Section |
Status |
HCD |
Name |
08.01.05 |
Formulary
|
 |
Panobinostat Farydak® |
05.03.01 |
Formulary
|
 |
Abacavir Ziagen® |
05.03.01 |
Formulary
|
 |
Abacavir 300mg, Lamivudine 150mg and Zidovudine 300mg tablet Trizivir® |
05.03.01 |
Formulary
|
 |
Abacavir, Lamivudine and Dolutegravir Triumeq® |
10.01.03 |
Formulary
|
 |
Abatacept Orencia® |
08.01.05 |
Formulary
|
 |
Abemaclib Verzenios® |
08.03.04.02 |
Formulary
|
 |
Abiraterone Zytiga® |
01.05.03 |
Formulary
|
 |
Adalimumab Humira® |
10.01.03 |
Formulary
|
 |
Adalimumab Humira® Amgevita® |
13.05.03 |
Formulary
|
 |
Adalimumab Humira® |
05.03.03.01 |
Formulary
|
 |
Adefovir Dipivoxil Hepsera® |
08.01.05 |
Formulary
|
 |
Afatinib Giotrif® |
11.08.02 |
Formulary
|
 |
Aflibercept Eylea® |
08.02.04 |
Formulary
|
 |
Aldesleukin Proleukin® |
13.05.01 |
Formulary
|
 |
Alitretinoin Toctino® |
05.02 |
Formulary
|
 |
Amphotericin AmBisome® |
05.03.01 |
Formulary
|
 |
Amprenavir Agenerase® |
05.02.04 |
Formulary
|
 |
Anidulafungin |
05.03.01 |
Formulary
|
 |
Atazanavir Reyataz® |
05.03.01 |
Formulary
|
 |
Atazanavir & Cobicistat Evotaz® |
08.02.04 |
Formulary
|
 |
Avelumab Bravencio® |
08.01.05 |
Formulary
|
 |
Axitinib Inlyta® |
08.01.03 |
Formulary
|
 |
Azacitidine Vidaza® |
10.01.03 |
Formulary
|
 |
Baricitinib Olumiant® |
08.01.01 |
Formulary
|
 |
Bendamustine |
08.01.05 |
Formulary
|
 |
Bevacizumab Avastin® |
08.01.05 |
Formulary
|
 |
Binimetinib Mektovi® |
05.03.03.02 |
Formulary
|
 |
Boceprevir Victrelis® |
08.01.05 |
Formulary
|
 |
Bortezomib Velcade® |
08.01.05 |
Formulary
|
 |
Bosutinib Bosulif® |
04.09.03 |
Formulary
|
 |
Botulinum Toxin Type A Dysport® |
04.09.03 |
Formulary
|
 |
Botulinum Toxin Type A Botox® |
08.01.05 |
Formulary
|
 |
Brentuximab vedotin Adcetris® |
08.01.05 |
Formulary
|
 |
Brigatinib Alunbrig® |
13.05.03 |
Formulary
|
 |
Brodalumab Kyntheum® |
13.01 |
Formulary
|
 |
Bromelain NexoBrid® |
03.04.03 |
Formulary
|
 |
C1 Esterase Inhibitor |
08.01.05 |
Formulary
|
 |
Cabazitaxel Jevtana® |
08.01.05 |
Formulary
|
 |
Cabozantinib Cometriq® |
18 |
Non Formulary
|
 |
Carboxypeptidase Glucarpidase |
08.01.05 |
Formulary
|
 |
Carfilzomib Kyprolis® |
05.02.04 |
Formulary
|
 |
Caspofungin Cancidas® |
08.01.05 |
Formulary
|
 |
Cemiplimab 350 mg concentrate for solution for infusion Libtayo® |
08.01.05 |
Formulary
|
 |
Ceritinib Zykadia® |
10.01.03 |
Formulary
|
 |
Certolizumab Pegol Cimzia® |
08.01.05 |
Formulary
|
 |
Cetuximab Erbitux® |
05.03.02.02 |
Formulary
|
 |
Cidofovir infusion Vistide® |
09.05.01.02 |
Formulary
|
 |
Cinacalcet Mimpara® |
08.01.03 |
Formulary
|
 |
Clofarabine Evoltra® |
08.01.05 |
Formulary
|
 |
Crizotinib Xalkori® |
08.01.05 |
Formulary
|
 |
Dabrafenib Tafinlar® |
05.03.03.02 |
Formulary
|
 |
