PREMIER Formulary Drug List
EFFECTIVE: JANUARY 1, 2026
About this drug list
This is a list of the medications included in your prescription plan. It is not, however, a complete list of products that are on the formulary, nor does it guarantee coverage. Please ask your prescriber to consider preferred medications from this list when medically appropriate.
How to read this drug list
Use the chart below to help you read this drug list. This chart is just an example. It may not show how these medications are actually covered on the 2025 Access Premier Formulary List. Medications are listed by the condition they treat, then listed alphabetically.
The formulary is the list of drugs included in your prescription plan. Ask your prescriber to consider PREFERRED medications from this list when medically appropriate. Inclusion on the list does not guarantee coverage. The following list is not a complete list of products that are on the formulary.
Newly FDA approved medications are subject to evaluation by the Plan for coverage status and formulary placement prior to inclusion in the Prescription Drug Benefit including the Specialty Drug Benefit.
Abbreviations next to medications
In this drug list, formulary status (i.e., generic, preferred, or non-preferred) and extra coverage requirements (i.e., prior authorization) are indicated to the right of the medication. Here’s what they mean:
(G)
(NP)
(EX)
Generic Medication
Generic medications are denoted by (G). The most affordable medications.
Non-Preferred Medication
Non-preferred medications are denoted by (NP). The more expensive medications.
Excluded Medication
Excluded medications are denoted by (EX). The medications your plan does not cover.
(SP)
(PA)
Specialty Medication
Some medications are considered specialty medications. These medications are denoted by (SP) and are available through our specialty pharmacy network.
Prior Authorization
Certain medications require VerusRx’s approval before they are covered by your plan. These medications are denoted by (PA). Unless your doctor requests and receives approval from VerusRx, your plan will not cover these medications.
Abbreviations next to medications
Medications are organized into groups in the table below. First, identify the appropriate group for your medication, then navigate to that section to view the covered medications. If you cannot find your medication within a group, please use the search feature or contact our customer service team for assistance.
This list contains injectable medical drugs covered under medical policies. For specific questions about your coverage, please call the phone number printed on your member ID card.
For the Health Care Provider: Please prescribe PREFERRED products and allow generic substitutions when medically appropriate.
| DRUG CLASS | DRUG NAME | FORMULARY STATUS | SPECIALTY (SP) | PRIOR AUTHORIZATION (PA) |
|---|---|---|---|---|
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | ADDERALL | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | ADDERALL XR | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | AMPHETAMINE/DEXTROAMPHETA | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | AMPHETAMINE SULFATE | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | APTENSIO XR | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | ARMODAFINIL | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | ATOMOXETINE | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | ATOMOXETINE HYDROCHLORIDE | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | AZSTARYS | PREFERRED | PA | |
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | CAFFEINE CITRATE | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | CAFFEINE CITRATE | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | CAFFEINE CITRATE | NON PREFERRED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | CAFFEINE ANHYDROUS | NON PREFERRED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | CAFFEINE CITRATED | NON PREFERRED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | CAFFEINE/SODIUM BENZOATE | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | CLONIDINE HCL ER | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | CLONIDINE HYDROCHLORIDE E | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | CONCERTA | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | DAYTRANA | EXCLUDED | PA | |
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | DEXMETHYLPHENIDATE HYDROC | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | DEXMETHYLPHENIDATE HCL ER | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | DEXMETHYLPHENIDATE HCL | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | DEXTROAMPHETAMINE SULFATE | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | DOPRAM | NON PREFERRED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | DYANAVEL XR | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | EVEKEO | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | FOCALIN | NON PREFERRED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | FOCALIN XR | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | GUANFACINE HYDROCHLORIDE | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | INTUNIV | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | JORNAY PM | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | LISDEXAMFETAMINE DIMESYLA | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | METADATE CD | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | METHAMPHETAMINE HYDROCHLO | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | METHYLIN | NON PREFERRED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | METHYLPHENIDATE HYDROCHLO | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | METHYLPHENIDATE | GENERIC | PA | |
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | MODAFINIL | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | NUVIGIL | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | Onyda XR | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | PROCENTRA | GENERIC | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | PROVIGIL | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | QELBREE | PREFERRED | PA | |
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | QUILLICHEW ER | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | QUILLIVANT XR | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | RELEXXII | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | RITALIN LA | NON PREFERRED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | RITALIN | NON PREFERRED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | VYVANSE | EXCLUDED | ||
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | WAKIX | PREFERRED | SP | PA |
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | XELSTRYM | EXCLUDED | PA | |
| ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS | ZENZEDI | GENERIC | ||
| AMEBICIDES | IODOQUINOL | NON PREFERRED | ||
| AMINOGLYCOSIDES | AMIKACIN SULFATE | GENERIC | ||
| AMINOGLYCOSIDES | AMIKACIN SULFATE | NON PREFERRED | ||
| AMINOGLYCOSIDES | ARIKAYCE | NON PREFERRED | SP | PA |
| AMINOGLYCOSIDES | BETHKIS | EXCLUDED | SP | PA |
| AMINOGLYCOSIDES | GENTAMICIN SULFATE/0.9% S | GENERIC | ||
| AMINOGLYCOSIDES | ISOTONIC GENTAMICIN | GENERIC | ||
| AMINOGLYCOSIDES | GENTAMICIN SULFATE PEDIAT | GENERIC | ||
| AMINOGLYCOSIDES | GENTAMICIN SULFATE | GENERIC | ||
| AMINOGLYCOSIDES | HUMATIN | EXCLUDED | ||
| AMINOGLYCOSIDES | KITABIS PAK | EXCLUDED | SP | PA |
| AMINOGLYCOSIDES | NEOMYCIN SULFATE | EXCLUDED | ||
| AMINOGLYCOSIDES | NEOMYCIN SULFATE | GENERIC | ||
| AMINOGLYCOSIDES | STREPTOMYCIN SULFATE | GENERIC | ||
| AMINOGLYCOSIDES | STREPTOMYCIN SULFATE | NON PREFERRED | ||
| AMINOGLYCOSIDES | TOBI | EXCLUDED | SP | PA |
| AMINOGLYCOSIDES | TOBI PODHALER | EXCLUDED | SP | PA |
| AMINOGLYCOSIDES | TOBRAMYCIN SULFATE | GENERIC | ||
| AMINOGLYCOSIDES | TOBRAMYCIN | GENERIC | SP | PA |
| AMINOGLYCOSIDES | TOBRAMYCIN SULFATE | NON PREFERRED | ||
| AMINOGLYCOSIDES | ZEMDRI | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | ABRILADA | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ACTEMRA | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ACTEMRA IV | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ADALIMUMAB-AACF | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ADALIMUMAB-AATY | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ADALIMUMAB-ADAZ | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ADALIMUMAB-ADBM | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ADALIMUMAB-FKJP | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ADALIMUMAB-RYVK | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | AMJEVITA | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ANAPROX DS | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | ARAVA | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | ARCALYST | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ARTHROTEC 50 | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | ARTHROTEC 75 | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | Avtozma | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | CALDOLOR | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | CELEBREX | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | CELECOXIB | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | CELECOXIB | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | COMBOGESIC | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | COXANTO | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | CYLTEZO | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | DICLOFENAC SODIUM/MISOPRO | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | DICLOFENAC POTASSIUM | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | DICLOFENAC POTASSIUM | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | DICLOFENAC SODIUM ER | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | DICLOFENAC SODIUM DR | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | EC-NAPROSYN | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | ENBREL | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ETODOLAC | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | ETODOLAC ER | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | ETODOLAC | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | FENOPROFEN CALCIUM | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | FENOPROFEN CALCIUM | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | FENOPRON | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | FLURBIPROFEN | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | FLURBIPROFEN | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | FLURBIPROFEN | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | HADLIMA | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | HULIO | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | Humira (1 Pen) | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | Humira (2 Pen) | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | HUMIRA | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | HYRIMOZ | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | HYRIMOZ | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | IBU | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | IBUPROFEN LYSINE | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | IBUPROFEN | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | IBUPROFEN | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | ILARIS | NON PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | INDOCIN | EXCLUDED | PA | |
| ANALGESICS - ANTI-INFLAMMATORY | INDOCIN | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | INDOMETHACIN | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | INDOMETHACIN ER | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | INDOMETHACIN | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | INDOMETHACIN | EXCLUDED | PA | |
| ANALGESICS - ANTI-INFLAMMATORY | INDOMETHACIN | GENERIC | PA | |
| ANALGESICS - ANTI-INFLAMMATORY | KETOROLAC TROMETHAMINE/BU | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | KETOROCAINE-L | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | KETOROLAC TROMETHAMINE | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | KETOROLAC TROMETHAMINE | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | KETAMINE HYDROCHLORIDE/RO | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | KEVZARA | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | KINERET | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | LEFLUNOMIDE | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | LODINE | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | LURBIRO | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | MECLOFENAMATE SODIUM | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | MEFENAMIC ACID | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | MELOXICAM | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | MELOXICAM | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | NABUMETONE | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | NABUMETONE | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | NAPROSYN | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | NAPROXEN DR | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | NAPROXEN | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | NAPROXEN | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | NAPROXEN SODIUM | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | NAPROXEN SODIUM | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | NAPROXEN | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | NEOPROFEN | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | OLUMIANT | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ORENCIA | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | ORENCIA | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | OTEZLA | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | OXAPROZIN | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | PHENYLBUTAZONE | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | PIROXICAM | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | PIROXICAM | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | RIDAURA | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | RINVOQ | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | Simlandi (1 Syringe) | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | SIMLANDI | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | SIMPONI ARIA | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | SIMPONI | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | SULINDAC | NON PREFERRED | ||
| ANALGESICS - ANTI-INFLAMMATORY | SULINDAC | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | TOFIDENCE | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | TOLECTIN 600 | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | TOLMETIN SODIUM | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | TOLMETIN SODIUM | GENERIC | ||
| ANALGESICS - ANTI-INFLAMMATORY | TRESNI | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | TYENNE | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | XELJANZ | PREFERRED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | XIFYRM | EXCLUDED | ||
| ANALGESICS - ANTI-INFLAMMATORY | YUFLYMA | EXCLUDED | SP | PA |
| ANALGESICS - ANTI-INFLAMMATORY | YUSIMRY | EXCLUDED | SP | PA |
| ANALGESICS - NON-NARCOTIC | ACETAMINOPHEN | GENERIC | ||
| ANALGESICS - NON-NARCOTIC | ACETAMINOPHEN | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | ACETYL SALICYLIC ACID | NON PREFERRED | ||
| ANALGESICS - NON-NARCOTIC | ALLZITAL | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | ASPIRIN | NON PREFERRED | ||
| ANALGESICS - NON-NARCOTIC | BAC | GENERIC | ||
| ANALGESICS - NON-NARCOTIC | BUTALBITAL/ACETAMINOPHEN/ | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | BUTALBITAL/ACETAMINOPHEN/ | GENERIC | ||
| ANALGESICS - NON-NARCOTIC | BUTALBITAL/ASPIRIN/CAFFEI | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | BUTALBITAL/ASPIRIN/CAFFEI | GENERIC | ||
| ANALGESICS - NON-NARCOTIC | BUTALBITAL/ACETAMINOPHEN | GENERIC | ||
| ANALGESICS - NON-NARCOTIC | CLONIDINE HYDROCHLORIDE | NON PREFERRED | ||
| ANALGESICS - NON-NARCOTIC | CLONIDINE HCL | GENERIC | ||
| ANALGESICS - NON-NARCOTIC | CLONIDINE HYDROCHLORIDE | GENERIC | ||
| ANALGESICS - NON-NARCOTIC | DIFLUNISAL | NON PREFERRED | ||
| ANALGESICS - NON-NARCOTIC | DIFLUNISAL | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | DIFLUNISAL | GENERIC | ||
| ANALGESICS - NON-NARCOTIC | DOLOBID | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | DURACLON | NON PREFERRED | ||
| ANALGESICS - NON-NARCOTIC | FIORICET | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | JOURNAVX | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | LOTREXONE | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | NALTREX | EXCLUDED | ||
| ANALGESICS - NON-NARCOTIC | PRIALT | NON PREFERRED | SP | PA |
| ANALGESICS - NON-NARCOTIC | SALSALATE | GENERIC | ||
| ANALGESICS - NON-NARCOTIC | SODIUM SALICYLATE | NON PREFERRED | ||
| ANALGESICS - NON-NARCOTIC | TENCON | GENERIC | ||
| ANALGESICS - OPIOID | APADAZ | EXCLUDED | ||
| ANALGESICS - OPIOID | ACETAMINOPHEN/CODEINE | GENERIC | ||
| ANALGESICS - OPIOID | ACETAMINOPHEN/CODEINE PHO | GENERIC | ||
| ANALGESICS - OPIOID | ACETAMINOPHEN/CAFFEINE/DI | GENERIC | ||
| ANALGESICS - OPIOID | ASCOMP/CODEINE | GENERIC | ||
| ANALGESICS - OPIOID | BELBUCA | PREFERRED | PA | |
| ANALGESICS - OPIOID | BENZHYDROCODONE/ACETAMINO | EXCLUDED | ||
| ANALGESICS - OPIOID | Brixadi (Weekly) | NON PREFERRED | SP | PA |
| ANALGESICS - OPIOID | BRIXADI | NON PREFERRED | SP | PA |
| ANALGESICS - OPIOID | BUPRENORPHINE HYDROCHLORI | GENERIC | ||
| ANALGESICS - OPIOID | BUPRENORPHINE HCL/NALOXON | GENERIC | ||
| ANALGESICS - OPIOID | BUPRENORPHINE | GENERIC | PA | |
| ANALGESICS - OPIOID | BUPRENORPHINE HCL | GENERIC | ||
| ANALGESICS - OPIOID | BUTALBITAL/ACETAMINOPHEN/ | GENERIC | ||
| ANALGESICS - OPIOID | BUTALBITAL/ASPIRIN/CAFFEI | GENERIC | ||
| ANALGESICS - OPIOID | BUTORPHANOL TARTRATE | GENERIC | ||
| ANALGESICS - OPIOID | BUTRANS | EXCLUDED | PA | |
| ANALGESICS - OPIOID | CODEINE SULFATE | NON PREFERRED | ||
| ANALGESICS - OPIOID | CODEINE SULFATE | GENERIC | ||
| ANALGESICS - OPIOID | DEMEROL | NON PREFERRED | ||
| ANALGESICS - OPIOID | DILAUDID | EXCLUDED | ||
| ANALGESICS - OPIOID | DILAUDID | NON PREFERRED | ||
| ANALGESICS - OPIOID | DURAMORPH | EXCLUDED | ||
| ANALGESICS - OPIOID | ENDOCET | GENERIC | ||
| ANALGESICS - OPIOID | FENTANYL CITRATE/BUPIVACA | EXCLUDED | ||
| ANALGESICS - OPIOID | FENTANYL/BUPIVACAINE HYDR | EXCLUDED | ||
| ANALGESICS - OPIOID | FENTANYL CITRATE/ROPIVACA | EXCLUDED | ||
| ANALGESICS - OPIOID | FENTANYL/ROPIVACAINE HYDR | EXCLUDED | ||
| ANALGESICS - OPIOID | FENTANYL CITRATE | EXCLUDED | PA | |
| ANALGESICS - OPIOID | FENTANYL CITRATE | GENERIC | PA | |
| ANALGESICS - OPIOID | FENTANYL CITRATE/SODIUM C | EXCLUDED | PA | |
| ANALGESICS - OPIOID | FENTANYL | GENERIC | PA | |
| ANALGESICS - OPIOID | FENTANYL/BUPIVACAINE/NACL | EXCLUDED | ||
| ANALGESICS - OPIOID | HYDROCODONE BITARTRATE/AC | GENERIC | ||
| ANALGESICS - OPIOID | HYDROMORPHONE HYDROCHLORI | EXCLUDED | ||
| ANALGESICS - OPIOID | HYDROCODONE/ACETAMINOPHEN | GENERIC | ||
| ANALGESICS - OPIOID | HYDROCODONE/IBUPROFEN | GENERIC | ||
| ANALGESICS - OPIOID | HYDROMORPHONE HCL/SODIUM | EXCLUDED | ||
| ANALGESICS - OPIOID | HYDROMORPHONE HYDROCHLORI | GENERIC | ||
| ANALGESICS - OPIOID | HYDROMORPHONE HCL | GENERIC | ||
| ANALGESICS - OPIOID | HYDROMORPHONE HYDROCHLORI | NON PREFERRED | ||
| ANALGESICS - OPIOID | HYDROMORPHONE HCL | EXCLUDED | ||
| ANALGESICS - OPIOID | HYDROMORPHONE HCL | NON PREFERRED | ||
| ANALGESICS - OPIOID | HYDROMORPHONE HCL ER | GENERIC | ||
| ANALGESICS - OPIOID | INFUMORPH 200 | NON PREFERRED | ||
| ANALGESICS - OPIOID | INFUMORPH 500 | NON PREFERRED | ||
| ANALGESICS - OPIOID | MEPERIDINE HCL | GENERIC | ||
| ANALGESICS - OPIOID | MEPERIDINE HYDROCHLORIDE | GENERIC | ||
| ANALGESICS - OPIOID | METHADONE HYDROCHLORIDE/S | NON PREFERRED | ||
| ANALGESICS - OPIOID | METHADONE HYDROCHLORIDE | GENERIC | PA | |
| ANALGESICS - OPIOID | METHADONE HCL | NON PREFERRED | PA | |
| ANALGESICS - OPIOID | METHADONE HYDROCHLORIDE | NON PREFERRED | PA | |
| ANALGESICS - OPIOID | METHADONE HYDROCHLORIDE I | GENERIC | PA | |
| ANALGESICS - OPIOID | METHADONE HCL | GENERIC | PA | |
| ANALGESICS - OPIOID | METHADOSE | NON PREFERRED | PA | |
| ANALGESICS - OPIOID | METHADOSE SUGAR-FREE | NON PREFERRED | PA | |
| ANALGESICS - OPIOID | METHADOSE | GENERIC | PA | |
| ANALGESICS - OPIOID | MITIGO | GENERIC | ||
| ANALGESICS - OPIOID | MORPHINE SULFATE | EXCLUDED | ||
| ANALGESICS - OPIOID | MORPHINE SULFATE/SODIUM C | EXCLUDED | ||
| ANALGESICS - OPIOID | MORPHINE SULFATE ER | GENERIC | ||
| ANALGESICS - OPIOID | MORPHINE SULFATE | GENERIC | ||
| ANALGESICS - OPIOID | MORPHINE SULFATE | NON PREFERRED | ||
| ANALGESICS - OPIOID | MS CONTIN | NON PREFERRED | ||
| ANALGESICS - OPIOID | NALBUPHINE HYDROCHLORIDE | GENERIC | ||
| ANALGESICS - OPIOID | NUCYNTA | EXCLUDED | ||
| ANALGESICS - OPIOID | OLINVYK | EXCLUDED | ||
| ANALGESICS - OPIOID | OXYCODONE HYDROCHLORIDE/A | EXCLUDED | ||
| ANALGESICS - OPIOID | OXYCODONE/ACETAMINOPHEN | GENERIC | ||
| ANALGESICS - OPIOID | OXYCODONE HCL | GENERIC | ||
| ANALGESICS - OPIOID | OXYCODONE HYDROCHLORIDE | GENERIC | ||
| ANALGESICS - OPIOID | OXYCONTIN | EXCLUDED | PA | |
| ANALGESICS - OPIOID | OXYMORPHONE HYDROCHLORIDE | EXCLUDED | ||
| ANALGESICS - OPIOID | OXYMORPHONE HYDROCHLORIDE | GENERIC | ||
| ANALGESICS - OPIOID | PENTAZOCINE/NALOXONE HCL | GENERIC | ||
| ANALGESICS - OPIOID | PERCOCET | EXCLUDED | ||
| ANALGESICS - OPIOID | REMIFENTANIL HYDROCHLORID | GENERIC | ||
| ANALGESICS - OPIOID | ROXICODONE | NON PREFERRED | ||
| ANALGESICS - OPIOID | SUBLOCADE | NON PREFERRED | SP | PA |
| ANALGESICS - OPIOID | SUBOXONE | EXCLUDED | ||
| ANALGESICS - OPIOID | TRAMADOL HYDROCHLORIDE/AC | GENERIC | ||
| ANALGESICS - OPIOID | TRAMADOL HYDROCHLORIDE | EXCLUDED | ||
| ANALGESICS - OPIOID | TRAMADOL HYDROCHLORIDE | GENERIC | ||
| ANALGESICS - OPIOID | TREZIX | GENERIC | ||
| ANALGESICS - OPIOID | ULTIVA | NON PREFERRED | ||
| ANALGESICS - OPIOID | ZUBSOLV | PREFERRED | ||
| ANDROGENS-ANABOLIC | AZMIRO | EXCLUDED | PA | |
| ANDROGENS-ANABOLIC | DANAZOL | EXCLUDED | PA | |
| ANDROGENS-ANABOLIC | DANAZOL | GENERIC | PA | |
| ANDROGENS-ANABOLIC | DEPO-TESTOSTERONE | GENERIC | PA | |
| ANDROGENS-ANABOLIC | KYZATREX | EXCLUDED | PA | |
| ANDROGENS-ANABOLIC | METHITEST | GENERIC | PA | |
| ANDROGENS-ANABOLIC | METHYLTESTOSTERONE | GENERIC | PA | |
| ANDROGENS-ANABOLIC | METHYLTESTOSTERONE | NON PREFERRED | PA | |
| ANDROGENS-ANABOLIC | TESTONE CIK | EXCLUDED | PA | |
| ANDROGENS-ANABOLIC | TESTOSTERONE CYPIONATE | EXCLUDED | PA | |
| ANDROGENS-ANABOLIC | TESTOSTERONE CYPIONATE | GENERIC | PA | |
| ANDROGENS-ANABOLIC | TESTOSTERONE ENANTHATE | GENERIC | PA | |
| ANDROGENS-ANABOLIC | UNDECATREX | EXCLUDED | PA | |
| ANORECTAL AND RELATED PRODUCTS | ANALPRAM HC | NON PREFERRED | ||
| ANORECTAL AND RELATED PRODUCTS | ANUCORT-HC | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | ANUSOL-HC | NON PREFERRED | ||
| ANORECTAL AND RELATED PRODUCTS | ANUSOL-HC | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | BARRIGEL | EXCLUDED | ||
| ANORECTAL AND RELATED PRODUCTS | BUDESONIDE | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | CORTENEMA | NON PREFERRED | ||
| ANORECTAL AND RELATED PRODUCTS | HYDROCORTISONE ACETATE/PR | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | HEMMOREX-HC | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | HYDROCORTISONE ACETATE | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | HYDROCORTISONE | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | LIDOCAINE HCL/HYDROCORTIS | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | LIDOCAINE HYDROCHLORIDE/H | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | LIDOCAINE HCL-HYDROCORTIS | NON PREFERRED | ||
| ANORECTAL AND RELATED PRODUCTS | LIDOCAINE HYDROCHLORIDE/H | EXCLUDED | ||
| ANORECTAL AND RELATED PRODUCTS | LIDOCORT | EXCLUDED | ||
| ANORECTAL AND RELATED PRODUCTS | NITROGLYCERIN | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | PROCORT | NON PREFERRED | ||
| ANORECTAL AND RELATED PRODUCTS | PROCTOCORT | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | PROCTOCORT | NON PREFERRED | ||
| ANORECTAL AND RELATED PRODUCTS | PROCTOFOAM HC | PREFERRED | ||
| ANORECTAL AND RELATED PRODUCTS | PROCTO-MED HC | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | PROCTOSOL HC | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | PROCTOZONE-HC | GENERIC | ||
| ANORECTAL AND RELATED PRODUCTS | RECTIV | NON PREFERRED | ||
| ANORECTAL AND RELATED PRODUCTS | UCERIS | NON PREFERRED | ||
| ANTACIDS | MAGNESIUM OXIDE HEAVY | NON PREFERRED | ||
| ANTACIDS | MAGNESIUM OXIDE LIGHT | NON PREFERRED | ||
| ANTACIDS | MAGNESIUM TRISILICATE | NON PREFERRED | ||
| ANTACIDS | MAGNESIUM TRISILICATE HYD | NON PREFERRED | ||
| ANTHELMINTICS | ALBENDAZOLE | GENERIC | ||
| ANTHELMINTICS | BENZNIDAZOLE | NON PREFERRED | ||
| ANTHELMINTICS | BILTRICIDE | NON PREFERRED | ||
| ANTHELMINTICS | Egaten | EXCLUDED | ||
| ANTHELMINTICS | IVERMECTIN | GENERIC | PA | |
| ANTHELMINTICS | IVERMECTIN | GENERIC | ||
| ANTHELMINTICS | PIPERAZINE CITRATE | NON PREFERRED | ||
| ANTHELMINTICS | PRAZIQUANTEL | GENERIC | ||
| ANTHELMINTICS | STROMECTOL | NON PREFERRED | PA | |
| ANTHELMINTICS | THIABENDAZOLE | NON PREFERRED | ||
| ANTIANGINAL AGENTS | ISORDIL TITRADOSE | NON PREFERRED | ||
| ANTIANGINAL AGENTS | ISOSORBIDE DINITRATE | GENERIC | ||
| ANTIANGINAL AGENTS | ISOSORBIDE MONONITRATE | NON PREFERRED | ||
| ANTIANGINAL AGENTS | ISOSORBIDE MONONITRATE ER | GENERIC | ||
| ANTIANGINAL AGENTS | NITRO-BID | NON PREFERRED | ||
| ANTIANGINAL AGENTS | NITRO-DUR | NON PREFERRED | ||
| ANTIANGINAL AGENTS | NITROGLYCERIN TRANSDERMAL | GENERIC | ||
| ANTIANGINAL AGENTS | NITROGLYCERIN IN DEXTROSE | GENERIC | ||
| ANTIANGINAL AGENTS | NITROGLYCERIN | GENERIC | ||
| ANTIANGINAL AGENTS | NITROSTAT | NON PREFERRED | ||
| ANTIANGINAL AGENTS | NITRO-TIME | GENERIC | ||
| ANTIANGINAL AGENTS | RANOLAZINE ER | GENERIC | ||
| ANTIANXIETY AGENTS | ALPRAZOLAM INTENSOL | NON PREFERRED | ||
| ANTIANXIETY AGENTS | ALPRAZOLAM ODT | GENERIC | ||
| ANTIANXIETY AGENTS | ALPRAZOLAM | GENERIC | ||
| ANTIANXIETY AGENTS | ALPRAZOLAM ER | GENERIC | ||
| ANTIANXIETY AGENTS | ALPRAZOLAM XR | GENERIC | ||
| ANTIANXIETY AGENTS | ATIVAN | EXCLUDED | ||
| ANTIANXIETY AGENTS | BUCAPSOL | EXCLUDED | ||
| ANTIANXIETY AGENTS | BUSPIRONE HYDROCHLORIDE | GENERIC | ||
| ANTIANXIETY AGENTS | BUSPIRONE HCL | GENERIC | ||
| ANTIANXIETY AGENTS | CHLORDIAZEPOXIDE HYDROCHL | EXCLUDED | ||
| ANTIANXIETY AGENTS | CHLORDIAZEPOXIDE HCL | GENERIC | ||
| ANTIANXIETY AGENTS | CHLORDIAZEPOXIDE HYDROCHL | GENERIC | ||
| ANTIANXIETY AGENTS | CLORAZEPATE DIPOTASSIUM | GENERIC | ||
| ANTIANXIETY AGENTS | DIAZEPAM | GENERIC | ||
| ANTIANXIETY AGENTS | DIAZEPAM INTENSOL | GENERIC | ||
| ANTIANXIETY AGENTS | DIAZEPAM | NON PREFERRED | ||
| ANTIANXIETY AGENTS | DIAZEPAM | EXCLUDED | ||
| ANTIANXIETY AGENTS | DROPERIDOL | GENERIC | ||
| ANTIANXIETY AGENTS | DROPERIDOL/SODIUM CHLORID | EXCLUDED | ||
| ANTIANXIETY AGENTS | HYDROXYZINE HCL | GENERIC | ||
| ANTIANXIETY AGENTS | HYDROXYZINE HYDROCHLORIDE | GENERIC | ||
| ANTIANXIETY AGENTS | HYDROXYZINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIANXIETY AGENTS | HYDROXYZINE PAMOATE | GENERIC | ||
| ANTIANXIETY AGENTS | HYDROXYZINE PAMOATE | EXCLUDED | ||
| ANTIANXIETY AGENTS | HYDROXYZINE PAMOATE | NON PREFERRED | ||
| ANTIANXIETY AGENTS | LORAZEPAM | EXCLUDED | ||
| ANTIANXIETY AGENTS | LORAZEPAM | GENERIC | ||
| ANTIANXIETY AGENTS | LORAZEPAM INTENSOL | GENERIC | ||
| ANTIANXIETY AGENTS | MEPROBAMATE | GENERIC | ||
| ANTIANXIETY AGENTS | OXAZEPAM | GENERIC | ||
| ANTIANXIETY AGENTS | VALIUM | NON PREFERRED | ||
| ANTIANXIETY AGENTS | XANAX | EXCLUDED | ||
| ANTIANXIETY AGENTS | XANAX XR | EXCLUDED | ||
| ANTIARRHYTHMICS | ADENOSINE | GENERIC | ||
| ANTIARRHYTHMICS | AMIODARONE HYDROCHLORIDE/ | EXCLUDED | ||
| ANTIARRHYTHMICS | AMIODARONE HYDROCHLORIDE | GENERIC | ||
| ANTIARRHYTHMICS | AMIODARONE HCL | GENERIC | ||
| ANTIARRHYTHMICS | CORVERT | NON PREFERRED | ||
| ANTIARRHYTHMICS | DISOPYRAMIDE PHOSPHATE | GENERIC | ||
| ANTIARRHYTHMICS | DOFETILIDE | GENERIC | SP | PA |
| ANTIARRHYTHMICS | FLECAINIDE ACETATE | GENERIC | ||
| ANTIARRHYTHMICS | FLECAINIDE ACETATE | EXCLUDED | ||
| ANTIARRHYTHMICS | IBUTILIDE FUMARATE | GENERIC | ||
| ANTIARRHYTHMICS | LIDOCAINE HYDROCHLORIDE/S | EXCLUDED | ||
| ANTIARRHYTHMICS | LIDOCAINE HYDROCHLORIDE/D | EXCLUDED | ||
| ANTIARRHYTHMICS | LIDOCAINE HCL IN D5W | GENERIC | ||
| ANTIARRHYTHMICS | LIDOCAINE HCL/DEXTROSE | GENERIC | ||
| ANTIARRHYTHMICS | LIDOCAINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIARRHYTHMICS | LIDOCAINE HCL | GENERIC | ||
| ANTIARRHYTHMICS | LIDOCAINE HCL | EXCLUDED | ||
| ANTIARRHYTHMICS | MEXILETINE HYDROCHLORIDE | GENERIC | ||
| ANTIARRHYTHMICS | MULTAQ | PREFERRED | ||
| ANTIARRHYTHMICS | NEXTERONE | EXCLUDED | ||
| ANTIARRHYTHMICS | NORPACE | EXCLUDED | ||
| ANTIARRHYTHMICS | NORPACE CR | NON PREFERRED | ||
| ANTIARRHYTHMICS | PACERONE | GENERIC | ||
| ANTIARRHYTHMICS | PROCAINAMIDE HYDROCHLORID | GENERIC | ||
| ANTIARRHYTHMICS | PROCAINAMIDE HCL | NON PREFERRED | ||
| ANTIARRHYTHMICS | PROPAFENONE HYDROCHLORIDE | GENERIC | ||
| ANTIARRHYTHMICS | PROPAFENONE HCL | GENERIC | ||
| ANTIARRHYTHMICS | QUINIDINE GLUCONATE CR | GENERIC | ||
| ANTIARRHYTHMICS | QUINIDINE GLUCONATE ER | GENERIC | ||
| ANTIARRHYTHMICS | QUINIDINE SULFATE | EXCLUDED | ||
| ANTIARRHYTHMICS | TIKOSYN | NON PREFERRED | SP | PA |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ACCOLATE | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ADVAIR DISKUS | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ADVAIR HFA | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | AIRSUPRA | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ALBUTEROL SULFATE | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ALBUTEROL SULFATE HFA | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ALBUTEROL SULFATE HFA | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ALBUTEROL SULFATE | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ALBUTEROL SULFATE | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ALVESCO | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | AMINOPHYLLINE | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | AMINOPHYLLINE ANHYDROUS | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ANORO ELLIPTA | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ARFORMOTEROL TARTRATE | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ARNUITY ELLIPTA | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ASMANEX TWISTHALER 120 ME | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ASMANEX TWISTHALER 14 MET | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ASMANEX TWISTHALER 30 MET | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ASMANEX TWISTHALER 60 MET | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ASMANEX HFA | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ATROVENT HFA | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | BEVESPI AEROSPHERE | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | BREO ELLIPTA | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | BREO ELLIPTA | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | BREYNA | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | BREZTRI AEROSPHERE | PREFERRED | PA | |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | BROVANA | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | BUDESONIDE/FORMOTEROL FUM | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | BUDESONIDE | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | CINQAIR | EXCLUDED | SP | PA |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | COMBIVENT RESPIMAT | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | CROMOLYN SODIUM | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | DALIRESP | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | DULERA | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ELIXOPHYLLIN | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | EPHEDRINE HCL | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | EPHEDRINE SULFATE | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | FASENRA | PREFERRED | SP | PA |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | Fasenra Pen | PREFERRED | SP | PA |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | FLUTICASONE PROPIONATE/SA | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | FLUTICASONE PROPIONATE/SA | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | FLUTICASONE FUROATE/VILAN | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | FLUTICASONE PROPIONATE DI | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | FLUTICASONE FUROATE ELLIP | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | FLUTICASONE PROPIONATE HF | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | FORMOTEROL FUMARATE | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | INCRUSE ELLIPTA | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | IPRATROPIUM BROMIDE/ALBUT | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | IPRATROPIUM BROMIDE | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | IPRATROPIUM BROMIDE MONOH | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | IPRATROPIUM BROMIDE | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | IPRATROPIUM BROMIDE | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ISOPROTERENOL HYDROCHLORI | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | LEVALBUTEROL TARTRATE HFA | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | LEVALBUTEROL HCL | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | LEVALBUTEROL HYDROCHLORID | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | METAPROTERENOL SULFATE | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | MONTELUKAST SODIUM | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | NUCALA | EXCLUDED | SP | PA |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | NUCALA | PREFERRED | SP | PA |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | OHTUVAYRE | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | PERFOROMIST | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | PULMICORT FLEXHALER | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | PULMICORT | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | PULMICORT FLEXHALER | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | QVAR REDIHALER | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ROFLUMILAST | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | SEREVENT DISKUS | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | SINGULAIR | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | SPIRIVA HANDIHALER | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | SPIRIVA RESPIMAT | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | STIOLTO RESPIMAT | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | STRIVERDI RESPIMAT | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | SYMBICORT | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | TERBUTALINE SULFATE | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | TERBUTALINE SULFATE | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | TEZSPIRE | PREFERRED | SP | PA |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | THEO-24 | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | THEOPHYLLINE ER | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | THEOPHYLLINE | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | THEOPHYLLINE ETHYLENEDIAM | NON PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | TIOTROPIUM BROMIDE | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | TRELEGY ELLIPTA | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | UMECLIDINIUM/VILANTEROL E | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | VENTOLIN HFA | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | WIXELA INHUB | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | XOLAIR | PREFERRED | SP | PA |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | XOPENEX HFA | EXCLUDED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | YUPELRI | PREFERRED | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ZAFIRLUKAST | GENERIC | ||
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ZILEUTON ER | EXCLUDED | PA | |
| ANTIASTHMATIC AND BRONCHODILATOR AGENTS | ZYFLO | NON PREFERRED | ||
| ANTICOAGULANTS | ACD FORMULA A | NON PREFERRED | ||
| ANTICOAGULANTS | ANTICOAGULANT SODIUM CITR | EXCLUDED | ||
| ANTICOAGULANTS | ANTICOAGULANT SODIUM CITR | NON PREFERRED | ||
| ANTICOAGULANTS | ARGATROBAN/SODIUM CHLORID | EXCLUDED | ||
| ANTICOAGULANTS | ARGATROBAN | GENERIC | ||
| ANTICOAGULANTS | ARGATROBAN | NON PREFERRED | ||
| ANTICOAGULANTS | ARIXTRA | NON PREFERRED | ||
