Section |
Status |
HCD |
Name |
05.03.01 |
Restricted Use
|
 |
Abacavir Ziagen® |
05.03.01 |
Restricted Use
|
 |
Abacavir and Lamivudine |
05.03.01 |
Restricted Use
|
 |
Abacavir and Lamivudine and Zidovudine Trizivir® |
10.01.03 |
Restricted Use
|
 |
Abatacept Orencia® |
08.01.05 |
Formulary
|
 |
Abemaciclib Verzenios® |
08.03.04.02 |
Restricted Use
|
 |
Abiraterone Zytiga® |
01.05.03 |
Restricted Use
|
 |
Adalimumab |
10.01.03 |
Restricted Use
|
 |
Adalimumab |
11.04.02 |
Restricted Use
|
 |
Adalimumab |
13.05.03 |
Restricted Use
|
 |
Adalimumab |
05.03.03.01 |
Restricted Use
|
 |
Adefovir Dipivoxil Hepsera® |
08.01.05 |
Restricted Use
|
 |
Aflibercept Zaltrap® |
11.08.02 |
Restricted Use
|
 |
Aflibercept Eylea® |
09.08.01 |
Non Formulary
|
 |
Agalsidase Alfa and Beta Fabrazyme® |
09.08.01 |
Non Formulary
|
 |
Agalsidase Alfa and Beta Replagal® |
02.11 |
Restricted Use
|
 |
Albutrepenonacog alfa Idelvion® |
08.02.04 |
Non Formulary
|
 |
Aldesleukin Proleukin® |
08.02.03 |
Formulary
|
 |
Alemtuzumab MabCampath® |
09.08.01 |
Non Formulary
|
 |
Alglucosidase Alfa Myozyme® |
13.05.01 |
Restricted Use
|
 |
Alitretinoin Toctino® |
02.05.01 |
Non Formulary
|
 |
Ambrisentan |
10.02.01 |
Non Formulary
|
 |
Amifampridine Firdapse |
10.01.03 |
Restricted Use
|
 |
Anakinra Kineret® |
05.02.04 |
Restricted Use
|
 |
Anidulafungin Ecalta® |
02.11 |
Restricted Use
|
 |
Antithrombin III Kybernin® |
09.01.03 |
Non Formulary
|
 |
Antithymocyte Immunoglobulin (Equine) |
08.02.02 |
Restricted Use
|
 |
Antithymocyte immunoglobulin (rabbit) Thymoglobuline® |
13.05.03 |
Restricted Use
|
 |
Apremilast Otezla® |
08.01.05 |
Restricted Use
|
 |
Arsenic Trioxide |
09.08.01 |
Non Formulary
|
 |
Asfotase alfa Strensiq® |
10.02 |
Restricted Use
|
 |
Ataluren Translarna® |
05.03.01 |
Restricted Use
|
 |
Atazanavir |
05.03.01 |
Restricted Use
|
 |
Atazanavir sulfate and cobicistat Evotaz® |
08.01.05 |
Restricted Use
|
 |
Atezolizumab Tecentriq® |
09.01.04 |
Restricted Use
|
 |
Avatrombopag Doptelet® |
08.02.03 |
Restricted Use
|
 |
Avelumab Bavencio® |
08.01.05 |
Restricted Use
|
 |
Axitinib Inlyta® |
08.01.03 |
Restricted Use
|
 |
Azacitidine Vidaza® |
05.01.02.03 |
Restricted Use
|
 |
Aztreonam nebuliser solution Cayston® |
10.01.03 |
Restricted Use
|
 |
Baricitinib Olumiant® |
08.02.02 |
Formulary
|
 |
Basiliximab Simulect® |
05.01.09 |
Restricted Use
|
 |
Bedaquiline Sirturo® |
08.02.02 |
Non Formulary
|
 |
Belatacept Nulojix® |
10.01 |
Restricted Use
|
 |
Belimumab Benlysta® |
08.01.01 |
Restricted Use
|
 |
Bendamustine |
03.05.02 |
Non Formulary
|
 |
Beractant Survanta® |
08.01.05 |
Restricted Use
|
 |
Bevacizumab Avastin® |
05.03.01 |
Restricted Use
|
 |
Bictegravir, emtricitabine and tenofovir alafenamide Biktarvy® |
08.02 |
Restricted Use
|
 |
Blinatumomab Blincyto® |
05.03.03.02 |
Non Formulary
|
 |
