| Gonadotropin-Releasing Hormone Antagonists (Infertility Agents) |
Cetrotide (cetrorelix), Generic cetrorelix, Fyremadel, Generic ganirelix |
| Gonadotropins - PA, NF |
Follistim AQ (follitropin beta), Gonal-F (follitropin alfa), Gonal-F RFF (follitropin alfa), Gonal-F RFF Redi-ject (follitropin alfa), Menopur (menotropins) |
| 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 |
| 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 |
| Hemangeol (propranolol hydrochloride oral solution) |
Hemangeol (propranolol hydrochloride oral solution) |
| Hemophilia B Gene Therapies - PA, NF |
Beqvez (fidanacogene elaparvovec-dzkt), Hemgenix (etranacogene dezaparvovec-drlb) |
| Hereditary Angioedema Agents (HAE) Quantity Limit Override |
Berinert (C1 esterase inhibitor [Human]), Ekterly (sebetralstat), Firazyr (icatibant), Kalbitor (ecallantide), Ruconest (C1 esterase inhibitor [Recombinant]), Sajazir (icatibant) |
| Hereditary Angioedema Agents - PA, NF |
Andembry (garadacimab-gxii), Berinert (C1 esterase inhibitor [Human]), Cinryze (C1 esterase inhibitor [Human]), Dawnzera (donidalorsen), Ekterly (sebetralstat), Firazyr (icatibant), Haegarda (C1 esterase inhibitor [Human]), Kalbitor (ecallantide), Orladeyo (berotralstat), Ruconest (C1 esterase inhibitor [Recombinant]), Sajazir (icatibant), Takhzyro (lanadelumab-flyo) |
| Hernexeos (zongertinib) |
Hernexeos (zongertinib) |
| 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 |
| High-Cost Brand with Generics Program |
|
| Horizant (gabapentin enacarbil) |
Horizant (gabapentin enacarbil) |
| Human Chorionic Gonadotropin (hCG) |
Novarel (chorionic gonadotropin), Pregnyl (chorionic gonadotropin), Ovidrel (chorionic gonadotropin) PreFilled Syringe |
| Hyaluronic Acid Derivatives - PA, NF |
Durolane/Euflexxa/Hyalgan/Sodium Hyaluronate/Supartz FX/Gelsyn-3/Genvisc 850/Triluron/TriVisc/Visco-3 (sodium hyaluronate), Gel-One (cross-linked hyaluronate), Monovisc/Orthovisc/Hymovis (hyaluronan), Synvisc/Synvisc-One (hylan), Synojoynt |
| Hyftor (sirolimus) topical gel |
Hyftor (sirolimus) topical gel |
| Ibrance (palbociclib) |
Ibrance (palbociclib) |
HEALTHY LIVING