Specialty Pharmacy Drug List AWS
Specialty Pharmacy Drug List Specialty medicines are usually prescribed by doctors who treat chronic and complex disease. These medications usually require a higher degree of management, are high in cost and are generally not stocked at retail pharmacies. Fairview Specialty Pharmacy is the exclusive network provider of specialty drugs for UCare State Public Program (Medicaid) members. Phone: 612-672-5260 or 1-800-595-7140 (toll free). A Fairview pharmacist is available 24 hours a day. Fax: 1-866-347-4939. The list below applies to State Public Programs and is updated regularly. Drugs with a Non-Formulary status may be covered under your medical benefit. Please go to ucare.org to review coverage criteria. F = Formulary, NF = Non-Formulary DRUG
FORMULARY STATUS
DRUG
FORMULARY STATUS
ABRAXANE 100 MG VIAL
NF
AFINITOR 10 MG TABLET
F
ACTEMRA 162 MG/0.9 ML SYRINGE
NF
AFINITOR 2.5 MG TABLET
F
ACTEMRA 200 MG/10 ML VIAL
NF
AFINITOR 5 MG TABLET
F
ACTEMRA 400 MG/20 ML VIAL
NF
AFINITOR 7.5 MG TABLET
F
ACTEMRA 80 MG/4 ML VIAL
NF
AFINITOR DISPERZ 2 MG TABLET
F
ACTIMMUNE 100 MCG/0.5 ML VIAL
NF
AFINITOR DISPERZ 3 MG TABLET
F
ADCETRIS 50 MG VIAL
NF
F
ADCIRCA 20 MG TABLET
NF
AFINITOR DISPERZ 5 MG TABLET
ADEFOVIR DIPIVOXIL 10 MG TAB
F
AFSTYLA 1,000 UNIT VIAL
F F
ADVATE 1,201-1,800 UNIT VIAL
F
AFSTYLA 1,500 UNIT RANGE VIAL AFSTYLA 2,000 UNIT VIAL
F
ADVATE 1,801-2,400 UNIT VIAL
F
AFSTYLA 2,500 UNIT RANGE VIAL
F
ADVATE 2,401-3,600 UNIT VIAL
F
AFSTYLA 250 UNIT VIAL
F
ADVATE 200-400 UNIT VIAL
F
AFSTYLA 3,000 UNIT VIAL
F
ADVATE 3,601-4,800 UNIT VIAL
F
AFSTYLA 500 UNIT VIAL
F NF
ADVATE 401-800 UNIT VIAL
F
ALDURAZYME 2.9 MG/5 ML VIAL
ADVATE 801-1,200 UNIT VIAL
F
ALECENSA 150 MG CAPSULE
F
PMAP MnCare MSC+ SNBC_010518_1 DHS Approved (01102018)
U7483 (01/18)
DRUG
FORMULARY STATUS
DRUG
FORMULARY STATUS
ALFERON N 5 MILLION UNITS VIAL
NF
ARANESP 300 MCG/0.6 ML SYRINGE
F
ALIMTA 100 MG VIAL
NF
ARANESP 300 MCG/ML VIAL
F
ALIMTA 500 MG VIAL
