Section |
Status |
Black Triangle |
Name |
08.01.05 |
Formulary
|
 |
Abemaciclib Verzenios® |
03.01.02 |
Formulary
|
 |
Aclidinium Eklira Genuair® |
03.01.04 |
Formulary
|
 |
Aclidinium and formoterol Duaklir Genuair® |
08.01.05 |
Formulary
|
 |
Alectinib Alecensa® |
08.01.05 |
Non Formulary
|
 |
Alpelisib Piqray® |
10.01.03 |
Formulary
|
 |
Apremilast |
13.05.03 |
Formulary
|
 |
Apremilast |
10.02 |
Formulary
|
 |
Ataluren Translarna® |
09.01.04 |
Formulary
|
 |
Avatrombopag Doptelet® |
08.01.05 |
Formulary
|
 |
Avelumab Bavencio® |
10.01.03 |
Formulary
|
 |
Baricitinib Olumiant® |
13.05.03 |
Formulary
|
 |
Baricitinib Olumiant® |
05.01.09 |
Formulary
|
 |
Bedaquiline Sirturo® |
10.01.03 |
Formulary
|
 |
Belimumab Benlysta® |
03.04.02 |
Formulary
|
 |
Benralizumab Fasenra® |
03.04.03 |
Formulary
|
 |
Berotralstat |
08.01.05 |
Formulary
|
 |
Brigatinib Alunbrig® |
11.08.02 |
Formulary
|
 |
Brolucizumab Beovu® |
09.08.01 |
Formulary
|
 |
Burosumab Crysvita® |
03.04.03 |
Formulary
|
 |
C1 esterase inhibitor Cinryze® |
02.09 |
Non Formulary
|
 |
Cangrelor Kengrexal® |
05.01.02.01 |
Formulary
|
 |
Ceftazidime/avibactam |
08.02.04 |
Formulary
|
 |
Cemiplimab Libtayo |
08.01.05 |
Formulary
|
 |
Ceritinib |
02.06.04 |
Non Formulary
|
 |
Cilostazol |
14.04 |
Formulary
|
 |
COVID-19 Vaccine |
05.03.03.02 |
Formulary
|
 |
Daclatasvir |
08.01.05 |
Formulary
|
 |
Dacomitinib Vizimpro® |
08.01.05 |
Formulary
|
 |
Daratumumab Darzalex® |
08.03.04.02 |
Formulary
|
 |
Darolutamide Nubeqa® |
05.03.03.02 |
Formulary
|
 |
Dasabuvir |
05.01.09 |
Formulary
|
 |
Delamanid Deltyba® |
08.01.05 |
Formulary
|
 |
Dinutuximab beta Qarziba® |
05.03.01 |
Formulary
|
 |
Dolutegravir sodium/rilpivirine hydrochloride Juluca® |
03.04.02 |
Non Formulary
|
 |
Dupilumab Dupixent® |
13.05.03 |
Formulary
|
 |
Dupilumab Dupixent®) (dermatology |
08.01.05 |
Formulary
|
 |
Durvalumab Imfinzi® |
02.08.02 |
Formulary
|
 |
Edoxaban Lixiana® |
05.03.03.02 |
Formulary
|
 |
Elbasvir with grazoprevir Zepatier® |
03.07 |
Restricted Use
|
 |
Elexacaftor/tezacaftor/ivacaftor Kaftrio® |
08.01.05 |
Formulary
|
 |
Encorafenib Braftovi® |
08.01.05 |
Formulary
|
 |
Entrectinib Rozlytrek® |
04.07.04.02 |
Formulary
|
 |
Erenumab Amiovig® |
06.01.02.03 |
Formulary
|
 |
Ertugliflozin |
10.01.03 |
Formulary
|
 |
Filgotinib Jyseleca® |
03.02 |
Formulary
|
 |
Fluticasone /umeclidinium / vilanterol Trelegy Ellipta® |
04.07.04.02 |
Formulary
|
 |
Fremanezumab Ajovy® |
04.07.04.02 |
Formulary
|
 |
Galcanezumab Emgality® |
08.01.05 |
Formulary
|
 |
Gemtuzumab ozogamicin Mylotarg® |
08.01.05 |
Formulary
|
 |
Gilteritinib Xospata® |
08.01.05 |
Non Formulary
|
 |
Glasdegib Daurismo® |
05.03.03.02 |
Formulary
|
 |
Glecaprevir with pibrentasvir Maviret® |
03.01.02 |
Formulary
|
 |
Glycopyrronium Seebri Breezhaler® |
03.01.04 |
Formulary
|
 |
Glycopyrronium and indacaterol Ultibro Breezhaler® |
13.08.01 |
Non Formulary
|
 |
Ingenol mebutate Picato® |
09.08.01 |
Formulary
|
 |
Inotersen Tegsedi® |
08.01.05 |
Formulary
|
 |
Inotuzumab ozogamicin Besponsa® |
06.01.01.01 |
Formulary
|
 |
Insulin aspart fast-acting Fiasp® |
06.01.01.02 |
Formulary
|
 |
Insulin glargine biosimilar Abasaglar®; Semglee® |
06.01.01.01 |
Non Formulary
|
 |
Insulin lispro fast-acting Lyumjev® |
