Drug - Brand Name (Generic Name) PA Status Class Drug Notes "Flebogamma (immune globulin IV, human-Flebogamma) - PA" PA BIOLOGICAL fluticasone propionate inhalation aerosol A90 - PA ≥ 5 years PA ≥ 5 years BRONCHODILATORS A90 fluticasone / salmeterol inhalation powder-Airduo Digihaler - PA PA BRONCHODILATORS "fluticasone / salmeterol inhalation powder-Airduo Respiclick BP, A90 - PA" PA BRONCHODILATORS "BP, A90" fluticasone furoate / umeclidinium / vilanterol - PA PA BRONCHODILATORS fluticasone propionate inhalation powder A90 - PA PA BRONCHODILATORS A90 fluticasone propionate inhalation powder-Armonair Digihaler - PA PA BRONCHODILATORS formoterol - PA PA BRONCHODILATORS Fetroja (cefiderocol) - PA PA ANTIBIOTICS Firmagon (degarelix) - PA PA CHEMOTHERAPY Fensolvi (leuprolide) - PA PA HORMONE AGENTS febuxostat M90 - PA PA GOUT AGENTS M90 fam-trastuzumab deruxtecan-nxki MB - PA PA CHEMOTHERAPY MB fulvestrant MB - PA PA CHEMOTHERAPY MB Faslodex (fulvestrant) MB - PA PA CHEMOTHERAPY MB Fosamax Plus D (alendronate / cholecalciferol) - PA PA ELECTROLYTES AND NUTRIENTS Forteo (teriparatide-Forteo) BP - PA PA HORMONE AGENTS BP fedratinib - PA PA CHEMOTHERAPY futibatinib - PA PA ANTINEOPLASTICS Fusilev (levoleucovorin powder for injection) - PA PA ANTIDOTES Fyarro (sirolimus injection) - PA PA IMMUNOMODULATOR Fotivda (tivozanib) - PA PA CHEMOTHERAPY fremanezumab-vfrm for migraine prophylaxis PD - PA PA CALCITONIN GENE-RELATED PEPTIDE INHIBITOR PD fostamatinib - PA PA HEMATOLOGIC fluphenazine A90 - PA < 6 years; See Table 24; See Table 71 PA ANTIPSYCHOTIC A90 Fanapt (iloperidone) - PA; See Table 24; See Table 71 PA ANTIPSYCHOTIC fluocinolone cream kit - PA PA GLUCOCORTICOIDS fluocinolone ointment kit - PA PA GLUCOCORTICOIDS fluocinolone solution kit - PA PA GLUCOCORTICOIDS "flurandrenolide cream, lotion A90 - PA" PA GLUCOCORTICOIDS A90 flurandrenolide ointment A90 - PA PA GLUCOCORTICOIDS A90 fluticasone lotion A90 - PA PA GLUCOCORTICOIDS A90 flurazepam - PA 1 unit/day; See Table 69; See Table 71 PA 1 unit/day BENZODIAZEPINES Fiasp (insulin aspart-Fiasp) - PA PA DIABETIC AGENTS Flowflex (COVID-19 antigen self-test) - PA > 2 tests/28 days; Non-Drug Product PA > 2 tests/28 days DIAGNOSTICS "Fluad (influenza virus vaccine, adjuvanted) 1 - PA < 65 years" PA BIOLOGICAL 1 "Fluzone (influenza virus vaccine, high dose) 1 - PA < 65 years " PA BIOLOGICAL 1 Florastor (saccharomyces boulardii) - PA ≥ 22 years PA ≥ 22 years GASTROINTESTINAL AGENT Fabrazyme (agalsidase beta) - PA PA ENZYMES Firdapse (amifampridine) - PA PA POTASSIUM CHANNEL BLOCKER Finacea (azelaic acid foam) - PA PA DERMATOLOGICAL Finacea (azelaic acid gel) A90 - PA PA DERMATOLOGICAL A90 Fleqsuvy (baclofen suspension) A90 - PA PA MUSCLE RELAXANT A90 Foltrate (cyanocobalamin / folic acid) - PA PA ELECTROLYTES AND NUTRIENTS Ferriprox (deferiprone) A90 - PA PA CHELATING AGENT A90 "fecal microbiota spores, live-brpk - PA" PA GASTROINTESTINAL AGENT "fecal microbiota, live-jslm - PA" PA MISCELLANEOUS ferric carboxymaltose injection MB - PA PA HEMATINIC AGENT MB ferric citrate - PA PA HEMATINIC AGENT ferric derisomaltose - PA PA HEMATINIC AGENT ferric maltol - PA PA HEMATINIC AGENT ferumoxytol - PA PA HEMATINIC AGENT Feraheme (ferumoxytol) - PA PA HEMATINIC AGENT