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Approved Formulary
Restricted Medications
Please review each of these drugs carefully.| abacavir |
|
| abatacept |
|
| abiraterone |
|
| acetaminophen-traMADol |
|
| acetylcysteine |
|
| acitretin |
|
| aclidinium |
|
| aclidinium-formoterol |
|
| adalimumab |
|
| adenosine |
|
| ado-trastuzumab emtansine |
|
| afatinib |
|
| albuterol |
|
| albuterol-budesonide |
|
| albuterol-ipratropium |
|
| aldesleukin |
|
| alefacept |
|
| alendronate |
|
| alfuzosin |
|
| aliskiren |
|
| alitretinoin topical |
|
| alogliptin |
|
| alogliptin-metFORMIN |
|
| alogliptin-pioglitazone |
|
| alteplase |
|
| altretamine |
|
| aluminum sulfate-calcium acetate topical |
|
| ambrisentan |
|
| amcinonide topical |
|
| aMILoride-hydroCHLOROthiazide |
|
| aminocaproic acid |
|
| amiodarone |
|
| amoxapine |
|
| amsacrine |
|
| anagrelide |
|
| andexanet alfa |
|
| antipyrine-benzocaine otic |
|
| apomorphine |
|
| aprepitant |
|
| arformoterol |
|
| argatroban |
|
| armodafinil |
|
| arsenic trioxide |
|
| asenapine |
|
| asparaginase Escherichia coli |
|
| aspirin-butalbital-caffeine |
|
| atropine |
|
| axitinib |
|
| azaCITIDine |
|
| azaTHIOprine IV |
|
| azilsartan |
|
| aztreonam-avibactam |
|
| beclomethasone |
|
| beclomethasone nasal |
|
| belantamab mafodotin |
|
| belimumab |
|
| belinostat |
|
| benazepril |
|
| bendamustine |
|
| benzocaine-butamben-tetracaine |
|
| betamethasone topical |
|
| betaxolol ophthalmic |
|
| bexarotene |
|
| bivalirudin |
|
| bleomycin |
|
| blinatumomab |
|
| bortezomib |
|
| bosentan |
|
| bosutinib |
|
| BRENtuximab vedotin |
|
| brompheniramine |
|
| budesonide nasal |
|
| budesonide-formoterol |
|
| budesonide-formoterol-glycopyrrolate |
|
| bumetanide |
|
| BUPivacaine |
|
| buprenorphine |
|
| buprenorphine-naloxone |
|
| busulfan |
|
| cabazitaxel |
|
| cabergoline |
|
| cabozantinib |
|
| caffeine-ergotamine |
|
| calcitonin |
|
| calcium carbonate-magnesium chloride |
|
| calcium gluconate |
|
| canagliflozin |
|
| candesartan |
|
| carbinoxamine |
|
| CARBOplatin |
|
| carboxymethylcellulose |
|
| carfilzomib |
|
| carmustine |
|
| caspofungin |
|
| cefaclor |
|
| cefadroxil |
|
| cefixime |
|
| cefotaxime |
|
| cefoTEtan |
|
| cefpodoxime |
|
| cefprozil |
|
| ceftaroline |
|
| cefTAZidime-avibactam |
|
| ceftibuten |
|
| ceftolozane-tazobactam |
|
| cenobamate |
|
| ceritinib |
|
| cetirizine |
|
| cetirizine-pseudoePHEDrine |
|
| cetrorelix |
|
| chlorambucil |
|
| chlordiazePOXIDE-clidinium |
|
| chlorpheniramine |
|
| chlorzoxazone |
|
| choline magnesium trisalicylate |
|
| choline salicylate |
|
| ciclesonide |
|
| ciclesonide nasal |
|
| ciclopirox topical |
|
| cimetidine |
|
| ciprofloxacin otic |
|
| ciprofloxacin-dexAMETHasone otic |
|
| ciprofloxacin-hydrocortisone otic |
|
| CISatracurium |
|
| CISplatin |
|
| cladribine |
|
| clioquinol topical |
|
| clioquinol-hydrocortisone topical |
|
| cloBAZam |
|
| clocortolone topical |
|
| clofarabine |
|
| clomiPHENE |
|
| clomiPRAMINE |
|
| cloxacillin |
|
| cobimetinib |
