Report : A-Z HCD items in Formulary 03/03/2021 11:56:58

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Section Status HCD Name 05.03.01 Formulary Abacavir Ziagen® 05.03.01 Formulary Abacavir and Lamivudine Kivexa® 05.03.01 Formulary Abacavir and Lamivudine and Zidovudine Trizivir® 10.01.03 Formulary Abatacept Orencia® 08.03.04.02 Formulary Abiraterone Zytiga® 01.05.03 Formulary Adalimumab  10.01.03 Formulary Adalimumab Humira® 13.05.03 Formulary Adalimumab  05.03.03.01 Formulary Adefovir Dipivoxil Hepsera® 11.08.02 Formulary Aflibercept  08.01.05 Formulary Alectinib Alecensa® 08.02.03 Formulary Alemtuzumab Lemtrada® 02.14 Restricted Use Alirocumab Praluent® 13.05.01 Formulary Alitretinoin Toctino® 05.02 Formulary Amphotericin Abelcet ® AmBisome ® Fungizone ® 10.01.03 Non Formulary Anakinra Kineret® 05.02.04 Formulary Anidulafungin Ecalta® 10.01.03 Formulary Apremilast  (Ortezla® ) 13.05.03 Formulary Apremilast Otezla® 08.01.05 Formulary Arsenic Trioxide Trisenox® 05.03.01 Formulary Atazanavir Reyataz® 08.02.04 Formulary Atezolizumab  (Tecentriq®) 08.02.04 Formulary Avelumab  (Bavencio®) 08.02.04 Formulary Axicabtagene ciloleuce (Yescarta®) 08.01.05 Formulary Axitinib Inlyta® 08.01.03 Formulary Azacitidine Vidaza® 10.01.03 Formulary Baricitinib  (Olumiant®) 08.02.02 Formulary Basiliximab Simulect® 10.01 Formulary Belimumab Benlysta® 08.01.01 Formulary Bendamustine  03.05.02 Formulary Beractant Survanta® 08.01.05 Formulary Bevacizumab Avastin® 08.01.05 Formulary Bexarotene Targretin® 08.02 Formulary Blinatumomab Blincyto® 05.03.03.02 Formulary Boceprevir Victrelis® 08.01.05 Formulary Bortezomib Velcade® 08.01.05 Formulary Bosutinib Bosulif® 04.07.04.02 Formulary Botulinum Toxin Type A botox® 08.01.05 Formulary Brentuximab vedotin Adcetris® 03.04.03 Formulary C1 Esterase Inhibitor Berinert® 03.04.03 Non Formulary C1 esterase inhibitor Cinryze® 08.01.05 Formulary Cabazitaxel Jevtana® 08.01.05 Formulary Carfilzomib Kyprolis® 05.02.04 Formulary Caspofungin Cancidas® 08.01.05 Formulary Ceritinib Zykadia 10.01.03 Formulary Certolizumab Pegol Cimzia® 08.01.05 Formulary Cetuximab Erbitux® 08.02.02 Formulary Ciclosporin  09.05.01.02 Formulary Cinacalcet Mimpara® 08.01.03 Formulary Cladribine Mavenclad® 08.01.03 Formulary Cladribine  08.01.03 Formulary Clofarabine Evoltra® 05.03.01 Formulary Cobicistat Tybost® 05.01.07 Formulary Colistimethate for nebulisation Colobreathe® 05.01.07 Formulary Colistimethate for nebulisation Promixin® 10.03.01 Formulary Collagenase Xiapex® 03.04.03 Formulary Conestat Alfa Ruconest® 08.01.05 Formulary Crizotinib Xalkori® 08.01.05 Formulary Dabrafenib Tafinlar® 05.03.03.02 Restricted Use Daclatasvir  Daklinza® 08.02.04 Formulary Daratumumab  (Darzalex®) 09.01.03 Formulary Darbepoetin Alfa Aranesp® 05.03.03.02 Formulary Dasabuvir Exviera® 08.01.05 Restricted Use Dasatinib Sprycel® 20 Non Formulary DAUNORUBICIN saline pre-filled syringe  20 Non Formulary DEFIBROTIDE Capsules 400 mg  20 Non Formulary DEFIBROTIDE Injection 200 mg  05.01.09 Non Formulary Delamanid Deltyba® 09.01.03 Formulary Desferrioxamine Mesilate  05.03.01 Formulary Didanosine Videx® 02.01.01 Non Formulary Digoxin specific antibody fragments Digifab® 18 Non Formulary Digoxin specific antibody fragments Digifab® 08.02.04 Formulary Dimethyl fumarate Tecfidera® 08.02.04 Formulary Dinutuximab  (Qarziba®) 08.01.05 Formulary Docetaxel Taxotere® 05.03.01 Formulary Dolutegravir tivicay ® 05.03.01 Formulary Dolutegravir, abacavir & lamivudine Triumeq® 03.07 Formulary Dornase Alfa  08.01.02 Formulary Doxorubicin Caelyx® 08.02.04 Formulary Durvalumab   (Imfinzi® ) 