Report : A-Z HCD items in Formulary 27/02/2021 10:02:17

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Section Status BlueTeq Name 10.01.03 Restricted Use Abatacept Orencia® 01.05.03 Restricted Use Adalimumab Amgevita®, Humira®, Imraldi® 10.01.03 Restricted Use Adalimumab Amgevita®, Humira®, Imraldi® 13.05.03 Restricted Use Adalimumab Amgevita®,Humira®, Imraldi® 02.12 Restricted Use Alirocumab  13.05.01 Restricted Use Alitretinoin Toctino® 10.01.03 Restricted Use Anakinra Kineret® 10.01.03 Restricted Use Apremilast Otezla® 13.05.03 Restricted Use Apremilast Otezla® 09.08.01 Restricted Use Asfotase alfa Strensiq® 08.01.05 Restricted Use Atezolizumab Tecentriq® 02.11 Restricted Use Avatrombopag Doptelet ® 10.01.03 Restricted Use Baricitinib Olumiant® 05.01.09 Restricted Use Bedaquiline Sirturo® 03.04.02 Restricted Use Benralizumab Fasenra® 04.09.03 Restricted Use Botulinum Toxin Dysport®, Botox®, Neurobloc®, 04.07.04.02 Restricted Use Botulinum Toxin Type A botox® 07.04.02 Restricted Use Botulinum toxin type A   13.12 Restricted Use Botulinum toxin type A   08.01.05 Restricted Use Brentuximab vedotin Adcetris® 10.01.03 Restricted Use Certolizumab Pegol Cimzia® 06.01.06 Restricted Use Continuous Glucose Monitoring (CGM) System  08.01.05 Restricted Use Crizotinib Xalkori® 13.05.01 Restricted Use Dupilumab Dupixent® 09.01.04 Restricted Use Eltrombopag Revolade® 02.11 Restricted Use Emicizumab Hemlibra® 10.01.03 Restricted Use Etanercept Enbrel®,Benepali® 13.05.03 Restricted Use Etanercept Enbrel®, Benepali® 08.01.05 Restricted Use Everolimus Votubia® 02.12 Restricted Use Evolocumab  06.01.06 Restricted Use Flash Glucose Scanning (FGS) System Freestyle Libre® 04.07.04.02 Restricted Use Fremanezumab Ajovy® 01.05.03 Restricted Use Golimumab Simponi® 10.01.03 Restricted Use Golimumab Simponi® 13.05.03 Restricted Use Guselkumab Tremfya® 01.05.03 Restricted Use Infliximab Flixabi®, Inflectra® 10.01.03 Restricted Use Infliximab Remsima®, Inflectra®, Remicade®, Flixabi® 13.05.03 Restricted Use Infliximab Remsima®, Inflectra®,Remicade® Flixabi® 08.01.05 Restricted Use Ixazomib Ninlaro® 10.01.03 Restricted Use Ixekizumab Taltz® 03.04.03 Restricted Use Lanadelumab Takhzyro® 02.11 Restricted Use Lusutrombopag Mulpleo® 08.02.04 Restricted Use Nivolumab Opdivo ® 10.02 Restricted Use Nusinersen Spinraza® 08.01.05 Restricted Use Pembrolizumab Keytruda® 20 Restricted Use Remdesivir  08.01.05 Restricted Use Ribociclib Kisqali® 13.05.03 Restricted Use Risankizumab Skyrizi® 10.02 Restricted Use Risdiplam Evrysdi 10.01.03 Restricted Use Rituximab (rheumatology) MabThera®, Truxima® 09.01.04 Restricted Use Romiplostim Nplate® 10.01.03 Restricted Use Secukinumab Cosentyx® 13.05.03 Restricted Use Secukinumab Cosentyx® 13.05.03 Restricted Use Tildrakizumab Ilumetri® 10.01.03 Restricted Use Tocilizumab RoActemra® 20.01 Restricted Use Tocilizumab  10.01.03 Restricted Use Tofacitinib Xeljanz® 01.05.03 Restricted Use Ustekinumab Stelara® 01.05.03 Non Formulary Ustekinumab Stelara® 10.01.03 Restricted Use Ustekinumab Stelara® 13.05.03 Restricted Use Ustekinumab

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