|
| cocaine topical |
|
| conjugated estrogens PO |
|
| conjugated estrogens topical |
|
| cortisone |
|
| crizotinib |
|
| crotamiton topical |
|
| cycloSPORINE ophthalmic |
|
| cytarabine |
|
| dabrafenib |
|
| dacarbazine |
|
| DACTINomycin |
|
| dapsone |
|
| DAPTOmycin |
|
| darifenacin |
|
| dasatinib |
|
| DAUNOrubicin |
|
| decitabine |
|
| deferiprone |
|
| deflazacort |
|
| degarelix |
|
| demeclocycline |
|
| demo |
|
| denosumab |
|
| desipramine |
|
| desloratadine |
|
| desoximetasone topical |
|
| dexlansoprazole |
|
| dexmedetomidine |
|
| dextromethorphan-quiNIDine |
|
| diazePAM |
|
| diclofenac |
|
| dicloxacillin |
|
| dietary supplements |
|
| diethylstilbestrol |
|
| diflorasone topical |
|
| diflunisal |
|
| difluprednate ophthalmic |
|
| digoxin |
|
| digoxin immune FAB |
|
| dihydroergotamine |
|
| dilTIAZem |
|
| dimenhyDRINATE |
|
| dipyridamole |
|
| DOBUTamine |
|
| DOCEtaxel |
|
| dofetilide |
|
| dolasetron |
|
| donepezil-memantine |
|
| DOPamine |
|
| doripenem |
|
| DOXOrubicin |
|
| DOXOrubicin liposomal |
|
| doxylamine |
|
| droPERidol |
|
| econazole topical |
|
| edoxaban |
|
| empagliflozin-linaGLIPtin |
|
| enfortumab vedotin |
|
| entecavir |
|
| enzalutamide |
|
| EPINEPHrine |
|
| epiRUBicin |
|
| eprosartan |
|
| eravacycline |
|
| eriBULin |
|
| ertapenem |
|
| ertugliflozin |
|
| ertugliflozin-metFORMIN |
|
| ertugliflozin-SITagliptin |
|
| eslicarbazepine |
|
| esmolol |
|
| estazolam |
|
| esterified estrogens-methylTESTOSTERone |
|
| estradiol IM |
|
| estramustine |
|
| estrogen/progesterone combinations |
|
| estropipate |
|
| eszopiclone |
|
| ethosuximide |
|
| etodolac |
|
| etoposide |
|
| everolimus |
|
| ezetimibe-simvastatin |
|
| fam-trastuzumab deruxtecan |
|
| famciclovir |
|
| felbamate |
|
| fenfluramine |
|
| fenoldopam |
|
| fenoprofen |
|
| fenoterol-ipratropium |
|
| fentaNYL |
|
| ferric carboxymaltose |
|
| ferrous fumarate |
|
| ferrous gluconate |
|
| ferumoxytol |
|
| fesoterodine |
|
| fexofenadine |
|
| fexofenadine-pseudoePHEDrine |
|
| fidaxomicin |
|
| filgrastim |
|
| finerenone |
|
| fingolimod |
|
| flavoxATE |
|
| floxuridine |
|
| fluconazole IV |
|
| fluconazole PO |
|
| fludarabine |
|
| flunisolide |
|
| flunisolide nasal |
|
| fluocinolone topical |
|
| fluorouracil |
|
| fluoxymesterone |
|
| flurandrenolide topical |
|
| flurazepam |
|
| flurbiprofen |
|
| flutamide |
|
| fluticasone topical |
|
| fluticasone-salmeterol |
|
| fluticasone-umeclidinium-vilanterol |
|
| fluticasone-vilanterol |
|
| fluvastatin |
|
| formoterol-glycopyrrolate |
|
| formoterol-mometasone |
|
| fosfomycin |
|
| fosinopril |
|
| frovatriptan |
|
| ganaxolone |
|
| ganciclovir ophthalmic |
|
| ganirelix |
|
| gemcitabine |
|
| gemtuzumab ozogamicin |
|
| glycopyrrolate-indacaterol |
|
| gonadotropin, chorionic (HCG) |
|
| granisetron |
|
| guaiFENesin-HYDROcodone |
|
| guanFACINE |
|
| halcinonide topical |
|
| halobetasol topical |
|
| haloperidol |
|
| heparin |
|
| herbal supplements |
|
| histrelin |
|
| hydrocortisone butyrate |
|
