State of Minnesota Health Plan
Clinical Documentation for the Public Employee Insurance Program and the State Employee Group Insurance Program
Select the starting letter of the medication to find the desired form.
A |
|---|
|
Abraxane |
|
Actemra |
|
Acthar |
|
Actimmune |
|
Adagen |
|
Adakveo |
|
Adapalene |
|
Adcetris |
|
Adempas |
|
Agonists, 5-HT1 |
|
Akynzeo |
|
Albenza Biltricide Egaten Emverm |
|
Aldurazyme |
|
Alecensa |
|
Alimta |
|
Aliqopa |
|
Alpha1-Proteinase Inhibitors |
|
Alunbrig |
|
Ambrisentan-Letairis |
|
Anabolic Steroids - Anadrol-50 |
|
Anabolic Steroids - Oxandrin |
|
Antiemetic 5-HT3 |
|
Antiobesity Agents |
|
Apokyn-Kynmobi |
|
Aranesp |
|
Arcalyst |
|
Arikayce |
|
Arzerra |
|
Asparlas |
|
Aubagio |
|
Austedo |
|
Avastin-Mvasi-Zirabev |
|
Aveed |
|
Avonex |
|
Ayvakit |
|
Azacitidine-Vidaza |
B |
|---|
|
Bafiertam |
|
Balversa |
|
Bavencio |
|
Beleodaq |
|
Benlysta |
|
Beovu |
|
Berinert |
|
Besponsa |
|
Betaseron-Extavia |
|
Bexarotene-Targretin |
|
Blenrep |
|
Blincyto |
|
Bortezomib-Velcade |
|
Bosentan-Tracleer |
|
Bosulif |
|
Botox |
|
Braftovi |
|
Bronchitol |
|
Brukinsa |
|
Buprenorphine |
|
Butorphanol Nasal Solution (Stadol) |
C |
|---|
|
Cabometyx |
|
Calquence |
|
Caprelsa |
|
Carbaglu |
|
Cayston |
|
Cerdelga |
|
Cerezyme |
|
Cesamet |
|
Cetrotide-Ganirelix |
|
Chloroquine, Hydroxychloroquine |
|
Cholbam |
|
Cimzia |
|
Cinacalcet-Sensipar |
|
Cinqair |
|
Cinryze |
|
Coagadex |
|
Cometriq |
|
Compounded Drug Products |
|
Contrave |
|
Copaxone-Glatopa |
|
Copiktra |
|
Corifact |
|
Cosentyx |
|
Cotellic |
|
Crysvita |
|
Cyramza |
|
Cystadane |
|
Cystagon |
|
Cystaran-Cystadrops |
D |
|---|
|
Daklinza |
|
Dalfampridine-Ampyra |
|
Daraprim |
|
Darzalex |
|
Darzalex Faspro |
|
Daurismo |
|
Decitabine-Dacogen |
|
Deferasirox-Exjade-Jadenu |
|
Deferoxamine-Desferal |
|
Diabetic Test Strips |
|
Diclofenac Sodium Gel 3 Percent |
|
Dificid |
|
Docetaxel |
|
Dofetilide-Tikosyn |
|
Dojolvi |
|
Doptelet |
|
Dronabinol |
|
Duopa |
|
Dupixent |
|
Dysport |
E |
|---|
|
Egrifta |
|
Elaprase |
|
Elelyso |
|
Eligard |
|
Emend, Cinvanti, Varubi |
|
Emflaza |
|
Empliciti |
|
Enbrel |
|
Endari |
|
Enhertu |
|
Enspryng |
|
Entresto |
|
Entyvio |
|
Epclusa |
|
Epidiolex |
|
Epogen-Procrit-Retacrit |
|
Epoprostenol-Flolan-Veletri |
|
Erbitux |
|
Erivedge |
|
Erleada |
|
Erwinaze |
|
Esbriet |
|
Eucrisa |
|
Evenity |
|
Everolimus-Afinitor |
|
Evrysdi |
|
Evzio, Narcan NS |
|
Exondys |
|
Eylea |
F |
|---|
|
Fabior |
|
Fabrazyme |
|
Factor IX |
|
Factor IX Complex |
|
Factor VIII |
|
Farydak |
|
Fasenra |
|
FEIBA |
|
Fensolvi |
|
Ferriprox |
|
Fibryga |
|
Fintepla |
|
Firdapse |
