Part D drug list for Medicare plans
View Medicare formularies, prior authorization, and step therapy criteria by selecting the appropriate plan and county.
Pharmacy Benefit drug policies for Commercial plans
- Policy Name
- abaloparatide injection (Tymlos)
- abatacept (Orencia)
- abemaciclib (Verzenio)
- abiraterone acetate (Yonsa)
- abiraterone (Zytiga)
- abrocitinib (Cibinqo)
- acalabrutinib (Calquence)
- aceclidine (Vizz)
- aclidinium bromide inhaler (Tudorza Pressair)
- acoltremon ophthalmic solution (Tryptyr)
- acoramidis hcl (Attruby)
- diclofenac sodium gel
- adagrasib (Krazati)
- adalimumab-aacf
- adalimumab-ryvk (Simlandi)
- adapalene 0.1% solution
- adapalene (Plixda)
- adapalene cream, gel, lotion (Differin)
- adapalene-benzoyl peroxide (Epiduo and Epiduo Forte)
- afatinib (Gilotrif)
- aficamten (Myqorzo)
- albuterol-budesonide (Airsupra)
- albuterol sulfate (ProAir Respiclick)
- alectinib (Alecensa)
- alendronate effervescent tablet (Binosto)
- alirocumab (Praluent)
- aliskiren (Tekturna)
- alitretinoin (Panretin)
- allergen extract (Grastek)
- allergen extract (Odactra)
- allergen extract (Oralair)
- short ragweed pollen allergen extract (Ragwitek)
- almotriptan (Axert)
- alogliptin (Nesina)
- alogliptin-metformin (Kazano)
- alogliptin-pioglitazone (Oseni)
- alosetron (Lotronex)
- alpelisib (Piqray)
- alpelisib (Vijoice)
- amantadine (Gocovri)
- ambrisarten (Letairis)
- amcinonide cream, ointment
- amifampridine phosphate (Firdapse)
- amikacin inhalation (Arikayce)
- mesalamine (Asacol HD, Delzicol, Dipentum, Pentasa)
- olsalazine (Dipentum)
- amlodipine-atorvastatin (Caduet)
- amlodipine (Katerzia, Norliqva)
- amphetamine-dextroamphetamine (Mydayis)
- anakinra (Kineret)
- amlodipine-valsartan-HCTZ (Exforge HCTZ)
- azilsartan-chlorthalidone (Edarbyclor)
- telmisartan-amlodipine
- anifrolumab-fnia (Saphnelo)
- apalutamide (Erleada)
- apomorphine (Apokyn)
- apremilast (Otezla, Otezla XR)
- aprepitant (Emend)
- aprocitentan (Tryvio)
- arimoclomol (Miplyffa)
- aripiprazole (Opipza)
- asciminib (Scemblix)
- asenapine (Secuado)
- asfotase alfa (Strensiq)
- aspirin/omeprazole (Yosprala)
- atomoxetine hcl (Atoncy)
- atorvastatin (Atorvaliq)
- atovaquone (Mepron)
- atrasentan (Vanrafia)
- avacopan (Tavneos)
- ayvapritinib (Ayvakit)
- avatrombopag (Doptelet)
- avutometinib-defactinib (Avmapki Fakzynja Co-Pack)
- axitinib (Inlyta)
- azacitidine (Onureg)
- azilsartan (Edarbi)
- aztreonam (Cayston)
- baricitinib (Olumiant)
- baxdrostat (Baxfendy)
- becaplermin (Regranex)
- bedaquiline (Sirturo)
- belimumab (Benlysta)
- belumosudil (Rezurock)
- belzutifan (Welireg)
- bempedoic acid-ezetimibe (Nexlizet)
- bempedoic acid (Nexletol)
- benralizumab (Fasenra)
- benzgalantamine (Zunveyl)
- berdazimer topical gel (Zelsuvmi)
- berotralstat (Orladeyo)
- betamethasone spray (Sernivo)
- bexagliflozin (Brenzavvy)
- bexarotene capsules and gel (Targretin)
- bimekizumab (Bimzelx)
- binimetinib (Mektovi)
- birch triterpenes (Filsuvez)
- Blood Glucose Test Strips
- bosentan (Tracleer)
- bosutinib (Bosulif)
- bremelanotide injection (Vyleesi)
- brensocatib (Brinsupri)
- brexpiprazole (Rexulti)
- brigatinib (Alunbrig)
- brimonidine (Mirvaso)
- brivaracetam (Briviact)
- brodalumab (Siliq)
- bromfenac (Prolensa 0.07%)
- bromfenac (Bromsite)
- bromocriptine (Cycloset)
- budesonide (Tarpeyo)
- budesonide (Uceris)
- budesonide-glycopyrrolate-formoterol (Breztri Aerosphere)
- budesonide suspension (Eohilia)
- bulevirtide-gmod (Hepcludex)
- bumetanide nasal (Enbumyst)
- buprenorphine film (Belbuca)
- c1-esterase inhibitor (Haegarda)
- c1 esterase inhibitor (human) (Berinert)
- c1 esterase inhibitor (human) (Cinryze)
- c1 esterase inhibitor (Ruconest)
- cabozantinib (Cabometyx)
- cabozantinib (Cometriq)
- calcifediol (Rayaldee)
- calcipotriene-betamethasone dipropionate cream (Wynzora)
- calcipotriene-betamethasone (Talconex)
- calcipotriene foam (Sorilux)
- canagliflozin (Invokana)
- canagliflozin-metformin (Invokamet/Invokamet XR)
- cannabidiol cbd extract (Epidiolex)
- capivasertib (Truqap)
- caplacizumab (Cablivi)
- capmatinib (Tabrecta)
- carbachol-brimonidine tartrate (Yuvezzi)
- carbamazepine 200mg chewable tablet
- carbidopa-levodopa er capsule (Crexont)