| ANTICOAGULANTS | BIVALIRUDIN | GENERIC | ||
| ANTICOAGULANTS | DABIGATRAN ETEXILATE | EXCLUDED | ||
| ANTICOAGULANTS | DABIGATRAN ETEXILATE | GENERIC | ||
| ANTICOAGULANTS | DEFENCATH | EXCLUDED | ||
| ANTICOAGULANTS | ELIQUIS | EXCLUDED | ||
| ANTICOAGULANTS | ELIQUIS STARTER PACK | PREFERRED | ||
| ANTICOAGULANTS | ELIQUIS | PREFERRED | ||
| ANTICOAGULANTS | ENOXAPARIN SODIUM | GENERIC | ||
| ANTICOAGULANTS | FONDAPARINUX SODIUM | GENERIC | ||
| ANTICOAGULANTS | FRAGMIN | NON PREFERRED | ||
| ANTICOAGULANTS | HEPARIN LOCK FLUSH | GENERIC | ||
| ANTICOAGULANTS | HEPARIN SODIUM | GENERIC | ||
| ANTICOAGULANTS | HEPARIN SODIUM LOCK FLUSH | GENERIC | ||
| ANTICOAGULANTS | HEPARIN SODIUM/D5W | EXCLUDED | ||
| ANTICOAGULANTS | HEPARIN SODIUM/DEXTROSE | EXCLUDED | ||
| ANTICOAGULANTS | HEPARIN SODIUM/SODIUM CHL | NON PREFERRED | ||
| ANTICOAGULANTS | HEPARIN SODIUM/NACL 0.45% | NON PREFERRED | ||
| ANTICOAGULANTS | HEPARIN SODIUM/NACL 0.45% | EXCLUDED | ||
| ANTICOAGULANTS | HEPARIN SODIUM/SODIUM CHL | EXCLUDED | ||
| ANTICOAGULANTS | BD HEPARIN POSIFLUSH | GENERIC | ||
| ANTICOAGULANTS | HEPARIN SODIUM | EXCLUDED | ||
| ANTICOAGULANTS | HEPARIN/SODIUM CHLORIDE | EXCLUDED | ||
| ANTICOAGULANTS | JANTOVEN | GENERIC | ||
| ANTICOAGULANTS | LOVENOX | NON PREFERRED | ||
| ANTICOAGULANTS | ACD-A NOCLOT-50 | NON PREFERRED | ||
| ANTICOAGULANTS | PRADAXA | EXCLUDED | ||
| ANTICOAGULANTS | RIVAROXABAN | GENERIC | ||
| ANTICOAGULANTS | SAVAYSA | EXCLUDED | ||
| ANTICOAGULANTS | SODIUM CITRATE/GENTAMICIN | EXCLUDED | ||
| ANTICOAGULANTS | SODIUM CITRATE | EXCLUDED | ||
| ANTICOAGULANTS | SODIUM CITRATE LOCK FLUSH | EXCLUDED | ||
| ANTICOAGULANTS | TRICITRASOL | NON PREFERRED | ||
| ANTICOAGULANTS | WARFARIN SODIUM | GENERIC | ||
| ANTICOAGULANTS | XARELTO STARTER PACK | PREFERRED | ||
| ANTICOAGULANTS | XARELTO | PREFERRED | ||
| ANTICONVULSANTS | APTIOM | NON PREFERRED | PA | |
| ANTICONVULSANTS | BANZEL | EXCLUDED | ||
| ANTICONVULSANTS | BRIVIACT | PREFERRED | PA | |
| ANTICONVULSANTS | CARBAMAZEPINE ER | GENERIC | ||
| ANTICONVULSANTS | CARBAMAZEPINE ER | EXCLUDED | ||
| ANTICONVULSANTS | CARBAMAZEPINE | GENERIC | ||
| ANTICONVULSANTS | CARBAMAZEPINE | NON PREFERRED | ||
| ANTICONVULSANTS | CARBAMAZEPINE | EXCLUDED | ||
| ANTICONVULSANTS | CARBATROL | NON PREFERRED | ||
| ANTICONVULSANTS | CELONTIN | NON PREFERRED | ||
| ANTICONVULSANTS | CEREBYX | NON PREFERRED | ||
| ANTICONVULSANTS | CLOBAZAM | GENERIC | ||
| ANTICONVULSANTS | CLONAZEPAM ODT | GENERIC | ||
| ANTICONVULSANTS | CLONAZEPAM | EXCLUDED | ||
| ANTICONVULSANTS | CLONAZEPAM | GENERIC | ||
| ANTICONVULSANTS | DEPAKOTE ER | EXCLUDED | ||
| ANTICONVULSANTS | DEPAKOTE SPRINKLES | EXCLUDED | ||
| ANTICONVULSANTS | DEPAKOTE | EXCLUDED | ||
| ANTICONVULSANTS | DIACOMIT | EXCLUDED | SP | PA |
| ANTICONVULSANTS | DIAZEPAM RECTAL GEL | GENERIC | PA | |
| ANTICONVULSANTS | DILANTIN | EXCLUDED | ||
| ANTICONVULSANTS | DILANTIN INFATABS | EXCLUDED | ||
| ANTICONVULSANTS | DILANTIN-125 | EXCLUDED | ||
| ANTICONVULSANTS | DIVALPROEX SODIUM DR | GENERIC | ||
| ANTICONVULSANTS | DIVALPROEX SODIUM ER | GENERIC | ||
| ANTICONVULSANTS | EPIDIOLEX | NON PREFERRED | SP | PA |
| ANTICONVULSANTS | EPRONTIA | EXCLUDED | ||
| ANTICONVULSANTS | ESLICARBAZEPINE ACETATE | GENERIC | PA | |
| ANTICONVULSANTS | ETHOSUXIMIDE | GENERIC | ||
| ANTICONVULSANTS | FELBAMATE | GENERIC | ||
| ANTICONVULSANTS | FELBATOL | NON PREFERRED | ||
| ANTICONVULSANTS | FINTEPLA | EXCLUDED | SP | PA |
| ANTICONVULSANTS | FOSPHENYTOIN SODIUM | GENERIC | ||
| ANTICONVULSANTS | FYCOMPA | NON PREFERRED | PA | |
| ANTICONVULSANTS | GABAPENTIN | GENERIC | ||
| ANTICONVULSANTS | GABAPENTIN TINYTABS | EXCLUDED | ||
| ANTICONVULSANTS | GABARONE | EXCLUDED | ||
| ANTICONVULSANTS | KEPPRA | EXCLUDED | ||
| ANTICONVULSANTS | KEPPRA XR | EXCLUDED | ||
| ANTICONVULSANTS | KLONOPIN | NON PREFERRED | ||
| ANTICONVULSANTS | LACOSAMIDE | GENERIC | ||
| ANTICONVULSANTS | LAMICTAL CHEWABLE DISPERS | EXCLUDED | ||
| ANTICONVULSANTS | LAMICTAL | EXCLUDED | ||
| ANTICONVULSANTS | LAMOTRIGINE | GENERIC | ||
| ANTICONVULSANTS | LEVETIRACETAM/SODIUM CHLO | GENERIC | ||
| ANTICONVULSANTS | LEVETIRACETAM/SODIUM CHLO | NON PREFERRED | ||
| ANTICONVULSANTS | LEVETIRACETAM | GENERIC | ||
| ANTICONVULSANTS | LEVETIRACETAM | EXCLUDED | PA | |
| ANTICONVULSANTS | LEVETIRACETAM ER | GENERIC | ||
| ANTICONVULSANTS | LYRICA | EXCLUDED | ||
| ANTICONVULSANTS | METHSUXIMIDE | GENERIC | ||
| ANTICONVULSANTS | MOTPOLY XR | EXCLUDED | ||
| ANTICONVULSANTS | MYSOLINE | NON PREFERRED | ||
| ANTICONVULSANTS | NAYZILAM | PREFERRED | PA | |
| ANTICONVULSANTS | NEURONTIN | NON PREFERRED | ||
| ANTICONVULSANTS | ONFI | EXCLUDED | ||
| ANTICONVULSANTS | OXCARBAZEPINE | GENERIC | ||
| ANTICONVULSANTS | PERAMPANEL | GENERIC | PA | |
| ANTICONVULSANTS | PHENYTEK | GENERIC | ||
| ANTICONVULSANTS | PHENYTOIN | GENERIC | ||
| ANTICONVULSANTS | PHENYTOIN INFATABS | GENERIC | ||
| ANTICONVULSANTS | PHENYTOIN SODIUM EXTENDED | GENERIC | ||
| ANTICONVULSANTS | PHENYTOIN SODIUM | GENERIC | ||
| ANTICONVULSANTS | PHENYTOIN SODIUM | NON PREFERRED | ||
| ANTICONVULSANTS | PREGABALIN | GENERIC | ||
| ANTICONVULSANTS | PRIMIDONE | EXCLUDED | ||
| ANTICONVULSANTS | PRIMIDONE | GENERIC | ||
| ANTICONVULSANTS | ROWEEPRA | GENERIC | ||
| ANTICONVULSANTS | RUFINAMIDE | GENERIC | ||
| ANTICONVULSANTS | SABRIL | EXCLUDED | SP | PA |
| ANTICONVULSANTS | SPRITAM | EXCLUDED | PA | |
| ANTICONVULSANTS | SUBVENITE | GENERIC | ||
| ANTICONVULSANTS | TEGRETOL | EXCLUDED | ||
| ANTICONVULSANTS | TEGRETOL-XR | EXCLUDED | ||
| ANTICONVULSANTS | TIAGABINE HYDROCHLORIDE | GENERIC | ||
| ANTICONVULSANTS | TOPAMAX SPRINKLE | NON PREFERRED | ||
| ANTICONVULSANTS | TOPAMAX | NON PREFERRED | ||
| ANTICONVULSANTS | TOPIRAMATE | GENERIC | ||
| ANTICONVULSANTS | TRILEPTAL | EXCLUDED | ||
| ANTICONVULSANTS | VALPROATE SODIUM | GENERIC | ||
| ANTICONVULSANTS | VALPROIC ACID | GENERIC | ||
| ANTICONVULSANTS | VALTOCO 10 MG DOSE | PREFERRED | PA | |
| ANTICONVULSANTS | VALTOCO 15 MG DOSE | PREFERRED | PA | |
| ANTICONVULSANTS | VALTOCO 20 MG DOSE | PREFERRED | PA | |
| ANTICONVULSANTS | VALTOCO 5 MG DOSE | PREFERRED | PA | |
| ANTICONVULSANTS | VIGABATRIN | GENERIC | SP | PA |
| ANTICONVULSANTS | VIGADRONE | GENERIC | SP | PA |
| ANTICONVULSANTS | VIGAFYDE | EXCLUDED | SP | PA |
| ANTICONVULSANTS | VIMPAT | EXCLUDED | ||
| ANTICONVULSANTS | XCOPRI | PREFERRED | PA | |
| ANTICONVULSANTS | ZARONTIN | NON PREFERRED | ||
| ANTICONVULSANTS | ZONEGRAN | EXCLUDED | ||
| ANTICONVULSANTS | ZONISADE | EXCLUDED | ||
| ANTICONVULSANTS | ZONISAMIDE | GENERIC | ||
| ANTICONVULSANTS | ZTALMY | EXCLUDED | SP | PA |
| ANTIDEPRESSANTS | AMITRIPTYLINE HCL | GENERIC | ||
| ANTIDEPRESSANTS | AMITRIPTYLINE HYDROCHLORI | GENERIC | ||
| ANTIDEPRESSANTS | AMOXAPINE | EXCLUDED | ||
| ANTIDEPRESSANTS | AMOXAPINE | GENERIC | ||
| ANTIDEPRESSANTS | BUPROPION HYDROCHLORIDE E | GENERIC | ||
| ANTIDEPRESSANTS | BUPROPION HYDROCHLORIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | BUPROPION HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | BUPROPION HYDROCHLORIDE E | EXCLUDED | ||
| ANTIDEPRESSANTS | CELEXA | NON PREFERRED | ||
| ANTIDEPRESSANTS | CITALOPRAM HYDROBROMIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | CITALOPRAM HYDROBROMIDE | GENERIC | ||
| ANTIDEPRESSANTS | CLOMIPRAMINE HCL | GENERIC | ||
| ANTIDEPRESSANTS | CLOMIPRAMINE HYDROCHLORID | GENERIC | ||
| ANTIDEPRESSANTS | DESIPRAMINE HCL | NON PREFERRED | ||
| ANTIDEPRESSANTS | DESIPRAMINE HCL | GENERIC | ||
| ANTIDEPRESSANTS | DESIPRAMINE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | DESIPRAMINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | DESVENLAFAXINE SUCCINATE | GENERIC | ||
| ANTIDEPRESSANTS | DESVENLAFAXINE ER | GENERIC | ||
| ANTIDEPRESSANTS | DESVENLAFAXINE ER | NON PREFERRED | ||
| ANTIDEPRESSANTS | DOXEPIN HYDROCHLORIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | DOXEPIN HCL | GENERIC | ||
| ANTIDEPRESSANTS | DOXEPIN HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | DULOXETINE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | EFFEXOR XR | EXCLUDED | ||
| ANTIDEPRESSANTS | EMSAM | NON PREFERRED | PA | |
| ANTIDEPRESSANTS | ESCITALOPRAM OXALATE | GENERIC | ||
| ANTIDEPRESSANTS | ESCITALOPRAM OXALATE | EXCLUDED | ||
| ANTIDEPRESSANTS | FETZIMA | NON PREFERRED | PA | |
| ANTIDEPRESSANTS | FETZIMA TITRATION PACK | NON PREFERRED | PA | |
| ANTIDEPRESSANTS | FLUOXETINE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | FLUOXETINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | FLUVOXAMINE MALEATE | EXCLUDED | ||
| ANTIDEPRESSANTS | FLUVOXAMINE MALEATE | GENERIC | ||
| ANTIDEPRESSANTS | FORFIVO XL | NON PREFERRED | ||
| ANTIDEPRESSANTS | IMIPRAMINE HCL | GENERIC | ||
| ANTIDEPRESSANTS | IMIPRAMINE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | IMIPRAMINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | IMIPRAMINE PAMOATE | GENERIC | ||
| ANTIDEPRESSANTS | IMIPRAMINE HCL | NON PREFERRED | ||
| ANTIDEPRESSANTS | LEXAPRO | EXCLUDED | ||
| ANTIDEPRESSANTS | MARPLAN | NON PREFERRED | ||
| ANTIDEPRESSANTS | MIRTAZAPINE ODT | GENERIC | ||
| ANTIDEPRESSANTS | MIRTAZAPINE | GENERIC | ||
| ANTIDEPRESSANTS | NARDIL | NON PREFERRED | ||
| ANTIDEPRESSANTS | NEFAZODONE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | NORPRAMIN | NON PREFERRED | ||
| ANTIDEPRESSANTS | NORTRIPTYLINE HYDROCHLORI | GENERIC | ||
| ANTIDEPRESSANTS | NORTRIPTYLINE HCL | GENERIC | ||
| ANTIDEPRESSANTS | NORTRIPTYLINE HCL | NON PREFERRED | ||
| ANTIDEPRESSANTS | PARNATE | NON PREFERRED | ||
| ANTIDEPRESSANTS | PAROXETINE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | PAROXETINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | PAROXETINE HCL | GENERIC | ||
| ANTIDEPRESSANTS | PAXIL | EXCLUDED | ||
| ANTIDEPRESSANTS | PHENELZINE SULFATE | GENERIC | ||
| ANTIDEPRESSANTS | PRISTIQ | EXCLUDED | ||
| ANTIDEPRESSANTS | PROTRIPTYLINE HCL | GENERIC | ||
| ANTIDEPRESSANTS | PROZAC | EXCLUDED | ||
| ANTIDEPRESSANTS | RALDESY | EXCLUDED | ||
| ANTIDEPRESSANTS | REMERON SOLTAB | NON PREFERRED | ||
| ANTIDEPRESSANTS | REMERON | NON PREFERRED | ||
| ANTIDEPRESSANTS | SERTRALINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | SERTRALINE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | SERTRALINE HCL | GENERIC | ||
| ANTIDEPRESSANTS | TRANYLCYPROMINE SULFATE | GENERIC | ||
| ANTIDEPRESSANTS | TRAZODONE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | TRAZODONE HYDROCHLORIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | TRIMIPRAMINE MALEATE | EXCLUDED | ||
| ANTIDEPRESSANTS | TRIMIPRAMINE MALEATE | GENERIC | ||
| ANTIDEPRESSANTS | TRIMIPRAMINE MALEATE | NON PREFERRED | ||
| ANTIDEPRESSANTS | TRINTELLIX | PREFERRED | ||
| ANTIDEPRESSANTS | VENLAFAXINE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | VENLAFAXINE HCL | GENERIC | ||
| ANTIDEPRESSANTS | VENLAFAXINE BESYLATE ER | EXCLUDED | ||
| ANTIDEPRESSANTS | VENLAFAXINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIDEPRESSANTS | VIIBRYD | EXCLUDED | ||
| ANTIDEPRESSANTS | VILAZODONE HYDROCHLORIDE | GENERIC | ||
| ANTIDEPRESSANTS | WELLBUTRIN SR | NON PREFERRED | ||
| ANTIDEPRESSANTS | ZOLOFT | EXCLUDED | ||
| ANTIDEPRESSANTS | ZURZUVAE | PREFERRED | SP | PA |
| ANTIDIABETICS | ACARBOSE | EXCLUDED | ||
| ANTIDIABETICS | ACARBOSE | GENERIC | ||
| ANTIDIABETICS | ACTOPLUS MET | NON PREFERRED | ||
| ANTIDIABETICS | ACTOS | EXCLUDED | ||
| ANTIDIABETICS | ADMELOG | EXCLUDED | ||
| ANTIDIABETICS | ADMELOG SOLOSTAR | EXCLUDED | ||
| ANTIDIABETICS | AFREZZA | EXCLUDED | ||
| ANTIDIABETICS | ALOGLIPTIN/PIOGLITAZONE | EXCLUDED | ||
| ANTIDIABETICS | ALOGLIPTIN/METFORMIN HYDR | EXCLUDED | ||
| ANTIDIABETICS | ALOGLIPTIN/METFORMIN HCL | EXCLUDED | ||
| ANTIDIABETICS | ALOGLIPTIN | EXCLUDED | ||
| ANTIDIABETICS | APIDRA SOLOSTAR | EXCLUDED | ||
| ANTIDIABETICS | Apidra | EXCLUDED | ||
| ANTIDIABETICS | BAQSIMI ONE PACK | PREFERRED | ||
| ANTIDIABETICS | BAQSIMI TWO PACK | PREFERRED | ||
| ANTIDIABETICS | BASAGLAR KWIKPEN | PREFERRED | ||
| ANTIDIABETICS | BASAGLAR TEMPO PEN | EXCLUDED | ||
| ANTIDIABETICS | BEXAGLIFLOZIN | EXCLUDED | ||
| ANTIDIABETICS | BRENZAVVY | EXCLUDED | ||
| ANTIDIABETICS | BRYNOVIN | EXCLUDED | ||
| ANTIDIABETICS | CYCLOSET | NON PREFERRED | ||
| ANTIDIABETICS | DAPAGLIFLOZIN PROPANEDIOL | EXCLUDED | ||
| ANTIDIABETICS | DIAZOXIDE | GENERIC | ||
| ANTIDIABETICS | DUETACT | NON PREFERRED | ||
| ANTIDIABETICS | EXENATIDE | EXCLUDED | PA | |
| ANTIDIABETICS | FARXIGA | PREFERRED | ||
| ANTIDIABETICS | FIASP FLEXTOUCH | PREFERRED | ||
| ANTIDIABETICS | FIASP PENFILL | PREFERRED | ||
| ANTIDIABETICS | FIASP PUMPCART | EXCLUDED | ||
| ANTIDIABETICS | FIASP | PREFERRED | ||
| ANTIDIABETICS | INSULIN GLARGINE-YFGN | EXCLUDED | ||
| ANTIDIABETICS | GLIMEPIRIDE | GENERIC | ||
| ANTIDIABETICS | GLIMEPIRIDE | EXCLUDED | ||
| ANTIDIABETICS | GLIPIZIDE/METFORMIN HYDRO | EXCLUDED | ||
| ANTIDIABETICS | GLIPIZIDE/METFORMIN HYDRO | GENERIC | ||
| ANTIDIABETICS | GLIPIZIDE ER | GENERIC | ||
| ANTIDIABETICS | GLIPIZIDE | NON PREFERRED | ||
| ANTIDIABETICS | GLIPIZIDE | GENERIC | ||
| ANTIDIABETICS | GLIPIZIDE | EXCLUDED | ||
| ANTIDIABETICS | GLUCAGON EMERGENCY KIT FO | EXCLUDED | ||
| ANTIDIABETICS | GLUCAGON EMERGENCY KIT FO | GENERIC | ||
| ANTIDIABETICS | GLUCOTROL XL | NON PREFERRED | ||
| ANTIDIABETICS | GLYBURIDE/METFORMIN HYDRO | GENERIC | ||
| ANTIDIABETICS | GLYBURIDE MICRONIZED | GENERIC | ||
| ANTIDIABETICS | GLYBURIDE | NON PREFERRED | ||
| ANTIDIABETICS | GLYBURIDE | EXCLUDED | ||
| ANTIDIABETICS | GLYBURIDE | GENERIC | ||
| ANTIDIABETICS | GLYXAMBI | PREFERRED | ||
| ANTIDIABETICS | GVOKE HYPOPEN 1-PACK | PREFERRED | ||
| ANTIDIABETICS | GVOKE HYPOPEN 2-PACK | PREFERRED | ||
| ANTIDIABETICS | GVOKE KIT | PREFERRED | ||
| ANTIDIABETICS | GVOKE PFS | PREFERRED | ||
| ANTIDIABETICS | HUMALOG | EXCLUDED | ||
| ANTIDIABETICS | HUMALOG JUNIOR KWIKPEN | EXCLUDED | ||
| ANTIDIABETICS | HUMALOG KWIKPEN | EXCLUDED | ||
| ANTIDIABETICS | HUMALOG MIX 50/50 KWIKPEN | EXCLUDED | ||
| ANTIDIABETICS | HUMALOG MIX 75/25 KWIKPEN | EXCLUDED | ||
| ANTIDIABETICS | HUMALOG MIX 75/25 | EXCLUDED | ||
| ANTIDIABETICS | HUMALOG TEMPO PEN | EXCLUDED | ||
| ANTIDIABETICS | HUMULIN R U-500 KWIKPEN | PREFERRED | ||
| ANTIDIABETICS | HUMULIN R U-500 (CONCENTR | PREFERRED | ||
| ANTIDIABETICS | INSULIN ASPART PROTAMINE/ | EXCLUDED | ||
| ANTIDIABETICS | INSULIN ASPART PENFILL | EXCLUDED | ||
| ANTIDIABETICS | INSULIN ASPART FLEXPEN | EXCLUDED | ||
| ANTIDIABETICS | INSULIN ASPART | EXCLUDED | ||
| ANTIDIABETICS | INSULIN DEGLUDEC FLEXTOUC | EXCLUDED | ||
| ANTIDIABETICS | INSULIN DEGLUDEC | EXCLUDED | ||
| ANTIDIABETICS | INSULIN LISPRO KWIKPEN | EXCLUDED | ||
| ANTIDIABETICS | INSULIN LISPRO JUNIOR KWI | EXCLUDED | ||
| ANTIDIABETICS | INSULIN LISPRO PROTAMINE/ | EXCLUDED | ||
| ANTIDIABETICS | INSULIN LISPRO | EXCLUDED | ||
| ANTIDIABETICS | INSULIN GLARGINE MAX SOLO | EXCLUDED | ||
| ANTIDIABETICS | INSULIN GLARGINE SOLOSTAR | EXCLUDED | ||
| ANTIDIABETICS | INVOKAMET | EXCLUDED | ||
| ANTIDIABETICS | INVOKAMET XR | EXCLUDED | ||
| ANTIDIABETICS | INVOKANA | EXCLUDED | ||
| ANTIDIABETICS | JANUMET | EXCLUDED | ||
| ANTIDIABETICS | JANUMET XR | EXCLUDED | ||
| ANTIDIABETICS | JANUVIA | EXCLUDED | ||
| ANTIDIABETICS | JARDIANCE | PREFERRED | ||
| ANTIDIABETICS | JENTADUETO | EXCLUDED | ||
| ANTIDIABETICS | JENTADUETO XR | EXCLUDED | ||
| ANTIDIABETICS | KIRSTY | EXCLUDED | ||
| ANTIDIABETICS | KORLYM | EXCLUDED | SP | PA |
| ANTIDIABETICS | LANTIDRA | NON PREFERRED | SP | PA |
| ANTIDIABETICS | LANTUS SOLOSTAR | EXCLUDED | ||
| ANTIDIABETICS | LANTUS | EXCLUDED | ||
| ANTIDIABETICS | LIRAGLUTIDE | GENERIC | PA | |
| ANTIDIABETICS | LYUMJEV KWIKPEN | EXCLUDED | ||
| ANTIDIABETICS | LYUMJEV TEMPO PEN | EXCLUDED | ||
| ANTIDIABETICS | LYUMJEV | EXCLUDED | ||
| ANTIDIABETICS | MERILOG | EXCLUDED | ||
| ANTIDIABETICS | MERILOG SOLOSTAR | EXCLUDED | ||
| ANTIDIABETICS | METFORMIN HYDROCHLORIDE E | GENERIC | ||
| ANTIDIABETICS | METFORMIN HYDROCHLORIDE | GENERIC | ||
| ANTIDIABETICS | METFORMIN HYDROCHLORIDE | EXCLUDED | ||
| ANTIDIABETICS | MIFEPRISTONE | GENERIC | SP | PA |
| ANTIDIABETICS | MIGLITOL | GENERIC | ||
| ANTIDIABETICS | MOUNJARO | PREFERRED | PA | |
| ANTIDIABETICS | MYXREDLIN | EXCLUDED | ||
| ANTIDIABETICS | NATEGLINIDE | GENERIC | ||
| ANTIDIABETICS | NOVOLOG PENFILL | PREFERRED | ||
| ANTIDIABETICS | NOVOLOG FLEXPEN | PREFERRED | ||
| ANTIDIABETICS | NOVOLOG MIX 70/30 PREFILL | PREFERRED | ||
| ANTIDIABETICS | NOVOLOG FLEXPEN RELION | EXCLUDED | ||
| ANTIDIABETICS | NOVOLOG RELION | EXCLUDED | ||
| ANTIDIABETICS | NOVOLOG MIX 70/30 PREFILL | EXCLUDED | ||
| ANTIDIABETICS | NOVOLOG MIX 70/30 | PREFERRED | ||
| ANTIDIABETICS | NOVOLOG MIX 70/30 RELION | EXCLUDED | ||
| ANTIDIABETICS | NOVOLOG | PREFERRED | ||
| ANTIDIABETICS | ONGLYZA | EXCLUDED | ||
| ANTIDIABETICS | OZEMPIC | PREFERRED | PA | |
| ANTIDIABETICS | PIOGLITAZONE HCL-GLIMEPIR | GENERIC | ||
| ANTIDIABETICS | PIOGLITAZONE HCL/METFORMI | GENERIC | ||
| ANTIDIABETICS | PIOGLITAZONE HYDROCHLORID | GENERIC | ||
| ANTIDIABETICS | PIOGLITAZONE HCL | GENERIC | ||
| ANTIDIABETICS | PROGLYCEM | NON PREFERRED | ||
| ANTIDIABETICS | REPAGLINIDE | EXCLUDED | ||
| ANTIDIABETICS | REPAGLINIDE | GENERIC | ||
| ANTIDIABETICS | REZVOGLAR KWIKPEN | EXCLUDED | ||
| ANTIDIABETICS | RIOMET | EXCLUDED | ||
| ANTIDIABETICS | RYBELSUS | PREFERRED | PA | |
| ANTIDIABETICS | SAXAGLIPTIN HYDROCHLORIDE | GENERIC | ||
| ANTIDIABETICS | SEGLUROMET | EXCLUDED | ||
| ANTIDIABETICS | SEMGLEE | EXCLUDED | ||
| ANTIDIABETICS | SITAGLIPTIN/METFORMIN HYD | EXCLUDED | ||
| ANTIDIABETICS | SITAGLIPTIN | EXCLUDED | ||
| ANTIDIABETICS | SOLIQUA 100/33 | PREFERRED | PA | |
| ANTIDIABETICS | STEGLATRO | EXCLUDED | ||
| ANTIDIABETICS | STEGLUJAN | EXCLUDED | ||
| ANTIDIABETICS | SYNJARDY | PREFERRED | ||
| ANTIDIABETICS | SYNJARDY XR | PREFERRED | ||
| ANTIDIABETICS | TOUJEO MAX SOLOSTAR | PREFERRED | ||
| ANTIDIABETICS | TOUJEO SOLOSTAR | PREFERRED | ||
| ANTIDIABETICS | TRADJENTA | EXCLUDED | ||
| ANTIDIABETICS | TRESIBA FLEXTOUCH | EXCLUDED | ||
| ANTIDIABETICS | TRESIBA | EXCLUDED | ||
| ANTIDIABETICS | TRIJARDY XR | PREFERRED | ||
| ANTIDIABETICS | TRULICITY | PREFERRED | PA | |
| ANTIDIABETICS | TZIELD | EXCLUDED | SP | PA |
| ANTIDIABETICS | VICTOZA | EXCLUDED | PA | |
| ANTIDIABETICS | XIGDUO XR | PREFERRED | ||
| ANTIDIABETICS | XULTOPHY 100/3.6 | PREFERRED | PA | |
| ANTIDIABETICS | ZITUVIMET | PREFERRED | ||
| ANTIDIABETICS | ZITUVIMET XR | PREFERRED | ||
| ANTIDIABETICS | ZITUVIO | PREFERRED | ||
| ANTIDIARRHEAL/PROBIOTIC AGENTS | DIPHENOXYLATE/ATROPINE | GENERIC | ||
| ANTIDIARRHEAL/PROBIOTIC AGENTS | DIPHENOXYLATE HYDROCHLORI | GENERIC | ||
| ANTIDIARRHEAL/PROBIOTIC AGENTS | KAOLIN | NON PREFERRED | ||
| ANTIDIARRHEAL/PROBIOTIC AGENTS | LOMOTIL | NON PREFERRED | ||
| ANTIDIARRHEAL/PROBIOTIC AGENTS | LOPERAMIDE HYDROCHLORIDE | GENERIC | ||
| ANTIDIARRHEAL/PROBIOTIC AGENTS | PECTIN | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | ACETADOTE | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | ACETYLCYSTEINE | GENERIC | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | BRIDION | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | CHARCOAL ACTIVATED | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | CHEMET | NON PREFERRED | PA | |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | CYANOKIT | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | DEFERASIROX | GENERIC | SP | PA |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | DEFERIPRONE | GENERIC | SP | PA |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | DEFEROXAMINE | GENERIC | SP | PA |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | DESFERAL | EXCLUDED | SP | PA |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | DIGIFAB | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | DIMERCAPTOPROPANE SULFONA | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | EDETATE CALCIUM DISODIUM | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | EDETATE CALCIUM DISODIUM | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | EXJADE | EXCLUDED | SP | PA |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | FERRIPROX | EXCLUDED | SP | PA |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | FLUMAZENIL | GENERIC | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | FOMEPIZOLE | GENERIC | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | JADENU | EXCLUDED | SP | PA |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | KLOXXADO | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | METHYLENE BLUE | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | METHYLENE BLUE | GENERIC | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | NALMEFENE HYDROCHLORIDE | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | NALOXONE HYDROCHLORIDE | GENERIC | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | NALOXONE HCL | GENERIC | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | NALTREXONE HYDROCHLORIDE | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | NALTREXONE HYDROCHLORIDE | GENERIC | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | NARCAN | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | NITHIODOTE | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | OPVEE | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | PENTETATE CALCIUM TRISODI | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | PENTETATE ZINC TRISODIUM | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | PRAXBIND | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | PREVDUO | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | PROTOPAM CHLORIDE | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | PROVAYBLUE | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | PYRIDOSTIGMINE BROMIDE ER | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | RADIOGARDASE | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | REXTOVY | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | SODIUM NITRITE | NON PREFERRED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | SODIUM THIOSULFATE | GENERIC | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | SUGAMMADEX SODIUM | EXCLUDED | ||
| ANTIDOTES AND SPECIFIC ANTAGONISTS | VISTOGARD | PREFERRED | SP | PA |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | VIVITROL | NON PREFERRED | SP | PA |
| ANTIDOTES AND SPECIFIC ANTAGONISTS | Zurnai | EXCLUDED | ||
| ANTIEMETICS | AKYNZEO | NON PREFERRED | PA | |
| ANTIEMETICS | ANZEMET | NON PREFERRED | PA | |
| ANTIEMETICS | APONVIE | EXCLUDED | PA | |
| ANTIEMETICS | APREPITANT | EXCLUDED | PA | |
| ANTIEMETICS | APREPITANT | GENERIC | PA | |
| ANTIEMETICS | BARHEMSYS | EXCLUDED | ||
| ANTIEMETICS | CINVANTI | EXCLUDED | PA | |
| ANTIEMETICS | DIMENHYDRINATE | NON PREFERRED | ||
| ANTIEMETICS | DRONABINOL | GENERIC | PA | |
| ANTIEMETICS | EMEND BIPACK | NON PREFERRED | PA | |
| ANTIEMETICS | EMEND | NON PREFERRED | ||
| ANTIEMETICS | EMEND | NON PREFERRED | PA | |
| ANTIEMETICS | EMEND TRIPACK | NON PREFERRED | PA | |
| ANTIEMETICS | FOCINVEZ | EXCLUDED | ||
| ANTIEMETICS | FOSAPREPITANT DIMEGLUMINE | GENERIC | ||
| ANTIEMETICS | GRANISETRON HCL | GENERIC | ||
| ANTIEMETICS | GRANISETRON HYDROCHLORIDE | GENERIC | ||
| ANTIEMETICS | MARINOL | NON PREFERRED | PA | |
| ANTIEMETICS | MECLIZINE HCL | GENERIC | ||
| ANTIEMETICS | MECLIZINE HYDROCHLORIDE | GENERIC | ||
| ANTIEMETICS | MECLIZINE HCL | NON PREFERRED | ||
| ANTIEMETICS | MECLIZINE HCL MONOHYDRATE | NON PREFERRED | ||
| ANTIEMETICS | MECLIZINE HYDROCHLORIDE M | NON PREFERRED | ||
| ANTIEMETICS | MECLIZINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIEMETICS | Ondansetron HCl | GENERIC | ||
| ANTIEMETICS | ONDANSETRON HYDROCHLORIDE | GENERIC | ||
| ANTIEMETICS | ONDANSETRON ODT | GENERIC | ||
| ANTIEMETICS | ONDANSETRON ODT | EXCLUDED | ||
| ANTIEMETICS | PALONOSETRON HYDROCHLORID | NON PREFERRED | ||
| ANTIEMETICS | PALONOSETRON HYDROCHLORID | GENERIC | ||
| ANTIEMETICS | POSFREA | EXCLUDED | ||
| ANTIEMETICS | SANCUSO | PREFERRED | PA | |
| ANTIEMETICS | SCOPOLAMINE | GENERIC | ||
| ANTIEMETICS | TIGAN | NON PREFERRED | ||
| ANTIEMETICS | TRIMETHOBENZAMIDE HYDROCH | EXCLUDED | ||
| ANTIEMETICS | TRIMETHOBENZAMIDE HYDROCH | GENERIC | ||
| ANTIEMETICS | VARUBI | NON PREFERRED | PA | |
| ANTIFUNGALS | AMBISOME | NON PREFERRED | ||
| ANTIFUNGALS | AMPHOTERICIN B | GENERIC | ||
| ANTIFUNGALS | AMPHOTERICIN B LIPOSOME | GENERIC | ||
| ANTIFUNGALS | ANCOBON | NON PREFERRED | PA | |
| ANTIFUNGALS | BREXAFEMME | NON PREFERRED | PA | |
| ANTIFUNGALS | CASPOFUNGIN ACETATE | GENERIC | ||
| ANTIFUNGALS | CASPOFUNGIN ACETATE | NON PREFERRED | ||
| ANTIFUNGALS | CRESEMBA | EXCLUDED | PA | |
| ANTIFUNGALS | CRESEMBA | NON PREFERRED | PA | |
| ANTIFUNGALS | DIFLUCAN | NON PREFERRED | ||
| ANTIFUNGALS | ERAXIS | NON PREFERRED | ||
| ANTIFUNGALS | FLUCONAZOLE | GENERIC | ||
| ANTIFUNGALS | FLUCONAZOLE IN NACL | GENERIC | ||
| ANTIFUNGALS | FLUCONAZOLE IN SODIUM CHL | GENERIC | ||
| ANTIFUNGALS | FLUCYTOSINE | GENERIC | PA | |
| ANTIFUNGALS | FLUCYTOSINE | EXCLUDED | PA | |
| ANTIFUNGALS | GRISEOFULVIN MICROSIZE | EXCLUDED | ||
| ANTIFUNGALS | GRISEOFULVIN MICROSIZE | GENERIC | ||
| ANTIFUNGALS | GRISEOFULVIN ULTRAMICROSI | GENERIC | ||
| ANTIFUNGALS | ITRACONAZOLE | GENERIC | ||
| ANTIFUNGALS | KETOCONAZOLE | GENERIC | ||
| ANTIFUNGALS | MICAFUNGIN | GENERIC | ||
| ANTIFUNGALS | MICAFUNGIN | NON PREFERRED | ||
| ANTIFUNGALS | MICAFUNGIN SODIUM/SODIUM | EXCLUDED | ||
| ANTIFUNGALS | MICAFUNGIN/SODIUM CHLORID | EXCLUDED | ||
| ANTIFUNGALS | MICONAZOLE | NON PREFERRED | ||
| ANTIFUNGALS | MYCAMINE | NON PREFERRED | ||
| ANTIFUNGALS | MYCAMINE | EXCLUDED | ||
| ANTIFUNGALS | NOXAFIL | EXCLUDED | PA | |
| ANTIFUNGALS | NYSTATIN | EXCLUDED | ||
| ANTIFUNGALS | NYSTATIN | GENERIC | ||
| ANTIFUNGALS | POSACONAZOLE | GENERIC | PA | |
| ANTIFUNGALS | POSACONAZOLE DR | EXCLUDED | PA | |
| ANTIFUNGALS | REZZAYO | NON PREFERRED | ||
| ANTIFUNGALS | SPORANOX | NON PREFERRED | ||
| ANTIFUNGALS | TERBINAFINE HCL | GENERIC | ||
| ANTIFUNGALS | TERBINAFINE HYDROCHLORIDE | GENERIC | ||
| ANTIFUNGALS | VFEND IV | NON PREFERRED | PA | |
| ANTIFUNGALS | VFEND | NON PREFERRED | PA | |
| ANTIFUNGALS | VIVJOA | NON PREFERRED | PA | |
| ANTIFUNGALS | VORICONAZOLE | GENERIC | PA | |
| ANTIFUNGALS | VORICONAZOLE | NON PREFERRED | PA | |
| ANTIHISTAMINES | BROMPHENIRAMINE MALEATE | NON PREFERRED | ||
| ANTIHISTAMINES | BROMPHENIRAMINE | EXCLUDED | ||
| ANTIHISTAMINES | BROMPHENIRAMINE MALEATE | EXCLUDED | ||
| ANTIHISTAMINES | CARBINOXAMINE MALEATE | GENERIC | ||
| ANTIHISTAMINES | CARBINOXAMINE MALEATE ER | GENERIC | ||
| ANTIHISTAMINES | CARBZAH | GENERIC | ||
| ANTIHISTAMINES | CETIRIZINE HYDROCHLORIDE | GENERIC | ||
| ANTIHISTAMINES | CHLORPHENIRAMINE MALEATE | NON PREFERRED | ||
| ANTIHISTAMINES | CLARINEX | NON PREFERRED | ||
| ANTIHISTAMINES | CLEMASTINE FUMARATE | GENERIC | ||
| ANTIHISTAMINES | CLEMSZA | EXCLUDED | ||
| ANTIHISTAMINES | CYPROHEPTADINE HCL | GENERIC | ||
| ANTIHISTAMINES | CYPROHEPTADINE HYDROCHLOR | GENERIC | ||
| ANTIHISTAMINES | CYPROHEPTADINE HYDROCHLOR | EXCLUDED | ||
| ANTIHISTAMINES | DESLORATADINE ODT | GENERIC | ||
| ANTIHISTAMINES | DESLORATADINE | GENERIC | ||
| ANTIHISTAMINES | DIPHENHYDRAMINE HCL | GENERIC | ||
| ANTIHISTAMINES | DIPHENHYDRAMINE HYDROCHLO | GENERIC | ||
| ANTIHISTAMINES | DOXYLAMINE SUCCINATE | NON PREFERRED | ||
| ANTIHISTAMINES | KARBINAL ER | NON PREFERRED | ||
| ANTIHISTAMINES | LEVOCETIRIZINE DIHYDROCHL | GENERIC | ||
| ANTIHISTAMINES | PHENERGAN | NON PREFERRED | ||
| ANTIHISTAMINES | PROMETHAZINE HCL | GENERIC | ||
| ANTIHISTAMINES | PROMETHAZINE HYDROCHLORID | GENERIC | ||
| ANTIHISTAMINES | PROMETHAZINE HYDROCHLORID | EXCLUDED | ||
| ANTIHISTAMINES | PROMETHEGAN | GENERIC | ||
| ANTIHISTAMINES | PYRILAMINE MALEATE | NON PREFERRED | ||
| ANTIHISTAMINES | RYCLORA | EXCLUDED | ||
| ANTIHISTAMINES | TRIPELENNAMINE HCL | NON PREFERRED | ||
| ANTIHYPERLIPIDEMICS | ATORVASTATIN CALCIUM | GENERIC | ||
| ANTIHYPERLIPIDEMICS | CHOLESTYRAMINE | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | CHOLESTYRAMINE | GENERIC | ||
| ANTIHYPERLIPIDEMICS | CHOLESTYRAMINE LIGHT | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | CHOLESTYRAMINE LIGHT | GENERIC | ||
| ANTIHYPERLIPIDEMICS | COLESEVELAM HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERLIPIDEMICS | COLESTID | NON PREFERRED | ||
| ANTIHYPERLIPIDEMICS | COLESTIPOL HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERLIPIDEMICS | CRESTOR | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | EVKEEZA | NON PREFERRED | SP | PA |
| ANTIHYPERLIPIDEMICS | EZETIMIBE | GENERIC | ||
| ANTIHYPERLIPIDEMICS | FENOFIBRATE | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | FENOFIBRATE MICRONIZED | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | FENOFIBRATE | GENERIC | ||
| ANTIHYPERLIPIDEMICS | FENOFIBRATE MICRONIZED | GENERIC | ||
| ANTIHYPERLIPIDEMICS | FENOFIBRIC ACID DR | GENERIC | ||
| ANTIHYPERLIPIDEMICS | FLUVASTATIN | GENERIC | ||
| ANTIHYPERLIPIDEMICS | FLUVASTATIN SODIUM ER | GENERIC | ||
| ANTIHYPERLIPIDEMICS | GEMFIBROZIL | NON PREFERRED | ||
| ANTIHYPERLIPIDEMICS | GEMFIBROZIL | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | GEMFIBROZIL | GENERIC | ||
| ANTIHYPERLIPIDEMICS | ICOSAPENT ETHYL | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | JUXTAPID | EXCLUDED | SP | PA |
| ANTIHYPERLIPIDEMICS | LEQVIO | EXCLUDED | PA | |
| ANTIHYPERLIPIDEMICS | LESCOL XL | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | LIPITOR | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | LIPOFEN | NON PREFERRED | ||
| ANTIHYPERLIPIDEMICS | LIVALO | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | LOPID | NON PREFERRED | ||
| ANTIHYPERLIPIDEMICS | LOVASTATIN | GENERIC | ||
| ANTIHYPERLIPIDEMICS | LOVAZA | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | NEXLIZET | PREFERRED | ||
| ANTIHYPERLIPIDEMICS | NIACIN ER | GENERIC | ||
| ANTIHYPERLIPIDEMICS | NIACIN | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | NIACOR | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | OMEGA-3-ACID ETHYL ESTERS | GENERIC | ||
| ANTIHYPERLIPIDEMICS | PITAVASTATIN CALCIUM | GENERIC | ||
| ANTIHYPERLIPIDEMICS | PRALUENT | EXCLUDED | PA | |
| ANTIHYPERLIPIDEMICS | PRAVASTATIN SODIUM | GENERIC | ||
| ANTIHYPERLIPIDEMICS | PREVALITE | GENERIC | ||
| ANTIHYPERLIPIDEMICS | QUESTRAN | NON PREFERRED | ||
| ANTIHYPERLIPIDEMICS | QUESTRAN LIGHT | NON PREFERRED | ||
| ANTIHYPERLIPIDEMICS | REPATHA | PREFERRED | PA | |
| ANTIHYPERLIPIDEMICS | REPATHA SURECLICK | PREFERRED | PA | |
| ANTIHYPERLIPIDEMICS | ROSUVASTATIN CALCIUM | GENERIC | ||
| ANTIHYPERLIPIDEMICS | ROSUVASTATIN CALCIUM | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | SIMVASTATIN | GENERIC | ||
| ANTIHYPERLIPIDEMICS | TRICOR | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | VASCEPA | PREFERRED | ||
| ANTIHYPERLIPIDEMICS | WELCHOL | NON PREFERRED | ||
| ANTIHYPERLIPIDEMICS | ZETIA | EXCLUDED | ||
| ANTIHYPERLIPIDEMICS | ZOCOR | NON PREFERRED | ||
| ANTIHYPERTENSIVES | ACCUPRIL | NON PREFERRED | ||
| ANTIHYPERTENSIVES | ACCURETIC | NON PREFERRED | ||
| ANTIHYPERTENSIVES | ALISKIREN | GENERIC | ||
| ANTIHYPERTENSIVES | AMLODIPINE/VALSARTAN/HYDR | GENERIC | ||
| ANTIHYPERTENSIVES | AMLODIPINE BESYLATE/BENAZ | GENERIC | ||
| ANTIHYPERTENSIVES | AMLODIPINE/OLMESARTAN MED | GENERIC | ||
| ANTIHYPERTENSIVES | AMLODIPINE BESYLATE/VALSA | GENERIC | ||
| ANTIHYPERTENSIVES | ARBLI | EXCLUDED | ||
| ANTIHYPERTENSIVES | ATACAND HCT | EXCLUDED | ||
| ANTIHYPERTENSIVES | ATACAND | EXCLUDED | ||
| ANTIHYPERTENSIVES | ATENOLOL/CHLORTHALIDONE | GENERIC | ||
| ANTIHYPERTENSIVES | ATENOLOL/CHLORTHALIDONE | EXCLUDED | ||
| ANTIHYPERTENSIVES | AVALIDE | NON PREFERRED | ||
| ANTIHYPERTENSIVES | AVAPRO | NON PREFERRED | ||
| ANTIHYPERTENSIVES | AZOR | EXCLUDED | ||
| ANTIHYPERTENSIVES | BENAZEPRIL HYDROCHLORIDE/ | GENERIC | ||
| ANTIHYPERTENSIVES | BENAZEPRIL HYDROCHLORIDE | EXCLUDED | ||
| ANTIHYPERTENSIVES | BENAZEPRIL HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERTENSIVES | BENICAR HCT | EXCLUDED | ||
| ANTIHYPERTENSIVES | BENICAR | EXCLUDED | ||
| ANTIHYPERTENSIVES | BISOPROLOL FUMARATE/HYDRO | GENERIC | ||
| ANTIHYPERTENSIVES | CANDESARTAN CILEXETIL/HYD | GENERIC | ||
| ANTIHYPERTENSIVES | CANDESARTAN CILEXETIL | GENERIC | ||
| ANTIHYPERTENSIVES | CAPTOPRIL/HYDROCHLOROTHIA | GENERIC | ||
| ANTIHYPERTENSIVES | CAPTOPRIL | GENERIC | ||
| ANTIHYPERTENSIVES | CARDURA | NON PREFERRED | ||
| ANTIHYPERTENSIVES | CLONIDINE HYDROCHLORIDE E | GENERIC | ||
| ANTIHYPERTENSIVES | CLONIDINE HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERTENSIVES | COZAAR | EXCLUDED | ||
| ANTIHYPERTENSIVES | DEMSER | NON PREFERRED | SP | PA |
| ANTIHYPERTENSIVES | DIBENZYLINE | NON PREFERRED | PA | |
| ANTIHYPERTENSIVES | DIOVAN HCT | EXCLUDED | ||
| ANTIHYPERTENSIVES | DIOVAN | EXCLUDED | ||
| ANTIHYPERTENSIVES | Doxazosin Mesylate | GENERIC | ||
| ANTIHYPERTENSIVES | DOXAZOSIN MESYLATE | EXCLUDED | ||
| ANTIHYPERTENSIVES | DOXAZOSIN | GENERIC | ||
| ANTIHYPERTENSIVES | EDARBI | EXCLUDED | ||
| ANTIHYPERTENSIVES | EDARBYCLOR | EXCLUDED | ||
| ANTIHYPERTENSIVES | ENALAPRIL MALEATE/HYDROCH | GENERIC | ||
| ANTIHYPERTENSIVES | ENALAPRIL MALEATE | GENERIC | ||
| ANTIHYPERTENSIVES | ENALAPRIL MALEATE | EXCLUDED | ||
| ANTIHYPERTENSIVES | ENALAPRILAT | GENERIC | ||
| ANTIHYPERTENSIVES | EPLERENONE | GENERIC | ||
| ANTIHYPERTENSIVES | EXFORGE HCT | EXCLUDED | ||
| ANTIHYPERTENSIVES | EXFORGE | EXCLUDED | ||
| ANTIHYPERTENSIVES | FOSINOPRIL SODIUM/HYDROCH | GENERIC | ||
| ANTIHYPERTENSIVES | FOSINOPRIL SODIUM | EXCLUDED | ||
| ANTIHYPERTENSIVES | FOSINOPRIL SODIUM | GENERIC | ||
| ANTIHYPERTENSIVES | GUANFACINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIHYPERTENSIVES | GUANFACINE HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERTENSIVES | HYDRALAZINE HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERTENSIVES | HYDRALAZINE HCL | GENERIC | ||
| ANTIHYPERTENSIVES | HYDRALAZINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIHYPERTENSIVES | HYZAAR | EXCLUDED | ||
| ANTIHYPERTENSIVES | INSPRA | NON PREFERRED | ||
| ANTIHYPERTENSIVES | IRBESARTAN/HYDROCHLOROTHI | GENERIC | ||
| ANTIHYPERTENSIVES | IRBESARTAN | EXCLUDED | ||
| ANTIHYPERTENSIVES | IRBESARTAN | GENERIC | ||
| ANTIHYPERTENSIVES | LISINOPRIL/HYDROCHLOROTHI | EXCLUDED | ||
| ANTIHYPERTENSIVES | LISINOPRIL/HYDROCHLOROTHI | GENERIC | ||
| ANTIHYPERTENSIVES | LISINOPRIL | EXCLUDED | ||
| ANTIHYPERTENSIVES | LISINOPRIL | GENERIC | ||
| ANTIHYPERTENSIVES | LOSARTAN POTASSIUM | GENERIC | ||
| ANTIHYPERTENSIVES | LOSARTAN POTASSIUM/HYDROC | GENERIC | ||
| ANTIHYPERTENSIVES | LOTENSIN HCT | NON PREFERRED | ||
| ANTIHYPERTENSIVES | LOTENSIN | NON PREFERRED | ||
| ANTIHYPERTENSIVES | LOTREL | NON PREFERRED | ||
| ANTIHYPERTENSIVES | METHYLDOPA | GENERIC | ||
| ANTIHYPERTENSIVES | METOPROLOL/HYDROCHLOROTHI | GENERIC | ||
| ANTIHYPERTENSIVES | METYROSINE | GENERIC | SP | PA |
| ANTIHYPERTENSIVES | MICARDIS HCT | EXCLUDED | ||
| ANTIHYPERTENSIVES | MICARDIS | EXCLUDED | ||
| ANTIHYPERTENSIVES | MINOXIDIL | GENERIC | ||
| ANTIHYPERTENSIVES | MOEXIPRIL HYDROCHLORIDE | EXCLUDED | ||
| ANTIHYPERTENSIVES | MOEXIPRIL HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERTENSIVES | NEXICLON XR | EXCLUDED | ||
| ANTIHYPERTENSIVES | NIPRIDE RTU | EXCLUDED | ||
| ANTIHYPERTENSIVES | SODIUM NITROPRUSSIDE/SODI | GENERIC | ||
| ANTIHYPERTENSIVES | OLMESARTAN MEDOXOMIL/AMLO | GENERIC | ||
| ANTIHYPERTENSIVES | OLMESARTAN MEDOXOMIL/HYDR | GENERIC | ||
| ANTIHYPERTENSIVES | OLMESARTAN MEDOXOMIL | GENERIC | ||
| ANTIHYPERTENSIVES | PERINDOPRIL ERBUMINE | GENERIC | ||
| ANTIHYPERTENSIVES | PHENOXYBENZAMINE HYDROCHL | GENERIC | PA | |
| ANTIHYPERTENSIVES | PHENTOLAMINE MESYLATE | GENERIC | ||
| ANTIHYPERTENSIVES | PRAZOSIN HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERTENSIVES | PRAZOSIN HYDROCHLORIDE | NON PREFERRED | ||
| ANTIHYPERTENSIVES | PRESTALIA | EXCLUDED | ||
| ANTIHYPERTENSIVES | QUINAPRIL/HYDROCHLOROTHIA | GENERIC | ||
| ANTIHYPERTENSIVES | QUINAPRIL/HYDROCHLOROTHIA | EXCLUDED | ||
| ANTIHYPERTENSIVES | QUINAPRIL HYDROCHLORIDE | EXCLUDED | ||
| ANTIHYPERTENSIVES | QUINAPRIL HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERTENSIVES | RAMIPRIL | GENERIC | ||
| ANTIHYPERTENSIVES | SODIUM NITROPRUSSIDE | GENERIC | ||
| ANTIHYPERTENSIVES | TEKTURNA | NON PREFERRED | ||
| ANTIHYPERTENSIVES | TELMISARTAN/AMLODIPINE | GENERIC | ||
| ANTIHYPERTENSIVES | TELMISARTAN/HYDROCHLOROTH | GENERIC | ||
| ANTIHYPERTENSIVES | TELMISARTAN | GENERIC | ||
| ANTIHYPERTENSIVES | TENORETIC 100 | NON PREFERRED | ||
| ANTIHYPERTENSIVES | TENORETIC 50 | NON PREFERRED | ||
| ANTIHYPERTENSIVES | TERAZOSIN HYDROCHLORIDE | EXCLUDED | ||
| ANTIHYPERTENSIVES | TERAZOSIN HCL | GENERIC | ||
| ANTIHYPERTENSIVES | TERAZOSIN HYDROCHLORIDE | GENERIC | ||
| ANTIHYPERTENSIVES | TEZRULY | EXCLUDED | ||
| ANTIHYPERTENSIVES | TRANDOLAPRIL/VERAPAMIL HC | GENERIC | ||
| ANTIHYPERTENSIVES | TRANDOLAPRIL | GENERIC | ||