|
Firmagon |
|
Follitropins |
|
Folotyn |
|
Fulvestrant-Faslodex |
|
Fuzeon |
G |
|---|
|
Galafold |
|
GamaSTAN SD |
|
Gattex |
|
Gavreto |
|
Gazyva |
|
Gemcitabine |
|
Gilenya |
|
Gilotrif |
|
Givlaari |
|
Grastek |
|
Growth Hormone With ISS |
H |
|---|
|
Haegarda |
|
Halaven |
|
Harvoni |
|
Hemlibra |
|
Herceptin and Trastuzumab Biosimilars |
|
Herceptin Hylecta |
|
Hetlioz |
|
Humira |
|
Hyaluronates |
|
Hycamtin Capsules |
|
Hydroxyprogesterone Caproate-Makena |
I |
|---|
|
Ibrance |
|
Icatibant-Firazyr |
|
Iclusig |
|
Idhifa |
|
Ilaris |
|
Ilumya |
|
Imatinib-Gleevec |
|
Imbruvica |
|
Imfinzi |
|
Imlygic |
|
Inbrija |
|
Increlex |
|
Influenza Treatment and Prevention |
|
Ingrezza |
|
Inlyta |
|
Inqovi |
|
Inrebic |
|
Intron |
|
Iressa |
|
Isturisa |
|
Itraconazole (Sporanox Capsules) |
|
Itraconazole (Sporanox) Oral Solution |
|
Ixempra |
J |
|---|
|
Jakafi |
|
Jetrea |
|
Jevtana |
|
Juxtapid |
|
Jynarque |
K |
|---|
|
Kadcyla |
|
Kalbitor |
|
Kalydeco |
|
Kanuma |
|
Kesimpta |
|
Keveyis |
|
Kevzara |
|
Keytruda |
|
Kineret |
|
Kisqali |
|
Kisqali Femara Co-Pack |
|
Korlym |
|
Koselugo |
|
Krystexxa |
|
Kuvan |
|
Kynamro |
|
Kyprolis |
L |
|---|
|
Lartruvo |
|
Lemtrada |
|
Lenvima |
|
Leukine |
|
Leuprolide |
|
Levoleucovorin-Fusilev-Khapzory |
|
Libtayo |
|
Lidocaine Topical Lidocaine-Prilocaine Lidocaine-Tetracaine |
|
Linzess |
|
Lonsurf |
|
Lorbrena |
|
Lucentis |
|
Lumizyme |
|
Lumoxiti |
|
Lupaneta Pack |
|
Lupron Depot Endometriosis-Fibroid |
|
Lupron Depot Prostate Cancer |
|
Lupron Depot-PED |
|
Lynparza |
M |
|---|
|
Macugen |
|
Mavenclad |
|
Mavyret |
|
Mayzent |
|
Mekinist |
|
Mektovi |
|
Menopur |
|
Mepsevii |
|
Miglustat-Zavesca |
|
Mircera |
|
Mitoxantrone |
|
Monjuvi |
|
Movantik |
|
Mozobil |
|
Mulpleta |
|
Myalept |
|
Mylotarg |
|
Myobloc |
N |
|---|
|
Natpara |
|
Nerlynx |
|
Neulasta and Pegfilgrastim Biosimilars |
|
Neupogen and Filgrastim Biosimilars |
|
Nexavar |
|
Ninlaro |
|
Northera |
|
Novoseven |
|
Nplate |
|
Nubeqa |
|
Nucala |
|
Nuplazid |
|
Nuvigil |
O |
|---|
|
Obizur |
|
Ocaliva |
|
Ocrevus |
|
Octreotide Products |
|
Odactra |
|
Odomzo |
|
Olumiant |
|
Olysio |
|
Oncaspar |
|
Onfi Sympazan |
|
Onpattro |
|
Onureg |
|
Opdivo |
|
Opioids ER - Step Therapy |
|
Opioids IR - 3-Day Acute Pain Duration |
|
Opioids IR - 3-Day APAP-ASA-IBU Combo Products - Acute Pain Duration |
|
Opioids IR - 7-Day Acute Pain Duration |
|
Opsumit |
|
Oral-Intranasal Fentanyl Products |
|
Oralair |
|
Orencia |
|
Orenitram |
|
Orfadin-Nityr |
|
Orkambi |
|
Otezla |
|
Otrexup |
|
Oxaliplatin |
|
Oxbryta |
|
Oxervate |
P |
|---|
|
Padcev |
|
Palynziq |
|
Parsabiv |
|
