Highmark

Abirtega Abiraterone Acetate

Absorica

Absorica Ld

Accrufer Ferric Maltol

Acthar Gel Vial Repository Corticotropin

Actimmune

Adalimumab Preferred Products

Adbry Tralokinumab Ldrm

Adcirca

Adcirca Tadalafil

Addyi Flibanserin

Adempas Riociguat

Afinitor Disperz Everolimus Tablets For Oral Suspension

Afinitor Everolimus

Agamree Vamorolone

Aimovig

Aimovig Erenumab Aooe

Ajovy

Ajovy Fremanezumab Vfrm

Akeega Niraparib And Abiraterone Acetate

Aklief

Alecensa Alectinib

Alferon N

Alhemo

Alkindi Sprinkle

All Other Targeted Medications

Altreno Tretinoin Lotion

Alunbrig Brigatinib

Alvaiz

Alyftrek

Alyq

Andembry

Androderm Testosterone Patch

Androgel 1

Androgel 1 62

Androgel Testosterone Packet Gel

Any Fertility Drug Addressed In This Policy

Any Medication Subject To Prior Authorization Or Step Therap

Any Products With Utilization Management

Anzupgo Delgocitinib

Aplenzin Bupropion Hydrobromide

Apokyn Apomorphine Hydrochloride Injection

Aqneursa Levacetylleucine

Arakoda Tafenoquine

Arcalyst Rilonacept

Arikayce Amikacin Liposome Inhalation Suspension

Atralin Tretinoin Gel

Attruby Acoramidis

Aubagio

Augtyro Repotrectinib

Austedo

Austedo Xr

Avita Tretinoin Cream And Gel

Avmapki Fakzynja Co Pack Avutometinib Defactinib

Avonex Interferon Beta 1a

Ayvakit Avapritinib

Baclofen

Baclofen Oral Solution

Bafiertam

Balversa Erdafitinib

Benlysta Belimumab Subcutaneous

Benznidazole

Berinert

Besremi

Betaseron Interferon Beta 1b

Bethkis

Bimzelx

Bimzelx Bimekizumab Bkzx

Bismuth Subcitrate Potassium Metronidazole Tetracycline Hydr

Bonjesta Doxylamine Succinate And Pyridoxine Hydrochloride

Bosulif Bosutinib

Braftovi Encorafenib Erbitux Cetuximab

Braftovi Encorafenib Erbitux Cetuximab Mfolfox6

Brexafemme Ibrexafungerp

Brinsupri Brensocatib

Bronchitol

Brukinsa Zanubrutinib

Bucapsol Capsules

Buphenyl Sodium Phenylbutyrate

Bupropion

Bupropion Extended Release Sr

Bupropion Extended Release Xl

Bylvay Odevixibat

Cablivi Caplacizumab Yhdp

Cabometyx Cabozantinib

Calquence Acalabrutinib

Camzyos Mavacamten

Cancer Chemotherapy Medications

Cancer Chemotherapy Medications Covered Under The Pharmacy B

Caprelsa Vandetanib

Carac Fluorouracil 0 5 Topical Cream

Carbaglu Carglumic Acid

Carospir Spironolactone Oral Suspension

Cayston

Cequa

Cerdelga Eliglustat

Cetrotide

Chenodal Chenodiol

Cholbam Cholic Acid

Cibinqo Abrocitinib

Cimzia

Cinryze

Clobetasol Propionate Ophthalmic Suspension 1

Clomiphene Citrate

Cometriq Cabozantinib

Compounded Medications

Conexxence

Conexxence Denosumab Bnht

Conjupri Levamlodipine

Contraceptive Therapies Oral Topical Etc