| ANTIHYPERTENSIVES | TRIBENZOR | NON PREFERRED | ||
| ANTIHYPERTENSIVES | TRYVIO | EXCLUDED | ||
| ANTIHYPERTENSIVES | VALSARTAN/HYDROCHLOROTHIA | GENERIC | ||
| ANTIHYPERTENSIVES | VALSARTAN | EXCLUDED | ||
| ANTIHYPERTENSIVES | VALSARTAN | GENERIC | ||
| ANTIHYPERTENSIVES | VASERETIC | NON PREFERRED | ||
| ANTIHYPERTENSIVES | ZESTORETIC | EXCLUDED | ||
| ANTIHYPERTENSIVES | ZESTRIL | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | ATOVAQUONE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | AZACTAM | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | AZTREONAM | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | BACTRIM DS | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | BACTRIM | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | Blujepa | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | CAYSTON | EXCLUDED | SP | PA |
| ANTI-INFECTIVE AGENTS - MISC. | CHLORAMPHENICOL SODIUM SU | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLEOCIN | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLEOCIN PEDIATRIC GRANULE | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLEOCIN PHOSPHATE | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLINDAMYCIN PHOSPHATE IN | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLINDAMYCIN PHOSPHATE/DEX | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLINDAMYCIN HYDROCHLORIDE | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLINDAMYCIN HYDROCHLORIDE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLINDAMYCIN HCL | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLINDAMYCIN PHOSPHATE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLINDAMYCIN PALMITATE HYD | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | CLINDAMYCIN/SODIUM CHLORI | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | COLISTIMETHATE SODIUM | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | COLY-MYCIN M | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | DALVANCE | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | DAPSONE | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | DAPSONE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | DAPTOMYCIN/SODIUM CHLORID | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | DAPTOMYCIN | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | DAPTOMYCIN | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | EMBLAVEO | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | ERTAPENEM SODIUM | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | FIRST-METRONIDAZOLE 50 | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | FIRVANQ | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | FOSFOMYCIN TROMETHAMINE | GENERIC | PA | |
| ANTI-INFECTIVE AGENTS - MISC. | HIPREX | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | IMIPENEM/CILASTATIN | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | IMPAVIDO | NON PREFERRED | PA | |
| ANTI-INFECTIVE AGENTS - MISC. | KIMYRSA | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | LAMPIT | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | LIKMEZ | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | LINCOCIN | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | LINCOMYCIN HYDROCHLORIDE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | LINEZOLID | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | LINEZOLID | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | MACROBID | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | MACRODANTIN | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | ME/NAPHOS/MB/HYO 1 | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | MEPRON | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | MEROPENEM/SODIUM CHLORIDE | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | MEROPENEM | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | MEROPENEM | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | METHENAMINE HIPPURATE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | METHENAMINE MANDELATE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | METRONIDAZOLE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | METRONIDAZOLE | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | METRONIDAZOLE | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | NALIDIXIC ACID | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | NEBUPENT | NON PREFERRED | PA | |
| ANTI-INFECTIVE AGENTS - MISC. | NITAZOXANIDE | GENERIC | PA | |
| ANTI-INFECTIVE AGENTS - MISC. | NITROFURANTOIN MACROCRYST | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | NITROFURANTOIN MONOHYDRAT | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | NITROFURANTOIN | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | NITROFURANTOIN | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | ORBACTIV | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | ORLYNVAH | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | PENTAM 300 | NON PREFERRED | PA | |
| ANTI-INFECTIVE AGENTS - MISC. | PENTAMIDINE ISETHIONATE | GENERIC | PA | |
| ANTI-INFECTIVE AGENTS - MISC. | POLYMYXIN B SULFATE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | POLYMYXIN B SULFATE | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | PRIMAXIN IV | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | RECARBRIO | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | SIVEXTRO | NON PREFERRED | PA | |
| ANTI-INFECTIVE AGENTS - MISC. | SULFAMETHOXAZOLE/TRIMETHO | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | SULFAMETHOXAZOLE/TRIMETHO | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | SULFATRIM PEDIATRIC | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | TINIDAZOLE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | TRIMETHOPRIM | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | TRIMETHOPRIM | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | URELLE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | URETRON D/S | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | URIBEL | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | UROGESIC-BLUE | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | URO-MP | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | VABOMERE | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | VANCOCIN | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | VANCOMYCIN HYDROCHLORIDE/ | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | VANCOMYCIN HYDROCHLORIDE | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | VANCOMYCIN HCL | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | VANCOMYCIN HYDROCHLORIDE | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | VANCOMYCIN HCL | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | VANCOMYCIN | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | VANCOMYCIN HYDROCHLORIDE | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | VANCOMYCIN HCL + SYRSPEND | EXCLUDED | ||
| ANTI-INFECTIVE AGENTS - MISC. | VIBATIV | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | VILAMIT MB | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | VILEVEV MB | GENERIC | ||
| ANTI-INFECTIVE AGENTS - MISC. | XACDURO | NON PREFERRED | ||
| ANTI-INFECTIVE AGENTS - MISC. | XIFAXAN | NON PREFERRED | PA | |
| ANTI-INFECTIVE AGENTS - MISC. | XIFAXAN | PREFERRED | PA | |
| ANTI-INFECTIVE AGENTS - MISC. | ZYVOX | NON PREFERRED | ||
| ANTIMALARIALS | ARAKODA | EXCLUDED | ||
| ANTIMALARIALS | ATOVAQUONE/PROGUANIL HYDR | GENERIC | ||
| ANTIMALARIALS | ATOVAQUONE/PROGUANIL HCL | GENERIC | ||
| ANTIMALARIALS | CHLOROQUINE PHOSPHATE | NON PREFERRED | ||
| ANTIMALARIALS | CHLOROQUINE PHOSPHATE | GENERIC | ||
| ANTIMALARIALS | COARTEM | NON PREFERRED | ||
| ANTIMALARIALS | DARAPRIM | EXCLUDED | PA | |
| ANTIMALARIALS | HYDROXYCHLOROQUINE SULFAT | GENERIC | ||
| ANTIMALARIALS | HYDROXYCHLOROQUINE SULFAT | EXCLUDED | ||
| ANTIMALARIALS | KRINTAFEL | EXCLUDED | ||
| ANTIMALARIALS | MALARONE | NON PREFERRED | ||
| ANTIMALARIALS | MEFLOQUINE HYDROCHLORIDE | GENERIC | ||
| ANTIMALARIALS | MEPACRINE DIHYDROCHLORIDE | NON PREFERRED | ||
| ANTIMALARIALS | PLAQUENIL | NON PREFERRED | ||
| ANTIMALARIALS | PRIMAQUINE PHOSPHATE | GENERIC | ||
| ANTIMALARIALS | PRIMAQUINE PHOSPHATE | NON PREFERRED | ||
| ANTIMALARIALS | PYRIMETHAMINE/LEUCOVORIN | EXCLUDED | ||
| ANTIMALARIALS | PYRIMETHAMINE | GENERIC | PA | |
| ANTIMALARIALS | QUINACRINE DIHYDROCHLORID | NON PREFERRED | ||
| ANTIMALARIALS | QUINACRINE HYDROCHLORIDE | NON PREFERRED | ||
| ANTIMALARIALS | QUININE SULFATE | GENERIC | ||
| ANTIMALARIALS | QUININE SULFATE DIHYDRATE | NON PREFERRED | ||
| ANTIMALARIALS | SOVUNA | EXCLUDED | ||
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | BLOXIVERZ | NON PREFERRED | ||
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | BLOXIVERZ | EXCLUDED | ||
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | FIRDAPSE | NON PREFERRED | SP | PA |
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | MESTINON | NON PREFERRED | ||
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | NEOSTIGMINE METHYLSULFATE | GENERIC | ||
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | NEOSTIGMINE METHYLSULFATE | NON PREFERRED | ||
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | NEOSTIGMINE METHYLSULFATE | EXCLUDED | ||
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | PYRIDOSTIGMINE BROMIDE | GENERIC | ||
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | PYRIDOSTIGMINE BROMIDE | EXCLUDED | ||
| ANTIMYASTHENIC/CHOLINERGIC AGENTS | REGONOL | NON PREFERRED | ||
| ANTIMYCOBACTERIAL AGENTS | AMINOSALICYLIC ACID | NON PREFERRED | ||
| ANTIMYCOBACTERIAL AGENTS | CYCLOSERINE | GENERIC | PA | |
| ANTIMYCOBACTERIAL AGENTS | ETHAMBUTOL HCL | NON PREFERRED | ||
| ANTIMYCOBACTERIAL AGENTS | ETHAMBUTOL HYDROCHLORIDE | GENERIC | ||
| ANTIMYCOBACTERIAL AGENTS | ISONIAZID | GENERIC | ||
| ANTIMYCOBACTERIAL AGENTS | ISONIAZID | NON PREFERRED | ||
| ANTIMYCOBACTERIAL AGENTS | ISONIAZID | EXCLUDED | ||
| ANTIMYCOBACTERIAL AGENTS | PRETOMANID | NON PREFERRED | PA | |
| ANTIMYCOBACTERIAL AGENTS | PRIFTIN | NON PREFERRED | ||
| ANTIMYCOBACTERIAL AGENTS | PYRAZINAMIDE | GENERIC | ||
| ANTIMYCOBACTERIAL AGENTS | RIFABUTIN | GENERIC | ||
| ANTIMYCOBACTERIAL AGENTS | RIFAMPIN | EXCLUDED | ||
| ANTIMYCOBACTERIAL AGENTS | RIFAMPIN | GENERIC | ||
| ANTIMYCOBACTERIAL AGENTS | RIFAMPIN/SYRSPEND SF PH4 | EXCLUDED | ||
| ANTIMYCOBACTERIAL AGENTS | SIRTURO | NON PREFERRED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ABIRATERONE ACETATE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ABIRTEGA | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ABRAXANE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ACTIMMUNE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ADCETRIS | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ADRIAMYCIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ADSTILADRIN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AFINITOR DISPERZ | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AFINITOR | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AKEEGA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ALECENSA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ALIMTA | EXCLUDED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ALUNBRIG | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ALYMSYS | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ANASTROZOLE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ANKTIVA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ARIMIDEX | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AROMASIN | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ARRANON | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ARSENIC TRIOXIDE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ARZERRA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ASPARLAS | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AUGTYRO | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AVASTIN | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AVGEMSI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AVMAPKI FAKZYNJA CO-PACK | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AXTLE | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AYVAKIT | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | AZACITIDINE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BALVERSA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BAVENCIO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BELEODAQ | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BELRAPZO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BENDAMUSTINE HYDROCHLORID | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BENDAMUSTINE HYDROCHLORID | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BENDEKA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BESPONSA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BESREMI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BEXAROTENE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BICALUTAMIDE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BIZENGRI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BLEOMYCIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BLINCYTO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BORTEZOMIB | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BORTEZOMIB | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BORUZU | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BOSULIF | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BRAFTOVI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BRUKINSA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BUSULFAN | GENERIC | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | BUSULFEX | NON PREFERRED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CABOMETYX | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CALQUENCE | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CAMCEVI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CAMPTOSAR | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CAPECITABINE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CAPRELSA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CARBOPLATIN | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CARMUSTINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CASODEX | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CISPLATIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CISPLATIN | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CLADRIBINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CLOFARABINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | COLUMVI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | COMETRIQ | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | COPIKTRA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | COSELA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | COTELLIC | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CYCLOPHOSPHAMIDE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CYCLOPHOSPHAMIDE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CYCLOPHOSPHAMIDE | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CYRAMZA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | CYTARABINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DACARBAZINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DACTINOMYCIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DANYELZA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DANZITEN | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DARZALEX FASPRO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DARZALEX | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DASATINIB | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DATROWAY | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DAUNORUBICIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DAUNORUBICIN | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DAURISMO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DECITABINE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DEXRAZOXANE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DOCETAXEL | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DOCETAXEL | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DOCIVYX | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DOXIL | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DOXORUBICIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | DOXORUBICIN | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ELAHERE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ELIGARD | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ELITEK | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ELLENCE | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ELREXFIO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ELZONRIS | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | EMPLICITI | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | EMRELIS | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ENHERTU | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ENSACOVE | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | EPKINLY | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ERBITUX | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ERIBULIN MESYLATE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ERIVEDGE | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ERLEADA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ERLOTINIB HYDROCHLORIDE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ETOPOPHOS | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ETOPOSIDE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | EULEXIN | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | EVEROLIMUS | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | EVOMELA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | EXEMESTANE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FARESTON | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FASLODEX | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FEMARA | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FIRMAGON | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FLOXURIDINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FLUDARABINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FLUOROURACIL | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FOLOTYN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FOTIVDA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FRINDOVYX | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FRUZAQLA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FULVESTRANT | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | FYARRO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GAVRETO | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GAZYVA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GEFITINIB | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GEMCITABINE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GEMCITABINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GEMCITABINE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GILOTRIF | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GLEEVEC | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GLEOSTINE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GLIADEL WAFER | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GOMEKLI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | GRAFAPEX | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HALAVEN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HEPZATO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HERCEPTIN HYLECTA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HERCEPTIN | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HERCESSI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HERNEXEOS | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HERZUMA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HYCAMTIN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HYCAMTIN | NON PREFERRED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HYDREA | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | HYDROXYUREA | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IBRANCE | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IBTROZI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ICLUSIG | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IDAMYCIN | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IDARUBICIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IDHIFA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IFEX | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IFOSFAMIDE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IFOSFAMIDE | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IMATINIB MESYLATE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IMBRUVICA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IMDELLTRA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IMFINZI | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IMJUDO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IMKELDI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | INLEXZO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | INLYTA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | INQOVI | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | INREBIC | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IRESSA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IRINOTECAN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ISTODAX | NON PREFERRED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ITOVEBI | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IVRA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IWILFIN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | IXEMPRA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | JAKAFI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | JAYPIRCA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | JELMYTO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | JEMPERLI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | JEVTANA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | JOBEVNE | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | JYLAMVO | NON PREFERRED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KADCYLA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KANJINTI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KEPIVANCE | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KEYTRUDA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KHAPZORY | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KIMMTRAK | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KISQALI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KOSELUGO | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KRAZATI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KYPROLIS | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | KYXATA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LAPATINIB DITOSYLATE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LAZCLUZE | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LENVIMA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LETROZOLE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LEUCOVORIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LEUCOVORIN CALCIUM | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LEUKERAN | NON PREFERRED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LEUPROLIDE ACETATE/BUPIVA | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LEUPROLIDE ACETATE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LEVAMISOLE HCL | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LEVOLEUCOVORIN CALCIUM | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LIBTAYO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LONSURF | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LOQTORZI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LORBRENA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LUMAKRAS | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LUNSUMIO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LUPRON DEPOT | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LUPRON DEPOT | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LUTATHERA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LUTRATE DEPOT | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LYNOZYFIC | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LYNOZYFIC | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LYNPARZA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LYSODREN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | LYTGOBI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MARGENZA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MATULANE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MEGESTROL ACETATE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MEGESTROL ACETATE | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MEKINIST | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MEKTOVI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MELPHALAN HYDROCHLORIDE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MERCAPTOPURINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MERCAPTOPURINE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MESNA | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MESNEX | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | METHOTREXATE | EXCLUDED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | METHOTREXATE | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | METHOTREXATE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | METHOTREXATE | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | METHOTREXATE SODIUM | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | METHOTREXATE SODIUM | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MITOMYCIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MUTAMYCIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MITOMYCIN | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MITOXANTRONE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MODEYSO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MONJUVI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MVASI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MYLERAN | NON PREFERRED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | MYLOTARG | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NELARABINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NERLYNX | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NEXAVAR | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NILANDRON | EXCLUDED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NILOTINIB | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NILOTINIB | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NILUTAMIDE | GENERIC | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NINLARO | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NIPENT | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | NUBEQA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ODOMZO | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | OGIVRI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | OGSIVEO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | OJEMDA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | OJJAARA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | OMISIRGE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ONCASPAR | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ONIVYDE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ONTRUZANT | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ONUREG | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | OPDIVO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | OPDIVO QVANTIG | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | OPDUALAG | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ORGOVYX | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ORSERDU | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | OXALIPLATIN | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PACLITAXEL | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PACLITAXEL PROTEIN-BOUND | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PACLITAXEL PROTEIN-BOUND | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PADCEV | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PAZOPANIB HYDROCHLORIDE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PEDMARK | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PEMAZYRE | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PEMETREXED | EXCLUDED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PEMETREXED | GENERIC | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PEMETREXED | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PEMETREXED | EXCLUDED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PEMFEXY | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PEMRYDI RTU | EXCLUDED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PERJETA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PHESGO | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PHOTOFRIN | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PHYRAGO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PIQRAY | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PLUVICTO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | POLIVY | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | POMALYST | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PORTRAZZA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | POTELIGEO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PROLEUKIN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | PURIXAN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | QINLOCK | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RETEVMO | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | REVUFORJ | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | REZLIDHIA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RIABNI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RITUXAN | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RITUXAN HYCELA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ROMIDEPSIN | GENERIC | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ROMVIMZA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ROZLYTREK | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RUBRACA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RUXIENCE | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RYBREVANT | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RYDAPT | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RYLAZE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | RYTELO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | SARCLISA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | SCEMBLIX | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | SOLTAMOX | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | SORAFENIB | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | SPRYCEL | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | STIVARGA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | STRONTIUM CHLORIDE SR-89 | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | SUNITINIB MALATE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | SUTENT | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TABLOID | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TABRECTA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TAFINLAR | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TAGRISSO | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TALVEY | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TALZENNA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TAMOXIFEN CITRATE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TARCEVA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TARGRETIN | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TASIGNA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TAZVERIK | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TECENTRIQ | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TECENTRIQ HYBREZA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TECVAYLI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TEMODAR (INJECTABLE) | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TEMOZOLOMIDE | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TEMSIROLIMUS | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TEPADINA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TEPMETKO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TEPYLUTE | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TEVIMBRA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | THIOTEPA | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TIBSOVO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TICE BCG | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TIVDAK | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TOPOTECAN HCL | GENERIC | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TOPOTECAN HCL | NON PREFERRED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TOREMIFENE CITRATE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TORISEL | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TORPENZ | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TRAZIMERA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TREANDA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TRELSTAR MIXJECT | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TRETINOIN | GENERIC | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TRISENOX | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TRODELVY | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TRUQAP | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TRUXIMA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TUKYSA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TURALIO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | TYKERB | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | UNITUXIN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | UNLOXCYT | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | UVADEX | NON PREFERRED | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VABRINTY | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VALRUBICIN | GENERIC | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VALSTAR | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VANFLYTA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VECTIBIX | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VEGZELMA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VELCADE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VENCLEXTA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VERZENIO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VIDAZA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VINBLASTINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VINCRISTINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VINORELBINE | GENERIC | ||
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VITRAKVI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VIVIMUSTA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VIZIMPRO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VONJO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VORANIGO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VORAXAZE | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VOTRIENT | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VYLOY | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | VYXEOS | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | WELIREG | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | XALKORI | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | XALKORI | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | XATMEP | NON PREFERRED | PA | |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | XELODA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | XOFIGO | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | XOSPATA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | XPOVIO | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | XTANDI | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | YERVOY | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | YONDELIS | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | YONSA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZALTRAP | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZEJULA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZELBORAF | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZEPZELCA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZEVALIN | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZIIHERA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZIRABEV | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZOLADEX | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZOLINZA | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZUSDURI | NON PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZYDELIG | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZYKADIA | PREFERRED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZYNLONTA | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZYNYZ | EXCLUDED | SP | PA |
| ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES | ZYTIGA | EXCLUDED | SP | PA |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | AMANTADINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | AMANTADINE HCL | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | AMANTADINE HYDROCHLORIDE | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | APOKYN | EXCLUDED | SP | PA |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | APOMORPHINE | GENERIC | SP | PA |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | AZILECT | NON PREFERRED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | BENZTROPINE MESYLATE | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | BENZTROPINE MESYLATE | EXCLUDED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | BROMOCRIPTINE MESYLATE | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | BROMOCRIPTINE MESYLATE | NON PREFERRED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | CARBIDOPA/LEVODOPA/ENTACA | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | CARBIDOPA/LEVODOPA ER | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | CARBIDOPA/LEVODOPA ODT | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | CARBIDOPA/LEVODOPA | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | CARBIDOPA | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | CREXONT | PREFERRED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | DHIVY | NON PREFERRED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | DUOPA | NON PREFERRED | SP | PA |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | ENTACAPONE | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | INBRIJA | PREFERRED | SP | PA |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | LEVODOPA | NON PREFERRED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | LODOSYN | NON PREFERRED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | NEUPRO | PREFERRED | PA | |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | NOURIANZ | EXCLUDED | PA | |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | ONAPGO | EXCLUDED | SP | PA |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | ONGENTYS | EXCLUDED | PA | |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | PARLODEL | NON PREFERRED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | PRAMIPEXOLE DIHYDROCHLORI | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | RASAGILINE MESYLATE | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | ROPINIROLE HYDROCHLORIDE | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | ROPINIROLE HCL | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | ROPINIROLE ER | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | RYTARY | PREFERRED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | SELEGILINE HCL | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | SELEGILINE HYDROCHLORIDE | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | SELEGILINE HYDROCHLORIDE | EXCLUDED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | SINEMET | NON PREFERRED | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | TASMAR | NON PREFERRED | PA | |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | TOLCAPONE | GENERIC | PA | |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | TRIHEXYPHENIDYL HCL | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | TRIHEXYPHENIDYL HYDROCHLO | GENERIC | ||
| ANTIPARKINSON AND RELATED THERAPY AGENTS | VYALEV | EXCLUDED | SP | PA |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | XADAGO | EXCLUDED | PA | |
| ANTIPARKINSON AND RELATED THERAPY AGENTS | ZELAPAR | NON PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ABILIFY ASIMTUFII | PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | Abilify Asimtufii | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ABILIFY MAINTENA | PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ABILIFY MYCITE MAINTENANC | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ABILIFY MYCITE STARTER KI | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ABILIFY | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ARIPIPRAZOLE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ARISTADA | NON PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ARISTADA INITIO | NON PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ASENAPINE MALEATE SL | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | CAPLYTA | NON PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | CHLORPROMAZINE HCL | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | CHLORPROMAZINE HYDROCHLOR | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | CHLORPROMAZINE HYDROCHLOR | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | CLOZAPINE ODT | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | CLOZAPINE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | CLOZARIL | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | COBENFY | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | COBENFY STARTER PACK | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | COMPRO | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | EQUETRO | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ERZOFRI | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | FANAPT TITRATION PACK A | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | FANAPT TITRATION PACK B | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | FANAPT TITRATION PACK C | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | FANAPT | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | FLUPHENAZINE DECANOATE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | FLUPHENAZINE HCL | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | FLUPHENAZINE HYDROCHLORID | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | GEODON | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | HALOPERIDOL DECANOATE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | HALOPERIDOL LACTATE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | HALOPERIDOL | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | INVEGA HAFYERA | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | INVEGA SUSTENNA | NON PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | INVEGA | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | INVEGA TRINZA | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LATUDA | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LITHIUM CARBONATE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LITHIUM CARBONATE | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LITHIUM CARBONATE ER | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LITHIUM | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LITHOBID | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LOXAPINE | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LOXAPINE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LOXAPINE SUCCINATE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | LURASIDONE HYDROCHLORIDE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | MOLINDONE HYDROCHLORIDE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | NUPLAZID | NON PREFERRED | SP | PA |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | OLANZAPINE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | OLANZAPINE | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | OPIPZA | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | PALIPERIDONE ER | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | PERPHENAZINE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | PROCHLORPERAZINE EDISYLAT | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | PROCHLORPERAZINE MALEATE | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | PROCHLORPERAZINE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | PROCHLORPERAZINE MALEATE | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | PROCHLORPERAZINE MALEATE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | QUETIAPINE FUMARATE ER | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | QUETIAPINE FUMARATE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | REXULTI | NON PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | RISPERDAL CONSTA | NON PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | RISPERDAL | NON PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | RISPERIDONE ER | GENERIC | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | RISPERIDONE ODT | GENERIC | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | RISPERIDONE ODT | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | RISPERIDONE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | RYKINDO | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | SAPHRIS | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | SECUADO | EXCLUDED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | SEROQUEL | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | SEROQUEL XR | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | THIORIDAZINE HYDROCHLORID | EXCLUDED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | THIORIDAZINE HYDROCHLORID | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | THIOTHIXENE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | TRIFLUOPERAZINE HCL | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | TRIFLUOPERAZINE HYDROCHLO | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | VERSACLOZ | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | VRAYLAR | PREFERRED | PA | |
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ZIPRASIDONE HCL | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ZIPRASIDONE HYDROCHLORIDE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ZIPRASIDONE MESYLATE | GENERIC | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ZYPREXA | NON PREFERRED | ||
| ANTIPSYCHOTICS/ANTIMANIC AGENTS | ZYPREXA RELPREVV | NON PREFERRED | PA | |
| ANTIVIRALS | ABACAVIR/LAMIVUDINE | GENERIC | ||
| ANTIVIRALS | ABACAVIR | GENERIC | ||
| ANTIVIRALS | ACYCLOVIR | GENERIC | ||
| ANTIVIRALS | ACYCLOVIR SODIUM | GENERIC | ||
| ANTIVIRALS | ACYCLOVIR SODIUM/SODIUM C | EXCLUDED | ||
| ANTIVIRALS | ADEFOVIR DIPIVOXIL | GENERIC | PA | |
| ANTIVIRALS | Apretude | NON PREFERRED | PA | |
| ANTIVIRALS | APRETUDE | PREFERRED | PA | |
| ANTIVIRALS | APTIVUS | EXCLUDED | ||
| ANTIVIRALS | ATAZANAVIR SULFATE | GENERIC | ||
| ANTIVIRALS | BARACLUDE | NON PREFERRED | PA | |
| ANTIVIRALS | BARACLUDE | EXCLUDED | PA | |
| ANTIVIRALS | BIKTARVY | PREFERRED | ||
| ANTIVIRALS | Cabenuva | PREFERRED | PA | |
| ANTIVIRALS | CIDOFOVIR | GENERIC | ||
| ANTIVIRALS | CIMDUO | PREFERRED | ||
| ANTIVIRALS | COMPLERA | EXCLUDED | ||
| ANTIVIRALS | DARUNAVIR | GENERIC | ||
| ANTIVIRALS | DELSTRIGO | EXCLUDED | ||
| ANTIVIRALS | DESCOVY | PREFERRED | ||
| ANTIVIRALS | DOVATO | PREFERRED | ||
| ANTIVIRALS | EDURANT | EXCLUDED | ||
| ANTIVIRALS | EFAVIRENZ/LAMIVUDINE/TENOFOVIR | GENERIC | ||
| ANTIVIRALS | EFAVIRENZ-EMTRICITABINE-TENOFOVIR DISOPROXIL | GENERIC | ||
| ANTIVIRALS | EFAVIRENZ | GENERIC | ||
| ANTIVIRALS | EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE | GENERIC | ||
| ANTIVIRALS | EMTRICITABINE-RILPIVIRINE-TENOFOVIR DISOPROXIL FUM | GENERIC | ||
| ANTIVIRALS | EMTRICITABINE | GENERIC | ||
| ANTIVIRALS | EMTRIVA | NON PREFERRED | ||
| ANTIVIRALS | ENTECAVIR | GENERIC | PA | |
| ANTIVIRALS | EPCLUSA | PREFERRED | SP | PA |
| ANTIVIRALS | EPIVIR | NON PREFERRED | ||
| ANTIVIRALS | ETRAVIRINE | GENERIC | ||
| ANTIVIRALS | EVOTAZ | NON PREFERRED | ||
| ANTIVIRALS | FAMCICLOVIR | GENERIC | ||
| ANTIVIRALS | FOSAMPRENAVIR | GENERIC | ||
| ANTIVIRALS | FOSCARNET SODIUM | GENERIC | ||
| ANTIVIRALS | FOSCAVIR | NON PREFERRED | ||
| ANTIVIRALS | FUZEON | NON PREFERRED | PA | |
| ANTIVIRALS | GANCICLOVIR | EXCLUDED | ||
| ANTIVIRALS | GANCICLOVIR | GENERIC | ||
| ANTIVIRALS | GENVOYA | PREFERRED | ||
| ANTIVIRALS | HARVONI | PREFERRED | SP | PA |
| ANTIVIRALS | INTELENCE | EXCLUDED | ||
| ANTIVIRALS | ISENTRESS | PREFERRED | ||
| ANTIVIRALS | ISENTRESS HD | PREFERRED | ||
| ANTIVIRALS | JULUCA | NON PREFERRED | ||
| ANTIVIRALS | KALETRA | NON PREFERRED | ||
| ANTIVIRALS | KALETRA | EXCLUDED | ||
| ANTIVIRALS | LAGEVRIO | NON PREFERRED | ||
| ANTIVIRALS | LAMIVUDINE/ZIDOVUDINE | GENERIC | ||
| ANTIVIRALS | LAMIVUDINE | GENERIC | ||
| ANTIVIRALS | LAMIVUDINE | GENERIC | PA | |
| ANTIVIRALS | LIVTENCITY | NON PREFERRED | SP | PA |
| ANTIVIRALS | LOPINAVIR/RITONAVIR | GENERIC | ||
| ANTIVIRALS | MARAVIROC | GENERIC | ||
| ANTIVIRALS | MAVYRET | EXCLUDED | SP | PA |
| ANTIVIRALS | NEVIRAPINE | GENERIC | ||
| ANTIVIRALS | NEVIRAPINE ER | GENERIC | ||
| ANTIVIRALS | NORVIR | EXCLUDED | ||
| ANTIVIRALS | ODEFSEY | PREFERRED | ||
| ANTIVIRALS | OSELTAMIVIR PHOSPHATE | GENERIC | ||
| ANTIVIRALS | PAPZIMEOS | NON PREFERRED | SP | PA |
| ANTIVIRALS | PAXLOVID | PREFERRED | ||
| ANTIVIRALS | PEGASYS | NON PREFERRED | SP | PA |
| ANTIVIRALS | PIFELTRO | EXCLUDED | ||
| ANTIVIRALS | PREVYMIS | NON PREFERRED | PA | |
| ANTIVIRALS | PREZCOBIX | NON PREFERRED | ||
| ANTIVIRALS | PREZISTA | EXCLUDED | ||
| ANTIVIRALS | RAPIVAB | NON PREFERRED | ||
| ANTIVIRALS | RELENZA DISKHALER | PREFERRED | ||
| ANTIVIRALS | RETROVIR | NON PREFERRED | ||
| ANTIVIRALS | RETROVIR IV | NON PREFERRED | ||
| ANTIVIRALS | REYATAZ | EXCLUDED | ||
| ANTIVIRALS | RIBAVIRIN | GENERIC | SP | PA |
| ANTIVIRALS | RIBAVIRIN | GENERIC | PA | |
| ANTIVIRALS | RIMANTADINE HYDROCHLORIDE | GENERIC | ||
| ANTIVIRALS | RITONAVIR | GENERIC | ||
| ANTIVIRALS | RUKOBIA | NON PREFERRED | ||
| ANTIVIRALS | SELZENTRY | EXCLUDED | ||
| ANTIVIRALS | SOVALDI | NON PREFERRED | SP | PA |
| ANTIVIRALS | STRIBILD | NON PREFERRED | ||
| ANTIVIRALS | SUNLENCA INJ | EXCLUDED | PA | |
| ANTIVIRALS | SUNLENCA | EXCLUDED | ||
| ANTIVIRALS | SYMFI | NON PREFERRED | ||
| ANTIVIRALS | SYMTUZA | PREFERRED | ||
| ANTIVIRALS | TAMIFLU | NON PREFERRED | ||
| ANTIVIRALS | TEMBEXA | NON PREFERRED | ||
| ANTIVIRALS | TENOFOVIR DISOPROXIL FUMA | GENERIC | ||
| ANTIVIRALS | TIVICAY | PREFERRED | ||
| ANTIVIRALS | TPOXX | NON PREFERRED | ||
| ANTIVIRALS | TRIUMEQ | PREFERRED | ||
| ANTIVIRALS | TROGARZO | NON PREFERRED | PA | |
| ANTIVIRALS | TRUVADA | EXCLUDED | ||
| ANTIVIRALS | TYBOST | NON PREFERRED | ||
| ANTIVIRALS | VALACYCLOVIR HYDROCHLORID | GENERIC | ||
| ANTIVIRALS | VALCYTE | EXCLUDED | ||
| ANTIVIRALS | VALGANCICLOVIR HYDROCHLOR | GENERIC | ||
| ANTIVIRALS | VALGANCICLOVIR | GENERIC | ||
| ANTIVIRALS | valGANciclovir HCl | GENERIC | ||
| ANTIVIRALS | VALTREX | EXCLUDED | ||
| ANTIVIRALS | VEKLURY | NON PREFERRED | PA | |
| ANTIVIRALS | VEMLIDY | EXCLUDED | PA | |
| ANTIVIRALS | VIRACEPT | EXCLUDED | ||
| ANTIVIRALS | VIREAD | NON PREFERRED | ||
| ANTIVIRALS | Vocabria | EXCLUDED | SP | PA |
| ANTIVIRALS | VOSEVI | PREFERRED | SP | PA |
| ANTIVIRALS | XOFLUZA | EXCLUDED | ||
| ANTIVIRALS | YEZTUGO | EXCLUDED | PA | |
| ANTIVIRALS | YEZTUGO | EXCLUDED | ||
| ANTIVIRALS | ZEPATIER | EXCLUDED | SP | PA |
| ANTIVIRALS | ZIAGEN | NON PREFERRED | ||
| ANTIVIRALS | ZIDOVUDINE | GENERIC | ||
| BETA BLOCKERS | ACEBUTOLOL HYDROCHLORIDE | GENERIC | ||
| BETA BLOCKERS | ACEBUTOLOL HCL | NON PREFERRED | ||
| BETA BLOCKERS | ATENOLOL | NON PREFERRED | ||
| BETA BLOCKERS | ATENOLOL/SYRSPEND SF PH4 | EXCLUDED | ||
| BETA BLOCKERS | ATENOLOL | GENERIC | ||
| BETA BLOCKERS | BETAPACE AF | EXCLUDED | ||
| BETA BLOCKERS | BETAXOLOL HCL | GENERIC | ||
| BETA BLOCKERS | BISOPROLOL FUMARATE | GENERIC | ||
| BETA BLOCKERS | BISOPROLOL FUMARATE | EXCLUDED | ||
| BETA BLOCKERS | BREVIBLOC PREMIXED DOUBLE | NON PREFERRED | ||
| BETA BLOCKERS | BREVIBLOC | NON PREFERRED | ||
| BETA BLOCKERS | BREVIBLOC PREMIXED | NON PREFERRED | ||
| BETA BLOCKERS | BYSTOLIC | EXCLUDED | ||
| BETA BLOCKERS | CARVEDILOL | GENERIC | ||
| BETA BLOCKERS | COREG | NON PREFERRED | ||
| BETA BLOCKERS | ESMOLOL HYDROCHLORIDE | EXCLUDED | ||
| BETA BLOCKERS | ESMOLOL HCL | GENERIC | ||
| BETA BLOCKERS | ESMOLOL HYDROCHLORIDE IN | NON PREFERRED | ||
| BETA BLOCKERS | ESMOLOL HYDROCHLORIDE IN | GENERIC | ||
| BETA BLOCKERS | ESMOLOL HYDROCHLORIDE/SOD | GENERIC | ||
| BETA BLOCKERS | HEMANGEOL | NON PREFERRED | PA | |
| BETA BLOCKERS | INDERAL LA | EXCLUDED | ||
| BETA BLOCKERS | KAPSPARGO SPRINKLE | EXCLUDED | ||
| BETA BLOCKERS | LABETALOL HYDROCHLORIDE | GENERIC | ||
| BETA BLOCKERS | LABETALOL HYDROCHLORIDE | EXCLUDED | ||
| BETA BLOCKERS | LABETALOL HYDROCHLORIDE | NON PREFERRED | ||
| BETA BLOCKERS | LOPRESSOR | EXCLUDED | ||
| BETA BLOCKERS | LOPRESSOR | NON PREFERRED | ||
| BETA BLOCKERS | METOPROLOL SUCCINATE ER | GENERIC | ||
| BETA BLOCKERS | METOPROLOL TARTRATE | GENERIC | ||
| BETA BLOCKERS | METOPROLOL TARTRATE | NON PREFERRED | ||
| BETA BLOCKERS | NADOLOL | NON PREFERRED | ||
| BETA BLOCKERS | NADOLOL | GENERIC | ||
| BETA BLOCKERS | NEBIVOLOL HYDROCHLORIDE | EXCLUDED | ||
| BETA BLOCKERS | NEBIVOLOL HYDROCHLORIDE | GENERIC | ||
| BETA BLOCKERS | PINDOLOL | GENERIC | ||
| BETA BLOCKERS | PROPRANOLOL HYDROCHLORIDE | GENERIC | ||
| BETA BLOCKERS | Propranolol HCl | GENERIC | ||
| BETA BLOCKERS | RAPIBLYK | EXCLUDED | ||
| BETA BLOCKERS | SOTALOL HCL (AF) | GENERIC | ||
| BETA BLOCKERS | SOTALOL HYDROCHLORIDE (AF | GENERIC | ||
| BETA BLOCKERS | SOTALOL HCL AF | GENERIC | ||
| BETA BLOCKERS | SOTALOL HYDROCHLORIDE AF | GENERIC | ||
| BETA BLOCKERS | SOTALOL HYDROCHLORIDE | NON PREFERRED | ||
| BETA BLOCKERS | SOTALOL HCL | GENERIC | ||
| BETA BLOCKERS | SOTALOL HYDROCHLORIDE | GENERIC | ||
| BETA BLOCKERS | SOTYLIZE | NON PREFERRED | ||
| BETA BLOCKERS | TENORMIN | NON PREFERRED | ||
| BETA BLOCKERS | TIMOLOL MALEATE | GENERIC | ||
| BETA BLOCKERS | TOPROL XL | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | AMLODIPINE BESYLATE/SYRSP | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | AMLODIPINE BESYLATE | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | CARDENE IV | NON PREFERRED | ||
| CALCIUM CHANNEL BLOCKERS | CARDIZEM LA | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | CARDIZEM | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | CARTIA XT | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | CLEVIPREX | NON PREFERRED | ||
| CALCIUM CHANNEL BLOCKERS | CONJUPRI | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HYDROCHLORIDE/S | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HYDROCHLORIDE E | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HCL ER | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HYDROCHLORIDE E | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HCL | NON PREFERRED | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HYDROCHLORIDE | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HCL | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HCL ER | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HYDROCHLORIDE | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | DILTIAZEM HYDROCHLORIDE/D | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | DILT-XR | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | FELODIPINE ER | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | FELODIPINE ER | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | ISRADIPINE | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | KATERZIA | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | LEVAMLODIPINE | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | MATZIM LA | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | NICARDIPINE HCL | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | NICARDIPINE HYDROCHLORIDE | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | niCARdipine HCl in NaCl | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | NICARDIPINE HYDROCHLORIDE | NON PREFERRED | ||
| CALCIUM CHANNEL BLOCKERS | NICARDIPINE HYDROCHLORIDE | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | NIFEDIPINE ER | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | NIFEDIPINE | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | NIFEDIPINE | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | NIFEDIPINE ER | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | NIMODIPINE | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | NISOLDIPINE ER | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | NORLIQVA | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | NORVASC | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | PROCARDIA XL | NON PREFERRED | ||
| CALCIUM CHANNEL BLOCKERS | SULAR | NON PREFERRED | ||
| CALCIUM CHANNEL BLOCKERS | TIADYLT ER | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | TIAZAC | NON PREFERRED | ||
| CALCIUM CHANNEL BLOCKERS | VERAPAMIL HYDROCHLORIDE E | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | VERAPAMIL HYDROCHLORIDE E | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | VERAPAMIL HCL ER | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | VERAPAMIL HYDROCHLORIDE S | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | VERAPAMIL HYDROCHLORIDE | GENERIC | ||
| CALCIUM CHANNEL BLOCKERS | VERAPAMIL HYDROCHLORIDE | EXCLUDED | ||
| CALCIUM CHANNEL BLOCKERS | VERAPAMIL HCL | GENERIC | ||
| CARDIOTONICS | DIGOXIN | GENERIC | ||
| CARDIOTONICS | DOBUTAMINE HCL/D5W | EXCLUDED | ||
| CARDIOTONICS | DOBUTAMINE HYDROCHLORIDE/ | EXCLUDED | ||
| CARDIOTONICS | DOBUTAMINE HYDROCHLORIDE | GENERIC | ||
| CARDIOTONICS | DOBUTAMINE HCL | GENERIC | ||
| CARDIOTONICS | DOPAMINE HYDROCHLORIDE | GENERIC | ||
| CARDIOTONICS | DOPAMINE HYDROCHLORIDE | EXCLUDED | ||
| CARDIOTONICS | DOPAMINE HYDROCHLORIDE/DE | EXCLUDED | ||
| CARDIOTONICS | DOPAMINE/D5W | EXCLUDED | ||
| CARDIOTONICS | LANOXIN | NON PREFERRED | ||
| CARDIOTONICS | LANOXIN PEDIATRIC | NON PREFERRED | ||
| CARDIOTONICS | LANOXIN | EXCLUDED | ||
| CARDIOTONICS | MILRINONE LACTATE | GENERIC | ||
| CARDIOTONICS | MILRINONE LACTATE IN DEXT | GENERIC | ||
| CARDIOVASCULAR AGENTS - MISC. | ABLYSINOL | EXCLUDED | ||
| CARDIOVASCULAR AGENTS - MISC. | ADCIRCA | NON PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | ADEMPAS | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | ADENOCAINE | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | ALPROSTADIL | GENERIC | ||
| CARDIOVASCULAR AGENTS - MISC. | ALYQ | GENERIC | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | AMBRISENTAN | GENERIC | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | AMLODIPINE BESYLATE/ATORV | GENERIC | ||
| CARDIOVASCULAR AGENTS - MISC. | ATTRUBY | EXCLUDED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | AURLUMYN | EXCLUDED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | BOSENTAN | GENERIC | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | CAMZYOS | NON PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | CARDIOPLEGIA INDUCTION HI | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | CARDIOPLEGIA INDUCTION PL | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | CARDIOPLEGIA MAINTENANCE | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | CARDIOPLEGIA REPERFUSATE/ | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | CARDIOPLEGIA DEL NIDO FOR | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | CARDIOPLEGIC | GENERIC | ||
| CARDIOVASCULAR AGENTS - MISC. | CARDIOPLEGIC | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | CORLANOR | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | DEHYDRATED ALCOHOL | GENERIC | ||
| CARDIOVASCULAR AGENTS - MISC. | DEL NIDO CARDIOPLEGIA SOL | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | ENTRESTO | NON PREFERRED | PA | |
| CARDIOVASCULAR AGENTS - MISC. | EPOPROSTENOL | GENERIC | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | FLOLAN | NON PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | INPEFA | EXCLUDED | PA | |
| CARDIOVASCULAR AGENTS - MISC. | IVABRADINE HYDROCHLORIDE | GENERIC | ||
| CARDIOVASCULAR AGENTS - MISC. | LETAIRIS | EXCLUDED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | LODOCO | EXCLUDED | ||
| CARDIOVASCULAR AGENTS - MISC. | MICROPLEGIA MSA/MSG | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | NYLIDRIN HYDROCHLORIDE | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | OPSUMIT | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | OPSYNVI | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | ORENITRAM | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | PAPAVERINE HYDROCHLORIDE | GENERIC | ||
| CARDIOVASCULAR AGENTS - MISC. | PAPAVERINE HCL | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | PAPAVERINE HYDROCHLORIDE | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | PLEGISOL | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | PROSTIN VR PEDIATRIC | NON PREFERRED | ||
| CARDIOVASCULAR AGENTS - MISC. | REMODULIN | EXCLUDED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | REMODULIN | NON PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | REVATIO IV | NON PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | REVATIO | NON PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | SACUBITRIL/VALSARTAN | GENERIC | PA | |
| CARDIOVASCULAR AGENTS - MISC. | SILDENAFIL CITRATE | GENERIC | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | TADALAFIL | GENERIC | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | TADLIQ | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | TRACLEER | EXCLUDED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | TREPROSTINIL SODIUM | GENERIC | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | TYVASO DPI | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | TYVASO | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | UPTRAVI IV | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | UPTRAVI | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | VELETRI | NON PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | VENTAVIS | NON PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | VERQUVO | PREFERRED | PA | |
| CARDIOVASCULAR AGENTS - MISC. | VYNDAMAX | PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | VYNDAQEL | EXCLUDED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | WINREVAIR | NON PREFERRED | SP | PA |
| CARDIOVASCULAR AGENTS - MISC. | YUTREPIA | PREFERRED | SP | PA |
| CEPHALOSPORINS | AVYCAZ | NON PREFERRED | ||
| CEPHALOSPORINS | CEFACLOR | GENERIC | ||
| CEPHALOSPORINS | CEFACLOR ER | NON PREFERRED | ||
| CEPHALOSPORINS | CEFADROXIL | GENERIC | ||
| CEPHALOSPORINS | CEFAZOLIN SODIUM/DEXTROSE | NON PREFERRED | ||
| CEPHALOSPORINS | CEFAZOLIN SODIUM/DEXTROSE | EXCLUDED | ||
| CEPHALOSPORINS | CEFAZOLIN/SODIUM CHLORIDE | EXCLUDED | ||
| CEPHALOSPORINS | CEFAZOLIN SODIUM/SODIUM C | EXCLUDED | ||
| CEPHALOSPORINS | CEFAZOLIN SODIUM | NON PREFERRED | ||
| CEPHALOSPORINS | CEFAZOLIN SODIUM | GENERIC | ||
| CEPHALOSPORINS | CEFAZOLIN SODIUM | EXCLUDED | ||
| CEPHALOSPORINS | CEFAZOLIN | GENERIC | ||
| CEPHALOSPORINS | CEFAZOLIN | NON PREFERRED | ||
| CEPHALOSPORINS | CEFAZOLIN/DEXTROSE | EXCLUDED | ||
| CEPHALOSPORINS | CEFAZOLIN | EXCLUDED | ||
| CEPHALOSPORINS | CEFDINIR | GENERIC | ||
| CEPHALOSPORINS | CEFEPIME HYDROCHLORIDE | GENERIC | ||
| CEPHALOSPORINS | CEFEPIME | GENERIC | ||
| CEPHALOSPORINS | CEFEPIME | NON PREFERRED | ||
| CEPHALOSPORINS | CEFEPIME HYDROCHLORIDE | EXCLUDED | ||
| CEPHALOSPORINS | CEFEPIME/DEXTROSE | NON PREFERRED | ||
| CEPHALOSPORINS | CEFIXIME | GENERIC | ||
| CEPHALOSPORINS | CEFOTAN | EXCLUDED | ||
| CEPHALOSPORINS | CEFOTAXIME SODIUM | EXCLUDED | ||
| CEPHALOSPORINS | CEFOTETAN | GENERIC | ||
| CEPHALOSPORINS | CEFOXITIN SODIUM | GENERIC | ||
| CEPHALOSPORINS | CEFOXITIN SODIUM | NON PREFERRED | ||
| CEPHALOSPORINS | CEFPODOXIME PROXETIL | GENERIC | ||
| CEPHALOSPORINS | CEFPROZIL | GENERIC | ||
| CEPHALOSPORINS | CEFTAZIDIME | GENERIC | ||
| CEPHALOSPORINS | CEFTRIAXONE/DEXTROSE | NON PREFERRED | ||
| CEPHALOSPORINS | CEFTRIAXONE SODIUM | NON PREFERRED | ||
| CEPHALOSPORINS | CEFTRIAXONE SODIUM | GENERIC | ||
| CEPHALOSPORINS | CEFTRIAXONE IN ISO-OSMOTI | GENERIC | ||
| CEPHALOSPORINS | CEFUROXIME SODIUM | GENERIC | ||
| CEPHALOSPORINS | CEFUROXIME AXETIL | GENERIC | ||
| CEPHALOSPORINS | CEPHALEXIN | EXCLUDED | ||
| CEPHALOSPORINS | CEPHALEXIN | GENERIC | ||
| CEPHALOSPORINS | FETROJA | NON PREFERRED | ||
| CEPHALOSPORINS | TAZICEF | GENERIC | ||
| CEPHALOSPORINS | TAZICEF | NON PREFERRED | ||
| CEPHALOSPORINS | TEFLARO | NON PREFERRED | ||
| CEPHALOSPORINS | ZERBAXA | NON PREFERRED | ||
| CEPHALOSPORINS | ZEVTERA | NON PREFERRED | ||
| CONTRACEPTIVES | AFIRMELLE | GENERIC | ||
| CONTRACEPTIVES | ALTAVERA | GENERIC | ||
| CONTRACEPTIVES | ALYACEN 1/35 | GENERIC | ||
| CONTRACEPTIVES | ALYACEN 7/7/7 | GENERIC | ||
| CONTRACEPTIVES | AMETHYST | GENERIC | ||
| CONTRACEPTIVES | APRI | GENERIC | ||
| CONTRACEPTIVES | ARANELLE | GENERIC | ||
| CONTRACEPTIVES | ASHLYNA | GENERIC | ||
| CONTRACEPTIVES | AUBRA EQ | GENERIC | ||
| CONTRACEPTIVES | AUROVELA 24 FE | GENERIC | ||
| CONTRACEPTIVES | AUROVELA FE 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | AUROVELA FE 1/20 | GENERIC | ||
| CONTRACEPTIVES | AUROVELA 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | AUROVELA 1/20 | GENERIC | ||
| CONTRACEPTIVES | AVERI | EXCLUDED | ||
| CONTRACEPTIVES | AVIANE | GENERIC | ||
| CONTRACEPTIVES | AYUNA | GENERIC | ||
| CONTRACEPTIVES | AZURETTE | GENERIC | ||
| CONTRACEPTIVES | BALCOLTRA | EXCLUDED | ||
| CONTRACEPTIVES | BALZIVA | GENERIC | ||
| CONTRACEPTIVES | BEYAZ | EXCLUDED | ||
| CONTRACEPTIVES | BLISOVI 24 FE | GENERIC | ||
| CONTRACEPTIVES | BLISOVI FE 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | BLISOVI FE 1/20 | GENERIC | ||
| CONTRACEPTIVES | BRIELLYN | GENERIC | ||
| CONTRACEPTIVES | CAMILA | GENERIC | ||
| CONTRACEPTIVES | CAMRESE | GENERIC | ||
| CONTRACEPTIVES | CAMRESE LO | GENERIC | ||
| CONTRACEPTIVES | CHARLOTTE 24 FE | GENERIC | ||
| CONTRACEPTIVES | CHATEAL EQ | GENERIC | ||
| CONTRACEPTIVES | CRYSELLE-28 | GENERIC | ||
| CONTRACEPTIVES | CYRED EQ | GENERIC | ||
| CONTRACEPTIVES | DASETTA 1/35 | GENERIC | ||
| CONTRACEPTIVES | DASETTA 7/7/7 | GENERIC | ||
| CONTRACEPTIVES | DAYSEE | GENERIC | ||
| CONTRACEPTIVES | DEBLITANE | GENERIC | ||
| CONTRACEPTIVES | DELYLA | GENERIC | ||
| CONTRACEPTIVES | DEPO-PROVERA CONTRACEPTIV | NON PREFERRED | ||
| CONTRACEPTIVES | DEPO-SUBQ PROVERA 104 | NON PREFERRED | ||
| CONTRACEPTIVES | DESOGESTREL/ETHINYL ESTRA | GENERIC | ||
| CONTRACEPTIVES | DOLISHALE | GENERIC | ||
| CONTRACEPTIVES | DROSPIRENONE/ETHINYL ESTR | GENERIC | ||
| CONTRACEPTIVES | ELINEST | GENERIC | ||
| CONTRACEPTIVES | ELLA | NON PREFERRED | ||
| CONTRACEPTIVES | ELURYNG | GENERIC | ||
| CONTRACEPTIVES | EMZAHH | GENERIC | ||
| CONTRACEPTIVES | ENILLORING | GENERIC | ||
| CONTRACEPTIVES | ENPRESSE-28 | GENERIC | ||
| CONTRACEPTIVES | ENSKYCE | GENERIC | ||
| CONTRACEPTIVES | ERRIN | GENERIC | ||
| CONTRACEPTIVES | ESTARYLLA | GENERIC | ||
| CONTRACEPTIVES | ETHYNODIOL DIACETATE/ETHI | GENERIC | ||
| CONTRACEPTIVES | ETONOGESTREL/ETHINYL ESTR | GENERIC | ||
| CONTRACEPTIVES | FALMINA | GENERIC | ||
| CONTRACEPTIVES | FEIRZA 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | FEIRZA 1/20 | GENERIC | ||
| CONTRACEPTIVES | FEMLYV | EXCLUDED | ||
| CONTRACEPTIVES | FINZALA | GENERIC | ||
| CONTRACEPTIVES | GALBRIELA | GENERIC | ||
| CONTRACEPTIVES | GEMMILY | GENERIC | ||
| CONTRACEPTIVES | HAILEY 24 FE | GENERIC | ||
| CONTRACEPTIVES | HAILEY FE 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | HAILEY FE 1/20 | GENERIC | ||
| CONTRACEPTIVES | HAILEY 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | HALOETTE | GENERIC | ||
| CONTRACEPTIVES | HEATHER | GENERIC | ||
| CONTRACEPTIVES | ICLEVIA | GENERIC | ||
| CONTRACEPTIVES | INCASSIA | GENERIC | ||
| CONTRACEPTIVES | INTROVALE | GENERIC | ||
| CONTRACEPTIVES | ISIBLOOM | GENERIC | ||
| CONTRACEPTIVES | JAIMIESS | GENERIC | ||
| CONTRACEPTIVES | JASMIEL | GENERIC | ||
| CONTRACEPTIVES | JENCYCLA | GENERIC | ||
| CONTRACEPTIVES | JOLESSA | GENERIC | ||
| CONTRACEPTIVES | JOYEAUX | GENERIC | ||
| CONTRACEPTIVES | JULEBER | GENERIC | ||
| CONTRACEPTIVES | JUNEL FE 24 | GENERIC | ||
| CONTRACEPTIVES | JUNEL 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | JUNEL 1/20 | GENERIC | ||
| CONTRACEPTIVES | JUNEL FE 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | JUNEL FE 1/20 | GENERIC | ||
| CONTRACEPTIVES | KAITLIB FE | GENERIC | ||
| CONTRACEPTIVES | KALLIGA | GENERIC | ||
| CONTRACEPTIVES | KARIVA | GENERIC | ||
| CONTRACEPTIVES | KELNOR 1/35 | GENERIC | ||
| CONTRACEPTIVES | KURVELO | GENERIC | ||
| CONTRACEPTIVES | KYLEENA | PREFERRED | PA | |
| CONTRACEPTIVES | LARIN 24 FE | GENERIC | ||
| CONTRACEPTIVES | LARIN FE 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | LARIN FE 1/20 | GENERIC | ||
| CONTRACEPTIVES | LARIN 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | LARIN 1/20 | GENERIC | ||
| CONTRACEPTIVES | LEENA | GENERIC | ||
| CONTRACEPTIVES | LESSINA | GENERIC | ||
| CONTRACEPTIVES | LEVONORGESTREL/ETHINYL ES | GENERIC | ||
| CONTRACEPTIVES | LEVONORGESTREL AND ETHINY | GENERIC | ||
| CONTRACEPTIVES | LEVONEST | GENERIC | ||
| CONTRACEPTIVES | LEVORA 0.15/30-28 | GENERIC | ||
| CONTRACEPTIVES | LILETTA | NON PREFERRED | PA | |
| CONTRACEPTIVES | LO LOESTRIN FE | PREFERRED | ||
| CONTRACEPTIVES | LOESTRIN 1/20-21 | GENERIC | ||
| CONTRACEPTIVES | LOESTRIN FE 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | LOESTRIN 1.5/30-21 | GENERIC | ||
| CONTRACEPTIVES | LOESTRIN FE 1/20 | GENERIC | ||
| CONTRACEPTIVES | LOJAIMIESS | GENERIC | ||
| CONTRACEPTIVES | LORYNA | GENERIC | ||
| CONTRACEPTIVES | LOW-OGESTREL | GENERIC | ||
| CONTRACEPTIVES | LO-ZUMANDIMINE | GENERIC | ||
| CONTRACEPTIVES | LUIZZA 1/20 | GENERIC | ||
| CONTRACEPTIVES | LUIZZA 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | LUTERA | GENERIC | ||
| CONTRACEPTIVES | LYLEQ | GENERIC | ||
| CONTRACEPTIVES | LYZA | GENERIC | ||
| CONTRACEPTIVES | MARLISSA | GENERIC | ||
| CONTRACEPTIVES | MEDROXYPROGESTERONE ACETA | GENERIC | ||
| CONTRACEPTIVES | MELEYA | GENERIC | ||
| CONTRACEPTIVES | MERZEE | GENERIC | ||
| CONTRACEPTIVES | MIBELAS 24 FE | GENERIC | ||
| CONTRACEPTIVES | MICROGESTIN 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | MICROGESTIN 1/20 | GENERIC | ||
| CONTRACEPTIVES | MICROGESTIN FE 1/20 | GENERIC | ||
| CONTRACEPTIVES | MICROGESTIN FE 1.5/30 | GENERIC | ||
| CONTRACEPTIVES | MILI | GENERIC | ||
| CONTRACEPTIVES | MINZOYA | GENERIC | ||
| CONTRACEPTIVES | MIRENA | PREFERRED | PA | |
| CONTRACEPTIVES | MIUDELLA COPPER INTRAUTER | EXCLUDED | ||
| CONTRACEPTIVES | MONO-LINYAH | GENERIC | ||
| CONTRACEPTIVES | NATAZIA | PREFERRED | ||
| CONTRACEPTIVES | NECON 0.5/35-28 | GENERIC | ||
| CONTRACEPTIVES | NEXPLANON | NON PREFERRED | PA | |
| CONTRACEPTIVES | NEXTSTELLIS | EXCLUDED | ||
| CONTRACEPTIVES | NIKKI | GENERIC | ||
| CONTRACEPTIVES | NORETHINDRONE ACETATE/ETH | GENERIC | ||
| CONTRACEPTIVES | NORA-BE | GENERIC | ||
| CONTRACEPTIVES | NORETHINDRONE & ETHINYL E | GENERIC | ||
| CONTRACEPTIVES | NORETHINDRONE/ETHINYL EST | GENERIC | ||
| CONTRACEPTIVES | NORELGESTROMIN/ETHINYL ES | GENERIC | ||
| CONTRACEPTIVES | NORETHINDRONE | GENERIC | ||
| CONTRACEPTIVES | NORGESTIMATE/ETHINYL ESTR | GENERIC | ||
| CONTRACEPTIVES | NORLYROC | GENERIC | ||
| CONTRACEPTIVES | NORTREL 0.5/35 (28) | GENERIC | ||
| CONTRACEPTIVES | NORTREL 1/35 | GENERIC | ||
| CONTRACEPTIVES | NORTREL 7/7/7 | GENERIC | ||
| CONTRACEPTIVES | NUVARING | EXCLUDED | ||
| CONTRACEPTIVES | NYLIA 1/35 | GENERIC | ||
| CONTRACEPTIVES | NYLIA 7/7/7 | GENERIC | ||
| CONTRACEPTIVES | OCELLA | GENERIC | ||
| CONTRACEPTIVES | ORQUIDEA | GENERIC | ||
| CONTRACEPTIVES | PARAGARD INTRAUTERINE COP | NON PREFERRED | ||
| CONTRACEPTIVES | PHILITH | GENERIC | ||
| CONTRACEPTIVES | PIMTREA | GENERIC | ||
| CONTRACEPTIVES | PORTIA-28 | GENERIC | ||
| CONTRACEPTIVES | RECLIPSEN | GENERIC | ||
| CONTRACEPTIVES | RIVELSA | GENERIC | ||
| CONTRACEPTIVES | ROSYRAH | GENERIC | ||
| CONTRACEPTIVES | SAFYRAL | NON PREFERRED | ||
| CONTRACEPTIVES | SETLAKIN | GENERIC | ||
| CONTRACEPTIVES | SHAROBEL | GENERIC | ||
| CONTRACEPTIVES | SIMLIYA | GENERIC | ||
| CONTRACEPTIVES | SIMPESSE | GENERIC | ||
| CONTRACEPTIVES | SKYLA | PREFERRED | PA | |
| CONTRACEPTIVES | SLYND | EXCLUDED | ||
| CONTRACEPTIVES | SPRINTEC 28 | GENERIC | ||
| CONTRACEPTIVES | SRONYX | GENERIC | ||
| CONTRACEPTIVES | SYEDA | GENERIC | ||
| CONTRACEPTIVES | TARINA 24 FE | GENERIC | ||
| CONTRACEPTIVES | TARINA FE 1/20 EQ | GENERIC | ||
| CONTRACEPTIVES | TAYSOFY | GENERIC | ||
| CONTRACEPTIVES | TAYTULLA | EXCLUDED | ||
| CONTRACEPTIVES | TILIA FE | GENERIC | ||
| CONTRACEPTIVES | TRI-ESTARYLLA | GENERIC | ||
| CONTRACEPTIVES | TRI-LEGEST FE | GENERIC | ||
| CONTRACEPTIVES | TRI-LINYAH | GENERIC | ||
| CONTRACEPTIVES | TRI-LO-ESTARYLLA | GENERIC | ||
| CONTRACEPTIVES | TRI-LO-MARZIA | GENERIC | ||
| CONTRACEPTIVES | TRI-LO-SPRINTEC | GENERIC | ||
| CONTRACEPTIVES | TRI-LO-MILI | GENERIC | ||
| CONTRACEPTIVES | TRI-MILI | GENERIC | ||
| CONTRACEPTIVES | TRI-SPRINTEC | GENERIC | ||
| CONTRACEPTIVES | TRI-VYLIBRA | GENERIC | ||
| CONTRACEPTIVES | TRI-VYLIBRA LO | GENERIC | ||
| CONTRACEPTIVES | TURQOZ | GENERIC | ||
| CONTRACEPTIVES | TWIRLA | EXCLUDED | ||
| CONTRACEPTIVES | TYBLUME | EXCLUDED | ||
| CONTRACEPTIVES | TYDEMY | GENERIC | ||
| CONTRACEPTIVES | VALTYA 1/50 | GENERIC | ||
