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This list houses the 2017 pharmacy list items, and is structured to match the 2016 list.

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Requirements
  
  
  
Acanyaclindamycin phosphate/benzoyl peroxide gel1/1/2017Requires Prior Approval, Requires Step TherapyFor policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Accunebalbuterol sulfate nebulization solution 1/1/2017Subject to Quantity LimitsFor policy information, contact CVS Caremark Customer Service at 888-321-3124Short-Acting Beta Agonists - Oral Inh
Actharcorticotropin gel8/1/2017Requires Prior ApprovalFor policy information, contact CVS Caremark Customer Service at 888-321-3124Seizure Disorders
Actimmuneinterferon gamma-1B solution1/1/2017Requires Prior ApprovalFor policy information, contact CVS Caremark Customer Service at 888-321-3124Infectious Disease
Adagenpegademase bovine solution1/1/2017Requires Prior ApprovalFor policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Adcetrisbrentuximab vedotin solution reconstituted1/1/2017Requires Prior ApprovalFor policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Adderallamphetamine-dextroamphetamine tablet1/1/2017Requires Prior Approval, Subject to Quantity LimitsFor policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Adempasriociguat tablets1/1/2017Requires Prior ApprovalFor policy information, contact CVS Caremark Customer Service at 888-321-3124Pulmonary Arterial Hypertension Agents
Advair Diskus and HFAfluticasone propionate and salmeterol xinafoate aerosol  and aerosolpowder1/1/2017Subject to Quantity LimitsFor policy information, contact CVS Caremark Customer Service at 888-321-3124LABA/Corticosteroid
AdvateAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Afinitoreverolimus tablets1/1/2017Requires Prior ApprovalFor policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
AfstylaAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Akne-Mycinerythromycin ointment1/1/2017Requires Prior Approval, Requires Step TherapyFor policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Akynzeonetupitant and palonosetron capsules1/1/2017Requires Prior Approval, Subject to Quantity LimitsFor policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
Albenzaalbendazole10/1/2017Requires Prior Approval, Subject to Quantity LimitsAnthelmintic
Aldurazymelaronidase solution1/1/2017Requires Prior ApprovalFor policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Alferon-Ninterferon alpha-n31/1/2017Requires Prior ApprovalFor policy information, contact CVS Caremark Customer Service at 888-321-3124Infectious Disease
Aloxipalonosetrom hci solution1/1/2017Requires Prior Approval, Subject to Quantity LimitsFor policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
AlphanateAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Ampyradalfampridine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Multiple Sclerosis
Anadrol-50oxmehtolone tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Anabolic Steroids
Androdermtestosterone transdermal patch1/1/2018Requires Prior ApprovalTestosterone Products
Androgeltestosterone topical gel1/1/2018Requires Prior ApprovalTestosterone Products
Androidmethyltestosterone, oral capsule1/1/2018Requires Prior ApprovalTestosterone Products
Androxyfluoxymesterone, oral tablet1/1/2018Requires Prior ApprovalTestosterone Products
Anzemetdolasetron1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
Apokynapomorphine hycrochloride solution1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Movement Disorders
Aralastalpha-1 proteinase inhibitor1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Alpha-1 Antitrypsin Deficiency
Aranespdarbepoetin solution1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Anemia
Arcalystrilonacept for subcutaneous [SC] injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Cryopyrin Associated Periodic Synd (CAPS)
Arcaptaindacaterol capsule1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Long-Acting Beta Agonists (LABA)
Arzerraofatumumab concentrate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Aubagioteriflunomide tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Multiple Sclerosis
Avastinbevacizumab solution1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Age-Related Macular Degen/Oncology
Avastinbevacizumab solution1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinal Disorders/Oncology
Aveedtestosterone undecanoate injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hormonal Therapies
Axertalmotriptan1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
Axirontestosterone topical solution1/1/2018Requires Prior ApprovalTestosterone Products
AzacitidineAzacitidine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Azelexazelaic acid cream1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Bavencio8/1/2017Oncology
Beleodaqbelinostat solution reconstituted1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Belviqlorcaserin hydrocholoride tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
Benlystabelimumab solution reconstituted1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Systemic Lupus Erythematosus
BenzphetamineBenzphetamine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
BerinertC1 esterase inhibitor [human] for IV1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hereditary Angioedema
Betaseroninterferon beta-1b for subcutaneous [SC] injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Multiple Sclerosis
Bethkistobramycin (oral inhalation) nebulization solution1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Cystic Fibrosis
BevespiGlycopyrrolate; Formoterol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124LABA/Anticholinergic