Contrave

Copaxone Glatiramer Acetate

Copiktra Duvelisib

Corlanor Ivabradine

Corlanor Ivabradine Oral Solution

Cosentyx

Cosentyx Sc Secukinumab

Crenessity Crinecerfont

Cresemba Isavuconazonium Sulfate Capsules

Crinone 8

Ctexli Chenodiol

Cuvposa Glycopyrrolate Oral Solution

Cystadane Betaine Anhydrous For Oral Solution

Cystadrops Cysteamine Ophthalmic Solution

Cystaran Cysteamine Ophthalmic Solution

Danziten Nilotinib

Daraprim Pyrimethamine

Dartisla Odt Glycopyrrolate

Daurismo Glasdegib

Daybue Trofinetide

Demser

Depo Testosterone Testosterone Cypionate Intramuscular Oil

Deutetrabenazine

Diacomit Stiripentol

Dibenzyline Phenoxybenzamine

Diclegis Doxylamine Succinate And Pyridoxine Hydrochloride

Diclofenac Potassium 25 Mg Tablet

Diclofenac Sodium 3 Topical Gel

Dificid Fidaxomicin Tablets

Dificid Oral Suspension

Dihydroergotamine Injection

Dojolvi Triheptanoin

Doptelet Tablet Avatrombopag

Drizalma Sprinkle Duloxetine

Droxidopa

Dupixent Dupilumab

Duvyzat Givinostat

Ebglyss Lebrikizumab Lbkz

Egrifta Sv Tesamorelin For Injection

Egrifta Wr Tesamorelin For Injection

Ekterly

Elidel Pimecrolimus Cream 1

Emflaza Deflazacort

Emgality

Emgality Galcanezumab Gnlm

Empaveli Pegcetacoplan

Enbrel Etanercept

Endari L Glutamine

Endometrin

Ensacove Ensartinib

Enspryng Satralizumab Mwge

Enteral Formulas

Entresto Sprinkle Sacubitril Valsartan

Entyvio Sc Vedolizumab

Eohilia Budesonide Oral Suspension

Epclusa

Epclusa Ag

Epclusa Sofosbuvir Velpatasvir

Epidiolex Cannabidiol Oral Solution

Epsolay

Erivedge Vismodegib

Erleada Apalutamide

Esbriet Pirfenidone

Evenity

Evoxac Cevimeline

Evrysdi Risdiplam

Excluded Anti Fungals

Excluded Anti Virals

Excluded Antibiotics

Excluded Combination Products

Excluded Contraceptive Any

Excluded Contraceptives

Exjade Deferasirox

Exservan Riluzole

Eysuvis

Fabhalta Iptacopan

Farydak Panobinostat

Fasenra

Fentanyl Citrate Actiq Transmucosal Lozenge

Fentanyl Citrate Buccal Tablet

Ferriprox Deferiprone

Filspari Sparsentan

Filsuvez Birch Triterpenes

Fintepla Fenfluramine

Firazyr

Firdapse Amifampridine

First Progesterone Vgs

Fleqsuvy Baclofen Oral Suspension

Fluorouracil 0 5 Topical Cream

Follistim Aq

Forfivo Xl Bupropion Xl

Forteo Teriparatide

Fortesta

Fortesta Testosterone Gel

Fotivda Tivozanib

Fruzaqla

Furoscix Furosemide

Gabarone Gabapentin

Galafold Migalastat

Ganirelix Acetate Fyremadel

Gattex Teduglutide

Gavreto Pralsetinib

Genotropin

Gilenya 0 25 Mg

Gilenya 0 5 Mg

Gilotrif Afatinib

Gimoti Metoclopramide Nasal Spray

Glatopa Glatiramer Acetate

Gleevec Imatinib

Gocovri Amantadine Er

Gonal F

Gonal F Rff