| CONTRACEPTIVES | VELIVET | GENERIC | ||
| CONTRACEPTIVES | VESTURA | GENERIC | ||
| CONTRACEPTIVES | VIENVA | GENERIC | ||
| CONTRACEPTIVES | VIORELE | GENERIC | ||
| CONTRACEPTIVES | VOLNEA | GENERIC | ||
| CONTRACEPTIVES | VYFEMLA | GENERIC | ||
| CONTRACEPTIVES | VYLIBRA | GENERIC | ||
| CONTRACEPTIVES | WERA | GENERIC | ||
| CONTRACEPTIVES | WYMZYA FE | GENERIC | ||
| CONTRACEPTIVES | XARAH FE | GENERIC | ||
| CONTRACEPTIVES | XELRIA FE | GENERIC | ||
| CONTRACEPTIVES | XULANE | GENERIC | ||
| CONTRACEPTIVES | YASMIN 28 | EXCLUDED | ||
| CONTRACEPTIVES | YAZ | EXCLUDED | ||
| CONTRACEPTIVES | ZAFEMY | GENERIC | ||
| CONTRACEPTIVES | ZOVIA 1/35 | GENERIC | ||
| CONTRACEPTIVES | ZUMANDIMINE | GENERIC | ||
| CORTICOSTEROIDS | AGAMREE | EXCLUDED | SP | PA |
| CORTICOSTEROIDS | BETAMETHASONE ACETATE/BET | EXCLUDED | ||
| CORTICOSTEROIDS | BETAMETHASONE COMBO | EXCLUDED | ||
| CORTICOSTEROIDS | BETAMETHASONE SODIUM PHOS | EXCLUDED | ||
| CORTICOSTEROIDS | BETAMETHASONE SODIUM PHOS | NON PREFERRED | ||
| CORTICOSTEROIDS | BETAMETHASONE SODIUM PHOS | GENERIC | ||
| CORTICOSTEROIDS | BUDESONIDE | GENERIC | PA | |
| CORTICOSTEROIDS | BUDESONIDE ER | EXCLUDED | PA | |
| CORTICOSTEROIDS | BUPIVACAINE HCL/DEXAMETHA | EXCLUDED | ||
| CORTICOSTEROIDS | CELESTONE SOLUSPAN | NON PREFERRED | ||
| CORTICOSTEROIDS | CORTEF | NON PREFERRED | ||
| CORTICOSTEROIDS | CORTISONE ACETATE | NON PREFERRED | ||
| CORTICOSTEROIDS | CORTISONE ACETATE | EXCLUDED | ||
| CORTICOSTEROIDS | DEFLAZACORT | GENERIC | SP | PA |
| CORTICOSTEROIDS | DEPO-MEDROL | NON PREFERRED | ||
| CORTICOSTEROIDS | DEXAMETHASONE SODIUM PHOS | EXCLUDED | ||
| CORTICOSTEROIDS | DEXAMETHASONE (LA) | NON PREFERRED | ||
| CORTICOSTEROIDS | DEXAMETHASONE SODIUM PHOS | GENERIC | ||
| CORTICOSTEROIDS | DEXAMETHASONE SODIUM PHOS | NON PREFERRED | ||
| CORTICOSTEROIDS | DEXAMETHASONE INTENSOL | NON PREFERRED | ||
| CORTICOSTEROIDS | DEXAMETHASONE | EXCLUDED | ||
| CORTICOSTEROIDS | DEXAMETHASONE | GENERIC | ||
| CORTICOSTEROIDS | DEXAMETHASONE ACETATE | EXCLUDED | ||
| CORTICOSTEROIDS | DEXAMETHASONE ACETATE/DEX | NON PREFERRED | ||
| CORTICOSTEROIDS | DEXAMETHASONE (LA) | EXCLUDED | ||
| CORTICOSTEROIDS | DEXLIDO | NON PREFERRED | ||
| CORTICOSTEROIDS | EMFLAZA | EXCLUDED | SP | PA |
| CORTICOSTEROIDS | EOHILIA | EXCLUDED | PA | |
| CORTICOSTEROIDS | FLUDROCORTISONE ACETATE | GENERIC | ||
| CORTICOSTEROIDS | HEXATRIONE | EXCLUDED | ||
| CORTICOSTEROIDS | HYDROCORTISONE SODIUM SUC | GENERIC | ||
| CORTICOSTEROIDS | HYDROCORTISONE | EXCLUDED | ||
| CORTICOSTEROIDS | HYDROCORTISONE | GENERIC | ||
| CORTICOSTEROIDS | JAYTHARI | GENERIC | SP | PA |
| CORTICOSTEROIDS | KENALOG-10 | NON PREFERRED | ||
| CORTICOSTEROIDS | KENALOG-40 | NON PREFERRED | ||
| CORTICOSTEROIDS | KENALOG-80 | NON PREFERRED | ||
| CORTICOSTEROIDS | KHINDIVI | EXCLUDED | ||
| CORTICOSTEROIDS | MARDEX-25 | NON PREFERRED | ||
| CORTICOSTEROIDS | MEDROL | NON PREFERRED | ||
| CORTICOSTEROIDS | MEDROL DOSEPAK | NON PREFERRED | ||
| CORTICOSTEROIDS | METHYLPREDNISOLONE ACETAT | EXCLUDED | ||
| CORTICOSTEROIDS | METHYLPREDNISOLONE/LIDOCA | EXCLUDED | ||
| CORTICOSTEROIDS | METHYLPREDNISOLONE ACETAT | GENERIC | ||
| CORTICOSTEROIDS | METHYLPREDNISOLONE ACETAT | NON PREFERRED | ||
| CORTICOSTEROIDS | METHYLPREDNISOLONE SODIUM | GENERIC | ||
| CORTICOSTEROIDS | METHYLPREDNISOLONE | NON PREFERRED | ||
| CORTICOSTEROIDS | METHYLPREDNISOLONE | GENERIC | ||
| CORTICOSTEROIDS | METHYLPREDNISOLONE DOSE P | GENERIC | ||
| CORTICOSTEROIDS | PEDIAPRED | NON PREFERRED | ||
| CORTICOSTEROIDS | PREDNISOLONE SODIUM PHOSP | EXCLUDED | ||
| CORTICOSTEROIDS | PREDNISOLONE SODIUM PHOSP | GENERIC | ||
| CORTICOSTEROIDS | PREDNISOLONE ACETATE | NON PREFERRED | ||
| CORTICOSTEROIDS | PREDNISOLONE | GENERIC | ||
| CORTICOSTEROIDS | PREDNISONE INTENSOL | NON PREFERRED | ||
| CORTICOSTEROIDS | PREDNISONE | GENERIC | ||
| CORTICOSTEROIDS | PREDNISONE | EXCLUDED | ||
| CORTICOSTEROIDS | PYQUVI | GENERIC | SP | PA |
| CORTICOSTEROIDS | ROPIDEX | EXCLUDED | ||
| CORTICOSTEROIDS | SOLU-CORTEF | NON PREFERRED | ||
| CORTICOSTEROIDS | SOLU-MEDROL | NON PREFERRED | ||
| CORTICOSTEROIDS | TRIAMCINOLONE ACETONIDE/B | EXCLUDED | ||
| CORTICOSTEROIDS | TRIAMCINOLONE ACETONIDE | GENERIC | ||
| CORTICOSTEROIDS | TRIAMCINOLONE ACETONIDE | NON PREFERRED | ||
| CORTICOSTEROIDS | TRIAMCINOLONE | NON PREFERRED | ||
| CORTICOSTEROIDS | TRIAMCINOLONE DIACETATE | NON PREFERRED | ||
| CORTICOSTEROIDS | TRIAMCINOLONE ACETONIDE | EXCLUDED | ||
| CORTICOSTEROIDS | TRIAMCINOLONE DIACETATE | EXCLUDED | ||
| CORTICOSTEROIDS | UCERIS | PREFERRED | PA | |
| COUGH/COLD/ALLERGY | ACETYLCYSTEINE | GENERIC | ||
| COUGH/COLD/ALLERGY | ACETYLCYSTEINE | NON PREFERRED | ||
| COUGH/COLD/ALLERGY | BENZONATATE | GENERIC | ||
| COUGH/COLD/ALLERGY | BROMPHEN/PSEUDOEPHEDRINE | GENERIC | ||
| COUGH/COLD/ALLERGY | BROMPHEN/PSEUDOEPHEDRINE | EXCLUDED | ||
| COUGH/COLD/ALLERGY | CLARINEX-D 12 HOUR | NON PREFERRED | ||
| COUGH/COLD/ALLERGY | GUAIFENESIN | NON PREFERRED | ||
| COUGH/COLD/ALLERGY | HYCODAN | EXCLUDED | ||
| COUGH/COLD/ALLERGY | HYDROCODONE POLISTIREX/CH | GENERIC | ||
| COUGH/COLD/ALLERGY | HYDROCODONE BITARTRATE/HO | GENERIC | ||
| COUGH/COLD/ALLERGY | HYDROCODONE/HOMATROPINE | GENERIC | ||
| COUGH/COLD/ALLERGY | HYDROMET | GENERIC | ||
| COUGH/COLD/ALLERGY | HYPERSAL | NON PREFERRED | ||
| COUGH/COLD/ALLERGY | N-ACETYL-L-CYSTEINE | NON PREFERRED | ||
| COUGH/COLD/ALLERGY | NEBUSAL | GENERIC | ||
| COUGH/COLD/ALLERGY | NEBUSAL | NON PREFERRED | ||
| COUGH/COLD/ALLERGY | NEOTUSS PLUS | EXCLUDED | ||
| COUGH/COLD/ALLERGY | POTASSIUM IODIDE | GENERIC | ||
| COUGH/COLD/ALLERGY | PROMETHAZINE/CODEINE | GENERIC | ||
| COUGH/COLD/ALLERGY | PROMETHAZINE HYDROCHLORID | GENERIC | ||
| COUGH/COLD/ALLERGY | PROMETHAZINE DM | GENERIC | ||
| COUGH/COLD/ALLERGY | PROMETHAZINE/DEXTROMETHOR | GENERIC | ||
| COUGH/COLD/ALLERGY | PULMOSAL | GENERIC | ||
| COUGH/COLD/ALLERGY | SODIUM CHLORIDE | EXCLUDED | ||
| COUGH/COLD/ALLERGY | SODIUM CHLORIDE | GENERIC | ||
| COUGH/COLD/ALLERGY | SSKI | NON PREFERRED | ||
| COUGH/COLD/ALLERGY | TERPIN HYDRATE MONOHYDRAT | NON PREFERRED | ||
| COUGH/COLD/ALLERGY | TERPIN HYDRATE | NON PREFERRED | ||
| COUGH/COLD/ALLERGY | TUXARIN ER | EXCLUDED | ||
| DERMATOLOGICALS | ABENOR | EXCLUDED | ||
| DERMATOLOGICALS | ABENOR HP | EXCLUDED | ||
| DERMATOLOGICALS | ACCUTANE | GENERIC | PA | |
| DERMATOLOGICALS | ACIOXIA | EXCLUDED | ||
| DERMATOLOGICALS | ACIOXIAY | EXCLUDED | ||
| DERMATOLOGICALS | ACITRETIN | GENERIC | PA | |
| DERMATOLOGICALS | ACYCLOVIR | GENERIC | ||
| DERMATOLOGICALS | ACZONE | EXCLUDED | ||
| DERMATOLOGICALS | ADAINZOXIA | EXCLUDED | ||
| DERMATOLOGICALS | ADALINA | EXCLUDED | ||
| DERMATOLOGICALS | ADAPALENE/BENZOYL PEROXID | GENERIC | ||
| DERMATOLOGICALS | ADAPALENE | GENERIC | ||
| DERMATOLOGICALS | ADAPALENE | EXCLUDED | ||
| DERMATOLOGICALS | ADAPALENE PUMP | EXCLUDED | ||
| DERMATOLOGICALS | ADAPALENE PUMP | GENERIC | ||
| DERMATOLOGICALS | ADBRY | NON PREFERRED | SP | PA |
| DERMATOLOGICALS | ADEINZDE | EXCLUDED | ||
| DERMATOLOGICALS | ADERMICA | EXCLUDED | ||
| DERMATOLOGICALS | ADERMICA HP | EXCLUDED | ||
| DERMATOLOGICALS | ADMIRAZOL | EXCLUDED | ||
| DERMATOLOGICALS | ADMIRAZOL HP | EXCLUDED | ||
| DERMATOLOGICALS | ALA-CORT | GENERIC | ||
| DERMATOLOGICALS | ALCLOMETASONE DIPROPIONAT | GENERIC | ||
| DERMATOLOGICALS | ALIXI | EXCLUDED | ||
| DERMATOLOGICALS | ALIXI HP | EXCLUDED | ||
| DERMATOLOGICALS | ALOMIRA | EXCLUDED | ||
| DERMATOLOGICALS | ALOMIRA HP | EXCLUDED | ||
| DERMATOLOGICALS | ALOMIRA LP | EXCLUDED | ||
| DERMATOLOGICALS | ALTRENO | EXCLUDED | ||
| DERMATOLOGICALS | ALUMINUM CHLORIDE ANHYDRO | NON PREFERRED | ||
| DERMATOLOGICALS | ALUMINUM CHLORIDE HEXAHYD | NON PREFERRED | ||
| DERMATOLOGICALS | ALURIS | EXCLUDED | ||
| DERMATOLOGICALS | ALURIS HP | EXCLUDED | ||
| DERMATOLOGICALS | ALURIS HP PLUS | EXCLUDED | ||
| DERMATOLOGICALS | ALURIS LP | EXCLUDED | ||
| DERMATOLOGICALS | ALURIS LP PLUS | EXCLUDED | ||
| DERMATOLOGICALS | ALURIS PLUS | EXCLUDED | ||
| DERMATOLOGICALS | ALUXOF HP | EXCLUDED | ||
| DERMATOLOGICALS | ALUXOF | EXCLUDED | ||
| DERMATOLOGICALS | ALVOX | EXCLUDED | ||
| DERMATOLOGICALS | ALVOX HP | EXCLUDED | ||
| DERMATOLOGICALS | AMCINONIDE | EXCLUDED | ||
| DERMATOLOGICALS | AMMONIUM LACTATE | GENERIC | ||
| DERMATOLOGICALS | AMNESTEEM | GENERIC | PA | |
| DERMATOLOGICALS | AMZEEQ | EXCLUDED | ||
| DERMATOLOGICALS | ANTHRALIN | NON PREFERRED | ||
| DERMATOLOGICALS | ANZUPGO | EXCLUDED | PA | |
| DERMATOLOGICALS | APEXOL CLEANSER | EXCLUDED | ||
| DERMATOLOGICALS | APEXOL HP CLEANSER | EXCLUDED | ||
| DERMATOLOGICALS | APHORIA | EXCLUDED | ||
| DERMATOLOGICALS | APORIX | EXCLUDED | ||
| DERMATOLOGICALS | ARNICA FLOWER | NON PREFERRED | ||
| DERMATOLOGICALS | ARTILIS | EXCLUDED | ||
| DERMATOLOGICALS | ARTILIS HP | EXCLUDED | ||
| DERMATOLOGICALS | ARZOL SILVER NITRATE APP | NON PREFERRED | ||
| DERMATOLOGICALS | AUGUSTIL | EXCLUDED | ||
| DERMATOLOGICALS | AVAR CLEANSER | GENERIC | ||
| DERMATOLOGICALS | AVAR LS CLEANSER | NON PREFERRED | ||
| DERMATOLOGICALS | AVEIDAOXIA | EXCLUDED | ||
| DERMATOLOGICALS | AVIDORA | EXCLUDED | ||
| DERMATOLOGICALS | AVIDORA HP | EXCLUDED | ||
| DERMATOLOGICALS | AWANIS | EXCLUDED | ||
| DERMATOLOGICALS | AZALTA | EXCLUDED | ||
| DERMATOLOGICALS | AZALTA HP | EXCLUDED | ||
| DERMATOLOGICALS | AZELAIC ACID | GENERIC | ||
| DERMATOLOGICALS | AZELEX | EXCLUDED | ||
| DERMATOLOGICALS | BACITRACIN | NON PREFERRED | ||
| DERMATOLOGICALS | BATIZIA | EXCLUDED | ||
| DERMATOLOGICALS | BAXONIL | EXCLUDED | ||
| DERMATOLOGICALS | BENZAC AC WASH | NON PREFERRED | ||
| DERMATOLOGICALS | BENZAMYCIN | NON PREFERRED | ||
| DERMATOLOGICALS | BENZEPRO CREAMY WASH | NON PREFERRED | ||
| DERMATOLOGICALS | BENZEPRO | EXCLUDED | ||
| DERMATOLOGICALS | BENZOIC ACID | NON PREFERRED | ||
| DERMATOLOGICALS | BENZOIN COMPOUND TINCTURE | GENERIC | ||
| DERMATOLOGICALS | BENZOIN TINCTURE | NON PREFERRED | ||
| DERMATOLOGICALS | BENZOYL PEROXIDE | NON PREFERRED | ||
| DERMATOLOGICALS | BENZOYL PEROXIDE HYDROUS | NON PREFERRED | ||
| DERMATOLOGICALS | PR BENZOYL PEROXIDE | EXCLUDED | ||
| DERMATOLOGICALS | PR BENZOYL PEROXIDE WASH | NON PREFERRED | ||
| DERMATOLOGICALS | BETAMETHASONE DIPROPIONAT | GENERIC | ||
| DERMATOLOGICALS | BETAMETHASONE DIPROPIONAT | EXCLUDED | ||
| DERMATOLOGICALS | BETAMETHASONE VALERATE | GENERIC | ||
| DERMATOLOGICALS | BEXAROTENE | GENERIC | SP | PA |
| DERMATOLOGICALS | BIMZELX | EXCLUDED | SP | PA |
| DERMATOLOGICALS | BORIC ACID | NON PREFERRED | ||
| DERMATOLOGICALS | BRYHALI | PREFERRED | ||
| DERMATOLOGICALS | CABTREO | EXCLUDED | ||
| DERMATOLOGICALS | CALAMINE | NON PREFERRED | ||
| DERMATOLOGICALS | CALCIPOTRIENE/BETAMETHASO | EXCLUDED | ||
| DERMATOLOGICALS | CALCIPOTRIENE | EXCLUDED | ||
| DERMATOLOGICALS | CALCIPOTRIENE | GENERIC | ||
| DERMATOLOGICALS | CALCITRENE | GENERIC | ||
| DERMATOLOGICALS | CALCITRIOL | EXCLUDED | ||
| DERMATOLOGICALS | CAMPHOR | NON PREFERRED | ||
| DERMATOLOGICALS | CETACAINE | EXCLUDED | ||
| DERMATOLOGICALS | CHLOHUX | EXCLUDED | ||
| DERMATOLOGICALS | CHLOOXIA | EXCLUDED | ||
| DERMATOLOGICALS | CHLOROACETIC ACID | NON PREFERRED | ||
| DERMATOLOGICALS | CIBINQO | PREFERRED | SP | PA |
| DERMATOLOGICALS | CICLOPIROX OLAMINE | GENERIC | ||
| DERMATOLOGICALS | CICLOPIROX | GENERIC | ||
| DERMATOLOGICALS | CLARAVIS | GENERIC | PA | |
| DERMATOLOGICALS | CLENIA PLUS | EXCLUDED | ||
| DERMATOLOGICALS | CLEOCIN-T | NON PREFERRED | ||
| DERMATOLOGICALS | CLINDAMYCIN PHOSPHATE/BEN | GENERIC | ||
| DERMATOLOGICALS | CLINDAMYCIN PHOSPHATE | EXCLUDED | ||
| DERMATOLOGICALS | CLINDAMYCIN PHOSPHATE | GENERIC | ||
| DERMATOLOGICALS | CLOBETASOL PROPIONATE | GENERIC | ||
| DERMATOLOGICALS | CLOBETASOL PROPIONATE E | GENERIC | ||
| DERMATOLOGICALS | CLOBETASOL PROPIONATE EMO | GENERIC | ||
| DERMATOLOGICALS | CLOBETASOL PROPIONATE | EXCLUDED | ||
| DERMATOLOGICALS | CLOBEX | NON PREFERRED | ||
| DERMATOLOGICALS | CLOBEX | EXCLUDED | ||
| DERMATOLOGICALS | CLOCORTOLONE PIVALATE | EXCLUDED | ||
| DERMATOLOGICALS | CLODAN | GENERIC | ||
| DERMATOLOGICALS | CLODERM | NON PREFERRED | ||
| DERMATOLOGICALS | CLOTRIMAZOLE/BETAMETHASON | GENERIC | ||
| DERMATOLOGICALS | CLOTRIMAZOLE | GENERIC | ||
| DERMATOLOGICALS | CLOTRIMAZOLE | NON PREFERRED | ||
| DERMATOLOGICALS | COAL TAR | GENERIC | ||
| DERMATOLOGICALS | COSENTYX IV | EXCLUDED | SP | PA |
| DERMATOLOGICALS | COSENTYX | PREFERRED | SP | PA |
| DERMATOLOGICALS | Cosentyx UnoReady | PREFERRED | SP | PA |
| DERMATOLOGICALS | CROTAN | GENERIC | ||
| DERMATOLOGICALS | CRYODOSE TA | NON PREFERRED | ||
| DERMATOLOGICALS | DAPSONE | EXCLUDED | ||
| DERMATOLOGICALS | DAPSONE | GENERIC | ||
| DERMATOLOGICALS | DAZAVEIDAOXIA | EXCLUDED | ||
| DERMATOLOGICALS | DAZOMON | EXCLUDED | ||
| DERMATOLOGICALS | DELIBON | EXCLUDED | ||
| DERMATOLOGICALS | DENVITA | EXCLUDED | ||
| DERMATOLOGICALS | DEOXIA | EXCLUDED | ||
| DERMATOLOGICALS | DEOXIATAR | EXCLUDED | ||
| DERMATOLOGICALS | DEOXIAVAR | EXCLUDED | ||
| DERMATOLOGICALS | DERMA-SMOOTHE/FS BODY | NON PREFERRED | ||
| DERMATOLOGICALS | DERMA-SMOOTHE/FS SCALP | NON PREFERRED | ||
| DERMATOLOGICALS | DESONIDE | GENERIC | ||
| DERMATOLOGICALS | DESONIDE | EXCLUDED | ||
| DERMATOLOGICALS | DESOXIMETASONE | GENERIC | ||
| DERMATOLOGICALS | DESOXIMETASONE | EXCLUDED | ||
| DERMATOLOGICALS | DIADIMAXIA | EXCLUDED | ||
| DERMATOLOGICALS | DIAOXIA | EXCLUDED | ||
| DERMATOLOGICALS | DIASAXIATAR | EXCLUDED | ||
| DERMATOLOGICALS | DIASDIMAXIA | EXCLUDED | ||
| DERMATOLOGICALS | DIASOXIA | EXCLUDED | ||
| DERMATOLOGICALS | DICLOFENAC SODIUM | GENERIC | ||
| DERMATOLOGICALS | DIFFERIN | NON PREFERRED | ||
| DERMATOLOGICALS | DIFFERIN PUMP | NON PREFERRED | ||
| DERMATOLOGICALS | DIFFERIN | EXCLUDED | ||
| DERMATOLOGICALS | DIFLORASONE DIACETATE | EXCLUDED | ||
| DERMATOLOGICALS | DIFMETIOXRIME | EXCLUDED | ||
| DERMATOLOGICALS | DIMOXIA | EXCLUDED | ||
| DERMATOLOGICALS | DIOCHLOY | EXCLUDED | ||
| DERMATOLOGICALS | DIONARIS | EXCLUDED | ||
| DERMATOLOGICALS | DIPROLENE | NON PREFERRED | ||
| DERMATOLOGICALS | DIVENDO | EXCLUDED | ||
| DERMATOLOGICALS | DIVINIX | EXCLUDED | ||
| DERMATOLOGICALS | DOMELA | EXCLUDED | ||
| DERMATOLOGICALS | DRAXACE | EXCLUDED | ||
| DERMATOLOGICALS | DRIXECE | EXCLUDED | ||
| DERMATOLOGICALS | DRYSOL | NON PREFERRED | ||
| DERMATOLOGICALS | DUPIXENT | PREFERRED | SP | PA |
| DERMATOLOGICALS | DYCLOPRO | EXCLUDED | ||
| DERMATOLOGICALS | DYNOMA | EXCLUDED | ||
| DERMATOLOGICALS | EBGLYSS | PREFERRED | SP | PA |
| DERMATOLOGICALS | ECEOXIA | EXCLUDED | ||
| DERMATOLOGICALS | ECONAZOLE NITRATE | GENERIC | ||
| DERMATOLOGICALS | EHA LOTION 4% | NON PREFERRED | ||
| DERMATOLOGICALS | ELIDEL | EXCLUDED | ||
| DERMATOLOGICALS | ELIMITE | EXCLUDED | ||
| DERMATOLOGICALS | ELYZIA | EXCLUDED | ||
| DERMATOLOGICALS | ENZNONUTY | EXCLUDED | ||
| DERMATOLOGICALS | EPIDUO | PREFERRED | ||
| DERMATOLOGICALS | EPIFOAM | NON PREFERRED | ||
| DERMATOLOGICALS | ERY | GENERIC | ||
| DERMATOLOGICALS | ERYTHROMYCIN/BENZOYL PERO | GENERIC | ||
| DERMATOLOGICALS | ERYGEL | NON PREFERRED | ||
| DERMATOLOGICALS | ERYTHROMYCIN | GENERIC | ||
| DERMATOLOGICALS | ETHOXIA | EXCLUDED | ||
| DERMATOLOGICALS | ETHYL CHLORIDE/FINE PINPO | NON PREFERRED | ||
| DERMATOLOGICALS | ETHYL CHLORIDE/FINE STREA | NON PREFERRED | ||
| DERMATOLOGICALS | ETHYL CHLORIDE/MEDIUM JET | NON PREFERRED | ||
| DERMATOLOGICALS | ETHYL CHLORIDE/MEDIUM STR | NON PREFERRED | ||
| DERMATOLOGICALS | ETHYL CHLORIDE/MIST | NON PREFERRED | ||
| DERMATOLOGICALS | ETHYL CHLORIDE | GENERIC | ||
| DERMATOLOGICALS | EUCRISA | PREFERRED | PA | |
| DERMATOLOGICALS | EXODERM | EXCLUDED | ||
| DERMATOLOGICALS | FENOVIA | EXCLUDED | ||
| DERMATOLOGICALS | FIDILA | EXCLUDED | ||
| DERMATOLOGICALS | FINACEA | PREFERRED | ||
| DERMATOLOGICALS | FLUOCINOLONE ACETONIDE | GENERIC | ||
| DERMATOLOGICALS | FLUOCINOLONE ACETONIDE BO | GENERIC | ||
| DERMATOLOGICALS | FLUOCINOLONE ACETONIDE TO | GENERIC | ||
| DERMATOLOGICALS | FLUOCINOLONE ACETONIDE SC | GENERIC | ||
| DERMATOLOGICALS | FLUOCINONIDE | GENERIC | ||
| DERMATOLOGICALS | FLUOCINONIDE | EXCLUDED | ||
| DERMATOLOGICALS | FLUOCINONIDE EMULSIFIED B | GENERIC | ||
| DERMATOLOGICALS | FLUOROURACIL | GENERIC | ||
| DERMATOLOGICALS | FLURANDRENOLIDE | EXCLUDED | ||
| DERMATOLOGICALS | FLUTICASONE PROPIONATE | GENERIC | ||
| DERMATOLOGICALS | FRIVO | EXCLUDED | ||
| DERMATOLOGICALS | FUNGIZYL AL | EXCLUDED | ||
| DERMATOLOGICALS | GEBAUERS SPRAY AND STRETC | NON PREFERRED | ||
| DERMATOLOGICALS | GENTAMICIN SULFATE | GENERIC | ||
| DERMATOLOGICALS | GENTIAN VIOLET | NON PREFERRED | ||
| DERMATOLOGICALS | GLYCOLIC ACID | NON PREFERRED | ||
| DERMATOLOGICALS | GLYCOLIC ACID 70% HIGH PU | NON PREFERRED | ||
| DERMATOLOGICALS | GLYDO | GENERIC | ||
| DERMATOLOGICALS | GORDOFILM | NON PREFERRED | ||
| DERMATOLOGICALS | HALCINONIDE | EXCLUDED | ||
| DERMATOLOGICALS | HALCINONIDE | GENERIC | ||
| DERMATOLOGICALS | HALOBETASOL PROPIONATE | GENERIC | ||
| DERMATOLOGICALS | HALOG | EXCLUDED | ||
| DERMATOLOGICALS | HAXCHLO | EXCLUDED | ||
| DERMATOLOGICALS | HAXCHLODREX | EXCLUDED | ||
| DERMATOLOGICALS | HYDROCORTISONE BUTYRATE | GENERIC | ||
| DERMATOLOGICALS | HYDROCORTISONE VALERATE | GENERIC | ||
| DERMATOLOGICALS | HOVYN | EXCLUDED | ||
| DERMATOLOGICALS | HURRI-FREEZE MEDIUM STREA | EXCLUDED | ||
| DERMATOLOGICALS | HURRI-FREEZE MIST SPRAY | EXCLUDED | ||
| DERMATOLOGICALS | HYDROCORTISONE ACETATE | GENERIC | ||
| DERMATOLOGICALS | HYDROCORTISONE | GENERIC | ||
| DERMATOLOGICALS | HYDROCORTISONE | EXCLUDED | ||
| DERMATOLOGICALS | HYPOCYN ANTIPRURITIC GEL | EXCLUDED | ||
| DERMATOLOGICALS | ICHTHAMMOL | NON PREFERRED | ||
| DERMATOLOGICALS | ILEXOR | EXCLUDED | ||
| DERMATOLOGICALS | ILUMYA | PREFERRED | SP | PA |
| DERMATOLOGICALS | IMIOXIA | EXCLUDED | ||
| DERMATOLOGICALS | IMIQUIMOD | GENERIC | ||
| DERMATOLOGICALS | IMULDOSA | EXCLUDED | SP | PA |
| DERMATOLOGICALS | INZDEAXIATAR | EXCLUDED | ||
| DERMATOLOGICALS | INZDEOXIA | EXCLUDED | ||
| DERMATOLOGICALS | ISOTRETINOIN | GENERIC | PA | |
| DERMATOLOGICALS | ISOTRETINOIN | EXCLUDED | PA | |
| DERMATOLOGICALS | ITHOXIA | EXCLUDED | ||
| DERMATOLOGICALS | KAZURI | EXCLUDED | ||
| DERMATOLOGICALS | KEFUNOVA | EXCLUDED | ||
| DERMATOLOGICALS | KERAXA | EXCLUDED | ||
| DERMATOLOGICALS | KERIDA | EXCLUDED | ||
| DERMATOLOGICALS | KETOCONAZOLE | GENERIC | ||
| DERMATOLOGICALS | KLARON | NON PREFERRED | ||
| DERMATOLOGICALS | KLAYESTA | GENERIC | ||
| DERMATOLOGICALS | KYNARA | EXCLUDED | ||
| DERMATOLOGICALS | L.E.T. | EXCLUDED | ||
| DERMATOLOGICALS | LACTIC ACID E | NON PREFERRED | ||
| DERMATOLOGICALS | LIDOCAINE/PRILOCAINE | GENERIC | ||
| DERMATOLOGICALS | LIDOCAINE HCL | GENERIC | ||
| DERMATOLOGICALS | LIDOCAINE HCL JELLY | GENERIC | ||
| DERMATOLOGICALS | LIDOCAINE | GENERIC | ||
| DERMATOLOGICALS | LIDOCAINE HYDROCHLORIDE J | GENERIC | ||
| DERMATOLOGICALS | PREMIUM LIDOCAINE | GENERIC | ||
| DERMATOLOGICALS | LIDOCAINE HYDROCHLORIDE | GENERIC | ||
| DERMATOLOGICALS | LIDOCAN | EXCLUDED | ||
| DERMATOLOGICALS | LIDOCAN | GENERIC | ||
| DERMATOLOGICALS | LIDODERM | NON PREFERRED | ||
| DERMATOLOGICALS | LIDOCAINE HYDROCHLORIDE/R | EXCLUDED | ||
| DERMATOLOGICALS | LIDORUB | EXCLUDED | ||
| DERMATOLOGICALS | LIDOTRAL + HYDROCORTISONE | EXCLUDED | ||
| DERMATOLOGICALS | LIDOTRAL | EXCLUDED | ||
| DERMATOLOGICALS | LIDTOPIC | EXCLUDED | ||
| DERMATOLOGICALS | LOUNZDOMDIOXIATAR | EXCLUDED | ||
| DERMATOLOGICALS | MALATHION | GENERIC | ||
| DERMATOLOGICALS | MELZARA | EXCLUDED | ||
| DERMATOLOGICALS | METDRAY | EXCLUDED | ||
| DERMATOLOGICALS | METHOXSALEN | GENERIC | ||
| DERMATOLOGICALS | METHYL SALICYLATE | NON PREFERRED | ||
| DERMATOLOGICALS | METROGEL | NON PREFERRED | ||
| DERMATOLOGICALS | METRONIDAZOLE | EXCLUDED | ||
| DERMATOLOGICALS | METRONIDAZOLE | GENERIC | ||
| DERMATOLOGICALS | MICONAZOLE NITRATE | NON PREFERRED | ||
| DERMATOLOGICALS | MICORT HC | GENERIC | ||
| DERMATOLOGICALS | MICURADERM | EXCLUDED | ||
| DERMATOLOGICALS | MOMETASONE FUROATE | GENERIC | ||
| DERMATOLOGICALS | MUPIROCIN | GENERIC | ||
| DERMATOLOGICALS | MYCOZYL AL | GENERIC | ||
| DERMATOLOGICALS | NAFTIFINE HYDROCHLORIDE | GENERIC | ||
| DERMATOLOGICALS | NATROBA | NON PREFERRED | ||
| DERMATOLOGICALS | NEMLUVIO | PREFERRED | SP | PA |
| DERMATOLOGICALS | NEUAC | GENERIC | ||
| DERMATOLOGICALS | NEXOBRID | EXCLUDED | ||
| DERMATOLOGICALS | NITROFURAZONE | NON PREFERRED | ||
| DERMATOLOGICALS | NOBELA | EXCLUDED | ||
| DERMATOLOGICALS | NOLIRA | EXCLUDED | ||
| DERMATOLOGICALS | NUCORT | NON PREFERRED | ||
| DERMATOLOGICALS | NUJO | EXCLUDED | ||
| DERMATOLOGICALS | NUJU | EXCLUDED | ||
| DERMATOLOGICALS | NYAMYC | GENERIC | ||
| DERMATOLOGICALS | NYNUTEY | EXCLUDED | ||
| DERMATOLOGICALS | NYSTATIN/TRIAMCINOLONE | GENERIC | ||
| DERMATOLOGICALS | NYSTATIN/TRIAMCINOLONE AC | GENERIC | ||
| DERMATOLOGICALS | NYSTATIN | GENERIC | ||
| DERMATOLOGICALS | NYSTOP | GENERIC | ||
| DERMATOLOGICALS | ONYCHO-MED | EXCLUDED | ||
| DERMATOLOGICALS | ONZDEAXIATAR | EXCLUDED | ||
| DERMATOLOGICALS | ONZDEAXIAVAR | EXCLUDED | ||
| DERMATOLOGICALS | ONZDEOXIA | EXCLUDED | ||
| DERMATOLOGICALS | OPZELURA | PREFERRED | PA | |
| DERMATOLOGICALS | OTULFI | EXCLUDED | SP | PA |
| DERMATOLOGICALS | OVIDE | NON PREFERRED | ||
| DERMATOLOGICALS | OXIAICE | EXCLUDED | ||
| DERMATOLOGICALS | OXIANUJO | EXCLUDED | ||
| DERMATOLOGICALS | OXIATAR | EXCLUDED | ||
| DERMATOLOGICALS | OXIAVAR | EXCLUDED | ||
| DERMATOLOGICALS | OXIAVARRY | EXCLUDED | ||
| DERMATOLOGICALS | OXIAZAR | EXCLUDED | ||
| DERMATOLOGICALS | GEBAUERS PAIN EASE | NON PREFERRED | ||
| DERMATOLOGICALS | PERMETHRIN | GENERIC | ||
| DERMATOLOGICALS | PHEYO | EXCLUDED | ||
| DERMATOLOGICALS | PIMECROLIMUS | GENERIC | ||
| DERMATOLOGICALS | PLENURA | EXCLUDED | ||
| DERMATOLOGICALS | PLEXION CLEANSER | NON PREFERRED | ||
| DERMATOLOGICALS | PODOCON-25 | NON PREFERRED | ||
| DERMATOLOGICALS | PODOFILOX | GENERIC | ||
| DERMATOLOGICALS | PRAMOSONE | NON PREFERRED | ||
| DERMATOLOGICALS | PRAMOXINE HCL | NON PREFERRED | ||
| DERMATOLOGICALS | PREPIV SUPPLY | EXCLUDED | ||
| DERMATOLOGICALS | PRONAL GEL | EXCLUDED | ||
| DERMATOLOGICALS | PRURADIK | GENERIC | ||
| DERMATOLOGICALS | PURAZIL | EXCLUDED | ||
| DERMATOLOGICALS | PYROGALLIC ACID | NON PREFERRED | ||
| DERMATOLOGICALS | PYZCHIVA | PREFERRED | SP | PA |
| DERMATOLOGICALS | QUIHOXVAR | EXCLUDED | ||
| DERMATOLOGICALS | REMYDA | EXCLUDED | ||
| DERMATOLOGICALS | RENSOTI | EXCLUDED | ||
| DERMATOLOGICALS | RESTIMO | EXCLUDED | ||
| DERMATOLOGICALS | RETIN-A | NON PREFERRED | ||
| DERMATOLOGICALS | ROAOXIA | EXCLUDED | ||
| DERMATOLOGICALS | ROSITARA | EXCLUDED | ||
| DERMATOLOGICALS | ROVIS | EXCLUDED | ||
| DERMATOLOGICALS | RUMILO | EXCLUDED | ||
| DERMATOLOGICALS | SALVAX DUO PLUS | NON PREFERRED | ||
| DERMATOLOGICALS | SANTYL | NON PREFERRED | ||
| DERMATOLOGICALS | SAROXIA | EXCLUDED | ||
| DERMATOLOGICALS | SCALACORT DK | NON PREFERRED | ||
| DERMATOLOGICALS | SCARTRATE | EXCLUDED | ||
| DERMATOLOGICALS | SELARSDI | EXCLUDED | SP | PA |
| DERMATOLOGICALS | SELENIUM SULFIDE | GENERIC | ||
| DERMATOLOGICALS | SILIQ | EXCLUDED | SP | PA |
| DERMATOLOGICALS | SILVADENE | NON PREFERRED | ||
| DERMATOLOGICALS | SILVER NITRATE | NON PREFERRED | ||
| DERMATOLOGICALS | SILVER SULFADIAZINE | GENERIC | ||
| DERMATOLOGICALS | SIRVANA | EXCLUDED | ||
| DERMATOLOGICALS | SKYRIZI | PREFERRED | SP | PA |
| DERMATOLOGICALS | SODIUM SULFACETAMIDE/SULF | GENERIC | ||
| DERMATOLOGICALS | SODIUM SULFACETAMIDE/SULF | EXCLUDED | ||
| DERMATOLOGICALS | SOFDRA | NON PREFERRED | ||
| DERMATOLOGICALS | SORIXIA | EXCLUDED | ||
| DERMATOLOGICALS | SOTYKTU | PREFERRED | SP | PA |
| DERMATOLOGICALS | SPEVIGO | NON PREFERRED | SP | PA |
| DERMATOLOGICALS | SPINOSAD | GENERIC | ||
| DERMATOLOGICALS | SSD | GENERIC | ||
| DERMATOLOGICALS | STELARA | PREFERRED | SP | PA |
| DERMATOLOGICALS | STEQEYMA | EXCLUDED | SP | PA |
| DERMATOLOGICALS | STERILE TOPICAL L.E.T. GE | EXCLUDED | ||
| DERMATOLOGICALS | SULFURATED LIME | NON PREFERRED | ||
| DERMATOLOGICALS | SODIUM SULFACETAMIDE | GENERIC | ||
| DERMATOLOGICALS | SULFACETAMIDE SODIUM | GENERIC | ||
| DERMATOLOGICALS | SULFACLEANSE 8/4 | GENERIC | ||
| DERMATOLOGICALS | SULFAMYLON | NON PREFERRED | ||
| DERMATOLOGICALS | SUMADAN WASH | NON PREFERRED | ||
| DERMATOLOGICALS | SYNALAR | NON PREFERRED | ||
| DERMATOLOGICALS | TACLONEX | NON PREFERRED | ||
| DERMATOLOGICALS | TACROLIMUS | GENERIC | ||
| DERMATOLOGICALS | TALTZ | EXCLUDED | SP | PA |
| DERMATOLOGICALS | TANNIC ACID | NON PREFERRED | ||
| DERMATOLOGICALS | TARDEOXIA | EXCLUDED | ||
| DERMATOLOGICALS | TARDIMAXIA | EXCLUDED | ||
| DERMATOLOGICALS | TARGRETIN GEL | EXCLUDED | SP | PA |
| DERMATOLOGICALS | TAROXIA | EXCLUDED | ||
| DERMATOLOGICALS | TAZAROTENE | GENERIC | ||
| DERMATOLOGICALS | TAZORAC | EXCLUDED | ||
| DERMATOLOGICALS | TELIORA | EXCLUDED | ||
| DERMATOLOGICALS | TETOXIA | EXCLUDED | ||
| DERMATOLOGICALS | TETRACYCLINE HCL | NON PREFERRED | ||
| DERMATOLOGICALS | TEXACORT | GENERIC | ||
| DERMATOLOGICALS | TOLAK | EXCLUDED | ||
| DERMATOLOGICALS | TOLNAFTATE | NON PREFERRED | ||
| DERMATOLOGICALS | TOPICAL L.E.T | EXCLUDED | ||
| DERMATOLOGICALS | TOPICORT | NON PREFERRED | ||
| DERMATOLOGICALS | TREMFYA | PREFERRED | SP | PA |
| DERMATOLOGICALS | TRETINOIN | GENERIC | ||
| DERMATOLOGICALS | TRIAMCINOLONE ACETONIDE | EXCLUDED | ||
| DERMATOLOGICALS | TRIAMCINOLONE ACETONIDE | GENERIC | ||
| DERMATOLOGICALS | TRIAMCINOLONE ACETONIDE I | EXCLUDED | ||
| DERMATOLOGICALS | TRIAMVEX | EXCLUDED | ||
| DERMATOLOGICALS | TRIDACAINE II | GENERIC | ||
| DERMATOLOGICALS | TRIDACAINE III | GENERIC | ||
| DERMATOLOGICALS | TRIDERM | GENERIC | ||
| DERMATOLOGICALS | TURPENTINE SPIRITS | NON PREFERRED | ||
| DERMATOLOGICALS | UNZDOMDIOXIAZAR | EXCLUDED | ||
| DERMATOLOGICALS | USTEKINUMAB-AEKN | EXCLUDED | SP | PA |
| DERMATOLOGICALS | USTEKINUMAB-TTWE | EXCLUDED | SP | PA |
| DERMATOLOGICALS | USTEKINUMAB | EXCLUDED | SP | PA |
| DERMATOLOGICALS | VALCHLOR | NON PREFERRED | SP | PA |
| DERMATOLOGICALS | VANOS | NON PREFERRED | ||
| DERMATOLOGICALS | VARDIMAXIA | EXCLUDED | ||
| DERMATOLOGICALS | VAROXIA | EXCLUDED | ||
| DERMATOLOGICALS | VECTICAL | EXCLUDED | ||
| DERMATOLOGICALS | VEVEN | EXCLUDED | ||
| DERMATOLOGICALS | WAYZEN | EXCLUDED | ||
| DERMATOLOGICALS | WELERIS | EXCLUDED | ||
| DERMATOLOGICALS | WEZLANA | EXCLUDED | SP | PA |
| DERMATOLOGICALS | XERAC AC | NON PREFERRED | ||
| DERMATOLOGICALS | XEROFORM OCCLUSIVE PETROL | NON PREFERRED | ||
| DERMATOLOGICALS | XICLO | EXCLUDED | ||
| DERMATOLOGICALS | XIRUN | EXCLUDED | ||
| DERMATOLOGICALS | YCANTH | EXCLUDED | ||
| DERMATOLOGICALS | YESINTEK | PREFERRED | SP | PA |
| DERMATOLOGICALS | ZACARE 4% KIT | NON PREFERRED | ||
| DERMATOLOGICALS | ZACARE 8% KIT | NON PREFERRED | ||
| DERMATOLOGICALS | ZACLIR CLEANSING | NON PREFERRED | ||
| DERMATOLOGICALS | ZELSUVMI | EXCLUDED | ||
| DERMATOLOGICALS | ZENATANE | GENERIC | PA | |
| DERMATOLOGICALS | ZITHRANOL | NON PREFERRED | ||
| DERMATOLOGICALS | ZORYVE | PREFERRED | ||
| DERMATOLOGICALS | ZOVIRAX | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | 12-PANEL POC TOXICOLOGY M | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | A1CNOW+ PROFESSIONAL MULT | GENERIC | ||
| DIAGNOSTIC PRODUCTS | ACCULA SARS-COV-2 | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | ADENOSINE | GENERIC | ||
| DIAGNOSTIC PRODUCTS | ARIDOL | EXCLUDED | ||
| DIAGNOSTIC PRODUCTS | BINAXNOW COVID-19 AG CARD | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | BLUDIGO | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | CANVAS DX DIAGNOSIS AID, | EXCLUDED | ||
| DIAGNOSTIC PRODUCTS | CHIRHOSTIM | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | CHOLESTEROL & LIPID TEST | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | COBAS LIAT SARS-COV-2 ASS | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | COBAS LIAT SARS-COV-2 CON | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | COBAS LIAT SARS-COV-2-AB | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | CORTROSYN | NON PREFERRED | PA | |
| DIAGNOSTIC PRODUCTS | COSYNTROPIN | GENERIC | PA | |
| DIAGNOSTIC PRODUCTS | STATUS COVID-19/FLU A&B | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | CYSVIEW | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | CYTALUX | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | D-CARE BLOOD GLUCOSE | EXCLUDED | ||
| DIAGNOSTIC PRODUCTS | DIPYRIDAMOLE | GENERIC | ||
| DIAGNOSTIC PRODUCTS | D-XYLOSE | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | GLEOLAN | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | GLUCAGON | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | GLUCAGON HCL DIAGNOSTIC | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | GVOKE VIALDX | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | HISTATROL | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | HOME PAP KIT | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | IC GREEN | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | ID NOW COVID-19 2.0 | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | ID NOW COVID-19 CONTROL S | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | ID NOW INFLUENZA A & B 2 | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | ID NOW COVID-19 | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | ID NOW RSV | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | ID NOW RSV CONTROL SWAB | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | ID NOW STREP A2 | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | ID NOW STREP A2 CONTROL S | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | INDOCYANINE GREEN | GENERIC | ||
| DIAGNOSTIC PRODUCTS | ISOSULFAN BLUE | GENERIC | ||
| DIAGNOSTIC PRODUCTS | KINEVAC | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | LEXISCAN | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | LUCIRA COVID-19 & FLU TES | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | LUCIRA COVID-19 ALL-IN-ON | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | LUMISIGHT | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | LYRA DIRECT SARS-COV-2 AS | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | LYRA SARS-COV-2 ASSAY | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | METHACHOLINE CHLORIDE | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | METOPIRONE | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | PH STRIPS | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | PRE-PEN | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | PROVOCHOLINE | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | QUICKVUE + STREP A TEST | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | QUICKVUE INFLUENZA A+B TE | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | QUICKVUE IN-LINE STREP A | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | QUICKVUE SARS ANTIGEN TES | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | QUICKVUE DIPSTICK STREP A | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | REGADENOSON | GENERIC | ||
| DIAGNOSTIC PRODUCTS | R-GENE 10 | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SECREFLO | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SINCALIDE | EXCLUDED | ||
| DIAGNOSTIC PRODUCTS | SOFIA2 SARS ANTIGEN FIA | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SOFIA INFLUENZA A+B FIA | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SOFIA STREP A FIA | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SOFIA STREP A+ FIA | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SOFIA SARS ANTIGEN FIA | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SOFIA2 FLU/SARS ANTIGEN F | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SPY AGENT GREEN | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SPY-MIS KIT | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | SPY-PHI KIT | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | THYROGEN | NON PREFERRED | SP | PA |
| DIAGNOSTIC PRODUCTS | TOXICOLOGY MEDICATED COLL | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | TYFAST FLU A/B & COVID-19 | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | UDSX MEDICATED SYSTEM | EXCLUDED | ||
| DIAGNOSTIC PRODUCTS | UDSXMP MEDICATED SYSTEM | EXCLUDED | ||
| DIAGNOSTIC PRODUCTS | VUEBLU | NON PREFERRED | ||
| DIAGNOSTIC PRODUCTS | XPERT XPRESS SARS-COV-2 | NON PREFERRED | ||
| DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS | CAMINO PRO COMPLETE/GLYTA | NON PREFERRED | ||
| DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS | GLYTACTIN COMPLETE 10PE | NON PREFERRED | ||
| DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS | GLYTACTIN SWIRL 15 | NON PREFERRED | ||
| DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS | HOMACTIN AA PLUS | NON PREFERRED | ||
| DIGESTIVE AIDS | CREON | PREFERRED | PA | |
| DIGESTIVE AIDS | L-GLUTAMIC ACID HCL | NON PREFERRED | ||
| DIGESTIVE AIDS | PANCREAZE | NON PREFERRED | PA | |
| DIGESTIVE AIDS | PEPSIN | NON PREFERRED | ||
| DIGESTIVE AIDS | PERTZYE | NON PREFERRED | PA | |
| DIGESTIVE AIDS | SUCRAID | NON PREFERRED | SP | PA |
| DIGESTIVE AIDS | VIOKACE | PREFERRED | PA | |
| DIGESTIVE AIDS | ZENPEP | PREFERRED | PA | |
| DIURETICS | ACETAZOLAMIDE ER | GENERIC | ||
| DIURETICS | ACETAZOLAMIDE SODIUM | GENERIC | ||
| DIURETICS | ACETAZOLAMIDE | EXCLUDED | ||
| DIURETICS | ACETAZOLAMIDE | GENERIC | ||
| DIURETICS | ALDACTONE | NON PREFERRED | ||
| DIURETICS | AMILORIDE/HYDROCHLOROTHIA | GENERIC | ||
| DIURETICS | AMILORIDE HYDROCHLORIDE | NON PREFERRED | ||
| DIURETICS | AMILORIDE HCL | NON PREFERRED | ||
| DIURETICS | AMILORIDE HCL | GENERIC | ||
| DIURETICS | AMILORIDE HYDROCHLORIDE | GENERIC | ||
| DIURETICS | BUMETANIDE | GENERIC | ||
| DIURETICS | BUMEX | NON PREFERRED | ||
| DIURETICS | CHLOROTHIAZIDE SODIUM | GENERIC | ||
| DIURETICS | CHLORTHALIDONE | GENERIC | ||
| DIURETICS | DICHLORPHENAMIDE | GENERIC | SP | PA |
| DIURETICS | DIURIL | NON PREFERRED | ||
| DIURETICS | EDECRIN | NON PREFERRED | PA | |
| DIURETICS | ETHACRYNATE SODIUM | GENERIC | ||
| DIURETICS | ETHACRYNIC ACID | GENERIC | PA | |
| DIURETICS | FUROSEMIDE | GENERIC | ||
| DIURETICS | FUROSEMIDE | EXCLUDED | ||
| DIURETICS | FUROSEMIDE/SODIUM CHLORID | EXCLUDED | ||
| DIURETICS | FUROSEMIDE | NON PREFERRED | ||
| DIURETICS | HEMICLOR | EXCLUDED | ||
| DIURETICS | HYDROCHLOROTHIAZIDE | GENERIC | ||
| DIURETICS | HYDROCHLOROTHIAZIDE | NON PREFERRED | ||
| DIURETICS | HYDROCHLOROTHIAZIDE | EXCLUDED | ||
| DIURETICS | INDAPAMIDE | GENERIC | ||
| DIURETICS | INZIRQO | EXCLUDED | ||
| DIURETICS | KEVEYIS | NON PREFERRED | SP | PA |
| DIURETICS | LASIX | NON PREFERRED | ||
| DIURETICS | MANNITOL | GENERIC | ||
| DIURETICS | METHAZOLAMIDE | NON PREFERRED | ||
| DIURETICS | METHAZOLAMIDE | GENERIC | ||
| DIURETICS | METOLAZONE | GENERIC | ||
| DIURETICS | ORMALVI | GENERIC | SP | PA |
| DIURETICS | OSMITROL VIAFLEX | GENERIC | ||
| DIURETICS | SPIRONOLACTONE/HYDROCHLOR | GENERIC | ||
| DIURETICS | SPIRONOLACTONE | GENERIC | ||
| DIURETICS | THALITONE | EXCLUDED | ||
| DIURETICS | TORSEMIDE | EXCLUDED | ||
| DIURETICS | TORSEMIDE | GENERIC | ||
| DIURETICS | TRIAMTERENE/HYDROCHLOROTH | EXCLUDED | ||
| DIURETICS | TRIAMTERENE/HYDROCHLOROTH | GENERIC | ||
