| 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), Leuprolide Acetate, Leuprolide Acetate Depot, Eligard (leuprolide acetate), Trelstar (triptorelin pamoate), 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 |
| 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) |
| Ilaris (canakinumab injection) |
Ilaris (canakinumab injection) |
| Ilumya (tildrakizumab-asmn) - PA, NF |
Ilumya (tildrakizumab-asmn) |
| Imatinib Products - PA, NF |
Gleevec (imatinib mesylate), Imkeldi |
| Imbruvica (ibrutinib) - PA, NF |
Imbruvica (ibrutinib) |
HEALTHY LIVING