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

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Acanyaclindamycin phosphate/benzoyl peroxide gel1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Accunebalbuterol sulfate nebulization solution 1/1/2017Subject to Quantity LimitsShort-Acting Beta Agonists - Oral Inh
Actharcorticotropin gel8/1/2017Requires Prior ApprovalSeizure Disorders
Actimmuneinterferon gamma-1B solution1/1/2017Requires Prior ApprovalInfectious Disease
Adagenpegademase bovine solution1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Adcetrisbrentuximab vedotin solution reconstituted1/1/2017Requires Prior ApprovalOncology
Adderallamphetamine-dextroamphetamine tablet1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Adempasriociguat tablets1/1/2017Requires Prior ApprovalPulmonary Arterial Hypertension Agents
Advair Diskus and HFAfluticasone propionate and salmeterol xinafoate aerosol  and aerosolpowder1/1/2017Subject to Quantity LimitsLABA/Corticosteroid
AdvateAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Afinitoreverolimus tablets1/1/2017Requires Prior ApprovalOncology
AfstylaAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Akne-Mycinerythromycin ointment1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Akynzeonetupitant and palonosetron capsules1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
Albenzaalbendazole10/1/2017Requires Prior Approval, Subject to Quantity LimitsAnthelmintic
Aldurazymelaronidase solution1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Alferon-Ninterferon alpha-n31/1/2017Requires Prior ApprovalInfectious Disease
Aloxipalonosetrom hci solution1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
AlphanateAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Ampyradalfampridine1/1/2017Requires Prior ApprovalMultiple Sclerosis
Anadrol-50oxmehtolone tablets1/1/2017Requires Prior ApprovalAnabolic Steroids
Anzemetdolasetron1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
Apokynapomorphine hycrochloride solution1/1/2017Requires Prior ApprovalMovement Disorders
Aralastalpha-1 proteinase inhibitor1/1/2017Requires Prior ApprovalAlpha-1 Antitrypsin Deficiency
Aranespdarbepoetin solution1/1/2017Requires Prior ApprovalAnemia
Arcalystrilonacept for subcutaneous [SC] injection1/1/2017Requires Prior ApprovalCryopyrin Associated Periodic Synd (CAPS)
Arcaptaindacaterol capsule1/1/2017Subject to Quantity LimitsLong-Acting Beta Agonists (LABA)
Arzerraofatumumab concentrate1/1/2017Requires Prior ApprovalOncology
Aubagioteriflunomide tablets1/1/2017Requires Prior ApprovalMultiple Sclerosis
Avastinbevacizumab solution1/1/2017Requires Prior ApprovalAge-Related Macular Degen/Oncology
Avastinbevacizumab solution1/1/2017Requires Prior ApprovalRetinal Disorders/Oncology
Aveedtestosterone undecanoate injection1/1/2017Requires Prior ApprovalHormonal Therapies
Axertalmotriptan1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntimigraine
AzacitidineAzacitidine1/1/2017Requires Prior ApprovalOncology
Azelexazelaic acid cream1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Bavencio8/1/2017Oncology
Beleodaqbelinostat solution reconstituted1/1/2017Requires Prior ApprovalOncology
Belviqlorcaserin hydrocholoride tablets1/1/2017Requires Prior ApprovalAntiobesity
Benlystabelimumab solution reconstituted1/1/2017Requires Prior ApprovalSystemic Lupus Erythematosus
BenzphetamineBenzphetamine1/1/2017Requires Prior ApprovalAntiobesity
BerinertC1 esterase inhibitor [human] for IV1/1/2017Requires Prior ApprovalHereditary Angioedema
Betaseroninterferon beta-1b for subcutaneous [SC] injection1/1/2017Requires Prior ApprovalMultiple Sclerosis
Bethkistobramycin (oral inhalation) nebulization solution1/1/2017Requires Prior ApprovalCystic Fibrosis
BevespiGlycopyrrolate; Formoterol1/1/2017Subject to Quantity LimitsLABA/Anticholinergic
Biltricidepraziquantel10/1/2017Requires Prior Approval, Subject to Quantity Limits
Binostoalendronate effervescent tablets1/1/2017Requires Step TherapyBisphosphanates
BlincytoBlinatumomab1/1/2017Requires Prior ApprovalOncology
Bontril PDMphendmetrazine tartrate tablets1/1/2017Requires Prior ApprovalAntiobesity
Bontril SRphendimetrazine tartrate1/1/2017Requires Prior ApprovalAntiobesity
Bosulifbosutinib tablets1/1/2017Requires Prior ApprovalOncology
Botoxonabotulinumtoxin A1/1/2017Requires Prior ApprovalBotulinum Toxins
Breo ElliptaFluticasone; Vilanterol1/1/2017Subject to Quantity LimitsLABA/Corticosteroid
BrovanaArformoterol1/1/2017Subject to Quantity LimitsLong-Acting Beta Agonists (LABA)
Bunavailbuprenorphine/naloxone buccal films1/1/2017Requires Prior ApprovalOpioid Antagonists
Buphenylsodium phenylbutyrate1/1/2017Requires Prior ApprovalUrea Cycle Disorders