Daclatasvir Daklinza® |
08.01.05 |
Non Formulary
|
 |
Dacomitinib film coated tablets Vizimpro® |
08.02.03 |
Formulary
|
 |
Daratumumab Darzalex® |
09.01.03 |
Formulary
|
 |
Darbepoetin Alfa Aranesp® |
05.03.01 |
Formulary
|
 |
Darunavir Prezista® |
05.03.01 |
Formulary
|
 |
Darunavir & Cobicistat Rezolsta® |
05.03.01 |
Formulary
|
 |
Darunavir/Cobicistat/Emtricitabine/Tenofovir Symtuza® |
05.03.03.02 |
Formulary
|
 |
Dasabuvir Exviera® |
08.01.05 |
Formulary
|
 |
Dasatinib Sprycel® |
08.01.02 |
Formulary
|
 |
Daunorubicin 44mg / Cytarabine 100mg Vyxeos |
20 |
Non Formulary
|
 |
DAUNORUBICIN saline pre-filled syringe |
09.01.03 |
Formulary
|
 |
Deferasirox Exjade® |
20 |
Non Formulary
|
 |
DEFIBROTIDE Capsules 400 mg |
20 |
Non Formulary
|
 |
DEFIBROTIDE Injection 200 mg |
09.01.03 |
Formulary
|
 |
Desferrioxamine Mesilate |
11.04.01 |
Formulary
|
 |
Dexamethasone intravitreal implant Ozurdex® |
05.03.01 |
Formulary
|
 |
Didanosine Videx® |
05.03.01 |
Formulary
|
 |
Didanosine 10mg/ml oral liquid |
02.01.01 |
Formulary
|
 |
Digoxin specific antibody fragments Digifab® |
18 |
Non Formulary
|
 |
Digoxin specific antibody fragments Digifab® |
08.02.04 |
Formulary
|
 |
Dimethyl fumarate Tecfidera® |
13.05.02 |
Formulary
|
 |
Dimethyl Fumarate Skilarene® |
05.03.01 |
Formulary
|
 |
Dolutegravir Tivicay® |
05.03.01 |
Formulary
|
 |
Doravirine Pifeltro® |
05.03.01 |
Formulary
|
 |
Doravirine 100 mg, Lamivudine 300 mg, Tenofovir disoproxil (as Tenofovir disoproxil fumarate) |
03.07 |
Restricted Use
|
 |
Dornase Alfa Pulmozyme® |
08.01.02 |
Formulary
|
 |
Doxorubicin Hydrochloride Caelyx® |
13.05.03 |
Formulary
|
 |
Dupilumab Dupixent® |
08.01.05 |
Formulary
|
 |
Durvalumab Imfinzi® |
05.03.01 |
Formulary
|
 |
Efavirenz |
05.03.01 |
Formulary
|
 |
Efavirenz 600mg, Emtricitabine 200mg and Tenofovir 245mg tablet Atripla® |
05.03.03.02 |
Formulary
|
 |
Elbasvir/Grazoprevir Zepatier® |
09.01.04 |
Formulary
|
 |
Eltrombopag |
05.03.01 |
Formulary
|
 |
Emtricitabine 200mg Emtriva® |
05.03.01 |
Formulary
|
 |
Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg tablet Eviplera® |
08.01.05 |
Formulary
|
 |
Encorafenib Braftovi® |
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® |
20 |
Non Formulary
|
 |
Eptotermin Alfa Osigraft® |
08.01.05 |
Formulary
|
 |
Eribulin Halaven® |
10.01.03 |
Formulary
|
 |
Etanercept Enbrel® |
13.05.03 |
Formulary
|
 |
Etanercept Enbrel® |
05.03.01 |
Formulary
|
 |
Etravirine Intelence® |
08.01.05 |
Formulary
|
 |
Everolimus Votubia® |
02.11 |
Formulary
|
 |
Factor IX Fraction, Dried |
02.11 |
Formulary
|
 |
Factor VIII Fraction, Dried |
02.11 |
Formulary
|
 |
Factor XI |
02.11 |
Formulary
|
 |
Factor XII |
08.02.04 |
Formulary
|
 |
Fingolimod Gilenya® |
