| Section |
Status |
BlueTeq |
Name |
| 08.03.04.02 |
Formulary
|
 |
Abiraterone acetate Zytiga ® |
| 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® |
| 08.01.05 |
Formulary
|
|
Bevacizumab Avastin® |
| 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
|
|
Cabazitaxel Jevtana® |
| 08.01.05 |
Formulary
|
|
Cabozantinib Cometriq®, Cabometyx® |
| 08.01.05 |
Formulary
|
|
Carfilzomib Kyprolis® |
| 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
|
|
Daratumumab DARZALEX® |
| 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® |
| 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
|
|
Eribulin Halaven® |
| 09.05.01.02 |
Formulary
|
|
Etelcalcetide Parsabiv® |
| 08.01.05 |
Formulary
|
|
Everolimus Afinitor® |
| 08.02.04 |
Formulary
|
|
Fingolimod Gilenya® |
| 08.01.05 |
Formulary
|
|
Gemtuzumab ozogamicin MYLOTARG® |
| 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
|
|
Ixazomib Ninlaro® |
| 08.01.05 |
Formulary
|
|
Lenvatinib Kisplyx®, Lenvima® |
| 08.01.05 |
Formulary
|
|
Liposomal Cytarabine-Daunorubicin Vyxeos® |
| 08.01.05 |
Formulary
|
|
Lutetium (177Lu) oxodotreotide Lutathera® |
| 03.04.02 |
Restricted Use
|
|
Mepolizumab Nucala® |
| 08.01.05 |
Formulary
|
|
Midostaurin Rydapt® |
| 08.02.04 |
Formulary
|
|
Natalizumab Tysabri® |
| 08.01.03 |
Formulary
|
|
Nelarabine Atriance® |
| 08.01.05 |
Formulary
|
|
Nilotinib Tasigna® |
| 03.11 |
Formulary
|
|
Nintedanib Ofev® |
| 08.01.05 |
Formulary
|
|
Niraparib Zejula® |
| 08.01.05 |
Formulary
|
|
Nivolumab Opdivo® |
| 01.09.01 |
Restricted Use
|
|
Obeticholic acid Ocaliva® |
| 08.02.03 |
Formulary
|
|
Obinutuzumab Gazyvaro® |
| 08.01.05 |
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® |
| 08.01.05 |
Formulary
|
|
Pembrolizumab Keytruda® |
| 08.01.05 |
Formulary
|
|
Pertuzumab Perjeta® |
| 03.11 |
Restricted Use
|
|
Pirfenidone Esbriet® |
| 09.01.07 |
Formulary
|
|
Plerixafor Mozobil® |
| 08.02.04 |
Formulary
|
|
Pomalidomide Imnovid® |
| 08.01.05 |
Formulary
|
|
Ponatinib Iclusig® |
| 08.01.05 |
Formulary
|
|
Regorafenib Stivarga® |
| 03.04.02 |
Restricted Use
|
|
Reslizumab Cinqaero® |
| 08.01.05 |
Formulary
|
|
Ribociclib Kisqali® |
| 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® |
| 08.01.03 |
Formulary
|
|
Trifluridine–tipiracil Lonsurf® |
| 08.01.05 |
Formulary
|
|
Vandetanib Caprelsa® |
| 09.08.01 |
Restricted Use
|
|
Velaglucerase alfa VPRIV® |
| 08.01.05 |
Formulary
|
|
Venetoclax Venclyxto® |
