| Non-Formulary & Excluded Drug Exceptions Process for Drugs of Clinical Concern |
APLENZIN, APTIOM, AUVELITY, AYVAKIT, BRUKINSA, BUPROPION HYDROCHLORIDE ER (XL), CAPLYTA, CITALOPRAM HYDROBROMIDE, COMBIVIR, DELSTRIGO, ELEPSIA XR, EMSAM, EMTRIVA, EPIVIR, EPRONTIA, EPZICOM, ESPEROCT, FINTEPLA, FORFIVO XL, GENVOYA, INTELENCE, JIVI, KALETRA, KCENTRA, LEXIVA, LYBALVI, NORVIR, NUBEQA, NUPLAZID, OXCARBAZEPINE ER, OXTELLAR XR, REBINYN, RETROVIR, RETROVIR IV INFUSION, REYATAZ, RYLAZE, SAVAYSA, SECUADO, SERTRALINE HYDROCHLORIDE, SPRITAM, STRIBILD, SUSTIVA, SYMFI, SYMFI LO, TROGARZO, VENLAFAXINE BESYLATE ER, VIMPAT, VIREAD, XEMBIFY, ZIAGEN, ZONISADE |
| Non-GLP-1 Agonist Anorexiants – PA, NF |
Contrave (naltrexone/bupropion), Generic phentermine, Adipex-P (phentermine), Lomaira (phentermine), generic phentermine-topiramate, Qsymia (phentermine and topiramate), Xenical (orlistat) |
| Non-hormonal Therapies for Vasomotor Symptoms |
Lynkuet (elinzanetant), Veozah (fezolinetant) |
| Non-Solid Oral Dosage Forms |
ATORVALIQ, DESMODA, GLOPERBA, JAVADIN, JYLAMVO, LIKMEZ, NORLIQVA, ONTRALFY, RALDESY, SDAMLO, SPIRONOLACTONE, SUBVENITE, TEZRULY, VYSCOXA, XATMEP, ZONISADE |
| Non-steroidal Anti-Inflammatory Agents - PA, ST |
Cambia (diclofenac) powder, Celebrex (celecoxib) capsule, Fenopron (fenoprofen calcium) capsule, Indocin (indomethacin), Indomethacin suspension 25mg/5ml, Lofena (diclofenac potassium) tablet, Pennsaid (diclofenac sodium) topical solution, Sprix (ketorolac tromethamine) nasal spray, Tolectin (tolmetin sodium) tablet, Zipsor (diclofenac potassium) capsule |
| Nonpreferred Adalimumab - PA, NF - Standard Default |
Drug Name: Abrilada (adalimumab-afzb), Cyltezo (adalimumab-adbm), Hadlima (adalimumab-bwwd), Hulio (adalimumab-fkjp), Hyrimoz (adalimumab-adaz), Idacio (adalimumab-aacf), Simlandi (adalimumab-ryvk), Yuflyma (adalimumab-aaty), Yusimry (adalimumab-aqvh), Amjevita (adalimumab-atto), Humira (adalimumab) |
| NonStimulant ADHD Agents Step Therapy - ST, NF |
Intuniv (guanfacine extended-release), Kapvay (clonidine hydrochloride extended-release), Onyda XR (clonidine hydrochloride extended - release oral suspension), Qelbree (viloxazine extended-release), Strattera (atomoxetine) |
| Northera (droxidopa) |
Northera (droxidopa) |
| Nourianz (istradefylline) |
Nourianz (istradefylline) |
| Nplate (romiplostim) |
Nplate (romiplostim) |
| Nubeqa (darolutamide) |
Nubeqa (darolutamide) |
| Nucala (mepolizumab) |
Nucala (mepolizumab) |
| Nuedexta (dextromethorphan HBr/quinidine) |
Nuedexta (dextromethorphan HBr/quinidine) |
| Nulibry (fosdenopterin) |
Nulibry (fosdenopterin) |
| Nuplazid (pimavanserin) |
Nuplazid (pimavanserin) |
| Obesity GLP-1 Agonists – PA, NF |
Foundayo (orforglipron), Saxenda (liraglutide), Wegovy HD (semaglutide 7.2 mg), Wegovy Injection (semaglutide), Wegovy Tablet (semaglutide), Zepbound (tirzepatide) Injection |
| Ocaliva (obeticholic acid) |
Ocaliva (obeticholic acid) |
| Octreotide Products - PA, NF |
Mycapssa (octreotide capsule, delayed release), Sandostatin (octreotide acetate), Bynfezia Pen (octreotide acetate), Sandostatin LAR Depot (octreotide acetate) |
| Odomzo (sonidegib) |
Odomzo (sonidegib) |
| Ogsiveo (nirogacestat) |
Ogsiveo (nirogacestat) |
HEALTHY LIVING