Section |
Status |
BlueTeq |
Name |
08.01.05 |
Formulary
|
 |
Abemaciclib Verzenios® |
08.03.04.02 |
Formulary
|
 |
Abiraterone acetate Zytiga ® |
08.01.05 |
Formulary
|
 |
Acalabrutinib Calquence® |
11.04.02 |
Restricted Use
|
 |
Adalimumab Humira® |
08.01.05 |
Formulary
|
 |
Alectinib Alecensa® |
08.02.04 |
Formulary
|
 |
Alemtuzumab Lemtrada® |
10.01.03 |
Restricted Use
|
 |
Anakinra Kineret® |
08.01.05 |
Formulary
|
 |
Arsenic Trioxide Trisenox® |
08.01.05 |
Formulary
|
 |
Atezolizumab Tecentriq® |
08.01.05 |
Formulary
|
 |
Avelumab Bavencio® |
08.01.05 |
Restricted Use
|
 |
Axicabtagene ciloleucel YESCARTA® |
08.01.01 |
Formulary
|
 |
Bendamustine Levact® |
03.04.02 |
Restricted Use
|
 |
Benralizumab Fasenra ® |
08.01.05 |
Formulary
|
 |
Bevacizumab Avastin® |
08.01.05 |
Formulary
|
 |
Binimetinib Mektovi® |
08.02.03 |
Formulary
|
 |
Blinatumomab Blincyto® |
08.01.05 |
Formulary
|
 |
Bortezomib Velcade® |
08.01.05 |
Formulary
|
 |
Bosutinib Bosulif® |
08.01.05 |
Formulary
|
 |
Brentuximab vedotin Adcetris® |
08.01.05 |
Formulary
|
 |
Brigatinib Alunbrig® |
08.01.05 |
Formulary
|
 |
Cabazitaxel Jevtana® |
08.01.05 |
Formulary
|
 |
Cabozantinib Cometriq®, Cabometyx® |
04.08.01 |
Restricted Use
|
 |
Cannabidiol Epidyolex® |
08.01.05 |
Formulary
|
 |
Carfilzomib Kyprolis® |
08.01.05 |
Formulary
|
 |
Cemiplimab Libtayo® |
08.01.05 |
Formulary
|
 |
Ceritinib Zykadia® |
08.01.05 |
Formulary
|
 |
Cetuximab Erbitux® |
08.02.04 |
Formulary
|
 |
Cladribine Mavenclad® |
08.01.03 |
Formulary
|
 |
Clofarabine Evoltra® |
08.01.05 |
Formulary
|
 |
Crizotinib Xalkori® |
05.03.03.02 |
Formulary
|
 |
Daclatasvir Daklinza® |
08.02.04 |
Non Formulary
|
 |
Daclizumab Zinbryta® |
08.01.05 |
Formulary
|
 |
Dacomitinib Vizimpro® |
08.01.05 |
Formulary
|
 |
Daratumumab DARZALEX® |
08.03.04.02 |
Formulary
|
 |
Darolutamide Nubeqa® |
05.03.03.02 |
Formulary
|
 |
Dasabuvir Exviera® |
08.01.05 |
Formulary
|
 |
Dasatinib Sprycel® |
08.02.04 |
Formulary
|
 |
Dimethyl fumarate Tecfidera® |
08.01.05 |
Restricted Use
|
 |
Dinumtuximab Qarziba® |
08.01.02 |
Formulary
|
 |
Doxorubicin Hydrochloride Caelyx® |
13.05.03 |
Formulary
|
 |
Dupilumab Dupixent® |
08.01.05 |
Formulary
|
 |
Durvalumab Imfinzi® |
09.01.03 |
Restricted Use
|
 |
Eculizumab Soliris® |
05.03.03.02 |
Formulary
|
 |
Elbasvir with Grazoprevir Zepatier® |
09.08.01 |
Restricted Use
|
 |
Eliglustat Cerdelga® |
02.11 |
Restricted Use
|
 |
Emicizumab Hemlibra® |
08.01.05 |
Formulary
|
 |
Encorafenib Braftovi® |
08.01.05 |
Formulary
|
 |
Entrectinib Rozlytrek® |
08.03.04.02 |
Formulary
|
 |
Enzalutamide Xtandi® |
08.01.05 |
Formulary
|
 |
Eribulin Halaven® |
09.05.01.02 |
Formulary
|
 |
Etelcalcetide Parsabiv® |
08.01.05 |
Formulary
|
 |
Everolimus Afinitor® |
08.02.04 |
Formulary
|
 |
Fingolimod Gilenya® |
08.03.04.01 |
Formulary
|
 |
Fulvestrant Faslodex® |
08.01.05 |
Formulary
|
 |
Gemtuzumab ozogamicin MYLOTARG® |
08.01.05 |
Formulary
|
 |
Gilteritinib Xospata® |
08.02.04 |
Formulary
|
 |
Glatiramer Acetate Copaxone® |
05.03.03.02 |
Formulary
|
 |
Glecaprevir with Pibrentasvir Maviret® |
11.99.99.99 |
Restricted Use
|
 |
Holoclar® Viable autologous human corneal epithelial cells |
08.01.05 |
Formulary
|
 |
Ibrutinib Imbruvica® |
09.08.01 |
Restricted Use
|
 |
Imiglucerase Cerezyme® |
08.01.05 |
Formulary
|
 |
Inotuzumab ozogamicin BESPONSA® |
08.02.04 |
Formulary
|
 |
Interferon Beta-1a & Interferon Beta 1-b Avonex®, Rebif®, Extavia® |
08.01.05 |
Formulary
|
 |
Isatuximab Sarclisa® |
