Section |
Status |
HCD |
Name |
05.03.01 |
Restricted Use
|
 |
Abacavir |
05.03.01 |
Restricted Use
|
 |
Abacavir + Lamivudine |
10.01.03 |
Restricted Use
|
 |
Abatacept |
08.03.04.02 |
Formulary
|
 |
Abiraterone |
01.05.03 |
Restricted Use
|
 |
Adalimumab |
10.01.03 |
Restricted Use
|
 |
Adalimumab |
13.05.03 |
Restricted Use
|
 |
Adalimumab |
05.03.03.01 |
Restricted Use
|
 |
Adefovir Dipivoxil |
08.01.05 |
Restricted Use
|
 |
Afatinib |
08.01.05 |
Formulary
|
 |
Aflibercept infusion Zaltrap® |
11.08.02 |
Restricted Use
|
 |
Aflibercept intraocular injection Eylea® |
09.08.01 |
Restricted Use
|
 |
Agalsidase alfa and beta Fabrazyme® |
09.08.01 |
Restricted Use
|
 |
Agalsidase alfa and beta Replagal® |
08.02.04 |
Non Formulary
|
 |
Aldesleukin |
08.01.05 |
Formulary
|
 |
Alectinib tabs |
09.08.01 |
Restricted Use
|
 |
Alglucosidase Alfa |
02.12 |
Restricted Use
|
 |
Alirocumab |
13.05.01 |
Formulary
|
 |
Alitretinoin |
02.05.01 |
Restricted Use
|
 |
Ambrisentan |
10.02.01 |
Non Formulary
|
 |
Amifampridine |
05.02 |
Non Formulary
|
 |
Amphotericin lipid complex infusion Abelcet® |
05.02 |
Restricted Use
|
 |
Amphotericin liposomal infusion AmBisome® |
10.01.03 |
Non Formulary
|
 |
Anakinra |
05.02.04 |
Restricted Use
|
 |
Anidulafungin |
02.11 |
Restricted Use
|
 |
Antithrombin III Kybemin® |
08.02.02 |
Restricted Use
|
 |
Antithymocyte immunoglobulin - rabbit Thymoglobuline® |
10.01.03 |
Restricted Use
|
 |
Apremilast |
13.05.03 |
Restricted Use
|
 |
Apremilast |
10.02 |
Non Formulary
|
 |
Ataluren granules |
05.03.01 |
Restricted Use
|
 |
Atazanavir |
05.03.01 |
Restricted Use
|
 |
Atazanavir + cobicistat Evotaz® |
09.01.04 |
Restricted Use
|
 |
Avatrombopag tabs |
08.01.05 |
Restricted Use
|
 |
Axitinib tabs |
08.01.03 |
Restricted Use
|
 |
Azacitidine |
09.09 |
Formulary
|
 |
Azathioprine |
05.01.02.03 |
Non Formulary
|
 |
Aztreonam nebuliser solution Cayston® |
08.02.02 |
Restricted Use
|
 |
Basiliximab |
05.01.09 |
Formulary
|
 |
Bedaquiline |
08.02.02 |
Non Formulary
|
 |
Belatacept |
10.01 |
Formulary
|
 |
Belimumab |
08.01.01 |
Restricted Use
|
 |
Bendamustine infusion |
03.05.02 |
Non Formulary
|
 |
Beractant |
08.01.05 |
Restricted Use
|
 |
Bevacizumab |
08.01.05 |
Restricted Use
|
 |
Binimetinib tabs |
08.01.05 |
Restricted Use
|
 |
Bortezomib injection |
02.05.01 |
Restricted Use
|
 |
Bosentan |
02.05.01 |
Restricted Use
|
 |
Bosentan |
08.01.05 |
Restricted Use
|
 |
Bosutinib |
04.07.04.02 |
Formulary
|
 |
Botulinum Toxin Type A Botox® |
08.01.05 |
Restricted Use
|
 |
Brentuximab vedotin infusion |
08.01.05 |
Formulary
|
 |
Brigatinib tabs |
13.05.03 |
Restricted Use
|
 |
Brodalumab |
03.04.03 |
Restricted Use
|
 |
C1 Esterase Inhibitor Cinryze® |