BuprenorphineBuprenorphine1/1/2017Requires Prior ApprovalOpioid Antagonists
Buprenorphine/NaloxoneBuprenorphine/Naloxone1/1/2017Requires Prior ApprovalOpioid Antagonists
Butorphanol Nasal SprayButorphanol Nasal Spray1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics
Cambiadiclofenac potassium powder for oral solution1/1/2017Requires Step TherapyCOX-2/NSAIDs
Caprelsa (Vandetanib)vandetanib1/1/2017Requires Prior ApprovalOncology
Carbaglucarglumic acid1/1/2017Requires Prior ApprovalUrea Cycle Disorders
Caystonaztreonam1/1/2017Requires Prior ApprovalCystic Fibrosis
Ceprotinprotein C1/1/2017Requires Prior ApprovalCoagulation Disorders
Cerezymeimiglucerase1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Cesametnabilone1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
Cetrotidecetrorelix1/1/2017Requires Prior ApprovalFertility Products - Specialty
Cholbamcholic acid1/1/2017Requires Prior ApprovalGI Disorders
Cialis 2.5 and 5 mgtadalafil1/1/2017Requires Prior Approval, Requires Step TherapyBPH
Ciclodan Kitciclopirox topical solution 8% moisturize10/1/2017Requires Prior ApprovalTopical Antifungals
CinryzeC1 esterase inhibitor (IV)1/1/2017Requires Prior ApprovalHereditary Angioedema
Claravisisotretinoin1/1/2017Requires Prior ApprovalIsotretinoins
Clindagelclindamycin phosphate gel1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Clomipheneclomiphene citrate1/1/2017Requires Prior ApprovalFertility Products - Non-Specialty
CNL8 Nail Kitciclopirox topical solution 8% nail lacquer remover swabs / emery board10/1/2017Requires Prior ApprovalTopical Antifungals
CometriqCabozantinib1/1/2017Requires Prior ApprovalOncology
Compounded Products-1/1/2017Requires Prior ApprovalCompounded Products
Concertamethylphenidate extended-release tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Contravenaltrexone Hcl/buproprion Hcl ER tablets1/1/2017Requires Prior ApprovalAntiobesity
Copaxoneglatiramer acetate injection1/1/2017Requires Prior ApprovalMultiple Sclerosis
Corifactantihemophilic factor1/1/2017Requires Prior ApprovalHemophilia
Corlanorivabradine tablets1/1/2017Requires Prior ApprovalMisc CV Agents
Crinoneprogesterone, vaginal1/1/2017Requires Prior ApprovalFertility Products - Non-Specialty
Cupriminepenicillamine10/1/2017Requires Prior Approval, Requires Step TherapyChelating Agent
CyramzaRamucirumab1/1/2017Requires Prior ApprovalOncology
Cystagonmepivacaine1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
CystaranCysteamine1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Daraprimpyrimethamine tablets1/1/2017Requires Prior ApprovalAntiparasitic
Darzalexdaratumumab1/1/2017Requires Prior ApprovalOncology
Daytranamethylphenidate transdermal system1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
DecitabineDecitabine1/1/2017Requires Prior ApprovalOncology
Depo-Testosteronetestosterone cypionate injection1/1/2017Requires Prior ApprovalTestosterone Products
Desferal (Deferoxamine)deferoxamine1/1/2017Requires Prior ApprovalIron Overload
Desoxynmethamphetamine tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
DextroamphetamineDextroamphetamine1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Didrexbenzphetamine hydrochloride tablets1/1/2017Requires Prior ApprovalAntiobesity
DiethylpropionDiethylpropion1/1/2017Requires Prior ApprovalAntiobesity
Differinadapalene1/1/2017Requires Prior ApprovalRetinoids
Dificidfidaxomicin1/1/2017Requires Prior ApprovalMacrolide Antibiotics
Doralquazepam1/1/2017Subject to Quantity LimitsSedative-Hypnotics
DronabinolDronabinol1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
DuleraFormoterol; mometasone1/1/2017Subject to Quantity LimitsLABA/Corticosteroid
Dupixent8/1/2017Requires Prior ApprovalEczema
Dyanavel XRamphetamine extended release1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
DysportAbobotulinumtoxinA1/1/2017Requires Prior ApprovalBotulinum Toxins
Egriftatesamorelin injection1/1/2017Requires Prior ApprovalHIV
ElapraseIdursulfase1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
ElelysoTaliglucerase Alfa1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
ElidelCalcineurin Inhibitor10/1/2017Requires Prior ApprovalChelating Agent
EligardLeuprolide1/1/2017Requires Prior ApprovalHormonal Therapies
Emendaprepitant capsules1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
EMLALidocaine; Prilocaine1/1/2017Requires Prior Approval, Subject to Quantity LimitsTopical Anesthetics - Lidocaine Containing
EmplicitiElotuzumab1/1/2017Requires Prior ApprovalOncology
Emvermmebendazole10/1/2017Requires Prior Approval, Subject to Quantity LimitsAnthelmintic
Enbreletanercept injection1/1/2017Requires Prior ApprovalPsoriasis/RA
