Prior authorization forms for prescription drugs

APTIOM (Eslicarbazepine acétate)

CALQUENCE (Acalabrutinib)

CRESEMBA (Isavuconazorium)

CYSTADROPS (Cystéamine)

DEXCOM G6 (SENSOR and TRANSMITTER)

DUODOPA (Lévodopa / Carbidopa)

EGRIFTA (Tésamoréline)

EPCLUSA (Sofosbuvir/Velpatasvir)

FIRDAPSE (Amifampridine)

GENOTROPIN (Somatropine)

HARVONI (Ledipasvir / Sofosbuvir )

HCG (Gonadotrophine chorionique)

HUMALOG (Lispro insulin)

HUMATROPE (Somatotropine)

ICLUSIG (Chlorhydrate de ponitinib)

INQOVI (Cedazuridine/Decitabine)

KANUMA (Sebelipase alfa)

KUVAN (Dichlorhydrate de saproptérine)

KYNMOBI (Apomorphine HCL)

LANTUS (Insuline glargine)

MAVIRET (Glécaprévir/Pibrentasvir)

MYOZYME (Alglucosidase alfa)

NEULASTA (Pegfilgrastim)

NORDITROPIN (Somatropin )

ORKAMBI (Lumacaftor / Ivacaftor)

OZURDEX (Dexaméthasone)

PEGASYS (Peginterféron alfa-2a)

PHEBURANE (Phénylbutyrate sodique)

PREGNYL (Chorionic gonadotropin)

PULMOZYME INHALATION (Dornase Alfa)

REBLOZYL (Luspatercept-aamt)

RETISERT (Acétonide de fluocinolone)

SANDOSTATIN LAR (Octréotide)

SATIVEX (Cannabidiol/Delta-9-tétrahydrocannabinol)

SIGNIFOR LAR (Pasiréotide)

STRENSIQ (Asfotase alfa)

SYMDEKO (Tezacaflor/Ivacaftor)

TAVALISSE (Fostamatinib)

TECFIDERA (Dimethyl Fumarate)

THYROGEN (Thyrotropine alfa)

TRIENTINE (Trientine hydrochloride)

TRIKAFTA (Exelecaftor/Tezacaftor/Ivacaftor)

VITRAKVI (Larotrectinib)

VYNDAQEL (Tafamidis Meglumine)

XEOMIN (IncobotulinumtoxinA)

XERMELO (Telotristat etiprate)

XIAFLEX (Collagénase de Clostridium histolyticum)

XYREM (Oxybate de sodium)

ZEPATIER (Elbasvir / Grazoprévir)

ZYTIGA (Acétate d'abiratérone)