08.01.05 |
Restricted Use
|
 |
Cabazitaxel |
08.01.05 |
Formulary
|
 |
Cabozantinib caps Cometriq® |
08.01.05 |
Restricted Use
|
 |
Cabozantinib tabs Cabometyx® |
10.01.04 |
Non Formulary
|
 |
Canakinumab |
09.08.01 |
Non Formulary
|
 |
Carglumic acid |
05.02.04 |
Restricted Use
|
 |
Caspofungin |
02.11 |
Non Formulary
|
 |
Catridecacog NovoThirteen® |
08.01.05 |
Restricted Use
|
 |
Ceritinib |
10.01.03 |
Restricted Use
|
 |
Certolizumab pegol |
13.05.03 |
Formulary
|
 |
Certolizumab pegol |
08.01.05 |
Restricted Use
|
 |
Cetuximab |
09.09 |
Formulary
|
 |
Ciclosporin |
05.03.02.02 |
Restricted Use
|
 |
Cidofovir infusion |
09.05.01.02 |
Restricted Use
|
 |
Cinacalcet |
08.01.03 |
Non Formulary
|
 |
Clofarabine |
04.09.01 |
Restricted Use
|
 |
Co-Careldopa intestinal gel Duodopa® |
05.01.07 |
Restricted Use
|
 |
Colistimethate for nebulisation |
05.01.07 |
Non Formulary
|
 |
Colistimethate inhaler Colobreathe® |
03.04.03 |
Restricted Use
|
 |
Conestat Alfa |
08.01.05 |
Restricted Use
|
 |
Crizotinib |
09.09 |
Formulary
|
 |
Cyclophosphamide tablets |
08.01.05 |
Restricted Use
|
 |
Dabrafenib caps |
09.09 |
Formulary
|
 |
Danazol |
09.01.03 |
Restricted Use
|
 |
Darbepoetin alfa Aranesp® |
05.03.01 |
Restricted Use
|
 |
Darunavir |
05.03.01 |
Formulary
|
 |
Darunavir + Cobicistat Rezolsta® |
05.03.03.02 |
Restricted Use
|
 |
Dasabuvir |
08.01.05 |
Restricted Use
|
 |
Dasatinib |
08.01.03 |
Non Formulary
|
 |
Decitabine |
09.01.03 |
Restricted Use
|
 |
Deferasirox |
09.01.03 |
Restricted Use
|
 |
Deferiprone |
05.01.09 |
Restricted Use
|
 |
Delamanid |
09.01.03 |
Restricted Use
|
 |
Desferrioxamine Mesilate |
11.04.01 |
Restricted Use
|
 |
Dexamethasone intravitreal implant Ozurdex® |
08.01 |
Non Formulary
|
 |
Dexrazoxane Cardioxane® |
02.01.01 |
Formulary
|
 |
Digoxin specific antibody fragments Digifab® |
18 |
Non Formulary
|
 |
Digoxin specific antibody fragments Digifab® |
08.02.04 |
Restricted Use
|
 |
Dimethyl fumarate Tecfidera® |
05.03.01 |
Formulary
|
 |
Dolutegravir |
05.03.01 |
Formulary
|
 |
Dolutegravir + Abacavir + Lamivudine Triumeq® |
05.03.01 |
Formulary
|
 |
Dolutegravir + Rilpivirine Juluca® |
03.07 |
Non Formulary
|
 |
Dornase alfa |
08.01.02 |
Restricted Use
|
 |
Doxorubicin pegylated liposomal Caelyx® |
04.13 |
Non Formulary
|
 |
Eculizumab infusion |
04.13 |
Non Formulary
|
 |
Eculizumab infusion |
09.01.03 |
Formulary
|
 |
Eculizumab infusion |
05.03.01 |
Formulary
|
 |
Efavirenz |
09.08.01 |
Formulary
|
 |
Eliglustat |
09.01.04 |
Restricted Use
|
 |
Eltrombopag |
05.03.01 |
Formulary
|
 |
Emtricitabine |
05.03.01 |
Restricted Use
|
 |
Emtricitabine + Rilpivirine + Tenofovir disoproxil Eviplera® |
08.01.05 |
