Excluded Medications/Products at a Glance
ABILIFY^ ABRILADA* ABSORICA LD
ASCENSIA (CONTOUR) ASPRUZYO SPRINKLE ER ATACAND^, ATACAND HCT^ ATORVALIQ ATRALIN^ ATRIPLA*^ ATROPINE PF 1% DROPPERETTE AUBAGIO*^ AUSTEDO*, AUSTEDO XR* AVALIDE^, AVAPRO^ AVASTIN* AVEED* AVODART^ AXTLE azelastine/fluticasone AZMIRO AZOPT^ AZOR^ BALCOLTRA^ BANZEL^ BARACLUDE TABLETS^ BASAGLAR, BASAGLAR TEMPO BECONASE AQ BENICAR^, BENICAR HCT^ BEPREVE^ BEQVEZ* BERINERT* BESIVANCE BESREMI* BETIMOL BEVESPI AEROSPHERE BIDIL^ BIGFOOT UNITY PROGRAM KIT BIJUVA BISOPROLOL FUMARATE 2.5MG TABLETS BKEMV* BONJESTA BORUZU* BOTOX* BRENZAVVY
CAROSPIR^ CELEBREX^ CELEXA^ CETRAXAL CHORIONIC GONADOTROPIN 10,000 UNITS* CIALIS^ ciclopirox 8% treatment kit CILOXAN OINTMENT CINQAIR* CINVANTI CIPRO HC CIPROFLOXACIN/ FLUOCINOLONE OTIC CITALOPRAM CAPSULES CITRANATAL clemastine CLENIA PLUS CLENPIQ CLIMARA PRO CLINDAGEL^
DAPSONE 7.5% GEL (TUBE) DARTISLA ODT DAXXIFY* DAYBUE* DELZICOL^ DENAVIR DETROL^, DETROL LA^ DEXILANT dexlansoprazole DHIVY DICLOFENAC 35MG CAPSULES DICLOFENAC EPOLAMINE PATCHES diflorasone, diflorasone/emollient DIOVAN^, DIOVAN HCT^ DIPENTUM DIVIGEL^ DOCIVYX* DOLOBID DORAL DORYX DR 50MG^ & 200MG^ DORYX DR 80MG, DORYX MPC, DOXYCYCLINE HYCLATE DR 80MG doxepin cream DRIZALMA SPRINKLE DRYSOL DUAKLIR PRESSAIR DUREZOL^ DUROLANE*
ACANYA^ ACIPHEX^ ACTEMRA IV*, ACTEMRA SC* ACUVAIL ADALIMUMAB-AACF* ADALIMUMAB-AATY* ADALIMUMAB-FKJP* ADCIRCA*^ ADDERALL^, ADDERALL XR^ ADMELOG ADTHYZA 16.25MG, 32.5MG, 65MG, 97.5MG, 130MG ADVAIR DISKUS^ AFINITOR*^, AFINITOR DISPERZ*^ AFREZZA AGAMREE* AIRDUO RESPICLICK AKEEGA* AKYNZEO CAPSULES ALBUTEROL SULFATE HFA (by Prasco) ALCORTIN A ALINIA TABLETS^ ALKINDI SPRINKLE ALOGLIPTIN ALOGLIPTIN/METFORMIN ALOGLIPTIN/PIOGLITAZONE ALOMIDE ALREX ALTOPREV ALVAIZ*
CLOBETASOL 0.025%, CLOBETASOL DROPS clocortolone CLONIDINE ER 0.17MG
COBENFY COLCRYS^ COLUMVI*
COMBOGESIC COMPLERA*^
CONCERTA^ CONDYLOX^ CONJUPRI CONZIP COPAXONE*^ COREG^ CORLANOR SOLUTION*, CORLANOR TABLETS CORTIFOAM CORTROPHIN GEL* COSOPT^, COSOPT PF^ COXANTO COZAAR^, HYZAAR^ CRESTOR^ CRINONE 4% crotamiton
DURYSTA* DUVYZAT* DYANAVEL XR DYMISTA DYRENIUM ECOZA EDARBI, EDARBYCLOR EFFEXOR XR^ ELELYSO* ELESTRIN ELI LILLY (TEMPO)
ALVESCO ALYMSYS* AMBIEN^, AMBIEN CR^ AMITIZA^ AMJEVITA* AMONDYS 45* AMPYRA*^ AMRIX^ ANDROGEL^ ANTIVERT ANUSOL-HC^
ELIDEL^ ELYXYB EMEND CAPSULES^, IV^, TRIFOLD PACK^ EMEND POWDER PACKETS EMFLAZA*^ EMROSI ENDARI*^ ENTADFI ENVARSUS XR* EOHILIA EPANED^ EPINEPHRINE AUTO-INJECTOR (by Amneal Pharma, Avkare)
BRILINTA^ BRIUMVI*
BROMSITE^ BUCAPSOL BUPAP^ BUPROPION XL 450MG BUTRANS^ BYSTOLIC^ CABTREO CALCIPOTRIENE FOAM CAMCEVI* CANASA^ CARAC CARAFATE^ CARBINOXAMINE ER 4MG/5ML SUSPENSION
ANZEMET APHEXDA* APIDRA
CUPRIMINE^ CUTAQUIG* CUVPOSA^ CUVRIOR* CYLTEZO* CYMBALTA^ CYSTADANE*^ CYSTADROPS*
APLENZIN APOKYN* APTENSIO XR^
ARANESP* ARIMIDEX^ ARKRAY PEN NEEDLES & SYRINGES ARMONAIR DIGIHALER ARNUITY ELLIPTA
CYTOMEL^ DALIRESP^ DAPAGLIFLOZIN DAPAGLIFLOZIN/METFORMIN ER
EPKINLY* EPOGEN* EPRONTIA
(continued)
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CRP1386903A 204612 EXCL-NPF-26 (08/08/2025)
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