Boceprevir Victrelis® |
08.01.05 |
Formulary
|
 |
Bortezomib |
02.05.01 |
Formulary
|
 |
Bosentan |
08.01.05 |
Restricted Use
|
 |
Bosutinib Bosulif® |
04.07.04.02 |
Formulary
|
 |
Botulinum Toxin Type A botox® |
08.01.05 |
Restricted Use
|
 |
Brentuximab vedotin Adcetris® |
13.05.02 |
Restricted Use
|
 |
Brodalumab Kyntheum® |
03.04.03 |
Formulary
|
 |
C1 esterase inhibitor Cinryze® |
03.04.03 |
Restricted Use
|
 |
C1 Esterase Inhibitor Berinert® |
08.01.05 |
Restricted Use
|
 |
Cabazitaxel Jevtana® |
08.01.05 |
Restricted Use
|
 |
Cabozantinib Cabometyx® |
08.01.05 |
Restricted Use
|
 |
Cabozantinib Cometriq® |
08.02.04 |
Restricted Use
|
 |
Canakinumab Ilaris® |
08.02.03 |
Restricted Use
|
 |
Caplacizumab Cablivi® |
08.01.05 |
Restricted Use
|
 |
Carfilzomib Kyprolis® |
09.08.01 |
Restricted Use
|
 |
Carglumic Acid Carbaglu® |
05.02.04 |
Restricted Use
|
 |
Caspofungin |
02.11 |
Non Formulary
|
 |
Catridecacog NovoThirteen® |
08.02.04 |
Formulary
|
 |
Cemiplimab Libtayo ® |
08.01.05 |
Restricted Use
|
 |
Ceritinib Zykadia |
10.01.03 |
Restricted Use
|
 |
Certolizumab Pegol Cimzia® |
08.01.05 |
Formulary
|
 |
Cetuximab Erbitux® |
09.08.01 |
Non Formulary
|
 |
Chenodeoxycholic acid Xenbilox® |
09.08.01 |
Non Formulary
|
 |
Chenodeoxycholic acid Leadiant biosciences |
01.09.01 |
Non Formulary
|
 |
Cholic acid Orphacol® |
01.09.01 |
Non Formulary
|
 |
Cholic acid Kolbam® |
08.02.02 |
Formulary
|
 |
Ciclosporin |
05.03.02.02 |
Restricted Use
|
 |
Cidofovir infusion |
09.05.01.02 |
Restricted Use
|
 |
Cinacalcet |
08.01.03 |
Formulary
|
 |
Cladribine |
08.01.03 |
Formulary
|
 |
Cladribine Mavenclad® |
08.01.03 |
Restricted Use
|
 |
Clofarabine |
05.03.01 |
Restricted Use
|
 |
Cobicistat Tybost® |
04.09.01 |
Restricted Use
|
 |
Co-Careldopa Duodopa® |
09.05.02.02 |
Non Formulary
|
 |
Colestilan BindRen® |
05.01.07 |
Restricted Use
|
 |
Colistimethate Promixin® |
05.01.07 |
Formulary
|
 |
Colistimethate for nebulisation Colomycin® |
05.01.07 |
Restricted Use
|
 |
Colistimethate inhaler Colobreathe® |
10.03.01 |
Non Formulary
|
 |
Collagenase Xiapex® |
03.04.03 |
Non Formulary
|
 |
Conestat Alfa Ruconest® |
08.01.05 |
Restricted Use
|
 |
Crizotinib Xalkori® |
08.01.05 |
Restricted Use
|
 |
Dabrafenib Tafinlar® |
05.03.03.02 |
Non Formulary
|
 |
Daclatasvir Daklinza® |
08.02.04 |
Restricted Use
|
 |
Daclizumab Zinbryta® |
08.01.05 |
Formulary
|
 |
Dacomitinib monohydrate Vizimpro® |
08.01.05 |
Restricted Use
|
 |
Daratumumab Darzalex® |
09.01.03 |
Restricted Use
|
 |
Darbepoetin Alfa Aranesp® |
08.03.04.02 |
Restricted Use
|
 |
Darolutamide Nubeqa ® |
05.03.01 |
Restricted Use
|
 |
Darunavir |
05.03.01 |
Restricted Use
|
 |
Darunavir and Cobicistat Rezolsta® |
05.03.03.02 |
Restricted Use
|
 |
Dasabuvir Exviera® |
08.01.05 |
Restricted Use
|
 |
Dasatinib Sprycel® |
20 |
Formulary
|
 |
