| Section |
Status |
Black Triangle |
Name |
| 06.06.01 |
Formulary
|
 |
Abaloparatide Eladynos® |
| 13.05.03 |
Formulary
|
|
Abrocitinib Cibinqo® |
| 08.01.05 |
Formulary
|
|
Acalabrutinib Calquence® |
| 13.14.07 |
Non Formulary
|
|
Afamelanotide Scenesse® |
| 08.02.03 |
Formulary
|
|
Alemtuzumab Lemtrada® |
| 02.08.02 |
Formulary
|
|
Andexanet alfa Ondexxya® |
| 05.04.01 |
Formulary
|
|
Artesunate |
| 08.01.05 |
Formulary
|
|
Asciminib Scemblix® |
| 09.08.01 |
Formulary
|
|
Asfotase alfa Strensiq® |
| 10.02.01 |
Formulary
|
|
Ataluren Translarna® |
| 19 |
Formulary
|
|
Atidarsagene autotemcel Libmeldy® |
| 04.07.04.02 |
Formulary
|
|
Atogepant Aquipta® |
| 08.01.05 |
Formulary
|
|
Autologous CD34+ enriched cell fraction Strimvelis® |
| 10.01.05 |
Formulary
|
|
Avacopan Tavneos® |
| 09.08.01 |
Formulary
|
|
Avalglucosidase alfa Nexviadyme® |
| 08.01.05 |
Formulary
|
|
Avapritinib Ayvakyt® |
| 08.01.05 |
Formulary
|
|
Axicabtagene ciloleucel Yescarta® |
| 10.01.03 |
Formulary
|
|
Belimumab Benlysta® |
| 08.01.05 |
Formulary
|
|
Belzutifan Welireg® |
| 03.04.03 |
Formulary
|
|
Berotralstat Orladeyo® |
| 11.08.02 |
Formulary
|
|
Bevacizumab gamma Lytenava® |
| 13.14.07 |
Formulary
|
|
Birch bark extract Filsuvez® |
| 08.02 |
Formulary
|
|
Blinatumomab Blincyto® |
| 08.01.05 |
Formulary
|
|
Brexucabtagene autoleucel Tecartus® |
| 05.03.03.02 |
Formulary
|
|
Bulevirtide Hepcludex® |
| 05.03.01 |
Formulary
|
|
Cabotegravir Vocabria® |
| 08.01.05 |
Formulary
|
|
Capivasertib Truqap® |
| 05.03.06 |
Non Formulary
|
|
Casirivimab with Imdevimab Ronapreve® |
| 08.01.05 |
Formulary
|
|
Cemiplimab Libtayo® |
| 04.08.01 |
Formulary
|
|
Cenobamate Ontozry® |
| 06.07 |
Formulary
|
|
Cerliponase alfa Brineura® |
| 01.09.01 |
Formulary
|
|
Cholic acid Orphacol® |
| 05.03.02.02 |
Formulary
|
|
Cidofovir infusion |
| 09.08.01 |
Formulary
|
|
Cipaglucosidase alfa (CIPA) Pombiliti® |
| 14.04 |
Formulary
|
|
COVID-19 vaccines |
| 09.01.03 |
Formulary
|
|
Crovalimab Piasky® |
| 09.01.03 |
Formulary
|
|
Danicopan Voydeya® |
| 04.01.01 |
Formulary
|
|
Daridorexant Quviviq® |
| 02.08 |
Formulary
|
|
Defibrotide |
| 05.01.09 |
Formulary
|
|
Delamanid |
| 13.05.03 |
Formulary
|
|
Deucravacitinib Sotyktu |
| 13.14.07 |
Formulary
|
|
Difelikefalin Kapruvia® |
| 08.01.05 |
Formulary
|
|
Dinutuximab beta Qarziba® |
| 08.01.05 |
Formulary
|
|
Dostarlimab Jemperli |
| 02.11 |
Formulary
|
|
Efanesoctocog alfa Altuvoct® |
| 10.02 |
Non Formulary
|
|
Efgartigimod alfa Vyvgart® |
| 08.03.04.01 |
