Preferred Drug List

Avoid out-of-pocket costs by using only preferred drugs on the Funds’ Preferred Drug List.

For Long-Term Medications, Members Must Use the 90-Day RX Solution

Print-friendly PDL
(Oct 2023 update)

Updated October 1, 2023. See list of non-covered drugs below.

Drug	Brand / Generic	Category	Subcategory	Restrictions
Claravis	Generic	Acne Therapy	Oral Acne Therapy	Do not use during pregnancy.
isotretinoin	Generic	Acne Therapy	Oral Acne Therapy	Do not use during pregnancy.
Myorisan	Generic	Acne Therapy	Oral Acne Therapy	Do not use during pregnancy.
Zenatane	Generic	Acne Therapy	Oral Acne Therapy	Do not use during pregnancy.
adapalene	Generic	Acne Therapy	Topical Acne Therapy
adapalene / benzoyl peroxide	Generic	Acne Therapy	Topical Acne Therapy
azelaic acid gel	Generic	Acne Therapy	Topical Acne Therapy
benzoyl peroxide	Generic	Acne Therapy	Topical Acne Therapy
benzoyl peroxide microspheres	Generic	Acne Therapy	Topical Acne Therapy
clindamycin / benzoyl peroxide	Generic	Acne Therapy	Topical Acne Therapy
clindamycin phosphate	Generic	Acne Therapy	Topical Acne Therapy
clindamycin phosphate/tretinoin	Generic	Acne Therapy	Topical Acne Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
dapsone 5% gel	Generic	Acne Therapy	Topical Acne Therapy
erythromycin base / benzoyl peroxide	Generic	Acne Therapy	Topical Acne Therapy
erythromycin base / ethyl alcohol	Generic	Acne Therapy	Topical Acne Therapy
erythromycin base / ethyl alcohol gel	Generic	Acne Therapy	Topical Acne Therapy
erythromycin base / ethyl alcohol swabs	Generic	Acne Therapy	Topical Acne Therapy
ivermectin 1% cream	Generic	Acne Therapy	Topical Acne Therapy
metronidazole cream, gel, lotion	Generic	Acne Therapy	Topical Acne Therapy
Neuac Gel	Generic	Acne Therapy	Topical Acne Therapy
sulfacetamide sodium / sulfur	Generic	Acne Therapy	Topical Acne Therapy
sulfacetamide sodium / sulfur / urea	Generic	Acne Therapy	Topical Acne Therapy
tazarotene 0.1% cream	Generic	Acne Therapy	Topical Acne Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
tazarotene gel	Generic	Acne Therapy	Topical Acne Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
tretinoin	Generic	Acne Therapy	Topical Acne Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
tretinoin microspheres	Generic	Acne Therapy	Topical Acne Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Azelex	Brand Name	Acne Therapy	Topical Acne Therapy
Finacea foam	Brand Name	Acne Therapy	Topical Acne Therapy
cortisone acetate	Generic	Adrenal Hormones
dexamethasone tablet, dose pack	Generic	Adrenal Hormones
fludrocortisone acetate	Generic	Adrenal Hormones
hydrocortisone	Generic	Adrenal Hormones
methylprednisolone	Generic	Adrenal Hormones
prednisolone	Generic	Adrenal Hormones
prednisolone sodium phosphate	Generic	Adrenal Hormones
prednisone	Generic	Adrenal Hormones
Celestone Solution	Brand Name	Adrenal Hormones
Medrol Tablet 2mg	Brand Name	Adrenal Hormones
donepezil	Generic	Alzheimer's Agents
galantamine	Generic	Alzheimer's Agents
memantine	Generic	Alzheimer's Agents
rivastigmine	Generic	Alzheimer's Agents
Namenda Dose Pak	Brand Name	Alzheimer's Agents
Namenda XR	Brand Name	Alzheimer's Agents
Namzaric	Brand Name	Alzheimer's Agents
abiraterone acetate	Generic	Antiandrogens		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
bicalutamide	Generic	Antiandrogens		Do not use during pregnancy. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
flutamide	Generic	Antiandrogens		Weigh the risk of birth defects or other adverse outcomes. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
nilutamide	Generic	Antiandrogens		This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Xtandi	Brand Name	Antiandrogens		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Mvasi	Brand Name	Anti-Angiogenic Therapy - Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Zirabev	Brand Name	Anti-Angiogenic Therapy - Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Riabni	Brand Name	Antibody Therapy - Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Ruxience	Brand Name	Antibody Therapy - Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Truxima	Brand Name	Antibody Therapy - Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
carbamazepine	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
carbamazepine XR	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
clobazam	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
clonazepam	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
diazepam kit	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
divalproex sodium	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
divalproex sodium ER	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
divalproex sodium sprinkles	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
ethosuximide	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
felbamate	Generic	Anticonvulsants
gabapentin	Generic	Anticonvulsants
lacosamide	Generic	Anticonvulsants
lamotrigine	Generic	Anticonvulsants
lamotrigine dose pack	Generic	Anticonvulsants
lamotrigine ODT	Generic	Anticonvulsants
lamotrigine XR	Generic	Anticonvulsants
levetiracetam	Generic	Anticonvulsants
levetiracetam XR	Generic	Anticonvulsants
oxcarbazepine	Generic	Anticonvulsants
phenobarbital	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
phenytoin chewable tablet	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
phenytoin extended-release	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
phenytoin suspension	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
pregabalin	Generic	Anticonvulsants		Subject to Quantity Duration Programs.
pregabalin ER	Generic	Anticonvulsants		Subject to Quantity Duration Programs.
primidone	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
Roweepra	Generic	Anticonvulsants
rufinamide	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
tiagabine	Generic	Anticonvulsants
topiramate	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
topiramate ER	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
valproic acid	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
vigabatrin	Generic	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
zonisamide	Generic	Anticonvulsants
Celontin	Brand Name	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
Dilantin 30mg	Brand Name	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
Epidiolex	Brand Name	Anticonvulsants		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Peganone	Brand Name	Anticonvulsants		Weigh the risk of birth defects or other adverse outcomes.
cefaclor, ER	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
cefadroxil hydrate	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
cefdinir	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
cefditoren pivoxil	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
cefixime capsule, suspension	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
cefpodoxime proxetil	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
cefprozil	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
ceftibuten	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
cefuroxime axetil	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
cephalexin monohydrate	Generic	Anti-Infectives (Antibiotics)	Oral Cephalosporins
azithromycin	Generic	Anti-Infectives (Antibiotics)	Oral Erythromycins and other Macrolides
clarithromycin, clarithromycin ER	Generic	Anti-Infectives (Antibiotics)	Oral Erythromycins and other Macrolides
erythromycin base	Generic	Anti-Infectives (Antibiotics)	Oral Erythromycins and other Macrolides
erythromycin ethylsuccinate / sulfisoxazole acetyl	Generic	Anti-Infectives (Antibiotics)	Oral Erythromycins and other Macrolides
erythromycin ethylsuccinate suspension	Generic	Anti-Infectives (Antibiotics)	Oral Erythromycins and other Macrolides
erythromycin ethylsuccinate tablet	Generic	Anti-Infectives (Antibiotics)	Oral Erythromycins and other Macrolides
erythromycin stearate	Generic	Anti-Infectives (Antibiotics)	Oral Erythromycins and other Macrolides
Dificid	Brand Name	Anti-Infectives (Antibiotics)	Oral Erythromycins and other Macrolides
amoxicillin trihydrate	Generic	Anti-Infectives (Antibiotics)	Oral Penicillins
amoxicillin trihydrate / potassium clavulanate chewable	Generic	Anti-Infectives (Antibiotics)	Oral Penicillins
amoxicillin trihydrate / potassium clavulanate suspension	Generic	Anti-Infectives (Antibiotics)	Oral Penicillins
amoxicillin trihydrate / potassium clavulanate, ER	Generic	Anti-Infectives (Antibiotics)	Oral Penicillins
ampicillin trihydrate	Generic	Anti-Infectives (Antibiotics)	Oral Penicillins
dicloxacillin sodium	Generic	Anti-Infectives (Antibiotics)	Oral Penicillins
penicillin v potassium	Generic	Anti-Infectives (Antibiotics)	Oral Penicillins
Augmentin Suspension 125 - 31.25mg / 5ml	Brand Name	Anti-Infectives (Antibiotics)	Oral Penicillins
ciprofloxacin HCl tablet	Generic	Anti-Infectives (Antibiotics)	Oral Quinolones
ciprofloxacin suspension	Generic	Anti-Infectives (Antibiotics)	Oral Quinolones
levofloxacin	Generic	Anti-Infectives (Antibiotics)	Oral Quinolones
moxifloxacin	Generic	Anti-Infectives (Antibiotics)	Oral Quinolones
ofloxacin	Generic	Anti-Infectives (Antibiotics)	Oral Quinolones
demeclocycline HCl	Generic	Anti-Infectives (Antibiotics)	Oral Tetracyclines	Weigh the risk of birth defects or other adverse outcomes.
doxycycline hyclate capsule	Generic	Anti-Infectives (Antibiotics)	Oral Tetracyclines	Weigh the risk of birth defects or other adverse outcomes.
doxycycline hyclate enteric coated tablet	Generic	Anti-Infectives (Antibiotics)	Oral Tetracyclines	Weigh the risk of birth defects or other adverse outcomes.
doxycycline hyclate tablet	Generic	Anti-Infectives (Antibiotics)	Oral Tetracyclines	Weigh the risk of birth defects or other adverse outcomes.
doxycycline monohydrate	Generic	Anti-Infectives (Antibiotics)	Oral Tetracyclines	Weigh the risk of birth defects or other adverse outcomes.
minocycline HCl	Generic	Anti-Infectives (Antibiotics)	Oral Tetracyclines	Weigh the risk of birth defects or other adverse outcomes.
minocycline HCl ER	Generic	Anti-Infectives (Antibiotics)	Oral Tetracyclines	Weigh the risk of birth defects or other adverse outcomes.
tetracycline HCl	Generic	Anti-Infectives (Antibiotics)	Oral Tetracyclines	Weigh the risk of birth defects or other adverse outcomes.
amantadine	Generic	Antiparkinsonism Agents
benztropine	Generic	Antiparkinsonism Agents
bromocriptine	Generic	Antiparkinsonism Agents
carbidopa	Generic	Antiparkinsonism Agents
carbidopa / levadopa	Generic	Antiparkinsonism Agents
carbidopa / levadopa / entacapone	Generic	Antiparkinsonism Agents
carbidopa / levadopa ER	Generic	Antiparkinsonism Agents
entacapone	Generic	Antiparkinsonism Agents
pramipexole Di-HCl	Generic	Antiparkinsonism Agents
pramipexole ER	Generic	Antiparkinsonism Agents
ropinirole	Generic	Antiparkinsonism Agents
selegiline	Generic	Antiparkinsonism Agents
tolcapone	Generic	Antiparkinsonism Agents
trihexylphenidyl	Generic	Antiparkinsonism Agents
Apokyn	Brand Name	Antiparkinsonism Agents		Must be obtained through Accredo.
calcipotriene	Generic	Antipsoriatic / Antiseborrheic	Antipsoriatic / Antiseborrheic Topical Agents
calcipotriene / betamethasone	Generic	Antipsoriatic / Antiseborrheic	Antipsoriatic / Antiseborrheic Topical Agents
calcitriol ointment	Generic	Antipsoriatic / Antiseborrheic	Antipsoriatic / Antiseborrheic Topical Agents
Drithocreme HP	Generic	Antipsoriatic / Antiseborrheic	Antipsoriatic / Antiseborrheic Topical Agents
hydrocortisone acetate / pramoxine	Generic	Antipsoriatic / Antiseborrheic	Antipsoriatic / Antiseborrheic Topical Agents
selenium sulfide	Generic	Antipsoriatic / Antiseborrheic	Antipsoriatic / Antiseborrheic Topical Agents
sodium sulfacetamide	Generic	Antipsoriatic / Antiseborrheic	Antipsoriatic / Antiseborrheic Topical Agents
Pramosone	Brand Name	Antipsoriatic / Antiseborrheic	Antipsoriatic / Antiseborrheic Topical Agents
doxylamine succinate/ pyridoxine HCl	Generic	Antivertigo and Antiemetic Drugs
granisetron HCl	Generic	Antivertigo and Antiemetic Drugs		This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
ondansetron HCl	Generic	Antivertigo and Antiemetic Drugs		This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
ondansetron ODT	Generic	Antivertigo and Antiemetic Drugs		This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Emend suspension	Brand Name	Antivertigo and Antiemetic Drugs		Subject to Quantity Duration Programs.