DAUNORUBICIN saline pre-filled syringe |
08.01.03 |
Non Formulary
|
 |
Decitabine Dacogen® |
09.01.03 |
Restricted Use
|
 |
Deferasirox Exjade® |
09.01.03 |
Formulary
|
 |
Deferiprone Ferriprox® |
02.10.02 |
Formulary
|
 |
Defibrotide |
20 |
Non Formulary
|
 |
DEFIBROTIDE Capsules 400 mg |
05.01.09 |
Non Formulary
|
 |
Delamanid Deltyba® |
09.01.03 |
Formulary
|
 |
Desferrioxamine Mesilate |
11.04.01 |
Restricted Use
|
 |
Dexamethasone intravitreal implant Ozurdex® |
08.01 |
Restricted Use
|
 |
Dexrazoxane Savene® |
08.01 |
Restricted Use
|
 |
Dexrazoxane Cardioxane® |
05.03.01 |
Restricted Use
|
 |
Didanosine Videx® |
02.01.01 |
Restricted Use
|
 |
Digoxin specific antibody fragments Digifab® |
18 |
Restricted Use
|
 |
Digoxin specific antibody fragments Digifab® |
08.02.04 |
Restricted Use
|
 |
Dimethyl fumarate Tecfidera® |
13.05.02 |
Restricted Use
|
 |
Dimethyl Fumarate |
08.02.04 |
Restricted Use
|
 |
Dinutuximab beta |
05.03.01 |
Formulary
|
 |
Dolutegravir |
05.03.01 |
Formulary
|
 |
Dolutegravir and lamivudine Dovato® |
05.03.01 |
Formulary
|
 |
Dolutegravir and rilpivirine Juluca® |
05.03.01 |
Formulary
|
 |
Dolutegravir, abacavir & lamivudine Triumeq® |
05.03.01 |
Non Formulary
|
 |
Dolutegravir, lamivudine & tenofovir Acriptega® |
05.03.01 |
Restricted Use
|
 |
Doravirine Pifeltro® |
05.03.01 |
Restricted Use
|
 |
Doravirine and Lamivudine and Tenofovir disoproxil Delstrigo® |
03.07 |
Formulary
|
 |
Dornase Alfa Pulmozyme® |
13.05.03 |
Restricted Use
|
 |
Dupilumab Dupixent® |
09.01.03 |
Restricted Use
|
 |
Eculizumab Soliris® |
05.03.01 |
Restricted Use
|
 |
Efavirenz Sustiva® |
02.11 |
Restricted Use
|
 |
Efmoroctocog alfa Elocta® |
02.11 |
Restricted Use
|
 |
Eftrenonacog alfa Alprolix® |
05.03.03.02 |
Restricted Use
|
 |
Elbasvir/Grazoprevir Zepatier® |
09.08.01 |
Non Formulary
|
 |
Eliglustat Cerdelga® |
09.08.01 |
Non Formulary
|
 |
Elosulfase alfa Vimizim® |
09.01.04 |
Restricted Use
|
 |
Eltrombopag Revolade® |
02.11 |
Restricted Use
|
 |
Emicizumab Hemlibra® |
05.03.01 |
Restricted Use
|
 |
Emtricitabine Emtriva® |
05.03.01 |
Restricted Use
|
 |
Emtricitabine + rilpivirine + tenofovir alafenamide Odefsey® |
05.03.01 |
Restricted Use
|
 |
Emtricitabine + tenofovir alafenamide Descovy® |
05.03.01 |
Restricted Use
|
 |
Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg Eviplera® |
08.01.05 |
Formulary
|
 |
Encorafenib Braftovi® |
05.03.01 |
Formulary
|
 |
Enfuvirtide Fuzeon® |
05.03.03.01 |
Restricted Use
|
 |
Entecavir |
08.01.05 |
Formulary
|
 |
Entrectinib Rozlytrek ® |
08.03.04.02 |
Restricted Use
|
 |
Enzalutamide Xtandi® |
09.01.03 |
Restricted Use
|
 |
Epoetin alfa Eprex® |
09.01.03 |
Restricted Use
|
 |
Epoetin beta NeoRecormon® |
02.08.01 |
Restricted Use
|
 |
Epoprostenol Flolan® |
20 |
Non Formulary
|
 |
Eptotermin Alfa Osigraft® |
08.01.05 |
Restricted Use
|
