Good Health Prior Authorization Drug List

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Michał Marek
5 lat temu
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1 Good Health Prior Authorization Drug List ACTEMRA ADCETRIS ADCIRCA ADEMPAS AFINITOR AIMOVIG AJOVY ALDURAZYME ALLERGY EXTRACTS APOKYN ARCALYST ARZERRA AUSTEDO AVASTIN BAVENCIO BELEODAQ BELRAPZO BENDEKA BENLYSTA BLINCYTO BOSULIF BOTOX BRAVELLE BUTRANS CABOMETYX CAPRELSA CARBAGLU CAVERJECT CETROTIDE CHORIONIC GONADOTROPIN CIMZIA CINRYZE CLOMIPHENE CITRATE COMETRIQ COSENTYX COTELLIC CRINONE CYRAMZA DARZALEX DAURISMO DESOXYN Includes: SubQ and IV Includes generic: TADALAFIL/ALYQ Includes: AFINITOR DISPERZ Includes: GRASTEK, ORALAIR, AND RAGWITEK Cancer diagnosis ONLY Includes generic: BENDAMUSTINE Includes generic: BUPRENORPHINE PATCH Includes generic: METHAMPHETAMINE HCL

2 DIFICID DUPIXENT DYSPORT EDEX EMGALITY EMPLICITI ENBREL ENDOMETRIN ENTYVIO EPCLUSA EPIDIOLEX ERBITUX ERIVEDGE ERLEADA ESBRIET EXJADE EYLEA FABRAZYME FARYDAK FASENRA FASLODEX FENTANYL CITRATE FENTORA FERRIPROX FIRAZYR FOLLISTIM FOLLISTIM AQ FOLOTYN FORTEO FUSILEV GANIRELIX GAZYVA GILOTRIF GONAL-F GROWTH HORMONE HALAVEN Includes: ENBREL MINI Includes generic: SOFOSBUVIR- VELPATASVIR Includes generic: DEFERASIROX Includes generic: FULVESTRANT Includes generic: ICATIBANT Includes generic: LEVOLEUCOVORIN CALCIUM Includes: GONAL-F RFF & GONAL F RFF REDIJECT Includes: GENOTROPIN, HUMATROPE, NORDITROPIN FLEXPRO, NUTROPIN AQ, NUTROPIN AQ NUSPIN, OMNITROPE, SAIZEN, SEROSTIM, SOMAVERT, ZOMACTON, AND ZORBTIVE

3 HARVONI HCG (human chorionic gonadotropin) HUMIRA IBRANCE ICLUSIG IMBRUVICA IMFINZI INCRELEX INFLECTRA INGREZZA INLYTA IPRIVASK IRESSA ISTODAX IXEMPRA JADENU JAKAFI JETREA JEVTANA JYNARQUE KADCYLA KALBITOR KALYDECO KEVZARA KEYTRUDA KINERET KORLYM KRYSTEXXA KUVAN KYMRIAH KYPROLIS LAZANDA LENVIMA LETAIRIS LONSURF LOTRONEX LUCENTIS LYNPARZA MAKENA MARQIBO Includes generic: LEDIPASVIR- SOFOSBUVIR Includes: HUMIRA PEN, HUMIRA PEN CROHN-UC-HS STARTER, HUMIRA PEN PSORIASIS-UVEITIS, AND HUMIRA PEDIATRIC CROHN'S Includes generic: ROMIDEPSIN Includes generic: AMBRISENTAN Includes generic: ALOSETRON HCL Includes generic: HYDROXYPROGESTERONE CAPROATE

4 MAVYRET MEKINIST MENOPUR MYOBLOC NEXAVAR NINLARO NORTHERA NOVAREL NUCALA OFEV OPDIVO OPSUMIT ORENCIA ORENITRAM ER OVIDREL PERJETA POMALYST PPACA PA PRALUENT PREGNYL PROFERRIN ES PROLIA PROVENGE REMICADE REMODULIN RENFLEXIS REPATHA REVATIO IV REVLIMID RUBRACA SABRIL SANCUSO SILIQ SIMPONI SMOKING CESSATION SOVALDI SPRAVATO SPRYCEL STELARA STIVARGA Includes: SubQ and IV Includes: RALOXIFENE (EVISTA) AND TAMOXIFEN Includes generic: SILDENAFIL Includes generic: VIGABATRIN/ VIGADRONE Includes: SIMPONI ARIA Includes: CHANTIX, NICOTROL, BUPROPION 150mg SR Includes: SubQ and IV

5 SUTENT SYLVANT SYNAGIS SYNRIBO TAFINLAR TAGRISSO TALTZ TARCEVA TASIGNA TECENTRIQ TESTOSTERONE REPLACEMENT TORISEL TRACLEER TREANDA TREMFYA TYKERB TYMLOS TYSABRI TYVASO UCERIS VALCHLOR VECTIBIX VENCLEXTA VENTAVIS VERZENIO VOSEVI VOTRIENT XALKORI XELJANZ XENAZINE XEOMIN XGEVA XIAFLEX XOFIGO XOLAIR XTANDI XYREM YERVOY YESCARTA ZAVESCA ZEJULA Includes: AUTO-INJECTOR AND SYRINGE Includes generic: ERLOTINIB Includes: ANDRODERM, ANDROGEL, DEPO- TESTOSTERONE, FORTESTA, STRIANT, TESTIM, TESTOPEL, TESTOSTERONE ENANTHATE, VOGELXO Includes generic: TEMSIROLIMUS Includes generic: BOSENTAN Includes generic: TREPROSTINIL Includes generic: BUDESONIDE ER Includes: XELJANZ XR Includes generic: TETRABENAZINE Includes generic: MIGLUSTAT

6 ZELBORAF ZEPATIER ZINPLAVA ZOLINZA ZYDELIG ZYKADIA ZYTIGA

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