Excluded Medications/Products at a Glance (continued)
MONOFERRIC MOTEGRITY^ MOTPOLY XR MOVIPREP^ MULPLETA* MYTESI*
ONFI^ ONGLYZA^ ONPATTRO* ONTRUZANT* ONUREG* ONYDA XR ONZETRA XSAIL OPIPZA opium tincture
PRODIGY DIABETES CARE PROLATE SOLUTION PROLENSA^ PROLIA* PROMACTA*^
RUBRACA* RUKOBIA ER* RYSTIGGO* RYTELO* RYZNEUTA* SABRIL*^ SAFYRAL^ SAIZEN, SAIZENPREP SAMSCA*^ SANDOSTATIN LAR DEPOT* SAPHRIS^ SAVAYSA SAXENDA SEASONIQUE^ SEGLENTIS SEGLUROMET SENSIPAR^ SEREVENT DISKUS SERNIVO SEROQUEL^, SEROQUEL XR^ SIGNIFOR LAR* SIKLOS SILIQ* SIMPLE DIAGNOSTICS PEN NEEDLES & SYRINGES SINGULAIR^ SITAGLIPTIN SITAGLIPTIN/METFORMIN, SITAGLIPTIN/METFORMIN ER SIVEXTRO SKYTROFA* SLYND SOAANZ SODIUM OXYBATE (by Amneal)* SOFDRA SOFOSBUVIR/VELPATASVIR* SOGROYA* SPRYCEL*^ STEGLATRO STEGLUJAN STELARA SC* # , STELARA IV* STEQEYMA IV*, STEQEYMA SC* STIMUFEND* STRATTERA^ STRIBILD* SUBOXONE^ SUFLAVE SULCONAZOLE SULFACETAMIDE/SULFUR 8%-4% CLEANSER SULFACETAMIDE/SULFUR 9%-4.25% SUSPENSION SOLIRIS* SORILUX SOVALDI* SOVUNA SPRAVATO* SPRIX
PROTONIX^ PROVIGIL^ PROZAC^
naftifine NAFTIN NALFON CAPSULES^ NAMENDA XR^ naproxen/ esomeprazole magnesium NATAL PNV NATAZIA NATESTO NATROBA^ NESINA
PULMICORT FLEXHALER PULMICORT RESPULES^ PYLERA^ PYRIDIUM^ PYZCHIVA IV*, PYZCHIVA SC* QALSODY* QBRELIS QBREXZA QDOLO QFITLIA* QINLOCK* QLOSI QNASL QTERN QUARTETTE^ QUAZEPAM QUETIAPINE 150MG TABLETS QUILLICHEW ER QUILLIVANT XR RABEPRAZOLE DR SPRINKLE
ORACEA^ OSPHENA OTREXUP OTULFI IV*, OTULFI SC*
OWEN MUMFORD PEN NEEDLES OXAPROZIN 300MG CAPSULES OXAYDO oxiconazole OXISTAT CREAM^ OXISTAT LOTION OXTELLAR XR^ OXYBUTYNIN 2.5MG OXYCODONE COATED TABLETS OXYCODONE ER OXYCONTIN OZOBAX, OZOBAX DS PALFORZIA* paroxetine mesylate penciclovir cream PHEXXI PIASKY* PIRFENIDONE 534MG TABLETS* PLAQUENIL^ PLIAGLIS POKONZA PONVORY* PRADAXA* PRALUENT PRED MILD PREGENNA PREMARIN TABLETS, PREMPHASE, PREMPRO PREVACID^, PREVACID SOLUTAB^ PREZCOBIX* PRILOSEC SUSPENSION PRIMIDONE 125MG TABLETS PENNSAID^ PERCOCET^ PERFOROMIST^ PERTZYE PLAVIX^ PLENVU
NEULASTA* NEUPOGEN* NEURONTIN^ NEVANAC NEXICLON XR NEXIUM^ NEXTSTELLIS NIKTIMVO* NITROFURANTOIN
50MG/5ML SUSPENSION NORDITROPIN FLEXPRO*
NORITATE NORLIQVA NORPACE^ NORPACE CR NORTHERA*^
RALDESY RAPAFLO^
RASUVO RAVICTI* REBINYN* RECOMBINATE*
NORVASC^ NOURIANZ* NOVAREL* NOVO NORDISK PEN NEEDLES NOVOLIN, NOVOLIN MIX, RELION NOVOLIN, RELION NOVOLIN MIX NOVOLOG, NOVOLOG MIX, RELION NOVOLOG, RELION NOVOLOG MIX NOVOSEVEN RT* NOXAFIL TABLETS^
RECORLEV* RELAFEN DS RELEUKO* RELEXXII ER RELISTOR TABLETS
RELPAX^ RELTONE
REMICADE* RENAGEL^ RENFLEXIS* RETIN-A MICRO 0.04% & 0.1%^ REVLIMID*^ REZLIDHIA* REZVOGLAR RIABNI* RITALIN^, RITALIN LA^ RITUXAN*, RITUXAN HYCELA* RIVFLOZA* RIXUBIS* ROCHE (ACCU-CHEK) ROLVEDON* ROSUVASTATIN/EZETIMIBE
NUCYNTA, NUCYNTA ER NUTROPIN AQ NUSPIN* NUVARING^ NUVIGIL^
NUWIQ* NYPOZI* NYVEPRIA* OHTUVAYRE*
PRIMLEV PRISTIQ^ PROAIR DIGIHALER, PROAIR RESPICLICK PROCTOFOAM-HC PROCYSBI*
OJJAARA* OMNARIS ONAPGO* ONDANSETRON ODT 16MG TABLETS
ROXYBOND ROZEREM^
(continued)
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CRP1386903A 204612 EXCL-NPF-26 (08/08/2025)
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