Section |
Status |
HCD |
Name |
10.01.03 |
Formulary
|
 |
Abatacept Orencia® |
08.03.04.02 |
Formulary
|
 |
Abiraterone Zytiga® |
01.05.03 |
Formulary
|
 |
Adalimumab Humira® |
10.01.03 |
Formulary
|
 |
Adalimumab Humira® |
11.99.99.99 |
Formulary
|
 |
Adalimumab |
13.05.03 |
Formulary
|
 |
Adalimumab Humira® |
05.03.03.01 |
Formulary
|
 |
Adefovir Dipivoxil Hepsera® |
08.01.05 |
Non Formulary
|
 |
Aflibercept Zaltrap® |
11.08.02 |
Formulary
|
 |
Aflibercept Eylea® |
09.08.01 |
Non Formulary
|
 |
Agalsidase Alfa and Beta Fabrazyme® |
09.08.01 |
Non Formulary
|
 |
Agalsidase Alfa and Beta Replagal® |
08.02.04 |
Formulary
|
 |
Aldesleukin Proleukin® |
08.02.03 |
Formulary
|
 |
Alemtuzumab Lemtrada® |
09.08.01 |
Non Formulary
|
 |
Alglucosidase Alfa Myozyme® |
02.12 |
Formulary
|
 |
Alirocumab Praluent® |
13.05.01 |
Formulary
|
 |
Alitretinoin Toctino® |
02.05.01 |
Non Formulary
|
 |
Ambrisentan |
05.02 |
Non Formulary
|
 |
Amphotericin Abelcet® |
05.02 |
Formulary
|
 |
Amphotericin AmBisome® |
10.01.03 |
Restricted Use
|
 |
Anakinra Kineret® |
05.02.04 |
Non Formulary
|
 |
Anidulafungin Ecalta® |
02.11 |
Formulary
|
 |
Antithrombin III Kybemin® |
08.02.02 |
Non Formulary
|
 |
Antithymocyte immunoglobulin (Rabbit) Thymoglobuline® |
09.01.03 |
Formulary
|
 |
Antithymocyte Immunoglobulin (Rabbit) |
13.05.03 |
Formulary
|
 |
Apremilast Otezla® |
10.02 |
Formulary
|
 |
Ataluren Translarna® |
05.03.01 |
Formulary
|
 |
Atazanavir Reyataz® |
08.01.05 |
Formulary
|
 |
Avelumab Bavencio® |
08.01.05 |
Formulary
|
 |
Axitinib Inlyta® |
08.01.03 |
Formulary
|
 |
Azacitidine Vidaza® |
05.01.02.03 |
Non Formulary
|
 |
Aztreonam nebuliser solution Cayston® |
10.01.03 |
Formulary
|
 |
Baricitinib Olumiant® |
08.02.02 |
Formulary
|
 |
Basiliximab Simulect® |
05.01.09 |
Formulary
|
 |
Bedaquiline Sirturo® |
08.02.02 |
Formulary
|
 |
Belatacept Nulojix® |
10.01 |
Formulary
|
 |
Belimumab Benlysta® |
08.01.01 |
Formulary
|
 |
Bendamustine Levact® |
03.05.02 |
Non Formulary
|
 |
Beractant Survanta® |
05.03.03.02 |
Formulary
|
 |
Boceprevir Victrelis® |
08.01.05 |
Formulary
|
 |
Bortezomib Velcade® |
02.05.01 |
Non Formulary
|
 |
Bosentan Tracleer® |
04.07.04.02 |
Formulary
|
 |
Botulinum Toxin Type A |
08.01.05 |
Formulary
|
 |
Brentuximab vedotin Adcetris® |
13.05.03 |
Formulary
|
 |
Brodalumab Kyntheum® |
10.01.03 |
Formulary
|
 |
Burosumab Crysvita® |
03.04.03 |
Non Formulary
|
 |
C1 esterase inhibitor Cinryze® |
03.04.03 |
Non Formulary
|
 |
C1 Esterase Inhibitor Berinert® |
08.01.05 |
Formulary
|
 |
Cabazitaxel Jevtana® |
08.01.05 |
Formulary
|
 |
Cabozantinib Cabometyx® |
08.02.04 |
Non Formulary
|
 |
Canakinumab Ilaris® |
08.01.05 |
Formulary
|
 |
Carfilzomib Kyprolis® |
09.08.01 |
Non Formulary
|
 |
Carglumic Acid Carbaglu® |
05.02.04 |
Non Formulary
|
 |
Caspofungin Cancidas® |
02.11 |
Non Formulary
|
 |
