NOTE: Not all plans cover these drugs nor require preauthorization. Please refer to the member's Individual Policy (also known as Certificate of Coverage, Master Contract or Plan Document) for information regarding coverage determination.

** This list does not guarantee coverage and is subject to change.**

  • abiraterone
  • Abrilada
  • Actemra SQ
  • Actimmune
  • adalimumab
  • Adbry
  • Adcirca
  • Adempas
  • Adipex-P
  • Afinitor
  • Aimovig
  • Ajovy
  • Akeega
  • Alecensa
  • Alunbrig
  • Alvaiz
  • Alyq
  • ambrisentan
  • Amjevita
  • Ampyra
  • Aubagio
  • Augtyro
  • Austedo
  • Avonex
  • Ayvakit
  • Bafiertam
  • Balversa
  • Benlysta SQ
  • benzphetamine
  • Besremi
  • Betaseron
  • Bimzelx
  • bexarotene
  • bosentan
  • Bosulif
  • Braftovi
  • Brukinsa
  • Bylvay
  • Cablivi
  • Cabometyx
  • Calquence
  • Caprelsa
  • Carbaglu
  • carglumic acid
  • Cerdelga
  • Cholbam
  • Cibinqo
  • Cimzia
  • Cometriq
  • Copaxone
  • Copiktra
  • Cosentyx
  • Cotellic
  • Cyltezo
  • dalfampridine
  • Daurismo
  • Daybue
  • deferasirox
  • deferiprone
  • Diacomit
  • dichlorphenamide
  • dimethyl fumarate
  • Doptelet
  • Dupixent
  • Emcyt
  • Emgality
  • Enbrel
  • Enspryng
  • Entyvio Pen
  • Epclusa
  • Epidiolex
  • Erivedge
  • Erleada
  • erlotinib
  • Esbriet
  • everolimus
  • Evrysdi
  • Exjade
  • Exkivity
  • Extavia
  • Fabhalta
  • Fareston
  • Fasenra Pen
  • Ferriprox
  • Filspari
  • Filsuvez
  • fingolimod
  • Fintepla
  • Firdapse
  • Forteo
  • Fruzaqla
  • Galafold
  • Gattex
  • Gavreto
  • gefitinib
  • Genotropin
  • Gilenya
  • Gilotrif
  • glatiramer
  • Glatopa
  • Gleevec
  • Hadlima
  • Harvoni
  • Hetlioz
  • Hulio
  • Humatrope
  • Humira
  • Hycamtin
  • Hyftor
  • Hyrimoz
  • Ibrance
  • Iclusig
  • Idacio
  • Idhifa
  • imatinib
  • Imbruvica
  • Increlex
  • Ingrezza
  • Inlyta
  • Inqovi
  • Inrebic
  • Iressa
  • Isturisa
  • Iwilfin
  • Jadenu
  • Jakafi
  • Jaypirca
  • Jesduvroq
  • Joenja
  • Juxtapid
  • Jynarque
  • Kalydeco
  • Kesimpta
  • Keveyis
  • Kevzara
  • Kineret
  • Kisqali
  • Kisqali Femara
  • Korlym
  • Koselugo
  • Krazati
  • Kuvan
  • lapatinib
  • ledipasvir/sofosbuvir
  • lenalidomide
  • Lenvima
  • Letairis
  • leuprolide non-depot
  • Litfulo
  • Livmarli
  • Lonsurf
  • Lorbrena
  • Lumakras
  • Lumryz
  • Lupaneta Pack
  • Lupkynis
  • Lynparza
  • Lytgobi
  • Matulane
  • Mavenclad
  • Mavyret
  • Mayzent
  • Mekinist
  • Mektovi
  • mifepristone
  • miglustat
  • Mulpleta
  • Mycapssa
  • Mytesi
  • Natpara
  • Nerlynx