Adbry	Brand Name	Atopic Dermatitis	Injectable	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Dupixent	Brand Name	Atopic Dermatitis	Injectable	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Cibinqo	Brand Name	Atopic Dermatitis	Oral	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Rinvoq	Brand Name	Atopic Dermatitis	Oral	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
pimecrolimus cream	Generic	Atopic Dermatitis	Topical
tacrolimus ointment	Generic	Atopic Dermatitis	Topical
Eucrisa ointment	Brand Name	Atopic Dermatitis	Topical	Subject to Quantity Duration Programs.
Opzelura cream	Brand Name	Atopic Dermatitis	Topical	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
alfuzosin HCl ER	Generic	Benign Prostate Hyperplasia (BPH) Therapy
doxazosin	Generic	Benign Prostate Hyperplasia (BPH) Therapy
dutasteride	Generic	Benign Prostate Hyperplasia (BPH) Therapy		Do not use during pregnancy.
dutasteride-tamsulosin	Generic	Benign Prostate Hyperplasia (BPH) Therapy		Do not use during pregnancy.
finasteride	Generic	Benign Prostate Hyperplasia (BPH) Therapy		Do not use during pregnancy.
silodosin	Generic	Benign Prostate Hyperplasia (BPH) Therapy
tamsulosin HCl	Generic	Benign Prostate Hyperplasia (BPH) Therapy
terazosin	Generic	Benign Prostate Hyperplasia (BPH) Therapy		Weigh the risk of birth defects or other adverse outcomes.
Aranesp	Brand Name	Biotechnology Drugs	Erythroid Stimulants	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Procrit	Brand Name	Biotechnology Drugs	Erythroid Stimulants	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Berinert	Brand Name	Biotechnology Drugs	Hereditary Angioedema - C1 Esterase Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Cinryze	Brand Name	Biotechnology Drugs	Hereditary Angioedema - C1 Esterase Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Haegarda	Brand Name	Biotechnology Drugs	Hereditary Angioedema - C1 Esterase Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Ruconest	Brand Name	Biotechnology Drugs	Hereditary Angioedema - C1 Esterase Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Kalbitor	Brand Name	Biotechnology Drugs	Hereditary Angioedema - Plasma Kallikrein Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Takhzyro	Brand Name	Biotechnology Drugs	Hereditary Angioedema - Plasma Kallikrein Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
icatibant	Generic	Biotechnology Drugs	Hereditary Angioedema- Bradykinin Receptor Antagonist	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Purified Cortrophin Gel	Brand Name	Corticotropin Injection (Treatment of Inflammatory Conditions)		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Acthar	Brand Name	Corticotropin Injection (Treatment of Inflammatory Conditions)		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
benazepril HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
captopril	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
enalapril maleate	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
enalapril maleate, oral solution	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
fosinopril sodium	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
lisinopril	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
moexipril HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
perindopril erbumine	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
quinapril	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
ramipril capsules	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
trandolapril	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	ACE Inhibitors	Weigh the risk of birth defects or other adverse outcomes.
aliskiren	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
candesartan	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
candesartan / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
eprosartan mesylate 600mg	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
irbesartan	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
irbesartan / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
losartan / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
losartan potassium	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
olmesartan	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
olmesartan / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
telmisartan	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
telmisartan / HCTZ	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
valsartan	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
valsartan / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Angiotensin II Blockers	Weigh the risk of birth defects or other adverse outcomes.
dabigatran etexilate	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Anticoagulants (oral)
warfarin	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Anticoagulants (oral)
Eliquis	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Anticoagulants (oral)
Pradaxa	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Anticoagulants (oral)
Savaysa	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Anticoagulants (oral)
Xarelto	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Anticoagulants (oral)
Praxbind	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antidotes
amlodipine / atorvastatin	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs	Do not use during pregnancy. Subject to Quantity Duration Programs.
atorvastatin calcium	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs	Do not use during pregnancy. Subject to Quantity Duration Programs.
colesevelam powder packet	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs
colesevelam tablet	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs
ezetimibe/simvastatin	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
fluvastatin, ER	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs	Do not use during pregnancy. Subject to Quantity Duration Programs.
lovastatin	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs	Do not use during pregnancy. Subject to Quantity Duration Programs.
pravastatin	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs	Do not use during pregnancy. Subject to Quantity Duration Programs.
rosuvastatin	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs	Do not use during pregnancy. Subject to Quantity Duration Programs.
simvastatin	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antilipidemics - Statin Drugs	Do not use during pregnancy. Subject to Quantity Duration Programs.
aspirin / dipyridamole	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antiplatelet Agents (oral)
cilostazol	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antiplatelet Agents (oral)
clopidogrel bisulfate	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antiplatelet Agents (oral)
dipyridamole	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antiplatelet Agents (oral)
prasugrel HCI	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antiplatelet Agents (oral)
Brilinta	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antiplatelet Agents (oral)
Zontivity	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Antiplatelet Agents (oral)
acebutolol HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
atenolol	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers	Weigh the risk of birth defects or other adverse outcomes.
betaxolol HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
bisoprolol fumarate	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
carvedilol	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
carvedilol ER	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
labetalol HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
metoprolol succinate XL	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
metoprolol tartrate	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
nadolol	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
nebivolol HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
pindolol	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
propranolol HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
propranolol HCl capsule, sustained action 24 hr	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
timolol maleate	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
Hemangeol	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Beta Blockers
diltiazem HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Calcium Channel Blockers
diltiazem HCl capsule, sustained release 12 hr	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Calcium Channel Blockers
diltiazem HCl capsule, sustained release 24 hr	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Calcium Channel Blockers
nimodipine	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Calcium Channel Blockers
Tiadylt ER	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Calcium Channel Blockers
verapamil ER	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Calcium Channel Blockers
verapamil ER PM	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Calcium Channel Blockers
verapamil HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Calcium Channel Blockers
verapamil HCl capsule, 24 hr sustained release pellets	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Calcium Channel Blockers
amlodipine besylate	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Dihydropyridines
felodipine	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Dihydropyridines
isradipine	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Dihydropyridines
nicardipine	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Dihydropyridines
nifedipine tablet, sustained action	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Dihydropyridines
nifedipine tablet, sustained release osmotic push	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Dihydropyridines
nisoldipine	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Dihydropyridines
isosorbide dinitrate/hydralazine	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Heart Failure Agents
Corlanor	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Heart Failure Agents
Entresto	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Heart Failure Agents	Weigh the risk of birth defects or other adverse outcomes.
Furoscix	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Heart Failure Agents	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Verquvo	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Heart Failure Agents	Do not use during pregnancy.
Kerendia	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Non-Steroidal Mineralocorticoid Receptor Antagonist (MRA)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
nitroglycerin patches, ointment	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Long-Acting Nitrates (Topical)
cholestyramine / aspartame	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
cholestyramine / sucrose	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
colestipol HCl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
fenofibrate	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
fenofibrate, micronized	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
fenofibrate, nanocrystal	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
fenofibric acid	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
gemfibrozil	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
icosapent ethyl	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
niacin 500mg tablet (Redmont Pharmaceutical)	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
niacin ER	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
omega-3 acid ethyl esters	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Colestid	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
Juxtapid	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Zetia	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Other Antilipidemics
Praluent Pen	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	PCSK9 Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Repatha Pushtronex	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	PCSK9 Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Repatha Sureclick	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	PCSK9 Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Repatha Syringe	Brand Name	Cardiovascular (Blood Pressure / Heart / Cholesterol)	PCSK9 Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
amlodipine / olmesartan	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
amlodipine / valsartan	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
amlodipine / valsartan / HCTZ	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
amlodipine besylate / benazepril	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
atenolol / chlorthalidone	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
benazepril HCl / HCTZ	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
bisoprolol fumarate / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives
captopril / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
enalapril maleate / HCTZ	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
fosinopril / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
lisinopril / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
methyldopa / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives
metoprolol / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives
metoprolol succinate/ HCTZ ER	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives
olmesartan / amlodipine / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
propranolol / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives
quinapril / hydrochlorothiazide	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
telmisartan / amlodipine	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
trandolapril / verapamil	Generic	Cardiovascular (Blood Pressure / Heart / Cholesterol)	Select Combination Antihypertensives	Weigh the risk of birth defects or other adverse outcomes.
darifenacin hydrobromide	Generic	Drugs to Treat Overactive Bladder
fesoterodine fumerate ER	Generic	Drugs to Treat Overactive Bladder
flavoxate	Generic	Drugs to Treat Overactive Bladder
oxybutynin chloride, ER	Generic	Drugs to Treat Overactive Bladder
solifenacin	Generic	Drugs to Treat Overactive Bladder
tolterodine tartrate, ER	Generic	Drugs to Treat Overactive Bladder
trospium chloride, ER	Generic	Drugs to Treat Overactive Bladder
Myrbetriq	Brand Name	Drugs to Treat Overactive Bladder
ACCU-CHEK Guide Me	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Monitoring Devices
ACCU-CHEK Guide Monitor System	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Monitoring Devices
Contour Next EZ Monitor	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Monitoring Devices
Contour Next Meter	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Monitoring Devices
Contour Next Monitor	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Monitoring Devices
Contour USB Meter	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Monitoring Devices
True Metrix Air Glucose Meter	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Monitoring Devices
True Metrix Blood Glucose Meter	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Monitoring Devices
ACCU-CHEK Aviva Plus Test Strips	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Test Strips
Breeze 2	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Test Strips
Contour Next Test Strips	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Test Strips
Contour Test Strips	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Test Strips
True Metrix Glucose Test Strips	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Blood Glucose Test Strips
Dexcom G6 Receiver	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
Dexcom G6 Sensor	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
Dexcom G6 Transmitter	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
Dexcom G7 Receiver	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
Dexcom G7 Sensor	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
FreeStyle Libre 2 System	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
FreeStyle Libre 3 Sensor	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
FreeStyle Libre 14 Day Reader	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
FreeStyle Libre 14 Day Sensor	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
FreeStyle Libre 14 Day System	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Continuous Glucose Monitoring (CGM) Systems
Omnipod Classic	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Wearable Insulin Delivery System
Omnipod Dash	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Wearable Insulin Delivery System
Omnipod 5	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Wearable Insulin Delivery System
V-Go	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Wearable Insulin Delivery System
Amethia, Amethia Lo	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Charlotte 24 Fe	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Cryselle	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
EluRyng	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
etonogestrel-ethinyl estradiol vaginal ring	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Gemmily	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Gianvi	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Gildess 24 FE	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Gildess FE	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Hailey Fe	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Joyeaux	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Junel FE	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
levonorgestrel ethinyl estradiol ferrous bisglycinate	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Lomedia 24 FE	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Loryna	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Merzee	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Mibelas 24 FE	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Microgestin, Microgestin FE	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Necon	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Next Choice	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Next Choice One Dose	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Norethindrone-e.estriadol-iron	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Norgestimate-Ethinyl Estradiol	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Nylia	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Orsythia	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Pirmella	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Previfem	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Rivelsa	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Syeda	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Tri-Previfem	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Wymzya FE	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Xulane Patch	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Zenchent FE	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Ella	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
Lo Loestrin FE	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Contraceptive Agents	Do not use during pregnancy.
saxagliptin HCl	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	DPP-4 Inhibitors
saxagliptin HCl/metformin HCl ER	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	DPP-4 Inhibitors
Janumet	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	DPP-4 Inhibitors
Janumet XR	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	DPP-4 Inhibitors
Januvia	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	DPP-4 Inhibitors
Jentadueto	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	DPP-4 Inhibitors	Subject to Quantity Duration Programs.
