Prior authorization forms for prescription drugs

ABRILADA (Adalimumab)

ACTEMRA (Tocilizumab)

ADCIRCA (Tadalafil)

ADEMPAS (Riociguat)

ADLYXINE (Lixisenatide)

ADTRALZA (Tralokinumab)

AFINITOR (Évérolimus)

AIMOVIG (Erenumab)

AJOVY (Fremanezumab)

ALBRIOZA (Sodium phenylbutyrate and ursodoxicoltaurine)

ALECENSARO (Alectinib)

ALUNBRIG (Brigatinib)

AMGEVITA (Adalimumab)

APTIOM (Eslicarbazepine acétate)

AUBAGIO (Tériflunomide)

AVSOLA (Infliximab)

BALVERSA (Erdafitinib)

STRIPS

BENLYSTA (Bélimumab)

BEOVU (Brolucizumab)

BIMZELX (Bimekizumab)

BOSULIF (Bosutinib)

BOTOX (OnabotulinumtoxinA)

BRAFTOVI (Encorafenib)

BRENZYS (Etanercept)

BRUKINSA (Zanubrutinib)

BYOOVIZ (Ranibizumab)

CABLIVI (Caplacizumab)

CABOMETYX (Cabozantinib)

CALQUENCE (Acalabrutinib)

CANNABIS

CAPRELSA (Vandétanib)

CIALIS (Tadalafil)

CIBINQO (Abrocitinib)

CIMZIA (Certolizumab pégol)

CINQAIR (Reslizumab)

CONTRAVE (Naltrexone/Bupropion)

COPAXONE (Acetate de glatiramere)

COSENTYX (Secukinumab)

COTELLIC (Cobimetinib)

CRESEMBA (Isavuconazorium)

CRINONE (Progestérone)

CRYSVITA (Burosumab)

CYSTADROPS (Cystéamine)

DAURSIMO (Glasdegib)

DEXCOM G6 (SENSOR and TRANSMITTER)

DOJOLVI (Triheptanoin)

DUODOPA (Lévodopa / Carbidopa)

DUPIXENT (Dupilumab)

DYSPORT (Toxine botulinique)

EGRIFTA (Tésamoréline)

EMGALITY (Galcanezumab)

ENBREL (Étanercept)

ENDOMETRIN (Progestérone)

ENSPRYNG (Satralizumab)

ENTYVIO (Vedolizumab)

EPCLUSA (Sofosbuvir/Velpatasvir)

ERELZI (Étanercept)

ERIVEDGE (Vismodégib)

ERLEADA (Apalutamide)

ESBRIET (Pirfénidone)

EVENITY (Romosozumab)

EVRYSDI (Risdiplam)

EXJADE (Deferasirox)

EYLEA (Aflibercept)

FAMPYRA (Fampridine)

FASENRA (Benralizumab)

FASTURTEC (Rasburicase)

FENTORA (Fentanyl)

FIRAZYR (Icatibant)

FIRDAPSE (Amifampridine)

FORTEO (Tériparatide)

FREESTYLE

GALAFOLD (Migalast)

GAVRETO (Pralsetinib)

GENOTROPIN (Somatropine)

GILENYA (Fingolimod)

GIOTRIF (Afatinib)

GIVLAARI (Givosiran)

GLEEVEC (Imatinib)

HADLIMA (Adalimumab)

HARVONI (Ledipasvir / Sofosbuvir )

HCG (Gonadotrophine chorionique)

HULIO (Adalimumab)

HUMALOG (Lispro insulin)

HUMATROPE (Somatotropine)

HUMIRA (Adalimumab)

HYRIMOZ (Adalimumab)

IBAVYR (Ribavirine)

IBRANCE (Palbociclib)

ICLUSIG (Chlorhydrate de ponitinib)

IDACIO (Adalimumab)

IDHIFA (Enasidenib)

ILARIS (Canakinumab)

ILUMYA (Tildrakizumab)

IMBRUVICA (Ibrutinib)

INFLECTRA (Infliximab)

INLYTA (Axitinib)