NF
F
ALKERAN 2 MG TABLET
NF
ARANESP 40 MCG/0.4 ML SYRINGE
ALKERAN 50 MG VIAL
NF
ARANESP 40 MCG/ML VIAL
F
ALPHANATE 1,000-400 UNIT VIAL
F
ARANESP 500 MCG/1 ML SYRINGE
F
ALPHANATE 1,500-600 UNIT VIAL
F
ARANESP 60 MCG/0.3 ML SYRINGE
F
ALPHANATE 2,000-800 UNIT VIAL
NF
ARANESP 60 MCG/ML VIAL
F NF
ALPHANATE 250-100 UNIT VIAL
F
ARIXTRA 10 MG/0.8 ML SYRINGE
NF
ALPHANATE 500-200 UNIT VIAL
F
ARIXTRA 2.5 MG/0.5 ML SYRINGE
NF
ALPHANINE SD 1,000 UNITS VIAL
NF
ARIXTRA 5 MG/0.4 ML SYRINGE
NF
ALPHANINE SD 1,500 UNITS VIAL
NF
ARIXTRA 7.5 MG/0.6 ML SYRINGE ARRANON 250 MG/50 ML VIAL
NF
ALPHANINE SD 500 UNITS VIAL
NF
ARZERRA 1,000 MG/50 ML VIAL
NF
ARALAST NP 1,000 MG VIAL
NF
ARZERRA 100 MG/5 ML VIAL
NF
ARALAST NP 500 MG VIAL
NF
NF
ARANESP 10 MCG/0.4 ML SYRINGE
F
ASTAGRAF XL 0.5 MG CAPSULE ASTAGRAF XL 1 MG CAPSULE
NF
ARANESP 100 MCG/0.5 ML SYRINGE
F
ASTAGRAF XL 5 MG CAPSULE
NF
ARANESP 100 MCG/ML VIAL
F
ATGAM 50 MG/ML AMPUL
F
ARANESP 150 MCG/0.3 ML SYRINGE
F
AVASTIN 100 MG/4 ML VIAL
NF
AVASTIN 400 MG/16 ML VIAL
NF
ARANESP 150 MCG/0.75 ML VIAL
F
AVONEX 30 MCG VIAL KIT
F
ARANESP 200 MCG/0.4 ML SYRINGE
F
AVONEX PEN 30 MCG/0.5 ML KIT
F
ARANESP 200 MCG/ML VIAL
F
AVONEX PREFILLED SYR 30 MCG
F
ARANESP 25 MCG/0.42 ML SYRING
F
AVONEX PREFILLED SYR 30 MCG KT
F
ARANESP 25 MCG/ML VIAL
F
DRUG
FORMULARY STATUS
DRUG
FORMULARY STATUS
BARACLUDE 0.05 MG/ML SOLUTION
F
CALCIUM FOLINATE POWDER
NF
BARACLUDE 0.5 MG TABLET
NF
CAMPTOSAR 100 MG/5 ML VIAL
NF
BARACLUDE 1 MG TABLET
NF
NF
BCG (TICE STRAIN) VIAL
NF
CAMPTOSAR 300 MG/15 ML VIAL
BCG VACCINE (TICE STRAIN) VIAL
NF
CAMPTOSAR 40 MG/2 ML VIAL
NF
BEBULIN 200-1,200 UNITS VIAL
NF
CAPECITABINE 150 MG TABLET
F
BENEFIX 1,000 UNIT RANGE
NF
CAPECITABINE 500 MG TABLET
F
BENEFIX 2,000 UNIT RANGE
NF
CARIMUNE NF 12 GM VIAL
NF
BENEFIX 250 UNIT RANGE
NF
CARIMUNE NF 6 GM VIAL
NF
BENEFIX 3,000 UNIT RANGE
NF
NF
BENEFIX 500 UNIT RANGE
NF
CELLCEPT 200 MG/ML ORAL SUSP
BENLYSTA 120 MG VIAL
NF
CELLCEPT 250 MG CAPSULE
NF
BENLYSTA 200 MG/ML AUTOINJECT
