Anemia/Blood Modifiers
Aranesp (PA)
Leukine
Neulasta
Neupogen
Procrit
Epogen (NF)
Neumega (NF)
Hemophilia (1) All blood factor products |
Hepatitis
Peg-Intron
Pegasys
Ribavirin
Infergen (NF)
Multiple Sclerosis
Avonex (ST)
Betaseron (ST)
Copaxone
Rebif
Rheumatoid Arthritis
Enbrel (PA)
Humira (PA)
Kineret (PA) |
Oncology (starting 9/1/2009)
Afinitor
Gleevec
Nexavar
Revlimid
Sprycel
Sutent
Tarceva
Tasigna
Temodar
Thalomid
Tykerb
Xeloda
Zolinza (PA)
tretinoin oral (Vesanoid) (NF)
|
Others
Acthar HP (2) (PA)
Banzel (PA)
Forteo (PA)
Fuzeon (MD)
Kuvan (PA)
Letairis (2) (PA)
Promacta (PA)
Raptiva (PA)
Revatio (PA)
Somavert (2) (PA)
Sucraid (PA)
Tracleer (2) (PA)
Ventavis (2) (PA)
Xenazine (3) (PA)
Serostim (NF)
Xolair (2) (NF)
Zorbtive (NF)
|
MD = physician-edit, PA = prior approval, ST = step-therapy, NF = non-formulary (not covered) This list is subject to change and is not all-inclusive. Some medications have limits (such as prior approval, physician edit or step therapy) as indicated in the Preferred Drug List (formulary) at healthpartners.com |