PCSK9i |
|
Pegasys |
|
Pemazyre |
|
Perjeta |
|
Phenylbutyrate-Buphenyl |
|
Phesgo |
|
Piqray |
|
Plegridy |
|
Polivy |
|
Pomalyst |
|
Portrazza |
|
Poteligeo |
|
Procysbi |
|
Proleukin |
|
Prolia |
|
Promacta |
|
Provigil |
|
Prudoxin, Zonalon |
|
Pulmozyme |
|
Purixan |
Q |
|---|
|
Qinlock |
|
Qsymia |
R |
|---|
|
Radicava |
|
Ragwitek |
|
Rasuvo |
|
Ravicti |
|
Rebif |
|
Reblozyl |
|
RediTrex |
|
Regranex |
|
Remicade-Avsola-Inflectra-Renflexis |
|
Retevmo |
|
Revlimid |
|
RiaSTAP |
|
Ribavirin |
|
Rinvoq |
|
Rituxan Hycela |
|
Rituxan-Ruxience-Truxima - Oncology |
|
Rituxan-Ruxience-Truxima - RA |
|
Romidepsin-Istodax |
|
Rozlytrek |
|
Rubraca |
|
Ruconest |
|
Ruzurgi |
|
Rydapt |
S |
|---|
|
Samsca |
|
Sarclisa |
|
Saxenda |
|
Serostim |
|
Sevenfact |
|
Signifor |
|
Signifor LAR |
|
Sildenafil-Revatio |
|
Siliq |
|
Simponi |
|
Simponi Aria |
|
Skyrizi |
|
Sogroya |
|
Soliris |
|
Somatuline Depot |
|
Somavert |
|
Sovaldi |
|
Spravato |
|
Sprycel |
|
Stelara |
|
Stimate |
|
Stivarga |
|
Strensiq |
|
Supprelin |
|
Sutent |
|
Sylatron |
|
Sylvant |
|
Symdeko |
|
Synagis |
|
Synribo |
T |
|---|
|
Tabrecta |
|
Tadalafil Products |
|
Tafinlar |
|
Tagrisso |
|
Takhzyro |
|
Taltz |
|
Talzenna |
|
Tarceva |
|
Tasigna |
|
Tavalisse |
|
Tazorac |
|
Tazverik |
|
Tecentriq |
|
Tecfidera |
|
Technivie |
|
Tegsedi |
|
Temozolomide-Temodar |
|
Tepezza |
|
Teriparatide-Forteo-Bonsity |
|
Testosterone - Oral Non-TGC |
|
Testosterone Products TGC |
|
Tetrabenazine-Xenazine |
|
Thalomid |
|
Tibsovo |
|
Tobramycin Inhalation |
|
Torisel |
|
Treanda-Bendeka-Belrapzo |
|
Trelstar |
|
Tremfya |
|
Treprostinil-Remodulin |
|
Tretinoins (Topical) |
|
Tretten |
|
Trikafta |
|
Triptodur |
|
Trodelvy |
|
Tukysa |
|
Turalio |
|
Tykerb |
|
Tymlos |
|
Tysabri |
|
Tyvaso |
U |
|---|
|
Ultomiris |
|
Uplizna |
|
Uptravi |
V |
|---|
|
Valchlor |
|
Vantas |
|
Vectibix |
|
Venclexta |
|
Ventavis |
|
Verzenio |
|
Viekira |
|
Vigabatrin-Sabril-Vigadrone |
|
Viltepso |
|
Vimizim |
|
Visudyne |
|
Vitrakvi |
|
Vivitrol |
|
Vizimpro |
|
Vonvendi |
|
Vosevi |
|
Votrient |
|
VPRIV |
|
Vumerity |
|
Vyndaqel-Vyndamax |
|
Vyondys 53 |
W |
|---|
|
Wakix |
|
Wilate |
X |
|---|
|
Xalkori |
|
Xeljanz-Xeljanz XR |
|
Xeloda |
|
Xenical |
|
Xeomin |
|
Xermelo |
|
Xgeva |
|
Xiaflex |
|
Xifaxan 550 mg |
|
Xolair |
|
Xospata |
|
Xpovio |
|
Xtandi |
|
Xyrem |
|
Xywav |
Y |
|---|
|
Yervoy |
|
Yonsa |
Z |
|---|
|
Zaltrap |
|
Zejula |
|
Zelboraf |
|
Zepatier |
|
Zeposia |
|
Zepzelca |
|
Zinbryta |
|
Zoladex |
|
Zoledronic Acid-Reclast |
|
Zoledronic Acid-Zometa |
|
Zolinza |
|
Zorbtive |
|
Zulresso |
|
Zydelig |
|
Zykadia |
|
Zytiga |
|
Zyvox |