressants Protriptyline protriptyline Antidepressants Trimipramine trimipramine Antidepressants Aplenzin, Forfivo XL bupropion extended-release Antidepressants Maprotiline maprotiline Antidepressants Spravato esketamine Antidepressants Alogliptin 6.25, 12.5mg, Nesina 25mg alogliptin Antidiabetic Agents Alogliptin/Metformin alogliptin/metformin Antidiabetic Agents Alogliptin/Pioglitazone alogliptin/pioglitazone Antidiabetic Agents Janumet XR sitagliptin/metformin ER Antidiabetic Agents Jentadueto XR linagliptin/metformin ER Antidiabetic Agents Prandimet, /Metformin repaglinide/metformin Antidiabetic Agents Fortamet, Metformin ER (generic Fortamet), metformin ER Antidiabetic Agents Riomet ER Glyxambi empagliflozin/linagliptin Antidiabetic Agents Invokamet XR canagliflozin/metformin ER Antidiabetic Agents Qtern dapagliflozin/saxagliptin Antidiabetic Agents Segluromet ertugliflozin/metformin Antidiabetic Agents Steglatro ertugliflozin Antidiabetic Agents Steglujan ertugliflozin/sitagliptin Antidiabetic Agents Synjardy, Synjardy XR empaglifozin/metformin, ER Antidiabetic Agents Trijardy XR empagliflozin/linagliptin/metformin ER Antidiabetic Agents chlorpropamide Antidiabetic Agents tolazamide Antidiabetic Agents tolbutamide Antidiabetic Agents Actoplus Met XR pioglitazone/metformin ER Antidiabetic Agents Avandia rosiglitazone Antidiabetic Agents Avandamet rosiglitazone/metformin Antidiabetic Agents Pioglitazone/Glimepride pioglitazone/ Antidiabetic Agents Pioglitazone/Metformin pioglitazone/metformin Antidiabetic Agents Bydureon/Bydureon BCise exenatide ER Antidiabetic Agents Symlin Pen pramlintide acetate Antidiabetic Agents Adlyxin lixisenatide Antidiabetic Agents Cycloset bromocriptine Antidiabetic Agents Ozempic, Rybelsus semaglutide Antidiabetic Agents Soliqua glargine/lixisenatide Antidiabetic Agents Tanzeum albiglutide Antidiabetic Agents Trulicity dulaglutide Antidiabetic Agents Xultophy insulin degludec/liraglutide Antidiabetic Agents Alosetron alosetron Antidiarrheals Motofen difenoxin/atropine Antidiarrheals Mytesi Antidiarrheals Opium Tincture opium tincture Antidiarrheals Viberzi eluxadoline Antidiarrheals Akynzeo netupitant/palonosetron Antiemetic/Antivertigo Agents Anzemet dolasetron Antiemetic/Antivertigo Agents Cesamet nabilone Antiemetic/Antivertigo Agents Compro prochlorperazine Antiemetic/Antivertigo Agents Dimenhydrinate Injection dimenhydrinate Antiemetic/Antivertigo Agents Dronabinol, Syndros dronabinol Antiemetic/Antivertigo Agents Emend Suspension aprepitant Antiemetic/Antivertigo Agents Granisetron, Sancuso granisetron Antiemetic/Antivertigo Agents Metoclopramide ODT metoclopramide Antiemetic/Antivertigo Agents Ondansetron Injection, Zuplenz ondansetron Antiemetic/Antivertigo Agents 50 mg Suppository promethazine Antiemetic/Antivertigo Agents Trimethobenzamide trimethobenzamide Antiemetic/Antivertigo Agents Varubi rolapitant Antiemetic/Antivertigo Agents Tranexamic Acid tranexamic acid Antifibrinolytic Agents Fluconazole Injection fluconazole , Injectable Ambisome liposome Antifungals, Injectable Cancidas caspofungin Antifungals, Injectable Voriconazole Injection voriconazole Antifungals, Injectable Cresemba isavuconazonium Antifungals, Oral Flucytosine flucytosine Antifungals, Oral griseofulvin Antifungals, Oral Lamisil Granules terbinafine Antifungals, Oral Noxafil posaconazole Antifungals, Oral Itraconazole, Omnel, Sporanox Solution Itraconazole Antifungals, Oral Oravig Antifungals, Oral