NF
CELLCEPT 500 MG TABLET
NF
CELLCEPT 500 MG VIAL
NF
BENLYSTA 200 MG/ML SYRINGE
NF
CEREZYME 400 UNITS VIAL
NF
BENLYSTA 400 MG VIAL
NF
CETROTIDE 0.25 MG KIT
NF
BERINERT 500 UNIT KIT
NF
CIMZIA 200 MG VIAL KIT
NF
BETASERON 0.3 MG KIT
F
CIMZIA 200 MG/ML STARTER KIT
NF
BETHKIS 300 MG/4 ML AMPULE
NF
CIMZIA 200 MG/ML SYRINGE KIT
NF
BICNU 100 MG VIAL
NF
CLOLAR 20 MG/20 ML VIAL
NF
BIVIGAM LIQUID 10% VIAL
NF
NF
BOTOX 100 UNITS VIAL
NF
COPAXONE 20 MG/ML SYRINGE
BOTOX 200 UNITS VIAL
NF
COPAXONE 40 MG/ML SYRINGE
F
BOTOX COSMETIC 100 UNITS VIAL
NF
COPEGUS 200 MG TABLET
NF
BOTOX COSMETIC 50 UNITS VIAL
NF
COSENTYX 150 MG/ML PEN INJECT
F
BRAVELLE 75 UNIT VIAL
NF
COSENTYX 150 MG/ML SYRINGE
F
BUSULFEX 60 MG/10 ML VIAL
NF
F
CALCIUM FOLINATE 10 MG/ML VIAL
F
COSENTYX 300 MG DOSE-2 PENS
DRUG
FORMULARY STATUS
COSENTYX 300 MG DOSE-2 SYRINGE
F
COSMEGEN 0.5 MG VIAL
NF
CYTOGAM 2.5 GM/50 ML VIAL
NF
DACOGEN 50 MG VIAL
NF
DAKLINZA 30 MG TABLET
NF
DAKLINZA 60 MG TABLET
NF
DAKLINZA 90 MG TABLET
NF
DAUNOXOME 50 MG (2 MG/ML) VIAL
DRUG
FORMULARY STATUS
ELITEK 1.5 MG VIAL
NF
ELITEK 7.5 MG VIAL
NF
ELLENCE 2 MG/ML VIAL
NF
ELOCTATE 1,000 UNIT NOMINAL
F
ELOCTATE 1,500 UNIT NOMINAL
F
ELOCTATE 2,000 UNIT NOMINAL
F
NF
ELOCTATE 250 UNIT NOMINAL
F
DDAVP 0.01% NASAL SPRAY
NF
F
DDAVP 0.1 MG TABLET
NF
ELOCTATE 3,000 UNIT NOMINAL
DDAVP 0.2 MG TABLET
NF
ELOCTATE 4,000 UNIT NOMINAL
F
DDAVP 10 MCG/0.1 ML SOLUTION
NF
ELOCTATE 5,000 UNIT NOMINAL
F
DDAVP 4 MCG/ML AMPUL
NF
F
DDAVP 4 MCG/ML VIAL
NF
ELOCTATE 500 UNIT NOMINAL
DEPOCYT 50 MG/5 ML VIAL
NF
ELOCTATE 6,000 UNIT NOMINAL
F
DESFERAL 2 GRAM VIAL
NF
F
DESFERAL MESYLATE 500 MG VL
NF
ELOCTATE 750 UNIT NOMINAL ELOXATIN 100 MG/20 ML VIAL
NF
DOCEFREZ 20 MG VIAL
NF
ELOXATIN 50 MG/10 ML VIAL
NF
DOCEFREZ 80 MG VIAL
NF
ELSPAR 10,000 UNITS VIAL
NF
DOXIL 2 MG/ML VIAL
NF
ENBREL 25 MG KIT
F
DUPIXENT 300 MG/2 ML SAFE SYRG
F
ENBREL 25 MG/0.5 ML SYRINGE
F
DYSPORT 300 UNIT VIAL
NF
F
DYSPORT 500 UNITS VIAL
NF
ENBREL 50 MG/ML MINI CARTRIDGE