| hydrocortisone-pramoxine topical |
|
| HYDROmorphone |
|
| ibandronate |
|
| ibutilide |
|
| icatibant |
|
| IDArubicin |
|
| ifosfamide |
|
| iloperidone |
|
| imatinib |
|
| imipenem-cilastatin |
|
| imipenem-cilastatin-relebactam |
|
| immune globulin intravenous and subcutaneous |
|
| indacaterol |
|
| inFLIXimab |
|
| inotuzumab ozogamicin |
|
| insulin aspart |
|
| insulin degludec |
|
| insulin detemir |
|
| insulin glulisine |
|
| insulin human in Normal Saline |
|
| insulin lispro-insulin lispro protamine |
|
| insulin regular |
|
| interferon alfa-2b |
|
| ipratropium |
|
| irbesartan |
|
| irinotecan |
|
| iron dextran |
|
| iron polysaccharide |
|
| iron sucrose |
|
| isoproterenol |
|
| ISOtretinoin |
|
| ivabradine |
|
| ixabepilone |
|
| ixazomib |
|
| ketamine |
|
| ketoconazole topical |
|
| ketoprofen |
|
| labetalol |
|
| lansoprazole |
|
| lenalidomide |
|
| lenvatinib |
|
| leuprolide |
|
| levalbuterol |
|
| levocetirizine |
|
| levomilnacipran |
|
| lidocaine |
|
| linaGLIPtin-metFORMIN |
|
| lindane topical |
|
| lodoxamide ophthalmic |
|
| lomitapide |
|
| lomustine |
|
| loncastuximab tesirine |
|
| loratadine-pseudoePHEDrine |
|
| LORazepam |
|
| lovastatin |
|
| lumateperone |
|
| lurasidone |
|
| lurbinectedin |
|
| macitentan |
|
| magnesium gluconate |
|
| magnesium salicylate |
|
| magnesium sulfate |
|
| malathion topical |
|
| mechlorethamine |
|
| meclofenamate |
|
| mefenamic acid |
|
| melphalan flufenamide |
|
| menotropins |
|
| menthol-methyl salicylate topical |
|
| meperidine |
|
| meprobamate |
|
| meropenem-vaborbactam |
|
| metFORMIN-repaglinide |
|
| metFORMIN-sAXagliptin |
|
| metFORMIN-SITagliptin |
|
| methadone |
|
| methazolAMIDE |
|
| methenamine-sodium acid phosphate |
|
| methenamine-sodium biphosphate |
|
| methicillin |
|
| methotrexate IV |
|
| methyl salicylate topical |
|
| methylcellulose |
|
| methylTESTOSTERone |
|
| metoprolol |
|
| micafungin |
|
| midazolam |
|
| miFEPRIStone |
|
| milnacipran |
|
| milrinone |
|
| miltefosine |
|
| mipomersen |
|
| mirvetuximab soravtansine |
|
| mitoMYcin |
|
| mitotane |
|
| mitoXANTRONE |
|
| moexipril |
|
| molnupiravir |
|
| mometasone |
|
| mometasone nasal |
|
| mometasone topical |
|
| morphine |
|
| moxifloxacin |
|
| nabumetone |
|
| nafarelin |
|
| naftifine topical |
|
| naphazoline-pheniramine ophthalmic |
|
| naratriptan |
|
| nelarabine |
|
| neomycin topical |
|
| neostigmine |
|
| neutraceuticals |
|
| niCARdipine |
|
| nilotinib |
|
| nitroglycerin |
|
| nitroprusside |
|
| nizatidine |
|
| norEPINEPHrine |
|
| ofloxacin ophthalmic |
|
| olaparib |
|
| olmesartan |
|
| olodaterol |
|
| olodaterol-tiotropium |
|
| olopatadine ophthalmic |
|
| olsalazine |
|
| omacetaxine |
|
| omadacycline |
|
| omeprazole |
|
| omeprazole-sodium bicarbonate |
|
| ospemifene |
|
| oxacillin |
|
| OXALIplatin |
|
| oxaprozin |
|
| oxazepam |
|
| oxiconazole topical |
|
| oxitropium |
|
| oxyMORphone |
|
| PACLitaxel |
|
| PACLitaxel protein-bound particles |
|
| palifermin |
|
| pamidronate |
|
| panobinostat |
|