Biltricidepraziquantel10/1/2017Requires Prior Approval, Subject to Quantity Limits
Binostoalendronate effervescent tablets1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Bisphosphanates
BlincytoBlinatumomab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Bontril PDMphendmetrazine tartrate tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
Bontril SRphendimetrazine tartrate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
Bosulifbosutinib tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Botoxonabotulinumtoxin A1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Botulinum Toxins
Breo ElliptaFluticasone; Vilanterol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124LABA/Corticosteroid
BrovanaArformoterol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Long-Acting Beta Agonists (LABA)
Bunavailbuprenorphine/naloxone buccal films1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Antagonists
Buphenylsodium phenylbutyrate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Urea Cycle Disorders
BuprenorphineBuprenorphine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Antagonists
Buprenorphine/NaloxoneBuprenorphine/Naloxone1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Antagonists
Butorphanol Nasal SprayButorphanol Nasal Spray1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics
Cambiadiclofenac potassium powder for oral solution1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124COX-2/NSAIDs
Caprelsa (Vandetanib)vandetanib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Carbaglucarglumic acid1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Urea Cycle Disorders
Caystonaztreonam1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Cystic Fibrosis
Ceprotinprotein C1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Coagulation Disorders
Cerezymeimiglucerase1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Cesametnabilone1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
Cetrotidecetrorelix1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Specialty
Cholbamcholic acid1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124GI Disorders
Cialis 2.5 and 5 mgtadalafil1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124BPH
Ciclodan Kitciclopirox topical solution 8% moisturize10/1/2017Requires Prior ApprovalTopical Antifungals
CinryzeC1 esterase inhibitor (IV)1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hereditary Angioedema
Claravisisotretinoin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Isotretinoins
Clindagelclindamycin phosphate gel1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Clomipheneclomiphene citrate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Non-Specialty
CNL8 Nail Kitciclopirox topical solution 8% nail lacquer remover swabs / emery board10/1/2017Requires Prior ApprovalTopical Antifungals
CometriqCabozantinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Compounded Products-1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Compounded Products
Concertamethylphenidate extended-release tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Contravenaltrexone Hcl/buproprion Hcl ER tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
Copaxoneglatiramer acetate injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Multiple Sclerosis
Corifactantihemophilic factor1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Corlanorivabradine tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Misc CV Agents
Crinoneprogesterone, vaginal1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Non-Specialty
Cupriminepenicillamine10/1/2017Requires Prior Approval, Requires Step TherapyChelating Agent
CyramzaRamucirumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Cystagonmepivacaine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
CystaranCysteamine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Daraprimpyrimethamine tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiparasitic
Darzalexdaratumumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Daytranamethylphenidate transdermal system1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
DecitabineDecitabine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Delatestryltestosterone enanthate injection1/1/2018Requires Prior ApprovalTestosterone Products
Depo-Testosteronetestosterone cypionate injection1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Desferal (Deferoxamine)deferoxamine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Iron Overload
Desoxynmethamphetamine tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
DextroamphetamineDextroamphetamine1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Didrexbenzphetamine hydrochloride tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
DiethylpropionDiethylpropion1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
Differinadapalene1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinoids
Dificidfidaxomicin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Macrolide Antibiotics
Doralquazepam1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Sedative-Hypnotics
DronabinolDronabinol1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
DuleraFormoterol; mometasone1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124LABA/Corticosteroid
Dupixent8/1/2017Requires Prior ApprovalEczema
Dyanavel XRamphetamine extended release1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
DysportAbobotulinumtoxinA1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Botulinum Toxins
Egriftatesamorelin injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124HIV
ElapraseIdursulfase1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