ELAPRASE 6 MG/3 ML VIAL
NF
ENBREL 50 MG/ML SURECLICK SYR
F
ELIGARD 22.5 MG SYRINGE KIT
NF
ENBREL 50 MG/ML SYRINGE
F
ELIGARD 30 MG SYRINGE KIT
NF
ENTECAVIR 0.5 MG TABLET
F
ELIGARD 45 MG SYRINGE KIT
NF
ENTECAVIR 1 MG TABLET
F
ELIGARD 7.5 MG SYRINGE KIT
NF
ENTYVIO 300 MG VIAL
NF
DRUG
FORMULARY STATUS
DRUG
FORMULARY STATUS
ENVARSUS XR 0.75 MG TABLET
NF
FEIBA NF 1,000 UNIT (NOMINAL)
F
ENVARSUS XR 1 MG TABLET
NF
F
ENVARSUS XR 4 MG TABLET
NF
FEIBA NF 1,750-3,250 UNIT VIAL
EPCLUSA 400 MG-100 MG TABLET
NF
FEIBA NF 2,500 UNIT (NOMINAL)
F
EPIVIR HBV 100 MG TABLET
NF
FEIBA NF 400-650 UNIT VIAL
F
EPIVIR HBV 25 MG/5 ML SOLN
F
FEIBA NF 500 UNIT (NOMINAL)
F
EPOGEN 10,000 UNITS/ML VIAL
F
FIRAZYR 30 MG/3 ML SYRINGE
F
EPOGEN 2,000 UNITS/ML VIAL
F
FIRMAGON 2 X 120 MG KIT
F
EPOGEN 20,000 UNITS/2 ML VIAL
F
FIRMAGON 2 X 120 MG VIALS
F
EPOGEN 20,000 UNITS/ML VIAL
F
FIRMAGON 80 MG KIT
F
FIRMAGON 80 MG VIAL
F
EPOGEN 3,000 UNITS/ML VIAL
F
FLEBOGAMMA DIF 10% VIAL
NF
EPOGEN 4,000 UNITS/ML VIAL
F
FLEBOGAMMA DIF 5% VIAL
NF
ERBITUX 100 MG/50 ML VIAL
NF
FLOXURIDINE 500 MG VIAL
F
ERBITUX 200 MG/100 ML VIAL
NF
FLOXURIDINE POWDER
NF
ESBRIET 267 MG CAPSULE
F
FOLLISTIM AQ 150 UNIT VIAL
NF
ESBRIET 267 MG TABLET
F
NF
ESBRIET 801 MG TABLET
F
FOLLISTIM AQ 300 UNIT CARTRIDG
ETOPOPHOS 100 MG VIAL
NF
FOLLISTIM AQ 600 UNIT CARTRIDG
NF
EUFLEXXA 20 MG/2 ML SYRINGE
F
FOLLISTIM AQ 75 UNIT VIAL
NF
EVOMELA 50 MG VIAL
NF
FOLLISTIM AQ 900 UNIT CARTRIDG
NF
EXJADE 125 MG TABLET
F
FOLOTYN 20 MG/ML VIAL
NF
EXJADE 250 MG TABLET
F
FOLOTYN 40 MG/2 ML VIAL
NF
EXJADE 500 MG TABLET
F
F
EXTAVIA 0.3 MG KIT
F
FORTEO 600 MCG/2.4 ML PEN INJ
EXTAVIA 0.3 MG VIAL
NF
FRAGMIN 10,000 UNITS/ML SYRING
NF
FABRAZYME 35 MG VIAL
F
FRAGMIN 12,500 UNITS/0.5 ML
NF
FABRAZYME 5 MG VIAL
F
FRAGMIN 15,000 UNITS/0.6 ML
NF
FASLODEX 250 MG/5 ML SYRINGE
F
FRAGMIN 18,000 UNITS/0.72 ML
NF
DRUG
FORMULARY STATUS
DRUG
FORMULARY STATUS
FRAGMIN 2,500 UNITS/0.2 ML SYR
NF
GAMMAPLEX 5 GRAM/50 ML VIAL
NF
FRAGMIN 25,000 UNITS/ML VIAL