- carbidopa-levodopa (Rytary)
- carglumic acid (Carbaglu)
- cariprazine (Vraylar)
- carvedilol (Coreg CR)
- celecoxib (Elyxyb)
- cenegermin (Oxervate)
- cenobamate (Xcopri)
- ceritinib (Zykadia)
- certolizumab (Cimzia)
- cetirizine solution (Zerviate)
- cetrorelix acetate (Cetrotide)
- chenodiol (Ctexli)
- chlorpromazine oral solution
- chlorthalidone (Thalitone)
- chlorzoxazone (Lorzone, Parafon DSC)
- cholic acid (Cholbam)
- choriogonadotropin alfa (Ovidrel)
- chorionic gonadotropin (Pregnyl, Novarel)
- ciprofloxacin-hydrocortisone otic (Cipro HC)
- citalopram 30 mg capsules (Celexa)
- citric acid-glucono delta-lactone-magnesium carbonate (Renacidin)
- cladribine (Mavenclad)
- clascoterone cream (Winlevi)
- clemastine syrup
- clindamycin phosphate-benzoyl peroxide gel (Onexton)
- clindamycin phosphate foam (Clindacin)
- clindamycin phosphate-tretinoin gel (Veltin, Ziana)
- clobazam (Sympazan)
- clobetasol 0.05% ophthalmic suspension (Byqlovi)
- clonidine extended release (Nexiclon XR)
- clonidine (Onyda XR)
- clozapine suspension (Versacloz)
- cobimetinib (Cotellic)
- colchicine (Lodoco)
- colchicine (Gloperba)
- Dexcom (CGM)
- Freestyle Libre (CGM)
- Guardian (CGM)
- Simplera (CGM)
- copper histidinate (Zycubo)
- corticotropin (Acthar, Cortrophin)
- crinecerfont (Crenessity)
- crisaborole (Eucrisa)
- crizotinib (Xalkori)
- crofelemer (Mytesi)
- crotamiton (Crotan)
- cyclobenzaprine (Amrix)
- cyclobenzaprine 7.5 mg (Fexmid)
- cyclosporine ophthalmic solution 0.09% (Cequa)
- cyclosporine (Verkazia)
- cysteamine eye drops (Cystadrops, Cystaran)
- cysteamine (Procysbi)
- dabigatran oral pellets (Pradaxa)
- dabrafenib (Tafinlar)
- dacomitinib (Vizimpro)
- dalfampridine (Ampyra)
- danicopan (Voydeya)
- dapagliflozin (Farxiga)
- dapagliflozin-metformin (Xigduo XR)
- dapagliflozin-saxagliptin
- dapsone (Aczone)
- darbepoetin alfa (Aranesp)
- darolutamide (Nubeqa)
- dasatinib (Sprycel, Phyrago)
- dasiglucagon injection (Zegalogue)
- cedazuridine-decitabine tablet (Inqovi)
- deferasirox sprinkle (Jadenu)
- deferiprone (Ferriprox)
- deflazacort (Emflaza, Jaythari, Kymbee, Pyqui)
- delafloxacin (Baxdela)
- delgocitinib (Anzupgo)
- desloratadine (Clarinex and Clarinex-D)
- desvenlafaxine ER (Khedezla)
- deucravacitinib (Sotyktu)
- deuruxolitinib (Leqselvi)
- deutetrabenzine (Austedo)
- dexamethasone dose pack (Dexabliss, Dxevo, HiDex, Taperdex, Zcort)
- dexamethasone (Hemady)
- dexlansoprazole (Dexilant)
- dextromethorphan-bupropion (Auvelity)
- dextromethorphan-quinidine (Nuedexta)
- diazepam buccal film (Libervant)
- diazepam nasal spray (Valtoco)
- diazoxide choline (Vykat XR)
- dichlorphenamide (Keveyis, Ormalvi)
- diclofenac patch (Flector, Licart)
- diclofenac potassium (Cambia)
- diclofenac topical gel (Solaraze)
- diclofenac topical solution (Pennsaid)
- diflorasone cream, ointment
- dihydroergotamine (D.H.E. 45)
- dihydroergotamine nasal spray (Migranal)
- dihydroergotamine spray (Trudhesa)
- dimethyl fumarate (Tecfidera)
- diroximel fumarate (Vumerity)
- donepezil (Aricept)
- donepezil (Adlarity)
- donidalorsen (Dawnzera)
- dordaviprone (Modeyso)
- doxazosin extended release (Cardura XL)
- doxecitine-doxribtimine (Kygevvi)
- doxepin (Silenor)
- doxepin 5% cream (Prudoxin, Zonalon)
- doxycycline 40 mg capsule
- doxylamine-pyridoxine (Bonjesta)
- dronabinol solution (Syndros)
- droxidopa (Northera)
- dulaglutide SQ (Trulicity)
- duloxetine delayed-release (Drizalma Sprinkle)
- dupilumab (Dupixent)
- dutasteride-tamsulosin (Jalyn)
- duvelisib (Copiktra)
- edaravone (Radicava ORS)
- edoxaban (Savaysa)
- efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)
- efinaconazole topical solution (Jublia)
- eflapegrastim-xnst (Rolvedon)
- eflornithine (Iwilfin)
- elacestrant (Orserdu)
- elafibranor (Iqirvo)
- elagolix-estradiol-norethisterone (Oriahnn)
- elagolix (Orilissa)
- elamipretide (Forzinity)
- elapegademase-lvlr (Revcovi)
- elbasvir-grazoprevir (Zepatier)
- elexacaftor-tezacaftor-ivacaftor (Trikafta)
- eliglustat (Cerdelga)
- elinzanetant (Lynkuet)
- eltrombopag (Alvaiz)
- eltrombopag (Promacta)
- eluxadoline (Viberzi)
- empagliflozin-linagliptin (Glyxambi)
- empagliflozin-linagliptin-metformin (Trijardy XR)
- enasidenib (Idhifa)
- encorafenib (Braftovi)