Catridecacog NovoThirteen® |
10.01.03 |
Formulary
|
 |
Certolizumab Pegol Cimzia® |
08.01.05 |
Formulary
|
 |
Cetuximab Erbitux® |
08.02.02 |
Formulary
|
 |
Ciclosporin |
05.03.02.02 |
Non Formulary
|
 |
Cidofovir infusion Vistide® |
08.01.03 |
Formulary
|
 |
Clofarabine Evoltra® |
05.03.01 |
Non Formulary
|
 |
Cobicistat Tybost® |
04.09.01 |
Non Formulary
|
 |
Co-Careldopa Intestinal gel Duodopa® |
09.05.02.02 |
Non Formulary
|
 |
Colestilan BindRen® |
03.04.03 |
Formulary
|
 |
Conestat Alfa Ruconest® |
08.01.05 |
Formulary
|
 |
Crizotinib Xalkori® |
08.01.05 |
Formulary
|
 |
Dabrafenib Tafinlar® |
05.03.03.02 |
Formulary
|
 |
Daclatasvir Daklinza® |
08.01.05 |
Formulary
|
 |
Daratumumab Darzalex® |
09.01.03 |
Formulary
|
 |
Darbepoetin alfa Aranesp® |
08.03.04.02 |
Formulary
|
 |
Darolutamide Nubeqa® |
05.03.01 |
Formulary
|
 |
Darunavir Prezista® |
05.03.03.02 |
Formulary
|
 |
Dasabuvir Exviera® |
08.01.05 |
Formulary
|
 |
Dasatinib Sprycel® |
20 |
Non Formulary
|
 |
DAUNORUBICIN saline pre-filled syringe |
08.01.03 |
Non Formulary
|
 |
Decitabine Dacogen® |
09.01.03 |
Formulary
|
 |
Deferasirox Exjade® |
09.01.03 |
Formulary
|
 |
Deferiprone Ferriprox® |
20 |
Non Formulary
|
 |
DEFIBROTIDE Capsules 400 mg |
20 |
Non Formulary
|
 |
DEFIBROTIDE Injection 200 mg |
05.01.09 |
Formulary
|
 |
Delamanid Deltyba® |
11.04.01 |
Formulary
|
 |
Dexamethasone Intravitreal Implant Ozurdex® |
08.01 |
Formulary
|
 |
Dexrazoxane Savene® |
02.01.01 |
Formulary
|
 |
Digoxin specific antibody fragments Digifab® |
08.02.04 |
Formulary
|
 |
Dimethyl fumarate Tecfidera® |
13.05.03 |
Formulary
|
 |
Dimethyl fumarate Skilarence® |
05.03.01 |
Formulary
|
 |
Dolutegravir Tivicay® |
05.03.01 |
Formulary
|
 |
Dolutegravir and Rilpivirine Juluca® |
05.03.01 |
Formulary
|
 |
Dolutegravir, abacavir & lamivudine Triumeq® |
03.07 |
Formulary
|
 |
Dornase Alfa Pulmozyme® |
08.01.02 |
Formulary
|
 |
Doxorubicin Caelyx® |
13.05.03 |
Formulary
|
 |
Dupilumab Dupixent® |
09.01.03 |
Formulary
|
 |
Eculizumab Soliris® |
05.03.01 |
Formulary
|
 |
Efavirenz Sustiva® |
09.08.01 |
Non Formulary
|
 |
Eliglustat Cerdelga® |
09.01.04 |
Formulary
|
 |
Eltrombopag Revolade® |
05.03.01 |
Formulary
|
 |
Enfuvirtide Fuzeon® |
05.03.03.01 |
Formulary
|
 |
Entecavir Baraclude® |
08.03.04.02 |
Formulary
|
 |
Enzalutamide Xtandi® |
09.01.03 |
Formulary
|
 |
Epoetin alfa Eprex® |
09.01.03 |
Formulary
|
 |
Epoetin beta NeoRecormon® |
09.01.03 |
Non Formulary
|
 |
Epoetin zeta Retacrit® |
02.08.01 |
Formulary
|
 |
Epoprostenol Flolan® |
20 |
Non Formulary
|
 |
Eptotermin Alfa Osigraft® |
08.01.05 |
Formulary
|
 |
Eribulin Halaven® |
08.01.05 |
Formulary
|
 |
Erlotinib Tarceva® |
10.01.03 |
Formulary
|
 |
Etanercept Enbrel® |
13.05.03 |
Formulary
|
 |
Etanercept |
05.03.01 |
Formulary
|
 |
Etravirine Intelence® |
08.01.05 |
Formulary
|
 |
Everolimus |
02.12 |
Formulary