Jentadueto XR	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	DPP-4 Inhibitors	Subject to Quantity Duration Programs.
Tradjenta	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	DPP-4 Inhibitors	Subject to Quantity Duration Programs.
estradiol	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen Patches	Do not use during pregnancy.
estradiol cream	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (non-oral)	Do not use during pregnancy.
Yuvafem	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (non-oral)	Do not use during pregnancy.
Estring	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (non-oral)	Do not use during pregnancy.
Imvexxy	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (non-oral)	Do not use during pregnancy.
Intrarosa	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (non-oral)	Do not use during pregnancy.
Premarin cream	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (non-oral)	Do not use during pregnancy.
estradiol tablets	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (oral)	Do not use during pregnancy.
Osphena	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (oral)	Do not use during pregnancy.
Premarin tablets	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (oral)	Do not use during pregnancy.
Premphase	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (oral)	Do not use during pregnancy.
Prempro	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Estrogen/ Hormonal Replacement Agents (oral)	Do not use during pregnancy.
Baqsimi	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Glucose Elevating Agents
Glucagen HypoKit	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Glucose Elevating Agents
Glucagon	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Glucose Elevating Agents
Gvoke HypoPen	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Glucose Elevating Agents
Gvoke Prefilled Syringe	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Glucose Elevating Agents
Zegalogue	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Glucose Elevating Agents
Bydureon Bcise	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Hypoglycemic Agents (GLP-1 receptor agonist - Non Oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Bydureon Pen	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Hypoglycemic Agents (GLP-1 receptor agonist - Non Oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Byetta	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Hypoglycemic Agents (GLP-1 receptor agonist - Non Oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Mounjaro	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Hypoglycemic Agents (GLP-1 receptor agonist - Non Oral)	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Ozempic	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Hypoglycemic Agents (GLP-1 receptor agonist - Non Oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Trulicity	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Hypoglycemic Agents (GLP-1 receptor agonist - Non Oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Victoza	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Hypoglycemic Agents (GLP-1 receptor agonist - Non Oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Rybelsus	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Hypoglycemic Agents (GLP-1 receptor agonist - Oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Soliqua	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Injectable Insulin / GLP-1 receptor agonist Combination
BD Insulin Pen Needle (Becton Dickinson)	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Pen Needle
BD Insulin Syringe (Becton Dickinson)	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Syringe
Humalog Mix 50-50	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Intermediate Acting
Humalog Mix 75-25	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Intermediate Acting
Humulin 70 / 30	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Intermediate Acting
Humulin 70 / 30 Kwikpen	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Intermediate Acting
Humulin N	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Intermediate Acting
Humulin N Kwikpen	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Intermediate Acting
Insulin lispro Mix 75-25	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Intermediate Acting
Insulin Glargine Solostar (Winthrop US)	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Long Acting
Insulin Glargine vial (Winthrop US)	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Long Acting
Lantus Solostar	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Long Acting
Levemir	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Long Acting
Levemir Flexpen	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Long Acting
Levemir Flextouch	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Long Acting
Toujeo Max Solostar	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Long Acting
Toujeo Solostar	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Long Acting
Tresiba Flextouch	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Long Acting
Afrezza	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Rapid Acting
Humalog (cartridge, Junior Kwikpen, Kwikpen, vial)	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Rapid Acting
Humalog Tempo Pen	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Rapid Acting
Insulin lispro (Junior Kwikpen, Kwikpen, vial)	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Rapid Acting
Lyumjev (Kwikpen, vial)	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Rapid Acting
Lyumjev Tempo Pen	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Rapid Acting
Humulin R	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Short Acting
Humulin R Kwikpen	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Insulin Therapy - Short Acting
Liletta	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Intrauterine Devices / Subdermal Implants	Do not use during pregnancy. Must be obtained through Accredo.
Nexplanon	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Intrauterine Devices / Subdermal Implants	Do not use during pregnancy. Must be obtained through Accredo.
Lupaneta	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Miscellaneous OB/GYN Agents (Endometriosis)	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Orilissa	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Miscellaneous OB/GYN Agents (Endometriosis)	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Lupron	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Miscellaneous OB/GYN Agents (Uterine Fibroids)	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Myfembree	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Miscellaneous OB/GYN Agents (Uterine Fibroids)	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Oriahnn	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Miscellaneous OB/GYN Agents (Uterine Fibroids)	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
methyltestosterone capsule	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral / Transdermal Testosterone Replacement Agents	Do not use during pregnancy.
testosterone gel in packet 25mg (1%), 50mg (1%). 1.25gm (1.62%), 2.5gm (1.62%)	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral / Transdermal Testosterone Replacement Agents	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
testosterone gel pump 1.25gm (1%), 10mg (2%), 12.5mg/1.25gm	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral / Transdermal Testosterone Replacement Agents	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
testosterone solution metered pump	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral / Transdermal Testosterone Replacement Agents	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Androderm Patch	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Oral / Transdermal Testosterone Replacement Agents	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Methitest	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Oral / Transdermal Testosterone Replacement Agents	Do not use during pregnancy.
acarbose	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
glimepiride	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
glipizide	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
glipizide ER	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
glipizide / metformin HCl	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents	Subject to Quantity Duration Programs.
glyburide	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
glyburide / metformin	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
glyburide micronized	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
metformin HCl	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
metformin HCl ER	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
metformin HCl solution	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
miglitol	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
nateglinide	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
pioglitazone HCl	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents	Subject to Quantity Duration Programs.
pioglitazone / glimepiride	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents	Subject to Quantity Duration Programs.
pioglitazone / metformin	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents	Subject to Quantity Duration Programs.
repaglinide	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
repaglinide / metformin	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents	Subject to Quantity Duration Programs.
tolbutamide	Generic	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents
Avandia	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	Oral Hypoglycemic Agents	Subject to Quantity Duration Programs.
Invokamet	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 - Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
Invokamet XR	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 - Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
Invokana	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 - Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
Jardiance	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 - Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
Segluromet	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 - Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
Steglatro	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 - Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
Synjardy	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 - Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
Synjardy XR	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 - Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
Glyxambi	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 / DPP4 Inhibitor Combinations
Steglujan	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 / DPP4 Inhibitor Combinations
Trijardy XR	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2 / DPP4 Inhibitor Combinations
Farxiga	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2- Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
Xigduo	Brand Name	Endocrine (Diabetes / Hormones / Contraceptives)	SGLT2- Sodium Glucose Co-transporter Agents	Subject to Quantity Duration Programs.
epinephrine injection, USP autoinjector 0.3mg, 0.15mg (Amneal and Avkare and AS Medication)	Generic	Epinephrine Autoinjectors
epinephrine injection, USP autoinjector 0.3mg, 0.15mg (Mylan and Teva)	Generic	Epinephrine Autoinjectors		This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
EpiPen 0.3mg (Mylan)	Brand Name	Epinephrine Autoinjectors
EpiPen Jr. 0.15mg (Mylan)	Brand Name	Epinephrine Autoinjectors
Symjepi	Brand Name	Epinephrine Autoinjectors
Gavilyte-C	Generic	Gastrointestinal	Bowel Evacuants
Gavilyte-G	Generic	Gastrointestinal	Bowel Evacuants
Gavilyte-H with bisacodyl	Generic	Gastrointestinal	Bowel Evacuants
Gavilyte-N	Generic	Gastrointestinal	Bowel Evacuants
PEG 3350 bowel preparation	Generic	Gastrointestinal	Bowel Evacuants
Peg-Prep	Generic	Gastrointestinal	Bowel Evacuants
sodium sulfate / potassium sulfate / magnesium sulfate 17.5-3.13 gm oral solution	Generic	Gastrointestinal	Bowel Evacuants
Trilyte w/ flavor packet	Generic	Gastrointestinal	Bowel Evacuants
Clenpiq	Brand Name	Gastrointestinal	Bowel Evacuants
Suprep	Brand Name	Gastrointestinal	Bowel Evacuants
Sutab	Brand Name	Gastrointestinal	Bowel Evacuants
lansoprazole / amoxicillin / clarithromycin	Generic	Gastrointestinal	H-Pylori Agents
Pylera	Brand Name	Gastrointestinal	H-Pylori Agents
Talicia	Brand Name	Gastrointestinal	H-Pylori Agents
lubiprostone	Generic	Gastrointestinal	Irritable Bowel Syndrome
Linzess	Brand Name	Gastrointestinal	Irritable Bowel Syndrome
Motegrity	Brand Name	Gastrointestinal	Irritable Bowel Syndrome
Trulance	Brand Name	Gastrointestinal	Irritable Bowel Syndrome
Creon	Brand Name	Gastrointestinal	Pancreatic Enzymes
Zenpep	Brand Name	Gastrointestinal	Pancreatic Enzymes
calcium acetate	Generic	Gastrointestinal	Phosphate Binders
lanthanum carbonate chewable tablet	Generic	Gastrointestinal	Phosphate Binders
sevelamer carbonate	Generic	Gastrointestinal	Phosphate Binders
cimetidine tablet	Generic	Gastrointestinal	Ulcer Drugs
dexlansoprazole DR	Generic	Gastrointestinal	Ulcer Drugs	Subject to Quantity Duration Programs.
esomeprazole capsule	Generic	Gastrointestinal	Ulcer Drugs	Subject to Quantity Duration Programs.
esomeprazole magnesium 10, 20, 40 mg suspension	Generic	Gastrointestinal	Ulcer Drugs	Subject to Quantity Duration Programs.
famotidine, famotidine suspension	Generic	Gastrointestinal	Ulcer Drugs
lansoprazole	Generic	Gastrointestinal	Ulcer Drugs	Subject to Quantity Duration Programs.
misoprostol	Generic	Gastrointestinal	Ulcer Drugs	Do not use during pregnancy.
nizatidine	Generic	Gastrointestinal	Ulcer Drugs
omeprazole	Generic	Gastrointestinal	Ulcer Drugs	Subject to Quantity Duration Programs.
pantoprazole granule packets	Generic	Gastrointestinal	Ulcer Drugs	Subject to Quantity Duration Programs.
rabeprazole tablets	Generic	Gastrointestinal	Ulcer Drugs	Subject to Quantity Duration Programs.
