WHA

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Generic-First Step Program ABILIFY, ACZONE, ALPHAGAN P, ALTACE, ARIMIDEX, ARTHROTEC 50, ARTHROTEC 75, ATACAND, AVAPRO, AVODART, AZOPT, BROVANA, BYSTOLIC, CANASA, CARBATROL, CARDIZEM LA, CARNITOR, CARNITOR SF, CATAPRES-TTS-1, CATAPRES-TTS-2, CATAPRES-TTS-3, CELEXA, CIALIS, CLARINEX, CLIMARA, CLOBEX, COLESTID, COLESTID FLAVORED, COMBIGAN, COREG, COREG CR, CORTEF, COSOPT, COSOPT PF, COZAAR, DELESTROGEN, DEPAKOTE, DEPAKOTE ER, DEPAKOTE SPRINKLES, DILANTIN-125, EFFEXOR XR, EPIDUO, ESTRACE, EXFORGE, FIORICET, FIORICET/CODEINE, FLOMAX, GOLYTELY, HALOG, HYZAAR, IMITREX, IMITREX STATDOSE REFILL, IMITREX STATDOSE SYSTEM, INDERAL LA, K-TAB, KEPPRA, KEPPRA XR, KLONOPIN, LAMICTAL, LAMICTAL CHEWABLE DISPERSIBLE, LAMICTAL ODT, LAMICTAL STARTER/NOT TAKING CARBAMAZEPINE, LAMICTAL STARTER/TAKING CARBAMAZEPINE/NOT TAKING VALPROATE, LAMICTAL STARTER/TAKING VALPROATE, LAMICTAL XR, LASIX, LATISSE, LATUDA, LOESTRIN 1.5/30-21, LOESTRIN 1/20-21, LOESTRIN FE 1.5/30, LOESTRIN FE 1/20, LOTREL, LYRICA, MAXALT, MAXALT-MLT, MICARDIS, MICARDIS HCT, NALFON, NATROBA, NEURONTIN, NITROSTAT, PAXIL, PAXIL CR, PLAQUENIL, PLAVIX, PRED FORTE, PREDNISOLONE ACETATE P-F, PROMETRIUM, PROPECIA, QUESTRAN, QUESTRAN LIGHT, RANEXA, RELPAX, RENAGEL, RESTORIL, RISPERDAL, RISPERDAL CONSTA, SAFYRAL, SEASONIQUE, SEROQUEL, SEROQUEL XR, SILVADENE, SOMA, SOVUNA, SUBOXONE, TEGRETOL, TEGRETOL-XR, TENORMIN, TIKOSYN, TIMOPTIC, TIMOPTIC OCUDOSE, TIMOPTIC-XE, TOPAMAX, TOPAMAX SPRINKLE, TOPICORT, TRAVATAN Z, TRICOR, TRILEPTAL, UCERIS, VALTREX, VANADOM, VECTICAL, VESICARE, VIGAMOX, VIMPAT, WELCHOL, XALATAN, YASMIN 28, ZANAFLEX, ZESTRIL, ZOLOFT, ZONEGRAN, ZOVIRAX, ZYPREXA
Gilenya (fingolimod) - PA, NF Gilenya (fingolimod)
Gilotrif (afatinib) Gilotrif (afatinib)
Glumetza (metformin ER tablets) Brand Glumetza (metformin ER tablets), Generic metformin hydrochloride extended-release tablets (Generic for Glumetza)
Glycopyrrolate Oral Solution Cuvposa (glycopyrrolate oral solution)
Gonadotropin-Releasing Hormone Agonists Camcevi (leuprolide), Generic leuprolide Acetate, Leuprolide Acetate Depot, Eligard (leuprolide acetate), Trelstar (triptorelin pamoate), Vabrinty (leuprolide acetate), Lupron Depot (leuprolide acetate) 1-Month 7.5 mg, Lupron Depot 3-Month 22.5 mg, Lupron Depot 4-Month 30 mg, Lupron Depot 6-Month 45 mg, Lupron Depot 1-Month 3.75 mg, Lupron Depot 3-Month 11.25 mg, Lupron Depot-PED (leuprolide acetate), Lutrate Depot (leuprolide acetate 22.5mg), Supprelin LA (histrelin acetate), Triptodur (triptorelin), Fensolvi (leuprolide acetate)
Growth Hormones - PA, NF Genotropin and Omnitrope, Genotropin, Humatrope, Norditropin Flexpro, Nutropin AQ NuSpin, Omnitrope, and Zomacton, Genotropin, Humatrope, Norditropin Flexpro, Nutropin AQ NuSpin, Omnitrope, Saizen, and Zomacton, Genotropin, Nutropin AQ NuSpin, and Omnitrope, Genotropin, Nutropin AQ NuSpin, Omnitrope, and Saizen, Humatrope and Zomacton, Ngenla (somatrogon-ghla), Norditropin Flexpro, Norditropin Flexpro and Humatrope, Norditropin Flexpro, Humatrope, and Zomacton, Norditropin Flexpro, Humatrope, and Zomacton, Nutropin AQ NuSpin, Serostim, Skytrofa (lonapegsomatropin-tcgd), Sogroya (somapacitan-beco), Zomacton, Zorbtive