05.03.01 Formulary Efavirenz Sustiva® 09.01.04 Formulary Eltrombopag Revolade® 05.03.01 Formulary Emtricitabine Emtriva® 05.03.01 Formulary Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg Eviplera® 05.03.03.01 Formulary Entecavir Baraclude® 08.03.04.02 Formulary Enzalutamide Xtandi® 09.01.03 Formulary Epoetin alfa Eprex® 09.01.03 Formulary Epoetin beta NeoRecormon® 20 Non Formulary Eptotermin Alfa  Osigraft® 08.01.05 Formulary Eribulin Halaven® 08.01.05 Formulary Erlotinib Tarceva® 08.01.05 Formulary Erlotinib Tarceva® 10.01.03 Formulary Etanercept Enbrel® 13.05.03 Formulary Etanercept  05.03.01 Formulary Etravirine Intelence® 08.01.05 Formulary Everolimus Votubia® 08.01.05 Restricted Use Everolimus Afinitor® 02.14 Restricted Use Evolocumab Repatha® 02.11 Restricted Use Factor VIIa (Recombinant) Novo 7® 08.02.04 Formulary Fingolimod  11.04.01 Formulary Fluocinolone intravitreal implant Iluvien® 18 Non Formulary Fomepizole  05.03.01 Formulary Fosamprenavir Telzir® 05.03.02.02 Formulary Ganciclovir Cymevene® 08.01.05 Formulary Gefitinib Iressa® 08.02.04 Formulary Glatiramer Acetate Copaxone® 05.03.03.02 Formulary Glecaprevir and Pibrentasvir Maviret® 18 Non Formulary Glucarpidase Carboxypeptidase 01.05.03 Formulary Golimumab  10.01.03 Formulary Golimumab Simponi® 08.01.05 Formulary Ibrutinib Imbruvica® 03.04.03 Formulary Icatibant Firazyr® 02.05.01 Formulary Iloprost injection   08.01.05 Formulary Imatinib Gilvec® 08.02.04 Formulary Immunocellular therapy containing tisagenlecleucel, autologous T cells genetically modified ex vivo using a lentiviral vector encoding an anti-CD19 chimeric antigen receptor (CAR) (Kymriah®) 01.05.03 Formulary Infliximab  10.01.03 Formulary Infliximab  13.05.03 Formulary Infliximab  08.01 Formulary Inotuzumab ozogamicin Besponsa® 08.02.04 Formulary Interferon Alfa  08.02.04 Formulary Interferon Alfa Roferon-A® 08.02.04 Formulary Interferon Beta Rebif® 08.02.04 Formulary Interferon Beta Betaferon® 08.02.04 Formulary Interferon Beta Avonex® 08.02.04 Formulary Interferon beta Extavia® 08.01.05 Formulary Ipilimumab Yervoy® 08.01.05 Formulary Ixazomib Ninlaro® 05.03.01 Formulary Lamivudine Epivir® 05.03.01 Formulary Lamivudine Zeffix® 08.03.04.03 Formulary Lanreotide  05.03.03.02 Formulary Ledipasvir and Sofosbuvir Harvoni® 08.02.04 Formulary Lenalidomide  09.01.06 Formulary Lenograstim Granocyte® 08.01.05 Formulary Lenvatinib Lenvima® and Kisplyx® 05.03.01 Formulary Lopinavir and Ritonavir Kaletra® 03.07 Formulary Mannitol inhalation Bronchitol ® 05.03.01 Formulary Maraviroc Celsentri® 08.01.05 Formulary Midostaurin Rydapt® 08.02.01 Formulary Mycophenolate Mofetil  08.02.04 Formulary Natalizumab Tysabri® 08.01.03 Formulary Nelarabine Atriance® 05.03.01 Formulary Nevirapine Viramune® 08.01.05 Formulary Nilotinib Tasigna® 03.11 Formulary Nintedanib Ofev® 08.01.05 Formulary Nintedanib Vargatef ® 08.02.04 Formulary Niraparib (Zejula®) 20 Non Formulary Nitazoxanide  08.02.04 Formulary Nivolumab Opdivo® 14.05.01 Non Formulary Normal immunoglobulin for Intramuscular use  14.05.01 Non Formulary Normal immunoglobulin for Intravenous use  14.05.01 Non Formulary Normal immunoglobulin for Subcutaneous use  08.02.03 Formulary Obinutuzumab Gazyvaro ® 08.03.04.03 Formulary Octreotide Sandostatin Lar® 08.03.04.03 Formulary Octreotide Sandostatin® 08.02.03 Formulary Ofatumumab Arzerra® 08.02.04 Formulary Olaparib Lynparza® 08.01.05 Formulary Olaratumab Lartruvo® 03.04.02 Formulary Omalizumab  05.03.03.02 Formulary Ombitasvir/ paritaprevir/ ritonavir Viekirax® 08.02.04 Formulary Osimertinib Tagrisso 08.01.05 Formulary