INQOVI (Cedazuridine/Decitabine)

INREBIC (Fedratinib)

IRESSA (Géfitinib)

JADENU (Deferasirox)

JAKAVI (Ruxolitinib)

JETREA (Ocriplasmine)

JINARC (Tolvaptan)

JUXTAPID (Lomitapide)

KALYDECO (Ivacaftor)

KANUMA (Sebelipase alfa)

KESIMPTA (Ofatumumab)

KETALAR (Kétamine)

KEVZARA (Sarilumab)

KINERET (Anakinra)

KISQALI (Ribociclib)

KOSELUGO (Selumetinib)

KUVAN (Dichlorhydrate de saproptérine)

LANTUS (Insuline glargine)

LEDAGA (Chlormetine)

LEMTRADA (Alemtuzumab)

LENVIMA (Lenvatinib)

LEQVIO (Inclisiran)

LEVITRA (Vardenafil)

LIVTENCITY (Maribavir)

LONSURF (Trifluridine)

LORBRENA (Lorlatinib)

LOVENOX (Enoxaparin)

LUCENTIS (Ranibizumab)

LUMAKRAS (Sotorasib)

LYNPARZA (Olaparib)

MAVENCLAD (Cladribine)

MAVIRET (Glécaprévir/Pibrentasvir)

MAYZENT (Siponimod)

MEKINIST (Tramétinib)

MEKTOVI (Binimetinib)

MENOPUR (Ménotropines)

MOVAPO (Chlorhydrate d'apomorphine)

MYOZYME (Alglucosidase alfa)

NERLYNX (Neratinib)

NEULASTA (Pegfilgrastim)

NEUPOGEN (Filgrastim)

NEXAVAR (Sorafénib)

NEXVIAZYME (Avalglucosidase alfa)

NGENLA (Somatrogon)

NINLARO (Ixazomib)

NORDITROPIN (Somatropin )

NOVORAPID (Insulin Aspart)

NPLATE (Romiplostim)

NUBEQA (Darolutamide)

NUCALA (Mepolizumab)

NUTROPIN (Somatropine)

OCALIVA (Acide obéticholique)

OCREVUS (Ocrélizumab)

ODOMZO (Sonidégib)

OFEV (Nintédanib)

OLUMIANT (Baricitinib)

OMNITROPE (Somatropine)

ONPATTRO (Patisiran)

ONUREG (Azacitidine)

ORENCIA (Abatacept)

ORFADIN (Nitisinone)

ORKAMBI (Lumacaftor / Ivacaftor)

ORLADEYO (Berotralstat)

OSNUVO (Teriparatide)

OTEZLA (Apremilast)

OXERVATE (Cenergemin)

OZEMPIC (Semaglutide)

PALYNZIQ (Pegvaliase)

PEGASYS (Peginterféron alfa-2a)

PEMAZYRE (Pemigatinib)

PHEBURANE (Phénylbutyrate sodique)

PIQRAY (Alpelisib)

POMALYST (Pomalidomide)

PONVORY (Ponesimod)

PRALUENT (Alirocumab)

PREGNYL (Chorionic gonadotropin)

PREVYMIS (Letermovir)

PROCYSBI (Cystéamine )

PROLASTIN-C (Alpha 1 antitrypsin)

PULMOZYME INHALATION (Dornase Alfa)

QINLOCK (Ripretinib)

QULIPTA (Atogepant)

RADICAVA (Edaravone)

RAVICTI (Phénylbutyrate de glycérol)

REBLOZYL (Luspatercept-aamt)

REMICADE (Infliximab)

REMSIMA (Infliximab)

RENFLEXIS (Infliximab)

REPATHA (Évolocumab)

RETEVMO (Selpercatinib)

REVATIO (Sildénafil)

REVESTIVE (Teduglutide)

REVLIMID (Lénalidomide)

REVOLADE (Eltrombopag)

REZUROCK (Belumosudil)

RIABNI ( Rituximab)

RINVOQ (Upadacitinib)

RITUXAN (Rituximab)

RIXIMYO (Rituximab)

