These exclusions are in addition to those listed on the MedImpact exclusion document.
Brand Name
|
Generic Name
|
| Abstral |
|
| Adakveo |
|
| Addiyi |
|
| Alcortin A |
|
| Andexxa |
|
| Auvi-Q |
|
Avastin (oncology)
|
|
| Avsola |
|
| Benlysta |
|
| Beovu |
|
| Cablivi |
|
Cetirizine
|
|
Dojolvi
|
|
| Emflaza |
|
Evrysdi
|
|
| Exondys 51 |
|
| Feraheme |
|
| Flolan |
|
| Gamifant |
|
Givlaari
|
|
Givosiran
|
|
| Gocovri |
|
Herceptin
|
|
| Inflectra |
|
| Ingrezza |
|
| Injectafer |
|
Isturisa
|
|
| Jublia |
|
Kesimpta
|
|
Kybella
|
|
Krystexxa
|
|
| Kymriah |
|
| Lutathera |
|
| Luxturna |
|
| Macugen |
|
| Micera |
|
| Nexletol |
|
| Nuplazid |
|
Ocaliva
|
|
Palforzia
|
|
| Praluent |
|
| Radicava |
|
| Repatha |
|
Rituxan
|
|
Reblozyl
|
|
| Sinuva |
|
| Spinraza |
|
| Spravato |
|
Supprelin LA
|
|
Synagis
|
|
Tecartus
|
|
Tepezza
|
|
| Translarna |
|
| Tysabri |
|
| Vyepti |
|
| Vyleesi |
|
| Vyondys 53 (golodirsen) |
|
| Xembify |
|
| Yescarta |
|
Zeposia
|
|
| Zinbryta |
|
| Zolgensma |
|
| Zostafax |
|
| Zulresso |
|