Endometrinprogesterone, vaginal1/1/2017Requires Prior ApprovalFertility Products - Non-Specialty
Entrestosacubitril-valsartan tablets1/1/2017Requires Prior ApprovalHeart Failure
EntyvioVedolizumab1/1/2017Requires Prior ApprovalIBS
EpclusaSofosbuvir1/1/2017Requires Prior ApprovalHepatitis C
Epiduoadapalene/benzoyl peroxide gel1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
EpogenEpoetin Alfa1/1/2017Requires Prior ApprovalAnemia
Epoprostenol (Flolan, Veletri)epoprostenol1/1/2017Requires Prior ApprovalPulmonary Arterial Hypertension
ErbituxCetuximab1/1/2017Requires Prior ApprovalOncology
Erivedgevismodegib capsules1/1/2017Requires Prior ApprovalOncology
ErwinazeL-asparaginase1/1/2017Requires Prior ApprovalOncology
Esbrietpirfenidone capsules1/1/2017Requires Prior ApprovalIdiopathic Pulmonary Fibrosis
Estazolamestazolam1/1/2017Subject to Quantity LimitsSedative-Hypnotics
Eszopicloneeszopiclone1/1/2017Requires Prior Approval, Subject to Quantity LimitsSedative-Hypnotics
Eucrisa8/1/2017Requires Prior Approval, Requires Step TherapyEczema
Evekeoamphetamine sulfate tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Exalgohydromorphone hcl extended release tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
ExjadeDeferasirox1/1/2017Requires Prior ApprovalIron Overload
EyleaAflibercept1/1/2017Requires Prior ApprovalRetinal Disorders
Fabiortazarotene foam1/1/2017Requires Prior Approval, Requires Step TherapyRetinoids
FabrazymeAgalsidase Beta1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Fanaptiloperidone10/1/2017Requires Prior ApprovalAtypical Antipsychotics
FeibaAntihemophilic Factor VIII1/1/2017Requires Prior ApprovalHemophilia
Fentanyl (Lozenge/Nasal Spray Forms)fentanyl citrate1/1/2017Requires Prior Approval, Subject to Quantity LimitsOral/Intranasal Fentanyl Products
Fentorafentanyl buccal tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsOral/Intranasal Fentanyl Products
Finaceaazelaic acid10/1/2017Requires Prior ApprovalRosacea
Firazyricatibant for subcutaneous [SC] injection1/1/2017Requires Prior ApprovalHereditary Angioedema
FirmagonDegarelix1/1/2017Requires Prior ApprovalHormonal Therapies
FlectorDiclofenac1/1/2017Requires Step TherapyCOX-2/NSAIDs
Flurazepamflurazepam1/1/2017Subject to Quantity LimitsSedative-Hypnotics
Focalindexmethylphenidate immediate release tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Focalin XRdexmethylphenidate extended release tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Follistim AQfollitropin beta1/1/2017Requires Prior ApprovalFertility Products - Specialty
FolotynPralatrexate1/1/2017Requires Prior ApprovalOncology
ForadilFormoterol1/1/2017Subject to Quantity LimitsLong-Acting Beta Agonists (LABA)
Fortamet and Glumetza8/1/2017Requires Prior Approval
Forteoteriparatide injection1/1/2017Requires Prior ApprovalOsteoporosis
Fosamax-DAlendronate1/1/2017Requires Step TherapyBisphosphanates
Frovafrovatriptan1/1/2017Requires Prior Approval, Requires Step Therapy, Subject to Quantity LimitsAntimigraine
FusilevLevoleucovorin1/1/2017Requires Prior ApprovalOncology
GammaguardImmune globulin1/1/2017Requires Prior ApprovalIVIG
Gammakedimmune globulin injection (Human)1/1/2017Requires Prior ApprovalIVIG
Gammunex-CImmune globulin1/1/2017Requires Prior ApprovalIVIG
Ganirelix acetateganirelix acetate1/1/2017Requires Prior ApprovalFertility Products - Specialty
GattexTeduglutide1/1/2017Requires Prior ApprovalGI Disorders
GazyvaObinutuzumab1/1/2017Requires Prior ApprovalOncology
Gel-Onehyaluronate1/1/2017Requires Prior ApprovalOsteoarthritis
Gilenyafingolimod capsules1/1/2017Requires Prior ApprovalMultiple Sclerosis
Gilotrifafatinib1/1/2017Requires Prior ApprovalOncology
GlassiaAlpha-1-proteinase Inhibitor1/1/2017Requires Prior ApprovalAlpha-1 Antitrypsin Deficiency
Glatopaglatiramer acetate injection1/1/2017Requires Prior ApprovalMultiple Sclerosis
Granisetrongranisetron1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
Granix Tbo-Filgrastim1/1/2017Requires Prior ApprovalNeutropenia
Grastektimothy grass pollen allergen extract sublingual [SL] tablets1/1/2017Requires Prior ApprovalSublingual Immunotherapy Products
H.P. Acthar Gel8/1/2017Seizure Disorders
HalavenEribulin1/1/2017Requires Prior ApprovalOncology
HalcionTriazolam1/1/2017Subject to Quantity LimitsSedative-Hypnotics
Harvonisofosbuvir/ledipasvir tablets1/1/2017Requires Prior ApprovalHepatitis C
Hemofil MAntihemophilic Factor VIII1/1/2017Requires Prior ApprovalHemophilia
HerceptinTrastuzumab1/1/2017Requires Prior ApprovalOncology
Hetlioztasimelteon capsules1/1/2017Requires Prior ApprovalSleep Disorders
Hizentraimmune globulin subcutaneous (Human)1/1/2017Requires Prior ApprovalIVIG