Restricted Use
|
 |
Encorafenib caps |
05.03.01 |
Restricted Use
|
 |
Enfuvirtide |
05.03.03.01 |
Formulary
|
 |
Entecavir |
08.01.05 |
Restricted Use
|
 |
Entrectinib caps |
08.03.04.02 |
Formulary
|
 |
Enzalutamide |
09.01.03 |
Restricted Use
|
 |
Epoetin alfa Eprex® |
09.01.03 |
Restricted Use
|
 |
Epoetin beta NeoRecormon® |
02.08.01 |
Restricted Use
|
 |
Epoprostenol |
08.01.05 |
Restricted Use
|
 |
Eribulin |
08.01.05 |
Restricted Use
|
 |
Erlotinib tab |
10.01.03 |
Restricted Use
|
 |
Etanercept |
13.05.03 |
Restricted Use
|
 |
Etanercept |
16.01 |
Restricted Use
|
 |
Etanercept |
09.05.01.02 |
Restricted Use
|
 |
Etelcalcetide |
05.03.01 |
Formulary
|
 |
Etravirine |
08.01.05 |
Restricted Use
|
 |
Everolimus Votubia® |
08.01.05 |
Restricted Use
|
 |
Everolimus Afinitor® |
08.02.02 |
Non Formulary
|
 |
Everolimus Certican® |
02.12 |
Restricted Use
|
 |
Evolocumab |
02.11 |
Restricted Use
|
 |
Factor IX |
02.11 |
Restricted Use
|
 |
Factor VIIa, recombinant Novo 7® |
02.11 |
Restricted Use
|
 |
Factor VIII |
02.11 |
Restricted Use
|
 |
Factor VIII Inhibitor Bypassing Fraction |
02.11 |
Restricted Use
|
 |
Factor X Coagadex® |
02.11 |
Restricted Use
|
 |
Factor XI Hemoleven® |
02.11 |
Restricted Use
|
 |
Factor XIII Fraction, Dried |
17.01 |
Restricted Use
|
 |
Fibrin Sealant Evicel® |
17.01 |
Formulary
|
 |
Fibrin Sealant Tisseel® Ready to Use |
08.02.04 |
Formulary
|
 |
Fingolimod |
11.04.01 |
Restricted Use
|
 |
Fluocinolone acetonide intravitreal implant Iluvien® |
18 |
Non Formulary
|
 |
Fomepizole |
05.03.01 |
Formulary
|
 |
Fosamprenavir |
05.03.02.02 |
Restricted Use
|
 |
Foscarnet sodium IV |
05.03.02.02 |
Restricted Use
|
 |
Ganciclovir IV |
08.01.05 |
Restricted Use
|
 |
Gefitinib |
08.01.05 |
Non Formulary
|
 |
Gilteritinib tabs |
08.01.05 |
Non Formulary
|
 |
Glasdegib tabs |
08.02.04 |
Restricted Use
|
 |
Glatiramer acetate |
18 |
Non Formulary
|
 |
Glucarpidase Carboxypeptidase |
01.05.03 |
Restricted Use
|
 |
Golimumab |
10.01.03 |
Restricted Use
|
 |
Golimumab |
13.05.03 |
Formulary
|
 |
Guselkumab |
09.08.02 |
Formulary
|
 |
Haem Arginate Normosang® |
02.11 |
Restricted Use
|
 |
Human fibrinogen Riastap® |
08.01.05 |
Restricted Use
|
 |
Ibrutinib |
03.04.03 |
Restricted Use
|
 |
Icatibant |
08.01.05 |
Restricted Use
|
 |
Idelalisib tabs |
09.08.01 |
Restricted Use
|
 |
Idursulfase |
02.05.01 |
Restricted Use
|
 |
Iloprost injection |
08.01.05 |
Restricted Use
|
 |
Imatinib tabs |
09.08.01 |
Restricted Use
|
 |
Imiglucerase |
01.05.03 |
Restricted Use
|
 |
Infliximab |
04.14 |
Restricted Use
|
 |
Infliximab |
10.01.03 |
Restricted Use
|
 |
Infliximab |
13.05.03 |
Restricted Use
|
 |
Infliximab |
16.01 |
Restricted Use
|
 |