06.01.01.01 |
Non Formulary
|
 |
Insulin lispro fast-acting Lyumjev® |
08.01.05 |
Formulary
|
 |
Isatuximab Sarclisa® |
08.01.05 |
Formulary
|
 |
Ixazomib Ninlaro® |
10.01.03 |
Formulary
|
 |
Ixekizumab Taltz® |
13.05.03 |
Formulary
|
 |
Ixekizumab Taltz® |
08.01.05 |
Formulary
|
 |
Larotrectinib Vitrakvi® |
05.03.03.02 |
Formulary
|
 |
Ledipasvir with sofosbuvir Harvoni® |
08.01.05 |
Formulary
|
 |
Lenvatinib Kisplyx®; Lenvima® |
05.03.02.02 |
Formulary
|
 |
Letermovir Prevymis® |
05.01.12 |
Formulary
|
 |
Levofloxacin Quinsair® |
01.06.07 |
Formulary
|
 |
Linaclotide Constella® |
08.01.05 |
Formulary
|
 |
Lorlatinib Lorviqua® |
03.07 |
Restricted Use
|
 |
Lumacaftor/ivacaftor Orkambi® |
09.01.04 |
Formulary
|
 |
Lusutrombopag Mulpleo® |
03.04.02 |
Formulary
|
 |
Mepolizumab Nucala® |
05.01.02.02 |
Formulary
|
 |
meropenem with vaborbactam Vaborem ® |
01.06.06 |
Non Formulary
|
 |
Methylnaltrexone Relistor® |
01.06.06 |
Formulary
|
 |
Naldemedine Rizmoic® |
01.06.06 |
Formulary
|
 |
Naloxegol Moventig ® |
08.01.05 |
Formulary
|
 |
Neratinib Nerlynx® |
08.01.05 |
Formulary
|
 |
Nivolumab Opdivo® |
10.02 |
Formulary
|
 |
Nusinersen Spinraza ® |
08.02.04 |
Formulary
|
 |
Ocrelizumab Ocrevus® |
03.01.01.01 |
Formulary
|
 |
Olodaterol Striverdi Respimat® |
05.03.03.02 |
Formulary
|
 |
Ombitasvir/ paritaprevir/ ritonavir Viekirax® |
08.01.05 |
Formulary
|
 |
Palbociclib Ibrance® |
09.02.01.01 |
Formulary
|
 |
Patiromer sorbitex calcium Veltassa® |
08.01.05 |
Formulary
|
 |
Pertuzumab/trastuzumab Phesgo® |
08.01.05 |
Formulary
|
 |
Polatuzumab vedotin Polivy® |
07.02.01 |
Non Formulary
|
 |
Prasterone Intrarosa® |
05.03 |
Formulary
|
 |
Remdesivir Veklury® |
08.01.05 |
Formulary
|
 |
Ribociclib Kisqali® |
10.02 |
Formulary
|
 |
Risdiplam |
08.01.05 |
Formulary
|
 |
Rucaparib Rubraca® |
02.11 |
Formulary
|
 |
Rurioctocog alfa pegol Adynovi® |
10.01.03 |
Formulary
|
 |
Secukinumab Cosentyx®) (Rheumatology |
13.05.03 |
Formulary
|
 |
Secukinumab Cosentyx®) (dermatology |
06.01.02.03 |
Formulary
|
 |
Semaglutide Ozempic® /Rybelsus® |
05.03.03.02 |
Formulary
|
 |
Simeprevir |
08.02.04 |
Formulary
|
 |
Siponimod Mayzent® |
04.02.03 |
Formulary
|
 |
Sodium valproate |
04.08.01 |
Formulary
|
 |
Sodium Valproate |
09.02.01.01 |
Formulary
|
 |
Sodium zirconium cyclosilicate Lokelma |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir with velpatasvir Epclusa® |
05.03.03.02 |
Formulary
|
 |
Sofosbuvir/velpatasvir/voxilaprevir Vosevi |
08.01.05 |
Formulary
|
 |
Talimogene laherparepvec Imlygic® |
01.04.02 |
Non Formulary
|
 |
Teduglutide Revestive® |
03.07 |
Restricted Use
|
 |
Tezacaftor/ivacaftor Symkevi® |
13.05.03 |
Formulary
|
 |
Tildrakizumab Ilumetri® |
03.01.04 |
Formulary
|
 |
Tiotropium and olodaterol Spiolto Respimat® |
01.05.03 |
Formulary
|
 |
Tofacitinib XELJANZ® |
02.11 |
Formulary
|
 |
Turoctocog alfa pegol Esperoct® |
03.01.02 |
Formulary
|
 |
Umeclidinium Incruse Ellipta® |
03.01.04 |
Formulary
|
 |
Umeclidinium and vilanterol Anoro Ellipta® |
10.01.03 |
Formulary
|
 |
Upadacitinib Rinvoq® |
04.02.03 |
Non Formulary
|
 |
Valproate semisodium |
04.08.01 |
Non Formulary
|
 |
Valproic acid Convulex® |
09.01 |
Formulary
|
 |
Vonicog alfa Veyvondi® |
05.03.04 |
Formulary
|
 |
Zanamivir Dectova® |