 |
Eribulin Halaven® |
08.01.05 |
Restricted Use
|
 |
Erlotinib |
10.01.03 |
Restricted Use
|
 |
Etanercept Enbrel® |
13.05.03 |
Formulary
|
 |
Etanercept Enbrel® |
05.03.01 |
Restricted Use
|
 |
Etravirine Intelence® |
08.01.05 |
Restricted Use
|
 |
Everolimus Votubia® |
08.01.05 |
Restricted Use
|
 |
Everolimus Afinitor® |
08.02.02 |
Non Formulary
|
 |
Everolimus Certican® |
02.11 |
Restricted Use
|
 |
Factor Eight Inhibitor Bypassing Fraction Feiba® |
02.11 |
Non Formulary
|
 |
Factor IX Fraction, Dried |
02.11 |
Restricted Use
|
 |
Factor VIIa (Recombinant), Eptacog alfa NovoSeven® |
02.11 |
Restricted Use
|
 |
Factor VIII NovoEight® |
02.11 |
Restricted Use
|
 |
Factor VIII - Von willebrand factor Type 8Y® |
02.11 |
Restricted Use
|
 |
Factor VIII - Von willebrand factor Wilate® |
02.11 |
Restricted Use
|
 |
Factor VIII + von Willebrand factor Voncento® |
02.11 |
Non Formulary
|
 |
Factor VIII Fraction, Dried |
02.11 |
Non Formulary
|
 |
Factor VIII Inhibitor Bypassing Fraction |
02.11 |
Non Formulary
|
 |
Factor XIII Fraction, Dried |
08.02.04 |
Non Formulary
|
 |
Fampridine |
05.01.07 |
Formulary
|
 |
Fidaxomicin Dificlir® |
09.01.06 |
Formulary
|
 |
Filgrastim Nivestim® |
09.01.06 |
Restricted Use
|
 |
Filgrastim Neupogen® |
08.02.04 |
Restricted Use
|
 |
Fingolimod |
11.04.01 |
Restricted Use
|
 |
Fluocinolone intravitreal implant Iluvien® |
18 |
Restricted Use
|
 |
Fomepizole |
05.03.01 |
Restricted Use
|
 |
Fosamprenavir Telzir® |
05.03.02.02 |
Restricted Use
|
 |
Foscarnet Sodium Foscavir® |
04.07.04.02 |
Formulary
|
 |
Fremanezumab Ajovy® |
05.03.02.02 |
Restricted Use
|
 |
Ganciclovir |
08.01.05 |
Restricted Use
|
 |
Gefitinib |
08.01.05 |
Restricted Use
|
 |
Gilteritinib Xospata® |
08.02.04 |
Formulary
|
 |
Glatiramer Acetate |
05.03.03.02 |
Formulary
|
 |
Glecaprevir/Pibrentasvir Maviret® |
18 |
Restricted Use
|
 |
Glucarpidase Carboxypeptidase |
01.05.03 |
Restricted Use
|
 |
Golimumab Simponi® |
10.01.03 |
Restricted Use
|
 |
Golimumab Simponi® |
13.05.03 |
Restricted Use
|
 |
Guselkumab Tremfya® |
09.08.02 |
Non Formulary
|
 |
Haem Arginate Normosang® |
02.11 |
Restricted Use
|
 |
Human Fibrinogen Riastap® |
08.01.05 |
Restricted Use
|
 |
Ibrutinib Imbruvica® |
03.04.03 |
Restricted Use
|
 |
Icatibant Firazyr® |
09.08.01 |
Non Formulary
|
 |
Idursulfase Elaprase® |
02.05.01 |
Formulary
|
 |
Iloprost injection |
08.01.05 |
Restricted Use
|
 |
Imatinib |
09.08.01 |
Non Formulary
|
 |
Imiglucerase Cerezyme® |
05.03.01 |
Non Formulary
|
 |
Indinavir Crixivan® |
01.05.03 |
Restricted Use
|
 |
Infliximab Remicade® |
01.05.03 |
Non Formulary
|
 |
Infliximab Inflectra® |
01.05.03 |
Restricted Use
|
 |
Infliximab Remsima® |
01.05.03 |
Restricted Use
|
 |
Infliximab Remsima® |
10.01.03 |
Restricted Use
|
 |
Infliximab Remicade® |
13.05.03 |
Formulary
|
 |
Infliximab Remicade® |