ElelysoTaliglucerase Alfa1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
ElidelCalcineurin Inhibitor10/1/2017Requires Prior ApprovalChelating Agent
Eligardleuprolide1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hormonal Therapies
Emendaprepitant capsules1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
EMLALidocaine; Prilocaine1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Anesthetics - Lidocaine Containing
EmplicitiElotuzumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Emvermmebendazole10/1/2017Requires Prior Approval, Subject to Quantity LimitsAnthelmintic
Enbreletanercept injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Psoriasis/RA
Endometrinprogesterone, vaginal1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Non-Specialty
Entrestosacubitril-valsartan tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Heart Failure
EntyvioVedolizumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124IBS
EpclusaSofosbuvir1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hepatitis C
Epiduoadapalene/benzoyl peroxide gel1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
EpogenEpoetin Alfa1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Anemia
Epoprostenol (Flolan, Veletri)epoprostenol1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Pulmonary Arterial Hypertension
ErbituxCetuximab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Erivedgevismodegib capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
ErwinazeL-asparaginase1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Esbrietpirfenidone capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Idiopathic Pulmonary Fibrosis
Estazolamestazolam1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Sedative-Hypnotics
Eszopicloneeszopiclone1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Sedative-Hypnotics
Eucrisa8/1/2017Requires Prior Approval, Requires Step TherapyEczema
Evekeoamphetamine sulfate tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Exalgohydromorphone hcl extended release tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
ExjadeDeferasirox1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Iron Overload
EyleaAflibercept1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinal Disorders
Fabiortazarotene foam1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinoids
FabrazymeAgalsidase Beta1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Fanaptiloperidone10/1/2017Requires Prior ApprovalAtypical Antipsychotics
FeibaAntihemophilic Factor VIII1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Fentanyl (Lozenge/Nasal Spray Forms)fentanyl citrate1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Oral/Intranasal Fentanyl Products
Fentorafentanyl buccal tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Oral/Intranasal Fentanyl Products
Finaceaazelaic acid10/1/2017Requires Prior ApprovalRosacea
Firazyricatibant for subcutaneous [SC] injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hereditary Angioedema
FirmagonDegarelix1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hormonal Therapies
FlectorDiclofenac1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124COX-2/NSAIDs
Flurazepamflurazepam1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Sedative-Hypnotics
Focalindexmethylphenidate immediate release tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Focalin XRdexmethylphenidate extended release tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Follistim AQfollitropin beta1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Specialty
FolotynPralatrexate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
ForadilFormoterol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Long-Acting Beta Agonists (LABA)
Fortamet and Glumetza8/1/2017Requires Prior Approval
Forteoteriparatide injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Osteoporosis
Fortestatestosterone topical gel1/1/2018Requires Prior ApprovalTestosterone Products
Fosamax-DAlendronate1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Bisphosphanates
Frovafrovatriptan1/1/2017Requires Prior Approval, Requires Step Therapy, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
FusilevLevoleucovorin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
GammaguardImmune globulin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124IVIG
Gammakedimmune globulin injection (Human)1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124IVIG
Gammunex-CImmune globulin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124IVIG
Ganirelix acetateganirelix acetate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Specialty
GattexTeduglutide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124GI Disorders
GazyvaObinutuzumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Gel-Onehyaluronate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Osteoarthritis
Gilenyafingolimod capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Multiple Sclerosis
Gilotrifafatinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
GlassiaAlpha-1-proteinase Inhibitor1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Alpha-1 Antitrypsin Deficiency
Glatopaglatiramer acetate injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Multiple Sclerosis
Granisetrongranisetron1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
Granix Tbo-Filgrastim1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Neutropenia
Grastektimothy grass pollen allergen extract sublingual [SL] tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Sublingual Immunotherapy Products
H.P. Acthar Gel8/1/2017Seizure Disorders
HalavenEribulin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