Vfend Suspension voriconazole Antifungals, Oral Bensal HP Antifungals, Topical Ciclopirox, Ciclodan Kit, Loprox Kit ciclopirox Antifungals, Topical / Lotion clotrimazole/betamethasone Antifungals, Topical Extina, Foam , Ketodan Kit ketoconazole Antifungals, Topical Jublia efinaconazole Antifungals, Topical Kerydin tavaborole Antifungals, Topical Luzu luliconazole Antifungals, Topical Naftifine Cream, Naftin Gel naftifine Antifungals, Topical Nystatin/ Cream nystatin/triamcinolone Antifungals, Topical Vusion miconazole/zinc oxide/petrolatum Antifungals, Topical Clarinex-D desloratadine/pseudoephedrine Antihistamines Clarinex Syrup, Desloratadine desloratadine Antihistamines Karbinal ER, Ryvent carbinoxamine ER Antihistamines Levocetirizine Solution levocetirizine Antihistamines Ryvent carbinoxamine Antihistamines Clonidine TTS clonidine TTS Antihypertensives, Sympatholytics Colchicine QLL, Colchicine Tablets, Gloperba colchicine Antihyperuricemics Febuxostat febuxostat Antihyperuricemics Krintafel tafenoquine Antimalarials Atovaquone/Proguanil, Malarone atovaquone/proguanil Antimalarials Coartem artemether/lumefantrine Antimalarials Sulfate quinine sulfate Antimalarials Ajovy fremanezumab-vfrm Antimigraine Agents, Other Emgality galcanezumab-gnlm Antimigraine Agents, Other Ubrelvy ubrogepant Antimigraine Agents, Other Aimovig erenumab-aooe Antimigraine Agents, Other Nurtec ODT rimegepant Antimigraine Agents, Other Reyvow lasmiditan Antimigraine Agents, Other Almotriptan almotriptan Antimigraine Agents, Triptans Dihydroergotamine, Migranal dihydroergotamine mesylate Antimigraine Agents, Triptans Eletriptan eletriptan Antimigraine Agents, Triptans Ergomar ergotamine Antimigraine Agents, Triptans Frova frovatriptan Antimigraine Agents, Triptans Migergot ergotamine/caffeine Antimigraine Agents, Triptans Nazatriptan nazatriptan Antimigraine Agents, Triptans Onzetra Xsail, Sumatriptan Injection, sumatriptan Antimigraine Agents, Triptans Tosymra, Zembrace Treximet sumatriptan/ Antimigraine Agents, Triptans Zolmitriptan, Zomig, Zomig ZMT zolmitriptan Antimigraine Agents, Triptans Pretomanid pretomanid Antimycobacterium Agents Sirturo Antimycobacterium Agents Eurax crotamiton Antiparasitics, Topical Lindane lindane Antiparasitics, Topical Malathion, Ovide malathion Antiparasitics, Topical Natroba, Spinosad spinosad Antiparasitics, Topical Sklice ivermectin Antiparasitics, Topical Apokyn, Kynmobi apomorphine Antiparkinson Agents Carbidopa/Levodopa ODT, Rytary carbidopa/levodopa Antiparkinson Agents Gocovri amantadine extended-release Antiparkinson Agents Inbrija levodopa Antiparkinson Agents Mirapex ER, Pramipexole ER pramipexole Antiparkinson Agents Neupro rotigotine Antiparkinson Agents Nourianz istradefylline Antiparkinson Agents Requip XL, Ropinirole ER ropinirole Antiparkinson Agents Tolcapone tolcapone Antiparkinson Agents Xadago Antiparkinson Agents Zelapar selegiline Antiparkinson Agents Zontivity vorapaxar Antiplatelet Drugs Benznidazole benznidazole Antiprotozoals Daraprim pyrimethamine Antiprotozoals Flagyl 375 mg, Metronidazole 375 mg metronidazole Antiprotozoals Lampit nifurtimox Antiprotozoals Tinidazole tinidazole Antiprotozoals Doxepin Cream, Prudoxin, Zonalon doxepin Antipruritics, Topical Calcipotriene ointment, Sorilux calcipotriene Antipsoriatic Agents Calcipotriene/betamethasone, Enstilar, calcipotriene/betamethasone Antipsoriatic Agents Taclonex Calcitriol, Vectical calcitriol Antipsoriatic Agents