Targeted Immune Modulators
PDL Reference Documents
- Targeted Immune Modulators DERP Summary - Aug 01, 2024
- Severe Inflammatory Skin Disease Prior Authorization Update - Jun 01, 2023
- Targeted Immune Modulators DERP summary - Oct 06, 2022
- Targeted Immune Modulators Class update with Ozanimod PA update - Oct 07, 2021
- Biologics for Autoimmune Diseases DERP summary - Oct 01, 2020
- Biologics for Autoimmune Conditions - Feb 06, 2020
- Biologics for Autoimmune Conditions - Jan 24, 2019
- Hidradenitis Suppurativa - Nov 29, 2018
- Biologics for Autoimmune Conditions - Jan 25, 2018
- Biologics for Autoimmune Conditions - Jul 27, 2017
- Biologics for Autoimmune Conditions - Sep 29, 2016
- Biologics - Sep 23, 2014
- Abbreviated Class Update: Targeted Immune Modulators (TIMs) and New Drug Evaluation: Xeljanz (tofacitinib) - Mar 28, 2013
- DERP Drug Class Review Executive Summary: TIMs - Jun 28, 2012
- Conclusions and Recommendations: TIMs - Jun 28, 2012
- P&T Committee Brief: Targeted Immune Modulators (TIMs) - Jun 28, 2012
Drug Use Review Documents
Newsletters
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| NDC | Brand Name | Generic Name | Form | Strength | PDL Status |
Rebate | Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|
| 00003218851 | ORENCIA CLICKJECT | abatacept | AUTO INJCT | 125 mg/mL | N | Y | PA Document |
| 00003218890 | ORENCIA CLICKJECT | abatacept | AUTO INJCT | 125 mg/mL | N | Y | PA Document |
| 00003218811 | ORENCIA | abatacept | SYRINGE | 125 mg/mL | N | Y | PA Document |
| 00003218891 | ORENCIA | abatacept | SYRINGE | 125 mg/mL | N | Y | PA Document |
| 00003281411 | ORENCIA | abatacept | SYRINGE | 50 mg/0.4 mL | N | Y | PA Document |
| 00003281811 | ORENCIA | abatacept | SYRINGE | 87.5 mg/0.7 mL | N | Y | PA Document |
| 00003218713 | ORENCIA | abatacept/maltose | VIAL | 250 mg | N | Y | PA Document |
| 00074055402 | HUMIRA(CF) PEN | adalimumab | PEN IJ KIT | 40 mg/0.4 mL | Y | Y | PA Document |
| 00074055471 | HUMIRA(CF) PEN | adalimumab | PEN IJ KIT | 40 mg/0.4 mL | Y | Y | PA Document |
| 00074433901 | HUMIRA PEN | adalimumab | PEN IJ KIT | 40 mg/0.8 mL | Y | Y | PA Document |
| 00074433902 | HUMIRA PEN | adalimumab | PEN IJ KIT | 40 mg/0.8 mL | Y | Y | PA Document |
| 00074433974 | HUMIRA PEN | adalimumab | PEN IJ KIT | 40 mg/0.8 mL | Y | Y | PA Document |
| 00074012402 | HUMIRA(CF) PEN | adalimumab | PEN IJ KIT | 80 mg/0.8 mL | Y | Y | PA Document |
| 00074012474 | HUMIRA(CF) PEN | adalimumab | PEN IJ KIT | 80 mg/0.8 mL | Y | Y | PA Document |
| 00074012403 | HUMIRA(CF) PEN CROHN'S-UC-HS | adalimumab | PEN IJ KIT | 80 mg/0.8 mL | Y | Y | PA Document |
| 00074153903 | HUMIRA(CF) PEN PSOR-UV-ADOL HS | adalimumab | PEN IJ KIT | 80 mg/0.8 mL (x 1)-40 mg/0.4 mL (x 2) | Y | Y | PA Document |
| 00074081702 | HUMIRA(CF) | adalimumab | SYRINGEKIT | 10 mg/0.1 mL | Y | Y | PA Document |
| 00074061602 | HUMIRA(CF) | adalimumab | SYRINGEKIT | 20 mg/0.2 mL | Y | Y | PA Document |
| 00074024302 | HUMIRA(CF) | adalimumab | SYRINGEKIT | 40 mg/0.4 mL | Y | Y | PA Document |
| 00074379902 | HUMIRA | adalimumab | SYRINGEKIT | 40 mg/0.8 mL | Y | Y | PA Document |
| 65219061299 | ADALIMUMAB-AACF(CF) PEN (2 PK) | adalimumab-aacf | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 65219061289 | ADALIMUMAB-AACF(CF) PEN CROHNS | adalimumab-aacf | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 65219061269 | ADALIMUMAB-AACF(CF) PEN PS-UV | adalimumab-aacf | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 65219055408 | IDACIO(CF) PEN (2 PACK) | adalimumab-aacf | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 65219055438 | IDACIO(CF) PEN CROHN'S-UC(6PK) | adalimumab-aacf | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 65219055428 | IDACIO(CF) PEN PSORIASIS (4PK) | adalimumab-aacf | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 65219057404 | IDACIO(CF) PEN | adalimumab-aacf | PEN INJCTR | 40 mg/0.8 mL | N | Y | PA Document |
| 65219061802 | ADALIMUMAB-AACF(CF) | adalimumab-aacf | SYRINGE | 40 mg/0.8 mL | N | Y | PA Document |
| 65219062020 | ADALIMUMAB-AACF(CF) (2 PK) | adalimumab-aacf | SYRINGEKIT | 40 mg/0.8 mL | N | Y | PA Document |