Gonal F Rff Redi Ject

Grastek

Growth Hormone Product

Haegarda

Harliku

Harvoni

Harvoni Ag

Harvoni Ledipasvir Sofosbuvir

Hemady Dexamethasone

Hemlibra

Hernexeos Zongertinib

Hetlioz Lq Tasimelteon

Hetlioz Tasimelteon

Horizant Gabapentin Enacarbil

Humatrope

Hyftor Sirolimus

Hympavzi

Ibrance Palbociclib

Ibtrozi Taletrectinib

Idhifa Enasidenib

Ilaris Canakinumab

Ilumya

Ilumya Tildrakizumab Asmn

Imbruvica Ibrutinib

Imbruvica Ibrutinib 140 Mg Tablets

Imbruvica Ibrutinib 280 Mg Tablets

Imbruvica Ibrutinib Oral Suspension

Imcivree Setmelanotide

Imkeldi Imatinib

Inbrija Levodopa

Increlex Mecasermin

Ingrezza

Ingrezza Sprinkle

Inlyta

Inqovi Decitabine Cedazuridine

Inrebic Fedratinib

Iqirvo Elafibranor

Iressa Gefitinib

Isturisa Osilodrostat

Itovebi Inavolisib

Iwilfin Eflornithine

Jadenu Deferasirox

Jakafi Ruxolitinib

Jatenzo

Jatenzo Testosterone Undecanoate Capsule

Javygtor Sapropterin Dihydrochloride

Jaypirca Pirtobrutinib

Jesduvroq Daprodustat

Joenja Leniolisib

Journavx Suzetrigine

Jubbonti

Jubbonti Denosumab Bbdz

Juxtapid Lomitapide

Jynarque Tolvaptan

Kalydeco

Katerzia Amlodipine Benzoate

Kesimpta Ofatumumab

Keveyis Dichlorphenamide

Kevzara

Khindivi

Kineret

Kisqali Femara Co Pack Ribociclib Letrozole

Kisqali Ribociclib

Kitabis Pak

Klisyri Tirbanibulin

Korlym Mifepristone

Krazati Adagrasib

Krintafel Tafenoquine

Kuvan Sapropterin Dihydrochloride

Kyzatrex

Kyzatrex Testosterone Undecanoate

Lampit Nifurtimox

Lazcluze Lazertinib

Lenvima

Leqembi Iqlik Lecanemab Irmb

Letairis

Letairis Ambrisentan

Leuprolide Acetate Depot 22 5 Mg

Levamlodipine

Lidocaine 5 Ointment

Likmez Metronidazole

Livdelzi Seladelpar

Livmarli Maralixibat

Livtencity Maribavir

Lodoco Colchicine

Lofena Diclofenac Potassium 25 Mg Tablet

Lokelma Sodium Zirconium Cyclosilicate

Lonsurf Trifluridine Tipiracil

Lorbrena Lorlatinib

Lotronex Alosetron

Lumakras Sotorasib

Lumryz

Lupkynis Voclosporin

Lupron Depot

Lupron Depot 11 25 Mg

Lupron Depot 22 5 Mg

Lupron Depot 3 75 Mg

Lupron Depot 30 Mg

Lupron Depot 45 Mg

Lupron Depot 7 5 Mg

Lupron Depot Ped

Lutrate Depot

Lybalvi Olanzapine Samidorphan

Lynparza Olaparib

Lytgobi Futibatinib

Lyvispah Baclofen Oral Granules

Mavenclad Cladribine

Mavyret

Mavyret Glecaprevir Pibrentasvir

Mayzent Siponimod

Menopur

Metaxalone 640 Mg

Methitest

Methitest Methyltestosterone Tablet

Methyltestosterone

Methyltestosterone Capsule

Metronidazole 125 Mg Tablet

Metyrosine

Miebo

Migergot Ergotamine Tartrate And Caffeine Suppository

Migranal Dihydroergotamine

Milnacipran

Miplyffa Arimoclomal

Modeyso Dordaviprone

Mulpleta Lusutrombopag