|
 |
Evolocumab Repatha® |
02.11 |
Formulary
|
 |
Factor IX Fraction, Dried |
02.11 |
Formulary
|
 |
Factor VIIa (Recombinant) Novo 7® |
02.11 |
Formulary
|
 |
Factor VIII Fraction, Dried |
02.11 |
Formulary
|
 |
Factor VIII Inhibitor Bypassing Fraction (FEIBA) |
02.11 |
Formulary
|
 |
Factor XIII Fraction, Dried |
08.02.04 |
Non Formulary
|
 |
Fampridine |
09.01.06 |
Formulary
|
 |
Filgrastim |
08.02.04 |
Formulary
|
 |
Fingolimod |
11.04.01 |
Formulary
|
 |
Fluocinolone Acetonide Intravitreal Implant Iluvien® |
18 |
Non Formulary
|
 |
Fomepizole |
05.03.01 |
Formulary
|
 |
Fosamprenavir Telzir® |
05.03.02.02 |
Formulary
|
 |
Foscarnet Sodium Foscavir® |
04.07.04.02 |
Formulary
|
 |
Galcanezumab Emgality® |
05.03.02.02 |
Formulary
|
 |
Ganciclovir Cymevene® |
08.01.05 |
Formulary
|
 |
Gefitinib Iressa® |
08.02.04 |
Formulary
|
 |
Glatiramer Acetate Copaxone® |
18 |
Non Formulary
|
 |
Glucarpidase Carboxypeptidase |
01.05.03 |
Formulary
|
 |
Golimumab Simponi® |
10.01.03 |
Formulary
|
 |
Golimumab Simponi® |
13.05.03 |
Formulary
|
 |
Guselkumab Tremfya® |
09.08.02 |
Formulary
|
 |
Haem Arginate Normosang® |
08.01.05 |
Formulary
|
 |
Ibrutinib Imbruvica® |
03.04.03 |
Non Formulary
|
 |
Icatibant Firazyr® |
02.05.01 |
Formulary
|
 |
Iloprost injection |
08.01.05 |
Non Formulary
|
 |
Imatinib Gilvec® |
08.01.05 |
Formulary
|
 |
Imatinib Gilvec® |
09.08.01 |
Non Formulary
|
 |
Imiglucerase Cerezyme® |
05.03.01 |
Formulary
|
 |
Indinavir Crixivan® |
01.05.03 |
Formulary
|
 |
Infliximab |
10.01.03 |
Formulary
|
 |
Infliximab |
13.05.03 |
Formulary
|
 |
Infliximab Remicade® |
09.08.01 |
Formulary
|
 |
Inotersen Tegsedi® |
08.02.04 |
Non Formulary
|
 |
Interferon Alfa |
08.02.04 |
Non Formulary
|
 |
Interferon Alfa Roferon-A® |
08.02.04 |
Non Formulary
|
 |
Interferon Alfa Viraferon® |
08.01.05 |
Formulary
|
 |
Ipilimumab Yervoy® |
03.07 |
Formulary
|
 |
Ivacaftor |
10.01.03 |
Formulary
|
 |
Ixekizumab Taltz® |
08.03.04.03 |
Formulary
|
 |
Lanreotide Somatuline Autogel® |
09.05.02.02 |
Formulary
|
 |
Lanthanum Fosrenol® |
08.01.05 |
Non Formulary
|
 |
Lapatinib Tyverb® |
09.08.01 |
Non Formulary
|
 |
Laronidase Aldurazyme® |
05.03.03.02 |
Formulary
|
 |
Ledipasvir and Sofosbuvir Harvoni® |
08.02.04 |
Formulary
|
 |
Lenalidomide Revlimid® |
09.01.06 |
Formulary
|
 |
Lenograstim Granocyte® |
09.08.01 |
Formulary
|
 |
Levocarnitine Carnitor® |
05.01.12 |
Formulary
|
 |
Levofloxacin Quinsair® |
09.01.06 |
Non Formulary
|
 |
Lipegfilgrastim Lonquex® |
02.12 |
Non Formulary
|
 |
Lomitapide Lojuxta®▼ |
05.03.01 |
Formulary
|
 |
Lopinavir and Ritonavir Kaletra® |
02.05.01 |
Formulary
|
 |
Macitentan Opsumit® |
03.07 |
Formulary
|
 |
Mannitol dry powder for inhalation |
05.03.01 |
Formulary
|
 |
Maraviroc Celsentri® |
06.07.04 |
Non Formulary
|
 |
Mecasermin Increlex® |
09.08.01 |
Non Formulary
|
 |