| 72606002210 | ADALIMUMAB-AATY(CF) AUTOINJ(2) | adalimumab-aaty | AUTOINJKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 72606002209 | ADALIMUMAB-AATY(CF) AUTOINJECT | adalimumab-aaty | AUTOINJKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 72606003010 | YUFLYMA(CF) AUTOINJECT (2 PCK) | adalimumab-aaty | AUTOINJKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 72606003009 | YUFLYMA(CF) AUTOINJECTOR | adalimumab-aaty | AUTOINJKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 72606004006 | ADALIMUMAB-AATY(CF) AI CROHNS | adalimumab-aaty | AUTOINJKIT | 80 mg/0.8 mL | N | Y | PA Document |
| 72606004004 | ADALIMUMAB-AATY(CF) AUTOINJECT | adalimumab-aaty | AUTOINJKIT | 80 mg/0.8 mL | N | Y | PA Document |
| 72606002307 | YUFLYMA(CF) AI CROHN'S-UC-HS | adalimumab-aaty | AUTOINJKIT | 80 mg/0.8 mL | N | Y | PA Document |
| 72606002304 | YUFLYMA(CF) AUTOINJECTOR | adalimumab-aaty | AUTOINJKIT | 80 mg/0.8 mL | N | Y | PA Document |
| 72606004101 | ADALIMUMAB-AATY(CF) (2 PK) | adalimumab-aaty | SYRINGEKIT | 20 mg/0.2 mL | N | Y | PA Document |
| 72606002401 | YUFLYMA(CF) (2 PACK) | adalimumab-aaty | SYRINGEKIT | 20 mg/0.2 mL | N | Y | PA Document |
| 72606002206 | ADALIMUMAB-AATY(CF) (2 PACK) | adalimumab-aaty | SYRINGEKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 72606003006 | YUFLYMA(CF) (2 PACK) | adalimumab-aaty | SYRINGEKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 61314032720 | ADALIMUMAB-ADAZ(CF) PEN | adalimumab-adaz | PEN INJCTR | 40 mg/0.4 mL | N | Y | PA Document |
| 61314047320 | HYRIMOZ(CF) PEN | adalimumab-adaz | PEN INJCTR | 40 mg/0.4 mL | N | Y | PA Document |
| 61314047377 | HYRIMOZ(CF) PEN | adalimumab-adaz | PEN INJCTR | 40 mg/0.4 mL | N | Y | PA Document |
| 61314047392 | HYRIMOZ(CF) PEN | adalimumab-adaz | PEN INJCTR | 40 mg/0.4 mL | N | Y | PA Document |
| 61314032520 | ADALIMUMAB-ADAZ(CF) PEN | adalimumab-adaz | PEN INJCTR | 80 mg/0.8 mL | N | Y | PA Document |
| 61314032596 | ADALIMUMAB-ADAZ(CF) PEN | adalimumab-adaz | PEN INJCTR | 80 mg/0.8 mL | N | Y | PA Document |
| 61314045420 | HYRIMOZ(CF) PEN | adalimumab-adaz | PEN INJCTR | 80 mg/0.8 mL | N | Y | PA Document |
| 61314045436 | HYRIMOZ(CF) PEN CROHN-UC START | adalimumab-adaz | PEN INJCTR | 80 mg/0.8 mL | N | Y | PA Document |
| 61314051736 | HYRIMOZ(CF) PEN PSORIASIS | adalimumab-adaz | PEN INJCTR | 80 mg/0.8 mL (x 1)-40 mg/0.4 mL (x 2) | N | Y | PA Document |
| 61314039164 | ADALIMUMAB-ADAZ(CF) | adalimumab-adaz | SYRINGE | 10 mg/0.1 mL | N | Y | PA Document |
| 61314039194 | ADALIMUMAB-ADAZ(CF) | adalimumab-adaz | SYRINGE | 10 mg/0.1 mL | N | Y | PA Document |
| 61314050964 | HYRIMOZ(CF) | adalimumab-adaz | SYRINGE | 10 mg/0.1 mL | N | Y | PA Document |
| 61314033264 | ADALIMUMAB-ADAZ(CF) | adalimumab-adaz | SYRINGE | 20 mg/0.2 mL | N | Y | PA Document |
| 61314033294 | ADALIMUMAB-ADAZ(CF) | adalimumab-adaz | SYRINGE | 20 mg/0.2 mL | N | Y | PA Document |
| 61314047664 | HYRIMOZ(CF) | adalimumab-adaz | SYRINGE | 20 mg/0.2 mL | N | Y | PA Document |
| 61314032764 | ADALIMUMAB-ADAZ(CF) | adalimumab-adaz | SYRINGE | 40 mg/0.4 mL | N | Y | PA Document |
| 61314047364 | HYRIMOZ(CF) | adalimumab-adaz | SYRINGE | 40 mg/0.4 mL | N | Y | PA Document |
| 61314045468 | HYRIMOZ(CF) PEDIATRIC CROHN'S | adalimumab-adaz | SYRINGE | 80 mg/0.8 mL | N | Y | PA Document |
| 61314053164 | HYRIMOZ(CF) PEDIATRIC CROHN'S | adalimumab-adaz | SYRINGE | 80 mg/0.8 mL-40 mg/0.4 mL | N | Y | PA Document |
| 00597057550 | ADALIMUMAB-ADBM(CF) PEN | adalimumab-adbm | PEN IJ KIT | 40 mg/0.4 mL | N | Y | PA Document |
| 82009014422 | ADALIMUMAB-ADBM(CF) PEN | adalimumab-adbm | PEN IJ KIT | 40 mg/0.4 mL | N | Y | PA Document |
| 00597057560 | ADALIMUMAB-ADBM(CF) PEN CROHNS | adalimumab-adbm | PEN IJ KIT | 40 mg/0.4 mL | N | Y | PA Document |
| 00597057540 | ADALIMUMAB-ADBM(CF) PEN PS-UV | adalimumab-adbm | PEN IJ KIT | 40 mg/0.4 mL | N | Y | PA Document |
| 00597049550 | CYLTEZO(CF) PEN | adalimumab-adbm | PEN IJ KIT | 40 mg/0.4 mL | N | Y | PA Document |
| 00597049560 | CYLTEZO(CF) PEN CROHN'S-UC-HS | adalimumab-adbm | PEN IJ KIT | 40 mg/0.4 mL | N | Y | PA Document |
| 00597049540 | CYLTEZO(CF) PEN PSORIASIS-UV | adalimumab-adbm | PEN IJ KIT | 40 mg/0.4 mL | N | Y | PA Document |
