| Authorized Brand Alternative (ABA) Policy |
Besifloxacin ophthalmic suspension 0.6%, Dapagliflozin, Dapagliflozin-Metformin hydrochloride Extended-Release, Fluticasone and Salmeterol HFA inhalation aerosol, Fluticasone and Vilanterol inhalation powder, Fluticasone Furoate Ellipta, Insulin Aspart 70/30 Injection Solution, Insulin Aspart 70/30 Flexpen, Novolog Relion 70/30, Novolog Relion 70/30 Flexpen, Insulin Aspart Injection Solution, Insulin Aspart Flexpen, Insulin Aspart Penfill, Novolog Relion, Novolog Relion Flexpen, Insulin Degludec Injection Solution, Insulin Degludec Flextouch Injection, Insulin Glargine Injection Solution, Insulin Glargine Solostar Injection, Insulin Glargine U-300 Solostar Injection Solution, Insulin Glargine U-300 Max Solostar Injection, Umeclidinum and Vilanterol Ellipta |
| Azole Antifungals - PA, NF |
Cresemba (isavuconazonium sulfate) capsules, Noxafil (posaconazole) oral suspension, Noxafil (posaconazole) tablets, Noxafil PowderMix (posaconazole) for delayed-release oral suspension, Sporanox (itraconazole) capsules, Sporanox (itraconazole) oral solution, Tolsura (itraconazole) capsules, Vfend (voriconazole) oral suspension, Vfend (voriconazole) tablets |
| Banzel (rufinamide) |
Banzel (rufinamide) tablets and oral suspension |
| Bendamustine Agents |
Belrapzo, Bendamustine, Bendeka, Treanda, Vivimusta |
| Benlysta (belimumab) |
Benlysta (belimumab IV), Benlysta (belimumab SC) |
| Bevacizumab - PA, NF |
Avastin (bevacizumab), Mvasi (bevacizumab-awwb), Zirabev (bevacizumab-bvzr), Alymsys (bevacizumab-maly), Vegzelma (bevacizumab-adcd) |
| Bimzelx (bimekizumab-bkzx) |
Bimzelx (bimekizumab-bkzx) |
| Blood Glucose Monitor & Test Strips - ST, QL, NF |
Blood glucose monitoring systems |
| Bonjesta, Diclegis (doxylamine/pyridoxine) |
Bonjesta, Diclegis (doxylamine succinate and pyridoxine hydrochloride) |
| Bortezomib |
Bortezomib (bortezomib), Boruzu (bortezomib), Velcade (bortezomib) |
| Bosulif (bosutinib) |
Bosulif (bosutinib) |
| Botox (onabotulinumtoxinA) |
Botox (onabotulinumtoxin A), Botox Cosmetic (onabotulinumtoxin A) |
| Bowel Prep Agents |
Moviprep, Plenvu |
| Brand Estradiol Transdermal Systems |
Alora (estradiol transdermal system), Menostar (estradiol transdermal system), Minivelle (estradiol transdermal system), Vivelle-Dot (estradiol transdermal system) |
| Bylvay (odevixibat) |
Bylvay (odevixibat) |
| Cablivi (caplacizumab-yhdp) |
Cablivi (caplacizumab-yhdp) |
| Cabometyx (cabozantinib) |
Cabometyx (cabozantinib) tablets |
| Cabotegravir Containing Agents - PA, NF |
Cabenuva (cabotegravir and rilpivirine) Injection, Vocabria (cabotegravir) Tablet |
| Cannabinoids |
Marinol (dronabinol) capsule, Syndros (dronabinol) oral solution |
| Caprelsa (vandetanib) |
Caprelsa (vandetanib) |
HEALTHY LIVING