Section |
Status |
HCD |
Name |
05.03.01 |
Formulary
|
 |
Abacavir Ziagen® |
05.03.01 |
Formulary
|
 |
Abacavir and Lamivudine Kivexa® |
05.03.01 |
Formulary
|
 |
Abacavir,Lamivudine and Zidovudine Trizivir® |
10.01.03 |
Formulary
|
 |
Abatacept |
08.03.04.01 |
Formulary
|
 |
Abemaciclib Verzenios® |
08.03.04.02 |
Formulary
|
 |
Abiraterone |
01.05.03 |
Formulary
|
 |
Adalimumab |
10.01.03 |
Formulary
|
 |
Adalimumab Amgevita®(biosimilar) or Humira® |
13.05.03 |
Formulary
|
 |
Adalimumab |
05.03.03.01 |
Non Formulary
|
 |
Adefovir Dipivoxil Hepsera® |
08.01.05 |
Formulary
|
 |
Aflibercept Zaltrap® |
11.08.02 |
Formulary
|
 |
Aflibercept |
08.02.04 |
Non Formulary
|
 |
Aldesleukin Proleukin® |
13.05.01 |
Formulary
|
 |
Alitretinoin Toctino® |
02.05.01 |
Non Formulary
|
 |
Ambrisentan |
10.02.01 |
Non Formulary
|
 |
Amifampridine Firdapse |
05.02 |
Formulary
|
 |
Amphotericin |
10.01.04 |
Formulary
|
 |
Anakinra |
05.02.04 |
Non Formulary
|
 |
Anidulafungin |
02.11 |
Non Formulary
|
 |
Antithrombin III Kybemin® |
08.02.02 |
Formulary
|
 |
Antithymocyte immunoglobulin (rabbit) |
13.05.03 |
Formulary
|
 |
Apremilast Otezla® |
05.03.01 |
Formulary
|
 |
Atazanavir Reyataz® |
08.01.05 |
Formulary
|
 |
Avelumab Bavencio ® |
08.01.05 |
Formulary
|
 |
Axicabtagene ciloleucel |
08.01.05 |
Formulary
|
 |
Axitinib |
08.01.03 |
Formulary
|
 |
Azacitidine Vidaza® |
08.02.02 |
Formulary
|
 |
Basiliximab Simulect® |
08.02.04 |
Formulary
|
 |
BCG Connaught |
05.01.09 |
Non Formulary
|
 |
Bedaquiline Sirturo® |
08.02.02 |
Non Formulary
|
 |
Belatacept Nulojix® |
10.01.03 |
Formulary
|
 |
Belimumab Benlysta® |
03.04.02 |
Formulary
|
 |
Benralizumab Fasenra® |
03.05.02 |
Non Formulary
|
 |
Beractant Survanta® |
08.01.05 |
Formulary
|
 |
Bevacizumab Avastin® |
01.05.03 |
Formulary
|
 |
Biosimilar Infliximab Inflectra® |
08.01.05 |
Formulary
|
 |
Bortezomib |
02.05.01 |
Formulary
|
 |
Bosentan |
08.01.05 |
Formulary
|
 |
Bosutinib |
08.01.05 |
Formulary
|
 |
Brentuximab vedotin Adcetris® |
08.01.05 |
Formulary
|
 |
Brigatinib Alunbrig® |
08.02.04 |
Formulary
|
 |
Brodalumab Kyntheum ® |
03.04.03 |
Non Formulary
|
 |
C1 esterase inhibitor Cinryze® |
03.04.03 |
Formulary
|
 |
C1 Esterase Inhibitor Berinert® |
08.01.05 |
Formulary
|
 |
Cabazitaxel |
08.01.05 |
Formulary
|
 |
Cabozantinib |
08.02.04 |
Non Formulary
|
 |
Canakinumab Ilaris® |
04.06 |
Formulary
|
 |
Cannabidiol Epidyolex® |
18 |
