Blue Cross Blue Shield Of Texas

Abaloparatide

Abiraterone 500 Mg

Abrilada Adalimumab Afzb

Abrocitinib

Actemra

Actemra Syringe

Acthar Gel Repository Corticotropin

Adalimumab Aacf

Adalimumab Aaty

Adalimumab Adaz

Adalimumab Adbm

Adalimumab Fkjp

Adalimumab Ryvk

Adbry

Adbry Tralokinumab Ldrm

Adcirca

Addyi

Adempas

Adipex P

Afinitor

Afinitor Disperz

Afrezza Insulin Regular Human

Aimovig

Ajovy

Alhemo

All Target Agents Except Actemra

Alpelisib Pros

Alprolix

Alvaiz

Alvaiz Eltrombopag

Ambien Cr Zolpidem

Ambien Zolpidem

Amifampridine Phosphate

Amikacin Sulfate Liposome

Amitiza Lubiprostone

Amjevita Adalimumab Atto

Andembry

Androgel

Apremilast

Aprocitentan

Aqneursa

Aranesp

Arcalyst

Arikayce

Arimoclomol Citrate

Aspirin Omeprazole

Attruby

Aubagio

Augtyro

Austedo

Austedo Xr

Avacopan

Aveed

Azmiro

Bafiertam

Belbuca

Belsomra Suvorexant

Belumosudil Mesylate

Benefix

Benlysta

Benzphetamine

Benzphetamine Hcl

Berdazimer Sodium Gel 10 3

Berinert

Biologic Immunomodulators Various Targeted Agents

Birch Triterpenes Gel 10

Bonjesta

Bonsity

Bosulif

Brekiya Dihydroergotamine Mesylate

Brexafemme Ibrexafungerp

Budesonide Delayed Release Cap

Budesonide Oral Suspension 2 Mg 10ml

Buphenyl

Butorphanol Tartrate

Butrans

Byetta

Bylvay Odevixibat

Camzyos Mavacamten

Cannabidiol

Carac Fluorouracil 0 5 Cream

Celexa

Cequa

Cequa Cyclosporine

Cerdelga

Cgrp Targeted Agents

Chenodiol

Cibinqo

Ciclopirox

Cinryze

Clascoterone Cream 1

Clozapine Odt

Clozaril Clozapine

Cobenfy Xanomeline And Trospium Chloride

Concizumab Mtci

Contrave

Conzip

Copaxone

Copaxone Glatiramer

Corlanor

Cosentyx 125 Mg 5 Ml Vial

Cosentyx 300 Mg

Crenessity

Cresemba Isavuconazole

Crexont

Crinecerfont

Ctexli

Cyclosporine

Cyclosporine Ophth Emulsion 0 1

Cyltezo Adalimumab Adbm

Cymbalta

Danicopan

Daraprim

Dawnzera

Daybue

Dayvigo Lemborexant

Depo Testosterone

Desvenlafaxine Extended Release Tablet

Dexcom G6

Dexcom G7

Dextromethorphan Hbr Quinidine Sulfate

Diazoxide Choline Tab Er

Diclegis

Diclofenac 3 Gel

Diethylpropion

Diethylpropion Hcl Er

Diethylpropion Hcl Tab

Diethylpropion Hydrochlor

Dojolvi

Doptelet

Doryx

Doryx Mpc

Doxepin Hydrochloride Cream 5

Drizalma

Droxidopa

Duexis

Dupilumab

Dupixent

Duvyzat

Ebglyss

Ebglyss Lebrikizumab Lbkz

Edaravone Oral Suspension 105 Mg 5ml

Edluar Zolpidem

Effexor Xr

Efinaconazole

Efudex Fluorouracil 5 Cream

Ekterly

Elidel Pimecrolimus Cream

Eliglustat

Elyxyb Celecoxib

Emgality

Empaveli Pegcetacoplan

Emrosi

Enspryng

Entyvio

Eohilia

Epclusa Sofosbuvir Velpatasvir

Epidiolex

Epogen

Esbriet

Eucrisa Crisaborole Ointment

Evrysdi

Exenatide

Exjade

Exjade Deferasirox

Extavia Interferon 1b

Exxua

Eysuvis

Eysuvis Loteprednol Etabonate

Fabhalta Iptacopan Hcl

Fanapt Iloperidone

Fasenra Pen

