Drug - Brand Name (Generic Name) PA Status Class Drug Notes "electrolye solution, pediatric *, A90" ELECTROLYTES AND NUTRIENTS "*, A90" Engerix-B (hepatitis B recombinant vaccine) 1 BIOLOGICAL 1 Eylea (aflibercept) MB OPHTHALMIC PREPARATIONS MB Erwinase (asparaginase erwinia chrysanthemi) MB - PA PA ANTINEOPLASTICS MB Erbitux (cetuximab) MB CHEMOTHERAPY MB ecallantide MB - PA PA ENZYMES MB eculizumab MB - PA PA BIOLOGICAL MB efgartigimod alfa-fcab MB - PA PA BIOLOGICAL MB efgartigimod alfa-fcab and hyaluronidase-qvfc MB - PA PA BIOLOGICAL MB eflapegrastim-xnst MB HEMATINICS & BLOOD CELL STIMULATORS MB elosulfase alfa MB - PA PA ENZYMES MB elotuzumab MB - PA PA CHEMOTHERAPY MB Empliciti (elotuzumab) MB - PA PA CHEMOTHERAPY MB enfortumab vedotin-ejfv MB - PA PA CHEMOTHERAPY MB epcoritamab-bysp MB - PA PA ANTINEOPLASTICS MB Epkinly (epcoritamab-bysp) MB - PA PA ANTINEOPLASTICS MB eptinezumab-jjmr MB - PA PA CALCITONIN GENE-RELATED PEPTIDE INHIBITOR MB eribulin MB - PA PA CHEMOTHERAPY MB etelcalcetide MB CALCIMIMETIC MB etoposide injection MB CHEMOTHERAPY MB etoposide phosphate MB - PA PA CHEMOTHERAPY MB Etopophos (etoposide phosphate) MB - PA PA CHEMOTHERAPY MB evinacumab-dgnb MB - PA PA LIPID LOWERING AGENTS MB Evkeeza (evinacumab-dgnb) MB - PA PA LIPID LOWERING AGENTS MB Enhertu (fam-trastuzumab deruxtecan-nxki) MB - PA PA CHEMOTHERAPY MB Euflexxa (hyaluronate-Euflexxa) MB - PA PA HYALURONAN MB Elaprase (idursulfase) MB - PA PA ENZYMES MB Evomela (melphalan injection) MB CHEMOTHERAPY MB Elahere (mirvetuximab soravtansine-gynx) MB - PA PA CHEMOTHERAPY MB Elitek (rasburicase) MB ENZYMES MB Enjaymo (sutimlimab-jome) MB - PA PA BIOLOGICAL MB Elzonris (tagraxofusp-erzs) MB - PA PA CHEMOTHERAPY MB Elelyso (taliglucerase alfa) MB - PA PA ENZYMES MB enoxaparin ANTICOAGULANTS # epinephrine 0.15 mg auto-injection-Epipen Jr ADRENERGICS # Epipen Jr # (epinephrine 0.15 mg auto-injection-Epipen Jr) ADRENERGICS # epinephrine 0.3 mg auto-injection-Epipen ADRENERGICS # Epipen # (epinephrine 0.3 mg auto-injection-Epipen) ADRENERGICS # epirubicin CHEMOTHERAPY # Ellence # (epirubicin) CHEMOTHERAPY # epoprostenol-Flolan CARDIOVASCULAR # ertapenem ANTIBIOTICS # esmolol CARDIOVASCULAR # estradiol-Delestrogen HORMONE REPLACEMENT THERAPY # eszopiclone - PA 1 unit/day; See Table 15; See Table 71 PA 1 unit/day SEDATIVES # Emend # (fosaprepitant injection) - PA > 2 vials/28 days PA > 2 vials/28 days ANTIEMETICS # "eplerenone BP, M90" ALDOSTERONE ANTAGONISTS "BP, M90" "esomeprazole magnesium 10 mg, 20 mg, 40 mg suspension BP, M90" PROTON PUMP INHIBITORS "BP, M90" "Emend (aprepitant trifold pack) BP, A90 - PA > 2 packs/28 days" PA > 2 packs/28 days ANTIEMETICS "BP, A90" "Exjade (deferasirox 125 mg, 250 mg, 500 mg) BP, A90" CHELATING AGENT "BP, A90" "emtricitabine BP, A90" ANTIVIRALS "BP, A90" "Emtriva (emtricitabine) BP, A90" ANTIVIRALS "BP, A90" "estradiol-Divigel BP, A90" HORMONE REPLACEMENT THERAPY "BP, A90" "etravirine BP, A90" ANTIVIRALS "BP, A90" "everolimus 2.5 mg, 5 mg, 7.5 mg, 10 mg BP, A90 - PA; See Table 20; See Table 57" PA CHEMOTHERAPY "BP, A90" "everolimus tablets for oral suspension BP, A90 - PA; See Table 20; See Table 57" PA CHEMOTHERAPY "BP, A90" "Efudex (fluorouracil 5% cream) BP, A90" CHEMOTHERAPY "BP, A90" "Elidel (pimecrolimus) BP, A90" DERMATOLOGICAL "BP, A90" "Exelon (rivastigmine patch) BP, A90 - PA > 1 unit/day" PA > 1 unit/day ALZHEIMER'S THERAPY "BP, A90" Eurax (crotamiton lotion) BP - PA PA ANTIPARASITICS BP exenatide 10 mcg injection BP - PA > 2.4 mL/30 days PA > 2.4 mL/30 days DIABETIC AGENTS BP exenatide 5 mcg injection BP - PA > 1.2 mL/30 days PA > 1.2 mL/30 days DIABETIC AGENTS BP Edurant (rilpivirine) BP ANTIVIRALS BP Eucrisa (crisaborole) PD - PA PA DERMATOLOGICAL PD elexacaftor / tezacaftor / ivacaftor PD - PA PA CYSTIC FIBROSIS AGENTS PD elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide PD ANTIVIRALS PD emtricitabine / rilpivirine / tenofovir alafenamide PD ANTIVIRALS PD emtricitabine / tenofovir alafenamide PD ANTIVIRALS PD etanercept PD - PA PA IMMUNOMODULATOR PD Enbrel (etanercept) PD - PA PA IMMUNOMODULATOR PD Emgality (galcanezumab-gnlm) PD - PA PA CALCITONIN GENE-RELATED PEPTIDE INHIBITOR PD Epclusa (sofosbuvir / velpatasvir) PD - PA PA ANTIVIRALS PD "Elevidys (delandistrogene moxeparvovec-rokl) CO, MB - PA" PA MISCELLANEOUS "CO, MB" "elivaldogene autotemcel CO, MB - PA" PA GENE THERAPY "CO, MB" "etranacogene dezaparvovec-drlb CO, MB - PA" PA ANTI-HEMOPHILIA AGENTS "CO, MB" Exforge # (amlodipine / valsartan) M90 CARDIOVASCULAR "M90, #" Exforge HCT # (amlodipine / valsartan / hydrochlorothiazide) M90 CARDIOVASCULAR "M90, #" enalapril M90 CARDIOVASCULAR "M90, #" enalapril / hydrochlorothiazide M90 CARDIOVASCULAR "M90, #" esomeprazole magnesium capsule M90 - PA > 1 unit/day PA > 1 unit/day PROTON PUMP INHIBITORS "M90, #" estradiol / norethindrone-Activella M90 HORMONE REPLACEMENT THERAPY "M90, #" estradiol tablet-Estrace M90 HORMONE REPLACEMENT THERAPY "M90, #" Estrace # (estradiol tablet-Estrace) M90 HORMONE REPLACEMENT THERAPY "M90, #" estradiol-Climara M90 HORMONE REPLACEMENT THERAPY "M90, #" estradiol-Minivelle M90 HORMONE REPLACEMENT THERAPY "M90, #" estradiol-Vagifem M90 HORMONE REPLACEMENT THERAPY "M90, #" estradiol-Vivelle-Dot M90 HORMONE REPLACEMENT THERAPY "M90, #" ethinyl estradiol / drospirenone / levomefolate-Beyaz M90 CONTRACEPTIVES "M90, #" ethinyl estradiol / drospirenone / levomefolate-Safyral M90 CONTRACEPTIVES "M90, #" ethinyl estradiol / drospirenone-Yasmin M90 CONTRACEPTIVES "M90, #" ethinyl