fezolinetant - PA PA UNCLASSIFIED DRUG PRODUCTS finerenone - PA PA ALDOSTERONE ANTAGONISTS fosdenopterin MB - PA PA ENZYMES MB furosemide on-body infusor - PA PA CARDIOVASCULAR Furoscix (furosemide on-body infusor) - PA PA CARDIOVASCULAR Filspari (sparsentan) - PA PA OTHER ANTIHYPERTENSIVES Fabior (tazarotene foam) - PA PA DERMATOLOGICAL fingolimod capsule A90 - PA > 1 unit/day PA > 1 unit/day SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR "A90, #" fingolimod orally disintegrating tablet - PA PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR "fluoxetine 10 mg, 20 mg tablet for premenstrual dysphoric disorder A90 - PA < 6 years; See Table 17; See Table 71" PA ANTIDEPRESSANTS A90 "fluoxetine 10 mg, 20 mg, 40 mg capsule, solution A90 - PA < 6 years; See Table 17; See Table 71" PA ANTIDEPRESSANTS "A90, #" fluvoxamine immediate-release A90 - PA < 6 years; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 Forfivo XL (bupropion hydrochloride extended-release 450 mg tablet) A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 fluoxetine 60 mg tablet A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 fluoxetine 90 mg delayed-release capsule A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 fluvoxamine extended-release A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 Fetzima (levomilnacipran) - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS Fortesta (testosterone 2% gel pump) BP - PA PA HORMONE REPLACEMENT THERAPY BP fostemsavir PD - PA PA ANTIVIRALS PD fluticasone propionate 50 mcg nasal spray M90 - PA > 1 inhaler/30 days PA > 1 inhaler/30 days NASAL PREPARATIONS M90 flunisolide nasal spray M90 - PA PA NASAL PREPARATIONS M90 fluticasone propionate 93 mcg nasal spray - PA PA NASAL PREPARATIONS "frovatriptan BP, A90 - PA" PA TRIPTAN "BP, A90" "Frova (frovatriptan) BP, A90 - PA" PA TRIPTAN "BP, A90" finasteride / tadalafil - PA PA BENIGN PROSTATIC HYPERPLASIA AGENTS Focalin # (dexmethylphenidate) - PA 3 units/day; See Table 31; See Table 71 PA 3 units/day CEREBRAL STIMULANTS # Focalin XR (dexmethylphenidate extended-release) BP - PA 2 units/day; See Table 31; See Table 71 PA 2 units/day CEREBRAL STIMULANTS BP First-Omeprazole (omeprazole suspension compounding kit) - PA PA PROTON PUMP INHIBITORS fidaxomicin - PA PA ANTIBIOTICS Flagyl (metronidazole 375 mg capsule) A90 - PA PA ANTIBIOTICS A90 Furadantin (nitrofurantoin 25 mg/5 mL suspension) A90 - PA PA ANTIBIOTICS A90 Fasenra (benralizumab) - PA PA BIOLOGICAL fosaprepitant injection - PA > 2 vials/28 days PA > 2 vials/28 days ANTIEMETICS # fosnetupitant / palonosetron injection - PA > 2 vials/28 days PA > 2 vials/28 days ANTIEMETICS Flector (diclofenac topical patch-Flector) A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 fenoprofen capsule A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 fenoprofen tablet A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 "fentanyl 12, 25, 50 mcg/hr transdermal system - PA > 50 mcg/hr and PA > 10 patches/30 days" PA > 50 mcg/hr and PA > 10 patches/30 days OPIOID ANALGESICS "fentanyl 37.5, 62.5, 87.5 mcg/hr transdermal system - PA" PA OPIOID ANALGESICS "fentanyl 75, 100 mcg/hr transdermal system - PA" PA OPIOID ANALGESICS fentanyl buccal tablet - PA PA OPIOID ANALGESICS