Methoxsalen methoxsalen Antipsoriatic Agents Cytovene Injection, Ganciclovir Injection ganciclovir Antivirals, General Prevymis letermovir Antivirals, General Valcyte Powder, Valganciclovir Powder valganciclovir Antivirals, General Valacyclovir QLL valacyclovir Antivirals, Oral Sitavig acyclovir Antivirals, Oral Xofluza baloxivir Antivirals, Oral Acyclovir Ointment acyclovir Antivirals, Topical Denavir penciclovir Antivirals, Topical Xerese acyclovir/ Antivirals, Topical meprobamate Anxiolytics and Barbiturates Alprazolam, Alprazolam ER, ODT alprazolam Anxiolytics Benzodiazepines and Barbiturates Chlordiazepoxide chlordiazepoxide Anxiolytics Benzodiazepines and Barbiturates ODT clonazepam Anxiolytics Benzodiazepines and Barbiturates Clorazepate clorazepate Anxiolytics Benzodiazepines and Barbiturates Diazepam diazepam Anxiolytics Benzodiazepines and Barbiturates lorazepam Anxiolytics Benzodiazepines and Barbiturates Oxazepam oxazepam Anxiolytics Benzodiazepines and Barbiturates Estazolam estazolam Anxiolytics Benzodiazepines and Barbiturates Flurazepam flurazepam Anxiolytics Benzodiazepines and Barbiturates Midazolam midazolam Anxiolytics Benzodiazepines and Barbiturates temazepam Anxiolytics Benzodiazepines and Barbiturates Triazolam triazolam Anxiolytics Benzodiazepines and Barbiturates Amytal amobarbital Anxiolytics Benzodiazepines and Barbiturates Butisol butabarbital Anxiolytics Benzodiazepines and Barbiturates Injection phenobarbital Anxiolytics Benzodiazepines and Barbiturates Seconal secobarbital Anxiolytics Benzodiazepines and Barbiturates Arikayce amikacin liposome inhalation suspension Arikayce Bevespi Aerosphere glycopyrrolate/formoterol Asthma and COPD Agents Duaklir Pressair aclidinium/formotoerol Asthma and COPD Agents Incruse Ellipta umeclidinium Asthma and COPD Agents Lonhala Magnair glycopyrrolate Asthma and COPD Agents Spiriva Respimat tiotropium Asthma and COPD Agents Tudorza Pressair aclidinium Asthma and COPD Agents Yupelri revefenacin Asthma and COPD Agents Albuterol Inhalation 0.021%, 0.042% albuterol Asthma and COPD Agents Albuterol Tablets albuterol Asthma and COPD Agents Brovana aformoterol Asthma and COPD Agents Levalbuterol, Xopenex HFA levalbuterol Asthma and COPD Agents Metaproterenol metaproterenol Asthma and COPD Agents Perforomist formoterol Asthma and COPD Agents ProAir Digihaler and Respiclick albuterol Asthma and COPD Agents Striverdi Respimat oladaterol Asthma and COPD Agents Terbutaline terbutaline Asthma and COPD Agents Alvesco Asthma and COPD Agents Armonair Digihaler Asthma and COPD Agents Arnuity Ellipta Asthma and COPD Agents Asmanex Twisthaler/HFA Asthma and COPD Agents Qvar Redihaler beclomethasone Asthma and COPD Agents AirDuo, Fluticasone/Salmeterol fluticasone/salmeterol Asthma and COPD Agents Breo Ellipta fluticasone/vilanterol Asthma and COPD Agents Breztri Aerosphere /glycopyrrolate/formoterol Asthma and COPD Agents Trelegy Ellipta fluticasone/umeclidinium/vilanterol Asthma and COPD Agents Daliresp roflumilast Asthma and COPD Agents Abilify Maintena, Aripiprazole, aripiprazole Atypical Antipsychotics Aristada/Aristada Initio Caplyta lumateperone Atypical Antipsychotics , Clozapine ODT, Versacloz clozapine Atypical Antipsychotics Fanapt iloperidone Atypical Antipsychotics Invega Sustenna, Invega Trinza, Paliperidone paliperidone Atypical Antipsychotics Latuda lurasidone Atypical Antipsychotics Nuplazid pimavanserin Atypical Antipsychotics Olanzapine, Zyprexa