Paclitaxel - Albumin Bound Formulation Abraxane® 05.03.05 Restricted Use Palivizumab Synagis® 08.01.05 Formulary Panitumumab Vectibix® 08.01.05 Formulary Panobinostat Farydak® 08.01.05 Formulary Pazopanib Votrient® 08.02.04 Formulary Peginterferon Alfa Pegasys® 08.02.04 Formulary Peginterferon Alfa ViraferonPeg® 08.02.04 Formulary Peginterferon Beta-1a Plegridy® 08.01.05 Formulary Pembrolizumab Keytruda® 08.01.03 Formulary Pemetrexed Alimta® 08.02.04 Formulary Pemrolizumab Keytruda® 08.01.05 Formulary Pertuzumab Perjeta® 03.11 Formulary pirfenidone Esbriet® 08.01.02 Formulary Pixantrone  09.01.07 Formulary Plerixafor Mozobil® 08.02.04 Formulary Pomalidomide Imnovid® 08.01.05 Formulary Ponatinib Iclusig® 03.05.02 Formulary Poractant Alfa Curosurf® 08.03.04.02 Formulary Radium-223 dichloride  05.03.01 Formulary Raltegravir Isentress ® 08.01.03 Formulary Raltitrexed Tomudex® 11.08.02 Formulary Ranibizumab Lucentis® 10.01.04 Formulary Rasburicase Fastertec 08.01.05 Formulary Regorafenib Stivarga® 05.03.05 Formulary Ribavirin  08.01.05 Formulary Ribociclib  05.03.01 Formulary Rilpivirine hydrochloride Edurant® 04.09.03 Formulary Riluzole Rilutek® 05.03.01 Formulary Ritonavir Norvir® 08.02.03 Formulary Rituximab MabThera®Truxima ® 10.01.03 Formulary Rituximab (rheumatology) MabThera® 09.01.04 Formulary Romiplostim Nplate® 08.01.05 Formulary Ruxolitinib Jakavi® 05.03.01 Formulary Saquinavir Invirase® 10.01.03 Formulary Sarilumab   (Kevzara®) 10.01.03 Formulary Secukinumab  13.05.03 Formulary Secukinumab  20 Non Formulary Sipuleucel- T  08.02.02 Formulary Sirolimus Rapamune® 05.03.03.02 Formulary Sofosbuvir Sovaldi® 05.03.03.02 Formulary Sofosbuvir, Velpatasvir and Voxilaprevir Vosevi® 06.05.01 Formulary Somatropin Omnitrope® Humatrope® genotropin® and Zomacton® 08.01.05 Formulary Sorafenib Nexavar® 05.03.01 Formulary Stavudine Zerit® 08.01.05 Formulary Sunitinib Sutent® 08.02.04 Formulary Talimogene laherparepvac Imlygic® 08.01.05 Formulary Talimogene laherparepvec Imlygic® 20 Non Formulary Taribavirin  05.03.03.02 Formulary Telaprevir Incivo® 08.01.05 Formulary Temozolomide Temodal® 08.01.05 Formulary Temsirolimus Torisel® 05.03.01 Formulary Tenofovir 245mg, Efavirenz 600mg and Emtricitabine 200mg Atripla® 05.03.01 Formulary Tenofovir alafenamide, elvitegravir, cobicistat & emtricitabine Genvoya® 05.03.01 Formulary Tenofovir and Emtricitabine Truvada® 05.03.01 Formulary Tenofovir Disproxil Viread® 05.03.01 Restricted Use Tenofovir, cobicistat, elvitegravir & emtricitabine Stribild® 08.02.04 Formulary Teriflunomide Aubagio® 20 Non Formulary TETRAHYDROBIOPTERIN Tablets 10 mg  08.02.04 Formulary Thalidomide Celgene® 05.01.04 Formulary Tobramycin  05.01.04 Formulary Tobramycin inhaler TOBI Podhaler® 10.01.03 Formulary Tocilizumab RoActemra® 10.01.03 Formulary Tofacitinib (Xeljanz®) 06.05.02 Formulary Tolvaptan Jinarc® 08.01.05 Formulary Trametinib Mekinist® 08.01.05 Formulary Trastuzumab Herceptin® 08.01.05 Formulary Trastuzumab emtansine Kadcyla® 20 Non Formulary Treprostinil   08.01.05 Formulary Trifluridine and Tipiracil  Lonsurf ® 01.05.03 Formulary Ustekinumab  Stelera ® 10.01.03 Formulary Ustekinumab  13.05.03 Formulary Ustekinumab  05.03.02.02 Formulary Valganciclovir Valcyte® 01.05.03 Formulary Vedolizumab  08.01.05 Formulary Vemurafenib Zelboraf® 08.01.05 Formulary Vemurafenib  (Zelboraf® ) 08.01.05 Formulary Venetoclax Venclyxto ® 11.08.02 Formulary Verteporfin Visudyne® 05.02 Formulary Voriconazole Vfend® 08.01.05 Restricted Use Vosaroxin Qinprezo 05.03.01 Formulary Zidovudine Retrovir®

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