| DIURETICS | TRIAMTERENE | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ACTHAR | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ACTONEL | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ALDURAZYME | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ALENDRONATE SODIUM | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | BILDYOS | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | BILPREVDA | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | BOMYNTRA | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | BONSITY | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | BRINEURA | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | BUPHENYL | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CABERGOLINE | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CALCITRIOL | EXCLUDED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CALCITRIOL | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CARBAGLU | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CARGLUMIC ACID | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CARNITOR | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CARNITOR SF | EXCLUDED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CARNITOR | EXCLUDED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CINACALCET HCL | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CONEXXENCE | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CORTROPHIN | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CRENESSITY | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | CRYSVITA | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | DDAVP | NON PREFERRED | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | DDAVP | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | DESMOPRESSIN ACETATE | GENERIC | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | DESMOPRESSIN ACETATE | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | DESMOPRESSIN ACETATE | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | DOXERCALCIFEROL | EXCLUDED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | DOXERCALCIFEROL | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | EGRIFTA | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | EGRIFTA WR | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ELAPRASE | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ELFABRIO | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | EVENITY | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | EVISTA | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | FABRAZYME | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | FENSOLVI | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | FORTEO | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | FOSAMAX PLUS D | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | FOSAMAX | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | GALAFOLD | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | HARLIKU | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | IBANDRONATE SODIUM | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | IMCIVREE | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | INCRELEX | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ISTURISA | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | JAVYGTOR | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | JUBBONTI | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | JYNARQUE | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | KANUMA | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | KEBILIDI | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | KERENDIA | PREFERRED | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | KUVAN | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | LAMZEDE | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | LANREOTIDE ACETATE | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | LANREOTIDE ACETATE | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | L-CARNITINE | EXCLUDED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | LEVOCARNITINE SF | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | LEVOCARNITINE | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | LUMIZYME | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | LUPRON DEPOT-PED | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | MEPSEVII | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | MIFEPREX | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | MIFEPRISTONE | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | MYALEPT | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | MYCAPSSA | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | NAGLAZYME | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | NEXVIAZYME | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | NITISINONE | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | NITYR | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | NULIBRY | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | OCTREOTIDE ACETATE | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | OLPRUVA | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | OPFOLDA | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ORFADIN | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ORILISSA | PREFERRED | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | OSENVELT | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | OSPHENA | EXCLUDED | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | PALYNZIQ | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | PAMIDRONATE | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | PAMIDRONATE | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | PARICALCITOL | GENERIC | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | PARSABIV | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | PHEBURANE | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SODIUM PHENYLACETATE/SODI | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SODIUM PHENYLBUTYRATE | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | POMBILITI | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | PROLIA | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | RALOXIFENE HYDROCHLORIDE | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | RAVICTI | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | RECLAST | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | RECORLEV | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | REVCOVI | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | RISEDRONATE SODIUM | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ROCALTROL | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SAMSCA | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SANDOSTATIN | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SANDOSTATIN | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SAPROPTERIN DIHYDROCHLORIDE | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SENSIPAR | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SEPHIENCE | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SIGNIFOR | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SIGNIFOR LAR | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | Sod Benz-Sod Phenylacet | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SOMATULINE DEPOT | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SOMAVERT | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | STOBOCLO | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | STRENSIQ | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SUPPRELIN LA | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | SYNAREL | NON PREFERRED | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | TEPEZZA | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | TERIPARATIDE | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | TERIPARATIDE | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | TERLIVAZ | EXCLUDED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | TOLVAPTAN | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | TRIPTODUR | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | TRYNGOLZA | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | TYMLOS | PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | VASOPRESSIN/DEXTROSE | EXCLUDED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | VASOPRESSIN/SODIUM CHLORI | EXCLUDED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | VASOPRESSIN | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | VASOPRESSIN +RFID | GENERIC | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | VASOSTRICT | NON PREFERRED | ||
| ENDOCRINE AND METABOLIC AGENTS - MISC. | VEOZAH | EXCLUDED | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | VIMIZIM | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | VOXZOGO | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | VYKAT XR | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | WYOST | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | XENPOZYME | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | XGEVA | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | XPHOZAH | EXCLUDED | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | XURIDEN | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | YORVIPATH | EXCLUDED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ZELVYSIA | GENERIC | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ZEMPLAR | NON PREFERRED | PA | |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ZOLEDRONIC ACID | NON PREFERRED | SP | PA |
| ENDOCRINE AND METABOLIC AGENTS - MISC. | ZOLEDRONIC ACID | GENERIC | SP | PA |
| ESTROGENS | ABIGALE LO | GENERIC | ||
| ESTROGENS | ABIGALE | GENERIC | ||
| ESTROGENS | ACTIVELLA | NON PREFERRED | ||
| ESTROGENS | ALORA | NON PREFERRED | ||
| ESTROGENS | ANGELIQ | NON PREFERRED | ||
| ESTROGENS | BIJUVA | NON PREFERRED | ||
| ESTROGENS | CLIMARA | EXCLUDED | ||
| ESTROGENS | CLIMARA PRO | EXCLUDED | ||
| ESTROGENS | COMBIPATCH | PREFERRED | ||
| ESTROGENS | COVARYX HS | GENERIC | ||
| ESTROGENS | COVARYX | GENERIC | ||
| ESTROGENS | DELESTROGEN | NON PREFERRED | ||
| ESTROGENS | DEPO-ESTRADIOL | NON PREFERRED | ||
| ESTROGENS | DIVIGEL | EXCLUDED | ||
| ESTROGENS | DOTTI | GENERIC | ||
| ESTROGENS | DUAVEE | PREFERRED | ||
| ESTROGENS | EEMT HS | GENERIC | ||
| ESTROGENS | EEMT | GENERIC | ||
| ESTROGENS | ELESTRIN | EXCLUDED | ||
| ESTROGENS | ESTERIFIED ESTROGENS/METH | GENERIC | ||
| ESTROGENS | ESTRADIOL/NORETHINDRONE A | GENERIC | ||
| ESTROGENS | ESTRADIOL VALERATE | GENERIC | ||
| ESTROGENS | ESTRADIOL | GENERIC | ||
| ESTROGENS | ESTRADIOL | EXCLUDED | ||
| ESTROGENS | ESTRATEST H.S. | GENERIC | ||
| ESTROGENS | ESTROGEL | NON PREFERRED | ||
| ESTROGENS | ETHINYL ESTRADIOL | NON PREFERRED | ||
| ESTROGENS | Evamist | NON PREFERRED | ||
| ESTROGENS | EVAMIST | EXCLUDED | ||
| ESTROGENS | FYAVOLV | GENERIC | ||
| ESTROGENS | JINTELI | GENERIC | ||
| ESTROGENS | LYLLANA | GENERIC | ||
| ESTROGENS | MENOSTAR | EXCLUDED | ||
| ESTROGENS | MIMVEY | GENERIC | ||
| ESTROGENS | MINIVELLE | EXCLUDED | ||
| ESTROGENS | MYFEMBREE | PREFERRED | PA | |
| ESTROGENS | NORETHINDRONE ACETATE/ETH | GENERIC | ||
| ESTROGENS | ORIAHNN | PREFERRED | PA | |
| ESTROGENS | PREMARIN | NON PREFERRED | ||
| ESTROGENS | PREMARIN | EXCLUDED | ||
| ESTROGENS | PREMPHASE | PREFERRED | ||
| ESTROGENS | PREMPRO | PREFERRED | ||
| ESTROGENS | VIVELLE-DOT | EXCLUDED | ||
| FLUOROQUINOLONES | BAXDELA | NON PREFERRED | PA | |
| FLUOROQUINOLONES | CIPRO | NON PREFERRED | ||
| FLUOROQUINOLONES | CIPROFLOXACIN I.V.-IN D5W | GENERIC | ||
| FLUOROQUINOLONES | CIPROFLOXACIN HYDROCHLORI | GENERIC | ||
| FLUOROQUINOLONES | CIPROFLOXACIN HCL | GENERIC | ||
| FLUOROQUINOLONES | LEVOFLOXACIN IN D5W | GENERIC | ||
| FLUOROQUINOLONES | LEVOFLOXACIN | GENERIC | ||
| FLUOROQUINOLONES | MOXIFLOXACIN HYDROCHLORID | EXCLUDED | ||
| FLUOROQUINOLONES | MOXIFLOXACIN HYDROCHLORI | GENERIC | ||
| FLUOROQUINOLONES | MOXIFLOXACIN HYDROCHLORID | GENERIC | ||
| FLUOROQUINOLONES | OFLOXACIN | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | 5-AMINOSALICYLIC ACID | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | ALOSETRON HYDROCHLORIDE | GENERIC | PA | |
| GASTROINTESTINAL AGENTS - MISC. | ALVIMOPAN | GENERIC | PA | |
| GASTROINTESTINAL AGENTS - MISC. | AMITIZA | EXCLUDED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | APRISO | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | AURYXIA | PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | AVSOLA | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | AZULFIDINE | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | AZULFIDINE EN-TABS | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | BALSALAZIDE DISODIUM | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | BYLVAY | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | CALCIUM ACETATE | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | CANASA | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | CHENODAL | GENERIC | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | CHOLBAM | NON PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | CIMZIA | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | COLAZAL | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | CROMOLYN SODIUM | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | CTEXLI | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | DEXPANTHENOL | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | DIPENTUM | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | ENTYVIO | NON PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | ENTYVIO | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | ENULOSE | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | FERRIC CITRATE | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | FOSRENOL | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | GASTROCROM | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | GATTEX | NON PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | GENERLAC | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | GENERLAC | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | IBSRELA | EXCLUDED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | IMULDOSA IV | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | INFLECTRA | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | INFLIXIMAB | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | IQIRVO | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | LACTULOSE | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | LANTHANUM CARBONATE | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | LIALDA | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | LINZESS | PREFERRED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | LIVDELZI | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | LIVMARLI | NON PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | LIVMARLI | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | LOTRONEX | NON PREFERRED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | LUBIPROSTONE | EXCLUDED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | LUBIPROSTONE | GENERIC | PA | |
| GASTROINTESTINAL AGENTS - MISC. | MESALAMINE ER | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | MESALAMINE DR | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | MESALAMINE | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | MESALAMINE | GENERIC | PA | |
| GASTROINTESTINAL AGENTS - MISC. | MESALAMINE | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | MESALAMINE | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | METOCLOPRAMIDE HCL | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | METOCLOPRAMIDE HYDROCHLOR | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | METOCLOPRAMIDE HCL MONOHY | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | METOCLOPRAMIDE HYDROCHLOR | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | MOTEGRITY | EXCLUDED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | MOVANTIK | PREFERRED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | OCALIVA | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | OMVOH | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | OTULFI IV | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | PENTASA | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | PRUCALOPRIDE | GENERIC | PA | |
| GASTROINTESTINAL AGENTS - MISC. | PYZCHIVA IV | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | REBYOTA | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | REGLAN | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | RELISTOR | EXCLUDED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | REMICADE | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | RENFLEXIS | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | RENVELA | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | REZDIFFRA | EXCLUDED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | ROWASA | NON PREFERRED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | SELARSDI IV | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | SEVELAMER CARBONATE | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | SEVELAMER HYDROCHLORIDE | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | SFROWASA | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | SIMETHICONE | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | SKYRIZI | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | SKYRIZI IV | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | STELARA IV | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | STEQEYMA IV | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | SULFASALAZINE | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | SULFASALAZINE | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | SYMPROIC | PREFERRED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | TREMFYA IV | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | TREMFYA | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | TRULANCE | NON PREFERRED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | URSO FORTE | NON PREFERRED | ||
| GASTROINTESTINAL AGENTS - MISC. | URSODIOL | GENERIC | ||
| GASTROINTESTINAL AGENTS - MISC. | URSODIOL/SYRSPEND SF PH4 | EXCLUDED | ||
| GASTROINTESTINAL AGENTS - MISC. | USTEKINUMAB-TTWE IV | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | USTEKINUMAB IV | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | VELPHORO | EXCLUDED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | VELSIPITY | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | VIBERZI | PREFERRED | PA | |
| GASTROINTESTINAL AGENTS - MISC. | VOWST | NON PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | WEZLANA IV | EXCLUDED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | XERMELO | NON PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | YESINTEK IV | PREFERRED | SP | PA |
| GASTROINTESTINAL AGENTS - MISC. | ZYMFENTRA | EXCLUDED | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | ACETIC ACID 0.25% | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | ALFUZOSIN HCL ER | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | ALFUZOSIN HYDROCHLORIDE E | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | ARGYLE STERILE SALINE | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | AVODART | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | CURITY STERILE SALINE | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | CYSTAGON | NON PREFERRED | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | CYTRA K CRYSTALS | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | DEFLUX | NON PREFERRED | PA | |
| GENITOURINARY AGENTS - MISCELLANEOUS | DUTASTERIDE | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | ELMIRON | EXCLUDED | PA | |
| GENITOURINARY AGENTS - MISCELLANEOUS | FILSPARI | PREFERRED | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | FINASTERIDE | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | GLYCINE (L) | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | GLYCINE | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | GLYCINE | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | POTASSIUM CITRATE AND CIT | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | POTASSIUM CITRATE/SODIUM | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | K-PHOS NO 2 | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | LITHOSTAT | EXCLUDED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | SODIUM CITRATE ANHYDROUS | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | NEOMYCIN/POLYMYXIN B SULF | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | OXLUMO | EXCLUDED | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | PENTOSAN POLYSULFATE SODI | EXCLUDED | PA | |
| GENITOURINARY AGENTS - MISCELLANEOUS | POTASSIUM CITRATE ER | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | POTASSIUM CITRATE MONOHYD | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | POTASSIUM CITRATE/CITRIC | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | POTASSIUM CITRATE | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | PROCYSBI | NON PREFERRED | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | PROCYSBI | EXCLUDED | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | PROSCAR | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | RAPAFLO | EXCLUDED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | RENACIDIN | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | RIMSO-50 | EXCLUDED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | RIVFLOZA | EXCLUDED | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | SILODOSIN | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | SODIUM CITRATE | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | SODIUM CITRATE AND CITRIC | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | SODIUM CHLORIDE 0.9% | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | SORBITOL | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | SORBITOL/MANNITOL IRRIGAT | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | TAMSULOSIN HYDROCHLORIDE | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | THIOLA | EXCLUDED | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | TIOPRONIN | GENERIC | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | TIOPRONIN EC | GENERIC | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | TRICITRATES | EXCLUDED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | TRICITRATES | GENERIC | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | UROCIT-K 10 | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | UROCIT-K 15 | NON PREFERRED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | UROXATRAL | EXCLUDED | ||
| GENITOURINARY AGENTS - MISCELLANEOUS | VANRAFIA | PREFERRED | SP | PA |
| GENITOURINARY AGENTS - MISCELLANEOUS | VENXXIVA | GENERIC | SP | PA |
| GOUT AGENTS | ALLOPURINOL SODIUM | GENERIC | ||
| GOUT AGENTS | ALLOPURINOL | EXCLUDED | ||
| GOUT AGENTS | ALLOPURINOL | GENERIC | ||
| GOUT AGENTS | ALOPRIM | NON PREFERRED | ||
| GOUT AGENTS | COLCHICINE | GENERIC | ||
| GOUT AGENTS | COLCHICINE | NON PREFERRED | ||
| GOUT AGENTS | FEBUXOSTAT | GENERIC | ||
| GOUT AGENTS | GLOPERBA | EXCLUDED | ||
| GOUT AGENTS | MITIGARE | EXCLUDED | ||
| GOUT AGENTS | PROBENECID/COLCHICINE | GENERIC | ||
| GOUT AGENTS | PROBENECID | GENERIC | ||
| GOUT AGENTS | ULORIC | EXCLUDED | ||
| HEMATOLOGICAL AGENTS - MISC. | ADVATE | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ADYNOVATE | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ADZYNMA | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | AFSTYLA | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | AGGRASTAT | NON PREFERRED | ||
| HEMATOLOGICAL AGENTS - MISC. | AGGRASTAT | EXCLUDED | ||
| HEMATOLOGICAL AGENTS - MISC. | AGRYLIN | NON PREFERRED | ||
| HEMATOLOGICAL AGENTS - MISC. | ALHEMO | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ALPHANATE | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ALPHANINE SD | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ALPROLIX | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ALTUVIIIO | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ANAGRELIDE HYDROCHLORIDE | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | ANDEMBRY | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ASPIRIN/DIPYRIDAMOLE | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | ASPIRIN/DIPYRIDAMOLE ER | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | BALFAXAR | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | BENEFIX | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | BERINERT | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | BKEMV | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | BRILINTA | PREFERRED | ||
| HEMATOLOGICAL AGENTS - MISC. | CABLIVI | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | CILOSTAZOL | EXCLUDED | ||
| HEMATOLOGICAL AGENTS - MISC. | CILOSTAZOL | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | CINRYZE | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | CLOPIDOGREL | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | COAGADEX | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | CORIFACT | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | DAWNZERA | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | DEFITELIO | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | DIPYRIDAMOLE | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | EFFIENT | NON PREFERRED | ||
| HEMATOLOGICAL AGENTS - MISC. | EKTERLY | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ELOCTATE | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | EMPAVELI | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ENJAYMO | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | EPTIFIBATIDE | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | EPYSQLI | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ESPEROCT | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | FABHALTA | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | FEIBA | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | FIBRYGA | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | FIRAZYR | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | GIVLAARI | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | GOHIBIC | EXCLUDED | ||
| HEMATOLOGICAL AGENTS - MISC. | HAEGARDA | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | HEMGENIX | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | HEMLIBRA | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | HEMOFIL-M | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | HUMATE-P | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | HYMPAVZI | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ICATIBANT ACETATE | GENERIC | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | IDELVION | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | IXINITY | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | JIVI | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | KALBITOR | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | KCENTRA | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | KENGREAL | EXCLUDED | ||
| HEMATOLOGICAL AGENTS - MISC. | KOATE | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | KOATE-DVI | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | KOGENATE FS | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | KOVALTRY | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | NOVOEIGHT | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | NOVOSEVEN | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | NUWIQ | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | OBIZUR | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ORLADEYO | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | PANHEMATIN | NON PREFERRED | ||
| HEMATOLOGICAL AGENTS - MISC. | PENTOXIFYLLINE ER | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | PIASKY | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | PLAVIX | EXCLUDED | ||
| HEMATOLOGICAL AGENTS - MISC. | PRASUGREL HYDROCHLORIDE | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | PROFILNINE SD | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | PYRUKYND | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | QFITLIA | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | REBINYN | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | RECOMBINATE | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | RIASTAP | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | RIXUBIS | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ROCTAVIAN | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | RUCONEST | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | SAJAZIR | GENERIC | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | SEVENFACT | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | SOLIRIS | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | TAKHZYRO | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | TAVALISSE | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | TAVNEOS | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | TICAGRELOR | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | TIROFIBAN HYDROCHLORIDE | GENERIC | ||
| HEMATOLOGICAL AGENTS - MISC. | TRETTEN | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ULTOMIRIS | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | VEOPOZ | NON PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | VONVENDI | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | VOYDEYA | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | WAYRILZ | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | WILATE | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | XYNTHA | PREFERRED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ZILBRYSQ | EXCLUDED | SP | PA |
| HEMATOLOGICAL AGENTS - MISC. | ZONTIVITY | EXCLUDED | ||
| HEMATOPOIETIC AGENTS | ADAKVEO | NON PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | ALVAIZ | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | APHEXDA | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | ARANESP | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | CASGEVY | NON PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | CERDELGA | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | CEREZYME | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | DOPTELET | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | DROXIA | NON PREFERRED | ||
| HEMATOPOIETIC AGENTS | ELELYSO | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | ELTROMBOPAG OLAMINE | GENERIC | SP | PA |
| HEMATOPOIETIC AGENTS | ENDARI | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | EPOGEN | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | FERROUS SULFATE ANHYDROUS | NON PREFERRED | ||
| HEMATOPOIETIC AGENTS | FERAHEME | NON PREFERRED | ||
| HEMATOPOIETIC AGENTS | SODIUM FERRIC GLUCONATE C | GENERIC | ||
| HEMATOPOIETIC AGENTS | FERRLECIT | NON PREFERRED | ||
| HEMATOPOIETIC AGENTS | FERROUS SULFATE HEPTAHYDR | NON PREFERRED | ||
| HEMATOPOIETIC AGENTS | FERUMOXYTOL | GENERIC | ||
| HEMATOPOIETIC AGENTS | FOLIC ACID | GENERIC | ||
| HEMATOPOIETIC AGENTS | FULPHILA | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | FYLNETRA | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | GRANIX | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | INFED | NON PREFERRED | ||
| HEMATOPOIETIC AGENTS | INJECTAFER | NON PREFERRED | ||
| HEMATOPOIETIC AGENTS | INJECTAFER | EXCLUDED | ||
| HEMATOPOIETIC AGENTS | IRON SUCROSE | GENERIC | ||
| HEMATOPOIETIC AGENTS | LEUKINE | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | L-GLUTAMINE | GENERIC | SP | PA |
| HEMATOPOIETIC AGENTS | LYFGENIA | NON PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | MIGLUSTAT | GENERIC | SP | PA |
| HEMATOPOIETIC AGENTS | MIRCERA | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | MONOFERRIC | EXCLUDED | ||
| HEMATOPOIETIC AGENTS | MOZOBIL | NON PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | MULPLETA | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | NEULASTA | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | NEULASTA ONPRO | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | NEUPOGEN | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | NIVESTYM | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | NPLATE | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | NYPOZI | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | NYVEPRIA | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | PLERIXAFOR | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | PLERIXAFOR | GENERIC | SP | PA |
| HEMATOPOIETIC AGENTS | PROCRIT | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | PROMACTA | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | PUREVIT DUALFE PLUS | GENERIC | ||
| HEMATOPOIETIC AGENTS | RELEUKO | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | RETACRIT | PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | ROLVEDON | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | RYZNEUTA | EXCLUDED | ||
| HEMATOPOIETIC AGENTS | SIKLOS | PREFERRED | PA | |
| HEMATOPOIETIC AGENTS | STIMUFEND | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | UDENYCA | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | VAFSEO | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | VENOFER | GENERIC | ||
| HEMATOPOIETIC AGENTS | VENOFER | NON PREFERRED | ||
| HEMATOPOIETIC AGENTS | VPRIV | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | XOLREMDI | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | XROMI | EXCLUDED | ||
| HEMATOPOIETIC AGENTS | YARGESA | GENERIC | SP | PA |
| HEMATOPOIETIC AGENTS | ZARXIO | EXCLUDED | SP | PA |
| HEMATOPOIETIC AGENTS | ZAVESCA | NON PREFERRED | SP | PA |
| HEMATOPOIETIC AGENTS | ZIEXTENZO | EXCLUDED | SP | PA |
| HEMOSTATICS | AMINOCAPROIC ACID | GENERIC | ||
| HEMOSTATICS | CYKLOKAPRON | NON PREFERRED | ||
| HEMOSTATICS | MONSELS FERRIC SUBSULFATE | NON PREFERRED | ||
| HEMOSTATICS | THROMBOGEN | NON PREFERRED | ||
| HEMOSTATICS | TRANEXAMIC ACID | GENERIC | ||
| HEMOSTATICS | TRANEXAMIC ACID/SODIUM CH | EXCLUDED | ||
| HEMOSTATICS | TRANEXAMIC ACID/SODIUM CH | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | AMBIEN CR | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | AMBIEN | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | BYFAVO | EXCLUDED | PA | |
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | CHLORAL HYDRATE | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | DEXMEDETOMIDINE HYDROCHLO | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | DEXMEDETOMIDINE HYDROCHLO | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | DEXMEDETOMIDINE HYDROCHLO | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | ESTAZOLAM | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | ESZOPICLONE | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | FLURAZEPAM HYDROCHLORIDE | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | HALCION | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | LUNESTA | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | MIDAZOLAM/SODIUM CHLORIDE | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | MIDAZOLAM HYDROCHLORIDE/S | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | MIDAZOLAM/SODIUM CHLORIDE | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | MIDAZOLAM HCL | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | MIDAZOLAM HYDROCHLORIDE | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | MIDAZOLAM HYDROCHLORIDE | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | MIDAZOLAM | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | Midazolam-Sodium Chloride | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | PENTOBARBITAL SODIUM | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | PENTOBARBITAL SODIUM | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | PHENOBARBITAL | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | PHENOBARBITAL | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | PHENOBARBITAL SODIUM | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | PHENOBARBITAL SODIUM | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | PHENOBARBITAL | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | PRECEDEX | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | RAMELTEON | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | ROZEREM | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | SEZABY | NON PREFERRED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | TEMAZEPAM | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | TRIAZOLAM | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | ZALEPLON | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | ZOLPIDEM TARTRATE ER | GENERIC | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | ZOLPIDEM TARTRATE | EXCLUDED | ||
| HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS | ZOLPIDEM TARTRATE | GENERIC | ||
| LAXATIVES | BISACODYL | NON PREFERRED | ||
| LAXATIVES | CLENPIQ | PREFERRED | ||
| LAXATIVES | CONSTULOSE | GENERIC | ||
| LAXATIVES | DOCUSATE SODIUM | NON PREFERRED | ||
| LAXATIVES | GAVILYTE-C | GENERIC | ||
| LAXATIVES | GAVILYTE-G | GENERIC | ||
| LAXATIVES | GAVILYTE-N/FLAVOR PACK | GENERIC | ||
| LAXATIVES | GOLYTELY | EXCLUDED | ||
| LAXATIVES | LACTULOSE | GENERIC | ||
| LAXATIVES | LACTULOSE | EXCLUDED | ||
| LAXATIVES | MAGNESIUM SULFATE HEPTAHY | NON PREFERRED | ||
| LAXATIVES | MAGNESIUM SULFATE | NON PREFERRED | ||
| LAXATIVES | MINERAL OIL HEAVY | GENERIC | ||
| LAXATIVES | MINERAL OIL HEAVY | NON PREFERRED | ||
| LAXATIVES | MINERAL OIL LIGHT | NON PREFERRED | ||
| LAXATIVES | MOVIPREP | EXCLUDED | ||
| LAXATIVES | MURI-LUBE | NON PREFERRED | ||
| LAXATIVES | PEG-3350/ELECTROLYTES/ASC | EXCLUDED | ||
| LAXATIVES | PEG-3350/SODIUM SULF/NACL | EXCLUDED | ||
| LAXATIVES | PEG-3350/ELECTROLYTES | GENERIC | ||
| LAXATIVES | PEG-3350/NACL/NA BICARBON | GENERIC | ||
| LAXATIVES | PEG-PREP | NON PREFERRED | ||
| LAXATIVES | PLENVU | EXCLUDED | ||
| LAXATIVES | SODIUM SULFATE/POTASSIUM | GENERIC | ||
| LAXATIVES | SUFLAVE | EXCLUDED | ||
| LAXATIVES | SUPREP BOWEL PREP KIT | EXCLUDED | ||
| LAXATIVES | SUTAB | EXCLUDED | ||
| LAXATIVES | VIBRANT | NON PREFERRED | ||
