Section |
Status |
HCD |
Name |
05.03.01 |
Formulary
|
 |
Abacavir |
05.03.01 |
Formulary
|
 |
Abacavir & Lamivudine |
05.03.01 |
Formulary
|
 |
Abacavir & Lamivudine & Dolutegravir |
05.03.01 |
Formulary
|
 |
Abacavir & Lamivudine & Zidovudine |
08.03.04.01 |
Formulary
|
 |
Abemaciclib Verzenios® |
08.03.04.02 |
Formulary
|
 |
Abiraterone |
01.05.03 |
Formulary
|
 |
Adalimumab |
11.04.02 |
Formulary
|
 |
Adalimumab |
13.05.03 |
Formulary
|
 |
Adalimumab |
08.01.05 |
Formulary
|
 |
Afatinib |
11.08.02 |
Formulary
|
 |
Aflibercept 4mg/0.1ml injection Eylea® |
02.12 |
Formulary
|
 |
Alirocumab |
13.05.01 |
Formulary
|
 |
Alitretinoin Toctino® |
02.05.01 |
Formulary
|
 |
Ambrisentan |
05.02.03 |
Formulary
|
 |
Amphotericin |
05.02.04 |
Formulary
|
 |
Anidulafungin |
08.02.02 |
Formulary
|
 |
Antithymocyte immunoglobulin (rabbit) Thymoglobuline® |
10.01.03 |
Formulary
|
 |
Apremilast Otezla® |
13.05.03 |
Formulary
|
 |
Apremilast Otezla® |
05.03.01 |
Formulary
|
 |
Atazanavir |
05.03.01 |
Formulary
|
 |
Atazanavir sulfate and cobicistat |
08.01.05 |
Formulary
|
 |
Atezolizumab |
09.01.04 |
Formulary
|
 |
Avatrombopag Doptelet® |
08.01.05 |
Formulary
|
 |
Axitinib |
05.01.02.03 |
Formulary
|
 |
Aztreonam nebuliser solution Cayston® |
10.01.03 |
Formulary
|
 |
Baricitinib Olumiant® |
05.01.09 |
Formulary
|
 |
Bedaquiline |
03.04.02 |
Formulary
|
 |
Benralizumab Fasenra® |
02.05.01 |
Formulary
|
 |
Bosentan |
08.01.05 |
Formulary
|
 |
Bosutinib Bosulif® |
04.09.03 |
Formulary
|
 |
Botulinum Toxi Type A injection Xeomin ® |
04.09.03 |
Formulary
|
 |
Botulinum Toxin Type A Botox® |
04.09.03 |
Formulary
|
 |
Botulinum Toxin Type A Vistabel® |
04.09.03 |
Formulary
|
 |
Botulinum Toxin Type A Dysport® |
04.09.03 |
Formulary
|
 |
Botulinum Toxin Type B NeuroBloc® |
08.01.05 |
Formulary
|
 |
Brentuximab vedotin Adcetris® |
08.01.05 |
Formulary
|
 |
Brigatinib Alunbrig® |
13.05.03 |
Formulary
|
 |
Brodalumab Kyntheum® |
03.04.03 |
Formulary
|
 |
C1 Esterase Inhibitor |
08.01.05 |
Formulary
|
 |
Cabozantinib Cometriq® |
04.06 |
Formulary
|
 |
Cannabidiol Epidyolex® |
09.08.01 |
Formulary
|
 |
Carnitine |
05.02.04 |
Formulary
|
 |
Caspofungin |
08.01.05 |
Formulary
|
 |
Ceritinib |
09.08.01 |
Formulary
|
 |
Chenodexoycholic acid Xenbilox® |
01.09.01 |
Formulary
|
 |
Cholic acid |
05.03.02.02 |
Formulary
|
 |
Cidofovir infusion |
09.05.01.02 |
Formulary
|
 |
Cinacalcet |
05.03.01 |
Formulary
|
 |
Cobicistat Tybost® |
08.01.05 |
Formulary
|
 |
Crizotinib |
05.03.03.02 |
Formulary
|
 |
Daclatasvir |
08.02.04 |
Formulary
|
 |
Daclizumab Zinbryta® |
08.01.05 |
Formulary
|
 |
Dacomitinib Vizimpro® |
09.01.03 |
Formulary
|
 |
Darbepoetin Alfa |
05.03.01 |
Formulary
|
 |
Darunavir |
05.03.01 |
Formulary
|
 |
Darunavir and Cobicistat |
05.03.03.02 |
Formulary
|
 |
Dasabuvir Exviera® |
20 |
Non Formulary
|
 |
