These exclusions are in addition to those listed on the MedImpact exclusion document.
Brand Name
|
Generic Name
|
| Abecma |
|
Abstral (same code as Fentanyl-needs NDC)
|
|
Accrufer
|
|
Adakveo
|
|
| Aduhelm |
|
Alcortin A
|
|
| Amondys 45 |
|
Andexxa
|
|
Apretude
|
|
| Asceniv |
|
| Auvi-Q |
|
| Avsola |
|
| Azstarys |
|
Benlysta
|
|
| Benralizumab |
|
| Beovu (brolucizumab) |
|
| Breyanzi |
|
| Byfavo |
|
| Bylvay |
|
| Cabenuva |
|
Carvykti
|
|
Cimzia
|
|
Conjupri
|
|
| Cosela |
|
| Cutaquig |
|
| Durolane |
|
| Ebanga |
|
| Empaveli |
|
| Enjaymo |
|
| Euflexxa |
|
| Evkeeza |
|
| Exondys 51 |
|
| Feraheme |
|
| Fulphila |
|
Gamifant
|
|
| Gel-One |
|
| Gelsyn-3 |
|
| Gemtesa |
|
| Givlaari (givosiran) |
|
| Granix |
|
| Hyalgan |
|
| Hyaluronan |
|
| Hymovis |
|
| Imcivree |
|
| Infliximab |
|
| Injectafer |
|
Inmazeb
|
|
| Jeuveau |
|
Jublia
|
|
| Kerendia |
|
| Klisyri |
|
| Korsuva |
|
Krystexxa
|
|
Kybella
|
|
| Kymriah |
|
| Livmarli |
|
| Lupkynis |
|
Lutathera
|
|
| Luxterna |
|
| Macugen |
|
| Margenza |
|
| Mavyret |
|
| Mayzent |
|
| Micafungin |
|
| Monovisc |
|
| Myfembree |
|
| Neulasta |
|
| Neulasta Onpro |
|
| Nextstellis |
|
| Nexviazyme |
|
| Nivestym |
|
| Nourianz |
|
| Nulibry |
|
Olinvyk
|
|
| Orgovyx |
|
| Orladeyo |
|
Orladeyo (berotralstat)
|
|
| Orthovisc |
|
| Oxlumo |
|
Palforzia
|
|
Panzyga
|
|
| Ponvory |
|
Pretomanid
|
|
| Qelbree |
|
| Qulipta |
|
Radicava
|
|
| Releuko |
|
| Rezurock |
|
| Rituxan |
|
| Roszet |
|
| Saphnelo |
|
Scenesse
|
|
Sinuva
|
|
Skytrofa
|
|
| Sotrovimab |
|
| Spinraza |
|
| Spravato |
|
| Sunosi |
|
| Supartz |
|
| Susvimo |
|
| Synojoynt |
|
| Synvisc |
|
| Synvisc One |
|
Tauvid
|
|
Tavneos
|
|
Tecartus (brexucabtagene autoleucel)
|
|
Tepezza (teprotumumab)
|
|
Translarna
|
|
Trastuzumab
|
|
| Triluron |
|
| Triptodur |
|
| TriVisc |
|
Tysabri
|
|
| Udenyca |
|
Uplizna (inebilizumab)
|
|
| Veklury |
|
| Verquvo |
|
| Visco-3 |
|
| Visudyne |
|
Viltepso
|
|
| Vocabria |
|
Vyndaqel
|
|
| Vyondis 53 |
|
Visudyne
|
|
| Vocabria |
|
Vyepti (eptinezumab)
|
|
| Vyleesi |
|
Vyondys 53 (golodirsen)
|
|
| Vyvgart |
|
| Welireg |
|
| Xembify |
|
| Xolair |
|
Yescarta
|
|
| Zarxio |
|
| Zegalogue |
|
| Ziextenzo |
|
Zinbryta
|
|
| Zokinvy |
|
Zolgensma
|
|
Zostavax
|
|
Zulresso
|
|
| Zynlonta |
|