Myalept Metreleptin

Mycapssa Octreotide

Myfembree

Myrbetriq Granules

Nascobal Cyanocobalamin

Natesto

Natesto Testosterone Nasal Gel

Nemluvio Nemolizumab Ilto

Nerlynx Neratinib

Nexavar

Nexletol

Nexletol Bempedoic Acid

Nexlizet

Nexlizet Bempedoic Acid Ezetimibe

Ngenla

Ninlaro Ixazomib

Nityr

Nityr 2 Mg

Non Formulary Products

Norditropin

Norliqva Amlodipine

Northera

Nourianz Istradefylline

Novarel Chorionic Gonadotropin

Noxafil Posaconazole Delayed Release Tablets

Noxafil Posaconazole Oral Suspension

Noxafil Posaconazole Powdermix For Delayed Release Oral Susp

Nplate Romiplostim

Nubeqa Darolutamide

Nuplazid Pimavanserin

Nurtec Odt

Nurtec Odt Rimegepant

Nutropin

Nuvigil Armodafinil

Nuwiq

Ocaliva Obeticholic Acid

Odactra

Odomzo Sonidegib

Ofev Nintedanib

Ogsiveo Nirogacestat

Ohtuvayre Ensifentrine

Ojjaara Momelotinib

Olpruva Sodium Phenylbutyrate

Olumiant

Omalizumab

Omnitrope

Omvoh

Onapgo Apomorphine Hydrochloride Injection

Ondansetron Orally Disintegrating Tablet Odt 16 Mg

Onfi Clobazam Oral Tablets And Suspension Brand Only

Ongentys Opicapone

Onureg Azacitidine

Opfolda Miglustat

Opzelura Ruxolitinib

Oralair

Orencia

Orencia Sc Abatacept

Orfadin Nitisinone Capsules

Orfadin Nitisinone Oral Suspension

Orgovyx Relugolix

Oriahnn

Orilissa

Orkambi

Orladeyo

Ormalvi Dichlorphenamide

Orserdu Elacestrant

Osmolex Er Amantadine Er

Otezla Apremilast

Ovidrel

Oxbryta Voxelotor Oral Tablets

Oxbryta Voxelotor Tablets For Oral Suspension

Oxervate Cenegermin Bkbj

Oxybutynin 2 5 Mg Tablet

Ozobax Baclofen Oral Solution

Ozobax Ds Baclofen Oral Solution

Palforzia Peanut Arachis Hypogaea Allergen Powder Dnfp

Palynziq Pegvaliase Pqpz

Panretin Gel Alitretinoin

Pegasys

Pemazyre Pemigatinib

Pennsaid Diclofenac Sodium Topical Solution 2

Pheburane Sodium Phenylbutyrate

Piqray Alpelisib

Plegridy Peginterferon Beta 1a

Pliaglis Lidocaine And Tetracaine Cream

Pokonza

Pokonza Potassium Chloride For Oral Solution

Pomalyst Pomalidomide

Ponvory Ponesimod

Praluent

Praluent Alirocumab

Pregnyl Chorionic Gonadotropin

Pretomanid

Prevymis Letermovir Oral Pellets

Procysbi Cysteamine Bitartrate

Prolia

Prolia Denosumab

Promacta Eltrombopag Olamine

Protopic Tacrolimus Ointment 0 1

Provigil Modafinil

Pulmozyme

Pylera

Pyrukynd Mitapivat

Qbrexza

Qdolo

Qfitlia

Qinlock Ripretinib

Qlosi

Qsymia

Qulipta

Qulipta Atogepant

Radicava Ors Edaravone

Ragwitek

Ravicti Glycerol Phenylbutyrate

Rayaldee Calcifediol

Rayos

Rebif Interferon Beta 1a

Recombinate

Recorlev Levoketoconazole

Relistor Methylnaltrexone Bromide Subcutaneous Injection