DAUNORUBICIN saline pre-filled syringe |
08.01.03 |
Formulary
|
 |
Daunorubicin/cytarabine Vyxeos® |
09.01.03 |
Formulary
|
 |
Deferasirox |
20 |
Non Formulary
|
 |
DEFIBROTIDE |
20 |
Non Formulary
|
 |
DEFIBROTIDE Capsules 400 mg |
05.01.09 |
Formulary
|
 |
Delamanid |
09.01.03 |
Formulary
|
 |
Desferrioxamine Mesilate |
11.04.01 |
Formulary
|
 |
Dexamethasone 700 microgram intravitreal implant Ozurdex® |
05.03.01 |
Formulary
|
 |
Didanosine |
08.02.04 |
Formulary
|
 |
Dimethyl fumarate Tecfidera® |
13.05.03 |
Formulary
|
 |
Dimethyl fumarate Skilarence® |
08.01.05 |
Formulary
|
 |
Dinutuximab beta Qarziba® |
05.03.01 |
Formulary
|
 |
Dolutegravir |
03.07 |
Formulary
|
 |
Dornase Alfa |
09.01.03 |
Formulary
|
 |
Eculizumab |
05.03.01 |
Formulary
|
 |
Efavirenz Sustiva® |
05.03.03.02 |
Formulary
|
 |
Elbasvir & grazoprevir Zepatier® |
09.01.04 |
Formulary
|
 |
Eltrombopag |
05.03.01 |
Formulary
|
 |
Emtricitabine |
08.01.05 |
Formulary
|
 |
Encorafenib Braftovi® |
05.03.01 |
Formulary
|
 |
Enfuvirtide |
05.03.03.01 |
Formulary
|
 |
Entecavir |
09.01.03 |
Formulary
|
 |
Epoetin alfa Eprex® |
09.01.03 |
Formulary
|
 |
Epoetin beta NeoRecormon® |
02.05.01 |
Formulary
|
 |
Epoprostenol |
02.08.01 |
Formulary
|
 |
Epoprostenol |
20 |
Non Formulary
|
 |
Eptotermin Alfa Osigraft® |
08.01.05 |
Formulary
|
 |
Eribulin Halaven® |
10.01.03 |
Formulary
|
 |
Etanercept |
13.05.03 |
Formulary
|
 |
Etanercept Enbrel®, Benapali® & Erelzi® |
09.05.01.02 |
Formulary
|
 |
Etelcalcetide Parsabiv® |
05.03.01 |
Formulary
|
 |
Etravirine Intelence® |
02.12 |
Formulary
|
 |
Evolocumab |
02.11 |
Formulary
|
 |
Factor VIIa (Recombinant) |
05.01.07 |
Formulary
|
 |
Fidaxomicin |
09.01.06 |
Formulary
|
 |
Filgrastim (G-CSF) Neupogen®, Ratiograstim® |
08.02.04 |
Formulary
|
 |
Fingolimod |
11.04.01 |
Formulary
|
 |
Fluocinolone 190 microgram intravitreal implant |
16 |
Formulary
|
 |
Fomepizole |
05.03.01 |
Formulary
|
 |
Fosamprenavir |
05.03.02.02 |
Formulary
|
 |
Foscarnet Sodium |
04.07.04.02 |
Formulary
|
 |
Fremanezumab Ajovy® |
05.03.02.02 |
Formulary
|
 |
Ganciclovir |
08.02.04 |
Formulary
|
 |
Glatiramer Acetate |
05.03.03.02 |
Formulary
|
 |
Glecaprevir & Pibrentasvir Maviret® |
01.05.03 |
Formulary
|
 |
Golimumab |
10.01.03 |
Formulary
|
 |
Golimumab Simponi® |
13.05.03 |
Formulary
|
 |
Guselkumab Tremfya® |
11.08.02.04 |
Formulary
|
 |
Holoclar® |
08.01.05 |
Formulary
|
 |
Ibrutinib Imbruvica® |
03.04.03 |
Formulary
|
 |
Icatibant Firazyr® |
08.01.05 |
Formulary
|
 |
Idelalisib |
02.05.01 |
Formulary
|
 |
Iloprost |
09.08.01 |
Formulary
|
 |
Imiglucerase Cerezyme® |
05.03.01 |
Formulary
|
 |
Indinavir |
04.12 |
Formulary
|
 |
Inotersen Tegsedi® |
08.01.05 |
Formulary
|
 |
Inotuzumab ozogamicin Besponsa® |
08.02.04 |
Formulary
|
 |
Interferon Alfa-2b Roferon-A® |
08.02.04 |
Formulary
|
 |
Interferon Beta Avonex® |
08.02.04 |
Formulary