08.01.05 |
Restricted Use
|
 |
Inotuzumab Ozogamicin Besponsa® |
08.02.04 |
Non Formulary
|
 |
Interferon Alfa Viraferon® |
08.02.04 |
Non Formulary
|
 |
Interferon Alfa-2a Roferon-A® |
08.02.04 |
Non Formulary
|
 |
Interferon Alfa-2b IntronA® |
08.02.04 |
Non Formulary
|
 |
Interferon Beta Proleukin® |
08.02.04 |
Restricted Use
|
 |
Interferon Beta-1a Avonex® |
08.02.04 |
Restricted Use
|
 |
Interferon Beta-1a Rebif® |
08.02.04 |
Restricted Use
|
 |
Interferon beta-1b Extavia® |
08.02.04 |
Non Formulary
|
 |
Interferon Beta-1b Betaferon® |
08.01.05 |
Restricted Use
|
 |
Ipilimumab Yervoy® |
08.01.05 |
Restricted Use
|
 |
Isatuximab Sarclisa® |
03.07 |
Restricted Use
|
 |
Ivacaftor |
03.07 |
Restricted Use
|
 |
Ivacaftor + Tezacaftor + Elexacaftor Kaftrio® |
13.05.02 |
Restricted Use
|
 |
Ixekizumab Taltz® |
05.03.01 |
Restricted Use
|
 |
Lamivudine Zeffix® |
05.03.01 |
Restricted Use
|
 |
Lamivudine Epivir® |
05.03.01 |
Non Formulary
|
 |
Lamivudine & raltegravir Dutrebis® |
03.04.03 |
Restricted Use
|
 |
Lanadelumab |
08.03.04.03 |
Restricted Use
|
 |
Lanreotide Somatuline Autogel® |
09.05.02.02 |
Restricted Use
|
 |
Lanthanum Fosrenol ® |
08.01.05 |
Restricted Use
|
 |
Lapatinib Tyverb® |
09.08.01 |
Non Formulary
|
 |
Laronidase Aldurazyme® |
08.01.05 |
Restricted Use
|
 |
Larotrectinib Vitrakvi® |
05.03.03.02 |
Restricted Use
|
 |
Ledipasvir and Sofosbuvir Harvoni® |
08.02.04 |
Restricted Use
|
 |
Lenalidomide |
09.01.06 |
Restricted Use
|
 |
Lenograstim Granocyte® |
08.01.05 |
Restricted Use
|
 |
Lenvatinib Kisplyx® |
08.01.05 |
Restricted Use
|
 |
Lenvatinib Lenvima® |
05.03.02.02 |
Formulary
|
 |
Letermovir Prevymis® |
09.08.01 |
Formulary
|
 |
Levocarnitine Carnitor® |
05.01.12 |
Restricted Use
|
 |
Levofloxacin Quinsair® |
06.02.01 |
Restricted Use
|
 |
Liothyronine (IV) |
09.01.06 |
Non Formulary
|
 |
Lipegfilgrastim Lonquex® |
05.02 |
Restricted Use
|
 |
Lipid-complex amphotericin Abelcet® |
05.02 |
Restricted Use
|
 |
Liposomal amphotericin AmBisome® |
08.01.02 |
Restricted Use
|
 |
Liposomal Cytarabine-Daunorubicin Vyxeos® |
02.12 |
Non Formulary
|
 |
Lomitapide Lojuxta® |
05.03.01 |
Restricted Use
|
 |
Lopinavir and Ritonavir Kaletra® |
09.01.04 |
Restricted Use
|
 |
Lusutrombopag Mulpleo® |
08.03.04.03 |
Restricted Use
|
 |
Lutetium (177Lu) oxodotreotide Lutathera® |
02.05.01 |
Non Formulary
|
 |
Macitentan Opsumit®
|
03.07 |
Restricted Use
|
 |
Mannitol inhalation Bronchitol ® |
05.03.01 |
Formulary
|
 |
Maraviroc Celsentri® |
06.07.04 |
Non Formulary
|
 |
Mecasermin Increlex® |
09.08.01 |
Non Formulary
|
 |
Mercaptamine Cystagon® |
09.08.01 |
Formulary
|
 |
Mercaptamine (cysteamine) eye drops |
09.01.03 |
Restricted Use
|
 |
Methoxy Polyethylene Glycol-Epoetin Beta Mircera® |
05.02.04 |
Restricted Use
|
 |
Micafungin Mycamine® |
08.01.05 |
Restricted Use
|
 |