Nexium OTC	Brand Name	Gastrointestinal	Ulcer Drugs	Subject to Quantity Duration Programs.
Nexium RX 2.5, 5 mg Suspension	Brand Name	Gastrointestinal	Ulcer Drugs	Subject to Quantity Duration Programs.
balsalazide disodium	Generic	Gastrointestinal	Ulcerative Colitis Agents
mesalamine delayed release capsule	Generic	Gastrointestinal	Ulcerative Colitis Agents
mesalamine enema	Generic	Gastrointestinal	Ulcerative Colitis Agents
mesalamine enteric coated tablet	Generic	Gastrointestinal	Ulcerative Colitis Agents
mesalamine 500mg extended release capsule	Generic	Gastrointestinal	Ulcerative Colitis Agents
mesalamine extended release capsule 24 HR	Generic	Gastrointestinal	Ulcerative Colitis Agents
mesalamine suppository	Generic	Gastrointestinal	Ulcerative Colitis Agents
sulfasalazine	Generic	Gastrointestinal	Ulcerative Colitis Agents
Cerezyme	Brand Name	Gaucher Disease		Subject to the Client Prior Authorization Program. Call the Benefit Fund at (646) 473-7446. Must be obtained through Accredo.
Vpriv	Brand Name	Gaucher Disease		Subject to the Client Prior Authorization Program. Call the Benefit Fund at (646) 473-7446. Must be obtained through Accredo.
allopurinol	Generic	Gout Therapy
colchicine tablet	Generic	Gout Therapy
febuxostat	Generic	Gout Therapy		Subject to Quantity Duration Programs.
probenecid	Generic	Gout Therapy
probenecid w/ colchicine	Generic	Gout Therapy
Gloperba	Brand Name	Gout Therapy
Krystexxa	Brand Name	Gout Therapy		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Mitigare	Brand Name	Gout Therapy
Uloric	Brand Name	Gout Therapy		Subject to Quantity Duration Programs.
Granix	Brand Name	Granulocyte Colony Stimulating Factor	Granulocyte Colony Stimulating Factor Products- Filgrastim	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Neupogen	Brand Name	Granulocyte Colony Stimulating Factor	Granulocyte Colony Stimulating Factor Products- Filgrastim	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Nivestym	Brand Name	Granulocyte Colony Stimulating Factor	Granulocyte Colony Stimulating Factor Products- Filgrastim	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Zarxio	Brand Name	Granulocyte Colony Stimulating Factor	Granulocyte Colony Stimulating Factor Products- Filgrastim	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Fulphila	Brand Name	Granulocyte Colony Stimulating Factor	Granulocyte Colony Stimulating Factor Products- Pegfilgrastim	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Neulasta	Brand Name	Granulocyte Colony Stimulating Factor	Granulocyte Colony Stimulating Factor Products- Pegfilgrastim	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Nyvepria	Brand Name	Granulocyte Colony Stimulating Factor	Granulocyte Colony Stimulating Factor Products- Pegfilgrastim	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Udenyca	Brand Name	Granulocyte Colony Stimulating Factor	Granulocyte Colony Stimulating Factor Products- Pegfilgrastim	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Ziextenzo	Brand Name	Granulocyte Colony Stimulating Factor	Granulocyte Colony Stimulating Factor Products- Pegfilgrastim	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Egrifta	Brand Name	Growth Hormones		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Humatrope	Brand Name	Growth Hormones		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Nordotropin Flexpro	Brand Name	Growth Hormones		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Skytrofa	Brand Name	Growth Hormones		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Zorbtive	Brand Name	Growth Hormones		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Mayvret	Brand Name	Hepatitis C Antivirals (Direct-Acting / Protease Inhibitors)	Genotype 1	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Zepatier	Brand Name	Hepatitis C Antivirals (Direct-Acting / Protease Inhibitors)	Genotype 1	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Mayvret	Brand Name	Hepatitis C Antivirals (Direct-Acting / Protease Inhibitors)	Genotype 2	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Mayvret	Brand Name	Hepatitis C Antivirals (Direct-Acting / Protease Inhibitors)	Genotype 3	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Mayvret	Brand Name	Hepatitis C Antivirals (Direct-Acting / Protease Inhibitors)	Genotype 4	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Zepatier	Brand Name	Hepatitis C Antivirals (Direct-Acting / Protease Inhibitors)	Genotype 4	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Mayvret	Brand Name	Hepatitis C Antivirals (Direct-Acting / Protease Inhibitors)	Genotype 5, 6	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Vosevi	Brand Name	Hepatitis C Antivirals (Direct-Acting / Protease Inhibitors)	Treatment Experienced	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Rukobia	Brand Name	HIV Antiretroviral Therapy (ART)	Attachment Inhibitors	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Sunlenca	Brand Name	HIV Antiretroviral Therapy (ART)	Capsid Inhibitors	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
maraviroc 150mg & 300mg tablet	Generic	HIV Antiretroviral Therapy (ART)	CCR5 Antagonists	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Selzentry oral solutions	Brand Name	HIV Antiretroviral Therapy (ART)	CCR5 Antagonists	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Selzentry 25mg & 75mg tablet	Brand Name	HIV Antiretroviral Therapy (ART)	CCR5 Antagonists	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
abacavir/lamivudine	Generic	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
abacavir/lamivudine/zidovudine	Generic	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
efavirenz/emtricitabine/tenofovir	Generic	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
efavirenz/lamivudine/tenofovir disoproxil fumarate	Generic	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
emtricitabine/tenofovir	Generic	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Iopinavir/ritonavir	Generic	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
lamivudine/zidovudine	Generic	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Biktarvy	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Cabenuva	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents
Cimduo	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Complera	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Delstrigo	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Descovy	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Dovato	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Evotaz	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Genvoya	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Juluca	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Odefsey	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Prezcobix	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Stribild	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Symtuza	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Triumeq	Brand Name	HIV Antiretroviral Therapy (ART)	Combination Agents	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Fuzeon	Brand Name	HIV Antiretroviral Therapy (ART)	Fusion Inhibitors	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Isentress	Brand Name	HIV Antiretroviral Therapy (ART)	Integrase Inhibitors	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Isentress HD	Brand Name	HIV Antiretroviral Therapy (ART)	Integrase Inhibitors	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Tivicay	Brand Name	HIV Antiretroviral Therapy (ART)	Integrase Inhibitors	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Vocabria	Brand Name	HIV Antiretroviral Therapy (ART)	Integrase Inhibitors
efavirenz	Generic	HIV Antiretroviral Therapy (ART)	Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
etravirine	Generic	HIV Antiretroviral Therapy (ART)	Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
nevirapine	Generic	HIV Antiretroviral Therapy (ART)	Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
nevirapine ER	Generic	HIV Antiretroviral Therapy (ART)	Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Edurant	Brand Name	HIV Antiretroviral Therapy (ART)	Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Intelence	Brand Name	HIV Antiretroviral Therapy (ART)	Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Pifeltro	Brand Name	HIV Antiretroviral Therapy (ART)	Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
abacavir	Generic	HIV Antiretroviral Therapy (ART)	Nucleoside Reverse Transcriptase Inhibitors (NRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
emtricitabine capsule	Generic	HIV Antiretroviral Therapy (ART)	Nucleoside Reverse Transcriptase Inhibitors (NRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
lamivudine	Generic	HIV Antiretroviral Therapy (ART)	Nucleoside Reverse Transcriptase Inhibitors (NRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
tenofovir disoproxil fumarate	Generic	HIV Antiretroviral Therapy (ART)	Nucleoside Reverse Transcriptase Inhibitors (NRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
zidovudine	Generic	HIV Antiretroviral Therapy (ART)	Nucleoside Reverse Transcriptase Inhibitors (NRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Emtriva oral solutions	Brand Name	HIV Antiretroviral Therapy (ART)	Nucleoside Reverse Transcriptase Inhibitors (NRTIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Tybost	Brand Name	HIV Antiretroviral Therapy (ART)	Pharmacokinetic Enhancers	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Trogarzo	Brand Name	HIV Antiretroviral Therapy (ART)	Post-Attachment Inhibitors	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
atazanavir sulfate	Generic	HIV Antiretroviral Therapy (ART)	Protease Inhibitors (PIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
darunavir 600mg & 800mg tablet	Generic	HIV Antiretroviral Therapy (ART)	Protease Inhibitors (PIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
fosamprenavir calcium	Generic	HIV Antiretroviral Therapy (ART)	Protease Inhibitors (PIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Aptivus	Brand Name	HIV Antiretroviral Therapy (ART)	Protease Inhibitors (PIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Invirase	Brand Name	HIV Antiretroviral Therapy (ART)	Protease Inhibitors (PIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Prezista oral suspension	Brand Name	HIV Antiretroviral Therapy (ART)	Protease Inhibitors (PIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Prezista 75mg & 150mg tablet	Brand Name	HIV Antiretroviral Therapy (ART)	Protease Inhibitors (PIs)	This category is based on current guidelines from the U.S. Department of Health and Human Services (HHS). It is not comprehensive and is for reference only.
Herzuma	Brand Name	Human Epidermal Growth Factor Receptor 2-positive (HER 2+) Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Kanjinti	Brand Name	Human Epidermal Growth Factor Receptor 2-positive (HER 2+) Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Ogivri	Brand Name	Human Epidermal Growth Factor Receptor 2-positive (HER 2+) Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Ontruzant	Brand Name	Human Epidermal Growth Factor Receptor 2-positive (HER 2+) Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Trazimera	Brand Name	Human Epidermal Growth Factor Receptor 2-positive (HER 2+) Biosimilar Cancer Drugs		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. Subject to Quantity Duration Programs.
calcium gluconate	Generic	Hyperkalemia Agents
Lokelma	Brand Name	Hyperkalemia Agents
Veltassa	Brand Name	Hyperkalemia Agents
Flebogamma DIF	Brand Name	Immunoglobulin Agents (injectables)		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Gamunex-C	Brand Name	Immunoglobulin Agents (injectables)		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Hizentra	Brand Name	Immunoglobulin Agents (injectables)		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Grastek	Brand Name	Immunotherapy (Oral)		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Odactra	Brand Name	Immunotherapy (Oral)		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Oralair	Brand Name	Immunotherapy (Oral)		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Ragwitek	Brand Name	Immunotherapy (Oral)		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
glatiramer acetate 40mg/ml	Generic	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Glatopa 20mg/ml	Generic	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Avonex	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Betaseron	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Copaxone 40mg/ml	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Extavia	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Kesimpta	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Plegridy	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Rebif	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Rebif Rebidose	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Ocrevus	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (IV infusion)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Tysabri	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (IV infusion)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
dimethyl fumarate	Generic	Multiple Sclerosis	Multiple Sclerosis Agents (oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
fingolimod HCl	Generic	Multiple Sclerosis	Multiple Sclerosis Agents (oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Aubagio	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Bafiertam	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Mavenclad	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Mayzent	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Ponvory	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Vumerity	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Zeposia	Brand Name	Multiple Sclerosis	Multiple Sclerosis Agents (oral)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
baclofen	Generic	Muscle Relaxants
carisoprodol cmpd / codeine	Generic	Muscle Relaxants		Weigh the risk of birth defects or other adverse outcomes.