estradiol / drospirenone-Yaz M90 CONTRACEPTIVES "M90, #" ethinyl estradiol / norethindrone / ferrous fumarate M90 CONTRACEPTIVES "M90, #" Estrostep FE # (ethinyl estradiol / norethindrone / ferrous fumarate) M90 CONTRACEPTIVES "M90, #" ethinyl estradiol / norethindrone / ferrous fumarate chewable 0.8 mg / 25 mcg M90 CONTRACEPTIVES "M90, #" ethinyl estradiol / norethindrone / ferrous fumarate chewable-Minastrin 24 Fe M90 CONTRACEPTIVES "M90, #" ethinyl estradiol / norethindrone-Ortho-Novum M90 CONTRACEPTIVES "M90, #" ethinyl estradiol / norgestimate-Ortho Tri-Cyclen M90 CONTRACEPTIVES "M90, #" ethinyl estradiol 2.5 mcg / norethindrone 0.5 mg-Femhrt M90 HORMONE REPLACEMENT THERAPY "M90, #" etonogestrel / ethinyl estradiol M90 CONTRACEPTIVES "M90, #" ezetimibe M90 LIPID LOWERING AGENTS "M90, #" ezetimibe / simvastatin M90 - PA > 1 unit/day PA > 1 unit/day LIPID LOWERING AGENTS "M90, #" Euthyrox # (levothyroxine-Euthyrox) M90 THYROID PREPARATIONS "M90, #" Evista # (raloxifene) M90 HORMONE REPLACEMENT THERAPY "M90, #" enalapril solution M90 - PA PA CARDIOVASCULAR M90 Epaned (enalapril solution) M90 - PA PA CARDIOVASCULAR M90 eprosartan M90 - PA PA CARDIOVASCULAR M90 ergocalciferol capsule M90 ELECTROLYTES AND NUTRIENTS M90 "esomeprazole magnesium 2.5 mg, 5 mg suspension M90 - PA" PA PROTON PUMP INHIBITORS M90 estradiol-Alora M90 HORMONE REPLACEMENT THERAPY M90 ethacrynic acid tablet M90 - PA PA CARDIOVASCULAR M90 Edecrin (ethacrynic acid tablet) M90 - PA PA CARDIOVASCULAR M90 ethinyl estradiol / desogestrel M90 CONTRACEPTIVES M90 ethinyl estradiol / ethynodiol M90 CONTRACEPTIVES M90 ethinyl estradiol / norelgestromin patch M90 CONTRACEPTIVES M90 ethinyl estradiol / norethindrone M90 CONTRACEPTIVES M90 ethinyl estradiol / norgestimate M90 CONTRACEPTIVES M90 ethinyl estradiol 5 mcg / norethindrone 1 mg M90 HORMONE REPLACEMENT THERAPY M90 etidronate M90 ELECTROLYTES AND NUTRIENTS M90 Epzicom # (abacavir / lamivudine) A90 ANTIVIRALS "A90, #" Emend # (aprepitant 80 mg) A90 - PA > 4 capsules/28 days PA > 4 capsules/28 days ANTIEMETICS "A90, #" Evoxac # (cevimeline) A90 PARASYMPATHETIC AGENTS "A90, #" efavirenz A90 ANTIVIRALS "A90, #" efavirenz / emtricitabine / tenofovir A90 ANTIVIRALS "A90, #" emtricitabine / tenofovir disoproxil fumarate A90 ANTIVIRALS "A90, #" entacapone A90 ANTIPARKINSON "A90, #" entecavir tablet A90 - PA > 1 unit/day PA > 1 unit/day ANTIVIRALS "A90, #" erythromycin ethylsuccinate suspension A90 ANTIBIOTICS "A90, #" Eryped # (erythromycin ethylsuccinate suspension) A90 ANTIBIOTICS "A90, #" erythromycin gel A90 ANTIBIOTICS "A90, #" Erygel # (erythromycin gel) A90 ANTIBIOTICS "A90, #" escitalopram A90 - PA < 6 years; See Table 17; See Table 71 PA ANTIDEPRESSANTS "A90, #" estradiol cream-Estrace A90 HORMONE