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Results 1 - 10 of 240

  • ABEMACICLIB

    Generic Brand HICL GCN Exception/Other

    ABEMACICLIB

    VERZENIO

    44537

     

     

  • ABIRATERONE

    Generic Brand HICL GCN Exception/Other

    ABIRATERONE ACETATE

    ZYTIGA

    37571

     

     

  • ABIRATERONE SUBMICRONIZED

    Generic Brand HICL GCN Exception/Other

    ABIRATERONE
    SUBMICRONIZED

    YONSA

    44946

     

    ROUTE = ORAL

  • ABROCITINIB

    Generic Brand HICL GCN Exception/Other

    ABROCITINIB

    CIBINQO

    47767

     

     

  • ACALABRUTINIB

    Generic

    Brand

    HICL

    GCN

    Exception/Other

    ACALABRUTINIB

    CALQUENCE

    44607

     

     

    ACALABRUTINIB MALEATE

    CALQUENCE

    48182

     

     

  • ADAGRASIB

    Generic Brand HICL GCN Exception/Other

    ADAGRASIB

    KRAZATI

    48522

     

     

  • AFATINIB

    Generic Brand HICL GCN Exception/Other

    AFATINIB
    DIMALEATE

    GILOTRIF

    40478

     

     

  • ALECTINIB

    Generic Brand HICL GCN Exception/Other

    ALECTINIB

    ALECENSA

    42895

     

     

    This drug requires a written request for prior authorization.

  • ALLERGEN EXTRACT-HOUSE DUST MITE

    Generic Brand HICL GCN Exception/Other

    HOUSE DUST MITE

    ODACTRA

     

    42527

    ROUTE = SUBLINGUAL

  • ALLERGEN EXTRACT-MIXED GRASS POLLEN

    Generic Brand HICL GCN Exception/Other

    GR POL-ORC/SW
    VER/RYE/KENT/TIM

    ORALAIR

    39918