cyclobenzaprine, XR	Generic	Muscle Relaxants
dantrolene sodium	Generic	Muscle Relaxants
meprobamate	Generic	Muscle Relaxants		Weigh the risk of birth defects or other adverse outcomes.
metaxalone	Generic	Muscle Relaxants
methocarbamol	Generic	Muscle Relaxants
orphenadrine citrate	Generic	Muscle Relaxants
tizanidine	Generic	Muscle Relaxants
tramadol	Generic	Narcotic Analgesics (Pain Relievers)	Miscellaneous Analgesic Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
tramadol / acetaminophen	Generic	Narcotic Analgesics (Pain Relievers)	Miscellaneous Analgesic Therapy	Subject to Quantity Duration Programs.
tramadol ER tablets	Generic	Narcotic Analgesics (Pain Relievers)	Miscellaneous Analgesic Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
acetaminophen / butalbital	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Weigh the risk of birth defects or other adverse outcomes.
acetaminophen / caffeine / butalbital	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Weigh the risk of birth defects or other adverse outcomes.
aspirin / caffeine / butalbital	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Weigh the risk of birth defects or other adverse outcomes.
buprenorphine HCl film	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
buprenorphine HCl SL tablets	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
buprenorphine patch	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
codeine	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
codeine / acetaminophen	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
codeine / acetaminophen / caffeine / butalbital	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
codeine / aspirin / caffeine / butalbital	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
codeine phosphate / acetaminophen	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
codeine sulfate tablet	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
dihydrocodeine / acetaminophen / caffeine	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
dihydrocodeine / APAP / caffeine	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics
fentanyl citrate lozenges	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
fentanyl patch	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
hydrocodone / ibuprofen	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
hydrocodone bit / acetaminophen	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics
hydrocodone bitartrate ER	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
hydromorphone	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
hydromorphone ER	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
levorphanol tartrate	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
meperidine tabs, solution	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
methadone	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
morphine sulfate	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
morphine sulfate, sustained action	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
oxycodone / acetaminophen	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
oxycodone / aspirin	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
oxycodone / ibuprofen	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
oxycodone HCl	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
oxymorphone	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to Quantity Duration Programs.
oxymorphone ER	Generic	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Oxycontin	Brand Name	Narcotic Analgesics (Pain Relievers)	Narcotics	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
naloxone nasal spray	Generic	Narcotic Analgesics (Pain Relievers)	Opiate Antagonist-Naloxone Products
naloxone syringe	Generic	Narcotic Analgesics (Pain Relievers)	Opiate Antagonist-Naloxone Products
naloxone vial	Generic	Narcotic Analgesics (Pain Relievers)	Opiate Antagonist-Naloxone Products
Aimovig	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Calcitonin Gene-Related Peptide Inhibitor (CGRP-1) Injectable Migraine Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Ajovy Autoinjector	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Calcitonin Gene-Related Peptide Inhibitor (CGRP-1) Injectable Migraine Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Ajovy Prefilled Syringe	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Calcitonin Gene-Related Peptide Inhibitor (CGRP-1) Injectable Migraine Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Emgality	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Calcitonin Gene-Related Peptide Inhibitor (CGRP-1) Injectable Migraine Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Nurtec ODT	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Calcitonin Gene-Related Peptide Inhibitor (CGRP-I) Oral Migraine Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Qulipta	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Calcitonin Gene-Related Peptide Inhibitor (CGRP-I) Oral Migraine Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Reyvow	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Calcitonin Gene-Related Peptide Inhibitor (CGRP-I) Oral Migraine Agents	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Ubrelvy	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Calcitonin Gene-Related Peptide Inhibitor (CGRP-I) Oral Migraine Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Elyxyb	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Migraine Acute Treatment - Nonsteroidal Anti-Inflammatory Drug	Do not use during pregnancy. Subject to Quantity Duration Programs.
almotriptan malate	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	Subject to Quantity Duration Programs.
eletriptan HBr	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	Subject to Quantity Duration Programs.
frovatriptan succinate	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	Subject to Quantity Duration Programs.
naratriptan	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	Subject to Quantity Duration Programs.
rizatriptan (tabs, disintegrating tabs)	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	Subject to Quantity Duration Programs.
sumatriptan (tabs, nasal spray)	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	Subject to Quantity Duration Programs.
sumatriptan injection	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
sumatriptan succinate / naproxen sodium	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
zolmitriptan	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	Subject to Quantity Duration Programs.
zolmitriptan 5mg nasal spray	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans
zolmitriptan ODT	Generic	Non-Narcotic Analgesics (Pain Relievers)	Migraine / Headache Therapy - Triptans	Subject to Quantity Duration Programs.
celecoxib	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAID COX-2 Inhibitors
diclofenac / misoprostol	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
diclofenac potassium	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
diclofenac sodium	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
diclofenac sodium topical drops, gel, solution metered dose pump	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
etodolac	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
etodolac tablet, sustained release 24 hr	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
fenoprofen calcium 400mg & 600mg	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
flurbiprofen	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
ibuprofen	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
indomethacin	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
indomethacin capsule, sustained action	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
ketoprofen 50mg and 75mg capsule	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
ketoprofen capsule, 24 hr sustained release pellets	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
ketorolac tablets	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
meclofenamate sodium	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
mefenamic acid	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
meloxicam tablets	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
nabumetone	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
naproxen	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
naproxen sodium, ER	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
oxaprozin	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
piroxicam	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
sulindac	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
tolmetin sodium	Generic	Non-Narcotic Analgesics (Pain Relievers)	NSAIDs	Weigh the risk of birth defects or other adverse outcomes.
Euflexxa	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Osteoarthritis Agents (Injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Monovisc	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Osteoarthritis Agents (Injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Orthovisc	Brand Name	Non-Narcotic Analgesics (Pain Relievers)	Osteoarthritis Agents (Injectable)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
bacitracin	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
bacitracin / polymyxin B	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
ciprofloxacin drops	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
erythromycin base ointment	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
gatifloxacin	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
gentamicin sulfate ointment, drops	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
levofloxacin	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
moxifloxacin HCL drops	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
neomycin sulfate / bacitracin / polymyxin B ointment	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
neomycin sulfate / gramicidin D / polymyxin B drops	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
ofloxacin drops	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
polymyxin B / trimethoprim drops	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
tobramycin sulfate drops	Generic	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
Ciloxan Oph Ointment	Brand Name	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
Tobrex Oph Ointment	Brand Name	Ophthalmics (Eye Preparations)	Antibiotic-Ophthalmics
cyclosporine single use dropperette	Generic	Ophthalmics (Eye Preparations)	Dry Eye Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Eysuvis	Brand Name	Ophthalmics (Eye Preparations)	Dry Eye Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Restasis Multidose	Brand Name	Ophthalmics (Eye Preparations)	Dry Eye Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Xiidra	Brand Name	Ophthalmics (Eye Preparations)	Dry Eye Therapy	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
azelastine	Generic	Ophthalmics (Eye Preparations)	Miscellaneous Ophthalmics-Antihistamine and Mast-Cell Stabilizers
bepotastine besilate	Generic	Ophthalmics (Eye Preparations)	Miscellaneous Ophthalmics-Antihistamine and Mast-Cell Stabilizers
cromolyn	Generic	Ophthalmics (Eye Preparations)	Miscellaneous Ophthalmics-Antihistamine and Mast-Cell Stabilizers
epinastine HCl	Generic	Ophthalmics (Eye Preparations)	Miscellaneous Ophthalmics-Antihistamine and Mast-Cell Stabilizers
olopatadine HCl	Generic	Ophthalmics (Eye Preparations)	Miscellaneous Ophthalmics-Antihistamine and Mast-Cell Stabilizers
apraclonidine HCL	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Alpha Agonists
brimonidine 0.15%	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Alpha Agonists
Alphagan-P 0.1%	Brand Name	Ophthalmics (Eye Preparations)	Ophthalmic Alpha Agonists
bromfenac sodium	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Anti-Inflammatory Agents (NSAIDs)
diclofenac sodium	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Anti-Inflammatory Agents (NSAIDs)
flurbiprofen sodium	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Anti-Inflammatory Agents (NSAIDs)
ketorolac tromethamine	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Anti-Inflammatory Agents (NSAIDs)
betaxolol HCL	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Beta-Blockers
carteolol	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Beta-Blockers
levobunolol	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Beta-Blockers
metipranolol	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Beta-Blockers
timolol maleate	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Beta-Blockers
brinzolamide	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Carbonic Anhydrase Inhibitors
dorzolamide	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Carbonic Anhydrase Inhibitors
brimonidine tartrate/timolol	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Combination Alpha Agonists / Beta Antagonists
Combigan	Brand Name	Ophthalmics (Eye Preparations)	Ophthalmic Combination Alpha Agonists / Beta Antagonists
dorzolamide / timolol	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Combination Carbonic Anhydrase Inhibitors / Beta Antagonists
dorzolamide / timolol PF	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Combination Carbonic Anhydrase Inhibitors / Beta Antagonists
Cosopt PF	Brand Name	Ophthalmics (Eye Preparations)	Ophthalmic Combination Carbonic Anhydrase Inhibitors / Beta Antagonists
Rocklatan	Brand Name	Ophthalmics (Eye Preparations)	Ophthalmic Combination Miotics/Prostagladin Agents
Rhopressa	Brand Name	Ophthalmics (Eye Preparations)	Ophthalmic Miotics Agents
bimatoprost	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Prostaglandin-Analogues
latanoprost	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Prostaglandin-Analogues
tafluprost	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Prostaglandin-Analogues
neomycin / bacitracin / polymyxin B / HC	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Steroid-Antibiotic Combinations
neomycin / polymyxin B / dexamethasone	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Steroid-Antibiotic Combinations
neomycin / polymyxin B / HC	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Steroid-Antibiotic Combinations
tobramycin-dexamethasone suspension	Generic	Ophthalmics (Eye Preparations)	Ophthalmic Steroid-Antibiotic Combinations
TobraDex Oint	Brand Name	Ophthalmics (Eye Preparations)	Ophthalmic Steroid-Antibiotic Combinations
dexamethasone	Generic	Ophthalmics (Eye Preparations)	Ophthalmics-Steroids
difluprednate	Generic	Ophthalmics (Eye Preparations)	Ophthalmics-Steroids
fluorometholone	Generic	Ophthalmics (Eye Preparations)	Ophthalmics-Steroids
loteprednol 0.5% gel drops	Generic	Ophthalmics (Eye Preparations)	Ophthalmics-Steroids
loteprednol suspension drops	Generic	Ophthalmics (Eye Preparations)	Ophthalmics-Steroids
prednisolone acetate	Generic	Ophthalmics (Eye Preparations)	Ophthalmics-Steroids
prednisolone sodium phosphate	Generic	Ophthalmics (Eye Preparations)	Ophthalmics-Steroids
FML S.O.P.	Brand Name	Ophthalmics (Eye Preparations)	Ophthalmics-Steroids
alendronate solutions	Generic	Osteoporosis / Paget's Disease	Bisphosphonates	Subject to Quantity Duration Programs.
alendronate tab	Generic	Osteoporosis / Paget's Disease	Bisphosphonates	Subject to Quantity Duration Programs.
alendronate weekly	Generic	Osteoporosis / Paget's Disease	Bisphosphonates	Subject to Quantity Duration Programs.
ibandronate	Generic	Osteoporosis / Paget's Disease	Bisphosphonates	Subject to Quantity Duration Programs.