HalcionTriazolam1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Sedative-Hypnotics
Harvonisofosbuvir/ledipasvir tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hepatitis C
Hemofil MAntihemophilic Factor VIII1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
HerceptinTrastuzumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Hetlioztasimelteon capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Sleep Disorders
Hizentraimmune globulin subcutaneous (Human)1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124IVIG
Humate-PAntihemophilic Factor VIII10/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Humatropesomatropin injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Growth Hormone and Related Disorders
Humiraadalimumab injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124IBS/RA/Psoriasis
HyalganSodium Hyaluronate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Osteoarthritis
HycamtinTopotecan1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Hysinglahydrocodone1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
IbrancePalbociclib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Iclusigponatinib tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Ilariscanakinumab for subcutaneous [SC] injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Cryopyrin Associated Periodic Synd (CAPS)
Imatinibimatinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
ImbruvicaIbrutinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Imitrexsumatriptan tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
ImlygicTalimogene Laherparepvec1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Increlexmecasermin [rDNA origin] injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Growth Hormone and Related Disorders
InlytaAxitinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Inovabenzoyl peroxide/salicylic acid pad1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Intron AInterferon Alfa-2b1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
IressaGefitinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
IstodaxRomidepsin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
IxempraIxabepilone1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
IxinityFactor IX Concentrates1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
JakafiRuxolitinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
JevtanaCabazitaxel1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Jubliaefinaconazole topical solution1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Antifungals
Juxtapidlomitapide capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lipid Disorders
KadcylaAdo-Trastuzumab emtansine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Kadianmorphine sulfate ER capsules1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
KalbitorEcallantide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hereditary Angioedema
Kalydecoivacaftor tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Cystic Fibrosis
KanumaSebelipase alfa1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Kerydintavaborole topical solution1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Antifungals
KeytrudaPembrolizumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Koate-DVIAntihemophilic factor VIII1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Kogenate FSAntihemophilic factor VIII1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Kogenate FSAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Korlymmifepristone1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Cushing's Syndrome
KovaltryAntihemophilic factor VIII1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
KovaltryAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
KrystexxaPegloticase1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Gout
Kuvansapropterin dihydrochloride1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Phenylketonuria (PKU)
Kynamromipomersen sodium injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lipid Disorders
KyprolisCarfilzomib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Lazandafentanyl nasal spray1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Oral/Intranasal Fentanyl Products
LenvimaLenvatinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Letairisambrisentan tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Pulmonary Arterial Hypertension
Leukineleukine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Neutropenia
Levalbuterol levalbuterol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Short-Acting Beta Agonists - Oral Inh
Lidocaine 5% OintmentLidocaine1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Anesthetics - Lidocaine Containing
Lidocaine Gel - 2% and 4%Lidocaine1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Anesthetics - Lidocaine Containing
Lidocaine HCL 4% SolutionLidocaine1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Anesthetics - Lidocaine Containing
Lidodermlidocaine patch 5%10/1/2017Requires Prior ApprovalTopical Anesthetics - Lidocaine Containing
LonsurfTrifluridine; Tipiracil1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Lovazaomega-3-acid ethyl esters capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Omega-3 Fatty Acids
LucentisRanibizumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinal Disorders
LumizymeAlglucosidase alfa1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
LupanetaLeuprolide; Norethindrone1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hormonal Therapies
Lupron Depot PED (leuprolide acetate)leuprolide acetate for depot suspension1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Central Precocious Puberty (CPP)
Lupron/Leuprolideleuprolide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Specialty