| 00597054566 | ADALIMUMAB-ADBM(CF) PEN CROHNS | adalimumab-adbm | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00597054544 | ADALIMUMAB-ADBM(CF) PEN PS-UV | adalimumab-adbm | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00597054522 | ADALIMUMAB-ADBM(CF)PEN | adalimumab-adbm | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 82009014822 | ADALIMUMAB-ADBM(CF)PEN | adalimumab-adbm | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00597037597 | CYLTEZO(CF) PEN | adalimumab-adbm | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00597037516 | CYLTEZO(CF) PEN CROHN'S-UC-HS | adalimumab-adbm | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00597037523 | CYLTEZO(CF) PEN PSORIASIS-UV | adalimumab-adbm | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00597058589 | ADALIMUMAB-ADBM(CF) | adalimumab-adbm | SYRINGEKIT | 10 mg/0.2 mL | N | Y | PA Document |
| 00597040089 | CYLTEZO(CF) | adalimumab-adbm | SYRINGEKIT | 10 mg/0.2 mL | N | Y | PA Document |
| 00597055580 | ADALIMUMAB-ADBM(CF) | adalimumab-adbm | SYRINGEKIT | 20 mg/0.4 mL | N | Y | PA Document |
| 00597040580 | CYLTEZO(CF) | adalimumab-adbm | SYRINGEKIT | 20 mg/0.4 mL | N | Y | PA Document |
| 00597056520 | ADALIMUMAB-ADBM(CF) | adalimumab-adbm | SYRINGEKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 82009014622 | ADALIMUMAB-ADBM(CF) | adalimumab-adbm | SYRINGEKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 00597048520 | CYLTEZO(CF) | adalimumab-adbm | SYRINGEKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 00597059520 | ADALIMUMAB-ADBM(CF) | adalimumab-adbm | SYRINGEKIT | 40 mg/0.8 mL | N | Y | PA Document |
| 82009015022 | ADALIMUMAB-ADBM(CF) | adalimumab-adbm | SYRINGEKIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00597037082 | CYLTEZO(CF) | adalimumab-adbm | SYRINGEKIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00025032501 | ABRILADA(CF) PEN | adalimumab-afzb | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00069032501 | ABRILADA(CF) PEN | adalimumab-afzb | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00025032502 | ABRILADA(CF) PEN (2 PACK) | adalimumab-afzb | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00069032502 | ABRILADA(CF) PEN (2 PACK) | adalimumab-afzb | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00025033302 | ABRILADA(CF) | adalimumab-afzb | SYRINGEKIT | 20 mg/0.4 mL | N | Y | PA Document |
| 00069033302 | ABRILADA(CF) | adalimumab-afzb | SYRINGEKIT | 20 mg/0.4 mL | N | Y | PA Document |
| 00025032802 | ABRILADA(CF) | adalimumab-afzb | SYRINGEKIT | 40 mg/0.8 mL | N | Y | PA Document |
| 00069032802 | ABRILADA(CF) | adalimumab-afzb | SYRINGEKIT | 40 mg/0.8 mL | N | Y | PA Document |
| 70114022002 | YUSIMRY(CF) PEN | adalimumab-aqvh | PEN INJCTR | 40 mg/0.8 mL | N | Y | PA Document |
| 55513048201 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 40 mg/0.4 mL | Y | Y | PA Document |
| 55513048202 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 40 mg/0.4 mL | Y | Y | PA Document |
| 72511048201 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 40 mg/0.4 mL | Y | Y | PA Document |
| 72511048202 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 40 mg/0.4 mL | Y | Y | PA Document |
| 55513040001 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 40 mg/0.8 mL | N | Y | PA Document |
| 55513040002 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 40 mg/0.8 mL | N | Y | PA Document |
| 72511040001 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 40 mg/0.8 mL | N | Y | PA Document |
| 72511040002 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 40 mg/0.8 mL | N | Y | PA Document |
| 55513048101 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 80 mg/0.8 mL | Y | Y | PA Document |
| 55513048102 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 80 mg/0.8 mL | Y | Y | PA Document |
| 72511048101 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 80 mg/0.8 mL | Y | Y | PA Document |
| 72511048102 | AMJEVITA(CF) AUTOINJECTOR | adalimumab-atto | AUTO INJCT | 80 mg/0.8 mL | Y | Y | PA Document |
| 55513041301 | AMJEVITA(CF) | adalimumab-atto | SYRINGE | 10 mg/0.2 mL | N | Y | PA Document |
| 55513039901 | AMJEVITA(CF) | adalimumab-atto | SYRINGE | 20 mg/0.2 mL | Y | Y | PA Document |
| 72511039901 | AMJEVITA(CF) | adalimumab-atto | SYRINGE | 20 mg/0.2 mL | Y | Y | PA Document |
| 55513041101 | AMJEVITA(CF) | adalimumab-atto | SYRINGE | 20 mg/0.4 mL | N | Y | PA Document |
| 55513047901 | AMJEVITA(CF) | adalimumab-atto | SYRINGE | 40 mg/0.4 mL | Y | Y | PA Document |
| 55513047902 | AMJEVITA(CF) | adalimumab-atto | SYRINGE | 40 mg/0.4 mL | Y | Y | PA Document |
| 72511047901 | AMJEVITA(CF) | adalimumab-atto | SYRINGE | 40 mg/0.4 mL | Y | Y | PA Document |