Midostaurin Rydapt® |
09.08.01 |
Non Formulary
|
 |
Migalastat Galafold® |
09.08.01 |
Non Formulary
|
 |
Miglustat Zavesca® |
02.11 |
Restricted Use
|
 |
Moroctocog alfa Refacto® |
08.02.01 |
Restricted Use
|
 |
Mycophenolate Mofetil |
08.02.04 |
Formulary
|
 |
Natalizumab Tysabri® |
08.01.05 |
Non Formulary
|
 |
Necitumumab Portrazza® |
08.01.03 |
Restricted Use
|
 |
Nelarabine Atriance® |
05.03.01 |
Non Formulary
|
 |
Nelfinavir Viracept® |
05.03.01 |
Restricted Use
|
 |
Nevirapine |
08.01.05 |
Restricted Use
|
 |
Nilotinib Tasigna® |
03.11 |
Restricted Use
|
 |
Nintedanib Ofev® |
03.11 |
Restricted Use
|
 |
Nintedanib Vargatef® |
08.02.04 |
Restricted Use
|
 |
Niraparib Zejula® |
20 |
Restricted Use
|
 |
Nitazoxanide |
08.02.04 |
Restricted Use
|
 |
Nivolumab Opdivo® |
02.11 |
Restricted Use
|
 |
Nonacog alfa BeneFIX® |
14.05.01 |
Restricted Use
|
 |
Normal immunoglobulin for Intramuscular use |
14.05.01 |
Restricted Use
|
 |
Normal immunoglobulin for Intravenous use |
14.05.01 |
Restricted Use
|
 |
Normal immunoglobulin for Subcutaneous use |
01.09.01 |
Restricted Use
|
 |
Obeticholic acid Ocaliva® |
08.02.03 |
Restricted Use
|
 |
Obinutuzumab Gazyvaro ® |
08.02.03 |
Restricted Use
|
 |
Ocrelizumab Ocrevus® |
11.08.02 |
Restricted Use
|
 |
Ocriplasmin Jetrea® |
02.11 |
Restricted Use
|
 |
Octocog alfa Kogenate® |
02.11 |
Restricted Use
|
 |
Octocog alfa Advate® |
08.03.04.03 |
Formulary
|
 |
Octreotide Sandostatin® |
08.03.04.03 |
Formulary
|
 |
Octreotide Sandostatin Lar® |
08.02.03 |
Non Formulary
|
 |
Ofatumumab Arzerra® |
08.02.04 |
Restricted Use
|
 |
Olaparib Lynparza® |
08.01.05 |
Non Formulary
|
 |
Olaratumab Lartruvo® |
03.04.02 |
Restricted Use
|
 |
Omalizumab Xolair® |
05.03.03.02 |
Restricted Use
|
 |
Ombitasvir/ paritaprevir/ ritonavir Viekirax® |
08.01.05 |
Restricted Use
|
 |
Osimertinib Tagrisso® |
08.01.05 |
Restricted Use
|
 |
Paclitaxel - Albumin Bound Formulation Abraxane® |
08.03.04.01 |
Formulary
|
 |
Palbociclib Ibrance® |
05.03.05 |
Restricted Use
|
 |
Palivizumab Synagis® |
08.01.05 |
Restricted Use
|
 |
Panitumumab Vectibix® |
08.01.05 |
Formulary
|
 |
Panobinostat Farydak® |
06.06.01 |
Non Formulary
|
 |
Parathyroid Hormone Preotact® |
06.05 |
Non Formulary
|
 |
Pasireotide |
08.01.05 |
Restricted Use
|
 |
Pazopanib Votrient® |
11.08.02 |
Non Formulary
|
 |
Pegaptanib Sodium Macugen® |
09.01.06 |
Non Formulary
|
 |
Pegfilgrastim Neulasta® |
08.02.04 |
Non Formulary
|
 |
Peginterferon Alfa PegIntron® |
08.02.04 |
Non Formulary
|
 |
Peginterferon Alfa ViraferonPeg® |
08.02.04 |
Non Formulary
|
 |
Peginterferon Alfa-2a Pegasys® |
08.02.04 |
Restricted Use
|
 |
Peginterferon Beta-1a Plegridy® |
06.05.01 |
Restricted Use
|
 |
Pegvisomant Somavert® |
08.01.02 |
Restricted Use
|
 |
Pegylated-liposomal doxorubicin Caelyx® |
08.01.05 |
Restricted Use
|
 |