Fecal Microbiota Spores Live Brpk Caps

Fenfluramine Hcl Oral Soln 2 2 Mg Ml

Fentanyl Td Patch

Ferriprox Deferiprone

Fetzima

Fezolinetant

Filspari

Filsuvez

Fintepla

Firazyr

Firdapse

Fitusiran Sodium

Flector

Fluoroplex

Fluoxetine 60 Mg Tablet

Fluoxetine Delayed Release Capsule

Fluticasone Propionate Nasal Exhaler 93 Mcg Act

Forfivo Xl

Forteo

Fortesta

Freestyle Libre

Freestyle Libre 2

Freestyle Libre 3

Furoscix

Furosemide Subcutaneous Cartridge Kit

Fylnetra Pegfilgrastim Pbbk

Galafold

Genotropin

Genotropin Miniquick

Geodon Ziprasidone

Gilenya

Gilenya Fingolimod

Givinostat Hcl Oral Suspension 8 86 Mg Ml

Gleevec

Glumetza

Gralise

Granix Tbo Filgrastim

Growth Hormone Agents Non Specified

Hadlima Adalimumab Bwwd

Haegarda

Harvoni Ledipasvir Sofosbuvir

Hetlioz

Hetlioz Lq

Horizant

Hulio Adalimumab Fkjp

Humira Adalimumab

Hydrocodone Bitartrate Er

Hydromorphone Hcl

Hyftor

Hympavzi

Hyrimoz Adalimumab Adaz

Hysingla Er

Ibrance

Ibsrela Tenapanor

Ibuprofen Famotidine

Icatibant

Icosapent Ethyl

Idacio Adalimumab Aacf

Idelvion

Il 4 Inhibitors

Il 5 Inhibitors

Ilet Insulin Infusion Kit

Ilet Insulin Pump

Ilet Starter Kit Contac

Ilet Starter Kit Inset

Imbruvica Tablets

Imcivree Setmelanotide Acetate

Imiquimod 5

Imkeldi

Imuldosa Ustekinumab Srlf

Infliximab Unbranded

Ingrezza

Invega Paliperidone

Iqirvo

Iressa

Isturisa

Ivabradine Hcl Oral Soln

Ivabradine Hcl Tab

Ixifi

Ixinity

Jadenu

Jadenu Deferasirox

Jatenzo

Joenja

Jublia

Jynarque

Kalbitor

Kalydeco

Kerydin

Kevzara

Klisyri

Korlym

Kyzatrex

Latuda Lurasidone

Ledipasvir Sofosbuvir

Leniolisib Phosphate

Letairis

Levacetylleucine

Levoketoconazole

Lexapro

Licart

Lidocaine Any Topical Agent Covered Under Policy

Lidocaine Topical Ointment 5

Lidoderm Lidocaine Patch 5

Liqrev

Livdelzi

Livmarli Maralixibat

Lonafarnib

Lotilaner Ophthalmic Solution 0 25

Luminopia

Lunesta Eszopiclone

Lupkynis

Lybalvi Olanzapine Samidorphan

Marstacimab Hncq

Mavenclad Cladribine

Mavorixafor

Mavyret Glecaprevir Pibrentasvir

Mekinist Oral Solution

Metformin Hydrochloride

Methitest

Methyltestosterone Capsule

Metreleptin

Miebo

Miebo Perfluorohexyloctane

Mifepristone

Migalastat Hcl

Miglustat

Miglustat Gaa Deficiency

Migranal Dihydroergotamine Mesylate

Minocycline Hydrochloride

Minolira

Miplyffa

Mircera

Morphine Sulfate Er

Motegrity Prucalopride

Ms Contin

Mulpleta

Mulpleta Lusutrombopag

Myalept

Mycapssa Octreotide Acetate

Myfembree

Naproxen Esomeprazole

Natesto

Nedosiran Sodium

Nemluvio

Nemluvio Nemolizumab Ilto

Nemolizumab Ilto

Neulasta Pegfilgrastim

Neupogen Filgrastim

Nexavar

Nexletol

Nexlizet

Ngenla

Non Preferred Factor Ix Agents Included In This Program

Non Preferred Hepatitis C Direct Acting Antivirals

Northera

Novoseven Rt

Noxafil Posaconazole

Nplate