| 72511047902 | AMJEVITA(CF) | adalimumab-atto | SYRINGE | 40 mg/0.4 mL | Y | Y | PA Document |
| 55513041001 | AMJEVITA(CF) | adalimumab-atto | SYRINGE | 40 mg/0.8 mL | N | Y | PA Document |
| 78206018701 | HADLIMA(CF) PUSHTOUCH | adalimumab-bwwd | AUTO INJCT | 40 mg/0.4 mL | N | Y | PA Document |
| 78206018799 | HADLIMA(CF) PUSHTOUCH | adalimumab-bwwd | AUTO INJCT | 40 mg/0.4 mL | N | Y | PA Document |
| 78206018401 | HADLIMA PUSHTOUCH | adalimumab-bwwd | AUTO INJCT | 40 mg/0.8 mL | N | Y | PA Document |
| 78206018499 | HADLIMA PUSHTOUCH | adalimumab-bwwd | AUTO INJCT | 40 mg/0.8 mL | N | Y | PA Document |
| 78206018601 | HADLIMA(CF) | adalimumab-bwwd | SYRINGE | 40 mg/0.4 mL | N | Y | PA Document |
| 78206018699 | HADLIMA(CF) | adalimumab-bwwd | SYRINGE | 40 mg/0.4 mL | N | Y | PA Document |
| 78206018301 | HADLIMA | adalimumab-bwwd | SYRINGE | 40 mg/0.8 mL | N | Y | PA Document |
| 78206018399 | HADLIMA | adalimumab-bwwd | SYRINGE | 40 mg/0.8 mL | N | Y | PA Document |
| 49502041602 | ADALIMUMAB-FKJP(CF) PEN | adalimumab-fkjp | PEN IJ KIT | 40 mg/0.8 mL | Y | Y | PA Document |
| 83257002232 | ADALIMUMAB-FKJP(CF) PEN | adalimumab-fkjp | PEN IJ KIT | 40 mg/0.8 mL | Y | Y | PA Document |
| 49502038002 | HULIO(CF) PEN | adalimumab-fkjp | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 83257001932 | HULIO(CF) PEN | adalimumab-fkjp | PEN IJ KIT | 40 mg/0.8 mL | N | Y | PA Document |
| 49502041606 | ADALIMUMAB-FKJP(CF) PEN | adalimumab-fkjp | PEN INJCTR | 40 mg/0.8 mL | Y | Y | PA Document |
| 49502038006 | HULIO(CF) PEN | adalimumab-fkjp | PEN INJCTR | 40 mg/0.8 mL | N | Y | PA Document |
| 49502041706 | ADALIMUMAB-FKJP(CF) | adalimumab-fkjp | SYRINGE | 20 mg/0.4 mL | Y | Y | PA Document |
| 49502038106 | HULIO(CF) | adalimumab-fkjp | SYRINGE | 20 mg/0.4 mL | N | Y | PA Document |
| 49502041806 | ADALIMUMAB-FKJP(CF) | adalimumab-fkjp | SYRINGE | 40 mg/0.8 mL | Y | Y | PA Document |
| 49502038206 | HULIO(CF) | adalimumab-fkjp | SYRINGE | 40 mg/0.8 mL | N | Y | PA Document |
| 49502041702 | ADALIMUMAB-FKJP(CF) | adalimumab-fkjp | SYRINGEKIT | 20 mg/0.4 mL | Y | Y | PA Document |
| 83257002042 | ADALIMUMAB-FKJP(CF) | adalimumab-fkjp | SYRINGEKIT | 20 mg/0.4 mL | Y | Y | PA Document |
| 49502038102 | HULIO(CF) | adalimumab-fkjp | SYRINGEKIT | 20 mg/0.4 mL | N | Y | PA Document |
| 83257001642 | HULIO(CF) | adalimumab-fkjp | SYRINGEKIT | 20 mg/0.4 mL | N | Y | PA Document |
| 49502041802 | ADALIMUMAB-FKJP(CF) | adalimumab-fkjp | SYRINGEKIT | 40 mg/0.8 mL | Y | Y | PA Document |
| 83257002142 | ADALIMUMAB-FKJP(CF) | adalimumab-fkjp | SYRINGEKIT | 40 mg/0.8 mL | Y | Y | PA Document |
| 49502038202 | HULIO(CF) | adalimumab-fkjp | SYRINGEKIT | 40 mg/0.8 mL | N | Y | PA Document |
| 83257001742 | HULIO(CF) | adalimumab-fkjp | SYRINGEKIT | 40 mg/0.8 mL | N | Y | PA Document |
| 82009015622 | ADALIMUMAB-RYVK(CF) AUTOINJECT | adalimumab-ryvk | AUTOINJKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 51759040202 | SIMLANDI(CF) AUTOINJECTOR | adalimumab-ryvk | AUTOINJKIT | 40 mg/0.4 mL | Y | Y | PA Document |
| 51759040217 | SIMLANDI(CF) AUTOINJECTOR | adalimumab-ryvk | AUTOINJKIT | 40 mg/0.4 mL | Y | Y | PA Document |
| 51759051321 | SIMLANDI(CF) AUTOINJECTOR | adalimumab-ryvk | AUTOINJKIT | 40 mg/0.4 mL | Y | Y | PA Document |
| 51759027417 | SIMLANDI(CF) AUTOINJECTOR | adalimumab-ryvk | AUTOINJKIT | 80 mg/0.8 mL | Y | Y | PA Document |
| 51759038421 | SIMLANDI(CF) AUTOINJECTOR | adalimumab-ryvk | AUTOINJKIT | 80 mg/0.8 mL | Y | Y | PA Document |
| 51759038622 | SIMLANDI(CF) | adalimumab-ryvk | SYRINGEKIT | 20 mg/0.2 mL | Y | Y | PA Document |
| 51759049731 | SIMLANDI(CF) | adalimumab-ryvk | SYRINGEKIT | 20 mg/0.2 mL | Y | Y | PA Document |
| 82009015822 | ADALIMUMAB-RYVK(CF) | adalimumab-ryvk | SYRINGEKIT | 40 mg/0.4 mL | N | Y | PA Document |
| 51759041222 | SIMLANDI(CF) | adalimumab-ryvk | SYRINGEKIT | 40 mg/0.4 mL | Y | Y | PA Document |
| 51759062431 | SIMLANDI(CF) | adalimumab-ryvk | SYRINGEKIT | 40 mg/0.4 mL | Y | Y | PA Document |
| 51759052321 | SIMLANDI(CF) | adalimumab-ryvk | SYRINGEKIT | 80 mg/0.8 mL | Y | Y | PA Document |
| 51759063431 | SIMLANDI(CF) | adalimumab-ryvk | SYRINGEKIT | 80 mg/0.8 mL | Y | Y | PA Document |
| 66658023401 | KINERET | anakinra | SYRINGE | 100 mg/0.67 mL | N | Y | PA Document |
| 66658023407 | KINERET | anakinra | SYRINGE | 100 mg/0.67 mL | N | Y | PA Document |