Humate-PAntihemophilic Factor VIII10/1/2017Requires Prior ApprovalHemophilia
Humatropesomatropin injection1/1/2017Requires Prior ApprovalGrowth Hormone and Related Disorders
Humiraadalimumab injection1/1/2017Requires Prior ApprovalIBS/RA/Psoriasis
HyalganSodium Hyaluronate1/1/2017Requires Prior ApprovalOsteoarthritis
HycamtinTopotecan1/1/2017Requires Prior ApprovalOncology
Hysinglahydrocodone1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
IbrancePalbociclib1/1/2017Requires Prior ApprovalOncology
Iclusigponatinib tablets1/1/2017Requires Prior ApprovalOncology
Ilariscanakinumab for subcutaneous [SC] injection1/1/2017Requires Prior ApprovalCryopyrin Associated Periodic Synd (CAPS)
Imatinibimatinib1/1/2017Requires Prior ApprovalOncology
ImbruvicaIbrutinib1/1/2017Requires Prior ApprovalOncology
Imitrexsumatriptan tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntimigraine
ImlygicTalimogene Laherparepvec1/1/2017Requires Prior ApprovalOncology
Increlexmecasermin [rDNA origin] injection1/1/2017Requires Prior ApprovalGrowth Hormone and Related Disorders
InlytaAxitinib1/1/2017Requires Prior ApprovalOncology
Inovabenzoyl peroxide/salicylic acid pad1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Intron AInterferon Alfa-2b1/1/2017Requires Prior ApprovalOncology
IressaGefitinib1/1/2017Requires Prior ApprovalOncology
IstodaxRomidepsin1/1/2017Requires Prior ApprovalOncology
IxempraIxabepilone1/1/2017Requires Prior ApprovalOncology
IxinityFactor IX Concentrates1/1/2017Requires Prior ApprovalHemophilia
JakafiRuxolitinib1/1/2017Requires Prior ApprovalOncology
JevtanaCabazitaxel1/1/2017Requires Prior ApprovalOncology
Jubliaefinaconazole topical solution1/1/2017Requires Prior ApprovalTopical Antifungals
Juxtapidlomitapide capsules1/1/2017Requires Prior ApprovalLipid Disorders
KadcylaAdo-Trastuzumab emtansine1/1/2017Requires Prior ApprovalOncology
Kadianmorphine sulfate ER capsules1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
KalbitorEcallantide1/1/2017Requires Prior ApprovalHereditary Angioedema
Kalydecoivacaftor tablets1/1/2017Requires Prior ApprovalCystic Fibrosis
KanumaSebelipase alfa1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Kerydintavaborole topical solution1/1/2017Requires Prior ApprovalTopical Antifungals
KeytrudaPembrolizumab1/1/2017Requires Prior ApprovalOncology
Koate-DVIAntihemophilic factor VIII1/1/2017Requires Prior ApprovalHemophilia
Kogenate FSAntihemophilic factor VIII1/1/2017Requires Prior ApprovalHemophilia
Kogenate FSAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Korlymmifepristone1/1/2017Requires Prior ApprovalCushing's Syndrome
KovaltryAntihemophilic factor VIII1/1/2017Requires Prior ApprovalHemophilia
KovaltryAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
KrystexxaPegloticase1/1/2017Requires Prior ApprovalGout
Kuvansapropterin dihydrochloride1/1/2017Requires Prior ApprovalPhenylketonuria (PKU)
Kynamromipomersen sodium injection1/1/2017Requires Prior ApprovalLipid Disorders
KyprolisCarfilzomib1/1/2017Requires Prior ApprovalOncology
Lazandafentanyl nasal spray1/1/2017Requires Prior Approval, Subject to Quantity LimitsOral/Intranasal Fentanyl Products
LenvimaLenvatinib1/1/2017Requires Prior ApprovalOncology
Letairisambrisentan tablets1/1/2017Requires Prior ApprovalPulmonary Arterial Hypertension
Leukineleukine1/1/2017Requires Prior ApprovalNeutropenia
Levalbuterol levalbuterol1/1/2017Subject to Quantity LimitsShort-Acting Beta Agonists - Oral Inh
Lidocaine 5% OintmentLidocaine1/1/2017Requires Prior Approval, Subject to Quantity LimitsTopical Anesthetics - Lidocaine Containing
Lidocaine Gel - 2% and 4%Lidocaine1/1/2017Requires Prior Approval, Subject to Quantity LimitsTopical Anesthetics - Lidocaine Containing
Lidocaine HCL 4% SolutionLidocaine1/1/2017Requires Prior Approval, Subject to Quantity LimitsTopical Anesthetics - Lidocaine Containing
Lidodermlidocaine patch 5%10/1/2017Requires Prior ApprovalTopical Anesthetics - Lidocaine Containing
LonsurfTrifluridine; Tipiracil1/1/2017Requires Prior ApprovalOncology
Lovazaomega-3-acid ethyl esters capsules1/1/2017Requires Prior ApprovalOmega-3 Fatty Acids
LucentisRanibizumab1/1/2017Requires Prior ApprovalRetinal Disorders
LumizymeAlglucosidase alfa1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
LupanetaLeuprolide; Norethindrone1/1/2017Requires Prior ApprovalHormonal Therapies
Lupron Depot PED (leuprolide acetate)leuprolide acetate1/1/2017Requires Prior ApprovalCentral Precocious Puberty (CPP)
Lupron/Leuprolideleuprolide1/1/2017Requires Prior ApprovalFertility Products - Specialty
LynparzaOlaparib1/1/2017Requires Prior ApprovalOncology
MarinolDronabinol1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
