Section |
Status |
HCD |
Name |
03.04.02 |
Formulary
|
 |
Omalizumab Xolair® |
10.01.03 |
Formulary
|
 |
Abatacept Orencia® |
08.01.05 |
Formulary
|
 |
Abemaciclib Verzenios® |
08.03.04.02 |
Formulary
|
 |
Abiraterone acetate Zytiga® |
01.05.03 |
Formulary
|
 |
Adalimumab Hyrimoz®, Amgevita®, Imraldi®, Hulio®, Humira® |
10.01.03 |
Formulary
|
 |
Adalimumab Hyrimoz®, Amgevita®, Imraldi®, Hulio®, Humira®
|
11.04.01 |
Formulary
|
 |
Adalimumab Hyrimoz®, Amgevita®, Imraldi®, Hulio®, Humira® |
13.05.03 |
Formulary
|
 |
Adalimumab Hyrimoz®, Amgevita®, Imraldi®, Hulio®, Humira® |
13.06 |
Formulary
|
 |
Adalimumab Hyrimoz®, Amgevita®, Imraldi®, Hulio®, Humira® |
05.03.03.01 |
Formulary
|
 |
Adefovir Dipivoxil Hepsera® |
08.01.05 |
Formulary
|
 |
Afatinib dimaleate Giotrif® |
11.08.02 |
Formulary
|
 |
Aflibercept Eylea® |
08.01.05 |
Formulary
|
 |
Alectinib hydrochloride Alecensa® |
08.02.03 |
Formulary
|
 |
Alemtuzumab Lemtrada® |
02.12 |
Formulary
|
 |
Alirocumab Praluent® |
13.05.01 |
Formulary
|
 |
Alitretinoin Toctino® |
02.05.01 |
Formulary
|
 |
Ambrisentan Volibris® |
10.02.01 |
Formulary
|
 |
Amifampridine Firdapse® |
10.01.03 |
Formulary
|
 |
Anakinra Kineret® |
10.01.03 |
Formulary
|
 |
Apremilast Otezla® |
13.05.03 |
Formulary
|
 |
Apremilast Otezla® |
08.01.05 |
Formulary
|
 |
Arsenic trioxide Trisenox® |
08.01.05 |
Formulary
|
 |
Atezolizumab Tecentriq® |
09.01.04 |
Formulary
|
 |
Avatrombopag Doptelet® |
08.01.05 |
Formulary
|
 |
Avelumab Bavencio® |
08.02.04 |
Formulary
|
 |
Axicabtagene ciloleucel Yescarta® |
08.01.05 |
Formulary
|
 |
Axitinib Inlyta® |
08.01.03 |
Formulary
|
 |
Azacitidine Vidaza® |
05.01.02.03 |
Formulary
|
 |
Aztreonam lysine powder nebuliser solution Cayston® |
10.01.03 |
Formulary
|
 |
Baricitinib Olumiant® |
08.02.02 |
Formulary
|
 |
Basiliximab Simulect® |
10.01.03 |
Formulary
|
 |
Belimumab Benlysta® |
08.01.01 |
Formulary
|
 |
Bendamustine hydrochloride |
03.04.02 |
Formulary
|
 |
Benralizumab Fasenra® |
03.05.02 |
Formulary
|
 |
Beractant Survanta® |
08.02.03 |
Formulary
|
 |
Blinatumomab Blincyto® |
05.03.03.02 |
Formulary
|
 |
Boceprevir Victrelis® |
08.01.05 |
Formulary
|
 |
Bortezomib Velcade® |
08.01.05 |
Formulary
|
 |
Bosutinib Bosulif® |
04.07.04.02 |
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® |
03.04.03 |
Formulary
|
 |
C1 esterase inhibitor |
08.01.05 |
Formulary
|
 |
Cabazitaxel Jevtana® |
08.01.05 |
Formulary
|
 |
Cabozantinib Cabometyx® |
04.08.01 |
Formulary
|
 |
