| Overactive Bladder Agents |
Gelnique (oxybutynin chloride) |
| PCSK9 Inhibitors - PA, ST, NF |
Praluent (alirocumab), Repatha (evolocumab) |
| Piqray (alpelisib) |
Piqray (alpelisib) |
| Pomalyst (pomalidomide) |
Pomalyst (pomalidomide) |
| Prior Authorization Administrative Guideline |
Admin, Administrative, albendazole, albenza, Prior Authorization |
| Prolia (denosumab) |
Prolia (denosumab) |
| Promacta (eltrombopag) |
Promacta (eltrombopag) |
| Proton Pump Inhibitors |
Aciphex (rabeprazole), Aciphex Sprinkle (rabeprazole), Dexilant (dexlansoprazole), Konvomep (omeprazole and sodium bicarbonate), Nexium (esomeprazole), Prevacid (lansoprazole), Prilosec (omeprazole), Protonix (pantoprazole), Zegerid (omeprazole/sodium bicarbonate) |
| Provigil (modafinil), Nuvigil (armodafinil) |
Nuvigil (armodafinil), Provigil (modafinil) |
| Pulmonary Arterial Hypertension Agents |
Adcirca (tadalafil) Tablets, Alyq (tadalafil) Tablets, Tadliq (tadalafil) Oral Suspension, Adempas (riociguat) Tablets, Flolan (epoprostenol sodium) Injection, Letairis (ambrisentan) Tablets, Liqrev (sildenafil) suspension, Opsumit (macitentan) Tablets, Opsynvi (macitentan/ tadalafil) Tablets, Orenitram (treprostinil) Tablets, Remodulin (treprostinil sodium) Injection, Revatio (sildenafil) Injection, Tablets, Oral Suspension, Tracleer (bosentan) Tablets, Tablets for Suspension, Tyvaso (treprostinil) Inhalation Solution, Tyvaso (treprostinil) DPI Inhalation Powder, Uptravi (selexipag) Tablets and Injection, Veletri (epoprostenol) Injection, Ventavis (iloprost) Inhalation Solution, Winrevair (sotatercept-csrk) Injection |
| Pulmozyme (dornase alfa inhalation solution) |
Pulmozyme (dornase alpha) Inhalation Solution |
| Qinlock (ripretinib) |
Qinlock (ripretinib) |
| Quantity Limit General |
Quantity, Quantity limit general |
| Reblozyl (luspatercept-aamt) |
Reblozyl (luspatercept-aamt) |
| Regranex (becaplermin) |
Regranex Gel (becaplermin) |
| Repository Corticotropin Gel Products - PA, NF |
Acthar Gel (repository corticotropin injection), Purified Cortrophin Gel (repository corticotropin injection) |
| Restasis (cyclosporine 0.05%) |
Restasis (cyclosporine 0.05%) ophthalmic emulsion |
| Restasis (cyclosporine 0.05%) - PA, NF |
Restasis (cyclosporine 0.05%) ophthalmic emulsion |
| Retevmo (selpercatinib) |
Retevmo (selpercatinib) |
| Revcovi (elapegademase-IvIr) |
Revcovi (elapegademase-IvIr) |
HEALTHY LIVING