Nplate Romiplostim

Nucala

Nucynta

Nucynta Er

Nuedexta

Nuplazid

Nurtec Odt

Nypozi Filgrastim Txid

Ocaliva

Ogsiveo

Ohtuvayre Ensifentrine Inhalation Suspension 3 Mg 2 5ml

Olezarsen Sod Subcut Soln Auto Inject 80 Mg 0 8ml

Olpruva

Olumiant

Omalizumab

Omaveloxolone

Omnipod 5 Dexcom G7g6 Int

Omnipod 5 Dexcom G7g6 Pod

Omnipod 5 G7 Intro Kit

Omnipod 5 G7 Pods Gen 5

Omnipod 5 Libre2 Plus G6

Omnipod Classic Pods Gen 3

Omnipod Dash Intro Kit

Omnipod Dash Pdm Kit

Omnipod Dash Pods Gen 4

Omnitrope

Omvoh

Omvoh 300 Mg

Opfolda

Opsynvi

Opzelura Ruxolitinib Phosphate Cream 1 5

Oracea

Oriahnn

Orilissa

Orkambi

Orladeyo

Orlistat

Osilodrostat Phosphate

Otezla

Otezla Apremilast

Otezla Xr

Otulfi Ustekinumab Aauz

Oxervate Cenegermin Bkbj

Oxycodone Hydrochloride E

Oxycontin

Oxymorphone Hydrochloride

Ozanimod

Ozanimod Hcl

Palopegteriparatide

Palovarotene

Paxil

Paxil Cr

Pcsk9 Inhibitors

Pennsaid

Pheburane

Phendimetrazine

Phendimetrazine Tartrate

Phendimetrazine Tartrate Cap Er

Phendimetrazine Tartrate Tab

Phentermine

Pimavanserin Tartrate

Pirfenidone

Pitolisant Hcl

Pliaglis Lidocaine 7 Tetracaine Cream 7

Ponvory Ponesimod

Praluent Alirocumab

Pristiq

Procrit

Procysbi Cysteamine Bitartrate

Promacta

Promacta Eltrombopag

Prozac

Prudoxin

Purified Cortrophin Gel Repository Corticotropin

Pyrukynd

Pyrukynd Taper Pack

Pyzchiva Ustekinumab Ttwe

Qbrexza

Qdolo

Qfitlia

Qsymia

Qudexy Xr

Qulipta

Quviviq Daridorexant

Radicava Ors

Radicava Ors Starter Kit

Ravicti

Rayos

Rebinyn

Recorlev

Releuko Filgrastim Ayow

Relistor Methylnaltrexone

Remeron

Remeron Soltab

Requested Agent

Requested Agent Imatinib Tablet Alternatives

Requested Agent Ohio Provision

Requested Agent Plan Members In Ohio

Requested Factor Ix Agents

Requested Hepatitis C Agent

Requested Hepatitis C Antiviral Agent Non Oncology Off Label

Resmetirom

Restasis

Restasis Cyclosporine Ophthalmic Emulsion

Retacrit

Revatio

Revatio Oral Suspension

Revatio Tablet

Reyvow

Reyvow Lasmiditan

Rezdiffra

Rezurock

Rilonacept

Rinvoq

Riomet

Risdiplam For Soln

Risdiplam Tab

Risperdal Risperidone

Rivfloza

Rixubis

Roflumilast Cream 0 15

Roflumilast Cream 0 3

Roflumilast Foam 0 3

Rolvedon Eflapegrastim Xnst

Rozerem Ramelteon

Ruconest

Rybelsus

Rytary

Ryzneuta Efbemalenograstim Alfa Vuxw

Sacrosidase

Saizen

Saizenprep

Saphris Asenapine

Satralizumab Mwge

Saxenda

Secuado Asenapine

Seroquel Quetiapine

Serostim

Sertraline Capsule

Sevenfact

Seysara

Sildenafil

Silenor Doxepin

Siliq

Simlandi Adalimumab Ryvk

Simponi

Sirolimus Gel 0 2

Skyclarys

Skyrizi

Skytrofa

Sofdra

Sofosbuvir Sovaldi

Sofosbuvir Velpatasvir

Sogroya

Sohonos

Solodyn

Solriamfetol Hcl

Somavert Pegvisomant

Sovaldi Sofosbuvir

Sparsentan

Spevigo Spesolimab Sbzo

Sporanox Itraconazole Capsules