Non Formulary
|
 |
Carboxypeptidase Glucarpidase |
05.02.04 |
Formulary
|
 |
Caspofungin |
02.11 |
Non Formulary
|
 |
Catridecacog NovoThirteen® |
08.01.05 |
Formulary
|
 |
Ceritinib |
10.01.03 |
Formulary
|
 |
Certolizumab Pegol |
08.01.05 |
Formulary
|
 |
Cetuximab |
08.02.02 |
Formulary
|
 |
Ciclosporin Neoral® |
05.03.02.02 |
Non Formulary
|
 |
Cidofovir infusion Vistide® |
09.05.01.02 |
Formulary
|
 |
Cinacalcet Mimpara® |
08.01.03 |
Formulary
|
 |
Cladribine |
08.01.03 |
Non Formulary
|
 |
Clofarabine Evoltra® |
05.03.01 |
Formulary
|
 |
Cobicistat Tybost® |
09.05.02.02 |
Non Formulary
|
 |
Colestilan BindRen® |
05.01.07 |
Formulary
|
 |
Colistimethate inhaler Colobreathe® |
05.01.07 |
Formulary
|
 |
Colistimethate sodium |
03.04.03 |
Non Formulary
|
 |
Conestat Alfa Ruconest® |
08.01.05 |
Formulary
|
 |
Crizotinib |
08.01.05 |
Formulary
|
 |
Dabrafenib Tafinlar® |
08.01.05 |
Formulary
|
 |
Daratumumab Darzalex ® |
09.01.03 |
Formulary
|
 |
Darbepoetin Alfa Aranesp® |
05.03.01 |
Formulary
|
 |
Darunavir Prezista® |
05.03.01 |
Formulary
|
 |
Darunavir and cobicistat Rezolsta® |
05.03.03.02 |
Non Formulary
|
 |
Dasabuvir Exviera® |
20 |
Non Formulary
|
 |
DAUNORUBICIN saline pre-filled syringe |
08.01.03 |
Formulary
|
 |
Daunorubicin/ cytarabine Vyxeos |
08.01.03 |
Non Formulary
|
 |
Decitabine Dacogen® |
09.01.03 |
Formulary
|
 |
Deferasirox Exjade® |
09.01.03 |
Non Formulary
|
 |
Deferiprone Ferriprox® |
20 |
Non Formulary
|
 |
DEFIBROTIDE Capsules 400 mg |
20 |
Non Formulary
|
 |
DEFIBROTIDE Injection 200 mg |
05.01.09 |
Non Formulary
|
 |
Delamanid Deltyba® |
09.01.03 |
Formulary
|
 |
Desferrioxamine Mesilate |
11.04.01 |
Formulary
|
 |
Dexamethasone intravitreal implant |
08.01 |
Formulary
|
 |
Dexrazoxane Savene® |
05.03.01 |
Formulary
|
 |
Didanosine Videx® |
02.01.01 |
Non Formulary
|
 |
Digoxin specific antibody fragments Digifab® |
18 |
Non Formulary
|
 |
Digoxin specific antibody fragments Digifab® |
08.02.04 |
Formulary
|
 |
Dimethyl fumarate |
08.02.04 |
Formulary
|
 |
Dinutuximab beta Qarziba® |
05.03.01 |
Formulary
|
 |
Dolutegravir Tivicay® |
05.03.01 |
Formulary
|
 |
Dolutegravir, abacavir and lamivudine Triumeq® |
03.07 |
Formulary
|
 |
Dornase Alfa Pulmozyme® |
09.01.03 |
Formulary
|
 |
Eculizumab |
05.03.01 |
Formulary
|
 |
Efavirenz Sustiva® |
09.08.01 |
Non Formulary
|
 |
Eliglustat Cerdelga® |
09.01.04 |
Formulary
|
 |
Eltrombopag Revolade® |
05.03.01 |