LynparzaOlaparib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
MarinolDronabinol1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
Maxaltrizatriptan1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
Mekinisttrametinib tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
MenopurMenotropins1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Specialty
Metadate CDmethylphenidate extended-release capsules1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Methamphetaminemethamphetamine1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Methitestmethyltestosterone tablets1/1/2018Requires Prior ApprovalTestosterone Products
Methylinmethylphenidate tablets, chewables, oral solution1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
MethylphenidateMethylphenidate1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Methylphenidate ERMethylphenidate ER1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Methyltestosteronemethyltestosterone1/1/2018Requires Prior ApprovalTestosterone Products
Metrocreammetronidazole10/1/2017Requires Prior Approval, Requires Step TherapyRosacea
Metrogel Topicalmetronidazole10/1/2017Requires Prior Approval, Requires Step TherapyRosacea
Migranaldihydroergotamine nasal spray1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
Mirvasobrimonidine10/1/2017Requires Prior ApprovalRosacea
Monoclate-PAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
MononineFactor IX Concentrates1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Morphine Sulfate ERMorphine Sulfate ER1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
MozobilPlerixafor1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hematopoietics
MS Continmorphine sulfate controlled-release tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
MyaleptMetreleptin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lipodystrophy
MyoblocRimabotulinumtoxinB1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Botulinum Toxins
MyorisanIsotretinoin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Isotretinoins
NaglazymeGalsulfase1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
NalfonFenoprofen1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124COX-2/NSAIDs
Naratriptannaratriptan1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
Natestotestosterone nasal gel1/1/2018Requires Prior ApprovalTestosterone Products
NatparaParathyroid Hormone Lyophilisate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hormonal Therapies
Neulastapegfilgrastim1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Neutropenia
Nexavarsorafenib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Ninlaroixazomib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Noritatemetronidazole10/1/2017Requires Prior ApprovalRosacea
Novarelhuman chorionic gonadotropin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Specialty
NovoEightAntihemophilic factor VIII1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
NovoeightAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
NovoSevenAntihemophilic factor VII1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Noxafilposaconazole1/1/2017 For policy information, contact CVS Caremark Customer Service at 888-321-3124Antifungal
NplateRomiplostim1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Idiopathic Thrombocytopenic Purpura (ITP)
NucyntaTapentadol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Pain - Opiod Analgesic
Nuvigilarmodafinil tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Narcolepsy (Other)
NuwiqAntihemophilic factor VIII1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
NuwiqAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Ocrevus8/1/2017Requires Prior ApprovalMultiple Sclerosis
Octreotide acetate (Sandostatin)octreotide acetate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Acromegaly
Ofevnintedanib capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Idiopathic Pulmonary Fibrosis
OncasparPegaspargase1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
OnextonBenzoyl Peroxide; Clindamycin1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Opana ERoxymorphone hcl ER tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
OpdivoNivolumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Oraceadoxycycline10/1/2017Requires Prior Approval, Requires Step TherapyRosacea
Oralairsweet vernal, orchard, perennial rye, timothy, and kentucky blue grass mixed pollens allergen extract SL tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Sublingual Immunotherapy Products
Orenitramtreprostinil ER tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Pulmonary Arterial Hypertension
OrfadinNitisinone1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Orkambilumacaftor/ivacaftor1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Cystic Fibrosis
Otrexupmethotrexate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Psoriasis/RA
Ovidrelhuman chorionic gonadotropin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Specialty
OxandrinOxandrolone1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Anabolic Steroids
Oxycodone EROxycodone ER1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
Oxycontinoxycodone controlled release tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
Oxymorphone EROxymorphone ER1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
Pedipirox-4 Nail Kitciclopirox topical solution 8% nail lacquer remover pads / nail file / with or withour foot powder10/1/2017Requires Prior ApprovalTopical Antifungals
Penlac Nail Lacquerciclopirox topical solution 8%10/1/2017Requires Prior ApprovalTopical Antifungals
PerformistFormoterol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Long-Acting Beta Agonists (LABA)
PerjetaPertuzumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
PexevaParoxetine1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124SSRIs
Phendimetrazinephendimetrazine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
Phenterminephentermine HCl1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
PliaglisLidocaine; Tetracaine1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Anesthetics - Lidocaine Containing
PomalystPomalidomide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Pregnylhuman chorionic gonadotropin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Specialty
Prilosec PacketsOmeprazole1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Proton Pump Inhibitors
Proair HFA and Respiclickalbuterol sulfate1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Short-Acting Beta Agonists - Oral Inh
Procentradextroamphetamine sulfate liquid1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
ProcysbiCysteamine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Profilnine SDFactor IX Complex1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Progesterone Vag Gelprogesterone, vaginal1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Non-Specialty
Prolastin-CAlpha-1-proteinase Inhibitor1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Alpha-1 Antitrypsin Deficiency
ProleukinAldesleukin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Promactaeltrombopag tablets and oral suspension1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Idiopathic Thrombocytopenic Purpura (ITP)
Protonix PacketsPantoprazole1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Proton Pump Inhibitors
Protopictacrolimus10/1/2017Requires Prior ApprovalCalcineurin Inhibitor
Provigilmodafinil tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Narcolepsy (Other)
Prudoxindoxepin10/1/2017Requires Prior Approval, Requires Step TherapyTopical Skin Product
PulmozymeDornase Alfa1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Cystic Fibrosis
Quillichew ERMethylphenidate1/1/2017 For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Quillivant XRmethylphenidate ER oral suspension1/1/2017 For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Ragwitekshort ragweed pollen allergen extract sublingual [SL] tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Sublingual Immunotherapy Products
RasuvoMethotrexate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Psoriasis/RA
RavictiGlycerol Phenylbutyrate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Urea Cycle Disorders
Rebifinterferon beta-1a subcutaneous1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Multiple Sclerosis
Reclast (zoledronic acid)zoledronic acid1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Osteoporosis
RecombinateAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Regimexbenzphetamine 25 mg tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
RelenzaZanamivir1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Influenza
Relpaxeletriptan1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
Remodulintreprostinil injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Pulmonary Arterial Hypertension
Repathaevolocumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lipid Disorders
RestasisCyclosporine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Ophthalmic Immunomodulators
RestorilTemazepam1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Sedative-Hypnotics
Retin-Atretinoin cream, gel, liquid1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinoids
Revlimidlenalidomide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Rexultibrexpipraziole10/1/2017Requires Prior ApprovalAtypical Antipsychotics
Rhofadeoxymetazoline hydrochloride10/1/2017Requires Prior ApprovalRosacea
RiaxBenzoyl Peroxide1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Ritalin LAmethylphenidate ER tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
RituxanRituximab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124RA/Oncology
RixubisFactor IX Concentrates1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
RosacSulfacetamide; Sulfur1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Rosadanmetronidazole10/1/2017Requires Prior Approval, Requires Step TherapyRosacea
Rosanilsodium sulfacetamide/sulfur cleanser1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Rubracarucaparib10/1/2017Requires Prior ApprovalOncology
Ruconestrecombinant C1 esterase inhibitor for IV use1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hereditary Angioedema
Ruconest8/1/2017Requires Prior Approval
Rydaptmidostaurin10/1/2017Requires Prior ApprovalOncology
SabrilVigabatrin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Seizure Disorders
SamscaTolvaptan1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Electrolyte disorders
Sancusogranisetron1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
Saphrisvraylar10/1/2017Requires Prior ApprovalAtypical Antipsychotics
Saxendaliraglutide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
SensiparCinacalcet1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Renal Disorder
Serevent DiskusSalmeterol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Long-Acting Beta Agonists (LABA)
Serostimsomatropin injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124HIV
SigniforPasireotide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Acromegaly/Cushing's Syndrome
SolarazeDiclofenac1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Actinic Keratosis
SolirisEculizumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Paroxysmal Nocturnal Hemoglobinuria (PNH)
Solodynminocycline ER tablets1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Oral Tetracyclines