risedronate sodium DR	Generic	Osteoporosis / Paget's Disease	Bisphosphonates	Subject to Quantity Duration Programs.
risedronate sodium tablet	Generic	Osteoporosis / Paget's Disease	Bisphosphonates	Subject to Quantity Duration Programs.
calcitonin-salmon injection	Generic	Osteoporosis / Paget's Disease	Calcitonin Salmon Agents	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
calcitonin-salmon nasal spray	Generic	Osteoporosis / Paget's Disease	Calcitonin Salmon Agents
Forteo	Brand Name	Osteoporosis / Paget's Disease	Parathyroid Hormone Analogs	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Teriparatide	Brand Name	Osteoporosis / Paget's Disease	Parathyroid Hormone Analogs	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Tymlos	Brand Name	Osteoporosis / Paget's Disease	Parathyroid Hormone Analogs	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
raloxifene HCl	Generic	Osteoporosis / Paget's Disease	Selective Estrogen Receptor Modifiers	Do not use during pregnancy.
alendronate solution	Generic	Osteoporosis / Paget's Disease		Subject to Quantity Duration Programs.
alendronate tab	Generic	Osteoporosis / Paget's Disease		Subject to Quantity Duration Programs.
alendronate weekly	Generic	Osteoporosis / Paget's Disease		Subject to Quantity Duration Programs.
ibandronate	Generic	Osteoporosis / Paget's Disease		Subject to Quantity Duration Programs.
risedronate sodium DR	Generic	Osteoporosis / Paget's Disease		Subject to Quantity Duration Programs.
risedronate sodium tablet	Generic	Osteoporosis / Paget's Disease		Subject to Quantity Duration Programs.
ciprofloxacin/dexamethasone	Generic	Otics (Ear Preparations)
neomycin / polymyxin / HC	Generic	Otics (Ear Preparations)
ofloxacin	Generic	Otics (Ear Preparations)
abiraterone	Generic	Prostate Cancer (Oral Agents)		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Erleada	Brand Name	Prostate Cancer (Oral Agents)		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Nubeqa	Brand Name	Prostate Cancer (Oral Agents)		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Xtandi	Brand Name	Prostate Cancer (Oral Agents)		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Yonsa	Brand Name	Prostate Cancer (Oral Agents)		If the indication is CANCER, and the drug is subject to management by eviCore Comprehensive Oncology Management Program, please contact (888) 910-1199 for additional assistance. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
chlorpromazine injection	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
fluphenazine decanoate injection	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
fluphenazine injection	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
haloperidol decanoate injection	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
haloperidol injection	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
haloperidol lactate concentrate	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)
olanzapine injection	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Aristada	Brand Name	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)
Aristada Initio	Brand Name	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Risperdal Consta	Brand Name	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Injectable)	This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
aripiprazole	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)	Subject to Quantity Duration Programs.
aripiprazole ODT	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)	Subject to Quantity Duration Programs.
asenapine maleate	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)	Subject to Quantity Duration Programs.
chlorpromazine tablet	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
clozapine	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
clozapine ODT	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
fluphenazine	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
haloperidol	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
haloperidol lactate concentrate	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
loxapine	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
lurasidone HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
molindone	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
olanzapine	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)	Subject to Quantity Duration Programs.
olanzapine ODT	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)	Subject to Quantity Duration Programs.
olanzapine-fluoxetine	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)	Subject to Quantity Duration Programs.
paliperidone	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)	Subject to Quantity Duration Programs.
perphenazine	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
pimozide	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
quetiapine fumarate	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
quetiapine fumarate ER	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
risperidone ODT	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
risperidone tab	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)	Subject to Quantity Duration Programs.
thioridazine	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
thiothixene	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
trifluoperazine HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)
ziprasidone HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Antipsychotics (Oral)	Subject to Quantity Duration Programs.
alprazolam, alprazolam ER, ODT	Generic	Psychotherapeutics (Anxiety / Depression)	Anxiolytics	Weigh the risk of birth defects or other adverse outcomes.
buspirone HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Anxiolytics
chlordiazepoxide HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Anxiolytics	Weigh the risk of birth defects or other adverse outcomes.
clorazepate dipotassium	Generic	Psychotherapeutics (Anxiety / Depression)	Anxiolytics	Weigh the risk of birth defects or other adverse outcomes.
diazepam	Generic	Psychotherapeutics (Anxiety / Depression)	Anxiolytics	Weigh the risk of birth defects or other adverse outcomes.
lorazepam	Generic	Psychotherapeutics (Anxiety / Depression)	Anxiolytics	Weigh the risk of birth defects or other adverse outcomes.
oxazepam	Generic	Psychotherapeutics (Anxiety / Depression)	Anxiolytics	Weigh the risk of birth defects or other adverse outcomes.
amphetamine	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
amphetamine and dextroamphetamine salts	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
amphetamine and dextroamphetamine salts ER	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
atomoxetine HCL	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
clonidine ER	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
D-amphetamine tablet	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
D-amphetamine ER	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
dexmethylphenidate	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
dexmethylphenidate ER	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
dextroamphetamine sulfate	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
guanfacine ER	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
lisdexamfetamine dimesylate	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
methylphenidate CD	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
methylphenidate ER	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
methylphenidate LA	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
methylphenidate patch 24 HR	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
methylphenidate tablet, chewable tablet, solution	Generic	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Dyanavel XR	Brand Name	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Mydayis	Brand Name	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Quillichew ER	Brand Name	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Quillivant XR	Brand Name	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Vyvanse	Brand Name	Psychotherapeutics (Anxiety / Depression)	Attention Deficit Hyperactivity Disorder	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
amitriptyline HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
amitriptyline-chlordiazepoxide	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
amitriptyline-perphenazine	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
amoxapine	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
bupropion HCl tablet	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants	Subject to Quantity Duration Programs.
bupropion HCl tablet, sust. action	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants	Subject to Quantity Duration Programs.
clomipramine HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
desipramine HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
doxepin HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
duloxetine HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants	Subject to Quantity Duration Programs.
imipramine HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants	Weigh the risk of birth defects or other adverse outcomes.
imipramine pamoate	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants	Weigh the risk of birth defects or other adverse outcomes.
maprotiline HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
mirtazapine tablet	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
mirtazapine tablet, rapid dissolve	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
nortriptyline HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
phenylzine sulfate	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
protriptyline HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
tranylcypromine sulfate	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
trazodone HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
trimipramine maleate	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
venlafaxine HCl, ER	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants	Subject to Quantity Duration Programs.
vilazodone HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants	Subject to Quantity Duration Programs.
Marplan	Brand Name	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants
Nuplazid	Brand Name	Psychotherapeutics (Anxiety / Depression)	Miscellaneous Antidepressants	Must be obtained through Accredo.
estazolam	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
eszopiclone	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Subject to Quantity Duration Programs.
flurazepam HCl	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
ramelteon	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
tasimelteon capsule	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Subject to Quantity Duration Programs.
temazepam	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
triazolam	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
zaleplon	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Subject to Quantity Duration Programs.
zolpidem SL tablet	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Subject to Quantity Duration Programs.
zolpidem, zolpidem ER	Generic	Psychotherapeutics (Anxiety / Depression)	Oral Hypnotic Agents	Subject to Quantity Duration Programs.
citalopram HBr	Generic	Psychotherapeutics (Anxiety / Depression)	SSRI Antidepressants	Subject to Quantity Duration Programs.
escitalopram oxalate	Generic	Psychotherapeutics (Anxiety / Depression)	SSRI Antidepressants	Subject to Quantity Duration Programs.
fluoxetine DR 90mg	Generic	Psychotherapeutics (Anxiety / Depression)	SSRI Antidepressants	Subject to Quantity Duration Programs.
fluoxetine HCl capsules, oral solution, tablets	Generic	Psychotherapeutics (Anxiety / Depression)	SSRI Antidepressants	Subject to Quantity Duration Programs.
fluvoxamine maleate, ER	Generic	Psychotherapeutics (Anxiety / Depression)	SSRI Antidepressants	Subject to Quantity Duration Programs.
paroxetine HCl	Generic	Psychotherapeutics (Anxiety / Depression)	SSRI Antidepressants	Weigh the risk of birth defects or other adverse outcomes. Subject to Quantity Duration Programs.
sertraline HCl	Generic	Psychotherapeutics (Anxiety / Depression)	SSRI Antidepressants	Subject to Quantity Duration Programs.
tiotropium bromide inhaler	Generic	Respiratory (Allergy / Asthma / COPD)	Anticholinergic / Muscarinic Agents - Long-Acting Agents (LAMA)	Subject to Quantity Duration Programs.
Incruse Ellipta	Brand Name	Respiratory (Allergy / Asthma / COPD)	Anticholinergic / Muscarinic Agents - Long-Acting Agents (LAMA)	Subject to Quantity Duration Programs.
Spiriva Inhaler	Brand Name	Respiratory (Allergy / Asthma / COPD)	Anticholinergic / Muscarinic Agents - Long-Acting Agents (LAMA)	Subject to Quantity Duration Programs.
Spiriva Respimat	Brand Name	Respiratory (Allergy / Asthma / COPD)	Anticholinergic / Muscarinic Agents - Long-Acting Agents (LAMA)	Subject to Quantity Duration Programs.
ipratropium inhalant soln	Generic	Respiratory (Allergy / Asthma / COPD)	Anticholinergic / Muscarinic Agents - Short-Acting Agents
Atrovent HFA Inhaler	Brand Name	Respiratory (Allergy / Asthma / COPD)	Anticholinergic / Muscarinic Agents - Short-Acting Agents
Arcapta Neohaler	Brand Name	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Long-Acting Beta Agonist (inhalers)
Serevent Diskus	Brand Name	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Long-Acting Beta Agonist (inhalers)	Subject to Quantity Duration Programs.
arformoterol tartrate	Generic	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Long-Acting Beta Agonist (nebulized solutions)
formoterol fumerate	Generic	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Long-Acting Beta Agonist (nebulized solutions)
albuterol sulfate HFA	Generic	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Short-Acting Beta Agonist (inhalers)
levalbuterol tartrate HFA	Generic	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Short-Acting Beta Agonist (inhalers)
ProAir HFA	Brand Name	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Short-Acting Beta Agonist (inhalers)
ProAir Respiclick	Brand Name	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Short-Acting Beta Agonist (inhalers)
Ventolin HFA	Brand Name	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Short-Acting Beta Agonist (inhalers)
albuterol sulfate inhalant solution	Generic	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Short-Acting Beta Agonist (nebulized solutions)
levalbuterol inhalation solution	Generic	Respiratory (Allergy / Asthma / COPD)	Beta Agonist Agents - Short-Acting Beta Agonist (nebulized solutions)
pirfenidone	Generic	Respiratory (Allergy / Asthma / COPD)	Idiopathic Pulmonary Fibrosis	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Ofev	Brand Name	Respiratory (Allergy / Asthma / COPD)	Idiopathic Pulmonary Fibrosis	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
budesonide/formoterol	Generic	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid / Long Acting Beta Agonist	Subject to Quantity Duration Programs.
fluticasone/salmeterol	Generic	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid / Long Acting Beta Agonist	Subject to Quantity Duration Programs.
Advair Diskus	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid / Long Acting Beta Agonist	Subject to Quantity Duration Programs.