|
 |
Interferon Beta Rebif® |
08.02.04 |
Formulary
|
 |
Interferon Beta Betaferon® |
08.02.04 |
Formulary
|
 |
Interferon beta Extavia® |
05.02.01 |
Formulary
|
 |
Isavuconazole Cresemba® |
03.07 |
Formulary
|
 |
Ivacaftor |
13.05.03 |
Formulary
|
 |
Ixekizumab Taltz® |
05.03.03.01 |
Formulary
|
 |
Lamivudine |
09.05.02.02 |
Formulary
|
 |
Lanthanum Fosrenol ® |
09.01.06 |
Formulary
|
 |
Lenograstim (rHuG-CSF) Granocyte® |
08.01.05 |
Formulary
|
 |
Lenvatinib Kisplyx® |
05.03.01 |
Formulary
|
 |
Lopinavir and Ritonavir Kaletra® |
02.05.01 |
Formulary
|
 |
Macitentan |
03.07 |
Formulary
|
 |
Mannitol inhalation Bronchitol ® |
05.03.01 |
Formulary
|
 |
Maraviroc |
03.04.02 |
Formulary
|
 |
Mepolizumab Nucala® |
09.08.01 |
Formulary
|
 |
Mercaptamine |
09.01.03 |
Formulary
|
 |
Methoxy Polyethylene Glycol-Epoetin Beta Mircera®, Pegzerepoetin® alfa |
04.07.03 |
Formulary
|
 |
Mexiletine |
19 |
Formulary
|
 |
Mexiletine Namuscla® |
05.02.04 |
Formulary
|
 |
Micafungin |
08.02.04 |
Formulary
|
 |
Natalizumab |
05.03.01 |
Formulary
|
 |
Nelfinavir |
08.01.05 |
Formulary
|
 |
Neratinib Nerlynx® |
05.03.01 |
Formulary
|
 |
Nevirapine |
03.11 |
Formulary
|
 |
Nintedanib Ofev® |
20 |
Non Formulary
|
 |
Nitazoxanide |
08.01.05 |
Formulary
|
 |
Nivolumab |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin Subcuvia® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin Privigen® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin Gammunex® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin Iqymune® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin Intratect® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin Cuvitru® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin Gammanorm® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin Octagam® |
14.05.01 |
Formulary
|
 |
Normal Immunoglobulin Kiovig® |
14.05.01 |
Formulary
|
 |
Normal immunoglobulin for Intramuscular use |
19 |
Formulary
|
 |
Nusinersen Spinraza® |
01.09.01 |
Formulary
|
 |
Obeticholic acid |
08.02.03 |
Formulary
|
 |
Obinutuzumab |
08.02.03 |
Formulary
|
 |
Ocrelizumab Ocrevus® |
11.08.02 |
Formulary
|
 |
Ocriplasmin Jetrea® |
08.01.05 |
Formulary
|
 |
Olaparib |
08.01.05 |
Formulary
|
 |
Olaratumab Lartuvo® |
03.04.02 |
Formulary
|
 |
Omalizumab |
05.03.03.02 |
Formulary
|
 |
Ombitasvir & paritaprevir & ritonavir Viekirax® |
08.03.04.01 |
Formulary
|
 |
Palbociclib Ibrance® |
05.03.05 |
Formulary
|
 |
Palivizumab |
08.01.05 |
Formulary
|
 |
Panitumumab Vectibix® |
08.03.04.03 |
Formulary
|
 |
Pasireotide Signifor® |
04.12 |
Formulary
|
 |
Patisiran Onpattro® |
09.01.06 |
Formulary
|
 |
Pegfilgrastim (G-CSF) |
08.02.04 |
Formulary
|
 |
Peginterferon Beta-1a Plegridy® |
08.01.05 |
Formulary
|
 |
Pertuzumab Perjeta® |
03.11 |
Formulary
|
 |
Pirfenidone Esbriet® |
09.01.07 |
Formulary
|
 |
Plerixafor Mozobil® |
08.02.04 |