Formulary
|
 |
Emtricitabine Emtriva® |
05.03.01 |
Formulary
|
 |
Emtricitabine rilpivirine and tenofovir Eviplera® |
08.01.05 |
Formulary
|
 |
Encorafenib Braftovi® |
05.03.01 |
Formulary
|
 |
Enfuvirtide Fuzeon® |
05.03.03.01 |
Formulary
|
 |
Entecavir |
08.03.04.02 |
Formulary
|
 |
Enzalutamide |
09.01.03 |
Formulary
|
 |
Epoetin alfa Eprex® |
09.01.03 |
Formulary
|
 |
Epoetin beta NeoRecormon® |
02.08.01 |
Non Formulary
|
 |
Epoprostenol Flolan® |
20 |
Non Formulary
|
 |
Eptotermin Alfa Osigraft® |
08.01.05 |
Formulary
|
 |
Eribulin Halaven® |
08.01.05 |
Formulary
|
 |
Erlotinib Tarceva® |
13.05.03 |
Formulary
|
 |
Etanercept |
05.03.01 |
Formulary
|
 |
Etravirine Intelence® |
08.01.05 |
Formulary
|
 |
Everolimus Votubia® |
02.11 |
Non Formulary
|
 |
Factor IX Fraction, Dried |
02.11 |
Non Formulary
|
 |
Factor VIIa (Recombinant) Novo 7® |
02.11 |
Non Formulary
|
 |
Factor VIII Fraction, Dried |
02.11 |
Non Formulary
|
 |
Factor VIII Inhibitor Bypassing Fraction |
02.11 |
Non Formulary
|
 |
Factor XIII Fraction, Dried |
08.02.04 |
Non Formulary
|
 |
Fampridine |
09.01.06 |
Formulary
|
 |
Filgrastim Neupogen® |
11.04.01 |
Formulary
|
 |
Fluocinolone intravitreal implant |
18 |
Non Formulary
|
 |
Fomepizole |
05.03.01 |
Formulary
|
 |
Fosamprenavir Telzir® |
05.03.02.02 |
Non Formulary
|
 |
Foscarnet Sodium Foscavir® |
05.03.02.02 |
Formulary
|
 |
Ganciclovir |
08.01.05 |
Formulary
|
 |
Gefitinib Iressa® |
08.02.04 |
Formulary
|
 |
Glatiramer Acetate |
01.05.03 |
Formulary
|
 |
Golimumab |
10.01.03 |
Formulary
|
 |
Golimumab |
08.01.05 |
Formulary
|
 |
Ibrutinib Imbruvica® |
03.04.03 |
Formulary
|
 |
Icatibant Firazyr® |
02.05.01 |
Formulary
|
 |
Iloprost injection |
08.01.05 |
Formulary
|
 |
Imatinib |
05.03.01 |
Formulary
|
 |
Indinavir Crixivan® |
01.05.03 |
Formulary
|
 |
Infliximab See 10.01.03 for preparations |
10.01.03 |
Formulary
|
 |
Infliximab |
13.05.03 |
Formulary
|
 |
Infliximab |
06.07 |
Formulary
|
 |
Inotersen |
08.01.05 |
Formulary
|
 |
Inotuzumab ozogamicin Besponsa® |
03.07 |
Non Formulary
|
 |
Ivacaftor |
10.01.03 |
Formulary
|
 |
Ixekizumab Taltz® |
05.03.01 |
Formulary
|
 |
Lamivudine Epivir®, Zeffix® |
08.03.04.03 |
Formulary
|
 |
Lanreotide |
09.05.02.02 |
Formulary
|
 |
Lanthanum Fosrenol ® |
05.03.03.02 |
Formulary
|
 |
Ledipasvir and Sofosbuvir Harvoni® |
08.02.04 |
Formulary
|
 |
Lenalidomide |
09.01.06 |
Formulary
|
 |
Lenograstim Granocyte® |