SomarvertPegvisomant1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Acromegaly
Somatuline Lanreotide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Acromegaly
Sonatazaleplon capsules1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Sedative-Hypnotics
Soolantraivermectin10/1/2017Requires Prior ApprovalRosacea
Soriataneacitretin10/1/2017Requires Prior ApprovalPsoriasis/RA
SotretIsotretinoin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Isotretinoins
Sovaldisofosbuvir tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hepatitis C
Spryceldasatinib tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Stiavigacyclovir buccal tablet10/1/2017Requires Prior Approval, Requires Step Therapy
StimateDesmopressin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Stivargaregorafenib tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Stratteraatomoxetine capsules1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
StrensiqAsfotase alfa1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Bone Disorders - Other
Strianttestosterone buccal system1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
StriverdiOlodaterol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Long-Acting Beta Agonists (LABA)
Suboxonebuprenorphine/naloxone sublingual films1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Antagonists
Subsysfentanyl sublingual spray1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Oral/Intranasal Fentanyl Products
Sumadansulfacetamide/sulfur wash1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
Sumatriptansumatriptan1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
Sumavelsumatriptan needle-free injection1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
Sumaxinsulfacetamide/sulfur wash1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Acne Products
SupartzSodium Hyaluronate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Osteoarthritis
Supprelin LAHistrelin1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Central Precocious Puberty (CPP)
Suprenzaphentermine hydrochloride orally disintegrating tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
SutentSunitinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Sylatronpeginterferon alfa-2b1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
SylvantSiltuximab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
SynagisPalivizumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124RSV
Synarelnafarelin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Fertility Products - Non-Specialty
SyneraLidocaine; Tetracaine1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Topical Anesthetics - Lidocaine Containing
SynriboOmacetaxine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Syprinetrientine10/1/2017Requires Prior Approval, Requires Step TherapyChelating Agent
Tafinlardabrafenib capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Tagrissoosimertinib tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
TamifluOseltamivir1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Influenza
Tarcevaerlotinib tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
TargretinBexarotene1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Tazoractazarotene cream, gel1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinoids
TechfideraDimethyl Fumarate1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Multiple Sclerosis
Temozolomidetemozolomide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Testimtestosterone topical gel1/1/2018Requires Prior ApprovalTestosterone Products
Testopeltestosterone pellets1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testosterone Buccal Systemtestosterone1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testosterone Cypionate Injtestosterone cypionate injection1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testosterone Enanthate Injtestosterone enanthate injection1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testosterone Nasal Geltestosterone nasal1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testosterone Patchtestosterone1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testosterone Propionate Implant Pelletstestosterone1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testosterone Topical Creamtestosterone1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testosterone Topical Geltestosterone1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testosterone Topical Ointmenttestosterone1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Testosterone Products
Testredmethyltestosterone capsules1/1/2018Requires Prior ApprovalTestosterone Products
Tetrabenazinetetrabenazine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Movement Disorders
Thalomidthalidomide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
TikosynDofetilide1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Cardiac Disorder
ToriselTemsirolimus1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Tracleerbosetan tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Pulmonary Arterial Hypertension
TreandaBendamustine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
TrelstarTriptorelin1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hormonal Therapies
Tretinointretinoin1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinoids
Tretin-XTretinoin1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinoids
Treximetsumatriptan/naproxen1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
TriglideFenofibrate1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Fibrates
Trulanceplecanatide10/1/2017Requires Prior ApprovalGI Disorders
