| Nonpreferred Adalimumab - PA, NF - Standard Default |
Abrilada (adalimumab-afzb), Cyltezo (adalimumab-adbm), Hadlima (adalimumab-bwwd), Hulio (adalimumab-fkjp), Hyrimoz (adalimumab-adaz), Idacio (adalimumab-aacf), Simlandi (adalimumab-ryvk), Yuflyma (adalimumab-aaty), Yusimry (adalimumab-aqvh), Humira (adalimumab) |
| Nonpreferred Adalimumab – Premium Value Formulary UM – PA, NF |
Abrilada (adalimumab-afzb), Amjevita (adalimumab-atto), Cyltezo (adalimumab-adbm), Hadlima (adalimumab-bwwd), Hulio (adalimumab-fkjp), Hyrimoz (adalimumab-adaz), Idacio (adalimumab-aacf), Simlandi (adalimumab-ryvk), Yuflyma (adalimumab-aaty), Yusimry (adalimumab-aqvh), Humira (adalimumab) |
| Nplate (romiplostim) |
Nplate (romiplostim) |
| Nucala (mepolizumab) |
Nucala (mepolizumab) |
| Obesity GLP-1 Agonists – PA, NF |
Saxenda (liraglutide), Wegovy (semaglutide), Zepbound (tirzepatide) Injection |
| Octreotide Products - PA, NF |
Mycapssa (octreotide capsule, delayed release), Sandostatin (octreotide acetate), Sandostatin LAR Depot (octreotide acetate) |
| Odomzo (sonidegib) |
Odomzo (sonidegib) |
| Ogsiveo (nirogacestat) |
Ogsiveo (nirogacestat) |
| Olumiant (baricitinib) |
Olumiant (baricitinib) |
| Omega-3-Acid Derivatives |
Generic icosapent ethyl, Lovaza (omega-3-acid ethyl esters), Vascepa (icosapent ethyl) |
| Oncology Injectable |
ABECMA, ADCETRIS, ALIQOPA, ARZERRA, AUCATZYL, BAVENCIO, BELEODAQ, BESPONSA, BIZENGRI, BLINCYTO, BREYANZI, CARVYKTI, COLUMVI, CYRAMZA, DANYELZA, DATROWAY, ELAHERE, ELREXFIO, ELZONRIS, EMPLICITI, ENHERTU, EPKINLY, ERBITUX, ERIBULIN MESYLATE, FIRMAGON, FOLOTYN, FYARRO, HALAVEN, IMFINZI, IMJUDO, ISTODAX, JEMPERLI, KADCYLA, KEYTRUDA, KYMRIAH, KYPROLIS, LIBTAYO, LUMOXITI, LUNSUMIO, MARGENZA, MONJUVI, MYLOTARG, OPDIVO, OPDIVO QVANTIG, PADCEV, PERJETA, PHESGO, POLIVY, PORTRAZZA, POTELIGEO, PRALATREXATE, PROVENGE, ROMIDEPSIN, RYLAZE, SARCLISA, TECARTUS, TECENTRIQ, TECENTRIQ HYBREZA, TECVAYLI, TIVDAK, VYLOY, YERVOY, YESCARTA, ZALTRAP, ZEPZELCA |
| Onpattro (patisiran) & Tegsedi (inotersen) |
Onpattro (patisiran), Tegsedi (inotersen) |
| Onureg (azacitidine) |
Onureg (azacitidine) |
| Ophthalmic Antihistamines |
LASTACAFT (alcaftadine), ZERVIATE (cetirizine) |
| Ophthalmic NSAIDs |
BROMSITE (bromfenac), ILEVRO (nepafenac), NEVANAC (nepafenac), Prolensa (bromfenac ophthalmic solution) |
| Opioid Quantity Limit Overrides |
Opioid quantity limit override |
| Opioid Risk Management |
ACETAMINOPHEN/CAFFEINE/DIHYDROCODEINE, ACETAMINOPHEN/CODEINE, ACETAMINOPHEN/CODEINE #3, ACETAMINOPHEN/CODEINE PHOSPHATE, APADAZ, BELBUCA, BENZHYDROCODONE/ACETAMINOPHEN, BUPRENORPHINE, BUPRENORPHINE BUCCAL, BUTORPHANOL TARTRATE, BUTRANS, CAPCOF, CHERATUSSIN AC, CODEINE SULFATE, CODEINE/ACETAMINOPHEN, CODEINE/GUAIFENESIN, CODITUSSIN AC, CODITUSSIN DAC, DILAUDID, ENDOCET, FENTANYL, G TUSSIN AC, GUAIATUSSIN AC, GUAIFENESIN AC, GUAIFENESIN/CODEINE, HYCET, HYDROCODONE BITARTRATE ER, HYDROCODONE BITARTRATE/ACETAMINOPHEN, HYDROCODONE BITARTRATE/HOMATROPINE METHYLBROMIDE, HYDROCODONE POLISTIREX/CHLORPHENIRAMINE POLISTIREX, HYDROCODONE/ACETAMINOPHEN, HYDROCODONE/HOMATROPINE, HYDROCODONE/IBUPROFEN, HYDROMET, HYDROMORPHONE HCL, HYDROMORPHONE HCL ER, HYDROMORPHONE HYDROCHLORIDE ER, HYSINGLA ER, LORTUSS EX, M-CLEAR WC, M-END PE, MAR-COF BP, MAR-COF CG EXPECTORANT, MEPERIDINE HCL, METHADONE HCL, METHADONE HYDROCHLORIDE, MORPHINE SULFATE, MORPHINE SULFATE CR, MORPHINE SULFATE ER, MS CONTIN, NALOCET, NINJACOF-XG, NUCYNTA, NUCYNTA ER, OPANA, OXAYDO, OXYCODONE HCL, OXYCODONE HCL ER, OXYCODONE HYDROCHLORIDE, OXYCODONE HYDROCHLORIDE/ACETAMINOPHEN, OXYCODONE/ACETAMINOPHEN, OXYCODONE/ASPIRIN, OXYCODONE/IBUPROFEN, OXYCONTIN, OXYMORPHONE HYDROCHLORIDE, OXYMORPHONE HYDROCHLORIDE ER, PENTAZOCINE/NALOXONE HCL, PERCOCET, POLY-TUSSIN AC, PRO-RED AC, PROLATE, PROMETHAZINE VC/CODEINE, PROMETHAZINE/CODEINE, PROMETHAZINE/PHENYLEPHRINE/CODEINE, QDOLO, RELCOF C, ROXICODONE, ROXYBOND, RYDEX, TRAMADOL HCL, TRAMADOL HYDROCHLORIDE, TRAMADOL HYDROCHLORIDE/ACETAMINOPHEN, TREZIX, TUXARIN ER, TUZISTRA XR, TYLENOL/CODEINE #3, TYLENOL/CODEINE #4, ULTRACET, ULTRAM, VIRTUSSIN A/C, XTAMPZA ER |
| Oral Fentanyl Products |
Actiq (fentanyl citrate) oral transmucosal lozenge, Fentora (fentanyl buccal tablet), Lazanda (fentanyl) nasal spray, Subsys (fentanyl sublingual spray) |
| Orencia (abatacept) |
Orencia (abatacept) IV, Orencia (abatacept) SC |
| Orgovyx (relugolix) |
Orgovyx (relugolix) |
HEALTHY LIVING