| 55513048595 | OTEZLA | apremilast | TAB DS PK | 10 mg (4)-20 mg (4)-30 mg (19) | Y | Y | PA Document |
| 55513036955 | OTEZLA | apremilast | TAB DS PK | 10 mg (4)-20 mg (4)-30 mg (47) | Y | Y | PA Document |
| 55513050855 | OTEZLA | apremilast | TAB DS PK | 10 mg (4)-20 mg (51) | Y | Y | PA Document |
| 55513049760 | OTEZLA | apremilast | TABLET | 20 mg | Y | Y | PA Document |
| 55513013728 | OTEZLA | apremilast | TABLET | 30 mg | Y | Y | PA Document |
| 55513013750 | OTEZLA | apremilast | TABLET | 30 mg | Y | Y | PA Document |
| 55513013760 | OTEZLA | apremilast | TABLET | 30 mg | Y | Y | PA Document |
| 00002473230 | OLUMIANT | baricitinib | TABLET | 1 mg | N | Y | PA Document |
| 00002418230 | OLUMIANT | baricitinib | TABLET | 2 mg | N | Y | PA Document |
| 00002447930 | OLUMIANT | baricitinib | TABLET | 4 mg | N | Y | PA Document |
| 50474078184 | BIMZELX AUTOINJECTOR | bimekizumab-bkzx | AUTO INJCT | 160 mg/mL | N | Y | PA Document |
| 50474078185 | BIMZELX AUTOINJECTOR | bimekizumab-bkzx | AUTO INJCT | 160 mg/mL | N | Y | PA Document |
| 50474078284 | BIMZELX AUTOINJECTOR | bimekizumab-bkzx | AUTO INJCT | 320 mg/2 mL | N | Y | PA Document |
| 50474078078 | BIMZELX | bimekizumab-bkzx | SYRINGE | 160 mg/mL | N | Y | PA Document |
| 50474078079 | BIMZELX | bimekizumab-bkzx | SYRINGE | 160 mg/mL | N | Y | PA Document |
| 50474078378 | BIMZELX | bimekizumab-bkzx | SYRINGE | 320 mg/2 mL | N | Y | PA Document |
| 00187000400 | SILIQ | brodalumab | SYRINGE | 210 mg/1.5 mL | N | Y | PA Document |
| 00187000402 | SILIQ | brodalumab | SYRINGE | 210 mg/1.5 mL | N | Y | PA Document |
| 00078073461 | ILARIS | canakinumab/PF | VIAL | 150 mg/mL | N | Y | PA Document |
| 50474070062 | CIMZIA (2 PACK) | certolizumab pegol | KIT | 400 mg (200 mg X 2) | N | Y | PA Document |
| 50474075010 | CIMZIA | certolizumab pegol | SYRINGEKIT | 200 mg/mL | N | Y | PA Document |
| 50474071081 | CIMZIA | certolizumab pegol | SYRINGEKIT | 400 mg/2 mL (200 mg/mL X 2) | N | Y | PA Document |
| 50474071079 | CIMZIA (2 PACK) | certolizumab pegol | SYRINGEKIT | 400 mg/2 mL (200 mg/mL X 2) | N | Y | PA Document |
| 00003089511 | SOTYKTU | deucravacitinib | TABLET | 6 mg | N | Y | PA Document |
| 00003089591 | SOTYKTU | deucravacitinib | TABLET | 6 mg | N | Y | PA Document |
| 58406004401 | ENBREL MINI | etanercept | CARTRIDGE | 50 mg/mL (1 mL) | Y | Y | PA Document |
| 58406004404 | ENBREL MINI | etanercept | CARTRIDGE | 50 mg/mL (1 mL) | Y | Y | PA Document |
| 58406004496 | ENBREL MINI | etanercept | CARTRIDGE | 50 mg/mL (1 mL) | Y | Y | PA Document |
| 58406003201 | ENBREL SURECLICK | etanercept | PEN INJCTR | 50 mg/mL (1 mL) | Y | Y | PA Document |
| 58406003204 | ENBREL SURECLICK | etanercept | PEN INJCTR | 50 mg/mL (1 mL) | Y | Y | PA Document |
| 58406003296 | ENBREL SURECLICK | etanercept | PEN INJCTR | 50 mg/mL (1 mL) | Y | Y | PA Document |
| 58406001001 | ENBREL | etanercept | SYRINGE | 25 mg/0.5 mL (0.5 mL) | Y | Y | PA Document |
| 58406001004 | ENBREL | etanercept | SYRINGE | 25 mg/0.5 mL (0.5 mL) | Y | Y | PA Document |
| 58406001096 | ENBREL | etanercept | SYRINGE | 25 mg/0.5 mL (0.5 mL) | Y | Y | PA Document |
| 58406002101 | ENBREL | etanercept | SYRINGE | 50 mg/mL (1 mL) | Y | Y | PA Document |
| 58406002104 | ENBREL | etanercept | SYRINGE | 50 mg/mL (1 mL) | Y | Y | PA Document |
| 58406002196 | ENBREL | etanercept | SYRINGE | 50 mg/mL (1 mL) | Y | Y | PA Document |
| 58406005501 | ENBREL | etanercept | VIAL | 25 mg/0.5 mL | Y | Y | PA Document |
| 58406005504 | ENBREL | etanercept | VIAL | 25 mg/0.5 mL | Y | Y | PA Document |
| 00069027430 | VELSIPITY | etrasimod arginine | TABLET | 2 mg | N | Y | PA Document |
| 57894007102 | SIMPONI | golimumab | PEN INJCTR | 100 mg/mL | N | Y | PA Document |
| 57894007002 | SIMPONI | golimumab | PEN INJCTR | 50 mg/0.5 mL | N | Y | PA Document |
| 57894007101 | SIMPONI | golimumab | SYRINGE | 100 mg/mL | N | Y | PA Document |
| 57894007001 | SIMPONI | golimumab | SYRINGE | 50 mg/0.5 mL | N | Y | PA Document |
| 57894035001 | SIMPONI ARIA | golimumab | VIAL | 50 mg/4 mL (12.5 mg/mL) | N | Y | PA Document |
| 57894064011 | TREMFYA ONE-PRESS | guselkumab | AUTO INJCT | 100 mg/mL | N | Y | PA Document |
| 57894064003 | TREMFYA PEN | guselkumab | PEN INJCTR | 100 mg/mL | N | Y | PA Document |