REPLACEMENT THERAPY "A90, #" Estrace # (estradiol cream-Estrace) A90 HORMONE REPLACEMENT THERAPY "A90, #" ethambutol A90 ANTIBIOTICS "A90, #" ethosuximide A90 ANTICONVULSANTS "A90, #" "everolimus 0.25 mg, 0.5 mg, 0.75 mg, 1 mg A90" IMMUNOMODULATOR "A90, #" exemestane A90 CHEMOTHERAPY "A90, #" Epivir # (lamivudine 10 mg/mL solution) A90 ANTIVIRALS "A90, #" Epivir HBV # (lamivudine 100 mg tablet) A90 - PA > 1 unit/day PA > 1 unit/day ANTIVIRALS "A90, #" "Epivir # (lamivudine 150 mg, 300 mg tablet) A90" ANTIVIRALS "A90, #" Effient # (prasugrel) A90 ANTIPLATELET AGENT "A90, #" Effexor XR # (venlafaxine extended-release capsule) A90 - PA < 6 years; See Table 17; See Table 71 PA ANTIDEPRESSANTS "A90, #" Emend (aprepitant 125 mg powder for oral suspension) A90 - PA > 6 units/28 days PA > 6 units/28 days ANTIEMETICS A90 Evoclin (clindamycin foam) A90 - PA PA ANTIBIOTICS A90 Enemeez Plus (docusate / benzocaine enema) A90 CONSTIPATION AGENTS A90 Enemeez (docusate sodium enema) A90 CONSTIPATION AGENTS A90 econazole 1% cream A90 FUNGICIDES A90 efavirenz 400 mg / lamivudine 300 mg / tenofovir disoproxil fumarate 300 mg A90 - PA PA ANTIVIRALS A90 efavirenz 600 mg / lamivudine 300 mg / tenofovir disoproxil fumarate 300 mg A90 - PA PA ANTIVIRALS A90 eletriptan A90 - PA PA TRIPTAN A90 epinastine A90 ANTIHISTAMINES A90 ergoloid A90 CARDIOVASCULAR A90 ergotamine / caffeine suppository A90 - PA PA ANALGESICS A90 ergotamine / caffeine tablet A90 - PA PA ANALGESICS A90 erlotinib A90 - PA PA CHEMOTHERAPY A90 "erythromycin / ethanol pads, pledgets A90 - PA" PA ANTIBIOTICS A90 "erythromycin delayed-release capsule, tablet A90" ANTIBIOTICS A90 erythromycin ophthalmic ointment A90 OPHTHALMIC PREPARATIONS A90 erythromycin solution A90 ANTIBIOTICS A90 erythromycin stearate tablet A90 ANTIBIOTICS A90 erythromycin tablet A90 ANTIBIOTICS A90 "estrogens,esterified A90" HORMONE REPLACEMENT THERAPY A90 etodolac A90 NONSTEROIDAL ANTI-INFLAMMATORY A90 etodolac extended-release A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 etoposide capsule A90 CHEMOTHERAPY A90 Extina (ketoconazole foam) A90 - PA PA FUNGICIDES A90 Epivir HBV (lamivudine 5 mg/mL solution) A90 - PA > 20 mL/day PA > 20 mL/day ANTIVIRALS A90 Esbriet (pirfenidone) A90 - PA PA PULMONARY FIBROSIS AGENTS A90 Evekeo ODT (amphetamine sulfate orally disintegrating tablet) - PA; See Table 31; See Table 71 PA CEREBRAL STIMULANTS Eraxis (anidulafungin) ANTIBIOTICS Erleada (apalutamide) - PA PA CHEMOTHERAPY Eliquis (apixaban) ANTICOAGULANTS Evotaz (atazanavir / cobicistat) ANTIVIRALS Edarbi (azilsartan) CARDIOVASCULAR Edarbyclor (azilsartan / chlorthalidone) CARDIOVASCULAR Enstilar (betamethasone / calcipotriene foam) GLUCOCORTICOIDS Epidiolex (cannabidiol) - PA PA ANTICONVULSANTS Equetro (carbamazepine