Tykerblapatinib ditosylate tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Tymlosabaloparatide10/1/2017Requires Prior ApprovalOsteoporosis
TysabriNatalizumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124IBS/RA/Psoriasis
Tyvasotreprostinil inhalation solution1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Pulmonary Arterial Hypertension
Uptraviselexipag tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Pulmonary Arterial Hypertension
ValchlorMechlorethamine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
VantasHistrelin1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hormonal Therapies
VarubiRolapitant1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
Vascepaicosapent ethyl capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Omega-3 Fatty Acids
VectibixPanitumumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
VelcadeBortezomib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Veltinclindamycin phosphate/tretinoin gel1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinoids
Ventavisiloprost inhalation solution1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Pulmonary Arterial Hypertension
Vfendvoriconazole1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antifungal
VimizimElosulfase alfa1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Vimovonaproxen/esomeprazole magnesium1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124COX-2/NSAIDs
VivitrolNaltrexone1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Alcohol/Opioid Dependency
Vogelxotestosterone topical gel1/1/2018Requires Prior ApprovalTestosterone Products
Voltaren Geldiclofenac sodium topical gel 1%10/1/2017Requires Prior ApprovalTopical Anesthetics - Lidocaine Containing
VotrientPazopanib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
VPRIVVelaglucerase Alfa1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Vraylarcariprazine10/1/2017Requires Prior ApprovalAtypical Antipsychotics
Vyvanselisdexamfetamine dimesylate capsules1/1/2017 For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Wilateantihemophilic factor viii1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
Xalkoricrizotinib capsules1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Xartemis XRAcetaminophen; Oxycodone1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Pain - Opiod Analgesic
XelodaCapecitabine1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Xenicalorlistat1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiobesity
XeominIncobotulinumtoxinA1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Botulinum Toxins
XgevaDenosumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Ximinominocycline1/1/2017 For policy information, contact CVS Caremark Customer Service at 888-321-3124Oral Tetracyclines
Xolairomalizumab injection for subcutaneous [SC] use1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Allergic Asthma
Xopenex Neb and Concentrate SolLevalbuterol1/1/2017Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Short-Acting Beta Agonists - Oral Inh
Xtampza EROxycodone1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
Xynthaantihemophilic factor viii1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hemophilia
XynthaAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Xyremsodium oxybate oral solution10/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Narcolepsy (Other)
YervoyIpilimumab1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
ZaltrapZiv-Aflibercept1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Zarxiofilgrastim-sndz injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Neutropenia
ZavescaMiglustat1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Lysosomal Storage Disorders
Zejula8/1/2017Requires Prior ApprovalOncology
Zelborafvemurafenib tablets1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
ZemairaAlpha-1-proteinase Inhibitor1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Alpha-1 Antitrypsin Deficiency
ZenataneIsotretinoin1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Isotretinoins
Zenzedidextroamphetamine tablets1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124ADHD-Narcolepsy Agents
Zianaclindamycin phosphate/tretinoin gel1/1/2017Requires Prior Approval, Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124Retinoids
ZipsorDiclofenac1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124COX-2/NSAIDs
Zofranondansetron1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
ZohydroHydrocodone1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Opioid Analgesics - Extended-Release
ZoladexGoserelin1/1/2018Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Hormonal Therapies
ZolinzaVorinostat1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Zolpidemzolpidem tartrate1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Sedative-Hypnotics
Zometa/Zoledronic Acidzoledronic acid1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Zomigzolmitriptan1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antimigraine
Zonalondoxepin10/1/2017Requires Prior Approval, Requires Step TherapyTopical Skin Product
Zorbtivesomatropin injection1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124GI Disorders
ZorvolexDiclofenac1/1/2017Requires Step Therapy For policy information, contact CVS Caremark Customer Service at 888-321-3124COX-2/NSAIDs
Zuplenzondansetron1/1/2017Requires Prior Approval, Subject to Quantity Limits For policy information, contact CVS Caremark Customer Service at 888-321-3124Antiemetics
ZydeligIdelalisib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
Zykadiaceritinib1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology
ZytigaAbiraterone1/1/2017Requires Prior Approval For policy information, contact CVS Caremark Customer Service at 888-321-3124Oncology