02.12 |
Non Formulary
|
 |
Lomitapide Lojuxta®▼ |
05.03.01 |
Formulary
|
 |
Lopinavir and ritonavir Kaletra® |
02.05.01 |
Non Formulary
|
 |
Macitentan Opsumit®
|
03.07 |
Non Formulary
|
 |
Mannitol inhalation Bronchitol ® |
05.03.01 |
Formulary
|
 |
Maraviroc Celsentri® |
06.07.04 |
Non Formulary
|
 |
Mecasermin Increlex® |
03.04.02 |
Formulary
|
 |
Mepolizumab Nucala |
09.01.03 |
Formulary
|
 |
Methoxy Polyethylene Glycol-Epoetin Beta Mircera® |
05.02.04 |
Non Formulary
|
 |
Micafungin Mycamine® |
08.02.01 |
Formulary
|
 |
Mycophenolate Mofetil |
08.02.04 |
Formulary
|
 |
Natalizumab |
08.01.05 |
Non Formulary
|
 |
Necitumumab |
08.01.03 |
Non Formulary
|
 |
Nelarabine Atriance® |
05.03.01 |
Non Formulary
|
 |
Nelfinavir Viracept® |
05.03.01 |
Formulary
|
 |
Nevirapine Viramune® |
08.01.05 |
Formulary
|
 |
Nilotinib |
03.11 |
Non Formulary
|
 |
Nintedanib Vargatef |
20 |
Non Formulary
|
 |
Nitazoxanide |
14.05.01 |
Formulary
|
 |
Normal immunoglobulin |
08.02.03 |
Formulary
|
 |
Obinutuzumab Gazyvaro ® |
08.02.03 |
Formulary
|
 |
Ocrelizumab Ocrevus® |
11.08.02 |
Formulary
|
 |
Ocriplasmin |
08.03.04.03 |
Formulary
|
 |
Octreotide |
08.03.04.03 |
Formulary
|
 |
Octreotide |
03.04.02 |
Formulary
|
 |
Omalizumab Xolair® |
05.03.03.02 |
Formulary
|
 |
Ombitasvir/ paritaprevir/ ritonavir Viekirax® |
05.03.05 |
Non Formulary
|
 |
Palivizumab Synagis® |
08.01.05 |
Non Formulary
|
 |
Panitumumab Vectibix® |
06.06.01 |
Non Formulary
|
 |
Parathyroid Hormone Preotact® |
06.05 |
Non Formulary
|
 |
Pasireotide |
09.02.01.01 |
Formulary
|
 |
Patiromer calcium Veltassa ® |
08.01.05 |
Formulary
|
 |
Pazopanib |
11.08.02 |
Non Formulary
|
 |
Pegaptanib Sodium Macugen® |
06.05.01 |
Non Formulary
|
 |
Pegvisomant Somavert® |
08.01.03 |
Formulary
|
 |
Pemetrexed |
08.01.05 |
Formulary
|
 |
Pertuzumab Perjeta® |
03.11 |
Formulary
|
 |
Pirfenidone Esbriet® |
08.01.02 |
Formulary
|
 |
Pixantrone |
09.01.07 |
Formulary
|
 |
Plerixafor Mozobil® |
08.02.04 |
Formulary
|
 |
Pomalidomide Imnovid® |
08.01.05 |
Formulary
|
 |
Ponatinib Iclusig® |
03.05.02 |
Formulary
|
 |
Poractant Alfa |
05.02 |
Non Formulary
|
 |
Posaconazole (IV) Noxafil® |
05.02 |
Formulary
|
 |
Posaconazole (oral) |
02.11 |
Non Formulary
|
 |
Protein C Concentrate Ceprotin® |
02.11 |
Non Formulary
|
 |
Prothrombin Complex Concentrate Octaplex® |
05.03.01 |
Formulary
|
 |
Raltegravir Isentress ® |
11.08.02 |
Formulary
|
 |
