| Policy Name |
 Adalimumab (Humira®) |
| Age Edits for Pharmaceuticals Covered Under the Pharmacy Benefit |
| Anakinra (Kineret®) |
| Androgens |
| Armodafinil (Nuvigil®) |
| Asenapine sublingual tablets (Saphris®) |
| Aztreonam (Cayston®) |
| Budesonide/Formoterol Fumarate Dihydrate (Symbicort®) |
| Buprenorphine and Naloxone (Suboxone®) and Buprenorphine (Subutex®) |
| Bupropion hydrobromide extended-release (Aplenzin®) |
| Carglumic Acid (Carbaglu) |
| Certolizumab (Cimzia®) Prefilled Syringe |
| Clonidine (Kapvay) extended-release |
| Clonidine extended release (Nexiclon XR™) tablets |
| Colchicine (Colcrys™) |
| Contraceptive Agents |
| Controlled Substance Prior Authorization |
| Controlled Substance Quantity Limits |
| Cosmetic Policy |
| Cyclobenzaprine hydrochloride extended-release (Amrix®) |
| Cyclooxygenase-2 (COX-2) Inhibitors and Meloxicam (Mobic®) |
| Dabigatran (Pradaxa®) |
| Dalfampridine (Ampyra™) |
| Deferasirox (Exjade®) |
| Desvenlafaxine (Pristiq™) |
| Dextromethorphan hydrobromide and Quinidine sulfate (Nuedexta) |
| Diclofenac epolamine 1.3% (Flector® Patch) |
| Diclofenac potassium (Zipsor™) |
| Doxycycline hyclate (Alodox™) |
| Doxycycline monohydrate (Avidoxy™) |
| Doxycycline monohydrate 75 mg capsules convenience kit (Nutridox™) |
| Efalizumab (Raptiva®) |
| Etanercept (Enbrel®) |
| Fesoterodine fumarate extended-release (Toviaz™) |
| Fingolamod (Gilenya®) |
| Fluticasone Furoate (Veramyst®) Nasal Spray |
| Gender Edits |
| Golibumab (Simponi™) |
| Growth Hormones |
| Guanfacine Extended Release (Intuniv™) |
| Iloperidone (Fanapt™) |
| Injectable Fertility Medications |
| Insulin Glargine (Lantus®) |
| Intranasal Steroids |
| Isosorbide Dinitrate and Hydralazine Hydrochloride (BiDil®) |
| Lacosamide (Vimpat) (Oral) |
| Levetiracetam Extended-Release (Keppra XR™) |
| Levocetirizine (Xyzal®) |
| Liraglutide (Victoza®) |
| Lisdexamfetamine Dimesylate (Vyvanse®) |
| Lurasidone (Latuda) |
| Mecasermin (Increlex™) |
| Methylphenidate Transdermal System (Daytrana®) |
| Milnacipran HCl (Savella™) |
| Modafinil (Provigil®) |
| Nabilone (Cesamet®) |
| New Jersey Infant Formula Mandate |
| Nonformulary Medication Requests |
| Non-Preferred Diabetic Test Strips |
| Non-Preferred Insulins |
| Omalizumab (Xolair®) |
| Oral Chemotherapy Agents |
| Oral Diabetic Agents |
| Paliperidone (Invega®) |
| Palivizumab (Synagis®) |
Peginterferon alfa-2b (Sylatron) |
| Pramlintide (Symlin®/SymlinPen®) |
| Pregabalin (Lyrica®) |
| Quantity Level Limits for Pharmaceuticals Covered Under the Pharmacy Benefit |
| Quetiapine fumarate (Seroquel XR®) |
| Quinine Sulfate (Qualaquin™) |
| Ranolazine (Ranexa®) |
| Repaglinide and Metformin hydrochloride (PrandiMet™) |
| Rufinamide (Banzel™) |
| Schedule II Prior Authorization |
| Schedule II Quantity Level Limits |
| Sevelamer Carbonate (Renvela) |
| Sleep Agents |
| Sumatriptan and naproxen sodium (Treximet™) |
| Teriparatide (Forteo™) (rDNA origin) Injection |
| Tetrabenazine (Xenazine) |
| Topical Retinoid Products |
| Topotecan capsule (Hycamtin®) |
| Tramadol Extended-Release (ER) (Ultram ER®) |
| Tramadol Extended Release (Ryzolt) |
| Vigabatrin (Sabril®) |
| Weight Loss Agents |