Maxaltrizatriptan1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntimigraine
Mekinisttrametinib tablets1/1/2017Requires Prior ApprovalOncology
MenopurMenotropins1/1/2017Requires Prior ApprovalFertility Products - Specialty
Metadate CDmethylphenidate extended-release capsules1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Methamphetaminemethamphetamine1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Methitestmethyltestosterone tablets1/1/2017Requires Prior ApprovalTestosterone Products
Methylinmethylphenidate tablets, chewables, oral solution1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
MethylphenidateMethylphenidate1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Methylphenidate ERMethylphenidate ER1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
MethyltestosteroneMethyltestosterone1/1/2017Requires 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 LimitsAntimigraine
Mirvasobrimonidine10/1/2017Requires Prior ApprovalRosacea
Monoclate-PAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
MononineFactor IX Concentrates1/1/2017Requires Prior ApprovalHemophilia
Morphine Sulfate ERMorphine Sulfate ER1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
MozobilPlerixafor1/1/2017Requires Prior ApprovalHematopoietics
MS Continmorphine sulfate controlled-release tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
MyaleptMetreleptin1/1/2017Requires Prior ApprovalLipodystrophy
MyoblocRimabotulinumtoxinB1/1/2017Requires Prior ApprovalBotulinum Toxins
MyorisanIsotretinoin1/1/2017Requires Prior ApprovalIsotretinoins
NaglazymeGalsulfase1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
NalfonFenoprofen1/1/2017Requires Step TherapyCOX-2/NSAIDs
Naratriptannaratriptan1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntimigraine
NatparaParathyroid Hormone Lyophilisate1/1/2017Requires Prior ApprovalHormonal Therapies
Neulastapegfilgrastim1/1/2017Requires Prior ApprovalNeutropenia
Nexavarsorafenib1/1/2017Requires Prior ApprovalOncology
Ninlaroixazomib1/1/2017Requires Prior ApprovalOncology
Noritatemetronidazole10/1/2017Requires Prior ApprovalRosacea
Novarelhuman chorionic gonadotropin1/1/2017Requires Prior ApprovalFertility Products - Specialty
NovoEightAntihemophilic factor VIII1/1/2017Requires Prior ApprovalHemophilia
NovoeightAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
NovoSevenAntihemophilic factor VII1/1/2017Requires Prior ApprovalHemophilia
Noxafilposaconazole1/1/2017Antifungal
NplateRomiplostim1/1/2017Requires Prior ApprovalIdiopathic Thrombocytopenic Purpura (ITP)
NucyntaTapentadol1/1/2017Subject to Quantity LimitsPain - Opiod Analgesic
Nuvigilarmodafinil tablets1/1/2017Requires Prior ApprovalNarcolepsy (Other)
NuwiqAntihemophilic factor VIII1/1/2017Requires Prior ApprovalHemophilia
NuwiqAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Ocrevus8/1/2017Requires Prior ApprovalMultiple Sclerosis
Octreotide acetate (Sandostatin)octreotide acetate1/1/2017Requires Prior ApprovalAcromegaly
Ofevnintedanib capsules1/1/2017Requires Prior ApprovalIdiopathic Pulmonary Fibrosis
OncasparPegaspargase1/1/2017Requires Prior ApprovalOncology
OnextonBenzoyl Peroxide; Clindamycin1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Opana ERoxymorphone hcl ER tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
OpdivoNivolumab1/1/2017Requires Prior ApprovalOncology
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 ApprovalSublingual Immunotherapy Products
Orenitramtreprostinil ER tablets1/1/2017Requires Prior ApprovalPulmonary Arterial Hypertension
OrfadinNitisinone1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Orkambilumacaftor/ivacaftor1/1/2017Requires Prior ApprovalCystic Fibrosis
Otrexupmethotrexate1/1/2017Requires Prior ApprovalPsoriasis/RA
Ovidrelhuman chorionic gonadotropin1/1/2017Requires Prior ApprovalFertility Products - Specialty
OxandrinOxandrolone1/1/2017Requires Prior ApprovalAnabolic Steroids
Oxycodone EROxycodone ER1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
Oxycontinoxycodone controlled release tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
Oxymorphone EROxymorphone ER1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid 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 LimitsLong-Acting Beta Agonists (LABA)
PerjetaPertuzumab1/1/2017Requires Prior ApprovalOncology
PexevaParoxetine1/1/2017Requires Step TherapySSRIs
Phendimetrazinephendimetrazine1/1/2017Requires Prior ApprovalAntiobesity
Phenterminephentermine HCl1/1/2017Requires Prior ApprovalAntiobesity
PliaglisLidocaine; Tetracaine1/1/2017Requires Prior Approval, Subject to Quantity LimitsTopical Anesthetics - Lidocaine Containing
PomalystPomalidomide1/1/2017Requires Prior ApprovalOncology