ROZLYTREK (Entrectinib)

RUKOBIA (Fostemsavir)

RUXIENCE (Rituximab)

RUZURGI (Amifampridine)

RYBELSUS (Semaglutide)

RYDAPT (Midostaurine)

SAIZEN (Somatropine)

SAMSCA (Tolvaptan)

SANDOSTATIN (Octréotide)

SANDOSTATIN LAR (Octréotide)

SAPHNELO (Anifrolumab)

SAXENDA (Liraglutide)

SCEMBLIX (Ascinimib)

SEROSTIM (Somatropine)

SIGNIFOR (Pasiréotide)

SIGNIFOR LAR (Pasiréotide)

SILIQ (Brodulamab)

SIMLANDI (Adalimumab)

SIMPONI (Golimumab)

SKYRIZI (Risankizumab)

SOHONOS (Palovarotene)

SOLIQUA (Insulin glargine and lixisenatide)

SOLIRIS (Eculizumab)

SOMAVERT (Pegvisomant)

SOTYKTU (Deucravacitinib)

SOVALDI (Sofosbuvir)

SPEVIGO (spesolimab)

SPRAVATO (Esketamine)

SPRYCEL (Dasatinib)

STAXYN (Vardenafil)

STELARA (Ustékinumab)

STIVARGA (Régorafénib)

STRENSIQ (Asfotase alfa)

SUTENT (Sunitinib)

SYLVANT (Siltuximab)

SYMDEKO (Tezacaflor/Ivacaftor)

TABRECTA (Capmatinib)

TAFINLAR (Dabrafénib)

TAGRISSO (Osimertinib)

TAKHZYRO (Lanadélumab)

TALTZ (Ixékizumab)

TARCEVA (Erlotinib)

TASIGNA (Nilotinib)

TAVALISSE (Fostamatinib)

TAVNEOS (Avacopan)

TECFIDERA (Dimethyl Fumarate)

TEGSEDI (Inotersen)

TEPMETKO (Tépotinib)

TEZSPIRE (Tezepelumab)

THALOMID (Thalidomide)

THYROGEN (Thyrotropine alfa)

TRACLEER (Bosentan)

TREMFYA (Guselkumab)

TRIENTINE (Trientine hydrochloride)

TRIKAFTA (Exelecaftor/Tezacaftor/Ivacaftor)

TRULICITY (Dulaglutide)

TRUXIMA (Rituximab)

TUKYSA (Tucatinib)

TYKERB (Lapatinib)

TYSABRI (Natalizumab)

ULTOMIRIS (Ravulizumab)

UPTRAVI (Selexipag)

VABYSMO (Faricimab-svoa)

VENCLEXTA (Venetoclax)

VERZENIO (Abemaciclib)

VIAGRA (Sildenafil)

VICTOZA (Liraglutide)

VITRAKVI (Larotrectinib)

VOLIBRIS (Ambrisentan)

VOSEVI (Sofosbuvir/Velpatasvir/Voxilaprévir)

VOTRIENT (Pazopanib)

VYEPTI (Eptinezumab)

VYNDAMAX (Tafamidis)

VYNDAQEL (Tafamidis Meglumine)

WAKIX (Pitolisant)

WELIREG (Belzutifan)

XALKORI (Crizotinib)

XELJANZ (Citrate de tofacitinib)

XENICAL (Orlistat)

XEOMIN (IncobotulinumtoxinA)

XERMELO (Telotristat etiprate)

XOLAIR (Omalizumab)

XOSPATA (Gilteritinib)

XPOVIO (Selinexor)

XTANDI (Enzalutamide)

XULTOPHY (Insulin deglutec and liraglutide)

XYREM (Oxybate de sodium)

YUFLYMA (Adalimumab)

ZAVESCA (Miglustat)

ZEJULA (Niraparib)

ZELBORAF (Vemurafénib)

ZEPOSIA (Ozanimod)

ZOLINZA (Vorinostat)

ZYDELIG (Idélalisib)

ZYKADIA (Céritinib)

ZYTIGA (Acétate d'abiratérone)