- ensartinib (Ensacove)
- ensifentrine (Ohtuvayre)
- entrectinib (Rozlytrek)
- enzalutamide (Xtandi)
- epinephrine nasal spray (Neffy)
- eplontersen (Wainua)
- epoetin alfa-epbx (Retacrit)
- epoetin alfa (Epogen)
- erythropoietin (Procrit)
- erdafitinib (Balversa)
- erlotinib (Tarceva)
- ertugliflozin (Steglatro)
- ertugliflozin-metformin (Segluromet)
- ertugliflozin-sitagliptin (Steglujan)
- erythromycin capsule, suspension, tablet
- eslicarbazepine (Aptiom)
- esomeprazole (Nexium)
- estradiol (Imvexxy)
- etanercept (Enbrel)
- ethacrynic acid (Edecrin)
- etrasimod arginine (Velsipity)
- etripamil (Cardamyst)
- everolimus tablet (Afinitor)
- everolimus suspension (Afinitor Disperz)
- evolocumab (Repatha)
- exenatide SQ (Byetta)
- minocycline extended-release (Solodyn)
- febuxostat (Uloric)
- fecal microbiota (Vowst)
- fedratinib (Inrebic)
- fenfluramine (Fintepla)
- fenofibrate (Lipofen)
- fenoprofen (Nalfon)
- ferric maltol (Accrufer)
- fezolinetant (Veozah)
- fidaxomicin (Dificid)
- filgrastim (Neupogen)
- filgrastim-aafi (Nivestym)
- filgrastim-ayow (Releuko)
- filgrastim-laha (Filkri)
- filgrastim-sndz (Zarxio)
- filgrastim-txid (Nypozi)
- finafloxacin otic suspension (Xtoro)
- finasteride-tadalafil (Entadfi)
- finerenone (Kerendia)
- fingolimod (Gilenya)
- fingolimod, ODT (Tascenso)
- flibanserin (Addyi)
- flurandrenolide (Cordran)
- fluticasone propionate spray (Xhance)
- fluticasone-salmeterol
- fluticasone-vilanterol
- fluvastatin extended-release (Lescol XL)
- fluvoxamine extended release (Luvox CR)
- folic acid solution (Quiofic)
- follitropin (Gonal-f, Gonal-F RFF Rediject, Follistim AQ)
- aclidinium-formoterol (Duaklir)
- formoterol-glycopyrrolate oral inhaler (Bevespi)
- foscarbidopa and foslevodopa (Vyalev)
- fostamatinib (Tavalisse)
- fostemsavir tromethamine (Rukobia)
- fruquintinib (Fruzaqla)
- furosemide (Furoscix)
- furosemide on body infusor (Lasix Onyu)
- futibatinib (Lytgobi)
- gabapentin enacarbil extended-release (Horizant)
- gabapentin (Gralise)
- ganaxolone suspension (Ztalmy)
- ganirelix acetate (Antagon, Fyremadel)
- garadacimab-gxii (Andembry)
- gefitinib (Iressa)
- gepirone (Exxua)
- gepotidacin (Blujepa)
- gilteritinib (Xospata)
- givinostat (Duvyzat)
- glasdegib (Daurismo)
- glatiramer acetate (Copaxone)
- glecaprevir-pibrentasvir (Mavyret)
- glutamine (Endari)
- glycopyrrolate liquid (Cuvposa)
- glycopyrronium pad (Qbrexza)
- golimumab (Simponi)
- granisetron patch (Sancuso)
- guselkumab injection (Tremfya)
- halcinonide (Halog)
- halobetasol-tazarotene (Duobrii)
- hydrochlorothiazide (Inzirqo)
- hydrocortisone (Alkindi)
- hydrocortisone (Khindivi)
- hydroxyurea (Siklos)
- hydroxyurea (Xromi)
- ibrexafungerp (Brexafemme)
- ibrutinib (Imbruvica)
- ibaticant (Firazyr)
- icosapent ethyl (Vascepa)
- icotrokinra (Icotyde)
- idelalisib (Zydelig)
- iloperidone (Fanapt)
- imatinib (Gleevec, Imkeldi)
- Imiquimod cream (Zyclara)
- imlunestrant (Inluriyo)
- inavolisib (Itovebi)
- indomethacin (Indocin)
- infliximab-dyyb (Zymfentra)
- beclomethasone dipropionate HFA
- ciclesonide (Alvesco)
- fluticasone (Flovent Diskus, and Flovent HFA)
- fluticasone furoate (Arnuity Ellipta)
- erenumab-aooe (Aimovig)
- fremanezumab-vfrm (Ajovy)
- galcanezumab-gnlm (Emgality)
- Inpen (Fiasp, Humalog, Novolog)
- insulin degludec-liraglutide injection (Xultophy)
- insulin glargine-lixisenatide injection (Soliqua)
- insulin regular (Afrezza)
- Cequr Simplicity 1U, 2U
- MODD1 Kit
- Omnipod
- Pivot
- Twiist
- V-Go
- interferon beta-1a (Avonex)
- interferon beta-1a (Rebif, Rebif Rebidose)
- interferon beta-1b (Betaseron)
- interferon gamma-1b (Actimmune)
- iptacopan (Fabhalta)
- ferric citrate (Auryxia)
- isavuconazonium (Cresemba)
- isotretinoin (Absorica LD)
- istradefylline (Nourianz)
- itraconazole solution (Sporanox)
- itraconazole (Tolsura)
- ivabradine (Corlanor)
- ivacaftor (Kalydeco)
- ivermectin cream (Soolantra)
- ivosidenib (Tibsovo)
- ixazomib (Ninlaro)
- ixekizumab (Taltz)
- empagliflozin (Jardiance)
- empagliflozin-metformin (Synjardy)
- suzetrigine (Journavx)
- ketoprofen ER 200 mg capsule
- ketorolac nasal (Sprix)
- lacosamide (Motpoly XR)
- lamotrigine titration packs (Lamictal XR)
- lamotrigine orally disintegrating tablet (Lamictal ODT)
