11.99.99.99 |
Restricted Use
|
 |
Adalimumab Amgevita®, Humira®, Imraldi® |
13.05.03 |
Restricted Use
|
 |
Adalimumab Amgevita®,Humira®, Imraldi® |
10.04 |
Restricted Use
|
 |
Autologous chondrocyte implantation (ACI) |
05.03.01 |
Restricted Use
|
 |
Bictegravir, emtricitabine, tenofovir alafenamide Biktarvy® |
10.01.03 |
Restricted Use
|
 |
Certolizumab Pegol Cimzia® |
20 |
Non Formulary
|
 |
Dibotermin alfa (recombinant human (Bone Morphogenetic Protein-2; rhBMP-2) InductOs® 1.5 mg/ml powder, solvent and matrix for implantation matrix |
20 |
Restricted Use
|
 |
Dibotermin Alfa, rhBMP-2 (Bone morphogenetic protein-2 ) Inductos® |
08.02.04 |
Formulary
|
 |
Dimethyl fumarate Tecfidera® |
05.03.03.02 |
Restricted Use
|
 |
Elbasvir and Grazoprevir Zepatier® |
13.05.03 |
Restricted Use
|
 |
Etanercept Enbrel®, Benepali® |
05.03.03.02 |
Restricted Use
|
 |
Glecaprevir and Pibrentasvir Maviret® |
09.08.01 |
Restricted Use
|
 |
Glycerol Phenylbutyrate Ravicti® |
08.03.04.01 |
Restricted Use
|
 |
Intrabeam radiotherapy system Carl Zeiss UK |
05.03.03.02 |
Restricted Use
|
 |
Ledipasvir and Sofosbuvir Harvoni® |
08.01.05 |
Restricted Use
|
 |
Liposomal Cytarabine–Daunorubicin Vyxeos® |
03.07 |
Restricted Use
|
 |
Lumacaftor/ivacaftor Orkambi® |
01.09.01 |
Restricted Use
|
 |
Obeticholic acid Ocaliva® |
08.03.04.03 |
Restricted Use
|
 |
Octreotide Sandostatin Lar® |
05.03.03.02 |
Restricted Use
|
 |
Ombitasvir, Paritaprevir and Ritonavir Viekirax® |
05.02 |
Restricted Use
|
 |
Posaconazole (IV) Noxafil® |
05.02 |
Restricted Use
|
 |
Posaconazole (oral) Noxafil® |
03.07 |
Restricted Use
|
 |
Tezacaftor/Ivacaftor Symkevi® |
08.01.05 |
Restricted Use
|
 |
Tisagenlecleucel Kymriah® |
08.01.05 |
Restricted Use
|
 |
Trastuzumab emtansine Kadcyla® |