Pregnylhuman chorionic gonadotropin1/1/2017Requires Prior ApprovalFertility Products - Specialty
Prilosec PacketsOmeprazole1/1/2017Requires Step TherapyProton Pump Inhibitors
Proair HFA and Respiclickalbuterol sulfate1/1/2017Subject to Quantity LimitsShort-Acting Beta Agonists - Oral Inh
Procentradextroamphetamine sulfate liquid1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
ProcysbiCysteamine1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Profilnine SDFactor IX Complex1/1/2017Requires Prior ApprovalHemophilia
Progesterone Vag Gelprogesterone, vaginal1/1/2017Requires Prior ApprovalFertility Products - Non-Specialty
Prolastin-CAlpha-1-proteinase Inhibitor1/1/2017Requires Prior ApprovalAlpha-1 Antitrypsin Deficiency
ProleukinAldesleukin1/1/2017Requires Prior ApprovalOncology
Promactaeltrombopag tablets and oral suspension1/1/2017Requires Prior ApprovalIdiopathic Thrombocytopenic Purpura (ITP)
Protonix PacketsPantoprazole1/1/2017Requires Step TherapyProton Pump Inhibitors
Protopictacrolimus10/1/2017Requires Prior ApprovalCalcineurin Inhibitor
Provigilmodafinil tablets1/1/2017Requires Prior ApprovalNarcolepsy (Other)
Prudoxindoxepin10/1/2017Requires Prior Approval, Requires Step TherapyTopical Skin Product
PulmozymeDornase Alfa1/1/2017Requires Prior ApprovalCystic Fibrosis
Quillichew ERMethylphenidate1/1/2017ADHD-Narcolepsy Agents
Quillivant XRmethylphenidate ER oral suspension1/1/2017ADHD-Narcolepsy Agents
Ragwitekshort ragweed pollen allergen extract sublingual [SL] tablets1/1/2017Requires Prior ApprovalSublingual Immunotherapy Products
RasuvoMethotrexate1/1/2017Requires Prior ApprovalPsoriasis/RA
RavictiGlycerol Phenylbutyrate1/1/2017Requires Prior ApprovalUrea Cycle Disorders
Rebifinterferon beta-1a subcutaneous1/1/2017Requires Prior ApprovalMultiple Sclerosis
Reclast (zoledronic acid)zoledronic acid1/1/2017Requires Prior ApprovalOsteoporosis
RecombinateAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Regimexbenzphetamine 25 mg tablets1/1/2017Requires Prior ApprovalAntiobesity
RelenzaZanamivir1/1/2017Requires Prior Approval, Subject to Quantity LimitsInfluenza
Relpaxeletriptan1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntimigraine
Remodulintreprostinil injection1/1/2017Requires Prior ApprovalPulmonary Arterial Hypertension
Repathaevolocumab1/1/2017Requires Prior ApprovalLipid Disorders
RestasisCyclosporine1/1/2017Requires Prior ApprovalOphthalmic Immunomodulators
RestorilTemazepam1/1/2017Subject to Quantity LimitsSedative-Hypnotics
Retin-Atretinoin cream, gel, liquid1/1/2017Requires Prior ApprovalRetinoids
Revlimidlenalidomide1/1/2017Requires Prior ApprovalOncology
Rexultibrexpipraziole10/1/2017Requires Prior ApprovalAtypical Antipsychotics
Rhofadeoxymetazoline hydrochloride10/1/2017Requires Prior ApprovalRosacea
RiaxBenzoyl Peroxide1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Ritalin LAmethylphenidate ER tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
RituxanRituximab1/1/2017Requires Prior ApprovalRA/Oncology
RixubisFactor IX Concentrates1/1/2017Requires Prior ApprovalHemophilia
RosacSulfacetamide; Sulfur1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Rosadanmetronidazole10/1/2017Requires Prior Approval, Requires Step TherapyRosacea
Rosanilsodium sulfacetamide/sulfur cleanser1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Rubracarucaparib10/1/2017Requires Prior ApprovalOncology
Ruconestrecombinant C1 esterase inhibitor for IV use1/1/2017Requires Prior ApprovalHereditary Angioedema
Ruconest8/1/2017Requires Prior Approval
Rydaptmidostaurin10/1/2017Requires Prior ApprovalOncology
SabrilVigabatrin1/1/2017Requires Prior ApprovalSeizure Disorders
SamscaTolvaptan1/1/2017Requires Prior ApprovalElectrolyte disorders
Sancusogranisetron1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
Saphrisvraylar10/1/2017Requires Prior ApprovalAtypical Antipsychotics
Saxendaliraglutide1/1/2017Requires Prior ApprovalAntiobesity
SensiparCinacalcet1/1/2017Requires Prior ApprovalRenal Disorder
Serevent DiskusSalmeterol1/1/2017Subject to Quantity LimitsLong-Acting Beta Agonists (LABA)
Serostimsomatropin injection1/1/2017Requires Prior ApprovalHIV
SigniforPasireotide1/1/2017Requires Prior ApprovalAcromegaly/Cushing's Syndrome
SolarazeDiclofenac1/1/2017Requires Prior ApprovalActinic Keratosis
SolirisEculizumab1/1/2017Requires Prior ApprovalParoxysmal Nocturnal Hemoglobinuria (PNH)
Solodynminocycline ER tablets1/1/2017Requires Prior Approval, Requires Step TherapyOral Tetracyclines
SomarvertPegvisomant1/1/2017Requires Prior ApprovalAcromegaly
Somatuline Lanreotide1/1/2017Requires Prior ApprovalAcromegaly
Sonatazaleplon capsules1/1/2017Requires Prior Approval, Subject to Quantity LimitsSedative-Hypnotics