Relprevv olanzapine Atypical Antipsychotics Olanzapine/Fluoxetine olanzapine/fluoxetine Atypical Antipsychotics Quetiapine IR and ER quetiapine Atypical Antipsychotics Rexulti brexpiprazole Atypical Antipsychotics Risperdal Consta, Risperidone risperidone Atypical Antipsychotics Saphris, Secuado asenapine Atypical Antipsychotics Vraylar cariprazine Atypical Antipsychotics Ziprasidone ziprasidone Atypical Antipsychotics Amoxicillin/Clavulanate chewable tablets, amoxicillin/clavulanate Augmentin Products 250/125 mg tablets Amoxicillin/Clavulanate ER amoxicillin/clavulanate extended-release Augmentin Products Amoxicillin/clavulanate 250-62.5 mg/5 ml, amoxicillin/clavulanate Augmentin Products Augmentin 125-31.25 mg/5 mL Aztreonam injection, Azactam Injection aztreonam Aztreonam Bystolic nebivolol Beta Blockers Coreg CR extended-release Beta Blockers Corzide nadolol/bendroflurmethiazide Beta Blockers Innopran XL propranolol extended-release Beta Blockers Metoprolol/Hydrochlorothiazide metoprolol/hydrochlorothiazide Beta Blockers Sotylize Beta Blockers Timolol timolol Beta Blockers BiDil /hydralazine HCl BiDil Cholestyramine, cholestyramine lite, cholestyramine Acid Sequestrants Prevalite powder packets Colestid and granules and packets colestipol Bile Acid Sequestrants Welchol colesevelam Bile Acid Sequestrants Arcalyst rilonacept Biologic Immunomodulators Benlysta Subcutaneous belimumab Biologic Immunomodulators Enbrel etanercept Biologic Immunomodulators Humira adalimumab Biologic Immunomodulators Ilaris canakinumab Biologic Immunomodulators Xeljanz tofacitinib Biologic Immunomodulators Xeljanz XR tofacitinib extended-release Biologic Immunomodulators Actemra Subcutaneous tocilizumab Biologic Immunomodulators Cimzia certolizumab Biologic Immunomodulators Cosentyx secukinumab Biologic Immunomodulators Dupixent dupilumab Biologic Immunomodulators Enspryng satralizumab-mwge Biologic Immunomodulators Fasenra Pen benralizumab Biologic Immunomodulators Kevzara sarilumab Biologic Immunomodulators Kineret anakinra Biologic Immunomodulators Nucala Pen mepolizumab Biologic Immunomodulators Olumiant baricitinib Biologic Immunomodulators Orencia Subcutaneous abatacept Biologic Immunomodulators Otezla apremilast Biologic Immunomodulators Rinvoq upadacitinib Biologic Immunomodulators Siliq brodalumab Biologic Immunomodulators Simponi golimumab Biologic Immunomodulators Skyrizi risankizumab Biologic Immunomodulators Stelara ustekinumab Biologic Immunomodulators Taltz ixekizumab Biologic Immunomodulators Tremfya guselkumab Biologic Immunomodulators Enablex Bladder Relaxant Preparations Flavoxate flavoxate Bladder Relaxant Preparations Gelnique oxybutunin Bladder Relaxant Preparations Myrbetriq mirabegron Bladder Relaxant Preparations IR, Tolterodine ER tolterodine Bladder Relaxant Preparations Trospium IR, Trospium ER trospium Bladder Relaxant Preparations Actonel 5 mg and 30 mg, Atelvia, risedronate Bone Resorption Suppression and Related Agents Risedronate Alendronate Oral Solution, Binosto alendronate Bone Resorption Suppression and Related Agents Forteo teriparatide Bone Resorption Suppression and Related Agents Fosamax Plus D alendronate with vitamin D Bone Resorption Suppression and Related Agents Ibandronate ibandronate Bone Resorption Suppression and Related Agents Miacalcin Injection calcitonin-salmon Bone Resorption Suppression and Related Agents Risedronate Delayed-Release risedronate DR Bone Resorption Suppression