EHP Medical Injectable Drug Criteria
A
Abraxane
Actemra - Criteria | Non-Preferred Product Exception Criteria
Acthar Gel
Actimmune
Adagen
Adakveo
Adcetris
Aduhelm
Advate
Adynovate
Afstyla
Aldurazyme
Alimta
Aliqopa
Alphanate/VWF Complex/Human
Alphanine SD
Alprolix
Altuviiio
Alyglo
Alymsys - Criteria | Non-Preferred Product Exception Criteria
Amondys
Amvuttra - Criteria | Non-Preferred Product Exception Criteria
Apokyn
Aralast NP - Criteria | Non-Preferred Exception Criteria
Aranesp
Arcalyst
Arzerra
Asceniv
Avastin - Criteria | Non-Preferred Product Exception Criteria
Aveed
Avsola
B
Bavencio
Beleodaq
Belrapzo
Bendamustine HCI
Bendeka
Benefix - Criteria | Non-Preferred Exception Criteria
Benlysta
Beovu
Berinert - Criteria | Non-Preferred Exception Criteria
Besponsa
Bivigam
Blenrep
Blincyto
Bortezomib
Botox
Breyanzi
Brineura
Briumvi - Criteria | Non-Preferred Product Exception Criteria
Bynfezia Pen
Byooviz
C
Cabenuva
Camcevi - Criteria | Non-Preferred Product Exception Criteria
Cerezyme - Criteria | Non-Preferred Exception Criteria
Cimerli
Cimzia - Criteria | Non-Preferred Exception Criteria
Cinqair - Criteria | Non-Preferred Exception Criteria
Cinryze
Coagadex
Cosela
Crysvita
Cutaquig
Cuvitru
Cyramza
D
Darzalex
Darzalex Faspro
Daxxify
Decitabine
Docefrez
Docetaxel
Docetaxel (non- alcohol)
Durolane - Criteria | Non-Preferred Exception Criteria
Dysport
E
Elaprase
Elelyso
Eligard
Eloctate
Elrexfio
Elzonris
Empliciti
Enhertu
Entyvio
Epogen - Criteria | Non-Preferred Product Exception Criteria
Epoprostenol sodium
Erbitux
Erwinaze
Esperoct - Criteria | Non-Preferred Product Exception Criteria
Euflexxa - Criteria | Non-Preferred Product Exception Criteria
Evenity
Evkeeza
Exondys 51
Eylea - Criteria | Non-Preferred Product Exception Criteria
a href="/-/media/johns-hopkins-health-plans/documents/ehp/drugs/ehp_eylea_criteria.pdf" target="_blank">Eylea HD
F
Fabrazyme
Fasenra
Feiba
Fensolvi
Fibryga
Firazyr
Firmagon - Criteria | Non-Preferred Product Exception Criteria
Flebogamma DIF
Flolan
Fulphila
Fusilev
Fyarro
Fylnetra - Criteria | Non-Preferred Product Exception Criteria
G
Gamifant
Gammagard
Gammagard S/D Less IgA
Gammaked
Gammaplex
Gamunex-C
Gazyva
Gel-one - Criteria | Non-Preferred Product Exception Criteria
Gelsyn-3 - Criteria | Non-Preferred Product Exception Criteria
Gemcitabine HCI
Gemzar
Genvisc 850 - Criteria | Non-Preferred Product Exception Criteria
Givlaari
Glassia - Criteria | Non-Preferred Product Exception Criteria
Granix - Criteria | Non-Preferred Product Exception Criteria
H
Haegarda
Halaven
Hemlibra
Hemofil M
Herceptin - Criteria | Non-Preferred Product Exception Criteria
Herceptin Hylecta - Criteria | Non-Preferred Product Exception Criteria
Herzuma - Criteria | Non-Preferred Product Exception Criteria
Hizentra
Humate-P
Hyalgan - Criteria | Non-Preferred Product Exception Criteria
Hymovis - Criteria | Non-Preferred Product Exception Criteria
Hyqvia
I
Icatibant Acetate
Idelvion
Ilaris
Ilumya
Imfinzi
Imlygic
Inflectra
Infliximab - Criteria | Non-Preferred Product Exception Criteria
Intron A
Ixempra Kit
Ixinity - Criteria | Non-Preferred Product Exception Criteria
J
K
Kadcyla
Kalbitor
Kanjinti - Criteria | Non-Preferred Product Exception Criteria
Kanuma
Keytruda
Koate
Koate-DVI
Kogenate FS
Kogenate FS Bio-Set
Kovaltry
Krystexxa
Kymriah
Kyprolis - Criteria | Non-Preferred Product Exception Criteria
L
Lemtrada - Criteria | Non-Preferred Product Exception Criteria
Leukine - Criteria | Non-Preferred Product Exception Criteria
Libtayo
Lucentis - Criteria | Non-Preferred Product Exception Criteria
Lumizyme