| 57894064006 | TREMFYA PEN | guselkumab | PEN INJCTR | 100 mg/mL | N | Y | PA Document |
| 57894065101 | TREMFYA PEN | guselkumab | PEN INJCTR | 200 mg/2 mL | N | Y | PA Document |
| 57894065102 | TREMFYA PEN | guselkumab | PEN INJCTR | 200 mg/2 mL | N | Y | PA Document |
| 57894065104 | TREMFYA PEN INDUCTION PK-CROHN | guselkumab | PEN INJCTR | 200 mg/2 mL | N | Y | PA Document |
| 57894064001 | TREMFYA | guselkumab | SYRINGE | 100 mg/mL | N | Y | PA Document |
| 57894065111 | TREMFYA | guselkumab | SYRINGE | 200 mg/2 mL | N | Y | PA Document |
| 57894065122 | TREMFYA | guselkumab | SYRINGE | 200 mg/2 mL | N | Y | PA Document |
| 57894065001 | TREMFYA | guselkumab | VIAL | 200 mg/20 mL (10 mg/mL) | N | Y | PA Document |
| 57894065002 | TREMFYA | guselkumab | VIAL | 200 mg/20 mL (10 mg/mL) | N | Y | PA Document |
| 57894016001 | INFLIXIMAB | infliximab | VIAL | 100 mg | N | Y | PA Document |
| 57894003001 | REMICADE | infliximab | VIAL | 100 mg | N | Y | PA Document |
| 78206016201 | RENFLEXIS | infliximab-abda | VIAL | 100 mg | N | Y | PA Document |
| 78206016299 | RENFLEXIS | infliximab-abda | VIAL | 100 mg | N | Y | PA Document |
| 55513067001 | AVSOLA | infliximab-axxq | VIAL | 100 mg | Y | Y | PA Document |
| 72606002501 | ZYMFENTRA | infliximab-dyyb | PEN IJ KIT | 120 mg/mL | N | Y | PA Document |
| 72606002502 | ZYMFENTRA PEN (2 PACK) | infliximab-dyyb | PEN IJ KIT | 120 mg/mL | N | Y | PA Document |
| 72606002510 | ZYMFENTRA (2 PACK) | infliximab-dyyb | SYRINGEKIT | 120 mg/mL | N | Y | PA Document |
| 00069080901 | INFLECTRA | infliximab-dyyb | VIAL | 100 mg | N | Y | PA Document |
| 00002144501 | TALTZ AUTOINJECTOR | ixekizumab | AUTO INJCT | 80 mg/mL | Y | Y | PA Document |
| 00002144511 | TALTZ AUTOINJECTOR | ixekizumab | AUTO INJCT | 80 mg/mL | Y | Y | PA Document |
| 00002144527 | TALTZ AUTOINJECTOR (2 PACK) | ixekizumab | AUTO INJCT | 80 mg/mL | Y | Y | PA Document |
| 00002144509 | TALTZ AUTOINJECTOR (3 PACK) | ixekizumab | AUTO INJCT | 80 mg/mL | Y | Y | PA Document |
| 00002890011 | TALTZ SYRINGE | ixekizumab | SYRINGE | 20 mg/0.25 mL | Y | Y | PA Document |
| 00002890501 | TALTZ SYRINGE | ixekizumab | SYRINGE | 40 mg/0.5 mL | Y | Y | PA Document |
| 00002890511 | TALTZ SYRINGE | ixekizumab | SYRINGE | 40 mg/0.5 mL | Y | Y | PA Document |
| 00002772401 | TALTZ SYRINGE | ixekizumab | SYRINGE | 80 mg/mL | Y | Y | PA Document |
| 00002772411 | TALTZ SYRINGE | ixekizumab | SYRINGE | 80 mg/mL | Y | Y | PA Document |
| 00002801101 | OMVOH PEN | mirikizumab-mrkz | PEN INJCTR | 100 mg/mL | N | Y | PA Document |
| 00002801127 | OMVOH PEN | mirikizumab-mrkz | PEN INJCTR | 100 mg/mL | N | Y | PA Document |
| 00002311601 | OMVOH PEN | mirikizumab-mrkz | PEN INJCTR | 200 mg/2 mL | N | Y | PA Document |
| 00002771711 | OMVOH PEN | mirikizumab-mrkz | PEN INJCTR | 300 mg/3 mL (100 mg/mL x 1 and 200 mg/2 mL x 1) | N | Y | PA Document |
| 00002887001 | OMVOH | mirikizumab-mrkz | SYRINGE | 100 mg/mL | N | Y | PA Document |
| 00002887027 | OMVOH | mirikizumab-mrkz | SYRINGE | 100 mg/mL | N | Y | PA Document |
| 00002144201 | OMVOH | mirikizumab-mrkz | SYRINGE | 200 mg/2 mL | N | Y | PA Document |
| 00002772211 | OMVOH | mirikizumab-mrkz | SYRINGE | 300 mg/3 mL (100 mg/mL x 1 and 200 mg/2 mL x 1) | N | Y | PA Document |
| 00002757501 | OMVOH | mirikizumab-mrkz | VIAL | 300 mg/15 mL (20 mg/mL) | N | Y | PA Document |
| 64406000801 | TYSABRI | natalizumab | VIAL | 300 mg/15 mL | N | Y | PA Document |
| 00074210001 | SKYRIZI PEN | risankizumab-rzaa | PEN INJCTR | 150 mg/mL | N | Y | PA Document |
| 00074105001 | SKYRIZI | risankizumab-rzaa | SYRINGE | 150 mg/mL | N | Y | PA Document |
| 00074501501 | SKYRIZI | risankizumab-rzaa | VIAL | 600 mg/10 mL (60 mg/mL) | N | Y | PA Document |
| 00074106501 | SKYRIZI ON-BODY | risankizumab-rzaa | WEAR INJCT | 180 mg/1.2 mL (150 mg/mL) | N | Y | PA Document |
| 00074106601 | SKYRIZI ON-BODY | risankizumab-rzaa | WEAR INJCT | 180 mg/1.2 mL (150 mg/mL) | N | Y | PA Document |
| 00074106901 | SKYRIZI ON-BODY | risankizumab-rzaa | WEAR INJCT | 360 mg/2.4 mL (150 mg/mL) | N | Y | PA Document |
| 00074107001 | SKYRIZI ON-BODY | risankizumab-rzaa | WEAR INJCT | 360 mg/2.4 mL (150 mg/mL) | N | Y | PA Document |
| 50242005121 | RITUXAN | rituximab | VIAL | 10 mg/mL | N | Y | PA Document |
| 50242005306 | RITUXAN | rituximab | VIAL | 10 mg/mL | N | Y | PA Document |