Relistor Methylnaltrexone Bromide Tablets

Repatha

Repatha Evolocumab

Restasis

Retevmo Selpercatinib

Retin A Micro Pump Tretinoin Gel

Retin A Micro Tretinoin Gel

Retin A Tretinoin Cream And Gel

Revatio

Revlimid Lenalidomide

Revuforj Revumenib

Reyvow Lasmiditan

Rezdiffra

Rezdiffra Resmetirom

Rezlidhia Olutasidenib

Rezurock Belumosudil

Ribavirin

Rinvoq

Rinvoq Er Tablet

Rinvoq Lq Upadacitinib

Rinvoq Tablets

Riomet Er

Rivfloza Nedosiran

Romvimza Vimseltinib

Rozlytrek Entrectinib

Ruconest

Rydapt Midostaurin

Sabril Vigabatrin

Saizen

Sajazir Icatibant

Salivamax

Samsca

Savella

Saxenda Liraglutide

Select New To Market Drugs

Sephience Sepiapterin

Serophene

Serostim

Signifor Pasireotide

Siklos

Siliq

Simponi

Simponi Aria

Skyclarys Omaveloxolone

Skytrofa

Sodium Oxybate

Sofdra

Sogroya

Sohonos Palovarotene

Somavert Pegvisomant

Sotyktu

Sovaldi

Sovaldi Sofosbuvir

Spevigo Spesolimab Sbzo Subcutaneous

Stivarga

Stoboclo

Stoboclo Denosumab Bmwo

Strensiq Asfotase Alfa

Sucraid Sacrosidase

Sunosi Solriamfetol

Sutent

Symbravo

Symdeko

Sympazan Clobazam Oral Film

Synarel Nafarelin Acetate

Syndros Dronabinol Oral Solution

Tabrecta Capmatinib

Tacrolimus Ointment 0 03

Tadliq

Tagrisso Osimertinib

Takhzyro

Talicia Omeprazole Amoxicillin And Rifabutin

Tarceva Erlotinib

Targeted Medications

Targretin Bexarotene Oral Capsules

Targretin Bexarotene Topical Gel

Tarpeyo Budesonide Delayed Release Capsules

Tascenso Odt 0 25 Mg

Tascenso Odt 0 5 Mg

Tavalisse Fostamatinib

Tavneos Avacopan

Tazverik Tazemetostat

Tecfidera Dimethyl Fumarate

Teglutik Riluzole

Tepmetko Tepotinib

Teriflunomide

Testim

Testim Testosterone Gel

Testone Cik Testosterone Cypionate Kit

Testopel Testosterone Subcutaneous Implant Pellets

Testosterone Cypionate Im

Testosterone Enanthate Intramuscular Oil

Testosterone Enanthate Oil For Injection

Testosterone Products

Testosterone Subcutaneous Implant Pellet

Testosterone Topical Solution

Tetracycline Tablet

Tezepelumab Ekko

Tezspire

Thalomid Thalidomide

Thiola Ec Tiopronin

Thiola Tiopronin

Tibsovo Ivosidenib

Tiglutik Riluzole

Tlando

Tlando Testosterone Undecanoate Capsule

Tobi

Tobi Podhaler

Tocilizumab Iv

Tocilizumab Sc

Tolsura Itraconazole

Tolvaptan

Torpenz Everolimus

Tracleer Oral Tablets

Trientine Hydrochloride 500 Mg Capsules

Trikafta

Trudhesa

Truqap Capivasertib

Tryngolza Olezarsen

Tryptyr

Tryvio Aprocitentan

Tukysa Tucatinib

Turalio Pexidartinib

Tykerb Lapatinib

Tymlos Abaloparatide

Tyrvaya

Ubrelvy

Ubrelvy Ubrogepant

Ultomiris Ravulizumab Cwvz Subcutaneous

Undecatrex

Undecatrex Testosterone Undecanoate Capsule