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 Infusion Foscavir® |
05.03.02.02 |
Formulary
|
 |
Ganciclovir Cymevene® |
08.01.05 |
Formulary
|
 |
Gefitinib Iressa® |
08.02.03 |
Formulary
|
 |
Gemtuzumab ozogamicin Mylotarg |
08.02.04 |
Formulary
|
 |
Glatiramer Acetate Copaxone® |
05.03.03.02 |
Formulary
|
 |
Glecaprevir/pibrentasvir Maviret® |
01.05.03 |
Formulary
|
 |
Golimumab Simponi® |
10.01.03 |
Formulary
|
 |
Golimumab Simponi® |
13.05.03 |
Formulary
|
 |
Guselkumab Tremfya® |
05.03.03.02 |
Formulary
|
 |
Harvoni Harvoni® |
08.01.05 |
Formulary
|
 |
Imatinib Gilvec® |
05.03.01 |
Formulary
|
 |
Indinavir Crixivan® |
01.05.03 |
Formulary
|
 |
Infliximab Remicade® Remsima® |
10.01.03 |
Formulary
|
 |
Infliximab Remicade® |
13.05.03 |
Formulary
|
 |
Infliximab Remicade® |
08.02.04 |
Formulary
|
 |
Interferon Alfa IntronA |
08.02.04 |
Formulary
|
 |
Interferon Alfa Roferon-A® |
08.02.04 |
Formulary
|
 |
Interferon beta Extavia® |
16.01 |
Formulary
|
 |
Ixazomib Ninlaro® |
05.03.01 |
Formulary
|
 |
Lamivudine |
05.03.01 |
Formulary
|
 |
Lamivudine 150mg / Zidovudine 300mg tablet |
08.01.05 |
Formulary
|
 |
Lapatinib Tyverb® |
08.02.04 |
Formulary
|
 |
Lenalidomide Revlimid® |
09.01.06 |
Formulary
|
 |
Lenograstim Granocyte® |
08.01.05 |
Formulary
|
 |
Lenvatinib Kisplyx® |
09.08.01 |
Formulary
|
 |
Levocarnitine Carnitor® |
05.03.01 |
Formulary
|
 |
Lopinavir and Ritonavir Kaletra® |
03.07 |
Formulary
|
 |
Mannitol inhalation Osmohale® |
05.03.01 |
Formulary
|
 |
Maraviroc Celsentri® |
08.02.01 |
Formulary
|
 |
Mycophenolate Mofetil |
08.02.04 |
Restricted Use
|
 |
Natalizumab Tysabri® |
08.01.03 |
Formulary
|
 |
Nelarabine Atriance® |
05.03.01 |
Formulary
|
 |
Nelfinavir Viracept® |
08.01.05 |
Formulary
|
 |
Neratinib Nerlynx® |
05.03.01 |
Formulary
|
 |
Nevirapine |
08.01.05 |
Formulary
|
 |
Nilotinib Tasigna® |
03.11 |
Non Formulary
|
 |
Nintedanib Vargatef |
20 |
Non Formulary
|
 |
Nitazoxanide |
08.02.04 |
Formulary
|
 |
Nivolumab Opdivo® |
08.02.03 |
Formulary
|
 |
Obinutuzumab Gazyvaro ® |
11.08.02 |
Formulary
|
 |
Ocriplasmin Jetrea® |
08.03.04.03 |
Formulary
|
 |
Octreotide |
08.03.04.03 |
Formulary
|
 |
Octreotide Sandostatin Lar® |
08.02.03 |
Formulary
|
 |
Ofatumumab Arzerra® |
05.03.03.02 |
Formulary
|
 |
Ombitasvir/ paritaprevir/ritonavir Viekirax® |
05.03.05 |
Formulary
|
 |
Palivizumab Synagis® |
08.01.05 |
Formulary
|
 |
Pazopanib Votrient® |
09.01.06 |
Formulary
|
 |
Pegfilgrastim Neulasta® |
08.02.04 |
Formulary
|
 |
Peginterferon Alfa |
08.02.04 |
Formulary
|
 |
Peginterferon beta-1a Plegridy® |
08.01.05 |
Formulary
|
 |
Pembrolizumab Keytruda® |
08.01.03 |
Formulary
|
 |
Pemetrexed Alimta® |
08.01.05 |
Formulary
|
 |
Pertuzumab Perjeta® |
03.11 |
Non Formulary