- lamotrigine suspension (Subvenite)
- lanadelumab-flyo (Takhzyro)
- lansoprazole ODT (Prevacid Solutab)
- lanthanum carbonate (Fosrenol)
- lapatinib (Tykerb)
- larotrectinib (Vitrakvi)
- lasmiditan (Reyvow)
- lazertinib (Lazcluze)
- lebrikizumab-lbkz (Ebglyss)
- lecanemab (Leqembi Iqlik)
- ledipasvir-sofosbuvir tablet (Harvoni)
- lenalidomide (Revlimid)
- leniolisib (Joenja)
- lenvatinib (Lenvima)
- lerodalcibep-liga (Lerochol)
- letermovir (Prevymis)
- leuprolide acetate (Lupron, Eligard)
- levacetylleucine (Aqneursa)
- levamlodipine (Conjupri)
- levetiracetam (Elepsia XR)
- levetiracetam (Spritam)
- levodopa (Inbrija)
- levomilnacipran (Fetzima)
- levothyroxine (Ermeza)
- lidocaine patch (ZTLido)
- lidocaine topical ointment
- linaclotide (Linzess)
- linagliptin (Tradjenta)
- linagliptin-metformin (Jentadueto/Jentadueto XR)
- linerixibat (Lynavoy)
- linezolid (Zyvox)
- liraglutide (Saxenda)
- liraglutide SQ (Victoza)
- lisdexamfetamine (Arynta)
- lisinopril solution (Qbrelis)
- lofexidine (Lucemyra)
- lomitapide (Juxtapid)
- lonafarnib (Zokinvy)
- lonapegsomatropin (Skytrofa)
- fentanyl patch (Duragesic)
- hydrocodone extended release (Hysingla ER)
- hydromorphone extended release (Exalgo)
- levorphanol
- methadone (Diskets, Dolophine)
- morphine ER (Avinza, Kadian)
- oxycodone extended release (Oxycontin)
- oxymorphone extended release (Opana ER)
- lorazepam extended-release (Loreev XR)
- lorlatinib (Lorbrena)
- losartan suspension (Arbli)
- loteprednol etabonate (Eysuvis)
- loteprednol preservative-free (Inveltys)
- lotilaner (Xdemvy)
- lubiprostone (Amitiza)
- lumacaftor-ivacaftor (Orkambi)
- lumateperone (Caplyta)
- lusutrombopag (Mulpleta)
- macitentan (Opsumit)
- macitentan-tadalafil (Opsynvi)
- mannitol (Bronchitol)
- maralixibat (Livmarli)
- maribavir (Livtencity)
- mavacamten (Camzyos)
- mavorixafor (Xolremdi)
- mebendazole (Emverm)
- mecasermin (Increlex)
- mechlorethamine topical (Valchlor)
- meclofenamate
- mefenamic acid (Ponstel)
- meloxicam (Vivlodex)
- menotropins (Menopur)
- mepolizumab (Nucala)
- mercaptopurine suspension (Purixan)
- metformin solution (Riomet)
- methyltrexate (Jylamvo)
- methotrexate (Jylamvo)
- methotrexate solution (Xatmep)
- methotrexate (Rasuvo)
- methoxy polyethylene glycol-epoetin beta (Mircera)
- methylnaltrexone bromide (Relistor)
- metoclopramide (Gimoti)
- metoclopramide orally disintegrating tablet (Metozolv ODT)
- metreleptin (Myalept)
- metronidazole suspension (Likmez)
- miconazole (Oravig)
- midazolam spray (Nayzilam)
- midostaurin (Rydapt)
- mifepristone (Korlym)
- migalastat (Galafold)
- miglustat (Opfolda)
- miglustat (Yargesa, Zavesca)
- milnacipran (Savella)
- milsaperidone (Bysanti)
- miltefosine (Impavido)
- minocycline foam (Amzeeq)
- minocycline foam (Zilxi)
- mirabegron (Myrbetriq)
- mirdametinib (Gomekli)
- mirikizumab-mrkz (Omvoh)
- mitapivat (Aqvesme)
- mitapivat (Pyrukynd)
- momelotinib (Ojjaara)
- mometasone-formoterol (Dulera)
- monomethyl fumarate (Bafiertam)
- mycophenolate mofetil (Myhibbin)
- nafarelin (Synarel)
- naldemedine (Symproic)
- naloxegol oxalate (Movantik)
- codeine phosphate-chlorpheniramine (Tuxarin)
- guaifenesin-codeine (Guaiatussin AC, GuaiFENesin AC, Maxi-Tuss, Virtussin)
- hydrocodone bitartrate-homatropine methylbromide (Hycodan, Hydromet)
- beclomethasone (Qnasl)
- ciclesonide (Omnaris)
- navepegritide (Yuviwel)
- nedosiran (Rivfloza)
- nemolizumab-ilto (Nemluvio)
- neomycin-fluocinolone (Neo-Synalar)
- nepafenac (Ilevro 0.3%)
- nerandomilast (Jascayd)
- neratinib (Nerlynx)
- nilotinib (Tasigna)
- nilotinib tartrate (Danziten)
- nimodipine (Nymalize)
- nintedanib (Ofev)
- niraparib-abiraterone (Akeega)
- niraparib (Zejula)
- nirogacestat (Ogsiveo)
- nitazoxanide (Alinia)
- nitisinone (Harliku)
- nitisinone (Orfadin)
- nitroglycerin ointment (Rectiv)
- desmopressin acetate (Nocdurna)
- amphetamine (Dyanavel XR)
- amphetamine extended-release (Adzenys XR ODT)
- dextroamphetamine transdermal (Xelstrym)
- baclofen (Ozobax)
- baclofen suspension (Fleqsuvy)
- insulin glargine-aldy (Langlara)
- insulin degludec
- insulin glargine (Basaglar)
- insulin glargine-aglr (Rezvoglar)
- insulin glargine-yfgn
- PEG 3350 (Clenpiq, Moviprep, Plenvu)
- PEG 3350 (Suflave)