NF
GAMUNEX-C 1 GRAM/10 ML VIAL
F
FRAGMIN 5,000 UNITS/0.2 ML SYR
NF
GAMUNEX-C 10 GRAM/100 ML VIAL
F
FRAGMIN 7,500 UNITS/0.3 ML SYR
NF
GAMUNEX-C 2.5 GRAM/25 ML VIAL
F
FRAGMIN 95,000 UNITS/3.8 ML VL
NF
GAMUNEX-C 20 GRAM/200 ML VIAL
F
FUZEON 90 MG VIAL
F
NF
GAMASTAN S-D VIAL
F
GAMUNEX-C 40 GRAM/400 ML VIAL
GAMMAGARD LIQUID 10% VIAL
F
GAMUNEX-C 5 GRAM/50 ML VIAL
F
GAMMAGARD S-D 10 G (IGA
FORMULARY STATUS
DRUG
FORMULARY STATUS
ABRAXANE 100 MG VIAL
NF
AFINITOR 10 MG TABLET
F
ACTEMRA 162 MG/0.9 ML SYRINGE
NF
AFINITOR 2.5 MG TABLET
F
ACTEMRA 200 MG/10 ML VIAL
NF
AFINITOR 5 MG TABLET
F
ACTEMRA 400 MG/20 ML VIAL
NF
AFINITOR 7.5 MG TABLET
F
ACTEMRA 80 MG/4 ML VIAL
NF
AFINITOR DISPERZ 2 MG TABLET
F
ACTIMMUNE 100 MCG/0.5 ML VIAL
NF
AFINITOR DISPERZ 3 MG TABLET
F
ADCETRIS 50 MG VIAL
NF
F
ADCIRCA 20 MG TABLET
NF
AFINITOR DISPERZ 5 MG TABLET
ADEFOVIR DIPIVOXIL 10 MG TAB
F
AFSTYLA 1,000 UNIT VIAL
F F
ADVATE 1,201-1,800 UNIT VIAL
F
AFSTYLA 1,500 UNIT RANGE VIAL AFSTYLA 2,000 UNIT VIAL
F
ADVATE 1,801-2,400 UNIT VIAL
F
AFSTYLA 2,500 UNIT RANGE VIAL
F
ADVATE 2,401-3,600 UNIT VIAL
F
AFSTYLA 250 UNIT VIAL
F
ADVATE 200-400 UNIT VIAL
F
AFSTYLA 3,000 UNIT VIAL
F
ADVATE 3,601-4,800 UNIT VIAL
F
AFSTYLA 500 UNIT VIAL
F NF
ADVATE 401-800 UNIT VIAL
F
ALDURAZYME 2.9 MG/5 ML VIAL
ADVATE 801-1,200 UNIT VIAL
F
ALECENSA 150 MG CAPSULE
F
PMAP MnCare MSC+ SNBC_010518_1 DHS Approved (01102018)
U7483 (01/18)
DRUG
FORMULARY STATUS
DRUG
FORMULARY STATUS
ALFERON N 5 MILLION UNITS VIAL
NF
ARANESP 300 MCG/0.6 ML SYRINGE
F
ALIMTA 100 MG VIAL
NF
ARANESP 300 MCG/ML VIAL
F
ALIMTA 500 MG VIAL
NF
F
ALKERAN 2 MG TABLET
NF
ARANESP 40 MCG/0.4 ML SYRINGE
ALKERAN 50 MG VIAL
NF
ARANESP 40 MCG/ML VIAL
F
ALPHANATE 1,000-400 UNIT VIAL
F
ARANESP 500 MCG/1 ML SYRINGE
F
ALPHANATE 1,500-600 UNIT VIAL
F
ARANESP 60 MCG/0.3 ML SYRINGE
F
ALPHANATE 2,000-800 UNIT VIAL
NF
ARANESP 60 MCG/ML VIAL
F NF
ALPHANATE 250-100 UNIT VIAL
F
ARIXTRA 10 MG/0.8 ML SYRINGE
NF
ALPHANATE 500-200 UNIT VIAL
F