| 63459010310 | TRUXIMA | rituximab-abbs | VIAL | 10 mg/mL | N | Y | PA Document |
| 63459010450 | TRUXIMA | rituximab-abbs | VIAL | 10 mg/mL | N | Y | PA Document |
| 55513022401 | RIABNI | rituximab-arrx | VIAL | 10 mg/mL | N | Y | PA Document |
| 55513032601 | RIABNI | rituximab-arrx | VIAL | 10 mg/mL | N | Y | PA Document |
| 00069023801 | RUXIENCE | rituximab-pvvr | VIAL | 10 mg/mL | N | Y | PA Document |
| 00069024901 | RUXIENCE | rituximab-pvvr | VIAL | 10 mg/mL | N | Y | PA Document |
| 00024592001 | KEVZARA | sarilumab | PEN INJCTR | 150 mg/1.14 mL | N | Y | PA Document |
| 00024592201 | KEVZARA | sarilumab | PEN INJCTR | 200 mg/1.14 mL | N | Y | PA Document |
| 00024590801 | KEVZARA | sarilumab | SYRINGE | 150 mg/1.14 mL | N | Y | PA Document |
| 00024591001 | KEVZARA | sarilumab | SYRINGE | 200 mg/1.14 mL | N | Y | PA Document |
| 00078063941 | COSENTYX SENSOREADY (2 PENS) | secukinumab | PEN INJCTR | 150 mg/mL | N | Y | PA Document |
| 00078063968 | COSENTYX SENSOREADY PEN | secukinumab | PEN INJCTR | 150 mg/mL | N | Y | PA Document |
| 00078107068 | COSENTYX UNOREADY PEN | secukinumab | PEN INJCTR | 300 mg/2 mL | N | Y | PA Document |
| 00078107096 | COSENTYX UNOREADY PEN | secukinumab | PEN INJCTR | 300 mg/2 mL | N | Y | PA Document |
| 00078063998 | COSENTYX (2 SYRINGES) | secukinumab | SYRINGE | 150 mg/mL | N | Y | PA Document |
| 00078063997 | COSENTYX SYRINGE | secukinumab | SYRINGE | 150 mg/mL | N | Y | PA Document |
| 00078105697 | COSENTYX SYRINGE | secukinumab | SYRINGE | 75 mg/0.5 mL | N | Y | PA Document |
| 00078116861 | COSENTYX | secukinumab | VIAL | 125 mg/5 mL (25 mg/mL) | N | Y | PA Document |
| 00597062010 | SPEVIGO | spesolimab-sbzo | SYRINGE | 150 mg/mL | N | Y | PA Document |
| 00597062020 | SPEVIGO | spesolimab-sbzo | SYRINGE | 150 mg/mL | N | Y | PA Document |
| 00597770538 | SPEVIGO | spesolimab-sbzo | SYRINGE | 300 mg/2 mL | N | Y | PA Document |
| 00597770541 | SPEVIGO | spesolimab-sbzo | SYRINGE | 300 mg/2 mL | N | Y | PA Document |
| 00597770572 | SPEVIGO | spesolimab-sbzo | SYRINGE | 300 mg/2 mL | N | Y | PA Document |
| 00597003510 | SPEVIGO | spesolimab-sbzo | VIAL | 450 mg/7.5 mL (60 mg/mL) | N | Y | PA Document |
| 47335017701 | ILUMYA | tildrakizumab-asmn | SYRINGE | 100 mg/mL | N | Y | PA Document |
| 47335017710 | ILUMYA | tildrakizumab-asmn | SYRINGE | 100 mg/mL | N | Y | PA Document |
| 47335017795 | ILUMYA | tildrakizumab-asmn | SYRINGE | 100 mg/mL | N | Y | PA Document |
| 47335017796 | ILUMYA | tildrakizumab-asmn | SYRINGE | 100 mg/mL | N | Y | PA Document |
| 50242014301 | ACTEMRA ACTPEN | tocilizumab | PEN INJCTR | 162 mg/0.9 mL | N | Y | PA Document |
| 50242013801 | ACTEMRA | tocilizumab | SYRINGE | 162 mg/0.9 mL | N | Y | PA Document |
| 50242013886 | ACTEMRA | tocilizumab | SYRINGE | 162 mg/0.9 mL | N | Y | PA Document |
| 50242013601 | ACTEMRA | tocilizumab | VIAL | 200 mg/10 mL (20 mg/mL) | N | Y | PA Document |
| 50242013701 | ACTEMRA | tocilizumab | VIAL | 400 mg/20 mL (20 mg/mL) | N | Y | PA Document |
| 50242013501 | ACTEMRA | tocilizumab | VIAL | 80 mg/4 mL (20 mg/mL) | N | Y | PA Document |
| 65219058401 | TYENNE AUTOINJECTOR | tocilizumab-aazg | PEN INJCTR | 162 mg/0.9 mL | N | Y | PA Document |
| 65219058604 | TYENNE | tocilizumab-aazg | SYRINGE | 162 mg/0.9 mL | N | Y | PA Document |
| 65219059810 | TYENNE | tocilizumab-aazg | SYRINGE | 162 mg/0.9 mL | Y | PA Document | |
| 65219059210 | TYENNE | tocilizumab-aazg | VIAL | 200 mg/10 mL (20 mg/mL) | N | Y | PA Document |
| 65219059420 | TYENNE | tocilizumab-aazg | VIAL | 400 mg/20 mL (20 mg/mL) | N | Y | PA Document |
| 65219059004 | TYENNE | tocilizumab-aazg | VIAL | 80 mg/4 mL (20 mg/mL) | N | Y | PA Document |
| 64406002201 | TOFIDENCE | tocilizumab-bavi | VIAL | 200 mg/10 mL (20 mg/mL) | N | Y | PA Document |
| 64406002301 | TOFIDENCE | tocilizumab-bavi | VIAL | 400 mg/20 mL (20 mg/mL) | N | Y | PA Document |
| 64406002401 | TOFIDENCE | tocilizumab-bavi | VIAL | 80 mg/4 mL (20 mg/mL) | N | Y | PA Document |
| 00069102901 | XELJANZ | tofacitinib citrate | SOLUTION | 1 mg/mL | Y | Y | PA Document |
| 00069102902 | XELJANZ | tofacitinib citrate | SOLUTION | 1 mg/mL | Y | Y | PA Document |
| 00069050114 | XELJANZ XR | tofacitinib citrate | TAB ER 24H | 11 mg | Y | Y | PA Document |
| 00069050130 | XELJANZ XR | tofacitinib citrate | TAB ER 24H | 11 mg | Y | Y | PA Document |