Soolantraivermectin10/1/2017Requires Prior ApprovalRosacea
Soriataneacitretin10/1/2017Requires Prior ApprovalPsoriasis/RA
SotretIsotretinoin1/1/2017Requires Prior ApprovalIsotretinoins
Sovaldisofosbuvir tablets1/1/2017Requires Prior ApprovalHepatitis C
Spryceldasatinib tablets1/1/2017Requires Prior ApprovalOncology
Stiavigacyclovir buccal tablet10/1/2017Requires Prior Approval, Requires Step Therapy
StimateDesmopressin1/1/2017Requires Prior ApprovalHemophilia
Stivargaregorafenib tablets1/1/2017Requires Prior ApprovalOncology
Stratteraatomoxetine capsules1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
StrensiqAsfotase alfa1/1/2017Requires Prior ApprovalBone Disorders - Other
Strianttestosterone buccal system1/1/2017Requires Prior ApprovalTestosterone Products
StriverdiOlodaterol1/1/2017Subject to Quantity LimitsLong-Acting Beta Agonists (LABA)
Suboxonebuprenorphine/naloxone sublingual films1/1/2017Requires Prior ApprovalOpioid Antagonists
Subsysfentanyl sublingual spray1/1/2017Requires Prior Approval, Subject to Quantity LimitsOral/Intranasal Fentanyl Products
Sumadansulfacetamide/sulfur wash1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
Sumatriptansumatriptan1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntimigraine
Sumavelsumatriptan needle-free injection1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntimigraine
Sumaxinsulfacetamide/sulfur wash1/1/2017Requires Prior Approval, Requires Step TherapyTopical Acne Products
SupartzSodium Hyaluronate1/1/2017Requires Prior ApprovalOsteoarthritis
Supprelin LAHistrelin1/1/2017Requires Prior ApprovalCentral Precocious Puberty (CPP)
Suprenzaphentermine hydrochloride orally disintegrating tablets1/1/2017Requires Prior ApprovalAntiobesity
SutentSunitinib1/1/2017Requires Prior ApprovalOncology
Sylatronpeginterferon alfa-2b1/1/2017Requires Prior ApprovalOncology
SylvantSiltuximab1/1/2017Requires Prior ApprovalOncology
SynagisPalivizumab1/1/2017Requires Prior ApprovalRSV
Synarelnafarelin1/1/2017Requires Prior ApprovalFertility Products - Non-Specialty
SyneraLidocaine; Tetracaine1/1/2017Requires Prior Approval, Subject to Quantity LimitsTopical Anesthetics - Lidocaine Containing
SynriboOmacetaxine1/1/2017Requires Prior ApprovalOncology
Syprinetrientine10/1/2017Requires Prior Approval, Requires Step TherapyChelating Agent
Tafinlardabrafenib capsules1/1/2017Requires Prior ApprovalOncology
Tagrissoosimertinib tablets1/1/2017Requires Prior ApprovalOncology
TamifluOseltamivir1/1/2017Requires Prior Approval, Subject to Quantity LimitsInfluenza
Tarcevaerlotinib tablets1/1/2017Requires Prior ApprovalOncology
TargretinBexarotene1/1/2017Requires Prior ApprovalOncology
Tazoractazarotene cream, gel1/1/2017Requires Prior ApprovalRetinoids
TechfideraDimethyl Fumarate1/1/2017Requires Prior ApprovalMultiple Sclerosis
Temozolomidetemozolomide1/1/2017Requires Prior ApprovalOncology
Testopeltestosterone pellets1/1/2017Requires Prior ApprovalTestosterone Products
Testosterone Buccal Systemtestosterone1/1/2017Requires Prior ApprovalTestosterone Products
Testosterone Cypionate Injtestosterone cypionate injection1/1/2017Requires Prior ApprovalTestosterone Products
Testosterone Enanthate Injtestosterone enanthate injection1/1/2017Requires Prior ApprovalTestosterone Products
Testosterone Nasal Geltestosterone nasal1/1/2017Requires Prior ApprovalTestosterone Products
Testosterone Patchtestosterone1/1/2017Requires Prior ApprovalTestosterone Products
Testosterone Propionate Implant Pelletstestosterone1/1/2017Requires Prior ApprovalTestosterone Products
Testosterone Topical Creamtestosterone1/1/2017Requires Prior ApprovalTestosterone Products
Testosterone Topical Geltestosterone1/1/2017Requires Prior ApprovalTestosterone Products
Testosterone Topical Ointmenttestosterone1/1/2017Requires Prior ApprovalTestosterone Products
Testredmethyltestosterone capsules1/1/2017Requires Prior ApprovalTestosterone Products
Tetrabenazinetetrabenazine1/1/2017Requires Prior ApprovalMovement Disorders
Thalomidthalidomide1/1/2017Requires Prior ApprovalOncology
TikosynDofetilide1/1/2017Requires Prior ApprovalCardiac Disorder
ToriselTemsirolimus1/1/2017Requires Prior ApprovalOncology
Tracleerbosetan tablets1/1/2017Requires Prior ApprovalPulmonary Arterial Hypertension
TreandaBendamustine1/1/2017Requires Prior ApprovalOncology
TrelstarTriptorelin1/1/2017Requires Prior ApprovalHormonal Therapies
Tretinointretinoin1/1/2017Requires Prior ApprovalRetinoids
Tretin-XTretinoin1/1/2017Requires Prior Approval, Requires Step TherapyRetinoids
Treximetsumatriptan/naproxen1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntimigraine
TriglideFenofibrate1/1/2017Requires Step TherapyFibrates