Formulary
|
 |
Pomalidomide Imnovid® |
08.01.05 |
Formulary
|
 |
Ponatinib Iclusig® |
03.05.02 |
Formulary
|
 |
Poractant Alfa |
05.02.01 |
Formulary
|
 |
Posaconazole Noxafil® |
08.03.04.02 |
Formulary
|
 |
Radium-223 dichloride |
05.03.01 |
Formulary
|
 |
Raltegravir |
11.08.02 |
Formulary
|
 |
Ranibizumab 10mg/1ml injection Lucentis® |
08.01.05 |
Formulary
|
 |
Regorafenib Stivarga® |
05.03.03.02 |
Formulary
|
 |
Ribavirin |
08.03.04.01 |
Formulary
|
 |
Ribociclib Kisqali® |
05.03.01 |
Formulary
|
 |
Rilpivirine hydrochloride |
04.09.03 |
Formulary
|
 |
Riluzole |
02.05.01 |
Formulary
|
 |
Riociguat |
13.05.03 |
Formulary
|
 |
Risankizumab Skyrizi® |
05.03.01 |
Formulary
|
 |
Ritonavir |
09.01.04 |
Formulary
|
 |
Romiplostim |
05.03.01 |
Formulary
|
 |
Saquinavir |
10.01.03 |
Formulary
|
 |
Sarilumab Kevzara® |
13.05.03 |
Formulary
|
 |
Secukinumab Cosentyx® |
09.05.02.02 |
Formulary
|
 |
Sevelamer Carbonate |
20 |
Non Formulary
|
 |
Sipuleucel- T |
04.01.01 |
Formulary
|
 |
Sodium Oxybate 500mg/1ml oral solution Xyrem® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir Sovaldi® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir & Ledipasvir Harvoni® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir & velpatasvir Epclusa® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir, Velpatasvir & Voxilaprevir Vosevi® |
08.01.05 |
Formulary
|
 |
Sorafenib Nexavar® |
05.03.01 |
Formulary
|
 |
Stavudine |
09.05.02.02 |
Formulary
|
 |
Sucroferric oxyhydroxide Velphoro® |
08.01.05 |
Formulary
|
 |
Sunitinib |
20 |
Non Formulary
|
 |
Taribavirin |
05.03.01 |
Formulary
|
 |
Tenofovir alafenamide & Cobicistat & Emtricitabine & Elvitegravir Genvoya® |
05.03.01 |
Formulary
|
 |
Tenofovir Disoproxil & Emtricitabine |
05.03.01 |
Formulary
|
 |
Tenofovir Disoproxil & Emtricitabine & Rilpivirine |
05.03.03.01 |
Formulary
|
 |
Tenofovir Disproxil Viread® |
05.03.01 |
Formulary
|
 |
Tenofovir Disproxil & Cobicistat & Elvitegravir & Emtricitabine |
05.03.01 |
Formulary
|
 |
Tenofovir Disproxil & Efavirenz & Emtricitabine |
08.02.04 |
Formulary
|
 |
Teriflunomide |
20 |
Non Formulary
|
 |
TETRAHYDROBIOPTERIN Tablets 10 mg |
05.03.01 |
Formulary
|
 |
Tipranavir |
05.01.04 |
Formulary
|
 |
Tobramycin |
10.01.03 |
Formulary
|
 |
Tofacitinib Xeljanz® |
06.05.02 |
Formulary
|
 |
Tolvaptan |
08.01.05 |
Formulary
|
 |
Trametinib |
08.01.05 |
Formulary
|
 |
Trastuzumab emtansine Kadcyla® |
20 |
Non Formulary
|
 |
Treprostinil |
09.08.01 |
Formulary
|
 |
Trientine Dihydrochloride |
01.05.03 |
Formulary
|
 |
Ustekinumab Stelara® |
13.05.03 |
Formulary
|
 |
Ustekinumab Stelara® |
05.03.02.02 |
Formulary
|
 |
Valganciclovir |
01.05.03 |
Formulary
|
 |
Vedolizumab |
11.08.02 |
Formulary
|
 |
Verteporfin 15mg Injection Visudyne® |
05.03.01 |
Formulary
|
 |
Zidovudine |
05.03.01 |
Formulary
|
 |
Zidovudine & Lamivudine |