- sodium sulfate-magnesium sulfate-potassium chloride (Sutab)
- bupropion ER (Forfivo XL)
- butalbital-acetaminophen (Allzital)
- butalbital-acetaminophen-caffeine (Capacet, Fioricet, Phrenilin Forte, Vanatol S)
- butalbital-acetaminophen-caffeine-codeine (Fioricet C)
- desonide gel (Desonate)
- doxycycline hyclate (Doryx, Targadox)
- doxycycline monohydrate (Monodoxyne NL)
- epinephrine, auto-injector pen (AuviQ)
- halobetasol (Lexette foam, Bryhali, Ultravate lotion)
- hydrocodone-acetaminophen
- hydrocortisone acetate (Anusol HC)
- insulin aspart (Fiasp, Kirsty, Merilog, Novolog)
- insulin glulisine (Apidra)
- insulin lispro (Admelog, Humalog, Lyumjev)
- insulin human (Novolin N)
- methylphenidate extended-release (Jornay, Relexxii)
- methylphenidate extended-release, chewable (Quillichew ER)
- methylphenidate orally disintegrating tablet (Cotempla XR ODT)
- methylphenidate patch (Daytrana)
- methylphenidate suspension, extended release (Quillivant XR)
- serdexmethylphenidate-dexmethylphenidate (Azstarys)
- insulin aspart (Novolog 70/30)
- insulin isophane and regular (Novolin 70/30)
- naloxone (Kloxxado nasal spray, Rezenopy nasal spray, Zimhi injection)
- oxybutynin chloride 2.5 mg
- oxybutynin patch (Oxytrol)
- oxycodone (Roxybond)
- insulin regular (Novolin R)
- dextroamphetamine (Procentra oral solution, Zenzedi)
- methamphetamine (Desoxyn)
- amphetamine sulfate (Evekeo ODT)
- tramadol extended-release (Conzip)
- tramadol (tramadol tablet, Qdolo)
- zolpidem (Edular, Intermezzo)
- Novopen Echo insulin delivery device
- ocreotide (Mycapssa)
- octreotide (Sandostatin)
- odevixibat (Bylvay)
- ofatumumab (Kesimpta)
- olanzapine-samidorphan (Lybalvi)
- olaparib (Lynparza)
- olezarsen (Tryngolza)
- olopatadine-mometasone (Ryaltris)
- olutasidenib (Rezlidhia)
- omadacycline (Nuzyra)
- omalizumab (Xolair)
- omaveloxolone (Skyclarys)
- omeprazole packet (Prilosec)
- omeprazole-bicarbonate (Konvomep)
- ondansetron 16 mg ODT
- bimatoprost (Lumigan, Zolymbus)
- brinzolamide (Azopt)
- latanoprost (Iyuzeh, Xelpros)
- latanoprostene (Vyzulta)
- netarsudil (Rhopressa)
- netarsudil-latanoprost (Rocklatan)
- omidenepag isopropyl (Omlonti)
- tafluprost (Zioptan)
- timolol preservative-free (Timoptic Ocudose)
- travoprost (Travatan Z)
- opicapone (Ongentys)
- atogepant (Qulipta)
- rimegepant sulfate (Nurtec)
- ubrogepant (Ubrelvy)
- naltrexone-bupropion (Contrave)
- orlistat (Xenical)
- phentermine-topiramate (Qsymia)
- daridorexant (Quviviq)
- lemborexant (Dayvigo)
- suvorexant (Belsomra)
- orforglipron calcium (Foundayo)
- orphenadrine-spirin-caffeine (Norgesic Forte, Orphengesic Forte)
- osilodrostat (Isturisa)
- osimertinib (Tagrisso)
- ospemifene (Osphena)
- oteseconazole (Vivjoa)
- oxcarbazepine (Oxtellar XR)
- calcium-magnesium-potassium-sodium oxybates solution (Xywav)
- oxycodone extended release (Xtampza ER)
- oxymetazoline hcl cream (Rhofade)
- oxymetazoline hcl ophthalmic solution (Upneeq)
- oxymorphone immediate release (Opana)
- ozanimod hcl capsule (Zeposia)
- pacritinib (Vonjo)
- palbociclib (Ibrance)
- palopegteriparatide (Yorvipath)
- palovarotene (Sohonos)
- paltusotine hcl (Palsonify)
- pancrelipase (Viokace, Pancreaze, Pertzye)
- paromomycin sulfate (Humatin)
- pasireotide (Signifor)
- patiromer powder (Veltassa)
- pazopanib (Votrient)
- avanafil (Stendra)
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra, Staxyn ODT)
- peanut allergen powder (Palforzia)
- pegcetacoplan (Empaveli)
- pegfilgrastim (Neulasta)
- pegfilgrastim-apgf (Nyvepria)
- pegfilgrastim-bmez (Ziextenzo)
- pegfilgrastim-cbqv (Udenyca)
- pegfilgrastim-fpgk (Stimufend)
- pegfilgrastim-jmdb (Fulphila)
- pegfilgrastim-pbbk (Fylnetra)
- pegfilgrastim-unne (Armlupeg)
- peginterferon alfa-2a (Pegasys)
- peg-interferon beta-1a (Plegridy)
- egvaliase-pqpz (Palynziq)
- pegvisomant (Somavert)
- pemigatinib (Pemazyre)
- penicillamine (Cuprimine)
- penicillamine (Depen)
- perampanel (Fycompa)
- perfluorohyxyloctane (Miebo)
- perindopril-amlodipine (Prestalia)
- pexidartinib (Turalio)
- phenoxybenzamine (Dibenzyline)
- glycerol phenylbutyrate (Ravicti)
- sodium phenylbutyrate (Buphenyl, Olpruva, Pheburane)
- phospholine iodide ophthalmic drops
- pilocarpine eye drops (Qlosi)