Inotersen injection |
08.02.04 |
Restricted Use
|
 |
Interferon Alfa IntronA® |
08.02.04 |
Restricted Use
|
 |
Interferon Alfa Roferon-A® |
08.02.04 |
Non Formulary
|
 |
Interferon Alfa Viraferon® |
08.02.04 |
Restricted Use
|
 |
Interferon beta-1a Rebif® |
08.02.04 |
Restricted Use
|
 |
Interferon beta-1a Avonex® |
08.02.04 |
Restricted Use
|
 |
Interferon beta-1b Betaferon® |
08.02.04 |
Non Formulary
|
 |
Interferon beta-1b Extavia® |
08.01.05 |
Restricted Use
|
 |
Ipilimumab |
03.07 |
Non Formulary
|
 |
Ivacaftor |
08.01.05 |
Formulary
|
 |
Ixazomib |
05.03.01 |
Restricted Use
|
 |
Lamivudine |
08.03.04.03 |
Restricted Use
|
 |
Lanreotide Somatuline Autogel® |
08.03.04.03 |
Restricted Use
|
 |
Lanreotide Somatuline® LA |
09.05.02.02 |
Restricted Use
|
 |
Lanthanum Fosrenol ® |
08.01.05 |
Restricted Use
|
 |
Lapatinib |
09.08.01 |
Restricted Use
|
 |
Laronidase |
08.01.05 |
Non Formulary
|
 |
Larotrectinib oral solution |
05.03.03.02 |
Restricted Use
|
 |
Ledipasvir + Sofosbuvir |
08.02.04 |
Restricted Use
|
 |
Lenalidomide caps |
09.01.06 |
Restricted Use
|
 |
Lenograstim Granocyte® |
08.01.05 |
Formulary
|
 |
Lenvatinib caps Lenvima® |
08.01.05 |
Formulary
|
 |
Lenvatinib caps Kisplyx® |
09.08.01 |
Formulary
|
 |
Levocarnitine |
05.01.12 |
Non Formulary
|
 |
Levofloxacin nebuliser Quinsair® |
02.12 |
Non Formulary
|
 |
Lomitapide |
05.03.01 |
Formulary
|
 |
Lopinavir + Ritonavir |
08.01.05 |
Restricted Use
|
 |
Lorlatinib tabs |
09.01.04 |
Restricted Use
|
 |
Lusutrombopag tabs |
02.05.01 |
Restricted Use
|
 |
Macitentan |
03.07 |
Non Formulary
|
 |
Mannitol inhalation Bronchitol® |
05.03.01 |
Restricted Use
|
 |
Maraviroc |
06.07.04 |
Non Formulary
|
 |
Mecasermin |
09.08.01 |
Restricted Use
|
 |
Mercaptamine Cystagon®, Procysbi® |
09.08.01 |
Non Formulary
|
 |
Mercaptamine eye drops Cystadrops® |
09.01.03 |
Restricted Use
|
 |
Methoxy Polyethylene Glycol-Epoetin Beta Mircera® |
05.02.04 |
Non Formulary
|
 |
Micafungin |
09.08.01 |
Restricted Use
|
 |
Migalastat caps |
09.08.01 |
Restricted Use
|
 |
Miglustat |
09.09 |
Formulary
|
 |
Mycophenolate mofetil |
10.04 |
Formulary
|
 |
Mycophenolate mofetil |
08.02.04 |
Restricted Use
|
 |
Natalizumab |
08.01.05 |
Non Formulary
|
 |
Necitumumab |
08.01.03 |
Non Formulary
|
 |
Nelarabine Atriance® |
05.03.01 |
Restricted Use
|
 |
Nevirapine |
08.01.05 |
Restricted Use
|
 |
Nilotinib |
03.11 |
Non Formulary
|
 |
Nintedanib Ofev® |
05.06 |
Formulary
|
 |
Nitazoxanide |
08.01.05 |
Restricted Use
|
 |
Nivolumab injection |
14.05.01 |
Formulary
|
 |
Normal immunoglobulin for Intramuscular use |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin for Intravenous use Panzyga® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin for Intravenous use Tegeline® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin for Intravenous use Iqymune® |