and Related Agents Tymlos abaloparatide Bone Resorption Suppression and Related Agents Cardura XL doxazosin BPH Agents Cialis 2.5 mg, 5 mg tadalafil BPH Agents Dutasteride/Tamsulosin dutasteride/tamsulosin BPH Agents Rapaflo silodosin BPH Agents Nymalize Channel Blockers isradipine Blockers Katerzia amlodipine Calcium Channel Blockers ER nisoldipine ER Calcium Channel Blockers CD 360 mg, Matzim LA diltiazem ER Calcium Channel Blockers Verapamil ER PM verapamil ER Calcium Channel Blockers Capecitabine capecitabine Capecitabine Carbaglu carglumic acid Carbaglu Doribax doripenem Carbapenems Meropenem meropenem Carbapenems Meropenem/Sodium Chloride meropenem/sodium chloride Carbapenems Primaxin, Imipenem/Cilastin imipenem/cilastin Carbapenems Celestone Soluspan betamethasone Celestone Soluspan Cefadroxil Tablets cefadroxil Cephalosporins and Related Antibiotics Cephalexin 750 mg and Tablets cephalexin Cephalosporins and Related Antibiotics Cefaclor ER, Suspension cefaclor Cephalosporins and Related Antibiotics Cefixime, Suprax cefixime Cephalosporins and Related Antibiotics Cefpodoxime cefpodoxime Cephalosporins and Related Antibiotics Avycaz ceftazidime/avibactam Cephalosporins, Injectable Teflaro ceftaroline Cephalosporins, Injectable Zerbaxa ceftolozane/tazobactam Cephalosporins, Injectable Depen Titratabs penicillamine Chelating Agents Ferriprox deferiprone Chelating Agents Jadenu Tablets, Deferasirox Granules deferasirox Chelating Agents Chenodal chenodiol Chenodal Cholbam Cholbam Fulphila, Neulasta, Udenyca, Ziextenzo Colony Stimulating Factors Granix tbo filgrastrim Colony Stimulating Factors Leukine Colony Stimulating Factors Neupogen, Nivestym, Zarxio Colony Stimulating Factors Amethia, Amethia Lo, Amethyst, Camrese, levonorgestrel/ethinyl Contraceptives Camrese Lo, Quartette, Twirla, generics Annovera /ethinyl estradiol Contraceptives Aranelle, Leena, generics norethindrone /ethinyl estradiol Contraceptives levonorgestrel/ethinyl estradiol/ferrous Balcoltra Contraceptives biglycinate / ethinyl estradiol/ Generics, Safyral Contraceptives levomefolate calcium Gianvi, Ocella, Zarah, generics drospirenone/ethinyl estradiol/ Contraceptives norethindrone acetate/ethinyl Layolis FE, Wymza FE, generics Contraceptives estradiol/ferrous fumarate norethindrone acetate/ethinyl Lo Loestrin FE, Minastrin 24 FE Contraceptives estradiol/ferrous fumarate Natazia estradiol valerate/dienogest Contraceptives Phexxi lactic acid/citric acid/potassium bitartrate Contraceptives Slynd drospirenone Contraceptives Tri-Lo Estaryll, Tri-Lo Marzia, Tri-Lo Sprintec, norgestimate/ethinyl estradiol Contraceptives generics Xulane, generics /ethinyl estradiol Contraceptives Zovia 1/50E, generics ethinyl estradiol/ethynodiol Contraceptives Corlanor ivabradine Corlanor Analpram-HC Cream, hydrocortisone acetate/pramoxine Combinations Hydrocortisone/Pramoxine, Procort Alkindi Sprinkle hydrocortisone , Oral Emflaza Corticosteroids, Oral Hemady, Taperdex Corticosteroids, Oral Millipred, ODT, 10mg/5mL, prednisolone Corticosteroids, Oral 20mg/5mL Ortikos budesonide extended-release Corticosteroids, Oral Rayos delayed-release Corticosteroids, Oral Augmented Betamethasone augmented betamethasone Corticosteroids, Topical , Clobex lotion/shampoo, Clodan clobetasol Corticosteroids, Topical Kit, Olux-E Ultravate X Kit halobetasol/lactic acid Corticosteroids, Topical Bryhali, Halobetasol Aerosol, Ultravate halobetasol Corticosteroids, Topical Lotion