Trulanceplecanatide10/1/2017Requires Prior ApprovalGI Disorders
Tykerblapatinib ditosylate tablets1/1/2017Requires Prior ApprovalOncology
Tymlosabaloparatide10/1/2017Requires Prior ApprovalOsteoporosis
TysabriNatalizumab1/1/2017Requires Prior ApprovalIBS/RA/Psoriasis
Tyvasotreprostinil inhalation solution1/1/2017Requires Prior ApprovalPulmonary Arterial Hypertension
Uptraviselexipag tablets1/1/2017Requires Prior ApprovalPulmonary Arterial Hypertension
ValchlorMechlorethamine1/1/2017Requires Prior ApprovalOncology
VantasHistrelin1/1/2017Requires Prior ApprovalHormonal Therapies
VarubiRolapitant1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
Vascepaicosapent ethyl capsules1/1/2017Requires Prior ApprovalOmega-3 Fatty Acids
VectibixPanitumumab1/1/2017Requires Prior ApprovalOncology
VelcadeBortezomib1/1/2017Requires Prior ApprovalOncology
Veltinclindamycin phosphate/tretinoin gel1/1/2017Requires Prior Approval, Requires Step TherapyRetinoids
Ventavisiloprost inhalation solution1/1/2017Requires Prior ApprovalPulmonary Arterial Hypertension
Vfendvoriconazole1/1/2017Requires Prior ApprovalAntifungal
VimizimElosulfase alfa1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Vimovonaproxen/esomeprazole magnesium1/1/2017Requires Step TherapyCOX-2/NSAIDs
VivitrolNaltrexone1/1/2017Requires Prior ApprovalAlcohol/Opioid Dependency
Voltaren Geldiclofenac sodium topical gel 1%10/1/2017Requires Prior ApprovalTopical Anesthetics - Lidocaine Containing
VotrientPazopanib1/1/2017Requires Prior ApprovalOncology
VPRIVVelaglucerase Alfa1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Vraylarcariprazine10/1/2017Requires Prior ApprovalAtypical Antipsychotics
Vyvanselisdexamfetamine dimesylate capsules1/1/2017ADHD-Narcolepsy Agents
Wilateantihemophilic factor viii1/1/2017Requires Prior ApprovalHemophilia
Xalkoricrizotinib capsules1/1/2017Requires Prior ApprovalOncology
Xartemis XRAcetaminophen; Oxycodone1/1/2017Subject to Quantity LimitsPain - Opiod Analgesic
XelodaCapecitabine1/1/2017Requires Prior ApprovalOncology
Xenicalorlistat1/1/2017Requires Prior ApprovalAntiobesity
XeominIncobotulinumtoxinA1/1/2017Requires Prior ApprovalBotulinum Toxins
XgevaDenosumab1/1/2017Requires Prior ApprovalOncology
Ximinominocycline1/1/2017Oral Tetracyclines
Xolairomalizumab injection for subcutaneous [SC] use1/1/2017Requires Prior ApprovalAllergic Asthma
Xopenex Neb and Concentrate SolLevalbuterol1/1/2017Subject to Quantity LimitsShort-Acting Beta Agonists - Oral Inh
Xtampza EROxycodone1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
Xynthaantihemophilic factor viii1/1/2017Requires Prior ApprovalHemophilia
XynthaAntihemophilic factor VIII10/1/2017Requires Prior ApprovalHemophilia
Xyremsodium oxybate oral solution10/1/2017Requires Prior Approval, Subject to Quantity LimitsNarcolepsy (Other)
YervoyIpilimumab1/1/2017Requires Prior ApprovalOncology
ZaltrapZiv-Aflibercept1/1/2017Requires Prior ApprovalOncology
Zarxiofilgrastim-sndz injection1/1/2017Requires Prior ApprovalNeutropenia
ZavescaMiglustat1/1/2017Requires Prior ApprovalLysosomal Storage Disorders
Zejula8/1/2017Requires Prior ApprovalOncology
Zelborafvemurafenib tablets1/1/2017Requires Prior ApprovalOncology
ZemairaAlpha-1-proteinase Inhibitor1/1/2017Requires Prior ApprovalAlpha-1 Antitrypsin Deficiency
ZenataneIsotretinoin1/1/2017Requires Prior Approval, Subject to Quantity LimitsIsotretinoins
Zenzedidextroamphetamine tablets1/1/2017Requires Prior Approval, Subject to Quantity LimitsADHD-Narcolepsy Agents
Zianaclindamycin phosphate/tretinoin gel1/1/2017Requires Prior Approval, Requires Step TherapyRetinoids
ZipsorDiclofenac1/1/2017Requires Step TherapyCOX-2/NSAIDs
Zofranondansetron1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
ZohydroHydrocodone1/1/2017Requires Prior Approval, Subject to Quantity LimitsOpioid Analgesics - Extended-Release
ZoladexGoserelin1/1/2017Requires Prior ApprovalHormonal Therapies
ZolinzaVorinostat1/1/2017Requires Prior ApprovalOncology
Zolpidemzolpidem tartrate1/1/2017Requires Prior Approval, Subject to Quantity LimitsSedative-Hypnotics
Zometa/Zoledronic Acidzoledronic acid1/1/2017Requires Prior ApprovalOncology
Zomigzolmitriptan1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntimigraine
Zonalondoxepin10/1/2017Requires Prior Approval, Requires Step TherapyTopical Skin Product
Zorbtivesomatropin injection1/1/2017Requires Prior ApprovalGI Disorders
ZorvolexDiclofenac1/1/2017Requires Step TherapyCOX-2/NSAIDs
Zuplenzondansetron1/1/2017Requires Prior Approval, Subject to Quantity LimitsAntiemetics
ZydeligIdelalisib1/1/2017Requires Prior ApprovalOncology
Zykadiaceritinib1/1/2017Requires Prior ApprovalOncology
ZytigaAbiraterone1/1/2017Requires Prior ApprovalOncology