Mercaptamine (Cysteamine) Cystagon® |
09.01.03 |
Formulary
|
 |
Methoxy Polyethylene Glycol-Epoetin Beta Mircera® |
05.02.04 |
Formulary
|
 |
Micafungin Mycamine® |
09.08.01 |
Non Formulary
|
 |
Miglustat Zavesca® |
08.02.04 |
Formulary
|
 |
Natalizumab Tysabri® |
08.01.05 |
Non Formulary
|
 |
Necitumumab Portrazza® |
08.01.03 |
Formulary
|
 |
Nelarabine Atriance® |
05.03.01 |
Formulary
|
 |
Nevirapine Viramune® |
08.01.05 |
Formulary
|
 |
Nilotinib Tasigna® |
03.11 |
Formulary
|
 |
Nintedanib Ofev® |
08.01.05 |
Formulary
|
 |
Nintedanib Vargatef® |
08.02.04 |
Formulary
|
 |
Nivolumab Opdivo® |
14.05.01 |
Non Formulary
|
 |
Normal immunoglobulin Vigam® |
14.05.01 |
Formulary
|
 |
Normal immunoglobulin Privigen® |
14.05.01 |
Non Formulary
|
 |
Normal immunoglobulin Gammagard S/D® |
08.02.03 |
Formulary
|
 |
Obinutuzumab Gazyvaro® |
11.08.02 |
Formulary
|
 |
Ocriplasmin Jetrea® |
08.03.04.03 |
Formulary
|
 |
Octreotide Sandostatin LAR® |
08.03.04.03 |
Formulary
|
 |
Octreotide Sandostatin® |
08.02.03 |
Formulary
|
 |
Ofatumumab Arzerra® |
08.02.04 |
Formulary
|
 |
Olaparib Lynparza® |
03.04.02 |
Formulary
|
 |
Omalizumab Xolair® |
05.03.03.02 |
Formulary
|
 |
Ombitasvir - Paritaprevir - Ritonavir Viekirax® |
08.01.05 |
Formulary
|
 |
Paclitaxel - Albumin Bound Formulation Abraxane® |
05.03.05 |
Formulary
|
 |
Palivizumab Synagis® |
08.01.05 |
Formulary
|
 |
Panitumumab Vectibix® |
08.01.05 |
Non Formulary
|
 |
Panobinostat Farydak® |
06.06.01 |
Non Formulary
|
 |
Parathyroid Hormone Preotact® |
06.05 |
Non Formulary
|
 |
Pasireotide |
08.01.05 |
Formulary
|
 |
Pazopanib Votrient® |
11.08.02 |
Non Formulary
|
 |
Pegaptanib Sodium Macugen® |
09.01.06 |
Non Formulary
|
 |
Pegfilgrastim Neulasta® |
08.02.04 |
Formulary
|
 |
Peginterferon Alfa Pegasys® |
08.02.04 |
Formulary
|
 |
Peginterferon Alfa ViraferonPeg® |
08.02.04 |
Formulary
|
 |
Peginterferon Beta-1a Plegridy® |
06.05.01 |
Non Formulary
|
 |
Pegvisomant Somavert® |
08.01.05 |
Formulary
|
 |
Pembrolizumab Keytruda® |
08.01.03 |
Formulary
|
 |
Pemetrexed Alimta® |
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 Curosurf® |
05.02 |
Formulary
|
 |
Posaconazole Noxafil® |
02.11 |
Formulary
|
 |
Protein C Concentrate Ceprotin® |
02.11 |
Formulary
|
 |
Prothrombin Complex Concentrate Octaplex® |
08.03.04.02 |
Formulary
|
 |
Radium-223 dichloride |
05.03.01 |
Formulary
|
 |
Raltegravir Isentress® |
08.01.05 |
Non Formulary
|
 |
Ramucirumab Cyramza® |
11.08.02 |
Formulary
|
 |
Ranibizumab Lucentis® |
10.01.04 |
Formulary
|
 |
Rasburicase Fastertec® |
08.01.05 |
Formulary
|
 |
Regorafenib Stivarga® |
05.03.05 |
Formulary
|
 |
Ribavirin Rebetol® |
05.03.05 |
Formulary
|
 |
Ribavirin Copegus® |
05.01.07 |
Formulary
|
 |
Rifaximin Targaxan® |
02.05.01 |
Non Formulary
|
 |
Riociguat Adempas® |
08.02.03 |
Formulary
|
 |
Rituximab MabThera® |
10.01.03 |
Formulary
|
 |