- pilocarpine hcl solution (Vuity)
- pimavanserin tartrate (Nuplazid)
- pioglitazone-glimepiride (Duetact)
- pirfenidone (Esbriet)
- pirtobrutinib (Jaypirca)
- pitavastatin (Livalo)
- pitavastatin magnesium (Zypitamag)
- pitolisant (Wakix)
- pivmecillinam (Pivya)
- plecanatide (Trulance)
- plerixafor (Mozobil)
- plozasiran (Redemplo)
- podofilox (Condylox)
- pomalidomide (Pomalyst)
- ponatinib (Iclusig)
- ponesimod (Ponvory)
- posaconazole (Noxafil)
- pralsetinib (Gavreto)
- pramlintide (SymlinPen)
- prasterone (Intrarosa)
- prednisolone (Millipred, Orapred ODT)
- amphetamine-dexamphetamine capsule, extended-release (Adderall XR)
- dexmethylphenidate extended-release (Focalin XR)
- lisdexamfetamine (Vyvanse)
- Methylphenidate capsule, long-acting (Ritalin LA)
- methylphenidate controlled-delivery (Metadate CD)
- methylphenidate extended-release (Aptensio XR, Metadate ER)
- methylphenidate tablet, extended-release (Concerta ER)
- dextroamphetamine extended-release (Dexedrine Spansule)
- amphetamine sulfate (Evekeo tablet)
- methylphenidate chewable tablets
- amphetamine-dexamphetamine tablet (Adderall)
- dexmethylphenidate tablet (Focalin)
- methylphenidate tablet (Ritalin)
- methylphenidate oral solution (Methylin)
- pregabalin (Lyrica CR)
- CitraNatal Harmony
- CitraNatal Rx
- Obstetrix One
- PNV-DHA+Docusate
- PreGen DHA
- Prenara
- Trinaz
- progesterone (Crinone 4)
- progesterone (Crinone 8)
- progesterone (Endometrin)
- propranolol SR (Inderal XL, Innopran XL)
- propranolol (Hemangeol)
- alprostadil (Caverject, Edex)
- prucalopride (Motegrity)
- pyrimethamine (Daraprim)
- quizartinib (Vanflyta)
- ramelteon (Rozerem)
- regorafenib (Stivarga)
- relacorilant (Lifyorli)
- relugolix-estradiol hemihydrate-norethindrone acetate (Myfembree)
- relugolix (Orgovyx)
- remibrutinib (Rhapsido)
- repotrectinib (Augtyro)
- resmetirom (Rezdiffra)
- revefenacin (Yupelri)
- revumenib citrate (Revuforj)
- ribociclib (Kisqali)
- rifaximin (Xifaxan)
- rilonacept (Arcalyst)
- riluzole (Tiglutik)
- rilzabrutinib (Wayrilz)
- riociguat (Adempas)
- ripretinib (Qinlock)
- risankizumab-rzaa (Skyrizi)
- risdiplam (Evrysdi)
- risedronate (Actonel 30 mg)
- ritlecitinib (Litfulo)
- roflumilast cream (Zoryve)
- roflumilast aerosol foam (Zoryve)
- ropeginterferon alfa-2b (Besremi)
- rucaparib (Rubraca)
- rufinamide (Banzel)
- ruxolitinib (Jakafi)
- ruxolitinib (Opzelura)
- sacrosidase (Sucraid)
- sacubitril-valsartan (Entresto Sprinkle)
- safinamide mesylate (Xadago)
- Prenyvia oral tablet chewable
- NutriChew oral tablet chewable
- adalimumab (Humira)
- adalimumab-aaty (Yuflyma)
- adalimumab-adaz (Hyrimoz)
- adalimumab-adbm (Cyltezo)
- adalimumab-afzb (Abrilada)
- adalimumab-aqvh (Yusimry)
- adalimumab-atto (Amjevita)
- adalimumab-bwwd (Hadlima)
- adalimumab-fkjp (Hulio)
- adapalene 0.1 % PAD
- adapalene-benzoyl peroxide-clindamycin (Cabtreo)
- allopurinol 200 mg tablet (Zyloprim)
- Altrixa
- amlodipine solution (Sdamlo)
- Azentra (Prenatal oral tablet)
- Azesco
- benzoyl peroxide (Epsolay)
- bupropion hydrobromide (Aplenzin)
- buspirone (Bucapsol)
- calcipotriene-betamethasone-dipropionate-foam (Enstilar)
- Carac 0.5% cream
- carbinoxamine 6 mg tablet (Ryvent)
- carbinoxamine solution (Carbzah)
- celecoxib 10 MG/ML suspension (Vyscoxa)
- clemastine 2.68 MG TAB (Clemsza, Chemasz)
- clobetasol propionate cream (Impoyz)
- clonidine 0.02 MG/ML solution (Javadin)
- Corphena 2 MG/5ML solution
- cyclobenzaprine 2.8 MG SL TAB (Tonmya)
- cyclosporine (Veyve)
- DermacinRx PNV Prenatol
- DermacinRx Pretrate
- desloratadine 0.5 MG/ML solution
- desmopressin oral solution (Desmoda)
- dexamethasone (Dexlyt)
- dexchlopheniramine (Ryclora)
- diclofenac potassium 25 mg (Lofena)
- diclofenac potassium capsule (Zipsor)
- dicyclomine 40 mg tablet
- diflunisal (Dolobid)
- dihydroergotamine (Brekiya)
- Doxycycline Hyclate Oral Capsule 75 MG
- econazole nitrate 1 % FOAM
- Embriva
- everolimus (Torpenz)
- fenopron 300 MG CAP
- flurbiprofen (Lurbiro)
- FolateXcel
- gabapentin (Gabarone)
- gabapentin (Relgaabi)
- glimepiride 3mg
- glycopyrrolate (Glycate)
- granisetron oral solution 2mg/10ml (Granisol)
- griseofulvin (Fulvicin)
- halcinonide 0.1 % solution
- hydrocortisone 2.5% solution, lotion, cream (Ala Scalp, MiCort HC)
