Displaying 1 - 50 of 58 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ACTEMRA 162 MG/0.9 ML SYRINGE
tocilizumab
50242013801 Yes Yes
CIMZIA 200 MG/ML STARTER KIT
certolizumab pegol
50474071081 Yes Yes
CIMZIA 200 MG/ML SYRINGE KIT
certolizumab pegol
50474071079 Yes Yes
COSENTYX 150 MG/ML PEN INJECT
secukinumab
00078063968 Yes Yes
COSENTYX 150 MG/ML SYRINGE
secukinumab
00078063997 Yes Yes
COSENTYX 300 MG DOSE-2 PENS
secukinumab
00078063941 Yes Yes
COSENTYX 300 MG DOSE-2 SYRINGE
secukinumab
00078063998 Yes Yes
ENBREL 25 MG KIT
etanercept
58406042534 Yes No
ENBREL 25 MG/0.5 ML SYRINGE
etanercept
58406045501 Yes No
ENBREL 25 MG/0.5 ML SYRINGE
etanercept
58406045504 Yes No
ENBREL 50 MG/ML MINI CARTRIDGE
etanercept
58406045601 No No
ENBREL 50 MG/ML MINI CARTRIDGE
etanercept
58406045604 No No
ENBREL 50 MG/ML SURECLICK SYR
etanercept
58406044504 Yes No
ENBREL 50 MG/ML SYRINGE
etanercept
58406043501 Yes No
ENBREL 50 MG/ML SYRINGE
etanercept
58406043504 Yes No
HUMIRA 10 MG/0.1 ML SYRINGE
adalimumab
00074081702 No No
HUMIRA 10 MG/0.2 ML SYRINGE
adalimumab
00074634702 No No
HUMIRA 20 MG/0.2 ML SYRINGE
adalimumab
00074061602 No No
HUMIRA 20 MG/0.4 ML SYRINGE
adalimumab
00074937402 Yes No
HUMIRA 40 MG/0.4 ML PEN
adalimumab
00074055402 No No
HUMIRA 40 MG/0.4 ML SYRINGE
adalimumab
00074024302 No No
HUMIRA 40 MG/0.8 ML PEN
adalimumab
00074433902 Yes No
HUMIRA 40 MG/0.8 ML SYRINGE
adalimumab
00074379902 Yes No
HUMIRA PED CROHNS 40 MG/0.8 ML
adalimumab
00074379903 Yes No
HUMIRA PED CROHNS 40 MG/0.8 ML
adalimumab
00074379906 Yes No
HUMIRA PED CROHNS 80 MG/0.8 ML
adalimumab
00074254003 No No
HUMIRA PEDIATR CROHN'S 80-40MG
adalimumab
00074006702 No No
HUMIRA PEN CROHN-UC-HS 40 MG
adalimumab
00074433906 Yes No
HUMIRA PEN CROHN-UC-HS 80 MG
adalimumab
00074012403 No No
HUMIRA PEN PSOR-UVEI 80MG-40MG
adalimumab
00074153903 No No
HUMIRA PEN PSORIA-UVEITIS 40MG
adalimumab
00074433907 Yes No
ILARIS 150 MG/ML VIAL
canakinumab/PF
00078058261 Yes Yes
ILARIS 150 MG/ML VIAL
canakinumab/PF
00078073461 Yes Yes
KEVZARA 150 MG/1.14 ML SYRINGE
sarilumab
00024590801 Yes Yes
KEVZARA 200 MG/1.14 ML SYRINGE
sarilumab
00024591001 Yes Yes
KINERET 100 MG/0.67 ML SYRINGE
anakinra
66658023407 Yes Yes
ORENCIA 125 MG/ML SYRINGE
abatacept
00003218811 Yes Yes
ORENCIA 50 MG/0.4 ML SYRINGE
abatacept
00003281411 Yes Yes
ORENCIA 87.5 MG/0.7 ML SYRINGE
abatacept
00003281811 Yes Yes
ORENCIA CLICKJECT 125 MG/ML
abatacept
00003218851 Yes Yes
OTEZLA 28 DAY STARTER PACK
apremilast
59572063255 No Yes
OTEZLA 30 MG TABLET
apremilast
59572063106 Yes Yes
SILIQ 210 MG/1.5 ML SYRINGE
brodalumab
00187000402 Yes Yes
SIMPONI 100 MG/ML PEN INJECTOR
golimumab
57894007102 Yes Yes
SIMPONI 100 MG/ML SYRINGE
golimumab
57894007101 Yes Yes
SIMPONI 50 MG/0.5 ML PEN INJEC
golimumab
57894007002 Yes Yes
SIMPONI 50 MG/0.5 ML SYRINGE
golimumab
57894007001 Yes Yes
SIMPONI ARIA 50 MG/4 ML VIAL
golimumab
57894035001 Yes Yes
STELARA 45 MG/0.5 ML SYRINGE
ustekinumab
57894006003 Yes Yes
STELARA 90 MG/ML SYRINGE
ustekinumab
57894006103 Yes Yes