Apexicon E, Diacetate Corticosteroids, Topical Dipropionate alclometasone 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trepostinil Pulmonary Arterial Hypertension Agents Revatio Suspension, Sildenafil 20 mg tablets sildenafil Pulmonary Arterial Hypertension Agents Tadalafil 20 mg tablets tadalafil Pulmonary Arterial Hypertension Agents Tracleer for Oral Suspension Pulmonary Arterial Hypertension Agents Uptravi selexipag Pulmonary Arterial Hypertension Agents Ventavis iloprost Pulmonary Arterial Hypertension Agents Esbriet pirfenidone Pulmonary Fibrosis Agents Ofev nintedinab Pulmonary Fibrosis Agents Pyridostigmine pyridostigmine Pyridostigmine Pyridostigmine Extended-Release pyridostigmine extended-release Pyridostigmine ranolazine Ranolazine Ravicti phenylbutyrate Ravicti Sodium Phenylbutyrate Powder sodium phenylbutyrate Ravicti Rectiv nitroglycerin Rectiv Regranex becaplermin Regranex Santyl collagenase Santyl Ambien, Edular, Zolpidem Sublingual zolpidem Hypnotics Ambien CR zolpidem ER Sedative Hypnotics Belsomra suvorexant Sedative Hypnotics Dayvigo lemborexant Sedative Hypnotics Lunesta Sedative Hypnotics Rozerem ramelteon Sedative Hypnotics Hetlioz tasimelteon Sedative Hypnotics Serostim somatotropin(recombinant) Serostim Endari l-glutamine Sickle Cell Agents Oxbryta voxelotor Sickle Cell Agents Sicklos hydroxyurea tablets Sickle Cell Agents Amrix ER Skeletal Muscle Relaxants 250 mg carisoprodol Skeletal Muscle Relaxants Carisoprodol/Aspirin/Codeine carisoprodol/aspirin/codeine Skeletal Muscle Relaxants Cyclobenzaprine 7.5 mg cyclobenzaprine Skeletal Muscle Relaxants Lorzone chlorzoxazone Skeletal Muscle Relaxants capsules, Zanaflex Capsules tizanidine Skeletal Muscle Relaxants Evrysdi risdiplam Spinal Muscular Atrophy Adzenys XR, Amphetamine ER oral amphetamine Stimulants and Related Agents suspension, Dyanavel XR, Evekeo Adderall XR, Amphetamine/Dextroamphetamine IR, amphetamine/dextroamphetamine IR/ER Stimulants and Related Agents Mydayis Dextroamphetamine IR/ER, Zenzedi dextroamphetamine IR/ER Stimulants and Related Agents Adhansia XR, Aptensio XR, Concerta, Cotempla XR, Daytrana, Jornay PM, methylphenidate IR/ER Stimulants and Related Agents Methylin, Methylphenidate IR/ER, Quillichew ER, Quillivant XR, Ritalin LA 10 mg Armodafinil armodafinil Stimulants and Related Agents Atomoxetine atomoxetine Stimulants and Related Agents Clonidine ER clonidine ER Stimulants and Related Agents Desoxyn, Methamphetamine methamphetamine Stimulants and Related Agents Dexmethylphenidate IR/ER, Focalin XR dexmethylphenidate IR/ER Stimulants and Related Agents Guanfacine ER guanfacine ER Stimulants and Related Agents Modafinil modafinil Stimulants and Related Agents Sunosi solriamfetol Stimulants and Related Agents Vyvanse lisdexamfetamine Stimulants and Related Agents Wakix pitolisant Stimulants and Related Agents Strensiq asfotase alfa Strensiq Sulfadiazine sulfadiazine Sulfonamides Synagis palivizumab Synagis Synribo omacetaxine Synribo Doryx, Doryx MCP, Hyclate DR doxycycline hyclate delayed-release Doxycycline Hyclate IR 75, 150 mg tablets doxycycline hyclate immediate-release Tetracyclines Doxycycline Monohydrate 75 mg and 150 mg doxycycline monohydrate Tetracyclines capsules Doxycycline [rosacea] DR, Oracea doxycycline [rosacea] delayed-release Tetracyclines Minocycline IR tablets, Minocycline ER, minocycline Tetracyclines Minolira, Solodyn Morgidox Kit doxycycline and cleanser Tetracyclines Nuzyra