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