Cannabidiol Epidyolex® |
08.01.05 |
Formulary
|
 |
Carfilzomib Kyprolis® |
08.01.01 |
Formulary
|
 |
Carmustine Gliadel® |
08.01.05 |
Formulary
|
 |
Cemiplimab Libtayo® |
08.01.05 |
Formulary
|
 |
Ceritinib Zykadia® |
10.01.03 |
Formulary
|
 |
Certolizumab Pegol Cimzia® |
08.01.05 |
Formulary
|
 |
Cetuximab Erbitux® |
08.01.03 |
Formulary
|
 |
Cladribine Mavenclad ® |
05.01.07 |
Formulary
|
 |
Colistimethate Promixin® |
05.01.07 |
Formulary
|
 |
Colistimethate Inhaler Colobreathe® |
10.03.01 |
Formulary
|
 |
Collagenase Xiapex® |
03.04.03 |
Formulary
|
 |
Conestat Alfa Ruconest® |
08.01.05 |
Formulary
|
 |
Crizotinib Xalkori® |
08.01.03 |
Formulary
|
 |
Cytarabine–daunorubicin liposomal Vyxeos® |
08.01.05 |
Formulary
|
 |
Dabrafenib mesilate Tafinlar® |
05.03.03.02 |
Formulary
|
 |
Daclatasvir Daklinza® |
08.02.04 |
Restricted Use
|
 |
Daclizumab Zinbryta® |
08.01.05 |
Formulary
|
 |
Dacomitinib Vizimpro® |
08.01.05 |
Formulary
|
 |
Daratumumab Darzalex® |
09.01.03 |
Formulary
|
 |
Darbepoetin Alfa Aranesp® |
05.03.03.02 |
Formulary
|
 |
Dasabuvir Sodium Monohydrate Exviera® |
08.01.05 |
Formulary
|
 |
Dasatinib Sprycel® |
20 |
Non Formulary
|
 |
DAUNORUBICIN saline pre-filled syringe |
20 |
Non Formulary
|
 |
DEFIBROTIDE Capsules 400 mg |
20 |
Non Formulary
|
 |
DEFIBROTIDE Injection 200 mg |
06.06.02 |
Formulary
|
 |
Denosumab |
11.04.01 |
Formulary
|
 |
Dexamethasone Ozurdex® |
08.03.01 |
Formulary
|
 |
Diethylstilbestrol |
02.01.01 |
Formulary
|
 |
Digifab® |
18 |
Non Formulary
|
 |
Digoxin specific antibody fragments Digifab® |
08.02.04 |
Formulary
|
 |
Dimethyl fumarate Tecfidera® |
13.05.03 |
Formulary
|
 |
Dimethyl Fumarate Skilarence® |
08.01.05 |
Formulary
|
 |
Dinutuximab beta Qarziba® |
08.01.05 |
Formulary
|
 |
Docetaxel |
03.07 |
Formulary
|
 |
Dornase Alfa Pulmozyme® |
08.01.05 |
Formulary
|
 |
Doxorubicin hydrochloride Caelyx® |
13.05.03 |
Formulary
|
 |
Dupilumab Dupixent® |
08.01.05 |
Formulary
|
 |
Durvalumab Imfinzi® |
09.01.03 |
Formulary
|
 |
Eculizumab Soliris® |
05.03.03.02 |
Formulary
|
 |
Elbasvir & Grazoprevir Zepatier® |
09.08.01 |
Formulary
|
 |
Elosulfase alfa Vimizim® |
09.01.04 |
Formulary
|
 |
Eltrombopag Revolade® |
08.01.05 |
Formulary
|
 |
Encorafenib Braftovi® |
05.03.03.01 |
Formulary
|
 |
Entecavir Monohydrate Baraclude® |
08.01.05 |
Formulary
|
 |
Entrectinib Rozlytrek® |
08.03.04.02 |
Formulary
|
 |
Enzalutamide Xtandi® |
09.01.03 |
Formulary
|
 |
Epoetin Alfa Eprex® |
09.01.03 |