Fentora (fentanyl buccal tablet) - PA PA OPIOID ANALGESICS fentanyl transmucosal system - PA PA OPIOID ANALGESICS Firazyr (icatibant) - PA PA ENZYMES "fenofibrate 40 mg, 120 mg tablet M90 - PA" PA LIPID LOWERING AGENTS M90 "Fenoglide (fenofibrate 40 mg, 120 mg tablet) M90 - PA" PA LIPID LOWERING AGENTS M90 fluvastatin M90 - PA PA LIPID LOWERING AGENTS M90 fluvastatin extended-release M90 - PA PA LIPID LOWERING AGENTS M90 fenfluramine - PA PA ANTICONVULSANTS Fintepla (fenfluramine) - PA PA ANTICONVULSANTS Fycompa (perampanel) - PA PA ANTICONVULSANTS Fosamax # (alendronate tablet) M90 ELECTROLYTES AND NUTRIENTS "M90, #" Feiba NF (anti-inhibitor coagulant complex-Feiba NF) ANTI-HEMOPHILIA AGENTS Fragmin (dalteparin) ANTICOAGULANTS Farxiga (dapagliflozin) DIABETIC AGENTS Fuzeon (enfuvirtide) ANTIVIRALS Flolan # (epoprostenol-Flolan) CARDIOVASCULAR # Femring (estradiol-Femring) HORMONE REPLACEMENT THERAPY Femhrt # (ethinyl estradiol 2.5 mcg / norethindrone 0.5 mg-Femhrt) M90 HORMONE REPLACEMENT THERAPY "M90, #" factor IX ANTI-HEMOPHILIA AGENTS factor IX complex human-Profilnine SD ANTI-HEMOPHILIA AGENTS factor IX human recombinant-Benefix PD ANTI-HEMOPHILIA AGENTS PD factor IX human recombinant-Ixinity ANTI-HEMOPHILIA AGENTS "factor IX recombinant, albumin fusion protein" ANTI-HEMOPHILIA AGENTS "factor IX recombinant, Fc fusion protein" ANTI-HEMOPHILIA AGENTS "factor IX, human" ANTI-HEMOPHILIA AGENTS "factor VIII recombinant, Fc fusion protein" ANTI-HEMOPHILIA AGENTS "factor VIII recombinant, glycopegylated-exei" ANTI-HEMOPHILIA AGENTS factor XIII A-subunit recombinant ANTI-HEMOPHILIA AGENTS "factor XIII concentrate, human" ANTI-HEMOPHILIA AGENTS famciclovir A90 ANTIVIRALS A90 famotidine injection H2 ANTAGONISTS famotidine suspension A90 H2 ANTAGONISTS A90 "famotidine tablet *, M90" H2 ANTAGONISTS "*, M90, #" faricimab-svoa MB OPHTHALMIC PREPARATIONS MB "fat emulsions, intravenous- intralipid" ELECTROLYTES AND NUTRIENTS "fat emulsions, intravenous-liposyn" ELECTROLYTES AND NUTRIENTS # felbamate A90 ANTICONVULSANTS "A90, #" Felbatol # (felbamate) A90 ANTICONVULSANTS "A90, #" felodipine extended-release M90 CARDIOVASCULAR M90 "fenofibrate 30 mg, 90 mg capsule M90" LIPID LOWERING AGENTS M90 "fenofibrate 43 mg, 67 mg, 130 mg, 134 mg, 200 mg capsule M90" LIPID LOWERING AGENTS M90 "fenofibrate 48 mg, 145 mg tablet M90" LIPID LOWERING AGENTS "M90, #" "fenofibrate 50 mg, 150 mg capsule M90" LIPID LOWERING AGENTS M90 "fenofibrate 54 mg, 160 mg tablet M90" LIPID LOWERING AGENTS M90 fenofibric acid M90 LIPID LOWERING AGENTS "M90, #" fenofibric acid tablet M90 LIPID LOWERING AGENTS M90 fentanyl injection OPIOID ANALGESICS ferric pyrophosphate citrate MB HEMATINIC AGENT MB "ferrous fumarate *, M90" HEMATINIC AGENT "*, M90" "ferrous gluconate *, M90" HEMATINIC AGENT "*, M90" "ferrous sulfate *, M90" HEMATINIC AGENT "*, M90" "fesoterodine BP, A90" URINARY ANTISPASMODICS "BP, A90" "fexofenadine / pseudoephedrine *, A90" ANTIHISTAMINES "*, A90" "fexofenadine tablet *, M90" ANTIHISTAMINES "*, M90" fibrinogen ANTI-HEMOPHILIA AGENTS Fibryga (fibrinogen) ANTI-HEMOPHILIA AGENTS fibrinogen concentrate ANTI-HEMOPHILIA AGENTS filgrastim HEMATINIC AGENT filgrastim-aafi HEMATINIC AGENT filgrastim-ayow HEMATINIC AGENT filgrastim-sndz