05.02.01 |
Restricted Use
|
 |
Isavuconazole CRESEMBA® |
08.01.05 |
Formulary
|
 |
Ixazomib Ninlaro® |
03.04.03 |
Restricted Use
|
 |
Lanadelumab Takhzyro® |
08.01.05 |
Restricted Use
|
 |
Larotrectinib Vitrakvi® |
08.02.04 |
Formulary
|
 |
Lenalidomide Revlimid® |
08.01.05 |
Formulary
|
 |
Lenvatinib Kisplyx®, Lenvima® |
05.03.02.02 |
Restricted Use
|
 |
Letermovir Prevymis® |
08.01.05 |
Formulary
|
 |
Liposomal Cytarabine-Daunorubicin Vyxeos® |
08.01.05 |
Restricted Use
|
 |
Lorlatinib Lorviqua® |
08.01.05 |
Formulary
|
 |
Lutetium (177Lu) oxodotreotide Lutathera® |
03.04.02 |
Restricted Use
|
 |
Mepolizumab Nucala® |
04.09.03 |
Restricted Use
|
 |
Mexiletine NaMuscla® |
08.01.05 |
Formulary
|
 |
Midostaurin Rydapt® |
08.02.04 |
Formulary
|
 |
Natalizumab Tysabri® |
08.01.03 |
Formulary
|
 |
Nelarabine Atriance® |
08.01.05 |
Formulary
|
 |
Neratinib Nerlynx® |
08.01.05 |
Formulary
|
 |
Nilotinib Tasigna® |
03.11 |
Formulary
|
 |
Nintedanib Ofev® |
08.01.05 |
Formulary
|
 |
Niraparib Zejula® |
08.01.05 |
Formulary
|
 |
Nivolumab Opdivo® |
04.09.03 |
Restricted Use
|
 |
Nusinersen Spinraza® |
01.09.01 |
Restricted Use
|
 |
Obeticholic acid Ocaliva® |
08.02.03 |
Formulary
|
 |
Obinutuzumab Gazyvaro® |
08.02.04 |
Formulary
|
 |
Ocrelizumab OCREVUS® |
08.01.05 |
Formulary
|
 |
Olaparib Lynparza® |
08.01.05 |
Non Formulary
|
 |
Olaratumab Lartruvo® |
03.04.02 |
Formulary
|
 |
Omalizumab Xolair® |
05.03.03.02 |
Formulary
|
 |
Ombitasvir with Paritaprevir and Ritonavir Viekirax® |
08.01.05 |
Formulary
|
 |
Osimertinib Tagrisso® |
08.01.05 |
Formulary
|
 |
Paclitaxel - Albumin Bound Formulation (Nab-paclitaxel) Abraxane® |
08.01.05 |
Formulary
|
 |
Palbociclib IBRANCE® |
05.03.05 |
Formulary
|
 |
Palivizumab Synagis® |
08.01.05 |
Formulary
|
 |
Panitumumab Vectibix® |
08.02.04 |
Formulary
|
 |
Peginterferon beta-1a Plegridy® |
06.05.01 |
Restricted Use
|
 |
Pegvisomant Somavert® |
08.01.05 |
Formulary
|
 |
Pembrolizumab Keytruda® |
08.01.05 |
Formulary
|
 |
Pemigatinib Pemazyre® |
08.01.05 |
Formulary
|
 |
Pertuzumab Perjeta® |
03.11 |
Restricted Use
|
 |
Pirfenidone Esbriet® |
09.01.07 |
Formulary
|
 |
Plerixafor Mozobil® |
08.01.05 |
Formulary
|
 |
Polatuzumab vedotin Polivy® |
08.02.04 |
Formulary
|
 |
Pomalidomide Imnovid® |
08.01.05 |
Formulary
|
 |
Ponatinib Iclusig® |
08.01.05 |
Formulary
|
 |
Regorafenib Stivarga® |
05.03 |
Restricted Use
|
 |
Remdesivir Veklury (r) |
03.04.02 |
Restricted Use
|
 |
Reslizumab Cinqaero® |
08.01.05 |
Formulary
|
 |
Ribociclib Kisqali® |
10.01.03 |
Formulary
|
 |
Rituximab MabThera® ; Truxima® |
08.01.05 |
Formulary
|
 |
Rucaparib Rubraca® |
08.01.05 |
Formulary
|
 |
Ruxolitinib Jakavi® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir Sovaldi® |
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 |
Formulary
|
 |
Sorafenib Nexavar® |
08.01.05 |
Formulary
|
 |
Talimogene laherparepvec Imlygic® |
08.02.04 |
Formulary
|
 |
Teriflunomide Aubagio® |
08.01.05 |
Restricted Use
|
 |
Tisagenlecleucel Kymriah® |
08.01.05 |
Formulary
|
 |
Tivozanib Fotivda® |
08.01.05 |
Formulary
|
 |
Trametinib Mekinist® |
08.01.05 |
Formulary
|
 |
Trastuzumab emtansine Kadcyla® |
08.01.01 |
Formulary
|
 |
Treosulfan Trecondil® |
08.01.03 |
Formulary
|
 |
Trifluridine–tipiracil Lonsurf® |
09.08.01 |
Restricted Use
|
 |
Velaglucerase alfa VPRIV® |
08.01.05 |
Formulary
|
 |
Venetoclax Venclyxto® |
02.12 |
Formulary
|
 |
Volanesorsen Waylivra® |
11.99.99.99 |
Non Formulary
|
 |
Voretigene neparvovec Luxturna® |