ARIXTRA 2.5 MG/0.5 ML SYRINGE
NF
ALPHANINE SD 1,000 UNITS VIAL
NF
ARIXTRA 5 MG/0.4 ML SYRINGE
NF
ALPHANINE SD 1,500 UNITS VIAL
NF
ARIXTRA 7.5 MG/0.6 ML SYRINGE ARRANON 250 MG/50 ML VIAL
NF
ALPHANINE SD 500 UNITS VIAL
NF
ARZERRA 1,000 MG/50 ML VIAL
NF
ARALAST NP 1,000 MG VIAL
NF
ARZERRA 100 MG/5 ML VIAL
NF
ARALAST NP 500 MG VIAL
NF
NF
ARANESP 10 MCG/0.4 ML SYRINGE
F
ASTAGRAF XL 0.5 MG CAPSULE ASTAGRAF XL 1 MG CAPSULE
NF
ARANESP 100 MCG/0.5 ML SYRINGE
F
ASTAGRAF XL 5 MG CAPSULE
NF
ARANESP 100 MCG/ML VIAL
F
ATGAM 50 MG/ML AMPUL
F
ARANESP 150 MCG/0.3 ML SYRINGE
F
AVASTIN 100 MG/4 ML VIAL
NF
AVASTIN 400 MG/16 ML VIAL
NF
ARANESP 150 MCG/0.75 ML VIAL
F
AVONEX 30 MCG VIAL KIT
F
ARANESP 200 MCG/0.4 ML SYRINGE
F
AVONEX PEN 30 MCG/0.5 ML KIT
F
ARANESP 200 MCG/ML VIAL
F
AVONEX PREFILLED SYR 30 MCG
F
ARANESP 25 MCG/0.42 ML SYRING
F
AVONEX PREFILLED SYR 30 MCG KT
F
ARANESP 25 MCG/ML VIAL
F
DRUG
FORMULARY STATUS
DRUG
FORMULARY STATUS
BARACLUDE 0.05 MG/ML SOLUTION
F
CALCIUM FOLINATE POWDER
NF
BARACLUDE 0.5 MG TABLET
NF
CAMPTOSAR 100 MG/5 ML VIAL
NF
BARACLUDE 1 MG TABLET
NF
NF
BCG (TICE STRAIN) VIAL
NF
CAMPTOSAR 300 MG/15 ML VIAL
BCG VACCINE (TICE STRAIN) VIAL
NF
CAMPTOSAR 40 MG/2 ML VIAL
NF
BEBULIN 200-1,200 UNITS VIAL
NF
CAPECITABINE 150 MG TABLET
F
BENEFIX 1,000 UNIT RANGE
NF
CAPECITABINE 500 MG TABLET
F
BENEFIX 2,000 UNIT RANGE
NF
CARIMUNE NF 12 GM VIAL
NF
BENEFIX 250 UNIT RANGE
NF
CARIMUNE NF 6 GM VIAL
NF
BENEFIX 3,000 UNIT RANGE
NF
NF
BENEFIX 500 UNIT RANGE
NF
CELLCEPT 200 MG/ML ORAL SUSP
BENLYSTA 120 MG VIAL
NF
CELLCEPT 250 MG CAPSULE
NF
BENLYSTA 200 MG/ML AUTOINJECT
NF
CELLCEPT 500 MG TABLET
NF
CELLCEPT 500 MG VIAL
NF
BENLYSTA 200 MG/ML SYRINGE
NF
CEREZYME 400 UNITS VIAL
NF
BENLYSTA 400 MG VIAL
NF
CETROTIDE 0.25 MG KIT
NF
BERINERT 500 UNIT KIT
NF
CIMZIA 200 MG VIAL KIT
NF
BETASERON 0.3 MG KIT
F
CIMZIA 200 MG/ML STARTER KIT
NF
BETHKIS 300 MG/4 ML AMPULE
NF
CIMZIA 200 MG/ML SYRINGE KIT
NF
BICNU 100 MG VIAL
NF
CLOLAR 20 MG/20 ML VIAL
NF