HEMATINIC AGENT finasteride M90 BENIGN PROSTATIC HYPERPLASIA AGENTS "M90, #" flavoxate A90 URINARY ANTISPASMODICS A90 flecainide M90 CARDIOVASCULAR M90 floxuridine MB CHEMOTHERAPY MB fluconazole A90 FUNGICIDES "A90, #" "flucytosine BP, A90" ANTIBIOTICS "BP, A90" fludarabine CHEMOTHERAPY fludrocortisone A90 GLUCOCORTICOIDS A90 fluocinolone 0.01% cream A90 GLUCOCORTICOIDS A90 fluocinolone 0.025% cream A90 GLUCOCORTICOIDS "A90, #" "fluocinolone body oil, scalp oil A90" GLUCOCORTICOIDS "A90, #" "fluocinolone oil, otic drops BP, A90" OTIC PREPARATIONS "BP, A90" fluocinolone ointment A90 GLUCOCORTICOIDS "A90, #" fluocinolone ophthalmic implant-Iluvien MB OPHTHALMIC PREPARATIONS MB fluocinolone ophthalmic implant-Retisert MB OPHTHALMIC PREPARATIONS MB fluocinolone ophthalmic implant-Yutiq MB OPHTHALMIC PREPARATIONS MB fluocinolone solution A90 GLUCOCORTICOIDS "A90, #" fluocinonide / emollient A90 GLUCOCORTICOIDS A90 fluocinonide 0.1% cream A90 GLUCOCORTICOIDS "A90, #" "fluocinonide cream, gel, ointment, solution A90" GLUCOCORTICOIDS A90 fluorescein / benoxinate A90 OPHTHALMIC PREPARATIONS A90 fluorometholone A90 OPHTHALMIC PREPARATIONS "A90, #" FML # (fluorometholone) A90 OPHTHALMIC PREPARATIONS "A90, #" fluorometholone acetate OPHTHALMIC PREPARATIONS Flarex (fluorometholone acetate) OPHTHALMIC PREPARATIONS "fluorouracil 0.5% cream BP, A90" CHEMOTHERAPY "BP, A90" "fluorouracil 5% cream BP, A90" CHEMOTHERAPY "BP, A90" fluorouracil injection MB CHEMOTHERAPY MB fluorouracil solution A90 CHEMOTHERAPY A90 flurbiprofen A90 NONSTEROIDAL ANTI-INFLAMMATORY A90 flurbiprofen ophthalmic solution A90 OPHTHALMIC PREPARATIONS A90 flutamide A90 CHEMOTHERAPY A90 "fluticasone / salmeterol inhalation-Advair BP, A90" BRONCHODILATORS "BP, A90" "fluticasone / vilanterol BP, A90" BRONCHODILATORS "BP, A90" fluticasone cream A90 GLUCOCORTICOIDS A90 fluticasone furoate inhalation powder BRONCHODILATORS fluticasone ointment A90 GLUCOCORTICOIDS A90 "folic acid *, M90" ELECTROLYTES AND NUTRIENTS "*, M90" fondaparinux ANTICOAGULANTS # "fosamprenavir BP, A90" ANTIVIRALS "BP, A90" foscarnet MB ANTIVIRALS MB fosfomycin A90 ANTIBIOTICS "A90, #" fosinopril M90 CARDIOVASCULAR M90 fosinopril / hydrochlorothiazide M90 CARDIOVASCULAR M90 fosphenytoin ANTICONVULSANTS # "furosemide tablet, solution, injection M90" CARDIOVASCULAR "M90, #" Fluarix (influenza virus vaccine-Fluarix) 1 BIOLOGICAL 1 Flublok (influenza virus vaccine-Flublok) 1 BIOLOGICAL 1 Flucelvax (influenza virus vaccine-Flucelvax) 1 BIOLOGICAL 1 Flulaval (influenza virus vaccine-Flulaval) 1 BIOLOGICAL 1 Flumist (influenza virus vaccine-Flumist) 1 BIOLOGICAL 1 Fluzone (influenza virus vaccine-Fluzone) 1 BIOLOGICAL 1 Fosrenol # (lanthanum) A90 ELECTROLYTES AND NUTRIENTS "A90, #" Femara # (letrozole) A90 CHEMOTHERAPY "A90, #" Fulphila (pegfilgrastim-jmdb) HEMATINIC AGENT Fylnetra (pegfilgrastim-pbbk) HEMATINICS & BLOOD CELL STIMULATORS Feldene # (piroxicam) A90 NONSTEROIDAL ANTI-INFLAMMATORY "A90, #" Folotyn (pralatrexate) MB CHEMOTHERAPY MB Ferrlecit # (sodium ferric gluconate complex) HEMATINIC AGENT # Flomax # (tamsulosin) M90 BENIGN PROSTATIC HYPERPLASIA AGENTS "M90, #" Fareston # (toremifene) A90 CHEMOTHERAPY "A90, #" "Firvanq (vancomycin oral solution) BP, A90" ANTIBIOTICS "BP, A90"