Growth Hormones - PA, NF Genotropin and Omnitrope, Genotropin, Humatrope, Norditropin Flexpro, Nutropin AQ NuSpin, Omnitrope, and Zomacton, Genotropin, Humatrope, Norditropin Flexpro, Nutropin AQ NuSpin, Omnitrope, Saizen, and Zomacton, Genotropin, Nutropin AQ NuSpin, and Omnitrope, Genotropin, Nutropin AQ NuSpin, Omnitrope, and Saizen, Humatrope and Zomacton, Ngenla (somatrogon-ghla), Norditropin Flexpro, Norditropin Flexpro and Humatrope, Norditropin Flexpro, Humatrope, and Zomacton, Norditropin Flexpro, Humatrope, and Zomacton, Nutropin AQ NuSpin, Serostim, Skytrofa (lonapegsomatropin-tcgd), Sogroya (somapacitan-beco), Zomacton, Zorbtive
Halcinonide cream Halcinonide cream
Harvoni (ledipasvir/sofosbuvir) - PA, NF Harvoni (ledipasvir/sofosbuvir)
Healthcare Reform Copay Waiver Review ANASTROZOLE, APO-VARENICLINE, APRETUDE, ARIMIDEX, AROMASIN, Aromatase Inhibitors, Aspirin, ATORVASTATIN CALCIUM, Bowel preparation agents for colorectal cancer screening, Breast cancer prevention, bupropion, DESCOVY, EMTRICITABINE/TENOFOVIR DISOPROXIL FUMARATE, ERYTHROMYCIN, EVISTA, EXEMESTANE, FEMARA, Fluoride supplementation products, FLUVASTATIN SODIUM, FLUVASTATIN SODIUM ER, Folic acid supplementation products, Health Care Reform Exceptions, Healthcare, Healthcare Reform Exceptions, Heplisav, Immunizations, Laxative, LETROZOLE, nicotine, NICOTROL INHALER, NICOTROL NS, PITAVASTATIN CALCIUM, PRAVASTATIN SODIUM, RALOXIFENE HYDROCHLORIDE, ROSUVASTATIN CALCIUM, Shingrix, SIMVASTATIN, SOLTAMOX, TAMOXIFEN CITRATE, TENOFOVIR DISOPROXIL FUMARATE, TRUVADA, VARENICLINE, VIREAD, VOCABRIA, Zostavax
Healthcare Reform Copay Waiver Review - Contraceptives Contraceptives, Health Care Reform Exceptions, Healthcare, Healthcare Reform Exceptions
Hereditary Angioedema Agents - PA, NF Berinert (C1 esterase inhibitor [Human]), Cinryze (C1 esterase inhibitor [Human]), Firazyr (icatibant), Haegarda (C1 esterase inhibitor [Human]), Kalbitor (ecallantide), Orladeyo (berotralstat), Ruconest (C1 esterase inhibitor [Recombinant]), Sajazir (icatibant), Takhzyro (lanadelumab-flyo)
Hetlioz, Hetlioz LQ (tasimelteon) - PA, NF Hetlioz (tasimelteon) capsule, Hetlioz LQ (tasimelteon) suspension
High Cost, Low Value Non-Formulary Program ABSORICA, ABSORICA LD, ACZONE, ADAPALENE, ANUSOL-HC, ARAZLO, ATOPADERM, AZESCO, BENSAL HP, CABTREO, CHLORZOXAZONE, COXANTO, DICLOFENAC EPOLAMINE, DORYX, DORYX MPC, DOXEPIN HYDROCHLORIDE, DUEXIS, EPICERAM, FENOPROFEN CALCIUM, FLECTOR, FLUOVIX, FLUOVIX PLUS, FOLIC-K, GENICIN VITA-S, IBUPROFEN/FAMOTIDINE, INDERAL XL, INNOPRAN XL, KAMDOY, KELARX, LICART, LIDOCAINE AND TETRACAINE CREAM, LIDOCAINE/TETRACAINE, NAPROSYN, NAPROXEN/ESOMEPRAZOLE MAGNESIUM, ORACEA, ORTHO DF, OXAPROZIN, PENNSAID, PLIAGLIS, POKONZA, PREGENNA, PRODIGEN, PROMETHAZINE HYDROCHLORIDE, PROMETHAZINE HYDROCHLORIDE PLAIN, PROMETHAZINE VC, PRUDOXIN, RAYOS, RELAFEN DS, SAJAZIR, SITAVIG, SPRIX, TOLSURA, VIMOVO, WINLEVI, XERESE, XHANCE, YOSPRALA, ZIPSOR, ZONALON, ZORVOLEX, ZTLIDO, ZYCLARA, ZYCLARA PUMP, ZYFLO
High Dollar/Claim Dollar Claim, Dollar, High
Human Chorionic Gonadotropin (hCG) Novarel (chorionic gonadotropin), Pregnyl (chorionic gonadotropin), Ovidrel (chorionic gonadotropin) PreFilled Syringe
Ibrance (palbociclib) Ibrance (palbociclib)
IBS - Diarrhea Lotronex (alosetron hydrochloride), Viberzi (eluxadoline)
Iclusig (ponatinib) Iclusig (ponatinib)