| LAXATIVES | VIBRANT STARTER KIT | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | ARTICADENT DENTAL | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | BUFFERED LIDOCAINE HYDROC | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | BUPIVACAINE HYDROCHLORIDE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | BUPIVACAINE HYDROCHLORIDE | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | BUPIVACAINE HYDROCHLORIDE | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | BUPIVACAINE FISIOPHARMA | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | BUPIVACAINE SPINAL | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | BUPIVACAINE HCL | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | BUPIVACAINE HCL MONOHYDRA | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | BUPIVACAINE/EPINEPHRINE | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | BUPIVACAINE/EPINEPHRINE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | CHLOROPROCAINE HYDROCHLOR | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | CLOROTEKAL | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | EXPAREL | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | LIDOCAINE/EPINEPHRINE | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | LIDOCAINE/EPINEPHRINE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | LIDOCAINE HYDROCHLORIDE/E | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | LIDOCAINE HYDROCHLORIDE | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | LIDOCAINE HCL | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | LIDOCAINE HYDROCHLORIDE B | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | LIDOCAINE HYDROCHLORIDE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | MARCAINE | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | MARCAINE SPINAL | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | MARCAINE/EPINEPHRINE | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | MARCAINE/EPINEPHRINE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | MEPIVACAINE HCL | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | NAROPIN | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | NESACAINE | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | NESACAINE-MPF | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | ORABLOC | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | POLOCAINE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | POLOCAINE-MPF | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | POLOCAINE-MPF | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | POSIMIR | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | PROCAINE HCL | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | PROCAINE HYDROCHLORIDE | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | RECK | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | ROPIVACAINE HYDROCHLORIDE | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | ROPIVACAINE HYDROCHLORIDE | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | ROPIVACAINE HYDROCHLORIDE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | ROPIVACAINE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | ROPIVACAINE HCL | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | SENSORCAINE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | SENSORCAINE-MPF | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | SENSORCAINE-MPF/EPINEPHRI | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | SENSORCAINE-MPF/EPINEPHRI | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | SENSORCAINE/EPINEPHRINE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | TETRACAINE HYDROCHLORIDE | GENERIC | ||
| LOCAL ANESTHETICS - PARENTERAL | XARACOLL | EXCLUDED | ||
| LOCAL ANESTHETICS - PARENTERAL | XYLOCAINE/EPINEPHRINE | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | XYLOCAINE | NON PREFERRED | ||
| LOCAL ANESTHETICS - PARENTERAL | XYLOCAINE-MPF/EPINEPHRINE | NON PREFERRED | ||
| MACROLIDES | AZITHROMYCIN | GENERIC | ||
| MACROLIDES | AZITHROMYCIN | EXCLUDED | ||
| MACROLIDES | CLARITHROMYCIN | GENERIC | ||
| MACROLIDES | CLARITHROMYCIN ER | GENERIC | ||
| MACROLIDES | DIFICID | PREFERRED | PA | |
| MACROLIDES | E.E.S. 400 | GENERIC | ||
| MACROLIDES | E.E.S. GRANULES | EXCLUDED | ||
| MACROLIDES | ERYPED 400 | EXCLUDED | ||
| MACROLIDES | ERYTHROCIN LACTOBIONATE | GENERIC | ||
| MACROLIDES | ERYTHROCIN LACTOBIONATE | NON PREFERRED | ||
| MACROLIDES | ERYTHROMYCIN ETHYLSUCCINA | GENERIC | ||
| MACROLIDES | ERYTHROMYCIN DR | GENERIC | ||
| MACROLIDES | ERYTHROMYCIN LACTOBIONATE | GENERIC | ||
| MACROLIDES | ERYTHROMYCIN | NON PREFERRED | ||
| MACROLIDES | ERYTHROMYCIN BASE | NON PREFERRED | ||
| MACROLIDES | ERYTHROMYCIN ETHYLSUCCINA | NON PREFERRED | ||
| MACROLIDES | ERYTHROMYCIN BASE | GENERIC | ||
| MACROLIDES | FIDAXOMICIN | GENERIC | PA | |
| MACROLIDES | ZITHROMAX | NON PREFERRED | ||
| MACROLIDES | ZITHROMAX TRI-PAK | NON PREFERRED | ||
| MACROLIDES | ZITHROMAX Z-PAK | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | APOGEE IC CATHETER/14FR/1 | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | CONCEPTION KIT | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | KANGAROO GASTROSTOMY TUBE | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | INNOSPIRE ELEGANCE COMPRE | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | LITETOUCH MASK LARGE | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | LITETOUCH MASK MEDIUM | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | LITETOUCH MASK SMALL | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | OPTICHAMBER DIAMOND/LARGE | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | OPTICHAMBER DIAMOND/MEDIU | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | OPTICHAMBER DIAMOND | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | SIDESTREAM PEDIATRIC FACE | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | T.E.D. ANTI-EMBOLISM STOC | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | VAPRO PLUS POCKET/12FR/16 | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | VAPRO PLUS POCKET/12FR/8" | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | VAPRO PLUS/14FR/16"/STRAI | NON PREFERRED | ||
| MEDICAL DEVICES AND SUPPLIES | VAPRO PLUS POCKET/14FR/8" | NON PREFERRED | ||
| MIGRAINE PRODUCTS | AIMOVIG | EXCLUDED | PA | |
| MIGRAINE PRODUCTS | AJOVY | PREFERRED | PA | |
| MIGRAINE PRODUCTS | ALMOTRIPTAN MALATE | GENERIC | ||
| MIGRAINE PRODUCTS | ALMOTRIPTAN | GENERIC | ||
| MIGRAINE PRODUCTS | Brekiya | EXCLUDED | ||
| MIGRAINE PRODUCTS | DIHYDROERGOTAMINE MESYLAT | NON PREFERRED | ||
| MIGRAINE PRODUCTS | ELETRIPTAN HYDROBROMIDE | GENERIC | ||
| MIGRAINE PRODUCTS | ELYXYB | EXCLUDED | PA | |
| MIGRAINE PRODUCTS | EMGALITY | PREFERRED | PA | |
| MIGRAINE PRODUCTS | ERGOTAMINE TARTRATE/CAFFE | EXCLUDED | ||
| MIGRAINE PRODUCTS | FROVA | NON PREFERRED | ||
| MIGRAINE PRODUCTS | FROVATRIPTAN SUCCINATE | GENERIC | ||
| MIGRAINE PRODUCTS | IMITREX STATDOSE REFILL | NON PREFERRED | ||
| MIGRAINE PRODUCTS | IMITREX STATDOSE SYSTEM | NON PREFERRED | ||
| MIGRAINE PRODUCTS | IMITREX | NON PREFERRED | ||
| MIGRAINE PRODUCTS | MAXALT | EXCLUDED | ||
| MIGRAINE PRODUCTS | MAXALT-MLT | EXCLUDED | ||
| MIGRAINE PRODUCTS | NARATRIPTAN HCL | GENERIC | ||
| MIGRAINE PRODUCTS | NURTEC | PREFERRED | PA | |
| MIGRAINE PRODUCTS | QULIPTA | PREFERRED | PA | |
| MIGRAINE PRODUCTS | RELPAX | NON PREFERRED | ||
| MIGRAINE PRODUCTS | REYVOW | NON PREFERRED | PA | |
| MIGRAINE PRODUCTS | RIZATRIPTAN BENZOATE ODT | GENERIC | ||
| MIGRAINE PRODUCTS | RIZATRIPTAN BENZOATE | GENERIC | ||
| MIGRAINE PRODUCTS | SUMANSETRON | EXCLUDED | ||
| MIGRAINE PRODUCTS | SUMATRIPTAN SUCCINATE REF | GENERIC | ||
| MIGRAINE PRODUCTS | SUMATRIPTAN SUCCINATE | GENERIC | ||
| MIGRAINE PRODUCTS | SUMATRIPTAN | GENERIC | ||
| MIGRAINE PRODUCTS | SYMBRAVO | EXCLUDED | ||
| MIGRAINE PRODUCTS | UBRELVY | PREFERRED | PA | |
| MIGRAINE PRODUCTS | VYEPTI | EXCLUDED | PA | |
| MIGRAINE PRODUCTS | Zavzpret | EXCLUDED | PA | |
| MIGRAINE PRODUCTS | ZOLMITRIPTAN ODT | GENERIC | ||
| MIGRAINE PRODUCTS | ZOLMITRIPTAN | GENERIC | ||
| MIGRAINE PRODUCTS | ZOMIG | NON PREFERRED | ||
| MIGRAINE PRODUCTS | ZOMIG | EXCLUDED | ||
| MINERALS & ELECTROLYTES | AQUASTAT SFR | GENERIC | ||
| MINERALS & ELECTROLYTES | AQUASTAT | GENERIC | ||
| MINERALS & ELECTROLYTES | BD POSIFLUSH | GENERIC | ||
| MINERALS & ELECTROLYTES | BD POSIFLUSH NORMAL SALIN | GENERIC | ||
| MINERALS & ELECTROLYTES | BD POSIFLUSH SAFESCRUB | GENERIC | ||
| MINERALS & ELECTROLYTES | CALCIUM CHLORIDE ANHYDROU | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM CHLORIDE DIHYDRAT | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM GLUCONATE/SODIUM | EXCLUDED | ||
| MINERALS & ELECTROLYTES | CALCIUM GLUCONATE/SODIUM | GENERIC | ||
| MINERALS & ELECTROLYTES | CALCIFOL | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM CARBONATE HEAVY | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM CARBONATE LIGHT | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM CARBONATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM CHLORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | CALCIUM CHLORIDE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM GLUCONATE | GENERIC | ||
| MINERALS & ELECTROLYTES | CALCIUM GLUCONATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM GLUCONATE | EXCLUDED | ||
| MINERALS & ELECTROLYTES | CALCIUM GLUCONATE ANHYDRO | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM GLUCONATE MONOHYD | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM LACTATE PENTAHYDR | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM PHOSPHATE DIBASIC | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CALCIUM PHOSPHATE TRIBASI | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CHROMIC CHLORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | CHROMIUM CHLORIDE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | COPPER | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CUPRIC CHLORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | CUPRIC SULFATE PENTAHYDRA | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | CUPRIC SULFATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | DEXTROSE 10%/SODIUM CHLOR | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | DEXTROSE 10%/SODIUM CHLOR | GENERIC | ||
| MINERALS & ELECTROLYTES | DEXTROSE 2.5%/SODIUM CHLO | GENERIC | ||
| MINERALS & ELECTROLYTES | DEXTROSE 2.5%/SODIUM CHLO | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | DEXTROSE 5%/LACTATED RING | GENERIC | ||
| MINERALS & ELECTROLYTES | DEXTROSE 5% | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | DEXTROSE 5%/SODIUM CHLORI | GENERIC | ||
| MINERALS & ELECTROLYTES | DEXTROSE 5%/SODIUM CHLORI | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | DEXTROSE 5%/SODIUM CHLORI | EXCLUDED | ||
| MINERALS & ELECTROLYTES | DEXTROSE/SODIUM CHLORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | DEXTROSE/SODIUM CHLORIDE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | EFFER-K | GENERIC | ||
| MINERALS & ELECTROLYTES | EFFER-K | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | ELLIOTTS B | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | FLUORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | MONOJECT PHARMA GRADE FLU | GENERIC | ||
| MINERALS & ELECTROLYTES | GALZIN | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | GLYCOPHOS | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | IODINE STRONG | GENERIC | ||
| MINERALS & ELECTROLYTES | IONOSOL-MB/DEXTROSE 5% | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | ISOLYTE-P/DEXTROSE 5% | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | ISOLYTE-S | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | ISOLYTE-S PH 7.4 | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | POTASSIUM PHOSPHATE/SODIU | EXCLUDED | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE/LIDOCA | EXCLUDED | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE/DEXTRO | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | KCL 0.075%/D5W/NACL 0.45% | GENERIC | ||
| MINERALS & ELECTROLYTES | KCL 0.15%/D5W/NACL 0.45% | GENERIC | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE/DEXTRO | GENERIC | ||
| MINERALS & ELECTROLYTES | KCL 0.15%/D5W/NACL 0.2% | GENERIC | ||
| MINERALS & ELECTROLYTES | KCL 0.15%/D5W/NACL 0.225% | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | KCL 0.15%/D5W/NACL 0.9% | GENERIC | ||
| MINERALS & ELECTROLYTES | KCL 0.3%/D5W/NACL 0.45% | GENERIC | ||
| MINERALS & ELECTROLYTES | KCL 0.3%/D5W/NACL 0.9% | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | KLOR-CON 10 | GENERIC | ||
| MINERALS & ELECTROLYTES | KLOR-CON 8 | GENERIC | ||
| MINERALS & ELECTROLYTES | KLOR-CON M10 | GENERIC | ||
| MINERALS & ELECTROLYTES | KLOR-CON M15 | GENERIC | ||
| MINERALS & ELECTROLYTES | KLOR-CON M20 | GENERIC | ||
| MINERALS & ELECTROLYTES | KLOR-CON/EF | GENERIC | ||
| MINERALS & ELECTROLYTES | K-PHOS NEUTRAL | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | K-PHOS | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | K-PRIME | GENERIC | ||
| MINERALS & ELECTROLYTES | LACTATED RINGERS | GENERIC | ||
| MINERALS & ELECTROLYTES | MAGNESIUM CARBONATE HEAVY | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | MAGNESIUM CARBONATE LIGHT | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | MAGNESIUM SULFATE/SODIUM | EXCLUDED | ||
| MINERALS & ELECTROLYTES | MAGNESIUM SULFATE/DEXTROS | EXCLUDED | ||
| MINERALS & ELECTROLYTES | MAGNESIUM CHLORIDE HEXAHY | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | MAGNESIUM CHLORIDE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | MAGNESIUM CHLORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | MAGNESIUM SULFATE | GENERIC | ||
| MINERALS & ELECTROLYTES | MAGNESIUM SULFATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | MAGNESIUM SULFATE | EXCLUDED | ||
| MINERALS & ELECTROLYTES | MANGANESE TRACE METAL | GENERIC | ||
| MINERALS & ELECTROLYTES | MAGNESIUM SULFATE IN D5W | GENERIC | ||
| MINERALS & ELECTROLYTES | MAGNESIUM SULFATE IN D5W | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | MULTIPLE ELECTROLYTES INJ | GENERIC | ||
| MINERALS & ELECTROLYTES | MULTRYS | EXCLUDED | ||
| MINERALS & ELECTROLYTES | NORMAL SALINE I.V. FLUSH | GENERIC | ||
| MINERALS & ELECTROLYTES | NORMOSOL-M/D5W | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | NORMOSOL -R | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | NORMOSOL-R | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | NORMOSOL-R/5% DEXTROSE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | PHOSPHA 250 NEUTRAL | GENERIC | ||
| MINERALS & ELECTROLYTES | PHOSPHOROUS | GENERIC | ||
| MINERALS & ELECTROLYTES | PHOSPHO-TRIN 250 NEUTRAL | GENERIC | ||
| MINERALS & ELECTROLYTES | PHOSPHO-TRIN K500 | GENERIC | ||
| MINERALS & ELECTROLYTES | PLASMA-LYTE 148 | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | PLASMA-LYTE A | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | POKONZA | EXCLUDED | ||
| MINERALS & ELECTROLYTES | POTASSIUM ACETATE | GENERIC | ||
| MINERALS & ELECTROLYTES | POTASSIUM ACETATE | EXCLUDED | ||
| MINERALS & ELECTROLYTES | POTASSIUM BICARBONATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE/DEXTRO | EXCLUDED | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE/SODIUM | EXCLUDED | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE/SODIUM | GENERIC | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE/SODIUM | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE ER | GENERIC | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE | EXCLUDED | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | POTASSIUM CHLORIDE CR | GENERIC | ||
| MINERALS & ELECTROLYTES | POTASSIUM PHOSPHATES/SODI | EXCLUDED | ||
| MINERALS & ELECTROLYTES | POTASSIUM PHOSPHATES | EXCLUDED | ||
| MINERALS & ELECTROLYTES | POTASSIUM PHOSPHATE | GENERIC | ||
| MINERALS & ELECTROLYTES | POTASSIUM PHOSPHATES | GENERIC | ||
| MINERALS & ELECTROLYTES | POTASSIUM PHOSPHATES | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | RINGERS INJECTION | GENERIC | ||
| MINERALS & ELECTROLYTES | SALINE FLUSH | GENERIC | ||
| MINERALS & ELECTROLYTES | SELENIOUS ACID | EXCLUDED | ||
| MINERALS & ELECTROLYTES | SODIUM ACETATE ANHYDROUS | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | SODIUM ACETATE | GENERIC | ||
| MINERALS & ELECTROLYTES | SODIUM ACETATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | SODIUM BICARBONATE | GENERIC | ||
| MINERALS & ELECTROLYTES | SODIUM BICARBONATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | SODIUM CHLORIDE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | SODIUM CHLORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | SODIUM CHLORIDE 0.45% | GENERIC | ||
| MINERALS & ELECTROLYTES | SODIUM CHLORIDE | EXCLUDED | ||
| MINERALS & ELECTROLYTES | MONOJECT SODIUM CHLORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | SODIUM CHLORIDE FLUSH | GENERIC | ||
| MINERALS & ELECTROLYTES | SODIUM CHLORIDE FLUSH | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | SODIUM FLUORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | SODIUM PHOSPHATES | GENERIC | ||
| MINERALS & ELECTROLYTES | SODIUM PHOSPHATE | GENERIC | ||
| MINERALS & ELECTROLYTES | SODIUM ACETATE TRIHYDRATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | THAM | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | TPN ELECTROLYTES | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | TRALEMENT | EXCLUDED | ||
| MINERALS & ELECTROLYTES | TROMETHAMINE | EXCLUDED | ||
| MINERALS & ELECTROLYTES | TROMETHAMINE | GENERIC | ||
| MINERALS & ELECTROLYTES | WES-PHOS 250 NEUTRAL | GENERIC | ||
| MINERALS & ELECTROLYTES | ZINC CHLORIDE | GENERIC | ||
| MINERALS & ELECTROLYTES | ZINC CHLORIDE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | ZINC SULFATE HEPTAHYDRATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | ZINC SULFATE | GENERIC | ||
| MINERALS & ELECTROLYTES | ZINC SULFATE | NON PREFERRED | ||
| MINERALS & ELECTROLYTES | ZINC SULFATE MONOHYDRATE | NON PREFERRED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | AMPHADASE | EXCLUDED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | ASCLERA | NON PREFERRED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | ASTAGRAF XL | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | ATGAM | NON PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | AZASAN | GENERIC | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | AZATHIOPRINE | EXCLUDED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | AZATHIOPRINE | NON PREFERRED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | AZATHIOPRINE | GENERIC | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | BENLYSTA IV | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | BENLYSTA | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | CELLCEPT | NON PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | CELLCEPT IV | NON PREFERRED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | CHYMOTRYPSIN ALPHA | NON PREFERRED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | CUPRIMINE | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | CUVRIOR | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | CYCLOSPORINE | GENERIC | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | DEPEN TITRA | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | EDETATE DISODIUM | EXCLUDED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | ENSPRYNG | PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | ENVARSUS XR | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | ETHAMOLIN | NON PREFERRED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | EUA PATIENT ASSESSMENT | NON PREFERRED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | EVEROLIMUS | GENERIC | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | GAMIFANT | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | GENGRAF | GENERIC | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | IMAAVY | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | IMURAN | NON PREFERRED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | JOENJA | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | KIONEX | GENERIC | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | KORSUVA | EXCLUDED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | LENALIDOMIDE | GENERIC | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | LOKELMA | EXCLUDED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | LUPKYNIS | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | MYCOPHENOLATE MOFETIL | GENERIC | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | MYCOPHENOLATE MOFETIL | GENERIC | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | MYCOPHENOLIC ACID DR | GENERIC | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | MYFORTIC | NON PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | MYHIBBIN | EXCLUDED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | NEORAL | NON PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | NIKTIMVO | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | NULOJIX | NON PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | PENICILLAMINE | GENERIC | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | POLYOXYL LAURYL ETHER | EXCLUDED | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | PROGRAF | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | REVLIMID | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | REZUROCK | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | RYONCIL | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | RYSTIGGO | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | SANDIMMUNE | NON PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | SANDIMMUNE IV | NON PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | SAPHNELO | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | SIMULECT | NON PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | SIROLIMUS | GENERIC | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | SODIUM POLYSTYRENE SULFON | GENERIC | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | SODIUM TETRADECYL SULFATE | GENERIC | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | SOLESTA | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | SOTRADECOL | GENERIC | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | SPS | GENERIC | ||
| MISCELLANEOUS THERAPEUTIC CLASSES | SYLVANT | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | SYPRINE | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | TACROLIMUS | GENERIC | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | THALOMID | PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | THYMOGLOBULIN | NON PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | TRIENTINE | GENERIC | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | TRIENTINE | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | UPLIZNA | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | VARITHENA | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | Veltassa | PREFERRED | PA | |
| MISCELLANEOUS THERAPEUTIC CLASSES | VIJOICE | EXCLUDED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | VYVGART | PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | VYVGART HYTRULO | PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | XIAFLEX | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | ZOKINVY | NON PREFERRED | SP | PA |
| MISCELLANEOUS THERAPEUTIC CLASSES | ZORTRESS | NON PREFERRED | PA | |
| MOUTH/THROAT/DENTAL AGENTS | ACYCLONINE MUM | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | AMPHOTERICIN B | NON PREFERRED | ||
| MOUTH/THROAT/DENTAL AGENTS | CEVIMELINE HYDROCHLORIDE | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | CHLORHEXIDINE GLUCONATE | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | CHLORHEXIDINE GLUCONATE | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | CLINPRO 5000 | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | CLOTRIMAZOLE | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | DENTA 5000 PLUS | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | DENTAGEL | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | EASYGEL | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | EVOXAC | NON PREFERRED | ||
| MOUTH/THROAT/DENTAL AGENTS | FIRST-MOUTHWASH BLM | NON PREFERRED | ||
| MOUTH/THROAT/DENTAL AGENTS | FLUORIDEX SENSITIVITY REL | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | FLUORIDEX DAILY RENEWAL | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | FLUORIDEX DAILY DEFENSE | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | FLUORIDEX ENHANCED WHITEN | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | FLUORIMAX 5000 SENSITIVE | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | FLUORIMAX 5000 | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | FRAICHE 5000 DENTAL | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | JUST RIGHT 5000 | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | KOURZEQ | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | LIDOCAINE HYDROCHLORIDE V | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | LIDOCAINE VISCOUS | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | LIDOCAINE HCL | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | NYSTATIN | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | NYSTATIN | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | ORALONE DENTAL PASTE | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | ORAMAGICRX | NON PREFERRED | ||
| MOUTH/THROAT/DENTAL AGENTS | ORAPEUTIC | NON PREFERRED | ||
| MOUTH/THROAT/DENTAL AGENTS | PERIDEX | NON PREFERRED | ||
| MOUTH/THROAT/DENTAL AGENTS | PERIOGARD | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | PILOCARPINE HYDROCHLORIDE | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | PREVIDENT 5000 PLUS | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | PREVIDENT 5000 DRY MOUTH | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | PREVIDENT 5000 ENAMEL PRO | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | PREVIDENT 5000 SENSITIVE | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | PREVIDENT 5000 BOOSTER PL | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | PREVIDENT 5000 ORTHO DEFE | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | PREVIDENT FLUORIDE | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | PREVIDENT RINSE | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | SALAGEN | NON PREFERRED | ||
| MOUTH/THROAT/DENTAL AGENTS | SF 5000 PLUS | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | SF | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | SODIUM FLUORIDE 5000 PPM | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | SODIUM FLUORIDE 5000 PPM | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | SODIUM FLUORIDE | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | SODIUM FLUORIDE 5000 PLUS | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | TRIAMCINOLONE ACETONIDE | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | TRIAMCINOLONE ACETONIDE D | GENERIC | ||
| MOUTH/THROAT/DENTAL AGENTS | VANISH | EXCLUDED | ||
| MOUTH/THROAT/DENTAL AGENTS | ZINC ACETATE | NON PREFERRED | ||
| MULTIVITAMINS | SUPERVITE | EXCLUDED | ||
| MUSCULOSKELETAL THERAPY AGENTS | BACLOFEN | GENERIC | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | BACLOFEN | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | BACLOFEN REFILL KIT FOR S | EXCLUDED | ||
| MUSCULOSKELETAL THERAPY AGENTS | BACLOFEN | NON PREFERRED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | BACLOFEN | EXCLUDED | ||
| MUSCULOSKELETAL THERAPY AGENTS | BACLOFEN | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | CARISOPRODOL | EXCLUDED | ||
| MUSCULOSKELETAL THERAPY AGENTS | CARISOPRODOL | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | CHLORZOXAZONE | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | CYCLOBENZAPRINE HYDROCHLO | EXCLUDED | ||
| MUSCULOSKELETAL THERAPY AGENTS | CYCLOBENZAPRINE HYDROCHLO | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | DANTRIUM | NON PREFERRED | ||
| MUSCULOSKELETAL THERAPY AGENTS | DANTRIUM IV | NON PREFERRED | ||
| MUSCULOSKELETAL THERAPY AGENTS | DANTROLENE SODIUM | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | DUROLANE | PREFERRED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | EUFLEXXA | PREFERRED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | GABLOFEN | NON PREFERRED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | GEL-ONE | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | GELSYN-3 | PREFERRED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | GENVISC 850 | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | HYALGAN | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | HYMOVIS | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | HYRONAN | EXCLUDED | ||
| MUSCULOSKELETAL THERAPY AGENTS | LIORESAL INTRATHECAL | NON PREFERRED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | METAXALONE | EXCLUDED | ||
| MUSCULOSKELETAL THERAPY AGENTS | METAXALONE | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | METHOCARBAMOL | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | METHOCARBAMOL | EXCLUDED | ||
| MUSCULOSKELETAL THERAPY AGENTS | MONOVISC | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | ORPHENADRINE CITRATE | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | ORPHENADRINE CITRATE | NON PREFERRED | ||
| MUSCULOSKELETAL THERAPY AGENTS | ORPHENADRINE CITRATE ER | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | ORTHOVISC | PREFERRED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | OZOBAX DS | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | REVONTO | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | ROBAXIN | NON PREFERRED | ||
| MUSCULOSKELETAL THERAPY AGENTS | SOHONOS | EXCLUDED | SP | PA |
| MUSCULOSKELETAL THERAPY AGENTS | SOMA | NON PREFERRED | ||
| MUSCULOSKELETAL THERAPY AGENTS | SUPARTZ FX | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | SYNOJOYNT | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | SYNVISC | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | SYNVISC ONE | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | TIZANIDINE HCL | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | TIZANIDINE HYDROCHLORIDE | GENERIC | ||
| MUSCULOSKELETAL THERAPY AGENTS | TRILURON | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | TRIVISC | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | VISCO-3 | EXCLUDED | PA | |
| MUSCULOSKELETAL THERAPY AGENTS | ZANAFLEX | EXCLUDED | ||
| MUSCULOSKELETAL THERAPY AGENTS | ZANAFLEX | NON PREFERRED | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | ADRENALIN | NON PREFERRED | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | AZELASTINE HYDROCHLORIDE | GENERIC | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | EPINEPHRINE CHLORIDE | GENERIC | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | FLUNISOLIDE | GENERIC | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | FLUTICASONE PROPIONATE | GENERIC | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | IPRATROPIUM BROMIDE | GENERIC | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | LIDOCAINE HYDROCHLORIDE/O | EXCLUDED | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | MOMETASONE FUROATE | GENERIC | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | OLOPATADINE HCL | GENERIC | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | OLOPATADINE HYDROCHLORIDE | GENERIC | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | PHENYLEPHRINE HCL | NON PREFERRED | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | PHENYLPROPANOLAMINE HYDRO | NON PREFERRED | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | PSEUDOEPHEDRINE HCL | NON PREFERRED | ||
| NASAL AGENTS - SYSTEMIC AND TOPICAL | RYALTRIS | EXCLUDED | ||
| NEUROMUSCULAR AGENTS | AMONDYS 45 | EXCLUDED | SP | PA |
| NEUROMUSCULAR AGENTS | BOTOX | EXCLUDED | PA | |
| NEUROMUSCULAR AGENTS | DAXXIFY | PREFERRED | ||
| NEUROMUSCULAR AGENTS | DAYBUE | NON PREFERRED | SP | PA |
| NEUROMUSCULAR AGENTS | DUVYZAT | EXCLUDED | SP | PA |
| NEUROMUSCULAR AGENTS | DYSPORT | PREFERRED | PA | |
| NEUROMUSCULAR AGENTS | EDARAVONE | GENERIC | SP | PA |
| NEUROMUSCULAR AGENTS | EVRYSDI | NON PREFERRED | SP | PA |
| NEUROMUSCULAR AGENTS | EXONDYS 51 | NON PREFERRED | SP | PA |
| NEUROMUSCULAR AGENTS | MYOBLOC | EXCLUDED | PA | |
| NEUROMUSCULAR AGENTS | QALSODY | NON PREFERRED | SP | PA |
| NEUROMUSCULAR AGENTS | RADICAVA | NON PREFERRED | SP | PA |
| NEUROMUSCULAR AGENTS | RADICAVA ORS | PREFERRED | SP | PA |
| NEUROMUSCULAR AGENTS | RILUZOLE | GENERIC | PA | |
| NEUROMUSCULAR AGENTS | SKYCLARYS | NON PREFERRED | SP | PA |
| NEUROMUSCULAR AGENTS | SPINRAZA | NON PREFERRED | SP | PA |
| NEUROMUSCULAR AGENTS | TEGLUTIK | EXCLUDED | PA | |
| NEUROMUSCULAR AGENTS | TIGLUTIK | EXCLUDED | PA | |
| NEUROMUSCULAR AGENTS | VILTEPSO | EXCLUDED | SP | PA |
| NEUROMUSCULAR AGENTS | VYONDYS 53 | EXCLUDED | SP | PA |
| NEUROMUSCULAR AGENTS | XEOMIN | PREFERRED | PA | |
| OPHTHALMIC AGENTS | ACULAR LS | NON PREFERRED | ||
| OPHTHALMIC AGENTS | ACULAR | NON PREFERRED | ||
| OPHTHALMIC AGENTS | ACUVAIL | EXCLUDED | ||
| OPHTHALMIC AGENTS | AK-FLUOR | GENERIC | ||
| OPHTHALMIC AGENTS | AKTEN | NON PREFERRED | ||
| OPHTHALMIC AGENTS | ALCAINE | NON PREFERRED | ||
| OPHTHALMIC AGENTS | ALPHAGAN P | PREFERRED | ||
| OPHTHALMIC AGENTS | ALTACAINE | GENERIC | ||
| OPHTHALMIC AGENTS | ALTAFLUOR BENOX | GENERIC | ||
| OPHTHALMIC AGENTS | ALTAFRIN | GENERIC | ||
| OPHTHALMIC AGENTS | APRACLONIDINE | GENERIC | ||
| OPHTHALMIC AGENTS | ATROPINE SULFATE | EXCLUDED | ||
| OPHTHALMIC AGENTS | ATROPINE SULFATE | GENERIC | ||
| OPHTHALMIC AGENTS | ATROPINE SULFATE | NON PREFERRED | ||
| OPHTHALMIC AGENTS | AZASITE | EXCLUDED | ||
| OPHTHALMIC AGENTS | AZELASTINE HYDROCHLORIDE | GENERIC | ||
| OPHTHALMIC AGENTS | AZELASTINE HCL | GENERIC | ||
| OPHTHALMIC AGENTS | AZOPT | NON PREFERRED | ||
| OPHTHALMIC AGENTS | BACITRACIN/POLYMYXIN B | GENERIC | ||
| OPHTHALMIC AGENTS | BACITRACIN | GENERIC | ||
| OPHTHALMIC AGENTS | BEOVU | EXCLUDED | SP | PA |
| OPHTHALMIC AGENTS | BEPOTASTINE BESILATE | GENERIC | ||
| OPHTHALMIC AGENTS | BEPREVE | EXCLUDED | ||
| OPHTHALMIC AGENTS | BESIVANCE | PREFERRED | ||
| OPHTHALMIC AGENTS | BETADINE OPHTHALMIC PREP | NON PREFERRED | ||
| OPHTHALMIC AGENTS | BETAXOLOL HCL | GENERIC | ||
| OPHTHALMIC AGENTS | BETOPTIC-S | PREFERRED | ||
| OPHTHALMIC AGENTS | BEVACIZUMAB | EXCLUDED | SP | PA |
| OPHTHALMIC AGENTS | BIMATOPROST/BRIMONIDINE T | EXCLUDED | ||
| OPHTHALMIC AGENTS | BIMATOPROST | GENERIC | PA | |
| OPHTHALMIC AGENTS | BIO GLO | NON PREFERRED | ||
| OPHTHALMIC AGENTS | BRIMONIDE/DORZOLAMIDE P-F | EXCLUDED | ||
| OPHTHALMIC AGENTS | BRIMONIDINE TARTRATE/TIMO | GENERIC | ||
| OPHTHALMIC AGENTS | BRIMONIDINE TARTRATE/DORZ | EXCLUDED | ||
| OPHTHALMIC AGENTS | BRIMONIDINE TARTRATE | GENERIC | ||
| OPHTHALMIC AGENTS | BRINZOLAMIDE | GENERIC | ||
| OPHTHALMIC AGENTS | BROMFENAC SODIUM | GENERIC | ||
| OPHTHALMIC AGENTS | BROMFENAC | GENERIC | ||
| OPHTHALMIC AGENTS | BROMSITE | EXCLUDED | ||
| OPHTHALMIC AGENTS | BSS PLUS | NON PREFERRED | ||
| OPHTHALMIC AGENTS | BSS | NON PREFERRED | ||
| OPHTHALMIC AGENTS | BUPIVACAINE HYDROCHLORIDE | EXCLUDED | ||
| OPHTHALMIC AGENTS | BUP-LIDO | EXCLUDED | ||
| OPHTHALMIC AGENTS | BYOOVIZ | PREFERRED | SP | PA |
| OPHTHALMIC AGENTS | CARTEOLOL HCL | GENERIC | ||
| OPHTHALMIC AGENTS | CEQUA | EXCLUDED | ||
| OPHTHALMIC AGENTS | CHONDROITIN SULFATE | EXCLUDED | ||
| OPHTHALMIC AGENTS | CIMERLI | NON PREFERRED | SP | PA |
| OPHTHALMIC AGENTS | CIPROFLOXACIN HYDROCHLORI | GENERIC | ||
| OPHTHALMIC AGENTS | CLOBETASOL PROPIONATE | EXCLUDED | ||
| OPHTHALMIC AGENTS | COMBIGAN | EXCLUDED | ||
| OPHTHALMIC AGENTS | COSOPT PF | NON PREFERRED | ||
| OPHTHALMIC AGENTS | COSOPT | NON PREFERRED | ||
| OPHTHALMIC AGENTS | CROMOLYN SODIUM | GENERIC | ||
| OPHTHALMIC AGENTS | CYCLOGYL | NON PREFERRED | ||
| OPHTHALMIC AGENTS | CYCLOMYDRIL | NON PREFERRED | ||
| OPHTHALMIC AGENTS | CYCLOPENTOLATE HCL | GENERIC | ||
| OPHTHALMIC AGENTS | CYCLOPENTOLATE HYDROCHLOR | GENERIC | ||
| OPHTHALMIC AGENTS | CYCLOSPORINE | EXCLUDED | ||
| OPHTHALMIC AGENTS | CYSTARAN | NON PREFERRED | SP | PA |
| OPHTHALMIC AGENTS | DEXAMETHASONE/MOXIFLOXACI | EXCLUDED | ||
| OPHTHALMIC AGENTS | DEXAMETHASONE SODIUM PHOS | GENERIC | ||
| OPHTHALMIC AGENTS | DICLOFENAC SODIUM | GENERIC | ||
| OPHTHALMIC AGENTS | DIFLUPREDNATE | GENERIC | ||
| OPHTHALMIC AGENTS | DORZOLAMIDE HYDROCHLORIDE | GENERIC | ||
| OPHTHALMIC AGENTS | DORZOLAMIDE HCL/TIMOLOL M | EXCLUDED | ||
| OPHTHALMIC AGENTS | DORZOLAMIDE HCL/TIMOLOL M | GENERIC | ||
| OPHTHALMIC AGENTS | DORZOLAMIDE HYDROCHLORIDE | EXCLUDED | ||
| OPHTHALMIC AGENTS | DORZOLAMIDE HYDROCHLORIDE | NON PREFERRED | ||
| OPHTHALMIC AGENTS | DUREZOL | NON PREFERRED | ||
| OPHTHALMIC AGENTS | DURYSTA | EXCLUDED | PA | |
| OPHTHALMIC AGENTS | ENCELTO | NON PREFERRED | SP | PA |
| OPHTHALMIC AGENTS | EPINASTINE HCL | GENERIC | ||
| OPHTHALMIC AGENTS | ERYTHROMYCIN | EXCLUDED | ||
| OPHTHALMIC AGENTS | ERYTHROMYCIN | GENERIC | ||
| OPHTHALMIC AGENTS | ERYTHROMYCIN | NON PREFERRED | ||
| OPHTHALMIC AGENTS | EYLEA HD | EXCLUDED | SP | PA |
| OPHTHALMIC AGENTS | EYLEA | EXCLUDED | SP | PA |
| OPHTHALMIC AGENTS | FLAREX | EXCLUDED | ||
| OPHTHALMIC AGENTS | FLUCAINE | GENERIC | ||
| OPHTHALMIC AGENTS | FLUORESCEIN SODIUM/BENOXI | NON PREFERRED | ||
| OPHTHALMIC AGENTS | FLUORESCEIN-BENOXINATE | GENERIC | ||
| OPHTHALMIC AGENTS | FLUORESCEIN | GENERIC | ||
| OPHTHALMIC AGENTS | FLUORESCEIN SODIUM | GENERIC | ||
| OPHTHALMIC AGENTS | FLUORESCEIN SODIUM | NON PREFERRED | ||
| OPHTHALMIC AGENTS | FLUORESCEIN/PROPARACAINE | GENERIC | ||
| OPHTHALMIC AGENTS | FLUORESCITE | NON PREFERRED | ||
| OPHTHALMIC AGENTS | FLUOR-I-STRIPS A.T. | NON PREFERRED | ||
