| Coverage of Drugs for Off-Label or Non-FDA Approved Indications |
|
| Daliresp (roflumilast) |
Daliresp (roflumilast) |
| Daraprim (pyrimethamine) |
Daraprim (pyrimethamine) |
| Darzalex (daratumumab), Darzalex Faspro (daratumumab and hyaluronidase-fihj) - PA, NF |
Darzalex (daratumumab), Darzalex Faspro (daratumumab and hyaluronidase-fihj) |
| DAW Override |
DAW override, Dispense, written |
| Deferasirox products |
Exjade (deferasirox), deferasirox tablet, Jadenu (deferasirox), Jadenu Sprinkle (deferasirox) |
| Deflazacort products - PA, NF |
Brand Emflaza (deflazacort), generic deflazacort, Jaythari (deflazacort), Pyquvi (deflazacort) |
| Demser (metyrosine) |
Demser (metyrosine) |
| Denosumab 120mg Products - PA, NF |
Xgeva (denosumab), Wyost (Denosumab-bbdz), Osenvelt (denosumab-bmwo), Bomyntra (Denosumab-bnht) |
| Denosumab 60mg Products - PA, NF |
Prolia (denosumab), Jubbonti (denosumab-bbdz), Stoboclo (denosumab-bmwo), Conexxence (Denosumab-bnht 60mg) |
| Diabetic GLP-1's |
Bydureon BCise (exenatide extended-release), Byetta (exenatide injection), Mounjaro (tirzepatide), Ozempic (semaglutide), Rybelsus (semaglutide), Trulicity (dulaglutide), Victoza (liraglutide injection) |
| Diacomit (stiripentol) |
Diacomit (stiripentol) |
| Dibenzyline (phenoxybenzamine) |
Dibenzyline (phenoxybenzamine) |
| Dichlorphenamide Agents |
Keveyis (dichlorphenamide), Ormalvi (dichlorphenamide) |
| DPP-4 Inhibitors |
Janumet (sitagliptin/metformin), Janumet XR (sitagliptin/metformin extended-release), Januvia (sitagliptin), Jentadueto (linagliptin/metformin), Jentadueto XR (linagliptin/metformin extended-release), Tradjenta (linagliptin) |
| Duexis (ibuprofen and famotidine) |
Duexis (ibuprofen/famotidine) |
| Dupixent (dupilumab) |
Dupixent (dupilumab) |
| Ebglyss (lebrikizumab-lbkz) |
Ebglyss (lebrikizumab-lbkz) |
| Eculizumab Products |
Bkemv (eculizumab-aeeb), Epysqli (eculizumab-aagh), Soliris (eculizumab) |
| Elaprase (idursulfase) |
Elaprase (idursulfase) [1] |
HEALTHY LIVING