- hydroxychloroquine (Sovuna)
- ibuprofen 300 mg tablet
- ibuprofen-acetaminophen (Combogesic)
- ibuprofen-famotidine (Duexis)
- indomethacin 25 MG/5ML suspension (Indocin)
- Jenliva Prenatal-Postnatal
- ketoprofen 25mg, 50mg CAP, 75 MG CAP
- lactulose (Kristalose)
- levetiracetam 250mg ODT
- levoketoconazole (Recorlev)
- Matervia
- Matriapro Oral Tablet Chewable
- meloxicam 7.5 MG/5ML suspension (Zybic)
- metaxalone 640 mg tablet
- metformin 625mg, 750mg, Glumetza
- methocarbamol 1000 mg
- methocarbamol oral suspension (Atmeksi)
- metoprolol tartrate 12.5 MG TAB (Lopressor)
- metronidazole (Noritate)
- metronidazole 125 mg tablet
- minocycline (Emrosi)
- Multi-Mac
- nabumetone (Relafen DS)
- naproxen (Naprelan CR)
- naproxen-esomeprazole (Vimovo)
- NatalCore Oral Tablet Chewable 29-1 MG
- NeoMaterna
- nitisinone (Nityr)
- nitrofurantoin 50 mg/5ml oral suspension
- Novyra (Prenatal oral tablet)
- omeprazole-sodium bicarbonate (Zegerid)
- Oracea
- oxaprozin (Coxanto)
- oxycodone-acetaminophen (Nalocet, Primlev, Prolate)
- Pirfenidone 534 MG TAB
- PNV Tabs 20-1
- potassium chloride powder (Pokonza)
- prednisone delayed-release (Rayos)
- PreGenna
- Prenatol-M
- Prenatrix
- Prenatryl
- Prenova (Prenatal oral tablet)
- Prenyra (Prenatal oral tablet)
- ranitidine HCl 150 MG, 300 MG TAB
- rizatriptan-meloxicam (Symbravo)
- sildenafil oral film (Vybrique)
- testosterone 200 MG CAP (Undecatrex)
- tizanidine (Zanaflex)
- tizanidine 2 MG/5ML SOLUTION (Ontralfy)
- tobramycin (Kitabis)
- tocilizumab syringe (Actemra)
- tocilizumab-anoh (Avtozma)
- tolmetin (Tolectin)
- torsemide (Soaanz)
- tramadol 75 mg tab
- ursodiol (Reltone, Ursolign )
- ustekinumab products (Imuldosa, Pyzchiva, Selarsdi, Stelara, Steqeyma, Starjemza, Wezlana, Otulfi)
- Zalvit
- Ziphex
- sapropterin (Kuvan)
- sarecycline (Seysara)
- sargramostim (Leukine)
- sarilumab (Kevzara)
- satralizumab (Enspryng)
- saxagliptin (Onglyza)
- saxagliptin-metformin (Kombiglyze XR)
- sebetralstat (Ekterly)
- secnidazole (Solosec)
- secukinumab (Cosentyx)
- seladelpar (Livdelzi)
- selexipag (Uptravi)
- selinexor (Xpovio)
- selpercatinib (Retevmo)
- selumetinib (Koselugo)
- semaglutide (Ozempic)
- semaglutide tablet (Rybelsus)
- semaglutide (Wegovy)
- sepiapterin (Sephience)
- setmelanotide (Imcivree)
- sevabertinib (Hyrnuo)
- sevelamer carbonate, oral packet (Renvela)
- benzphetamine (Didrex)
- diethylpropion (Tenuate)
- phendimetrazine (Bontril PDM)
- phentermine (Adipex-P, Lomaira)
- sibeprenlimab-szsi (Voyxact)
- sildenafil 20mg tab, suspension (Revatio)
- sildenafil suspension (Liqrev)
- simvastatin suspension (FloLipid)
- sinecatechins ointment (Veregen)
- siponimod (Mayzent)
- sirolimus gel (Hyftor)
- sitagliptin (Januvia)
- sitagliptin-metformin (Janumet, Janumet XR)
- sitagliptin oral solution (Brynovin)
- sitagliptin (Zituvio)
- sitagliptin-metformin (Zituvimet, Zituvimet XR)
- sodium oxybate ER oral suspension (Lumryz)
- sodium oxybate (Xyrem)
- sofosbuvir (Sovaldi)
- velpatasvir-sofosbuvir (Epclusa)
- sofosbuvir-velpatasvir-voxilaprevir (Vosevi)
- sofpironium topical gel (Sofdra)
- solriamfetol (Sunosi)
- somapacitan-beco (Sogroya)
- somatrogon-ghla (Ngenla)
- somatropin (Genotropin, Humatrope, Norditropin, Omnitrope, Saizen, Zomacton)
- somatropin (Serostim)
- sonidegib (Odomzo)
- sorafenib (Nexavar)
- sotagliflozin (Inpefa)
- sotalol (Sotylize)
- sotatercept-csrk (Winrevair)
- sotorasib (Lumakras)
- sparsentan (Filspari)
- spesolimab-sbzo (Spevigo)
- spironolactone oral suspension (Carospir)
- stiripentol (Diacomit)
- sucroferric oxyhydroxide (Velphoro)
- sulfacetamide sodium-sulfur (cleanser, cream, gel, lotion, pad)
- sulopenem etzadroxil-probenecid (Orlynvah)
- sumatriptan injection (Zembrace)
- sumatriptan-naproxen (Treximet)
- sumatriptan nasal spray (Onzetra Xsail)
- sumatriptan spray (Tosymra)
- sunitinib (Sutent)
- tacrolimus (Envarsus XR)
- tacrolimus (Prograf Packet)
- tadalafil 20mg (Adcirca, Alyq, Tadliq)
- tafamidis capsule (Vyndamax, Vyndaqel)
- tafenoquine (Arakoda)
- talazoparib (Talzenna)
- taletrectinib (Ibtrozi)
- tapentadol (Nucynta)
- tapentadol (Nucynta ER)
- tapinarof cream (Vtama)
- tasimelteon (Hetlioz, Hetlioz LQ)
- tazarotene (Arazlo)