| 00069050230 | XELJANZ XR | tofacitinib citrate | TAB ER 24H | 22 mg | Y | Y | PA Document |
| 00069100201 | XELJANZ | tofacitinib citrate | TABLET | 10 mg | Y | Y | PA Document |
| 00069100101 | XELJANZ | tofacitinib citrate | TABLET | 5 mg | Y | Y | PA Document |
| 00074232001 | RINVOQ LQ | upadacitinib | SOLUTION | 1 mg/mL | N | Y | PA Document |
| 00074230630 | RINVOQ | upadacitinib | TAB ER 24H | 15 mg | N | Y | PA Document |
| 00074230670 | RINVOQ | upadacitinib | TAB ER 24H | 15 mg | N | Y | PA Document |
| 00074231030 | RINVOQ | upadacitinib | TAB ER 24H | 30 mg | N | Y | PA Document |
| 00074104328 | RINVOQ | upadacitinib | TAB ER 24H | 45 mg | N | Y | PA Document |
| 57894006003 | STELARA | ustekinumab | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 57894006004 | STELARA | ustekinumab | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 57894044001 | USTEKINUMAB | ustekinumab | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 57894006103 | STELARA | ustekinumab | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 57894006104 | STELARA | ustekinumab | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 57894044101 | USTEKINUMAB | ustekinumab | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 57894005416 | STELARA | ustekinumab | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 57894005427 | STELARA | ustekinumab | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 57894044401 | USTEKINUMAB | ustekinumab | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 57894006002 | STELARA | ustekinumab | VIAL | 45 mg/0.5 mL | N | Y | PA Document |
| 57894044003 | USTEKINUMAB | ustekinumab | VIAL | 45 mg/0.5 mL | N | Y | PA Document |
| 65219082401 | OTULFI | ustekinumab-aauz | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 65219082626 | OTULFI | ustekinumab-aauz | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 65219082805 | OTULFI | ustekinumab-aauz | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 51759050532 | SELARSDI | ustekinumab-aekn | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 51759070932 | USTEKINUMAB-AEKN | ustekinumab-aekn | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 51759060732 | SELARSDI | ustekinumab-aekn | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 51759071032 | USTEKINUMAB-AEKN | ustekinumab-aekn | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 51759070813 | SELARSDI | ustekinumab-aekn | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 83257002341 | YESINTEK | ustekinumab-kfce | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 83257002541 | YESINTEK | ustekinumab-kfce | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 83257002611 | YESINTEK | ustekinumab-kfce | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 83257002411 | YESINTEK | ustekinumab-kfce | VIAL | 45 mg/0.5 mL | N | Y | PA Document |
| 69448001763 | IMULDOSA | ustekinumab-srlf | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 69448001863 | IMULDOSA | ustekinumab-srlf | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 69448001926 | IMULDOSA | ustekinumab-srlf | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 72606002701 | STEQEYMA | ustekinumab-stba | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 72606002801 | STEQEYMA | ustekinumab-stba | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 72606002901 | STEQEYMA | ustekinumab-stba | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 61314065101 | PYZCHIVA | ustekinumab-ttwe | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 82009016011 | USTEKINUMAB-TTWE | ustekinumab-ttwe | SYRINGE | 45 mg/0.5 mL | N | Y | PA Document |
| 61314065201 | PYZCHIVA | ustekinumab-ttwe | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 82009016211 | USTEKINUMAB-TTWE | ustekinumab-ttwe | SYRINGE | 90 mg/mL | N | Y | PA Document |
| 61314065494 | PYZCHIVA | ustekinumab-ttwe | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 82009016394 | USTEKINUMAB-TTWE | ustekinumab-ttwe | VIAL | 130 mg/26 mL | N | Y | PA Document |
| 61314065194 | PYZCHIVA | ustekinumab-ttwe | VIAL | 45 mg/0.5 mL | N | Y | PA Document |
| 64764010820 | ENTYVIO PEN | vedolizumab | PEN INJCTR | 108 mg/0.68 mL | N | Y | PA Document |
| 64764010821 | ENTYVIO PEN | vedolizumab | PEN INJCTR | 108 mg/0.68 mL | N | Y | PA Document |
| 64764030020 | ENTYVIO | vedolizumab | VIAL | 300 mg | N | Y | PA Document |