| OPHTHALMIC AGENTS | FLUOROMETHOLONE | GENERIC | ||
| OPHTHALMIC AGENTS | FLURA-SAFE | NON PREFERRED | ||
| OPHTHALMIC AGENTS | FLURBIPROFEN SODIUM | GENERIC | ||
| OPHTHALMIC AGENTS | FML FORTE | EXCLUDED | ||
| OPHTHALMIC AGENTS | FML LIQUIFILM | EXCLUDED | ||
| OPHTHALMIC AGENTS | GATIFLOXACIN | GENERIC | ||
| OPHTHALMIC AGENTS | GENTAMICIN SULFATE | GENERIC | ||
| OPHTHALMIC AGENTS | GLOSTRIPS | NON PREFERRED | ||
| OPHTHALMIC AGENTS | GREEN GLO LISSAMINE GREEN | NON PREFERRED | ||
| OPHTHALMIC AGENTS | HOMATROPAIRE | GENERIC | ||
| OPHTHALMIC AGENTS | IDOSE TR | EXCLUDED | ||
| OPHTHALMIC AGENTS | ILEVRO | PREFERRED | ||
| OPHTHALMIC AGENTS | INVELTYS | EXCLUDED | ||
| OPHTHALMIC AGENTS | IOPIDINE | NON PREFERRED | ||
| OPHTHALMIC AGENTS | ISTALOL | NON PREFERRED | ||
| OPHTHALMIC AGENTS | IYUZEH | EXCLUDED | ||
| OPHTHALMIC AGENTS | IZERVAY | EXCLUDED | SP | PA |
| OPHTHALMIC AGENTS | KETOROLAC TROMETHAMINE | GENERIC | ||
| OPHTHALMIC AGENTS | KLARITY-A | EXCLUDED | ||
| OPHTHALMIC AGENTS | KLARITY-C DROPS | EXCLUDED | ||
| OPHTHALMIC AGENTS | LATANOPROST | EXCLUDED | ||
| OPHTHALMIC AGENTS | LATANOPROST | GENERIC | ||
| OPHTHALMIC AGENTS | LEVOBUNOLOL HCL | GENERIC | ||
| OPHTHALMIC AGENTS | LEVOFLOXACIN | GENERIC | ||
| OPHTHALMIC AGENTS | LIDOCAINE HYDROCHLORIDE/P | EXCLUDED | ||
| OPHTHALMIC AGENTS | LIDOCAINE HYDROCHLORIDE/E | EXCLUDED | ||
| OPHTHALMIC AGENTS | LOTEMAX | EXCLUDED | ||
| OPHTHALMIC AGENTS | LOTEMAX SM | EXCLUDED | ||
| OPHTHALMIC AGENTS | LOTEPREDNOL ETABONATE | GENERIC | ||
| OPHTHALMIC AGENTS | LUCENTIS | EXCLUDED | SP | PA |
| OPHTHALMIC AGENTS | LUMIGAN | EXCLUDED | PA | |
| OPHTHALMIC AGENTS | MAXIDEX | EXCLUDED | PA | |
| OPHTHALMIC AGENTS | MAXITROL | NON PREFERRED | ||
| OPHTHALMIC AGENTS | MIEBO | EXCLUDED | PA | |
| OPHTHALMIC AGENTS | MIOCHOL-E | NON PREFERRED | ||
| OPHTHALMIC AGENTS | MIOSTAT | NON PREFERRED | ||
| OPHTHALMIC AGENTS | MITOMYCIN | EXCLUDED | ||
| OPHTHALMIC AGENTS | MOXIFLOXACIN/BROMFENAC | EXCLUDED | ||
| OPHTHALMIC AGENTS | MOXIFLOXACIN HYDROCHLORID | EXCLUDED | ||
| OPHTHALMIC AGENTS | MYDCOMBI | EXCLUDED | ||
| OPHTHALMIC AGENTS | MYDRIACYL | NON PREFERRED | ||
| OPHTHALMIC AGENTS | NATACYN | NON PREFERRED | ||
| OPHTHALMIC AGENTS | NEOMYCIN/BACITRACIN/POLYM | GENERIC | ||
| OPHTHALMIC AGENTS | NEOMYCIN/POLYMYXIN/BACITR | GENERIC | ||
| OPHTHALMIC AGENTS | NEOMYCIN/POLYMYXIN/DEXAME | GENERIC | ||
| OPHTHALMIC AGENTS | NEOMYCIN/POLYMYXIN/GRAMIC | GENERIC | ||
| OPHTHALMIC AGENTS | NEOMYCIN/POLYMYXIN/HYDROC | GENERIC | ||
| OPHTHALMIC AGENTS | NEO-POLYCIN HC | GENERIC | ||
| OPHTHALMIC AGENTS | NEO-POLYCIN | GENERIC | ||
| OPHTHALMIC AGENTS | NEVANAC | EXCLUDED | ||
| OPHTHALMIC AGENTS | OCUFLOX | NON PREFERRED | ||
| OPHTHALMIC AGENTS | OFLOXACIN | GENERIC | ||
| OPHTHALMIC AGENTS | OLOPATADINE HYDROCHLORIDE | GENERIC | ||
| OPHTHALMIC AGENTS | PAVBLU | EXCLUDED | SP | PA |
| OPHTHALMIC AGENTS | PHENYLEPHRINE HYDROCHLORI | GENERIC | ||
| OPHTHALMIC AGENTS | PHENYLEPHRINE HYDROCHLORI | EXCLUDED | ||
| OPHTHALMIC AGENTS | PHOSPHOLINE IODIDE | NON PREFERRED | ||
| OPHTHALMIC AGENTS | PHOTREXA/PHOTREXA VISCOUS | EXCLUDED | ||
| OPHTHALMIC AGENTS | PILOCARPINE HCL | GENERIC | ||
| OPHTHALMIC AGENTS | PILOCARPINE HYDROCHLORIDE | GENERIC | ||
| OPHTHALMIC AGENTS | PILOCARPINE HYDROCHLORIDE | GENERIC | PA | |
| OPHTHALMIC AGENTS | POLYCIN | GENERIC | ||
| OPHTHALMIC AGENTS | POVIDONE IODINE | NON PREFERRED | ||
| OPHTHALMIC AGENTS | PRED FORTE | EXCLUDED | ||
| OPHTHALMIC AGENTS | PRED MILD | EXCLUDED | ||
| OPHTHALMIC AGENTS | PREDNISOLONE SODIUM PHOSP | EXCLUDED | ||
| OPHTHALMIC AGENTS | PREDNISOLONE SODIUM PHOSP | NON PREFERRED | ||
| OPHTHALMIC AGENTS | PREDNISOLONE ACETATE/NEPA | EXCLUDED | ||
| OPHTHALMIC AGENTS | PREDNISOLONE/GATIFLOXACIN | EXCLUDED | ||
| OPHTHALMIC AGENTS | PREDNISOLONE ACETATE/MOXI | EXCLUDED | ||
| OPHTHALMIC AGENTS | PREDNISOLONE/BROMFENAC | EXCLUDED | ||
| OPHTHALMIC AGENTS | PREDNISOLONE PHOSPHATE/MO | EXCLUDED | ||
| OPHTHALMIC AGENTS | PREDNISOLONE ACETATE P-F | NON PREFERRED | ||
| OPHTHALMIC AGENTS | PREDNISOLONE ACETATE | GENERIC | ||
| OPHTHALMIC AGENTS | PREDNISOLONE PHOSPHATE/BR | EXCLUDED | ||
| OPHTHALMIC AGENTS | PROLENSA | NON PREFERRED | ||
| OPHTHALMIC AGENTS | PROPARACAINE HCL | GENERIC | ||
| OPHTHALMIC AGENTS | PROPARACAINE HYDROCHLORID | GENERIC | ||
| OPHTHALMIC AGENTS | QLOSI | EXCLUDED | ||
| OPHTHALMIC AGENTS | RESTASIS | PREFERRED | ||
| OPHTHALMIC AGENTS | RESTASIS MULTIDOSE | PREFERRED | ||
| OPHTHALMIC AGENTS | RHOPRESSA | EXCLUDED | PA | |
| OPHTHALMIC AGENTS | ROCKLATAN | EXCLUDED | PA | |
| OPHTHALMIC AGENTS | SIMBRINZA | PREFERRED | ||
| OPHTHALMIC AGENTS | SULFACETAMIDE SODIUM/PRED | GENERIC | ||
| OPHTHALMIC AGENTS | SULFACETAMIDE SODIUM | GENERIC | ||
| OPHTHALMIC AGENTS | SUSVIMO | EXCLUDED | SP | PA |
| OPHTHALMIC AGENTS | SYFOVRE | NON PREFERRED | SP | PA |
| OPHTHALMIC AGENTS | TAFLUPROST | GENERIC | ||
| OPHTHALMIC AGENTS | TETRACAINE HYDROCHLORIDE | GENERIC | ||
| OPHTHALMIC AGENTS | TETRACAINE HCL | GENERIC | ||
| OPHTHALMIC AGENTS | TIMOLOL/BRIMONIDE/DORZOLA | EXCLUDED | ||
| OPHTHALMIC AGENTS | TIMOLOL/BRIMONIDINE TARTR | EXCLUDED | ||
| OPHTHALMIC AGENTS | TIMOLOL/BRIMONIDINE/DORZO | EXCLUDED | ||
| OPHTHALMIC AGENTS | TIMOLOL/DORZOLAMIDE/LATAN | EXCLUDED | ||
| OPHTHALMIC AGENTS | TIMOLOL/BRIMONIDE TARTRAT | EXCLUDED | ||
| OPHTHALMIC AGENTS | TIMOLOL/DORZOLAMIDE/BIMAT | EXCLUDED | ||
| OPHTHALMIC AGENTS | TIMOLOL/LATANOPROST | EXCLUDED | ||
| OPHTHALMIC AGENTS | TIMOLOL MALEATE OPHTHALMI | GENERIC | ||
| OPHTHALMIC AGENTS | TIMOLOL MALEATE | GENERIC | ||
| OPHTHALMIC AGENTS | TIMOLOL MALEATE IN OCUDOS | GENERIC | ||
| OPHTHALMIC AGENTS | TIMOLOL MALEATE/BIMATOPRO | EXCLUDED | ||
| OPHTHALMIC AGENTS | TIMOPTIC OCUDOSE | EXCLUDED | ||
| OPHTHALMIC AGENTS | TOBRAMYCIN/DEXAMETHASONE | GENERIC | ||
| OPHTHALMIC AGENTS | TOBRAMYCIN/VANCOMYCIN HYD | EXCLUDED | ||
| OPHTHALMIC AGENTS | TOBRADEX | PREFERRED | ||
| OPHTHALMIC AGENTS | TOBRADEX ST | EXCLUDED | ||
| OPHTHALMIC AGENTS | TOBRAMYCIN | GENERIC | ||
| OPHTHALMIC AGENTS | TOBRAMYCIN SULFATE | GENERIC | ||
| OPHTHALMIC AGENTS | TOBREX | NON PREFERRED | ||
| OPHTHALMIC AGENTS | TRAVATAN Z | EXCLUDED | ||
| OPHTHALMIC AGENTS | TRAVOPROST | EXCLUDED | ||
| OPHTHALMIC AGENTS | TRAVOPROST | GENERIC | ||
| OPHTHALMIC AGENTS | TRIFLURIDINE | GENERIC | ||
| OPHTHALMIC AGENTS | POLYMYXIN B SULFATE/TRIME | GENERIC | ||
| OPHTHALMIC AGENTS | TRIMOXI+ | EXCLUDED | ||
| OPHTHALMIC AGENTS | TROPICAMIDE/CYCLOPENTOLAT | EXCLUDED | ||
| OPHTHALMIC AGENTS | TROPICAMIDE | GENERIC | ||
| OPHTHALMIC AGENTS | TROPICAMIDE/PHENYLEPHRINE | EXCLUDED | ||
| OPHTHALMIC AGENTS | TROPICAMIDE/PROPARACAINE/ | EXCLUDED | ||
| OPHTHALMIC AGENTS | TRYPTYR | EXCLUDED | ||
| OPHTHALMIC AGENTS | UPNEEQ | EXCLUDED | ||
| OPHTHALMIC AGENTS | VABYSMO | EXCLUDED | SP | PA |
| OPHTHALMIC AGENTS | VERKAZIA | EXCLUDED | ||
| OPHTHALMIC AGENTS | VEVYE | PREFERRED | ||
| OPHTHALMIC AGENTS | VIZZ | EXCLUDED | ||
| OPHTHALMIC AGENTS | VUITY | EXCLUDED | PA | |
| OPHTHALMIC AGENTS | VYZULTA | EXCLUDED | ||
| OPHTHALMIC AGENTS | XALATAN | NON PREFERRED | ||
| OPHTHALMIC AGENTS | XDEMVY | PREFERRED | ||
| OPHTHALMIC AGENTS | XELPROS | EXCLUDED | ||
| OPHTHALMIC AGENTS | XIIDRA | EXCLUDED | ||
| OPHTHALMIC AGENTS | Xiidra | PREFERRED | ||
| OPHTHALMIC AGENTS | ZERVIATE | EXCLUDED | ||
| OPHTHALMIC AGENTS | ZIOPTAN | NON PREFERRED | ||
| OPHTHALMIC AGENTS | ZIRGAN | EXCLUDED | ||
| OPHTHALMIC AGENTS | ZYLET | EXCLUDED | ||
| OTIC AGENTS | ACETIC ACID | EXCLUDED | ||
| OTIC AGENTS | ACETIC ACID | GENERIC | ||
| OTIC AGENTS | CETRAXAL | NON PREFERRED | ||
| OTIC AGENTS | CIPRO HC | EXCLUDED | ||
| OTIC AGENTS | CIPROFLOXACIN/DEXAMETHASO | GENERIC | ||
| OTIC AGENTS | CIPROFLOXACIN/FLUOCINOLON | EXCLUDED | ||
| OTIC AGENTS | CIPROFLOXACIN | GENERIC | ||
| OTIC AGENTS | CORTISPORIN-TC | NON PREFERRED | ||
| OTIC AGENTS | DERMOTIC | NON PREFERRED | ||
| OTIC AGENTS | DEX24 | EXCLUDED | ||
| OTIC AGENTS | FLUOCINOLONE ACETONIDE | GENERIC | ||
| OTIC AGENTS | FLUOCINOLONE ACETONIDE EA | GENERIC | ||
| OTIC AGENTS | HYDROCORTISONE/ACETIC ACI | GENERIC | ||
| OTIC AGENTS | NEOMYCIN/POLYMYXIN/HC | GENERIC | ||
| OTIC AGENTS | NEOMYCIN/POLYMYXIN/HYDROC | GENERIC | ||
| OTIC AGENTS | OFLOXACIN | GENERIC | ||
| OTIC AGENTS | OTOVEL | EXCLUDED | ||
| OTIC AGENTS | PRAMOTIC | NON PREFERRED | ||
| OXYTOCICS | CARBOPROST TROMETHAMINE | EXCLUDED | ||
| OXYTOCICS | CARBOPROST TROMETHAMINE | GENERIC | ||
| OXYTOCICS | CERVIDIL | NON PREFERRED | ||
| OXYTOCICS | HEMABATE | NON PREFERRED | ||
| OXYTOCICS | METHERGINE | GENERIC | ||
| OXYTOCICS | METHYLERGONOVINE MALEATE | GENERIC | ||
| OXYTOCICS | OXYTOCIN +RFID | GENERIC | ||
| OXYTOCICS | OXYTOCIN | GENERIC | ||
| OXYTOCICS | OXYTOCIN | NON PREFERRED | ||
| OXYTOCICS | OXYTOCIN/LACTATED RINGERS | EXCLUDED | ||
| OXYTOCICS | OXYTOCIN/SODIUM CHLORIDE | EXCLUDED | ||
| OXYTOCICS | PITOCIN | NON PREFERRED | ||
| OXYTOCICS | PREPIDIL | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | ALYGLO | EXCLUDED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | ANASCORP | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | ANAVIP | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | ANTIVENIN LATRODECTUS MAC | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | ANTIVENIN NORTH AMERICAN | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | ASCENIV | EXCLUDED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | BABYBIG | EXCLUDED | PA | |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | BEYFORTUS | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | BIVIGAM | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | CNJ-016 | EXCLUDED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | CROFAB | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | CUTAQUIG | PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | CUVITRU | EXCLUDED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | CYTOGAM | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | ENFLONSIA | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | FLEBOGAMMA DIF | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | GAMASTAN | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | GAMMAGARD LIQUID | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | GAMMAGARD S/D | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | GAMMAKED | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | GAMMAPLEX 10% | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | GAMMAPLEX | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | GAMUNEX-C | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | HEPAGAM B | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | HIZENTRA | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | HYPERHEP B | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | HYPERRAB | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | HYPERRAB | EXCLUDED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | HYPERRHO S/D | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | HYPERTET | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | HYQVIA | EXCLUDED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | KEDRAB | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | NABI-HB | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | OCTAGAM | EXCLUDED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | PANZYGA | EXCLUDED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | PEMGARDA | NON PREFERRED | ||
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | PRIVIGEN | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | RHOGAM ULTRA-FILTERED PLUS | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | RHOPHYLAC | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | SYNAGIS | EXCLUDED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | VARIZIG | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | WINRHO SDF | NON PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | XEMBIFY | PREFERRED | SP | PA |
| PASSIVE IMMUNIZING AND TREATMENT AGENTS | ZINPLAVA | EXCLUDED | ||
| PENICILLINS | AMOXICILLIN/CLAVULANATE P | GENERIC | ||
| PENICILLINS | AMOXICILLIN/CLAVULANATE P | EXCLUDED | ||
| PENICILLINS | AMOXICILLIN | EXCLUDED | ||
| PENICILLINS | AMOXICILLIN | GENERIC | ||
| PENICILLINS | AMOXICILLIN TRIHYDRATE | NON PREFERRED | ||
| PENICILLINS | AMPICILLIN/SULBACTAM | GENERIC | ||
| PENICILLINS | AMPICILLIN | GENERIC | ||
| PENICILLINS | AMPICILLIN SODIUM | EXCLUDED | ||
| PENICILLINS | AMPICILLIN SODIUM | GENERIC | ||
| PENICILLINS | AMPICILLIN-SULBACTAM | GENERIC | ||
| PENICILLINS | AUGMENTIN | NON PREFERRED | ||
| PENICILLINS | AUGMENTIN ES-600 | NON PREFERRED | ||
| PENICILLINS | BICILLIN C-R | NON PREFERRED | ||
| PENICILLINS | BICILLIN L-A | NON PREFERRED | ||
| PENICILLINS | DICLOXACILLIN SODIUM | GENERIC | ||
| PENICILLINS | LENTOCILIN | NON PREFERRED | ||
| PENICILLINS | NAFCILLIN SODIUM | GENERIC | ||
| PENICILLINS | NAFCILLIN | NON PREFERRED | ||
| PENICILLINS | OXACILLIN SODIUM | GENERIC | ||
| PENICILLINS | OXACILLIN SODIUM | NON PREFERRED | ||
| PENICILLINS | PENICILLIN G SODIUM | GENERIC | ||
| PENICILLINS | PENICILLIN G POTASSIUM IN | NON PREFERRED | ||
| PENICILLINS | PENICILLIN G POTASSIUM | GENERIC | ||
| PENICILLINS | PENICILLIN V POTASSIUM | GENERIC | ||
| PENICILLINS | PFIZERPEN | GENERIC | ||
| PENICILLINS | PIPERACILLIN SODIUM/TAZOB | GENERIC | ||
| PENICILLINS | UNASYN | NON PREFERRED | ||
| PENICILLINS | UNASYN BULK PACK | NON PREFERRED | ||
| PENICILLINS | ZOSYN | NON PREFERRED | ||
| PROGESTINS | GALLIFREY | GENERIC | ||
| PROGESTINS | MEDROXYPROGESTERONE ACETA | GENERIC | ||
| PROGESTINS | MEGESTROL ACETATE | GENERIC | ||
| PROGESTINS | NORETHINDRONE ACETATE | GENERIC | ||
| PROGESTINS | NORETHINDRONE ACETATE | NON PREFERRED | ||
| PROGESTINS | PROGESTERONE | GENERIC | PA | |
| PROGESTINS | PROGESTERONE | GENERIC | ||
| PROGESTINS | PROMETRIUM | EXCLUDED | ||
| PROGESTINS | PROVERA | NON PREFERRED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | ACAMPROSATE CALCIUM DR | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | AMPYRA | NON PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | AQNEURSA | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | ARICEPT | NON PREFERRED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | AUBAGIO | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | AUSTEDO | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | AUSTEDO | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | AVONEX | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | BAFIERTAM | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | BETASERON | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | BRIUMVI | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | BUPROPION HYDROCHLORIDE E | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | CHLORDIAZEPOXIDE/AMITRIPT | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | CHANTIX | PREFERRED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | COPAXONE | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | COPAXONE | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | DALFAMPRIDINE | GENERIC | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | DIMETHYL FUMARATE | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | DIMETHYL FUMARATE | GENERIC | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | DISULFIRAM | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | DISULFIRAM | EXCLUDED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | DONEPEZIL HCL | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | DONEPEZIL HYDROCHLORIDE O | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | DONEPEZIL HYDROCHLORIDE | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | EXELON | NON PREFERRED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | FINGOLIMOD | GENERIC | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | GALANTAMINE HYDROBROMIDE | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | GILENYA | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | GLATIRAMER ACETATE | GENERIC | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | GLATOPA | GENERIC | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | INGREZZA | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | KESIMPTA | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | KISUNLA | NON PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | LEMTRADA | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | LENMELDY | NON PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | LEQEMBI IQLIK | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | LEQEMBI | NON PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | LOFEXIDINE HYDROCHLORIDE | GENERIC | PA | |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | LUCEMYRA | EXCLUDED | PA | |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | MAVENCLAD | NON PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | MAYZENT | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | MEMANTINE HCL TITRATION P | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | MEMANTINE HYDROCHLORIDE E | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | MEMANTINE HYDROCHLORIDE | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | MEMANTINE HYDROCHLORIDE | EXCLUDED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | MIPLYFFA | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | NAMENDA TITRATION PAK | NON PREFERRED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | NICOTROL NS | NON PREFERRED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | NUEDEXTA | EXCLUDED | PA | |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | OCREVUS | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | OCREVUS ZUNOVO | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | ONPATTRO | NON PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | PERPHENAZINE/AMITRIPTYLIN | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | PIMOZIDE | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | PLEGRIDY | NON PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | PONVORY | NON PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | REBIF | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | RIVASTIGMINE TARTRATE | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | RIVASTIGMINE TRANSDERMAL | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | SAVELLA TITRATION PACK | NON PREFERRED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | SAVELLA | NON PREFERRED | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | SKYSONA | NON PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | TASCENSO ODT | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | TECFIDERA | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | TERIFLUNOMIDE | GENERIC | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | TETRABENAZINE | GENERIC | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | TYSABRI | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | VARENICLINE STARTING MONT | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | VARENICLINE STARTING PACK | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | VARENICLINE TARTRATE | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | VARENICLINE TARTRATE CONT | GENERIC | ||
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | VUMERITY | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | WAINUA | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | XENAZINE | EXCLUDED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | XYWAV | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | ZEPOSIA | PREFERRED | SP | PA |
| PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. | ZUNVEYL | EXCLUDED | ||
| RESPIRATORY AGENTS - MISC. | ALYFTREK | EXCLUDED | SP | PA |
| RESPIRATORY AGENTS - MISC. | ARALAST NP | PREFERRED | SP | PA |
| RESPIRATORY AGENTS - MISC. | BRINSUPRI | EXCLUDED | PA | |
| RESPIRATORY AGENTS - MISC. | BRONCHITOL | EXCLUDED | SP | PA |
| RESPIRATORY AGENTS - MISC. | CUROSURF | NON PREFERRED | ||
| RESPIRATORY AGENTS - MISC. | ESBRIET | EXCLUDED | SP | PA |
| RESPIRATORY AGENTS - MISC. | GLASSIA | PREFERRED | SP | PA |
| RESPIRATORY AGENTS - MISC. | INFASURF | NON PREFERRED | ||
| RESPIRATORY AGENTS - MISC. | KALYDECO | NON PREFERRED | SP | PA |
| RESPIRATORY AGENTS - MISC. | OFEV | PREFERRED | SP | PA |
| RESPIRATORY AGENTS - MISC. | ORKAMBI | NON PREFERRED | SP | PA |
| RESPIRATORY AGENTS - MISC. | PIRFENIDONE | GENERIC | SP | PA |
| RESPIRATORY AGENTS - MISC. | PIRFENIDONE | EXCLUDED | SP | PA |
| RESPIRATORY AGENTS - MISC. | PROLASTIN-C | EXCLUDED | SP | PA |
| RESPIRATORY AGENTS - MISC. | PULMOZYME | NON PREFERRED | SP | PA |
| RESPIRATORY AGENTS - MISC. | SCLEROSOL INTRAPLEURAL | NON PREFERRED | ||
| RESPIRATORY AGENTS - MISC. | STERILE TALC POWDER | NON PREFERRED | ||
| RESPIRATORY AGENTS - MISC. | STERITALC | NON PREFERRED | ||
| RESPIRATORY AGENTS - MISC. | SURVANTA INTRATRACHEAL | NON PREFERRED | ||
| RESPIRATORY AGENTS - MISC. | SYMDEKO | NON PREFERRED | SP | PA |
| RESPIRATORY AGENTS - MISC. | TRIKAFTA | NON PREFERRED | SP | PA |
| RESPIRATORY AGENTS - MISC. | ZEMAIRA | PREFERRED | SP | PA |
| SULFONAMIDES | SULFADIAZINE | NON PREFERRED | ||
| SULFONAMIDES | SULFADIAZINE SODIUM | NON PREFERRED | ||
| SULFONAMIDES | SULFADIAZINE | EXCLUDED | ||
| SULFONAMIDES | SULFADIAZINE | GENERIC | ||
| SULFONAMIDES | SULFAMETHOXAZOLE | NON PREFERRED | ||
| SULFONAMIDES | SULFAMETHOXAZOLE MICRO | NON PREFERRED | ||
| SULFONAMIDES | SULFAPYRIDINE | NON PREFERRED | ||
| SULFONAMIDES | SULFATHIAZOLE | NON PREFERRED | ||
| SULFONAMIDES | SULFISOXIZOLE | NON PREFERRED | ||
| TETRACYCLINES | AVIDOXY | GENERIC | ||
| TETRACYCLINES | DEMECLOCYCLINE HCL | GENERIC | ||
| TETRACYCLINES | DEMECLOCYCLINE HYDROCHLOR | GENERIC | ||
| TETRACYCLINES | DOXYCYCLINE MONOHYDRATE | GENERIC | ||
| TETRACYCLINES | DOXYCYCLINE MONOHYDRATE | EXCLUDED | ||
| TETRACYCLINES | DOXYCYCLINE HYCLATE | GENERIC | ||
| TETRACYCLINES | DOXYCYCLINE HYCLATE | EXCLUDED | ||
| TETRACYCLINES | DOXYCYCLINE HYCLATE | NON PREFERRED | ||
| TETRACYCLINES | DOXYCYCLINE | EXCLUDED | ||
| TETRACYCLINES | DOXYCYCLINE | GENERIC | ||
| TETRACYCLINES | MINOCIN | NON PREFERRED | ||
| TETRACYCLINES | MINOCYCLINE HYDROCHLORIDE | GENERIC | ||
| TETRACYCLINES | MINOCYCLINE HCL | GENERIC | ||
| TETRACYCLINES | MINOCYCLINE HCL | NON PREFERRED | ||
| TETRACYCLINES | MONDOXYNE NL | GENERIC | ||
| TETRACYCLINES | OXYTETRACYCLINE HCL | NON PREFERRED | ||
| TETRACYCLINES | TARGADOX | EXCLUDED | ||
| TETRACYCLINES | TETRACYCLINE HYDROCHLORID | GENERIC | ||
| TETRACYCLINES | TETRACYCLINE HYDROCHLORID | EXCLUDED | ||
| TETRACYCLINES | TIGECYCLINE | EXCLUDED | ||
| TETRACYCLINES | TIGECYCLINE | GENERIC | ||
| TETRACYCLINES | TYGACIL | EXCLUDED | ||
| TETRACYCLINES | XERAVA | NON PREFERRED | ||
| THYROID AGENTS | ARMOUR THYROID | NON PREFERRED | ||
| THYROID AGENTS | CYTOMEL | EXCLUDED | ||
| THYROID AGENTS | LEVO-T | GENERIC | ||
| THYROID AGENTS | LEVOTHYROXINE SODIUM | GENERIC | ||
| THYROID AGENTS | LEVOTHYROXINE SODIUM | NON PREFERRED | ||
| THYROID AGENTS | LEVOXYL | GENERIC | ||
| THYROID AGENTS | LIOMNY | GENERIC | ||
| THYROID AGENTS | LIOTHYRONINE SODIUM | GENERIC | ||
| THYROID AGENTS | METHIMAZOLE | NON PREFERRED | ||
| THYROID AGENTS | METHIMAZOLE | GENERIC | ||
| THYROID AGENTS | NP THYROID 120 | NON PREFERRED | ||
| THYROID AGENTS | NP THYROID 15 | NON PREFERRED | ||
| THYROID AGENTS | NP THYROID 30 | NON PREFERRED | ||
| THYROID AGENTS | NP THYROID 60 | NON PREFERRED | ||
| THYROID AGENTS | NP THYROID 90 | NON PREFERRED | ||
| THYROID AGENTS | PROPYLTHIOURACIL | GENERIC | ||
| THYROID AGENTS | RENTHYROID | EXCLUDED | ||
| THYROID AGENTS | SODIUM IODIDE I-131 | EXCLUDED | ||
| THYROID AGENTS | SYNTHROID | PREFERRED | ||
| THYROID AGENTS | THYROID | NON PREFERRED | ||
| THYROID AGENTS | THYROID PORCINE | NON PREFERRED | ||
| THYROID AGENTS | THYROID | EXCLUDED | ||
| THYROID AGENTS | UNITHROID | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | ACIPHEX | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | LANSOPRAZOLE/AMOXICILLIN/ | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | ATROPINE SULFATE | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | ATROPINE SULFATE | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | ATROPINE SULFATE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | ATROPINE SULFATE MONOHYDR | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | CARAFATE | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | CHLORDIAZEPOXIDE HYDROCHL | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | CHLORDIAZEPOXIDE HYDROCHL | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | CIMETIDINE HYDROCHLORIDE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | CIMETIDINE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | CUVPOSA | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | CYTOTEC | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | DEXILANT | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | DEXLANSOPRAZOLE | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | DICYCLOMINE HYDROCHLORIDE | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | DICYCLOMINE HYDROCHLORIDE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | DICYCLOMINE HCL | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | DONNATAL | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | ESOMEPRAZOLE MAGNESIUM | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | ESOMEPRAZOLE MAGNESIUM DR | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | ESOMEPRAZOLE SODIUM | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | FAMOTIDINE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | FAMOTIDINE PREMIXED | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | FAMOTIDINE | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | FIRST-OMEPRAZOLE | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | First-Pantoprazole | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | GLYCATE | EXCLUDED | PA | |
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | GLYCOPYRROLATE | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | GLYCOPYRROLATE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | GLYCOPYRROLATE | EXCLUDED | PA | |
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | GLYRX-PF | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | HYOSCYAMINE SULFATE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | HYOSCYAMINE SULFATE ODT | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | HYOSCYAMINE SULFATE SL | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | HYOSCYAMINE SULFATE SL | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | HYOSCYAMINE SULFATE | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | HYOSCYAMINE SULFATE ODT | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | HYOSCYAMINE SULFATE ER | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | HYOSYNE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | ISOPROPAMIDE IODIDE | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | LANSOPRAZOLE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | FIRST-LANSOPRAZOLE | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | LEVBID | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | LEVSIN | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | LEVSIN/SL | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | LIBRAX | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | METHSCOPOLAMINE BROMIDE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | MISOPROSTOL | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | NEXIUM | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | NIZATIDINE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | NULEV | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | OMEPRAZOLE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | OMEPRAZOLE DR | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | OSCIMIN | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PANTOPRAZOLE SODIUM/SODIU | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PANTOPRAZOLE SODIUM | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PANTOPRAZOLE SODIUM | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PANTOPRAZOLE SODIUM | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PEPCID | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PHENOBARBITAL/HYOSCYAMINE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PHENOHYTRO | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PREVACID | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PRILOSEC | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PROTONIX | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | PROTONIX | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | RABEPRAZOLE SODIUM | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | SUCRALFATE | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | SUCRALFATE | EXCLUDED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | SUCRALFATE | GENERIC | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | VOQUEZNA TRIPLE PAK | NON PREFERRED | ||
| ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS | VOQUEZNA | NON PREFERRED | ||
| URINARY ANTISPASMODICS | BETHANECHOL CHLORIDE | EXCLUDED | ||
| URINARY ANTISPASMODICS | BETHANECHOL CHLORIDE | GENERIC | ||
| URINARY ANTISPASMODICS | DARIFENACIN HYDROBROMIDE | GENERIC | ||
| URINARY ANTISPASMODICS | DETROL | NON PREFERRED | ||
| URINARY ANTISPASMODICS | FESOTERODINE FUMARATE ER | GENERIC | ||
| URINARY ANTISPASMODICS | FLAVOXATE HCL | GENERIC | ||
| URINARY ANTISPASMODICS | GEMTESA | PREFERRED | PA | |
| URINARY ANTISPASMODICS | MIRABEGRON ER | GENERIC | ||
| URINARY ANTISPASMODICS | MYRBETRIQ | EXCLUDED | ||
| URINARY ANTISPASMODICS | OXYBUTYNIN CHLORIDE | EXCLUDED | ||
| URINARY ANTISPASMODICS | OXYBUTYNIN CHLORIDE | GENERIC | ||
| URINARY ANTISPASMODICS | OXYBUTYNIN CHLORIDE ER | EXCLUDED | ||
| URINARY ANTISPASMODICS | OXYBUTYNIN CHLORIDE ER | GENERIC | ||
| URINARY ANTISPASMODICS | SOLIFENACIN SUCCINATE | GENERIC | ||
| URINARY ANTISPASMODICS | TOLTERODINE TARTRATE | GENERIC | ||
| URINARY ANTISPASMODICS | TOVIAZ | EXCLUDED | ||
| URINARY ANTISPASMODICS | TROSPIUM CHLORIDE | EXCLUDED | ||
| URINARY ANTISPASMODICS | TROSPIUM CHLORIDE | GENERIC | ||
| URINARY ANTISPASMODICS | VESICARE | NON PREFERRED | ||
| VACCINES | ABRYSVO | NON PREFERRED | ||
| VACCINES | ACAM2000 | NON PREFERRED | ||
| VACCINES | ACTHIB | NON PREFERRED | ||
| VACCINES | ADACEL | NON PREFERRED | ||
| VACCINES | AFLURIA 2025-2026 | NON PREFERRED | ||
| VACCINES | AREXVY | NON PREFERRED | ||
| VACCINES | AUDENZ | NON PREFERRED | ||
| VACCINES | BCG VACCINE | NON PREFERRED | ||
| VACCINES | BEXSERO | NON PREFERRED | ||
| VACCINES | BIOTHRAX | NON PREFERRED | ||
| VACCINES | BOOSTRIX | NON PREFERRED | ||
| VACCINES | CAPVAXIVE | NON PREFERRED | ||
| VACCINES | COMIRNATY/5-11Y/2025-26 | NON PREFERRED | ||
| VACCINES | COMIRNATY 2025-26 | NON PREFERRED | ||
| VACCINES | DAPTACEL | NON PREFERRED | ||
| VACCINES | DENGVAXIA | NON PREFERRED | ||
| VACCINES | ENGERIX-B | NON PREFERRED | ||
| VACCINES | ERVEBO | NON PREFERRED | ||
| VACCINES | FLUAD 2025-2026 | NON PREFERRED | ||
| VACCINES | FLUARIX 2025-2026 | NON PREFERRED | ||
| VACCINES | FLUBLOK 2025-2026 | NON PREFERRED | ||
| VACCINES | FLUCELVAX 2025-2026 | NON PREFERRED | ||
| VACCINES | FLULAVAL 2025-2026 | NON PREFERRED | ||
| VACCINES | FLUMIST NASAL VACCINE 202 | NON PREFERRED | ||
| VACCINES | FLUZONE HIGH-DOSE 2025-20 | NON PREFERRED | ||
| VACCINES | FLUZONE 2025-2026 | NON PREFERRED | ||
| VACCINES | GARDASIL 9 | NON PREFERRED | ||
| VACCINES | HAVRIX | NON PREFERRED | ||
| VACCINES | HEPLISAV-B | NON PREFERRED | ||
| VACCINES | HIBERIX | NON PREFERRED | ||
| VACCINES | IMOVAX RABIES (H.D.C.V.) | NON PREFERRED | ||
| VACCINES | INFANRIX | NON PREFERRED | ||
| VACCINES | IPOL INACTIVATED IPV | NON PREFERRED | ||
| VACCINES | IXCHIQ | NON PREFERRED | ||
| VACCINES | IXIARO | NON PREFERRED | ||
| VACCINES | JYNNEOS | NON PREFERRED | ||
| VACCINES | KINRIX | NON PREFERRED | ||
| VACCINES | MENQUADFI | NON PREFERRED | ||
| VACCINES | MENVEO | NON PREFERRED | ||
| VACCINES | M-M-R II | NON PREFERRED | ||
| VACCINES | MNEXSPIKE COVID-19 VACCIN | NON PREFERRED | ||
| VACCINES | MRESVIA | NON PREFERRED | ||
| VACCINES | NUVAXOVID COVID-19 VACCIN | NON PREFERRED | ||
| VACCINES | PEDIARIX | NON PREFERRED | ||
| VACCINES | PEDVAX HIB | NON PREFERRED | ||
| VACCINES | PENBRAYA | NON PREFERRED | ||
| VACCINES | PENMENVY | NON PREFERRED | ||
| VACCINES | PENTACEL | NON PREFERRED | ||
| VACCINES | PNEUMOVAX 23 | NON PREFERRED | ||
| VACCINES | PREVNAR 20 | NON PREFERRED | ||
| VACCINES | PRIORIX | NON PREFERRED | ||
| VACCINES | PROQUAD | NON PREFERRED | ||
| VACCINES | QUADRACEL | NON PREFERRED | ||
| VACCINES | RABAVERT | NON PREFERRED | ||
| VACCINES | RECOMBIVAX HB | NON PREFERRED | ||
| VACCINES | ROTARIX | NON PREFERRED | ||
| VACCINES | ROTATEQ | NON PREFERRED | ||
| VACCINES | SHINGRIX | NON PREFERRED | ||
| VACCINES | SPIKEVAX COVID-19 VACCINE | NON PREFERRED | ||
| VACCINES | TENIVAC | NON PREFERRED | ||
| VACCINES | TICOVAC | NON PREFERRED | ||
| VACCINES | TRUMENBA | NON PREFERRED | ||
| VACCINES | TWINRIX | NON PREFERRED | ||
| VACCINES | TYPHIM VI | NON PREFERRED | ||
| VACCINES | VAQTA | NON PREFERRED | ||
| VACCINES | VARIVAX | NON PREFERRED | ||
| VACCINES | VAXCHORA | NON PREFERRED | ||
| VACCINES | VAXELIS | NON PREFERRED | ||
| VACCINES | VAXNEUVANCE | NON PREFERRED | ||
| VACCINES | VIMKUNYA | NON PREFERRED | ||
| VACCINES | VIVOTIF | NON PREFERRED | ||
| VACCINES | YF-VAX | NON PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | CLEOCIN | NON PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | CLINDAMYCIN PHOSPHATE | GENERIC | ||
| VAGINAL AND RELATED PRODUCTS | CLINDESSE | NON PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | ESTRACE | NON PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | ESTRADIOL | GENERIC | ||
| VAGINAL AND RELATED PRODUCTS | ESTRADIOL | EXCLUDED | ||
| VAGINAL AND RELATED PRODUCTS | ESTRING | EXCLUDED | ||
| VAGINAL AND RELATED PRODUCTS | FEM PH | NON PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | FEMRING | EXCLUDED | PA | |
| VAGINAL AND RELATED PRODUCTS | GYNAZOLE-1 | NON PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | IMVEXXY MAINTENANCE PACK | PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | IMVEXXY STARTER PACK | PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | INTRAROSA | EXCLUDED | PA | |
| VAGINAL AND RELATED PRODUCTS | METRONIDAZOLE VAGINAL | GENERIC | ||
| VAGINAL AND RELATED PRODUCTS | MICONAZOLE 3 | GENERIC | ||
| VAGINAL AND RELATED PRODUCTS | PHEXXI | NON PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | PREMARIN | EXCLUDED | ||
| VAGINAL AND RELATED PRODUCTS | TERCONAZOLE | GENERIC | ||
| VAGINAL AND RELATED PRODUCTS | TRIMO-SAN | EXCLUDED | ||
| VAGINAL AND RELATED PRODUCTS | VAGIFEM | PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | VANDAZOLE | EXCLUDED | ||
| VAGINAL AND RELATED PRODUCTS | XACIATO | NON PREFERRED | ||
| VAGINAL AND RELATED PRODUCTS | YUVAFEM | EXCLUDED | ||
| VASOPRESSORS | ADRENALIN | EXCLUDED | ||
| VASOPRESSORS | AKOVAZ | EXCLUDED | ||
| VASOPRESSORS | AUVI-Q | PREFERRED | ||
| VASOPRESSORS | BIORPHEN | EXCLUDED | ||
| VASOPRESSORS | DROXIDOPA | GENERIC | SP | PA |
| VASOPRESSORS | EMERPHED | EXCLUDED | ||
| VASOPRESSORS | EPHEDRINE SULFATE/SODIUM | EXCLUDED | ||
| VASOPRESSORS | EPHEDRINE SULFATE | EXCLUDED | ||
| VASOPRESSORS | EPHEDRINE SULFATE | GENERIC | ||
| VASOPRESSORS | EPHEDRINE SULFATE | NON PREFERRED | ||
| VASOPRESSORS | EPINEPHRINE/SODIUM CHLORI | EXCLUDED | ||
| VASOPRESSORS | EPINEPHRINE HYDROCHLORIDE | EXCLUDED | ||
| VASOPRESSORS | EPINEPHRINE PROFESSIONAL | EXCLUDED | ||
| VASOPRESSORS | EPINEPHRINE/DEXTROSE | EXCLUDED | ||
| VASOPRESSORS | EPINEPHRINE | GENERIC | ||
| VASOPRESSORS | EPINEPHRINE | EXCLUDED | ||
| VASOPRESSORS | EPINEPHRINE BITARTRATE/SO | EXCLUDED | ||
| VASOPRESSORS | EPINEPHRINE | NON PREFERRED | ||
| VASOPRESSORS | EPINEPHRINE HCL | NON PREFERRED | ||
| VASOPRESSORS | EPINEPHRINESNAP-EMS | EXCLUDED | ||
| VASOPRESSORS | EPINEPHRINESNAP | EXCLUDED | ||
| VASOPRESSORS | EPINEPHRINESNAP-V | EXCLUDED | ||
| VASOPRESSORS | EPIPEN 2-PAK | EXCLUDED | ||
| VASOPRESSORS | EPIPEN-JR 2-PAK | EXCLUDED | ||
| VASOPRESSORS | GIAPREZA | EXCLUDED | ||
| VASOPRESSORS | IMMPHENTIV | EXCLUDED | ||
| VASOPRESSORS | LEVOPHED | NON PREFERRED | ||
| VASOPRESSORS | MIDODRINE HYDROCHLORIDE | GENERIC | ||
| VASOPRESSORS | NEFFY | EXCLUDED | ||
| VASOPRESSORS | NOREPINEPHRINE BITARTRATE | EXCLUDED | ||
| VASOPRESSORS | NOREPINEPHRINE/DEXTROSE | EXCLUDED | ||
| VASOPRESSORS | NOREPINEPHRINE/SODIUM CHL | EXCLUDED | ||
| VASOPRESSORS | NOREPINEPHRINE BITARTRATE | GENERIC | ||
| VASOPRESSORS | NORTHERA | EXCLUDED | SP | PA |
| VASOPRESSORS | PHENYLEPHRINE HYDROCHLORI | EXCLUDED | ||
| VASOPRESSORS | PHENYLEPHRINE HYDROCHLORI | NON PREFERRED | ||
| VASOPRESSORS | PHENYLEPHRINE HYDROCHLORI | GENERIC | ||
| VASOPRESSORS | VAZCULEP | NON PREFERRED |