extended-release) - PA < 6 years; See Table 20; See Table 71 PA ANTICONVULSANTS Elyxyb (celecoxib oral solution) - PA PA NONSTEROIDAL ANTI-INFLAMMATORY Eurax (crotamiton cream) ANTIPARASITICS Emflaza (deflazacort) - PA PA GLUCOCORTICOIDS echothiophate iodide OPHTHALMIC PREPARATIONS edaravone injection - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS edaravone suspension - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS edoxaban - PA PA ANTICOAGULANTS efinaconazole - PA PA FUNGICIDES elacestrant - PA PA ANTINEOPLASTICS elagolix - PA PA HORMONE AGENTS elagolix / estradiol / norethindrone - PA PA OTHER HORMONES elapegademase-lvlr - PA PA ENZYMES elbasvir / grazoprevir - PA PA ANTIVIRALS eliglustat - PA PA ENZYMES eltrombopag - PA PA HEMATINIC AGENT eluxadoline - PA PA GASTROINTESTINAL AGENT elvitegravir / cobicistat / emtricitabine / tenofovir disoproxil fumarate ANTIVIRALS emapalumab-lzsg - PA PA BIOLOGICAL emicizumab-kxwh ANTI-HEMOPHILIA AGENTS empagliflozin DIABETIC AGENTS empagliflozin / linagliptin - PA PA DIABETIC AGENTS empagliflozin / linagliptin / metformin extended-release - PA PA DIABETIC AGENTS empagliflozin / metformin DIABETIC AGENTS empagliflozin / metformin extended-release DIABETIC AGENTS emtricitabine / rilpivirine / tenofovir disoproxil fumarate ANTIVIRALS enasidenib - PA PA CHEMOTHERAPY encorafenib - PA PA CHEMOTHERAPY enfuvirtide ANTIVIRALS entecavir solution - PA > 20 mL/day PA > 20 mL/day ANTIVIRALS entrectinib - PA PA CHEMOTHERAPY enzalutamide - PA PA CHEMOTHERAPY epinephrine auto-injection ADRENERGICS epinephrine auto-injection-Auvi-Q - PA PA ADRENERGICS epinephrine injection ADRENERGICS epoetin alfa-epbx - PA PA HEMATINIC AGENT epoetin alfa-Epogen - PA PA HEMATINIC AGENT Epogen (epoetin alfa-Epogen) - PA PA HEMATINIC AGENT epoetin alfa-Procrit - PA PA HEMATINIC AGENT epoprostenol-Veletri - PA PA CARDIOVASCULAR eravacycline - PA PA ANTIBIOTICS erdafitinib - PA PA CHEMOTHERAPY erenumab-aooe - PA PA CALCITONIN GENE-RELATED PEPTIDE INHIBITOR ertugliflozin - PA PA DIABETIC AGENTS ertugliflozin / metformin - PA PA DIABETIC AGENTS ertugliflozin / sitagliptin - PA PA DIABETIC AGENTS erythromycin injection ANTIBIOTICS Erythrocin (erythromycin injection) ANTIBIOTICS esketamine - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS eslicarbazepine - PA; See Table 20; See Table 71 PA ANTICONVULSANTS esomeprazole sodium IV - PA PA PROTON PUMP INHIBITORS estazolam - PA 1 unit/day; See Table 69; See Table 71 PA 1 unit/day BENZODIAZEPINES estradiol / drospirenone HORMONE REPLACEMENT THERAPY estradiol / norethindrone-Combipatch HORMONE REPLACEMENT THERAPY estradiol / norgestimate HORMONE REPLACEMENT THERAPY estradiol / progesterone - PA PA HORMONE REPLACEMENT THERAPY estradiol valerate and