  • Nexavar
  • Ngenla
  • Nilandron
  • nilutamide
  • Ninlaro
  • nitisinone
  • Nityr
  • Norditropin
  • Nubeqa
  • Nucala
  • Nurtec
  • Nutropin AQ
  • Odomzo
  • Ofev
  • Ogsiveo
  • Ojemda
  • Ojjaara
  • Olpruva
  • Olumiant
  • Omnitrope
  • Omvoh
  • Onureg
  • Opfolda
  • Opsumit
  • Opzelura
  • Orencia SQ
  • Orenitram
  • Orfadin
  • Orgovyx
  • Orkambi
  • Orladeyo
  • Orserdu
  • Otezla
  • Oxbryta
  • Oxervate
  • Palynziq
  • pazopanib
  • Pemazyre
  • phendimetrazine
  • Piqray
  • pirfenidone
  • Plegridy
  • Pomalyst
  • Ponvory
  • Praluent
  • Procysbi
  • Promacta
  • Pyrukynd
  • Qinlock
  • Qulipta
  • Ravicti
  • Rebif
  • Reblozyl
  • Regimex
  • Repatha
  • Retevmo
  • Revlimid
  • Reyvow
  • Rezdiffra
  • Rezlidhia
  • Rezurock
  • Rinvoq
  • Rivfloza
  • Rozlytrek
  • Rubraca
  • Rydapt
  • Saizen
  • Samsca
  • sapropterin
  • Scemblix
  • Serostim
  • Signifor
  • Siliq
  • Spevigo
  • Simponi SQ
  • Skyclarys
  • Skyrizi
  • Skytrofa
  • sodium oxybate
  • sofosbuvir/ velpatasvir
  • Sogroya
  • Sohonos
  • Somavert
  • sorafenib
  • Sotyktu
  • Sovaldi
  • Sprycel
  • Stelara
  • Stivarga
  • Strensiq
  • Sucraid
  • sunitinib
  • Sunosi
  • Sutent
  • Symdeko
  • Tabloid
  • Tabrecta
  • tadalafil 20mg
  • Tafinlar
  • Tagrisso
  • Takhzyro
  • Taltz
  • Talzenna
  • Tarceva
  • Targretin
  • Tarpeyo
  • Tascenso
  • Tasigna
  • tasimelteon  
  • Tavalisse
  • Tavneos
  • Tazverik
  • Tecfidera
  • Tegsedi
  • Temodar
  • temozolomide
  • Tepmetko
  • teriflunomide
  • teriparatide
  • tetrabenazine
  • Tezspire
  • Thalomid
  • Tibsovo
  • tolvaptan
  • toremifine
  • Tracleer
  • Tremfya
  • Trikafta
  • Truqap
  • Tukysa
  • Turalio
  • Tykerb
  • Tymlos
  • Tyvaso
  • Ubrelvy
  • Uptravi
  • Vanflyta
  • Velsipity
  • Venclexta
  • Ventavis
  • Verzenio
  • Vijoice
  • Vitrakvi
  • Vizimpro
  • Vonjo
  • Vosevi
  • Votrient
  • Vowst
  • Voxzogo
  • Voydeya
  • Vtama
  • Vumerity
  • Vyndamax
  • Vyndaqel
  • Wainua
  • Wakix
  • Wegovy
  • Welireg
  • Wezlana SQ
  • Winrevair
  • Xalkori
  • Xeljanz
  • Xenazine
  • Xermelo
  • Xolair prefilled syringe, auto-injector
  • Xolremdi
  • Xospata
  • Xpovio
  • Xtandi
  • Xuriden
  • Xyrem
  • Yonsa
  • Yuflyma
  • Yusimry
  • Zavesca
  • Zavzpret
  • Zejula
  • Zelboraf
  • Zepatier
  • Zepbound
  • Zeposia
  • Zilbrysq
  • Zokinvy
  • Zolinza
  • Zomacton
  • Zorbtive
  • Zydelig
  • Zykadia
  • Zymfentra
  • Zytalmy
  • Zytiga

Reviewed by LJS on 8/9/24

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