omadacycline Tetracyclines Thiola and Thiola EC tiopronin/tiopronin delayed-release Thiola Doptelet avatrombopag Thrombopoiesis Stimulating Proteins Mulpleta lusutrombopag Thrombopoiesis Stimulating Proteins Promacta eltrombopag Thrombopoiesis Stimulating Proteins Tavalisse fostamatinib Thrombopoiesis Stimulating Proteins Nplate romisplostim Thrombopoiesis Stimulating Proteins Injection, Tirosint levothyroxine Thyroid Liothyronine Injection liothyronine Thyroid Hormones Bupropion [smoking deterrent] bupropion SR Tobacco Cessation Nicotrol Inhaler, Nicotrol Nasal Spray Tobacco Cessation Valchlor mechlorethamine Topical Antineoplastic and Genital Warts Therapy Diclofenac 3% Gel diclofenac Topical Antineoplastic and Genital Warts Therapy Picato ingenol mebutate Topical Antineoplastic and Genital Warts Therapy Podofilox Solution podofilox Topical Antineoplastic and Genital Warts Therapy Veregen sinecatechins Topical Antineoplastic and Genital Warts Therapy Zyclara imiquimod Topical Antineoplastic and Genital Warts Therapy Tacrolimus Ointment tacrolimus Topical Immunomodulators Actiq, Fentanyl Oral Lozenges fentanyl oral lozenges Transmucosal Fentanyl Fentora fentanyl buccal tablets Transmucosal Fentanyl Lazanda fentanyl nasal spray Transmucosal Fentanyl Subsys fentanyl sublingual spray Transmucosal Fentanyl Trelstar Depot, Trelstar LA triptorelin pamoate Trelstar Tygacil tigecycline Tygacil Mesalamine DR mesalamine delayed-release Ulcerative Colitis Agents Mesalamine Rectal , SFRowasa mesalamine Ulcerative Colitis Agents Giazo balsalazide Ulcerative Colitis Agents Uceris budesonide Ulcerative Colitis Agents Kerafoam, Kerol, Laxtrix, Umecta, Uralytic, urea Urea Products Uramaxin, Urea Methenamine hippurate methenamine hippurate Urinary Antiinfectives Nitrofurantoin Suspension nitrofurantoin Urinary Antiinfectives Urimar-T, Urogesic Blue hyoscamine combination Urinary Antiinfectives Potassium Citrate ER, Urocit-K potassium citrate Urocit-K Femring QLL, Imvexxy estradiol Vaginal Estrogen Preparations Intrarosa Vaginal Estrogen Preparations GoNitro, Nitroglycerin Spray, Nitromist nitroglycerin Vasodilators, Coronary Jynarque tolvaptan Vasopressor Receptor Antagonists Vecamyl mecamylamine Vecamyl Vimizim elosulfase alfa Vimizim Doxercalciferol, Hectorol doxercalciferol Vitamin D and ESRD Products Paricalcitol 4 mcg paricalcitol Vitamin D and ESRD Products Rayaldee calcifediol Vitamin D and ESRD Products Sensipar cinacalet Vitamin D and ESRD Products Aluminum Hydroxide aluminum hydroxide Vitamin D and ESRD Products calcium carbonate Vitamin D and ESRD Products Calcium Lactate calcium lactate Vitamin D and ESRD Products Calcium docusate calcium Vitamin D and ESRD Products Docusate Sodium docusate sodium Vitamin D and ESRD Products Magnebind calcium carbonate/magnesium carbonate Vitamin D and ESRD Products Magnesium Carbonate magnesium carbonate Vitamin D and ESRD Products Niacin niacin Vitamin D and ESRD Products Pyridoxine pyridoxine Vitamin D and ESRD Products Sodium Bicarbonate sodium bicarbonate Vitamin D and ESRD Products Thiamine Hydrochloride thiamine hydrochloride Vitamin D and ESRD Products Dialyvite, Nephplex Rx, Nephron FA, Renal, Reno Caps, Triphrocaps, Virt-Caps, Virt-Vite vitamin B complex/folic acid and/or zinc Vitamin D and ESRD Products Plus, Vital-D Rx, Vol-Care Rx Vyndaqel, Vyndamax tafamidis Vyndaqel-Vyndamax Xenical Xenical Xospata gilteritinib Xospata

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