Formulary
|
 |
Epoetin Beta NeoRecormon® |
09.01.03 |
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 hydrochloride Tarceva® |
10.01.03 |
Formulary
|
 |
Etanercept Enbrel®, Benepali®, Erelzi® |
13.05.03 |
Formulary
|
 |
Etanercept Enbrel®, Benepali®, Erelzi® |
08.01.05 |
Formulary
|
 |
Everolimus |
02.12 |
Formulary
|
 |
Evolocumab Repatha® |
10.02.01 |
Formulary
|
 |
Fampridine Fampyra® |
08.02.04 |
Formulary
|
 |
Fingolimod Gilenya® |
08.01.03 |
Formulary
|
 |
Fludarabine phosphate |
11.04.01 |
Formulary
|
 |
Fluocinolone acetonide Iluvien® |
18 |
Non Formulary
|
 |
Fomepizole |
04.07.04.02 |
Formulary
|
 |
Fremanezumab |
08.01.05 |
Formulary
|
 |
Gefitinib Iressa® |
08.01.03 |
Formulary
|
 |
Gemcitabine |
08.01.05 |
Formulary
|
 |
Gemtuzumab ozogamicin Mylotarg® |
08.01.05 |
Formulary
|
 |
Gilteritinib Xospata® |
08.02.04 |
Formulary
|
 |
Glatiramer acetate Copaxone® |
05.03.03.02 |
Formulary
|
 |
Glecaprevir & Pibrentasvir Maviret® |
18 |
Non Formulary
|
 |
Glucarpidase Carboxypeptidase |
01.05.03 |
Formulary
|
 |
Golimumab Simponi® |
10.01.03 |
Formulary
|
 |
Golimumab Simponi® |
13.05.03 |
Formulary
|
 |
Guselkumab Tremfya® |
08.01.05 |
Formulary
|
 |
Ibrutinib Imbruvica® |
03.04.03 |
Formulary
|
 |
Icatibant Firazyr® |
08.01.05 |
Formulary
|
 |
Idelalisib Zydelig® |
08.01.05 |
Formulary
|
 |
Imatinib mesilate |
01.05.03 |
Formulary
|
 |
Infliximab Flixabi®, Inflectra®, Remicade®, Remsima® |
10.01.03 |
Formulary
|
 |
Infliximab Flixabi®, Inflectra®, Remicade®, Remsima® |
13.05.03 |
Formulary
|
 |
Infliximab Flixabi®, Inflectra®, Remicade®, Remsima® |
08.01.05 |
Formulary
|
 |
Inotuzumab ozogamicin Besponsa® |
08.02.04 |
Formulary
|
 |
Interferon Beta |
08.01.05 |
Formulary
|
 |
Ipilimumab Yervoy® |
03.07 |
Formulary
|
 |
Ivacaftor Kalydeco® |
08.01.05 |
Formulary
|
 |
Ixazomib Ninlaro® |
10.01.03 |
Formulary
|
 |
Ixekizumab Taltz® |
13.05.03 |
Formulary
|
 |
Ixekizumab Taltz® |
03.04.03 |
Formulary
|
 |
Lanadelumab Takhzyro® |
08.03.04.03 |
Formulary
|
 |
Lanreotide acetate |
08.03.04.03 |
Formulary
|
 |
Lanreotide acetate |
09.05.02.02 |
Formulary
|
 |
Lanthanum carbonate Fosrenol® |
08.01.05 |
Formulary
|
 |
Larotrectinib |
05.03.03.02 |
Formulary
|
 |
Ledipasvir & Sofosbuvir Harvoni® |
08.02.04 |
Formulary
|
 |
Lenalidomide Revlimid® |
09.01.06 |
Formulary
|
 |
Lenograstim Granocyte® |
08.01.05 |
Formulary
|
 |
Lenvatinib |
05.03.02.02 |
Formulary
|
 |
Letermovir Prevymis® |
05.01.12 |
Formulary
|
 |