Formulary
|
|
Elacestrant Korserdu ® |
| 09.08.01 |
Formulary
|
|
Eladocagene exuparvovec Upstaza® |
| 01.09.01 |
Formulary
|
|
Elafibranor Iqirvo® |
| 09.08.01 |
Formulary
|
|
Eliglustat Cerdelga® |
| 08.01.05 |
Formulary
|
|
Elranatamab Elrexfio ® |
| 08.01.05 |
Formulary
|
|
Entrectinib Rozlytrek® |
| 08.01.05 |
Formulary
|
|
Epcoritamab Tepkinly® |
| 04.12 |
Formulary
|
|
Eplontersen Wainzua ® |
| 04.07.04.02 |
Formulary
|
|
Eptinezumab Vyepti® |
| 08.01.05 |
Formulary
|
|
Erdafitinib Balversa® |
| 02.11 |
Formulary
|
|
Etranacogene dezaparvovec Hemgenix® |
| 01.05.03 |
Formulary
|
|
Etrasimod Velsipity® |
| 02.12 |
Formulary
|
|
Evinacumab Evkeeza® |
| 09.01 |
Formulary
|
|
Exagamglogene Autotemcel Casgevy® |
| 11.08.02 |
Formulary
|
|
Faricimab Vabysmo® |
| 08.01.05 |
Formulary
|
|
Fedratinib |
| 04.08.01 |
Formulary
|
|
Fenfluramine Fintepla® |
| 01.05.03 |
Formulary
|
|
Filgotinib Jyseleca® |
| 02.02.03 |
Formulary
|
|
Finerenone Kerendia® |
| 08.01.05 |
Formulary
|
|
Fostamatinib |
| 05.03.01 |
Formulary
|
|
Fostemsavir Rukobia® |
| 08.01.05 |
Formulary
|
|
Fruquintinib Fruzaqla® |
| 08.01.05 |
Formulary
|
|
Futibatinib Lytgobi ® |
| 04.08.01 |
Non Formulary
|
|
Ganaxolone Ztalmy ® |
| 03.09.01 |
Non Formulary
|
|
Gefapixant |
| 08.01.05 |
Formulary
|
|
Glofitamab Columvi® |
| 08.01 |
Formulary
|
|
Glucarpidase Voraxaze® |
| 04.04 |
Formulary
|
|
Guanfacine Intuniv® |
| 11.08.02.04 |
Formulary
|
|
Holoclar® |
| 02.12 |
Formulary
|
|
Icosapent ethyl Vazkepa® |
| 08.01.05 |
Non Formulary
|
|
Idecabtagene vicleucel |
| 09.08.01 |
Formulary
|
|
Idursulfase |
| 08.01.05 |
Formulary
|
|
Imlifidase Idefirix® |
| 02.12 |
Formulary
|
|
Inclisiran Leqvio® |
| 14.04 |
Formulary
|
|
Influenza vaccine |
| 06.01.01.01 |
Formulary
|
|
Insulin Aspart NovoRapid® Trurapi® |
| 07.03.02.03 |
Formulary
|
|
Intra-uterine Progestogen Only System Jaydess® |
| 09.01.03 |
Formulary
|
|
Iptacopan Fabhalta® |
| 13.06.02 |
Formulary
|
|
Isotretinoin capsules |
| 08.01.05 |
Formulary
|
|
Ivosidenib Tibsovo® |
| 06.07 |
Formulary
|
|
Ketoconazole Ketoconazole HRA |
| 08.01.05 |
Formulary
|
|
Larotrectinib |
| 11.06 |
Formulary
|
|
Latanoprost 50microgram/ml with Netarsudil 200microgram/ml eye drops Roclanda® |
| 13.05.03 |
Formulary
|
|
Lebrikizumab Ebglyss® |
| 09.08.01 |
Formulary
|
|
Leniolisib Joenja® |
| 06.07.02 |
Formulary
|
|
Linzagolix Yselty® |
| 08.01.05 |
Non Formulary
|
|
Lisocabtagene maraleucel |
| 08.01.05 |
Formulary
|
|
Lisocabtagene maraleucel Breyanzi® |
