Drug Exclusion List | Pharmaceutical Benefits

Drug Exclusion List

 

These exclusions are in addition to those listed on the MedImpact exclusion document.

 

Brand Name
Generic Name
Abstral
Addiyi
Alcortin A
Aransep  
Auvi-Q
Benlysta
Emflaza
Epogen  
Evenity (osteoporosis)
 
Exondys 51
Gamifant  
Gocovri
Inflectra  
Ingrezza
Jublia  
Kymriah
Lutathera  
Luxturna
Micera  
Nuplazid  
Praluent  
Procrit
Radicava  
Remicade
Repatha
Sinuva  
Spinraza
Spravato  
Translarna
Tysabri
Yervoy
Yescarta  
Zinbryta
Zolgensma  
Zostafax
Zulresso