Report : A-Z HCD items in Formulary 03/06/2020 04:09:38

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Section Status HCD Name 01.05.03 Formulary Vedolizumab  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 Non Formulary Avatrombopag  08.01.05 Restricted Use Axitinib  08.01.03 Restricted Use Azacitidine  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  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  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 Restricted Use 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  05.03.02.02 Restricted Use Cidofovir infusion  09.05.01.02 Restricted Use Cinacalcet  08.01.03 Non Formulary Clofarabine  05.03.01 Restricted Use Cobicistat  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  08.01.05 Restricted Use Dabrafenib caps  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® 03.07 Non Formulary Dornase alfa  08.01.02 Restricted Use Doxorubicin pegylated liposomal Caelyx® 09.01.03 Formulary Eculizumab  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  08.03.04.02 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  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  08.02.04 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  04.13 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  05.03.03.02 Restricted Use Ledipasvir + Sofosbuvir  08.02.04 Restricted Use Lenalidomide  09.01.06 Restricted Use Lenograstim Granocyte® 08.01.05 Formulary Lenvatinib caps Kisplyx® 08.01.05 Formulary Lenvatinib caps Lenvima® 09.08.01 Formulary Levocarnitine  05.01.12 Non Formulary Levofloxacin nebuliser Quinsair® 02.12 Non Formulary Lomitapide  05.03.01 Formulary Lopinavir + Ritonavir  09.01.04 Non Formulary Lusutrombopag  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  08.02.01 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 Iqymune® 14.05.01 Formulary Normal Immunoglobulin for Intravenous use Tegeline® 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 Abraxane® 08.01.05 Restricted Use Palbociclib  05.03.05 Restricted Use Palivizumab  08.01.05 Restricted Use Panitumumab  08.01.05 Restricted Use Panobinostat  06.06.01 Non Formulary Parathyroid Hormone Natpar® 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 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  08.02.04 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  11.08.02 Restricted Use Ranibizumab intravitrial injection  10.01.04 Formulary Rasburicase  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  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

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