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 |
|