Advair HFA	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid / Long Acting Beta Agonist	Subject to Quantity Duration Programs.
Airduo	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid / Long Acting Beta Agonist	Subject to Quantity Duration Programs.
Breo Ellipta	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid / Long Acting Beta Agonist	Subject to Quantity Duration Programs.
Dulera	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid / Long Acting Beta Agonist	Subject to Quantity Duration Programs.
Symbicort	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid / Long Acting Beta Agonist	Subject to Quantity Duration Programs.
budesonide soln	Generic	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid Therapy	Subject to Quantity Duration Programs.
fluticasone propionate HFA	Generic	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid Therapy
Alvesco	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid Therapy	Subject to Quantity Duration Programs.
Arnuity Ellipta	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid Therapy	Subject to Quantity Duration Programs.
Asmanex HFA	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid Therapy	Subject to Quantity Duration Programs.
Flovent Diskus	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid Therapy	Subject to Quantity Duration Programs.
Flovent HFA	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid Therapy	Subject to Quantity Duration Programs.
Pulmicort Flexhaler	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid Therapy	Subject to Quantity Duration Programs.
QVAR Redihaler	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid Therapy	Subject to Quantity Duration Programs.
Breztri Aerosphere	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid/Anticholinergic/Long-acting Beta Agonist Agents	Subject to Quantity Duration Programs.
Trelegy Ellipta	Brand Name	Respiratory (Allergy / Asthma / COPD)	Inhaled Corticosteroid/Anticholinergic/Long-acting Beta Agonist Agents	Subject to Quantity Duration Programs.
Anoro Ellipta	Brand Name	Respiratory (Allergy / Asthma / COPD)	Long-Acting Muscarinic / Beta 2 combination Agents	Subject to Quantity Duration Programs.
Bevespi Aerosphere	Brand Name	Respiratory (Allergy / Asthma / COPD)	Long-Acting Muscarinic / Beta 2 combination Agents	Subject to Quantity Duration Programs.
Stiolto Respimat	Brand Name	Respiratory (Allergy / Asthma / COPD)	Long-Acting Muscarinic / Beta 2 combination Agents	Subject to Quantity Duration Programs.
Utibron Neohaler	Brand Name	Respiratory (Allergy / Asthma / COPD)	Long-Acting Muscarinic / Beta 2 combination Agents	Subject to Quantity Duration Programs.
azelastine/fluticasone	Generic	Respiratory (Allergy / Asthma / COPD)	Nasal Combination Antihistamine/Corticosteroids Agent
budesonide	Generic	Respiratory (Allergy / Asthma / COPD)	Nasal Corticosteroids
flunisolide	Generic	Respiratory (Allergy / Asthma / COPD)	Nasal Corticosteroids
fluticasone propionate	Generic	Respiratory (Allergy / Asthma / COPD)	Nasal Corticosteroids
mometasone furoate	Generic	Respiratory (Allergy / Asthma / COPD)	Nasal Corticosteroids
triamcinolone acetonide	Generic	Respiratory (Allergy / Asthma / COPD)	Nasal Corticosteroids
abrisentan	Generic	Respiratory (Allergy / Asthma / COPD)	Pulmonary Arterial Hypertension (PAH) Agents (Endothelial Receptor Antagonist)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
bosentan tablet	Generic	Respiratory (Allergy / Asthma / COPD)	Pulmonary Arterial Hypertension (PAH) Agents (Endothelial Receptor Antagonist)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Opsumit	Brand Name	Respiratory (Allergy / Asthma / COPD)	Pulmonary Arterial Hypertension (PAH) Agents (Endothelial Receptor Antagonist)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Tracleer tablet for suspension	Brand Name	Respiratory (Allergy / Asthma / COPD)	Pulmonary Arterial Hypertension (PAH) Agents (Endothelial Receptor Antagonist)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Uptravi	Brand Name	Respiratory (Allergy / Asthma / COPD)	Pulmonary Arterial Hypertension (PAH) Agents (Endothelial Receptor Antagonist)	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Cinqair	Brand Name	Respiratory (Allergy / Asthma / COPD)	Severe Asthma	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Dupixent	Brand Name	Respiratory (Allergy / Asthma / COPD)	Severe Asthma	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Fasenra	Brand Name	Respiratory (Allergy / Asthma / COPD)	Severe Asthma	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Nucala	Brand Name	Respiratory (Allergy / Asthma / COPD)	Severe Asthma	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Xolair	Brand Name	Respiratory (Allergy / Asthma / COPD)	Severe Asthma	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to Quantity Duration Programs.
Combivent Respimat	Brand Name	Respiratory (Allergy / Asthma / COPD)	Short-Acting Beta Agonist / Anticholinergic Combination Agent
Soliris	Brand Name	Myasthenia Gravis		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Adalimumab – ADAZ (Sandoz)	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Amjevita	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Cyltezo	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Enbrel	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Humira	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Hyrimoz	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Inflectra	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Infliximab	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Remicade	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Rinvoq	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Taltz	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Xeljanz	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Xeljanz XR	Brand Name	Select Biologic and Immunologic Agents	Ankylosing Spondylitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Adalimumab – ADAZ (Sandoz)	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Amjevita	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Cyltezo	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Humira	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Humira Pediatric	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Hyrimoz	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Inflectra	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Infliximab	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Remicade	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Skyrizi	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Stelara SC	Brand Name	Select Biologic and Immunologic Agents	Crohn's Disease Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Adalimumab – ADAZ (Sandoz)	Brand Name	Select Biologic and Immunologic Agents	Juvenile Idiopathic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Amjevita	Brand Name	Select Biologic and Immunologic Agents	Juvenile Idiopathic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Cyltezo	Brand Name	Select Biologic and Immunologic Agents	Juvenile Idiopathic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Enbrel	Brand Name	Select Biologic and Immunologic Agents	Juvenile Idiopathic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Humira	Brand Name	Select Biologic and Immunologic Agents	Juvenile Idiopathic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Hyrimoz	Brand Name	Select Biologic and Immunologic Agents	Juvenile Idiopathic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Xeljanz	Brand Name	Select Biologic and Immunologic Agents	Juvenile Idiopathic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Xeljanz XR	Brand Name	Select Biologic and Immunologic Agents	Juvenile Idiopathic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Otrexup	Brand Name	Select Biologic and Immunologic Agents	Methotrexate Auto Injectors - Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Rasuvo	Brand Name	Select Biologic and Immunologic Agents	Methotrexate Auto Injectors - Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Cimzia	Brand Name	Select Biologic and Immunologic Agents	Non-Radiographic Spondyloarthritis	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Rinvoq	Brand Name	Select Biologic and Immunologic Agents	Non-Radiographic Spondyloarthritis	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Taltz	Brand Name	Select Biologic and Immunologic Agents	Non-Radiographic Spondyloarthritis	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Adalimumab – ADAZ (Sandoz)	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Amjevita	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Cyltezo	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Enbrel	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Humira	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Hyrimoz	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Inflectra	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Infliximab	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Otezla	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Remicade	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Skyrizi	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Stelara SC	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Taltz	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Tremfya	Brand Name	Select Biologic and Immunologic Agents	Plaque Psoriasis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Adalimumab – ADAZ (Sandoz)	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Amjevita	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Cyltezo	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Enbrel	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Humira	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Hyrimoz	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Inflectra	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Infliximab	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Otezla	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Remicade	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Rinvoq	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Skyrizi	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Stelara SC	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Taltz	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Tremfya	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Xeljanz	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Xeljanz XR	Brand Name	Select Biologic and Immunologic Agents	Psoriatic Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Adalimumab – ADAZ (Sandoz)	Brand Name	Select Biologic and Immunologic Agents	Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Amjevita	Brand Name	Select Biologic and Immunologic Agents	Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Cyltezo	Brand Name	Select Biologic and Immunologic Agents	Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Enbrel	Brand Name	Select Biologic and Immunologic Agents	Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Humira	Brand Name	Select Biologic and Immunologic Agents	Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Hyrimoz	Brand Name	Select Biologic and Immunologic Agents	Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Inflectra	Brand Name	Select Biologic and Immunologic Agents	Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Infliximab	Brand Name	Select Biologic and Immunologic Agents	Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Remicade	Brand Name	Select Biologic and Immunologic Agents	Rheumatoid Arthritis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Adalimumab – ADAZ (Sandoz)	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Amjevita	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Cyltezo	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Entyvio	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Humira	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Hyrimoz	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage. Subject to Quantity Duration Programs.
Inflectra	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Infliximab	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Remicade	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Renflexis	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Rinvoq	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Stelara SC	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Xeljanz	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
Xeljanz XR	Brand Name	Select Biologic and Immunologic Agents	Ulcerative Colitis Agents	Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo. Subject to the Step Therapy Program.
bupropion HCl tablet, sust. action	Generic	Smoking Cessation		Subject to Quantity Duration Programs.
varenicline tartrate	Generic	Smoking Cessation
Nicotrol Inhaler	Brand Name	Smoking Cessation		Subject to Quantity Duration Programs.
Nicotrol Nasal Spray	Brand Name	Smoking Cessation		Subject to Quantity Duration Programs.
fluorouracil cream 5%	Generic	Topical Actinic Keratosis Agents		This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
fluorouracil solution 2%, 5%	Generic	Topical Actinic Keratosis Agents		This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
imiquimod 3.75%, 5%	Generic	Topical Actinic Keratosis Agents		This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Klisyri	Brand Name	Topical Actinic Keratosis Agents
Picato Gel 0.015%, 0.05%	Brand Name	Topical Actinic Keratosis Agents		This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
ciclopirox	Generic	Topical Antifungals
ciclopirox solution	Generic	Topical Antifungals
clotrimazole	Generic	Topical Antifungals
clotrimazole / betamethasone	Generic	Topical Antifungals
econazole nitrate	Generic	Topical Antifungals
ketoconazole	Generic	Topical Antifungals
naftifine 1% gel	Generic	Topical Antifungals
naftifine cream	Generic	Topical Antifungals
nystatin	Generic	Topical Antifungals
nystatin w/ triamcinolone	Generic	Topical Antifungals
oxiconazole nitrate 1% cream	Generic	Topical Antifungals
acyclovir ointment	Generic	Topical Antiviral Therapy
penciclovir cream	Generic	Topical Antiviral Therapy
Denavir Cream	Brand Name	Topical Antiviral Therapy
amcinonide (cream, lotion)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
apexicon E (cream)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
betamethasone dipropionate (cream, gel, lotion, ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
betamethasone DP augmented (cream, lotion)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
betamethasone valerate 0.1% (ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
desoximetasone (cream, ointment, spray 0.25%, gel 0.05%)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
diflorasone diacetate 0.05% (cream)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
fluocinonide (gel, cream, ointment, solution)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
fluocinonide-E (cream)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
halcinonide 0.1% (cream)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
triamcinolone acetonide 0.5% (cream, ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - High Potency
alclometasone (cream, ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Low Potency
desonide 0.05% (cream, gel, lotion, ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Low Potency
fluocinolone (cream, ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Low Potency
hydrocortisone (cream, ointment, lotion)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Low Potency
Capex Shampoo 0.01%	Brand Name	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Low Potency
betamethasone valerate (cream lotion, foam)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
desoximetasone 0.05% (cream, ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
fluocinolone 0.025% (cream, ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
flurandrenolide 0.05% (cream, ointment, lotion)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
fluticasone (cream, ointment, lotion)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
hydrocortisone butyrate (cream, ointment, solution)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
hydrocortisone butyrate / emollient (cream)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
hydrocortisone valerate (cream)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
mometasone 0.1% (cream, ointment, solution)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
prednicarbate 0.1% (cream, ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
triamcinolone 0.025%, 0.1% (cream, ointment, lotion, aerosol)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
Cordran Tape	Brand Name	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Medium Potency
betamethasone augmented (ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Very High Potency
clobetasol E (cream)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Very High Potency
clobetasol propionate (cream, ointment, lotion, solution, spray, foam, gel, shampoo)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Very High Potency
clodan shampoo	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Very High Potency
diflorasone diacetate (ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Very High Potency
halobetasol propionate (cream, ointment)	Generic	Topical Corticosteroids (Topical Skin Products)	Topical Corticosteroids - Very High Potency
lidocaine (cream, oint, gel, patch)	Generic	Topical Miscellaneous Anesthetic Preparations		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Subject to Quantity Duration Programs.
