Medicaid Medication Policies

Name	Type	State
Adcetris	Medical & Pharmacy	PA Medicaid
Alimta	Medical & Pharmacy	PA Medicaid
Aloxi	Medical & Pharmacy	PA Medicaid
Antipsychotics for Children Less than 18	Pharmacy	PA Medicaid
Avastin & Bevacizumab Biosimilars	Medical & Pharmacy	PA Medicaid
Avonex	Pharmacy	PA Medicaid
Benlysta	Medical & Pharmacy	PA Medicaid
Botox	Medical & Pharmacy	PA Medicaid
Brineura	Medical & Pharmacy	PA Medicaid
Cerdelga	Pharmacy	PA Medicaid
Cerezyme	Medical & Pharmacy	PA Medicaid
Cidofovir	Medical & Pharmacy	PA Medicaid
Chantix	Pharmacy	PA Medicaid
Cimzia	Pharmacy	PA Medicaid
Copaxone	Pharmacy	PA Medicaid
Cough and Cold Medications for Children less than 4	Pharmacy	PA Medicaid
Crysvita	Pharmacy	PA Medicaid
Cystic Fibrosis Biologic Response Modifiers	Pharmacy	PA Medicaid
Daraprim	Pharmacy	PA Medicaid
Depen	Pharmacy	PA Medicaid
Duzallo	Pharmacy	PA Medicaid
Emflaza	Pharmacy	PA Medicaid
Strensiq	Pharmacy	PA Medicaid
Enbrel & Etanercept Biosimilars	Pharmacy	PA Medicaid
Erbitux	Medical & Pharmacy	PA Medicaid
Erythropoiesis Stimulating Agents	Pharmacy	PA Medicaid
Esbriet	Pharmacy	PA Medicaid
Eucrisa	Pharmacy	PA Medicaid
Exondys-51	Medical & Pharmacy	PA Medicaid
Eylea	Medical & Pharmacy	PA Medicaid
Ezetimibe	Pharmacy	PA Medicaid
Fabrazyme	Pharmacy	PA Medicaid
Faslodex	Medical & Pharmacy	PA Medicaid
Feraheme	Medical & Pharmacy	PA Medicaid
Freestyle Libre	Pharmacy	PA Medicaid
Gilenya	Pharmacy	PA Medicaid
Granulocyte Colony Stimulating Factors (GCS-Fs)	Medical & Pharmacy	PA Medicaid
Growth Hormone	Pharmacy	PA Medicaid
H.P. Acthar Gel	Pharmacy	PA Medicaid
Hemophila & Blood Factor Products	Pharmacy	PA Medicaid
Hepatitis B	Pharmacy	PA Medicaid
Hepatitis C Medications	Pharmacy	PA Medicaid
Herceptin	Medical & Pharmacy	PA Medicaid
Hereditary Angioedema (HAE) Medications	Pharmacy	PA Medicaid
Humira & Adalimumab Biosimilars	Pharmacy	PA Medicaid
Idiopathic Pulmonary Fibrosis(IPF) Medications	Pharmacy	PA Medicaid
Injectafer	Medical & Pharmacy	PA Medicaid
Interleukin-5 Inhibitors	Medical & Pharmacy	PA Medicaid
Intravenous and Subcutaneous Immune Globulin (IVIG & SCIG)	Medical & Pharmacy	PA Medicaid
Intravenous (IV) Iron	Medical & Pharmacy	PA Medicaid
Keytruda	Medical & Pharmacy	PA Medicaid
Kyprolis	Medical & Pharmacy	PA Medicaid
Krystexxa	Medical & Pharmacy	PA Medicaid
Latuda	Pharmacy	PA Medicaid
Lidocaine Patch	Pharmacy	PA Medicaid
Lucentis	Medical & Pharmacy	PA Medicaid
Lumizyme	Medical & Pharmacy	PA Medicaid
Lupron	Medical & Pharmacy	PA Medicaid
Luxturna	Medical & Pharmacy	PA Medicaid
Lyrica	Pharmacy	PA Medicaid
Makena	Medical & Pharmacy	PA Medicaid
Modafinil	Pharmacy	PA Medicaid
Mozobil	Medical & Pharmacy	PA Medicaid
Multiple Sclerosis (MS) Medications	Medical & Pharmacy	PA Medicaid
Non-TNF Biologics	Pharmacy	PA Medicaid
Nplate	Medical & Pharmacy	PA Medicaid
Ocrevus	Medical & Pharmacy	PA Medicaid
Oncology Medications	Medical & Pharmacy	PA Medicaid
Opdivo	Medical & Pharmacy	PA Medicaid
Opioid Analgesics	Pharmacy	PA Medicaid
Ozempic	Pharmacy	PA Medicaid
PCSK9 Inhibitors	Pharmacy	PA Medicaid
Perjeta	Medical & Pharmacy	PA Medicaid
Photofrin	Medical & Pharmacy	PA Medicaid
Portrazza	Medical & Pharmacy	PA Medicaid
Prialt	Medical & Pharmacy	PA Medicaid
Pulmonary Arterial Hypertension(PAH) Agents	Pharmacy	PA Medicaid
Pulmozyme	Pharmacy	PA Medicaid
Radicava	Pharmacy	PA Medicaid
Remicade & Infliximab Biosimilars	Medical & Pharmacy	PA Medicaid
Restasis	Pharmacy	PA Medicaid
Restasis	Pharmacy	PA Medicaid
Rituxan	Medical & Pharmacy	PA Medicaid
Simponi/Simponi Aria	Pharmacy	PA Medicaid
Soliris	Medical & Pharmacy	PA Medicaid
Somatuline Depot	Medical & Pharmacy	PA Medicaid
Spinraza	Medical & Pharmacy	PA Medicaid
Sublingual Immunotherapy Medications	Pharmacy	PA Medicaid
Supprelin LA & Vantas	Medical & Pharmacy	PA Medicaid
Synagis	Medical & Pharmacy	PA Medicaid
Synvisc & Synvisc-One	Pharmacy	PA Medicaid
Tacrolimus Ointment	Pharmacy	PA Medicaid
Tecfidera	Pharmacy	PA Medicaid
Thrombopoietin (TPO) Receptor Agonists	Medical & Pharmacy	PA Medicaid
Topical Retinoid	Pharmacy	PA Medicaid
Trogarzo	Pharmacy	PA Medicaid
Tysabri	Medical & Pharmacy	PA Medicaid
Velcade	Medical & Pharmacy	PA Medicaid
Victoza	Pharmacy	PA Medicaid
Vimizim	Medical & Pharmacy	PA Medicaid
Voltaren Gel	Pharmacy	PA Medicaid
Voltaren Gel	Pharmacy	PA Medicaid
Xeljanz and Xeljanz XR	Pharmacy	PA Medicaid
Xgeva and Prolia	Pharmacy	PA Medicaid
Xifaxan	Pharmacy	PA Medicaid
Xolair	Medical & Pharmacy	PA Medicaid
Yervoy	Medical & Pharmacy	PA Medicaid
Zyvox	Pharmacy	PA Medicaid
Buprenorphine SL	Pharmacy	PA Medicaid
DPP-4 & SGLT2 Inhibitors	Pharmacy	PA Medicaid
Sandostatin LAR Depot Kit	Medical & Pharmacy	PA Medicaid
Quantity Limits	Pharmacy	PA Medicaid
Non-Formulary Medication/Medical Necessity	Pharmacy	PA Medicaid
Stimulant Medications (ADHD & Narcolepsy)	Pharmacy	PA Medicaid