Levofloxacin nebuliser solution Quinsair® |
08.01.05 |
Formulary
|
 |
Lorlatinib |
09.01.04 |
Formulary
|
 |
Lusutrombopag Mulpleo® |
08.03.04.03 |
Formulary
|
 |
Lutetium (177Lu) oxodotreotide |
03.07 |
Formulary
|
 |
Mannitol inhalation Bronchitol ® |
06.07.04 |
Formulary
|
 |
Mecasermin Increlex® |
03.04.02 |
Restricted Use
|
 |
Mepolizumab Nucala® |
08.01.05 |
Formulary
|
 |
Midostaurin Rydapt ® |
08.02.04 |
Formulary
|
 |
Mifamurtide Mepact® |
08.02.04 |
Formulary
|
 |
Natalizumab Tysabri® |
08.03.04.01 |
Formulary
|
 |
Neratinib Nerlynx® |
08.01.05 |
Formulary
|
 |
Nilotinib Tasigna® |
08.01.05 |
Formulary
|
 |
Nintedanib esilate |
08.01.05 |
Formulary
|
 |
Niraparib Zejula® |
20 |
Non Formulary
|
 |
Nitazoxanide |
08.01.05 |
Formulary
|
 |
Nivolumab Opdivo® |
14.05.01 |
Non Formulary
|
 |
Normal immunoglobulin for Intramuscular use |
14.05.01 |
Non Formulary
|
 |
Normal immunoglobulin for Intravenous use |
14.05.01 |
Non Formulary
|
 |
Normal immunoglobulin for Subcutaneous use |
10.02 |
Formulary
|
 |
Nusinersen Spinraza ® |
01.09.01 |
Restricted Use
|
 |
Obeticholic acid |
08.02.03 |
Formulary
|
 |
Obinutuzumab Gazyvaro® |
08.02.03 |
Formulary
|
 |
Ocrelizumab Ocrevus® |
11.08.02 |
Formulary
|
 |
Ocriplasmin Jetrea® |
08.03.04.03 |
Formulary
|
 |
Octreotide acetate |
08.03.04.03 |
Formulary
|
 |
Octreotide acetate |
08.02.03 |
Formulary
|
 |
Ofatumumab Arzerra® |
08.01.05 |
Formulary
|
 |
Olaparib Lynparza® |
08.01.05 |
Formulary
|
 |
Olaratumab Lartruvo® |
05.03.03.02 |
Formulary
|
 |
Ombitasvir, paritaprevir & ritonavir Viekirax® |
08.01.05 |
Formulary
|
 |
Osimertinib Tagrisso® |
08.01.05 |
Formulary
|
 |
Oxaliplatin |
08.01.05 |
Formulary
|
 |
Paclitaxel |
08.01.05 |
Formulary
|
 |
Palbociclib Ibrance® |
08.01.05 |
Formulary
|
 |
Panitumumab Vectibix® |
08.01.05 |
Formulary
|
 |
Panobinostat Farydak® |
08.01.05 |
Formulary
|
 |
Pazopanib Votrient® |
08.01.05 |
Formulary
|
 |
Pegaspargase Oncaspar® |
08.02.04 |
Formulary
|
 |
Peginterferon Beta-1a Plegridy® |
08.01.05 |
Formulary
|
 |
Pembrolizumab Keytruda® |
08.01.03 |
Formulary
|
 |
Pemetrexed disodium Alimta® |
07.04.03 |
Formulary
|
 |
Pentosan polysulfate sodium Elmiron® |
08.01.05 |
Formulary
|
 |
Pertuzumab Perjeta® |
03.11 |
Formulary
|
 |
Pirfenidone Esbriet® |
08.01.02 |
Formulary
|
 |
Pixantrone dimaleate Pixuvri® |
09.01.07 |
Formulary
|
 |
Plerixafor Mozobil® |
08.01.05 |
Formulary
|
 |
Polatuzumab vedotin Polivy® |
08.02.04 |
Formulary
|
 |