Ferrex 150 Forte	Generic	Vitamins	Iron Supplement Therapy	All generics are preferred. Only commonly used vitamins are listed.
Ferrex 150 Forte Plus	Generic	Vitamins	Iron Supplement Therapy	All generics are preferred. Only commonly used vitamins are listed.
Ferrex 28	Generic	Vitamins	Iron Supplement Therapy	All generics are preferred. Only commonly used vitamins are listed.
Multigen Plus	Generic	Vitamins	Iron Supplement Therapy	All generics are preferred. Only commonly used vitamins are listed.
Poly-Iron 150 Forte	Generic	Vitamins	Iron Supplement Therapy	All generics are preferred. Only commonly used vitamins are listed.
Corvita	Generic	Vitamins	Multivitamin Therapy	All generics are preferred. Only commonly used vitamins are listed.
V-C Forte	Generic	Vitamins	Multivitamin Therapy	All generics are preferred. Only commonly used vitamins are listed.
PNV-DHA	Generic	Vitamins	Prenatal Vitamin Therapy	All generics are preferred. Only commonly used vitamins are listed.
Prenatal Plus	Generic	Vitamins	Prenatal Vitamin Therapy	All generics are preferred. Only commonly used vitamins are listed.
Zatean-PN DHA	Generic	Vitamins	Prenatal Vitamin Therapy	All generics are preferred. Only commonly used vitamins are listed.
Zatean-PN Plus	Generic	Vitamins	Prenatal Vitamin Therapy	All generics are preferred. Only commonly used vitamins are listed.
Folbee	Generic	Vitamins	Vitamin B Therapy	All generics are preferred. Only commonly used vitamins are listed.
Folbee Plus	Generic	Vitamins	Vitamin B Therapy	All generics are preferred. Only commonly used vitamins are listed.
Folbic	Generic	Vitamins	Vitamin B Therapy	All generics are preferred. Only commonly used vitamins are listed.
Renal Caps	Generic	Vitamins	Vitamin B Therapy	All generics are preferred. Only commonly used vitamins are listed.
Triphrocaps	Generic	Vitamins	Vitamin B Therapy	All generics are preferred. Only commonly used vitamins are listed.
calcitriol	Generic	Vitamins	Vitamin D Analog Agents	All generics are preferred. Only commonly used vitamins are listed.
doxercalciferol	Generic	Vitamins	Vitamin D Analog Agents	All generics are preferred. Only commonly used vitamins are listed.
paricalcitol	Generic	Vitamins	Vitamin D Analog Agents	All generics are preferred. Only commonly used vitamins are listed.
benzphetamine HCL	Generic	Weight Loss Agents		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
diethylpropion HCL, ER	Generic	Weight Loss Agents		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
phendimetrazine tartrate	Generic	Weight Loss Agents		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
phentermine HCL	Generic	Weight Loss Agents		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Contrave ER	Brand Name	Weight Loss Agents		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Qsymia	Brand Name	Weight Loss Agents		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Saxenda	Brand Name	Weight Loss Agents		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. This specialty drug is available through the NYC Municipal Program called PICA. NYC municipal employees can contact Accredo Customer Service at (800) 467-2006 and inquire about drug coverage.
Wegovy	Brand Name	Weight Loss Agents		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Xenical	Brand Name	Weight Loss Agents		Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851.
Beovu	Brand Name	Vascular Endothelial Growth Factor (VEGF) Inhibitor		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Byooviz	Brand Name	Vascular Endothelial Growth Factor (VEGF) Inhibitor		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Eylea	Brand Name	Vascular Endothelial Growth Factor (VEGF) Inhibitor		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Lucentis	Brand Name	Vascular Endothelial Growth Factor (VEGF) Inhibitor		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Vabysmo	Brand Name	Vascular Endothelial Growth Factor (VEGF) Inhibitor		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
Visudyne	Brand Name	Vascular Endothelial Growth Factor (VEGF) Inhibitor		Do not use during pregnancy. Subject to prior authorization at express-path.com or by calling Express Scripts at (800) 753-2851. Must be obtained through Accredo.
NONPREFERRED PRODUCT:Abilify Maintena POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Abilify Mycite POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Accrufer POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Aciphex Sprinkle POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Actemra SC (Juvenile Idiopathic Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Actemra SC (Rheumatoid Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Actoplus Met XR POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Acuvail POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adalimumab-FKJP (Mylan) (Ankylosing Spondylitis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adalimumab-FKJP (Mylan) (Crohn’s Disease indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adalimumab-FKJP (Mylan) (Juvenile Idiopathic Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adalimumab-FKJP (Mylan) (Plaque Psoriasis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adalimumab-FKJP (Mylan) (Psoriatic Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adalimumab-FKJP (Mylan) (Rheumatoid Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adalimumab-FKJP (Mylan) (Ulcerative Colitis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adasuve Inhaler POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adhansia XR POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adlarity POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adlyxin POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Admelog POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Admelog Solostar POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adzenys ER POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Adzenys XR-ODT POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Aklief POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Akynzeo POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Allzital POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Alocril POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:alogliptin (Perrigo) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:alogliptin-metformin (Perrigo) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:alogliptin-pioglitazone (Perrigo) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Alomide POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Alora POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Alrex POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Altoprev POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Altreno POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:amphetamine ER 1.25mg/ml suspension (Prasco) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Amrix POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Amzeeq POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Anastia POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Annovera POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Antara 30mg, 90mg POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Antivert POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Anzemet POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Apadaz POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Apidra POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Apidra Solostar POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Aplenzin POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Aptiom POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Arazlo POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Armonair Digihaler POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Auvelity POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Auvi-Q POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Avar (foam, pads),Avar-E,Avar LS POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Avastin POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Avsola (Ankylosing Spondylitis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Avsola (Crohn’s Disease indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Avsola (Plaque Psoriasis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Avsola (Psoriatic Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Avsola (Rheumatoid Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Avsola (Ulcerative Colitis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Azasite POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Azeschew POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Azstarys POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:baclofen oral solution (Palmetto Pharmaceutical) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Bacmin POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Balcoltra POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Basaglar Kwikpen POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Basaglar Tempo Pen POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Baxdela POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Beconase AQ POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Belbuca POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Belsomra POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:BenzEFoam POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Besivance POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Betimol POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Betoptic S POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Binosto POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Bivigam POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Brenzavvy POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Briviact POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Bromsite POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Bryhali POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:buproprion 450mg XL tablet POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:calcipotriene (Ayurax) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:calcipotriene-betamethasone suspension (LEO Pharmaceutical) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Caplyta POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Capsinac POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Carac POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cardizem LA 120mg POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cequa POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cimzia (Ankylosing Spondylitis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cimzia (Crohn's Disease Indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cimzia (Plaque Psoriasis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cimzia (Psoriatic Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cimzia (Rheumatoid Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cipro HC POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Citranatal Rx POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Clenia Plus POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Clindacin ETZ, Clindacin PAC POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Clodan POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cloderm POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:clozapine ODT 150mg, 200mg (Teva) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:colchicine capsule POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Conjupri POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Conzip POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Coreg CR POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cortisporin-TC POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Corvite POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cosentyx (Ankylosing Spondylitis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cosentyx (Non-Radiographic Spondyloarthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cosentyx (Plaque Psoriasis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cosentyx (Psoriatic Arthritis indication only) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cotempla XR-ODT POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cuvitru POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Cycloset POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:dapsone gel with pump 7.5% (Taro) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Daytrana POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dayvigo POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dermacinrx Prenatrix POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dermacinrx Prenatryl POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dermacinrx Pretrate POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:desvenlafaxine ER POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dextenza POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dexycu POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dhivy POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Diacomit POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:diclofenac epolamine patch (Greenstone & Teva) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Diclofono Gel Packet POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Diclosaicin POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Diclovix M POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Differin Lotion POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dimentho POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dipentum POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Divigel POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Doral POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Doryx 80mg DR Tablet POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Doryx MPC POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:doxycycline hyclate 80mg enteric coated tablet (Basiem) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:doxycycline IR-DR POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Drizalma Sprinkle POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dsuvia POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Duaklir Pressair POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Duexis POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Duobrii POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Durlaza POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Durolane POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Durysta POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Dutoprol POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:E.E.S. suspension POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Ecoza POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Edarbi POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Edarbyclor POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Edluar POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Elelyso POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Elepsia XR POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Elestrin POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Emsam POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Enlite Glucose Sensor POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Entadfi POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Enzoclear POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Epclusa (Genotype 1,2,3,4,5,6) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Epiduo Forte POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Epifoam POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Epogen POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Epsolay POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Equetro POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Ertaczo POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Esomep-EZS POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:esomeprazole strontium POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Estrace Vaginal Cream POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Estrogel POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Evamist POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Eversense E3 Sensor-Holder POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Eversense E3 Smart Transmitter POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Eversense Sensor-Holder POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Eversense Smart Transmitter POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Evkeeza POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Evzio Auto-Injector POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Exelderm POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fabior POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Factive POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fanapt POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Femring POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fenofibrate Capsule (Ani Pharmaceutical) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fenortho POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fenovar POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fentora POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Ferralet 90 POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fetzima POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fiasp POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fiasp Flextouch POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fiasp Penfill POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fintepla POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:First-Lansoprazole POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:First-Omeprazole POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Flarex POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Flector Patch POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fluoroplex POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:fluoxetine 60mg tablet (Edgemont Pharmaceuticals) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:FML-Forte POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Forfivo XL POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fosamax D POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fosrenol Powder Packet POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Freestyle (Blood Glucose Monitoring Devices & Test Strips) POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Frotek Cream POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Fycompa POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Gamastan S-D POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Gammagard Liquid POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Gammagard S-D POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Gammaked POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Gammaplex POSSIBLE PREFERRED ALTERNATIVES:
NONPREFERRED PRODUCT:Gel-One POSSIBLE PREFERRED ALTERNATIVES:

Preferred Drug List

For Long-Term Medications, Members Must Use the 90-Day RX Solution

Print-friendly PDL (Oct 2023 update)

Print-friendly PDL
(Oct 2023 update)