| pasireotide |
|
| PAZOPanib |
|
| peginesatide |
|
| PEMEtrexed |
|
| penciclovir topical |
|
| pentetate calcium trisodium |
|
| pentosan polysulfate sodium |
|
| pentostatin |
|
| perampanel |
|
| perphenazine |
|
| phenoxybenzamine |
|
| phenylephrine |
|
| phenylephrine nasal |
|
| phenytoin IV |
|
| pimavanserin |
|
| pimozide |
|
| pipobroman |
|
| piroxicam |
|
| pitavastatin |
|
| plecanatide |
|
| plerixafor |
|
| polatuzumab vedotin |
|
| polyethylene glycol-propylene glycol |
|
| polyvinyl alcohol |
|
| pomalidomide |
|
| PONATinib |
|
| potassium chloride |
|
| potassium phosphate |
|
| PRALAtrexate |
|
| pramoxine topical |
|
| pramoxine-zinc oxide topical |
|
| pravastatin |
|
| primaquine |
|
| probenecid |
|
| procainamide |
|
| propofol |
|
| propranolol |
|
| protamine |
|
| quazepam |
|
| quinapril |
|
| RABEprazole |
|
| raloxifene |
|
| ramelteon |
|
| ramipril |
|
| regorafenib |
|
| reslizumab |
|
| revefenacin |
|
| ribavirin |
|
| riMANTAdine |
|
| riociguat |
|
| risedronate |
|
| riTUXimab |
|
| rocuronium |
|
| romiDEPsin |
|
| rufinamide |
|
| saccharomyces boulardii lyo |
|
| sacituzumab govitecan |
|
| salmeterol |
|
| sarecycline |
|
| sarilumab |
|
| sAXagliptin |
|
| sertaconazole topical |
|
| simvastatin |
|
| sirolimus |
|
| SITagliptin |
|
| sodium chloride IV solution (Hypertonic) |
|
| sodium chloride, hypertonic, ophthalmic |
|
| sodium hypochlorite topical |
|
| sodium phosphate |
|
| sodium salicylate |
|
| somatropin |
|
| sonidegib |
|
| sotalol |
|
| spironolactone-hydroCHLOROthiazide |
|
| stiripentol |
|
| streptozocin |
|
| succinylcholine |
|
| sulconazole topical |
|
| sulfacetamide sodium ophthalmic |
|
| sulfamethoxazole |
|
| sulindac |
|
| tedizolid |
|
| telavancin |
|
| telmisartan |
|
| temozolomide |
|
| temsirolimus |
|
| tenecteplase |
|
| teniposide |
|
| terbinafine topical |
|
| terconazole topical |
|
| teriflunomide |
|
| testosterone topical |
|
| tetracycline |
|
| thioguanine |
|
| thiopental |
|
| thiotepa |
|
| thiothixene |
|
| tiaGABine |
|
| ticarcillin-clavulanate |
|
| tigecycline |
|
| timolol |
|
| tiotropium |
|
| tipiracil-trifluridine |
|
| tirofiban |
|
| tisotumab vedotin |
|
| tocilizumab |
|
| tofacitinib |
|
| tolmetin |
|
| tolnaftate topical |
|
| topotecan |
|
| toremifene |
|
| trabectedin |
|
| trametinib |
|
| trandolapril |
|
| trandolapril-verapamil |
|
| trastuzumab |
|
| tretinoin topical |
|
| triamcinolone inhaler |
|
| triamcinolone nasal |
|
| triamterene |
|
| triazolam |
|
| triethanolamine otic |
|
| trihexyphenidyl |
|
| trimethoprim |
|
| triprolidine |
|
| triptorelin |
|
| ulipristal |
|
| umeclidinium |
|
| umeclidinium-vilanterol |
|
| uracil mustard |
|
| urofollitropin |
|
| ustekinumab |
|
| valrubicin |
|
| vandetanib |
|
| vasopressin |
|
| vecuronium |
|
| vedolizumab |
|
| vemurafenib |
|
| verapamil |
|
| vigabatrin |
|
| vinBLAStine |
|
| vinCRIStine |
|
| vinORELBine |
|
| vismodegib |
|
| vitamin A |
|
| vorinostat |
|
| zaleplon |
|
| ziv-aflibercept |
|
| zoledronic acid |
|
| ZOLMitriptan |
|