14.05.01 |
Restricted Use
|
 |
Normal immunoglobulin for subcutaneous use Cuvitru® |
14.05.01 |
Non Formulary
|
 |
Normal immunoglobulin for Subcutaneous use Hyqvia® |
01.09.01 |
Formulary
|
 |
Obeticholic acid |
08.02.03 |
Restricted Use
|
 |
Obinutuzumab |
11.08.02 |
Restricted Use
|
 |
Ocriplasmin intravitreal injection |
08.03.04.03 |
Formulary
|
 |
Octreotide immediate acting injection |
08.03.04.03 |
Formulary
|
 |
Octreotide long acting injection Sandostatin Lar® |
08.02.03 |
Restricted Use
|
 |
Ofatumumab |
08.01.05 |
Restricted Use
|
 |
Olaparib |
03.04.02 |
Restricted Use
|
 |
Omalizumab |
05.03.03.02 |
Restricted Use
|
 |
Ombitasvir + paritaprevir + ritonavir Viekirax® |
08.01.05 |
Restricted Use
|
 |
Paclitaxel - Albumin Bound Formulation, solution for infusion Abraxane® |
08.01.05 |
Restricted Use
|
 |
Palbociclib cap |
05.03.05 |
Restricted Use
|
 |
Palivizumab |
08.01.05 |
Restricted Use
|
 |
Panitumumab |
08.01.05 |
Restricted Use
|
 |
Panobinostat |
06.05 |
Non Formulary
|
 |
Pasireotide |
08.01.05 |
Restricted Use
|
 |
Pazopanib |
11.08.02 |
Non Formulary
|
 |
Pegaptanib Sodium Macugen® |
09.01.06 |
Non Formulary
|
 |
Pegfilgrastim |
08.02.04 |
Restricted Use
|
 |
Peginterferon Alfa Pegasys® |
08.02.04 |
Restricted Use
|
 |
Peginterferon Beta-1a inj Plegridy® |
06.05.01 |
Formulary
|
 |
Pegvisomant |
08.01.05 |
Formulary
|
 |
Pembrolizumab injection |
08.01.03 |
Restricted Use
|
 |
Pemetrexed |
08.01.05 |
Restricted Use
|
 |
Pertuzumab injection |
03.11 |
Restricted Use
|
 |
Pirfenidone |
08.01.02 |
Formulary
|
 |
Pixantrone |
09.01.07 |
Non Formulary
|
 |
Plerixafor |
08.01.05 |
Non Formulary
|
 |
Polatuzumab vedotin solution for infusion |
08.02.04 |
Restricted Use
|
 |
Pomalidomide |
08.01.05 |
Restricted Use
|
 |
Ponatinib |
03.05.02 |
Restricted Use
|
 |
Poractant Alfa |
05.02 |
Restricted Use
|
 |
Posaconazole |
02.11 |
Non Formulary
|
 |
Protein C Concentrate Ceprotin® |
02.11 |
Restricted Use
|
 |
Prothrombin Complex Concentrate Octaplex® |
08.03.04.02 |
Restricted Use
|
 |
Radium-223 dichloride |
05.03.01 |
Restricted Use
|
 |
Raltegravir |
08.01.05 |
Non Formulary
|
 |
Ramucirumab infusion |
11.08.02 |
Restricted Use
|
 |
Ranibizumab intravitrial injection |
10.01.04 |
Formulary
|
 |
Rasburicase |
06.06.01 |
Non Formulary
|
 |
Recombinant human parathyroid hormone Natpar® |
08.01.05 |
Formulary
|
 |
Regorafenib tab |
05.03.03.02 |
Restricted Use
|
 |
Ribavirin |
08.01.05 |
Formulary
|
 |
Ribociclib |
05.03.01 |
Formulary
|
 |
Rilpivirine |
04.09.03 |
Restricted Use
|
 |
Riluzole |
