Indication Based Management
Drug Class
Excluded Medications
Preferred Alternatives
ADALIMUMAB-AACF, IDACIO ADALIMUMAB-AATY, YUFLYMA ADALIMUMAB-FKJP, HULIO
ABRILADA AMJEVITA CYLTEZO HADLIMA HUMIRA HYRIMOZ YUSIMRY
ADALIMUMAB-ADAZ ADALIMUMAB-ADBM (by Boehringer Ingelheim & Quallent) ADALIMUMAB-RYVK (by Quallent), SIMLANDI
Adalimumab Products for Inflammatory Conditions ‡
Tocilizumab Products for Inflammatory Conditions ‡ Ustekinumab Products for Inflammatory Conditions ‡
ACTEMRA SC
TYENNE SC
OTULFI SC, PYZCHIVA SC, STELARA SC # , STEQEYMA SC, USTEKINUMAB SC, USTEKINUMAB-AEKN SC, WEZLANA SC
SELARSDI SC, USTEKINUMAB-TTWE SC (by Quallent), YESINTEK SC
Referenced excluded medications for Inflammatory Conditions ‡ as indicated
KINERET, SILIQ
See below for Preferred Alternatives
Drug Class
Other Medications
Preferred Alternatives
Preferred: ADALIMUMAB-ADAZ, ADALIMUMAB-ADBM (by Boehringer Ingelheim & Quallent), ADALIMUMAB-RYVK (by Quallent), ENBREL, OMVOH SC, OTEZLA, RINVOQ, RINVOQ LQ, SELARSDI SC, SIMLANDI, SKYRIZI, SOTYKTU, TALTZ, TREMFYA SC, USTEKINUMAB-TTWE SC (by Quallent), VELSIPITY, XELJANZ, XELJANZ SOLUTION, XELJANZ XR, YESINTEK SC, ZYMFENTRA Preferred for Non-Radiographic Axial Spondyloarthritis (nr-axSpA) only: CIMZIA, TALTZ Preferred after use of one Preferred Medication: CIMZIA (for Crohn’s Disease only), SIMPONI 100MG, TYENNE SC
All other Brand Name medications for Inflammatory Conditions may require a trial of one or more Preferred medications as part of the Formulary exceptions process.
Inflammatory Conditions ‡
‡ Please note that formulary and product placement for treatment of Inflammatory and Atopic Conditions in the Inflammatory and Atopic Conditions Care Value (IACCV) Program are subject to change throughout the year based upon changes in market dynamics, new indications for existing products, biosimilar and new product launches. # Continuation of Therapy applies through June 30, 2026; Excluded for all utilizers effective July 1, 2026.
(continued)
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CRP1386903A 204612 EXCL-NPF-26 (08/08/2025)
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