estradiol valerate / dienogest CONTRACEPTIVES estradiol-Depo-estradiol HORMONE REPLACEMENT THERAPY estradiol-Elestrin HORMONE REPLACEMENT THERAPY Elestrin (estradiol-Elestrin) HORMONE REPLACEMENT THERAPY estradiol-Estring HORMONE REPLACEMENT THERAPY Estring (estradiol-Estring) HORMONE REPLACEMENT THERAPY estradiol-Evamist HORMONE REPLACEMENT THERAPY Evamist (estradiol-Evamist) HORMONE REPLACEMENT THERAPY estradiol-Femring HORMONE REPLACEMENT THERAPY estradiol-menostar HORMONE REPLACEMENT THERAPY estramustine CHEMOTHERAPY Emcyt (estramustine) CHEMOTHERAPY "estrogens, conjugated" HORMONE REPLACEMENT THERAPY "estrogens, conjugated/bazedoxifene" ESTROGENS eteplirsen - PA PA BIOLOGICAL Exondys 51 (eteplirsen) - PA PA BIOLOGICAL ethionamide TB PREPARATIONS etonogestrel implant-Nexplanon CONTRACEPTIVES evolocumab - PA PA LIPID LOWERING AGENTS exenatide extended-release auto-injection - PA PA DIABETIC AGENTS exenatide extended-release pen DIABETIC AGENTS "Eloctate (factor VIII recombinant, Fc fusion protein)" ANTI-HEMOPHILIA AGENTS "Esperoct (factor VIII recombinant, glycopegylated-exei)" ANTI-HEMOPHILIA AGENTS Entadfi (finasteride / tadalafil) - PA PA BENIGN PROSTATIC HYPERPLASIA AGENTS Extavia (interferon beta-1b-Extavia) - PA PA MULTIPLE SCLEROSIS AGENTS Endari (l-glutamine) - PA PA ELECTROLYTES AND NUTRIENTS Eligard (leuprolide) - PA PA CHEMOTHERAPY Elepsia XR (levetiracetam extended-release-Elepsia XR) - PA PA ANTICONVULSANTS Ermeza (levothyroxine-Ermeza) THYROID PREPARATIONS Eysuvis (loteprednol 0.25% suspension) - PA PA OPHTHALMIC PREPARATIONS Exkivity (mobocertinib) - PA PA CHEMOTHERAPY "Empaveli (pegcetacoplan 1,080 mg/20 mL vial) - PA" PA BIOLOGICAL Elfabrio (pegunigalsidase alfa-iwxj) - PA PA ENZYMES Elmiron (pentosan) ANALGESICS Endometrin (progesterone vaginal insert) - PA PA PROGESTERONE Exservan (riluzole film) - PA PA AMYOTROPHIC LATERAL SCLEROSIS AGENTS Evrysdi (risdiplam) - PA PA BIOLOGICAL Evenity (romosozumab-aqqg) - PA PA BIOLOGICAL Ezallor (rosuvastatin sprinkle capsule) - PA PA LIPID LOWERING AGENTS Entresto (sacubitril / valsartan) - PA PA CARDIOVASCULAR Enspryng (satralizumab-mwge) - PA PA BIOLOGICAL Emsam (selegiline transdermal patch) - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS Ertaczo (sertaconazole) FUNGICIDES Envarsus XR (tacrolimus extended-release tablet) - PA PA IMMUNOMODULATOR Egrifta SV (tesamorelin) - PA PA OTHER HORMONES Eprontia (topiramate solution) - PA; See Table 20; See Table 71 PA ANTICONVULSANTS Egaten (triclabendazole) - PA PA ANTIPARASITICS Ella (ulipristal acetate) CONTRACEPTIVES Entyvio (vedolizumab) - PA PA UNCLASSIFIED DRUG PRODUCTS Erivedge (vismodegib) - PA PA CHEMOTHERAPY "Edluar (zolpidem 5 mg, 10 mg sublingual tablet) - PA; See Table 15; See Table 71" PA SEDATIVES