02.05.01 |
Restricted Use
|
 |
Riociguat |
05.03.01 |
Formulary
|
 |
Ritonavir |
08.02.03 |
Restricted Use
|
 |
Rituximab |
10.01.03 |
Restricted Use
|
 |
Rituximab |
20 |
Restricted Use
|
 |
Rituximab |
09.01.04 |
Restricted Use
|
 |
Romiplostim |
08.01.05 |
Restricted Use
|
 |
Ruxolitinib |
09.04.01 |
Non Formulary
|
 |
Sapropterin dihydrochloride |
05.03.01 |
Formulary
|
 |
Saquinavir |
10.01.03 |
Restricted Use
|
 |
Secukinumab |
13.05.03 |
Restricted Use
|
 |
Secukinumab |
09.05.02.02 |
Formulary
|
 |
Sevelamer carbonate |
09.05.02.02 |
Restricted Use
|
 |
Sevelamer hydrochloride |
08.02.02 |
Formulary
|
 |
Sirolimus |
04.01.01 |
Non Formulary
|
 |
Sodium Oxybate |
05.03.03.02 |
Restricted Use
|
 |
Sofosbuvir |
06.05.01 |
Restricted Use
|
 |
Somatropin |
08.01.05 |
Restricted Use
|
 |
Sorafenib tabs |
05.03.01 |
Formulary
|
 |
Stavudine |
08.01.05 |
Restricted Use
|
 |
Sunitinib |
01.04.02 |
Non Formulary
|
 |
Teduglutide |
08.01.05 |
Restricted Use
|
 |
Temozolomide |
08.01.05 |
Non Formulary
|
 |
Temsirolimus |
05.03.01 |
Restricted Use
|
 |
Tenofovir alafenamide + Elvitegravir + Cobicistat + Emtricitabine Genvoya® |
05.03.01 |
Formulary
|
 |
Tenofovir disoproxil + Cobicistat + Elvitegravir + Emtricitabine Stribild® |
05.03.01 |
Formulary
|
 |
Tenofovir disoproxil + Efavirenz + Emtricitabine |
05.03.01 |
Formulary
|
 |
Tenofovir disoproxil + Emtricitabine |
05.03.01 |
Formulary
|
 |
Tenofovir disproxil |
08.02.04 |
Restricted Use
|
 |
Teriflunomide |
06.06.01 |
Formulary
|
 |
Teriparatide |
08.02.04 |
Restricted Use
|
 |
Thalidomide |
13.05.03 |
Formulary
|
 |
Tildrakizumab |
05.03.01 |
Restricted Use
|
 |
Tipranavir |
08.01.05 |
Formulary
|
 |
Tivozanib |
05.01.04 |
Non Formulary
|
 |
Tobramycin inhaler |
05.01.04 |
Non Formulary
|
 |
Tobramycin nebuliser |
10.01.03 |
Restricted Use
|
 |
Tocilizumab |
06.05.02 |
Restricted Use
|
 |
Tolvaptan Samsca® |
06.05.02 |
Restricted Use
|
 |
Tolvaptan Jinarc® |
08.01.05 |
Restricted Use
|
 |
Trametinib tabs |
09.08.01 |
Formulary
|
 |
Trientine Dihydrochloride |
01.05.03 |
Formulary
|
 |
Ustekinumab |
10.01.03 |
Restricted Use
|
 |
Ustekinumab |
13.05.03 |
Restricted Use
|
 |
Ustekinumab |
05.03.02.02 |
Restricted Use
|
 |
Valganciclovir |
08.01.05 |
Non Formulary
|
 |
Vandetanib tabs |
01.05.03 |
Formulary
|
 |
Vedolizumab |
09.08.01 |
Restricted Use
|
 |
Velaglucerase alfa |
08.01.05 |
Restricted Use
|
 |
Vemurafenib |
11.08.02 |
Restricted Use
|
 |
Verteporfin Visudyne® |
08.01.05 |
Restricted Use
|
 |
Vismodegib |
05.02 |
Restricted Use
|
 |
Voriconazole |
08.01.05 |
Non Formulary
|
 |
Vosaroxin Qinprezo |
05.03.01 |
Restricted Use
|
 |
Zidovudine |
05.03.01 |
Formulary
|
 |
Zidovudine + Lamivudine |