Rituximab MabThera® |
09.01.04 |
Formulary
|
 |
Romiplostim Nplate® |
08.01.05 |
Formulary
|
 |
Ruxolitinib Jakavi® |
09.04.01 |
Non Formulary
|
 |
Sapropterin Dihydrochloride Kuvan® |
05.03.01 |
Formulary
|
 |
Saquinavir Invirase® |
10.01.03 |
Formulary
|
 |
Sarilumab Kevzara® |
13.05.03 |
Formulary
|
 |
Secukinumab Cosentyx® |
09.05.02.02 |
Formulary
|
 |
Sevelamer Carbonate 2.4g sachets Renvela® |
09.05.02.02 |
Formulary
|
 |
Sevelamer Hydrochloride Renagel® |
02.05.01 |
Formulary
|
 |
Sildenafil Revatio® |
05.03.03.02 |
Formulary
|
 |
Simeprevir Olysio® |
08.02.04 |
Formulary
|
 |
Siponimod Mayzent® |
20 |
Non Formulary
|
 |
Sipuleucel- T |
08.02.02 |
Non Formulary
|
 |
Sirolimus Rapamune® |
04.01.01 |
Formulary
|
 |
Sodium Oxybate Xyrem® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir Sovaldi® |
06.05.01 |
Formulary
|
 |
Somatropin Zomacton® |
06.05.01 |
Formulary
|
 |
Somatropin Omnitrope®, Genotropin® |
06.05.01 |
Formulary
|
 |
Somatropin Saizen® |
08.01.05 |
Formulary
|
 |
Sorafenib Nexavar® |
08.01.05 |
Formulary
|
 |
Sunitinib Sutent® |
20 |
Non Formulary
|
 |
Taribavirin |
01.04.02 |
Non Formulary
|
 |
Teduglutide Revestive® |
05.03.03.02 |
Formulary
|
 |
Telaprevir Incivo® |
08.01.05 |
Formulary
|
 |
Temozolomide Temodal® |
08.01.05 |
Non Formulary
|
 |
Temsirolimus Torisel® |
08.02.04 |
Formulary
|
 |
Teriflunomide Aubagio® |
06.06.01 |
Formulary
|
 |
Teriparatide Forsteo® |
06.06.01 |
Formulary
|
 |
Teriparatide Movymia® |
20 |
Non Formulary
|
 |
TETRAHYDROBIOPTERIN Tablets 10 mg |
03.07 |
Formulary
|
 |
Tezacaftor with Ivacaftor and Elexacaftor Kaftrio ® |
08.02.04 |
Formulary
|
 |
Thalidomide Celgene® |
13.05.03 |
Formulary
|
 |
Tildrakizumab Ilumetri® |
05.03.01 |
Formulary
|
 |
Tipranavir Aptivus® |
08.01.05 |
Formulary
|
 |
Tivozanib Fotivda® |
05.01.04 |
Formulary
|
 |
Tobramycin |
05.01.04 |
Formulary
|
 |
Tobramycin inhaler TOBI Podhaler® |
10.01.03 |
Formulary
|
 |
Tocilizumab RoActemra® |
10.01.03 |
Formulary
|
 |
Tofacitinib citrate Xeljanz® |
06.05.02 |
Non Formulary
|
 |
Tolvaptan Samsca® |
06.05.02 |
Formulary
|
 |
Tolvaptan Jinarc® |
08.01.05 |
Formulary
|
 |
Trametinib Mekinist® |
08.01.05 |
Formulary
|
 |
Trastuzumab Herceptin® |
08.01.05 |
Formulary
|
 |
Trastuzumab emtansine Kadcyla® |
20 |
Non Formulary
|
 |
Treprostinil |
10.01.03 |
Formulary
|
 |
Upadacitinib Rinvoq® |
01.05.03 |
Formulary
|
 |
Ustekinumab Stelara® |
13.05.03 |
Formulary
|
 |
Ustekinumab Stelara® |
05.03.02.02 |
Formulary
|
 |
Valganciclovir Valcyte® |
08.01.05 |
Non Formulary
|
 |
Vandetanib Caprelsa® |
01.05.03 |
Formulary
|
 |
Vedolizumab Entyvio® |
08.01.05 |
Formulary
|
 |
Vemurafenib Zelboraf® |
11.08.02 |
Formulary
|
 |
Verteporfin Visudyne® |
08.01.05 |
Non Formulary
|
 |
Vismodegib Erivedge® |
05.02 |
Formulary
|
 |
Voriconazole Vfend® |
08.01.05 |
Non Formulary
|
 |
Vosaroxin Qinprezo |