Ranibizumab |
10.01.04 |
Formulary
|
 |
Rasburicase Fastertec® |
08.01.05 |
Formulary
|
 |
Regorafenib Stivarga® |
05.03.05 |
Formulary
|
 |
Ribavirin |
05.03.01 |
Formulary
|
 |
Rilpivirine hydrochloride Edurant® |
04.09.03 |
Formulary
|
 |
Riluzole |
02.05.01 |
Non Formulary
|
 |
Riociguat Adempas® |
05.03.01 |
Formulary
|
 |
Ritonavir Norvir® |
08.02.03 |
Formulary
|
 |
Rituximab |
10.01.03 |
Formulary
|
 |
Rituximab |
09.01.04 |
Formulary
|
 |
Romiplostim Nplate® |
08.01.05 |
Formulary
|
 |
Ruxolitinib |
04.09.01 |
Formulary
|
 |
Safinamide Xadago |
05.03.01 |
Formulary
|
 |
Saquinavir Invirase® |
13.05.03 |
Formulary
|
 |
Secukinumab |
09.05.02.02 |
Formulary
|
 |
Sevelamer Carbonate Renvela® |
09.05.02.02 |
Formulary
|
 |
Sevelamer Hydrochloride Renagel® |
20 |
Non Formulary
|
 |
Sipuleucel- T |
08.02.02 |
Formulary
|
 |
Sirolimus |
04.01.01 |
Non Formulary
|
 |
Sodium Oxybate Xyrem® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir |
06.05.01 |
Formulary
|
 |
Somatropin |
08.01.05 |
Formulary
|
 |
Sorafenib |
05.03.01 |
Formulary
|
 |
Stavudine Zerit® |
08.01.05 |
Formulary
|
 |
Sunitinib |
20 |
Non Formulary
|
 |
Taribavirin |
01.04.02 |
Non Formulary
|
 |
Teduglutide Revestive® |
08.01.05 |
Formulary
|
 |
Temozolomide |
05.03.01 |
Formulary
|
 |
Tenofovir and emtricitabine Truvada® |
05.03.01 |
Formulary
|
 |
Tenofovir Disproxil |
05.03.01 |
Formulary
|
 |
Tenofovir, cobicistat, elvitegravir and emtricitabine Stribild® |
05.03.01 |
Formulary
|
 |
Tenofovir, efavirenz and emtricitabine Atripla® |
08.02.04 |
Formulary
|
 |
Teriflunomide |
06.06.01 |
Formulary
|
 |
Teriparatide |
20 |
Non Formulary
|
 |
TETRAHYDROBIOPTERIN Tablets 10 mg |
08.02.04 |
Formulary
|
 |
Thalidomide |
05.03.01 |
Formulary
|
 |
Tipranavir Aptivus® |
08.01.05 |
Formulary
|
 |
Tisagenlecleucel Kymriah® |
05.01.04 |
Formulary
|
 |
Tobramycin inhaler TOBI Podhaler® |
10.01.03 |
Formulary
|
 |
Tocilizumab |
06.05.02 |
Formulary
|
 |
Tolvaptan Jinarc® |
20 |
Non Formulary
|
 |
Treprostinil |
13.05.03 |
Formulary
|
 |
Ustekinumab |
05.03.02.02 |
Formulary
|
 |
Valganciclovir |
08.01.05 |
Non Formulary
|
 |
Vandetanib Caprelsa® |
08.01.05 |
Formulary
|
 |
Vemurafenib |
11.08.02 |
Formulary
|
 |
Verteporfin |
08.01.05 |
Non Formulary
|
 |
Vismodegib Erivedge® |
05.02 |
Formulary
|
 |
Voriconazole |
08.01.05 |
Non Formulary
|
 |
Vosaroxin Qinprezo |
05.03.01 |
Formulary
|
 |
Zidovudine Retrovir® |