| 08.01.05 |
Formulary
|
|
Loncastuximab tesirine Zynlonta® |
| 08.01.05 |
Formulary
|
|
Lorlatinib Lorviqua® |
| 09.08.01 |
Formulary
|
|
Lumasiran Oxlumo® |
| 08.01.05 |
Formulary
|
|
Lutetium (177Lu) |
| 05.03.02.02 |
Formulary
|
|
Maribavir Livtencity® |
| 02.11 |
Formulary
|
|
Marstacimab Hympavzi® |
| 02.11 |
Non Formulary
|
|
Marstacimab Hympavzi® |
| 02.16 |
Formulary
|
|
Mavacamten Camzyos® |
| 06.07.04 |
Formulary
|
|
Mecasermin Increlex® |
| 06.08 |
Formulary
|
|
Metreleptin |
| 01.05.03 |
Formulary
|
|
Mirikizumab Omvoh® |
| 05.03.06 |
Restricted Use
|
|
Molnupiravir Lagevrio® |
| 08.01.05 |
Formulary
|
|
Momelotinib Omjjara® |
| 08.01.05 |
Non Formulary
|
|
Mosunetuzumab Lunsumio® |
| 04.05.01 |
Non Formulary
|
|
Naltrexone/ bupropion Mysimba® |
| 08.01.03 |
Formulary
|
|
Nelarabine Atriance® |
| 05.03.06 |
Formulary
|
|
Nirmatrelvir and Ritonavir Paxlovid® |
| 08.01.05 |
Formulary
|
|
Nivolumab-relatlimab Opdualag® |
| 01.09.01 |
Formulary
|
|
Obeticholic acid |
| 01.09.01 |
Formulary
|
|
Odevixibat Bylvay® |
| 08.02.03 |
Formulary
|
|
Ofatumumab Kesimpta® |
| 09.08.01 |
Non Formulary
|
|
Olipudase alfa Xenpozyme® |
| 19 |
Formulary
|
|
Onasemnogene abeparvovec Zolgenmsa® |
| 01.05.03 |
Formulary
|
|
Ozanimod Zeposia® |
| 09.01.03 |
Formulary
|
|
Pegcetacoplan Aspaveli® |
| 09.08.01 |
Formulary
|
|
Pegunigalsidase alfa Elfabrio® |
| 08.01.05 |
Formulary
|
|
Pemigatinib Pemaryze® |
| 04.04 |
Formulary
|
|
Pitolisant Wakix® |
| 08.01.05 |
Formulary
|
|
Polatuzumab vedotin Polivy® |
| 08.01.05 |
Formulary
|
|
Pomalidomide |
| 08.02.04 |
Formulary
|
|
Ponesimod Ponvory® |
| 08.01.05 |
Formulary
|
|
Quizartinib Vanflyta® |
| 08.03.04.02 |
Formulary
|
|
Radium-223 dichloride |
| 06.07.02 |
Formulary
|
|
Relugolix–estradiol–norethisterone acetate Ryeqo® |
| 05.03.06 |
Restricted Use
|
|
Remdesivir Veklury® |
| 05.02.04 |
Formulary
|
|
Rezafungin Rezzayo ® |
| 04.07.04.02 |
Formulary
|
|
Rimegepant Vydura® |
| 08.01.05 |
Non Formulary
|
|
Ripretinib Qinlock® |
| 10.02 |
Formulary
|
|
Risdiplam Evrysdi® |
| 13.05.03 |
Formulary
|
|
Ritlecitinib Litfulo® |
| 09.01.03 |
Formulary
|
|
Roxadustat Evrenzo® |
| 08.01.05 |
Formulary
|
|
Rucaparib |
| 08.01.05 |
Formulary
|
|
Sacituzumab govitecan Trodelvy® |
| 10.02.01 |
Non Formulary
|
|
Satralizumab Enspryng® |
| 09.08.01 |
Non Formulary
|
|
Sebelipase alfa Kanuma® |
| 09.08.01 |
Formulary
|
|
Sebelipase alfa Kanuma® |
| 08.01.05 |
Formulary
|
|
Selinexor Nexpovio® |
| 08.01.05 |
Formulary
|