Vafseo Vadadustat

Valchlor Mechlorethamine

Vanflyta Quizartinib

Vanrafia Atrasentan

Velsipity

Velsipity Etrasimod

Veltassa Patiromer

Venclexta Venetoclax

Venlafaxine Besylate

Venxxiva Tiopronin

Veozah Fezolinetant

Verkazia Cyclosporine Ophthalmic Emulsion

Verquvo Vericiguat

Verzenio Abemaciclib

Vesicare Ls

Vevye

Viberzi Eluxadoline

Viekira Pak

Viekira Pak Ombitasvir Paritaprevir Ritonavir Dasabuvir

Vigadrone Vigabatrin

Vigafyde Vigabatrin

Vigpoder Vigabatrin

Vijoice Alpelisib

Vitrakvi Larotrectinib

Vivjoa Oteseconazole

Vivlodex Meloxicam

Vizimpro Dacomitinib

Vogelxo

Vogelxo Testosterone Gel

Vonjo Pacritinib

Voquezna

Voquezna Dual Pak

Voquezna Triple Pak

Voranigo Vorasidenib

Vosevi

Vosevi Sofosbuvir Velpatasvir Voxilaprevir

Votrient

Vowst Fecal Microbiota Spores Live Brpk

Voxzogo Vosoritide

Voydeya Danicopan

Vtama Tapinarof

Vuity

Vumerity

Vusion Miconazole Nitrate 0 25 Zinc Oxide 15 White Petrolatu

Vykat Xr Diazoxide Choline

Vyleesi Bremelanotide Injection

Vyndamax Tafamidis

Vyndaqel Tafamidis Meglumine

Vyvgart Hytrulo Efgartigimod Alfa And Hyaluronidase Qvfc

Wainua Eplontersen

Wakix Pitolisant

Wegovy

Wegovy Semaglutide

Welireg Belzutifan

Wellbutrin Sr Bupropion Sr

Wellbutrin Xl Bupropion Xl

Xadago Safinamide

Xalkori Crizotinib

Xcopri Cenobamate

Xdemvy Lotilaner

Xeljanz

Xeljanz Oral Solution

Xeljanz Tablets

Xeljanz Tofacitinib

Xeljanz Xr

Xeljanz Xr Tofacitinib

Xenazine Tetrabenazine

Xenical

Xerese Acyclovir 5 And Hydrocortisone 1 Topical Cream

Xermelo Telotristat Ethyl

Xolair

Xolair Autoinjector

Xolair Omalizumab Autoinjector

Xolair Omalizumab Prefilled Syringe

Xolair Prefilled Syringe

Xolremdi Mavorixafor

Xospata Gilteritinib

Xphozah Tenapanor

Xpovio Selinexor

Xromi

Xtandi Enzalutamide

Xuriden Uridine Triacetate

Xyosted

Xyosted Testosterone Enanthate Subcutaneous Solution

Xyrem

Xywav

Yargesa Miglustat

Yonsa Abiraterone Acetate Micronized

Yorvipath Palopegteriparatide

Yosprala Aspirin And Omeprazole

Zavesca Miglustat

Zavzpret

Zavzpret Zavegepant

Zelsuvmi Berdazimer

Zepatier

Zepatier Elbasvir Grazoprevir

Zepbound

Zeposia

Zeposia Ozanimod

Zilbrysq Zilucoplan

Zipsor Diclofenac Potassium Capsule

Zokinvy Lonafarnib

Zolinza Vorinostat

Zolpidem Capsules

Zomacton

Zorbtive

Zorvolex Diclofenac Capsule

Zoryve 0 15 Cream Roflumilast

Zoryve 0 3 Cream Roflumilast

Zoryve Foam Roflumilast

Zovirax Acyclovir Topical Cream

Ztalmy Ganaxolone

Zurzuvae Zuranolone

Zyclara Imiquimod Cream 2 5

Zyclara Imiquimod Cream 3 75

Zydelig Idelalisib

Zykadia Ceritinib

Zymfentra

Zymfentra Infliximab Dyyb Sc

Zytiga Abiraterone Acetate