- tazarotene aerosol foam (Fabior)
- tbo-filgrastim (Granix)
- tedizolid (Sivextro)
- teglutide (Gattex)
- telotristat etiprate (Xermelo)
- tenapanor hydrochloride (Ibsrela)
- tenapanor (Xphozah)
- tenofovir-alafenamide (Vemlidy)
- tepotinib (Tepmetko)
- terazosin (Tezruly)
- teriflunomide (Aubagio)
- teriparatide SQ (Forteo, Bonsity)
- tesamorelin (Egrifta)
- methyltestosterone capsule (Methitest)
- testosterone enanthate injection (Xyosted)
- testosterone gel, packet, patch, pump (Androgel, Fortesta, Testim, Vogelxo)
- testosterone nasal (Natesto)
- testosterone undecanoate capsule (Jatenzo, Kyzatrex, Tlando)
- tetrabenazine (Xenazine)
- tezacaftor-ivacaftor (Symdeko)
- tezepelumab-ekko autoinjector pen (Tezspire)
- thalidomide (Thalomid)
- tiopronin (Thiola, Thiola EC, Venxxiva)
- tiotropium bromide (Spiriva HandiHaler)
- tiotropium-olodaterol (Stiolto Respimat)
- tirbanibulin (Klisyri)
- tirzepatide (Mounjaro)
- tirzepatide (Zepbound)
- tivozanib (Fotivda)
- tobramycin inhalation solution (Bethkis, Tobi)
- tocilizumab-aazg syringe (Tyenne)
- tofacitinib (Xeljanz/Xeljanz XR, Xeljanz solution)
- tolcapone (Tasmar)
- tolvaptan (Jynarque)
- tolvaptan (Samsca)
- econazole (Ecoza)
- ketoconazole (Ketodan)
- luliconazole (Luzu)
- miconazole nitrate-zinc oxide-white petrolatum ointment (Vusion)
- naftifine cream, gel (Naftin)
- oxiconazole (Oxistat)
- sertaconazole (Ertaczo)
- acyclovir cream, ointment (Zovirax)
- acyclovir-hydrocortisone cream ( Xerese)
- penciclovir cream (Denavir)
- betamethasone foam (Luxiq Foam)
- clocortolone pivalate (Cloderm)
- fluticasone lotion (Beser, Cutivate)
- clobetasol foam (Tovet)
- desoximetasone 0.05% cream, ointment (Topicort)
- hydrocortisone butyrate hydrophilic lipo base cream, lotion (Locoid)
- triamcinolone 0.05% ointment (Trianex)
- topiramate extended release capsule (Qudexy XR)
- topiramate (Eprontia)
- topiramate sprinkle capsule 50 mg
- topiramate er (Trokendi XR)
- tovorafenib (Ojemda)
- tradipitant (Nereus)
- tralokinumab-ldrm (Adbry)
- trametinib (Mekinist)
- trazodone oral solution (Raldesy)
- treprostinil (Tyvaso DPI, Yutrepia)
- treprostinil (Orenitram ER)
- tretinoin-benzoyl peroxide cream (Twyneo)
- tretinoin gel (Atralin)
- tretinoin lotion (Altreno)
- tretinoin microsphere (Retin-A Micro)
- tretinoin cream, gel (Retin-A, Avita)
- triameterene (Dyrenium)
- trientine (Syprine)
- trientine tetrahydrochloride (Cuvrior)
- trifarotene (Aklief)
- trifluridine-tipiracil (Lonsurf)
- triheptanoin (Dojolvi)
- eletriptan (Relpax)
- naratriptan (Amerge)
- rizatriptan (Maxalt)
- sumatriptan (Imitrex)
- zolmitriptan tablets, ODT (Zomig)
- trofinetide (Daybue)
- tucatinib (Tukysa)
- umeclidinium Ellipta
- umeclidinium-vilanterol (Anoro Ellipta)
- upadacitinib (Rinvoq)
- uridine triacetate granule (Xuriden)
- ustekinumab (Yesintek)
- valbenazine (Ingrezza)
- valsartan oral solution
- vamorolone (Agamree)
- vancomycin solution (Firvanq)
- vandetanib (Caprelsa)
- vanzacaftor-tezacaftor-deutivacaftor (Alyftrek)
- varenicline spray (Tyrvaya)
- vedolizumab (Entyvio pen)
- vemurafenib (Zelboraf)
- venetoclax (Venclexta)
- vepdegestrant (Veppanu)
- vericiguat (Verquvo)
- vibegron (Gemtesa)
- vigabatrin (Sabril)
- vigabatrin (Vigafyde)
- viloxazine hcl (Qelbree)
- vimseltinib (Romvimza)
- vismodegib (Erivedge)
- voclosporin (Lupkynis)
- vonopazan (Voquezna)
- vorasidenib (Voranigo)
- voriconazole (Vfend)
- vorinostat (Zolinza)
- vortioxetine (Trintellix)
- vosoritide (Voxzogo)
- xanomeline-trospium (Cobenfy)
- zanubrutinib (Brukinsa)
- zavegepant (Zavzpret)
- ziftomenib (Komzifti)
- zileuton controlled release (Zyflo CR)
- zilucoplan injection (Zilbrysq)
- zolmitriptan nasal spray (Zomig)
- zongertinib (Hernexeos)
- zonisamide (Zonisade)
- zuranolone (Zurzuvae)
Medication policy user guide
This brief user guide describes our medication policy, explains terms used, and includes contact info for more information
About medication policy
Find out how our medication policy, which determines if a service will be covered by a plan, is reviewed and updated.
Drug formulary, policy and forms
Search our drug formulary database, get prior authorization forms, and find information on oral and topical drugs, home-injectable drugs and more.