|
Selpercatinib |
| 08.01.05 |
Formulary
|
|
Selumetinib Koselugo® |
| 06.07 |
Formulary
|
|
Setmelanotide Imcivree® |
| 04.07.04.02 |
Formulary
|
|
Sodium valproate |
| 04.08.01 |
Formulary
|
|
Sodium Valproate |
| 04.02.03 |
Formulary
|
|
Sodium valproate 200mg, 300mg, and 500mg tablets Epilim Chrono® |
| 04.08.01 |
Formulary
|
|
Sodium Valproate Injection |
| 09.02.01.01 |
Formulary
|
|
Sodium zirconium cyclosilicate Lokelma® |
| 04.04 |
Formulary
|
|
Solriamfetol Sunosi® |
| 06.05.01 |
Formulary
|
|
Somapacitan Sogroya® |
| 06.05.01 |
Formulary
|
|
Somatrogon Ngenla® |
| 08.01.05 |
Formulary
|
|
Sotorasib Lumykras |
| 05.03.06 |
Formulary
|
|
Sotrovimab Xevudy® |
| 02.05.05 |
Formulary
|
|
Sparsentan Filspari ® |
| 13.05.03 |
Formulary
|
|
Spesolimab Spevigo® |
| 04.12 |
Formulary
|
|
Tafamidis Vyndaqel® |
| 08.01.05 |
Non Formulary
|
|
Tafasitamab Minjuvi® |
| 08.01.05 |
Formulary
|
|
Tebentafusp Kimmtrak ® |
| 08.01.05 |
Formulary
|
|
Teclistamab Tecvayli® |
| 01.04.02 |
Formulary
|
|
Teduglutide Revestive® |
| 08.02 |
Formulary
|
|
Tepotinib Tepmetko® |
| 06.06.01 |
Formulary
|
|
Teriparatide 250microgram in 1ml prefilled pen Biosimilar brands - Movymia®,Terrosa® & Teva |
| 03.04.02 |
Formulary
|
|
Tezepelumab Tezspire® |
| 13.08.01 |
Formulary
|
|
Tirbanibulin |
| 06.01.02.03 |
Formulary
|
|
Tirzepatide Mounjaro® |
| 08.01.05 |
Non Formulary
|
|
Tisagenlecleucel |
| 08.01.05 |
Formulary
|
|
Tisagenlecleucel |
| 05.03.06 |
Non Formulary
|
|
Tixagevimab plus cilgavimab |
| 04.07.04.02 |
Formulary
|
|
Topiramate |
| 13.05.03 |
Formulary
|
|
Tralokinumab Adtralza® |
| 08.01.05 |
Non Formulary
|
|
Trastuzumab deruxtecan Enhertu® |
| 08.01.05 |
Formulary
|
|
Trastuzumab deruxtecan Enhertu |
| 13.06.01 |
Formulary
|
|
Trifarotene Aklief ® |
| 08.02.03 |
Formulary
|
|
Ublituximab Briumvi® |
| 09.01.03 |
Formulary
|
|
Vadadustat Vafseo ® |
| 04.02.03 |
Formulary
|
|
Valproic Acid Depakote® |
| 10.02 |
Formulary
|
|
Vamorolone Agamree® |
| 09.08.01 |
Formulary
|
|
Velmanase alfa Lamzede ® |
| 07.04.02 |
Formulary
|
|
Vibegron Obgemsa® |
| 08.02.02 |
Formulary
|
|
Voclosporin Lupkynis® |
| 19 |
Formulary
|
|
Volanesorsen Waylivra® |
| 11.08.02 |
Formulary
|
|
Voretigene neparvovec Luxturna® |
| 04.12 |
Formulary
|
|
Vutrisiran Amvuttra® |
| 05.03.04 |
Formulary
|
|
Zanamivir Injection Dectova® |
| 08.01.05 |
Formulary
|
|
Zanubrutinib Brukinsa® |
| 08.01.05 |
Non Formulary
|
|
Zanubrutinib Brukinsa® |
| 08.01.05 |
Non Formulary
|
|
zolbetuximab Vyloy® |