Pembrolizumab Keytruda® |
08.01.03 |
Restricted Use
|
 |
Pemetrexed Alimta® |
08.01.05 |
Restricted Use
|
 |
Pertuzumab Perjeta® |
03.11 |
Restricted Use
|
 |
Pirfenidone Esbriet® |
08.01.02 |
Restricted Use
|
 |
Pixantrone |
09.01.07 |
Restricted Use
|
 |
Plerixafor Mozobil® |
08.01.05 |
Restricted Use
|
 |
Polatuzumab Vedotin |
08.02.04 |
Restricted Use
|
 |
Pomalidomide Imnovid® |
08.01.05 |
Restricted Use
|
 |
Ponatinib Iclusig® |
03.05.02 |
Formulary
|
 |
Poractant Alfa Curosurf® |
05.02 |
Restricted Use
|
 |
Posaconazole (IV) Noxafil® |
05.02 |
Restricted Use
|
 |
Posaconazole (oral) Noxafil® |
02.11 |
Restricted Use
|
 |
Protein C Concentrate Ceprotin® |
02.11 |
Restricted Use
|
 |
Prothrombin Complex Concentrate Octaplex® |
08.03.04.02 |
Restricted Use
|
 |
Radium-223 dichloride |
05.03.01 |
Formulary
|
 |
Raltegravir Isentress ® |
08.01.05 |
Non Formulary
|
 |
Ramucirumab Cyramza® |
11.08.02 |
Formulary
|
 |
Ranibizumab Lucentis® |
10.01.04 |
Restricted Use
|
 |
Rasburicase Fastertec® |
08.01.05 |
Restricted Use
|
 |
Regorafenib Stivarga® |
05.03.05 |
Restricted Use
|
 |
Ribavirin |
08.03.04.01 |
Restricted Use
|
 |
Ribociclib Kisqali® |
05.03.01 |
Restricted Use
|
 |
Rilpivirine hydrochloride Edurant® |
04.09.03 |
Restricted Use
|
 |
Riluzole |
02.05.01 |
Non Formulary
|
 |
Riociguat Adempas® |
13.05.02 |
Formulary
|
 |
Risankizumab Skyrizi® |
05.03.01 |
Restricted Use
|
 |
Ritonavir |
08.02.03 |
Restricted Use
|
 |
Rituximab MabThera® |
08.02.03 |
Restricted Use
|
 |
Rituximab Truxima® |
08.02.03 |
Restricted Use
|
 |
Rituximab MabThera® |
10.01.03 |
Restricted Use
|
 |
Rituximab Truxima® |
10.01.03 |
Restricted Use
|
 |
Rituximab MabThera® |
09.01.04 |
Restricted Use
|
 |
Romiplostim Nplate® |
08.02.04 |
Restricted Use
|
 |
Rucaparib Rubraca® |
02.11 |
Restricted Use
|
 |
Rurioctocog alfa pegol Adynovi® |
08.01.05 |
Restricted Use
|
 |
Ruxolitinib Jakavi® |
09.04.01 |
Formulary
|
 |
Sapropterin Dihydrochloride Kuvan® |
05.03.01 |
Restricted Use
|
 |
Saquinavir Invirase® |
10.01.03 |
Restricted Use
|
 |
Sarilumab Kevzara® |
13.05.03 |
Restricted Use
|
 |
Secukinumab Cosentyx® |
09.05.02.02 |
Restricted Use
|
 |
Sevelamer Carbonate |
09.05.02.02 |
Non Formulary
|
 |
Sevelamer Hydrochloride Renagel® |
02.05.01 |
Formulary
|
 |
Sildenafil Revatio® |
05.03.03.02 |
Non Formulary
|
 |
Simeprevir Olysio® |
02.11 |
Restricted Use
|
 |
Simoctocog alfa Nuwiq® |
20 |
Non Formulary
|
 |
Sipuleucel- T |
08.02.02 |
Formulary
|
 |
Sirolimus Rapamune® |
04.01.01 |
Restricted Use
|
 |
Sodium Oxybate Xyrem® |
05.03.03.02 |
Restricted Use
|
 |
Sofosbuvir Sovaldi® |
05.03.03.02 |
Restricted Use
|
 |
Sofosbuvir and Velpatasvir Epclusa® |
05.03.03.02 |
Restricted Use
|
 |
Sofosbuvir, Velpatasvir and Voxilaprevir Vosevi® |
06.05.01 |
Restricted Use
|
 |
Somatropin |
08.01.05 |
Restricted Use
|
 |