Pomalidomide Imnovid® |
08.01.05 |
Formulary
|
 |
Ponatinib Iclusig® |
03.05.02 |
Formulary
|
 |
Poractant Alfa Curosurf® |
11.08.02 |
Formulary
|
 |
Ranibizumab Lucentis® |
08.01.05 |
Formulary
|
 |
Regorafenib Stivarga® |
03.04.02 |
Formulary
|
 |
Reslizumab Cinquil® |
05.03.03.02 |
Formulary
|
 |
Ribavirin |
08.01.05 |
Formulary
|
 |
Ribociclib succinate Kisqali® |
13.05.03 |
Formulary
|
 |
Risankizumab Skyrizi® |
08.02.03 |
Formulary
|
 |
Rituximab MabThera®, Rixathon®, Truxima® |
10.01.03 |
Formulary
|
 |
Rituximab MabThera®, Rixathon®, Truxima® |
09.01.04 |
Formulary
|
 |
Romiplostim Nplate® |
08.02.04 |
Formulary
|
 |
Rucaparib Rubraca® |
08.01.05 |
Formulary
|
 |
Ruxolitinib phosphate Jakavi® |
10.01.03 |
Formulary
|
 |
Sarilumab Kevzara® |
10.01.03 |
Formulary
|
 |
Secukinumab Cosentyx® |
13.05.03 |
Formulary
|
 |
Secukinumab Cosentyx® |
05.03.03.02 |
Formulary
|
 |
Simeprevir Olysio® |
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 |
08.01.05 |
Formulary
|
 |
Sorafenib tosylate Nexavar® |
08.01.05 |
Formulary
|
 |
Sunitinib Sutent® |
08.01.05 |
Formulary
|
 |
Talimogene laherparepvac Imlygic® |
20 |
Non Formulary
|
 |
Taribavirin |
05.03.03.02 |
Formulary
|
 |
Telaprevir Incivo® |
08.01.05 |
Formulary
|
 |
Temozolomide |
05.03.03.01 |
Formulary
|
 |
Tenofovir Disproxil Viread® |
05.03.01 |
Formulary
|
 |
Tenofovir, cobicistat, elvitegravir & emtricitabine Stribild® |
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® |
13.05.03 |
Formulary
|
 |
Tildrakizumab Ilumetri® |
08.01.05 |
Formulary
|
 |
Tisagenlecleucel Kymriah® |
08.01.05 |
Formulary
|
 |
Tivozanib Fotivda® |
05.01.04 |
Formulary
|
 |
Tobramycin dry powder for inhalation Tobi® Podhaler |
10.01.03 |
Formulary
|
 |
Tocilizumab RoActemra® |
01.05.03 |
Formulary
|
 |
Tofacitinib Xeljanz® |
10.01.03 |
Formulary
|
 |
Tofacitinib Xeljanz® |
06.05.02 |
Formulary
|
 |
Tolvaptan Jinarc® |
08.01.05 |
Formulary
|
 |
Topotecan Hycamtin® |
08.01.05 |
Formulary
|
 |
Trametinib Mekinist® |
08.01.05 |
Formulary
|
 |
Trastuzumab |
08.01.05 |
Formulary
|
 |
Trastuzumab emtansine |
08.01.01 |
Formulary
|
 |
Treosulfan Trecondi® |
20 |
Non Formulary
|
 |
Treprostinil |
08.01.05 |
Formulary
|
 |
Trifluridine-tipiracil Lonsurf® |
01.05.03 |
Formulary
|
 |
Ustekinumab Stelara® |
13.05.03 |
Formulary
|
 |
Ustekinumab Stelara® |
01.05.03 |
Formulary
|
 |
Vedolizumab Entyvio® |
08.01.05 |
Formulary
|
 |
Vemurafenib Zelboraf® |
11.08.02 |
Formulary
|
 |
Verteporfin Visudyne® |