BIVIGAM LIQUID 10% VIAL
NF
NF
BOTOX 100 UNITS VIAL
NF
COPAXONE 20 MG/ML SYRINGE
BOTOX 200 UNITS VIAL
NF
COPAXONE 40 MG/ML SYRINGE
F
BOTOX COSMETIC 100 UNITS VIAL
NF
COPEGUS 200 MG TABLET
NF
BOTOX COSMETIC 50 UNITS VIAL
NF
COSENTYX 150 MG/ML PEN INJECT
F
BRAVELLE 75 UNIT VIAL
NF
COSENTYX 150 MG/ML SYRINGE
F
BUSULFEX 60 MG/10 ML VIAL
NF
F
CALCIUM FOLINATE 10 MG/ML VIAL
F
COSENTYX 300 MG DOSE-2 PENS
DRUG
FORMULARY STATUS
COSENTYX 300 MG DOSE-2 SYRINGE
F
COSMEGEN 0.5 MG VIAL
NF
CYTOGAM 2.5 GM/50 ML VIAL
NF
DACOGEN 50 MG VIAL
NF
DAKLINZA 30 MG TABLET
NF
DAKLINZA 60 MG TABLET
NF
DAKLINZA 90 MG TABLET
NF
DAUNOXOME 50 MG (2 MG/ML) VIAL
DRUG
FORMULARY STATUS
ELITEK 1.5 MG VIAL
NF
ELITEK 7.5 MG VIAL
NF
ELLENCE 2 MG/ML VIAL
NF
ELOCTATE 1,000 UNIT NOMINAL
F
ELOCTATE 1,500 UNIT NOMINAL
F
ELOCTATE 2,000 UNIT NOMINAL
F
NF
ELOCTATE 250 UNIT NOMINAL
F
DDAVP 0.01% NASAL SPRAY
NF
F
DDAVP 0.1 MG TABLET
NF
ELOCTATE 3,000 UNIT NOMINAL
DDAVP 0.2 MG TABLET
NF
ELOCTATE 4,000 UNIT NOMINAL
F
DDAVP 10 MCG/0.1 ML SOLUTION
NF
ELOCTATE 5,000 UNIT NOMINAL
F
DDAVP 4 MCG/ML AMPUL
NF
F
DDAVP 4 MCG/ML VIAL
NF
ELOCTATE 500 UNIT NOMINAL
DEPOCYT 50 MG/5 ML VIAL
NF
ELOCTATE 6,000 UNIT NOMINAL
F
DESFERAL 2 GRAM VIAL
NF
F
DESFERAL MESYLATE 500 MG VL
NF
ELOCTATE 750 UNIT NOMINAL ELOXATIN 100 MG/20 ML VIAL
NF
DOCEFREZ 20 MG VIAL
NF
ELOXATIN 50 MG/10 ML VIAL
NF
DOCEFREZ 80 MG VIAL
NF
ELSPAR 10,000 UNITS VIAL
NF
DOXIL 2 MG/ML VIAL
NF
ENBREL 25 MG KIT
F
DUPIXENT 300 MG/2 ML SAFE SYRG
F
ENBREL 25 MG/0.5 ML SYRINGE
F
DYSPORT 300 UNIT VIAL
NF
F
DYSPORT 500 UNITS VIAL
NF
ENBREL 50 MG/ML MINI CARTRIDGE
ELAPRASE 6 MG/3 ML VIAL
NF
ENBREL 50 MG/ML SURECLICK SYR
F
ELIGARD 22.5 MG SYRINGE KIT
NF
ENBREL 50 MG/ML SYRINGE
F
ELIGARD 30 MG SYRINGE KIT
NF
ENTECAVIR 0.5 MG TABLET
F
ELIGARD 45 MG SYRINGE KIT
NF
ENTECAVIR 1 MG TABLET
F
ELIGARD 7.5 MG SYRINGE KIT
NF
ENTYVIO 300 MG VIAL
NF
DRUG
FORMULARY STATUS
DRUG
FORMULARY STATUS
ENVARSUS XR 0.75 MG TABLET
NF
FEIBA NF 1,000 UNIT (NOMINAL)
F