Sporanox Itraconazole Solution

Sprycel

Stelara Ustekinumab

Stimufend Pegfilgrastim Fpgk

Sucraid

Sunosi

Sutent

Symdeko

Synera Lidocaine 70 Mg Tetracaine 70 Mg Patch

Tadalafil

Tadliq

Takhzyro

Tapinarof Cream 1

Tarceva

Target Agent S

Target Agent S Biologic Immunomodulators

Target Short Acting Agent S

Targretin

Tarpeyo

Tascenso Odt Fingolimod

Tasigna

Tasimelteon Capsule

Tasimelteon Oral Suspension

Tavaborole

Tavalisse

Tavneos

Tecfidera

Tecfidera Dimethyl Fumarate

Tegsedi

Temodar

Tenapanor Hcl

Teriparatide

Teriparatide Non Preferred

Testim

Testopel

Testosterone Enanthate Intramuscular Injection Solution

Testosterone Gel

Testosterone Topical Solution

Tetracycline Hydrochloride

Tezepelumab Ekko

Tezspire

Tirbanibulin Ointment 1

Tlando

Tobi Podhaler

Tolak

Tolsura Itraconazole

Tolvaptan

Tracleer

Tramadol Hcl

Tramadol Hcl Er

Tramadol Hydrochloride

Tremfya

Tremfya 200 Mg

Treximet

Triheptanoin

Trikafta

Trintellix

Trofinetide Oral Soln 200 Mg Ml

Trokendi Xr

Trudhesa Dihydroergotamine Mesylate Hfa

Tryngolza

Tryptyr

Tryptyr Acoltremon

Tryvio

Twiist Refill Kit

Twiist Refill Kit Infusio Disposable Pump Reservoir Infus Se

Twiist Starter Kit

Tykerb

Tymlos

Tyrvaya

Tyrvaya Varenicline

Tyvaso

Ubrelvy

Udenyca Pegfilgrastim Cbqv

Undecatrex

Ustekinumab

Ustekinumab 90 Mg Product

Ustekinumab Aekn

Ustekinumab Iv Product

Ustekinumab Products

Ustekinumab Ttwe

Vanrafia Atrasentan Hcl

Vascepa

Venlafaxine Extended Release Tablet

Veozah

Vericiguat

Verkazia

Verquvo

Versacloz Clozapine

Verzenio

Vevye

Vevye Cyclosporine

Vfend Voriconazole

Vibramycin

Victoza

Viibryd

Vijoice

Vimovo

Vivjoa Oteseconazole

Vmat2 Inhibitors

Vogelxo

Vosevi Sofosbuvir Velpatasvir Voxilaprevir

Vosoritide

Votrient

Vowst

Voxzogo

Voydeya

Vtama

Vumerity Diroximel Fumarate

Vykat Xr

Vyleesi

Vyndamax

Vyndaqel

Vyvgart Hytrulo Efgartigimod Alfa Hyaluronidase Qvfc

Wainua

Wakix

Wegovy

Wellbutrin Sr

Wellbutrin Xl

Wezlana Ustekinumab Auub

Wilate

Winlevi

Winrevair

Xdemvy

Xeljanz

Xeljanz Xr

Xeloda

Xenazine

Xenical

Xerese

Xhance

Xifaxan 550mg

Xiidra

Xiidra Lifitegrast

Ximino

Xolair

Xolremdi

Xphozah

Xtampza Er

Xyntha

Xyntha Solofuse

Xyosted

Yesintek Ustekinumab Kfce

Yorvipath

Yosprala

Yuflyma Adalimumab Aaty

Yusimry Adalimumab Aqvh

Yutrepia

Zavesca

Zavzpret

Zegerid

Zelsuvmi

Zembrace Symtouch

Zepatier Elbasvir Grazoprevir

Zepbound

Zeposia

Zeposia 7 Day Starter Pac

Zeposia Ozanimod

Zeposia Starter Kit

Ziextenzo Pegfilgrastim Bmez

Zilbrysq

Zilucoplan Sodium

Zipsor

Zokinvy

Zoloft

Zomacton

Zonalon

Zorbtive

Zoryve

Ztlido Lidocaine Topical System 1 8

Zurzuvae

Zyclara 2 5 Cream

Zyclara Imiquimod 3 75 Cream

Zyflo

Zymfentra

Zyprexa Olanzapine

Zyprexa Zydis Olanzapine

Zytiga

Zytiga 500 Mg

Zytiga 500 Mg Abiraterone 500 Mg