08.01.05 |
Restricted Use
|
 |
Axicabtagene ciloleucel YESCARTA® |
08.01.05 |
Formulary
|
 |
Brentuximab vedotin Adcetris® |
11.08.02 |
Formulary
|
 |
Brolucizumab Beovu® ,Novartis |
08.01.05 |
Formulary
|
 |
Cabozantinib Cometriq®, Cabometyx® |
05.03.03.02 |
Formulary
|
 |
Elbasvir with Grazoprevir Zepatier® |
08.01.05 |
Formulary
|
 |
Gemtuzumab ozogamicin MYLOTARG® |
05.03.03.02 |
Formulary
|
 |
Glecaprevir with Pibrentasvir Maviret® |
08.01.05 |
Formulary
|
 |
Inotuzumab ozogamicin BESPONSA® |
03.12 |
Formulary
|
 |
Ivacaftor/Tezacaftor/Elexacaftor Kaftrio® |
08.01.05 |
Formulary
|
 |
Lenvatinib Kisplyx®, Lenvima® |
08.01.05 |
Formulary
|
 |
Lutetium (177Lu) oxodotreotide Lutathera® |
14.04 |
Formulary
|
 |
Meningococcal group B Vaccine Bexsero® |
08.01.05 |
Formulary
|
 |
Nintedanib Vargatef®, Ofev® |
05.03.03.02 |
Formulary
|
 |
Ombitasvir with Paritaprevir and Ritonavir Viekirax® |
09.02.01.01 |
Formulary
|
 |
Patiromer Sorbitex Calcium Veltassa |
08.01.05 |
Formulary
|
 |
Polatuzumab vedotin Polivy® |
09.02.01.01 |
Formulary
|
 |
sodium zirconium cyclosilicate Lokelma® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir with ledipasvir Harvoni® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir with velpatasvir Epclusa® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir with Velpatasvir and Voxilaprevir Vosevi® |
08.01.05 |
Restricted Use
|
 |
Tisagenlecleucel Kymriah® |
08.01.05 |
Formulary
|
 |
Trastuzumab emtansine Kadcyla® |