Lupron Depot (Endometriosis & Fibroids) - Criteria | Non-Preferred Product Exception Criteria
Lupron Depot (Prostate Cancer, Ovarian Cancer, Gender Dysphoria & Salivary Gland Tumors)
Lupron Depot-PED
Luxturna
M
Macugen
Margenza - Criteria | Non-Preferred Product Exception Criteria
Mepsevii
Mircera - Criteria | Non-Preferred Product Exception Criteria
Mitoxantrone HCI
Monjuvi
Monovisc
Mvasi
Myobloc - Criteria | Non-Preferred Product Exception Criteria
Mycapssa
N
Naglazyme
Neulasta
Neulasta Onpro
Neupogen - Criteria | Non-Preferred Product Exception Criteria
Nexviazyme
Nivestym - Criteria | Non-Preferred Product Exception Criteria
Novoeight
NovoSeven RT
Nplate
Nucala
Nuwiq
Nyvepria - Criteria | Non-Preferred Product Exception Criteria
O
Obizur
Ocrevus
Octagam
Octreotide Acetate
Ogivri
Oncaspar
Onpattro
Ontruzant - Criteria | Non-Preferred Product Exception Criteria
Opdivo
Opfolda
Orencia - Criteria | Non-Preferred Product Exception Criteria
Orthovisc
Oxaliplatin
P
Padcev
Parsabiv
Perjeta
Phesgo
Polivy
Pombiliti
Poteligeo
Purified Cortrophin Gel
Privigen
Procrit
Profilnine
Profilnine SD
Prolastin-C
Proleukin
Prolia
Q
R
Radicava
Rebinyn
Reblozyl
Reclast
Recombinate - Criteria | Non-Preferred Product Exception Criteria
Remicade - Criteria | Non-Preferred Product Exception Criteria
Remodulin
Renflexis - Criteria | Non-Preferred Product Exception Criteria
Retacrit - Criteria | Non-Preferred Product Exception Criteria
Riabni (Oncology)
Riabni (Other) - Criteria | Non-Preferred Product Exception Criteria
Riastap
Rituxan (Oncology)
Rituxan (Other) - Criteria | Non-Preferred Product Exception Criteria
Rituxan Hycela - Criteria | Non-Preferred Product Exception Criteria
Rixubis - Criteria | Non-Preferred Product Exception Criteria
Ruconest
Ruxience (Oncology)
Ruxience (Other) - Criteria | Non-Preferred Product Exception Criteria
S
Sandostatin
Sandostatin LAR Depot
Sarclisa
Sevenfact
Signifor LAR - Criteria | Non-Preferred Product Exception Criteria
Simponi Aria
Soliris
Somatuline Depot
Somavert - Criteria | Non-Preferred Product Exception Criteria
Spinraza
Stelara IV
Stimufend - Criteria | Non-Preferred Product Exception Criteria
Supartz
Supartz FX - Criteria | Non-Preferred Product Exception Criteria
Supprelin LA
Sylvant
SynoJoynt - Criteria | Non-Preferred Product Exception Criteria
Synvisc - Criteria | Non-Preferred Product Exception Criteria
Synvisc One - Criteria | Non-Preferred Product Exception Criteria
T
Takhzyro
Talvey
Taxotere
Tecartus
Tecentriq
Tegsedi - Criteria | Non-Preferred Product Exception Criteria
Temodar
Temsirolimus
Tepezza
Tezspire
Tofidence
Torisel
Trazimera - Criteria | Non-Preferred Product Exception Criteria
Treanda
Trelstar - Criteria | Non-Preferred Product Exception Criteria
Treprostinil
Tretten
Triluron
Triptodur
Trivisc - Criteria | Non-Preferred Product Exception Criteria
Trodelvy
Truxima (Oncology)
Truxima (Other)
Tysabri
U
Udenyca, Udenyca Onbody - Criteria | Non-Preferred Product Exception Criteria
Ultomiris - Criteria | Non-Preferred Product Exception Criteria
Uplizna
V
Vantas
Vectibix
Vegzelma - Criteria | Non-Preferred Product Exception Criteria
Velcade
Veletri
Vimizim
Visco-3 - Criteria | Non-Preferred Product Exception Criteria
Viltepso
Vonvendi
Vpriv - Criteria | Non-Preferred Product Exception Criteria
Vyondys
W
X
Xembify
Xeomin
Xgeva
Xiaflex
Xolair
Xyntha
Xyntha Solofuse
Y
Z
Zaltrap
Zarxio
Zemaira - Criteria | Non-Preferred Product Exception Criteria
Zepzelca
Ziextenzo - Criteria | Non-Preferred Product Exception Criteria
Zirabev - Criteria | Non-Preferred Product Exception Criteria
Zoladex - Criteria | Non-Preferred Product Exception Criteria
Zolgensma
Zometa