Sorafenib Nexavar® |
05.03.01 |
Non Formulary
|
 |
Stavudine Zerit® |
08.01.05 |
Restricted Use
|
 |
Sunitinib Sutent® |
02.11 |
Restricted Use
|
 |
Susoctocog alfa Obizur® |
20 |
Non Formulary
|
 |
Taribavirin |
01.04.02 |
Non Formulary
|
 |
Teduglutide Revestive® |
05.03.03.02 |
Non Formulary
|
 |
Telaprevir Incivo® |
08.01.05 |
Formulary
|
 |
Temozolomide Temodal® |
08.01.05 |
Restricted Use
|
 |
Temsirolimus Torisel® |
05.03.01 |
Restricted Use
|
 |
Tenofovir 245mg, Efavirenz 600mg and Emtricitabine 200mg |
05.03.01 |
Restricted Use
|
 |
Tenofovir alafenamide, elvitegravir, cobicistat & emtricitabine Genvoya® |
05.03.01 |
Restricted Use
|
 |
Tenofovir and Emtricitabine |
05.03.01 |
Restricted Use
|
 |
Tenofovir Disproxil |
05.03.01 |
Restricted Use
|
 |
Tenofovir, cobicistat, elvitegravir & emtricitabine Stribild® |
08.02.04 |
Restricted Use
|
 |
Teriflunomide Aubagio® |
06.06.01 |
Restricted Use
|
 |
Teriparatide Forsteo® |
06.06.01 |
Restricted Use
|
 |
Teriparatide Movymia® |
20 |
Formulary
|
 |
TETRAHYDROBIOPTERIN Tablets 10 mg |
03.07 |
Formulary
|
 |
Tezacaftor + Ivacaftor Symkevi® |
08.02.04 |
Restricted Use
|
 |
Thalidomide Celgene® |
13.05.03 |
Restricted Use
|
 |
Tildrakizumab Ilumetri® |
05.03.01 |
Restricted Use
|
 |
Tipranavir Aptivus® |
08.01 |
Restricted Use
|
 |
Tivozanib Fotivda® |
05.01.04 |
Restricted Use
|
 |
Tobramycin |
05.01.04 |
Restricted Use
|
 |
Tobramycin inhaler TOBI Podhaler® |
10.01.03 |
Restricted Use
|
 |
Tocilizumab RoActemra® |
10.01.03 |
Restricted Use
|
 |
Tofacitinib citrate |
06.05.02 |
Restricted Use
|
 |
Tolvaptan Jinarc® |
06.05.02 |
Non Formulary
|
 |
Tolvaptan Samsca® |
08.01.05 |
Restricted Use
|
 |
Trametinib Mekinist® |
08.01.05 |
Formulary
|
 |
Trastuzumab Herceptin® |
08.01.05 |
Restricted Use
|
 |
Trastuzumab Herceptin® |
08.01.05 |
Restricted Use
|
 |
Trastuzumab Ontruzant® |
08.01.05 |
Restricted Use
|
 |
Trastuzumab emtansine Kadcyla® |
20 |
Non Formulary
|
 |
Treprostinil |
08.01.05 |
Restricted Use
|
 |
Trifluridine-tipiracil Lonsurf® |
02.11 |
Restricted Use
|
 |
Turoctocog alfa pegol Esperoct® |
13.05.03 |
Formulary
|
 |
Ustekinumab |
05.03.02.02 |
Restricted Use
|
 |
Valganciclovir |
01.05.03 |
Restricted Use
|
 |
Vedolizumab Entyvio® |
09.08.01 |
Non Formulary
|
 |
Velaglucerase alfa VPRIV® |
08.01.05 |
Restricted Use
|
 |
Vemurafenib Zelboraf® |
08.01.05 |
Restricted Use
|
 |
Venetoclax Venclyxto® |
11.08.02 |
Restricted Use
|
 |
Verteporfin Visudyne® |
08.01.05 |
Restricted Use
|
 |
Vismodegib Erivedge® |
02.11 |
Restricted Use
|
 |
Von willebrand factor Willfact® |
02.11 |
Restricted Use
|
 |
Vonicog Alfa Veyvondi® |
05.02 |
Restricted Use
|
 |
Voriconazole Vfend® |
08.01.05 |
Restricted Use
|
 |
Vosaroxin Qinprezo |
05.03.01 |
Restricted Use
|
 |
Zidovudine Retrovir® |
05.03.01 |
Formulary
|
 |
Zidovudine and lamivudine |