ENVARSUS XR 1 MG TABLET
NF
F
ENVARSUS XR 4 MG TABLET
NF
FEIBA NF 1,750-3,250 UNIT VIAL
EPCLUSA 400 MG-100 MG TABLET
NF
FEIBA NF 2,500 UNIT (NOMINAL)
F
EPIVIR HBV 100 MG TABLET
NF
FEIBA NF 400-650 UNIT VIAL
F
EPIVIR HBV 25 MG/5 ML SOLN
F
FEIBA NF 500 UNIT (NOMINAL)
F
EPOGEN 10,000 UNITS/ML VIAL
F
FIRAZYR 30 MG/3 ML SYRINGE
F
EPOGEN 2,000 UNITS/ML VIAL
F
FIRMAGON 2 X 120 MG KIT
F
EPOGEN 20,000 UNITS/2 ML VIAL
F
FIRMAGON 2 X 120 MG VIALS
F
EPOGEN 20,000 UNITS/ML VIAL
F
FIRMAGON 80 MG KIT
F
FIRMAGON 80 MG VIAL
F
EPOGEN 3,000 UNITS/ML VIAL
F
FLEBOGAMMA DIF 10% VIAL
NF
EPOGEN 4,000 UNITS/ML VIAL
F
FLEBOGAMMA DIF 5% VIAL
NF
ERBITUX 100 MG/50 ML VIAL
NF
FLOXURIDINE 500 MG VIAL
F
ERBITUX 200 MG/100 ML VIAL
NF
FLOXURIDINE POWDER
NF
ESBRIET 267 MG CAPSULE
F
FOLLISTIM AQ 150 UNIT VIAL
NF
ESBRIET 267 MG TABLET
F
NF
ESBRIET 801 MG TABLET
F
FOLLISTIM AQ 300 UNIT CARTRIDG
ETOPOPHOS 100 MG VIAL
NF
FOLLISTIM AQ 600 UNIT CARTRIDG
NF
EUFLEXXA 20 MG/2 ML SYRINGE
F
FOLLISTIM AQ 75 UNIT VIAL
NF
EVOMELA 50 MG VIAL
NF
FOLLISTIM AQ 900 UNIT CARTRIDG
NF
EXJADE 125 MG TABLET
F
FOLOTYN 20 MG/ML VIAL
NF
EXJADE 250 MG TABLET
F
FOLOTYN 40 MG/2 ML VIAL
NF
EXJADE 500 MG TABLET
F
F
EXTAVIA 0.3 MG KIT
F
FORTEO 600 MCG/2.4 ML PEN INJ
EXTAVIA 0.3 MG VIAL
NF
FRAGMIN 10,000 UNITS/ML SYRING
NF
FABRAZYME 35 MG VIAL
F
FRAGMIN 12,500 UNITS/0.5 ML
NF
FABRAZYME 5 MG VIAL
F
FRAGMIN 15,000 UNITS/0.6 ML
NF
FASLODEX 250 MG/5 ML SYRINGE
F
FRAGMIN 18,000 UNITS/0.72 ML
NF
DRUG
FORMULARY STATUS
DRUG
FORMULARY STATUS
FRAGMIN 2,500 UNITS/0.2 ML SYR
NF
GAMMAPLEX 5 GRAM/50 ML VIAL
NF
FRAGMIN 25,000 UNITS/ML VIAL
NF
GAMUNEX-C 1 GRAM/10 ML VIAL
F
FRAGMIN 5,000 UNITS/0.2 ML SYR
NF
GAMUNEX-C 10 GRAM/100 ML VIAL
F
FRAGMIN 7,500 UNITS/0.3 ML SYR
NF
GAMUNEX-C 2.5 GRAM/25 ML VIAL
F
FRAGMIN 95,000 UNITS/3.8 ML VL
NF
GAMUNEX-C 20 GRAM/200 ML VIAL
F
FUZEON 90 MG VIAL
F
NF
GAMASTAN S-D VIAL
F
GAMUNEX-C 40 GRAM/400 ML VIAL
GAMMAGARD LIQUID 10% VIAL
F
GAMUNEX-C 5 GRAM/50 ML VIAL
F
GAMMAGARD S-D 10 G (IGA