|
 |
pirfenidone Esbriet® |
08.01.02 |
Formulary
|
 |
Pixantrone |
08.02.04 |
Formulary
|
 |
Pomalidomide Imnovid® |
08.01.05 |
Formulary
|
 |
Ponatinib Iclusig® |
03.05.02 |
Formulary
|
 |
Poractant Curosurf® |
05.02 |
Formulary
|
 |
Posaconazole (oral) Noxafil® |
02.11 |
Formulary
|
 |
Protein C Concentrate Ceprotin® |
02.11 |
Formulary
|
 |
Prothrombin Complex Concentrate Octaplex® |
05.03.01 |
Formulary
|
 |
Raltegravir Isentress ® |
11.08.02 |
Formulary
|
 |
Ranibizumab Lucentis® |
10.01.04 |
Formulary
|
 |
Rasburicase Fastertec® |
05.03.01 |
Formulary
|
 |
Rilpivirine hydrochloride Edurant® |
04.09.03 |
Formulary
|
 |
Riluzole |
13.05.03 |
Formulary
|
 |
Risankizumab |
05.03.01 |
Formulary
|
 |
Ritonavir Norvir® |
08.02.03 |
Formulary
|
 |
Rituximab MabThera® |
10.01.03 |
Formulary
|
 |
Rituximab MabThera® |
09.01.04 |
Formulary
|
 |
Romiplostim Nplate® |
08.01.05 |
Formulary
|
 |
Ruxolitinib Jakavi® |
05.03.01 |
Formulary
|
 |
Saquinavir Invirase® |
13.05.03 |
Formulary
|
 |
Secukinumab Cosentyx® |
09.05.02.02 |
Formulary
|
 |
Sevelamer Hydrochloride |
02.05.01 |
Formulary
|
 |
Sildenafil |
20 |
Non Formulary
|
 |
Sipuleucel- T |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir Sovaldi® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir /Velpatasvir Epclusa® |
05.03.03.02 |
Formulary
|
 |
sofosbuvir/velpatasvir/voxilaprevir Vosevi® |
06.05.01 |
Formulary
|
 |
Somatropin |
05.03.01 |
Formulary
|
 |
Stavudine Zerit® |
08.01.05 |
Formulary
|
 |
Sunitinib |
20 |
Non Formulary
|
 |
Taribavirin |
05.03.03.02 |
Formulary
|
 |
Telaprevir Incivo® |
08.01.05 |
Formulary
|
 |
Temsirolimus Torisel® |
05.03.01 |
Formulary
|
 |
Tenofovir 245mg and Emtricitabine 200mg tablet Truvada® |
05.03.01 |
Formulary
|
 |
Tenofovir 245mg, cobicistat 150mg, elvitegravir 150mg and emtricitabine 200mg tablet Stribild® |
05.03.01 |
Formulary
|
 |
Tenofovir Disproxil Viread® |
08.02.04 |
Formulary
|
 |
Teriflunomide Aubagio® |
06.06.01 |
Formulary
|
 |
Teriparatide Forsteo® |
20 |
Non Formulary
|
 |
TETRAHYDROBIOPTERIN Tablets 10 mg |
08.02.04 |
Formulary
|
 |
Thalidomide Celgene® |
05.03.01 |
Formulary
|
 |
Tipranavir Aptivus® |
10.01.03 |
Formulary
|
 |
Tocilizumab RoActemra® |
10.01.05 |
Formulary
|
 |
Tofacitinib Xeljanz® |
06.05.02 |
Formulary
|
 |
Tolvaptan Samsca® |
08.01.05 |
Formulary
|
 |
Trastuzumab emtansine |
20 |
Non Formulary
|
 |
Treprostinil |
13.05.03 |
Formulary
|
 |
Ustekinumab Stelara® |
05.03.02.02 |
Formulary
|
 |
Valganciclovir tablet Valcyte® |
01.05.03 |
Formulary
|
 |
Vedolizumab Entyvio® |
08.01.05 |
Formulary
|
 |
Vemurafenib Zelboraf® |
08.01.05 |
Formulary
|
 |
Vismodegib Erivedge® |
05.02 |
Formulary
|
 |
Voriconazole Vfend® |
05.03.01 |
Formulary
|
 |
Zidovudine |