Drug - Brand Name (Generic Name) PA Status Class Drug Notes Norliqva (amlodipine solution) - PA PA CARDIOVASCULAR "Novoeight (antihemophilic factor, recombinant-Novoeight)" ANTI-HEMOPHILIA AGENTS "Nuwiq (antihemophilic factor, recombinant-Nuwiq)" ANTI-HEMOPHILIA AGENTS Nulojix (belatacept) - PA PA IMMUNOMODULATOR Nexletol (bempedoic acid) - PA PA LIPID LOWERING AGENTS Nexlizet (bempedoic acid / ezetimibe) - PA PA LIPID LOWERING AGENTS "Novoseven (coagulation factor VIIa, recombinant)" ANTI-HEMOPHILIA AGENTS "Novavax COVID-19 vaccine, adjuvanted (COVID EUA – October 3, 2023 for members ≥ 12 years of age)" COVID - 19 related Treatments and Vaccines Nascobal (cyanocobalamin-Nascobal) - PA PA ELECTROLYTES AND NUTRIENTS Nubeqa (darolutamide) - PA PA CHEMOTHERAPY Nocdurna (desmopressin-Nocdurna) - PA PA HORMONE AGENTS Nuedexta (dextromethorphan / quinidine) - PA PA MULTIPLE SCLEROSIS AGENTS Norpace CR (disopyramide controlled-release) CARDIOVASCULAR Nexium  IV (esomeprazole sodium IV) - PA PA PROTON PUMP INHIBITORS Natazia (estradiol valerate and estradiol valerate / dienogest) CONTRACEPTIVES Nexplanon (etonogestrel implant-Nexplanon) CONTRACEPTIVES Neupogen (filgrastim) HEMATINIC AGENT Nivestym (filgrastim-aafi) HEMATINIC AGENT "Nabi-HB (hepatitis B immune globulin IM, human-Nabi-HB)" BIOLOGICAL Novolog (insulin aspart 70/30-Novolog) - PA PA DIABETIC AGENTS Novolog (insulin aspart-Novolog) - PA PA DIABETIC AGENTS Novolin N (insulin NPH) DIABETIC AGENTS Novolin (insulin NPH / regular insulin 70/30) DIABETIC AGENTS Novolin R (insulin regular) DIABETIC AGENTS Ninlaro (ixazomib) - PA PA CHEMOTHERAPY Namzaric (memantine / donepezil extended-release) - PA 1 unit/day; See Table 56; See Table 71 PA 1 unit/day ALZHEIMER'S THERAPY Nucala (mepolizumab) - PA PA BIOLOGICAL Noritate (metronidazole 1% cream) DERMATOLOGICAL Nuvessa (metronidazole 1.3% vaginal gel) - PA PA ANTIBIOTICS Nayzilam (midazolam nasal spray) - PA > 10 units/30 days PA > 10 units/30 days BENZODIAZEPINES nabumetone 1000 mg - PA PA NONSTEROIDAL ANTI-INFLAMMATORY nafarelin - PA PA HORMONE AGENTS nafcillin ANTIBIOTICS nalbuphine OPIOID ANALGESICS naldemedine - PA PA CONSTIPATION AGENTS nalmefene - PA PA ALCOHOL AND DRUG CESSATION AGENT naloxegol - PA PA LAXATIVES naloxone 5 mg / 0.5 mL syringe ANTIDOTES naloxone syringe kit - PA PA ANTIDOTES "naloxone vial, 0.4 mg/mL syringe, 2 mg/2 mL syringe" ANTIDOTES nandrolone HORMONE AGENTS natalizumab MULTIPLE SCLEROSIS AGENTS natamycin OPHTHALMIC PREPARATIONS Natacyn (natamycin) OPHTHALMIC PREPARATIONS necitumumab - PA PA CHEMOTHERAPY nedocromil OPHTHALMIC PREPARATIONS nelfinavir ANTIVIRALS nepafenac 0.1% ophthalmic suspension OPHTHALMIC PREPARATIONS Nevanac (nepafenac 0.1% ophthalmic suspension) OPHTHALMIC PREPARATIONS nepafenac 0.3% ophthalmic suspension - PA PA OPHTHALMIC PREPARATIONS neratinib - PA PA CHEMOTHERAPY Nerlynx (neratinib) - PA PA CHEMOTHERAPY netarsudil - PA PA OPHTHALMIC PREPARATIONS netarsudil / latanoprost - PA PA OPHTHALMIC PREPARATIONS netupitant / palonosetron capsule - PA > 2 capsules/28 days PA > 2 capsules/28 days ANTIEMETICS nicardipine injection CARDIOVASCULAR nicotine inhalation system SMOKING CESSATION Nicotrol Inhaler (nicotine inhalation system) SMOKING CESSATION nicotine nasal spray SMOKING CESSATION Nicotrol NS (nicotine nasal spray) SMOKING CESSATION nifurtimox - PA PA ANTIBIOTICS nilotinib CHEMOTHERAPY nimodipine capsule - PA > 21 days treatment/365 days PA > 21 days treatment/365 days CARDIOVASCULAR nimodipine oral solution - PA > 21 days treatment/365 days PA > 21 days treatment/365 days CARDIOVASCULAR Nymalize (nimodipine oral solution) - PA > 21 days treatment/365 days PA > 21 days treatment/365 days CARDIOVASCULAR nintedanib - PA PA PULMONARY FIBROSIS AGENTS niraparib - PA PA CHEMOTHERAPY niraparib/abiraterone - PA PA ANTINEOPLASTICS nirmatrelvir / ritonavir for members ≥ 18 years of age COVID - 19 related Treatments and Vaccines "nirmatrelvir/ritonavir COVID EUA – December 22, 2021" COVID - 19 related Treatments and Vaccines nirsevimab-alip - PA ≥ 8 months of age PA ≥ 8 months of age ANTIVIRALS nitazoxanide - PA PA ANTIPARASITICS nitisinone ENDOCRINE/METABOLIC AGENTS Nityr (nitisinone) ENDOCRINE/METABOLIC AGENTS nitroglycerin 0.4% ointment GASTROINTESTINAL AGENT nitroglycerin injection CARDIOVASCULAR nitroglycerin sublingual powder - PA PA CARDIOVASCULAR norethindrone / ethinyl estradiol / ferrous fumarate CONTRACEPTIVES Nuzyra (omadacycline injection) - PA PA ANTIBIOTICS Nuzyra (omadacycline tablet) - PA PA ANTIBIOTICS Neumega (oprelvekin) HEMATINIC AGENT Natpara (parathyroid hormone) - PA PA HORMONE AGENTS Neulasta (pegfilgrastim) HEMATINIC AGENT Nyvepria (pegfilgrastim-apgf) HEMATINIC AGENT Nuplazid (pimavanserin) - PA PA ANTIPSYCHOTIC Noxafil (posaconazole powder for oral suspension) - PA PA ANTIFUNGALS "Norvir (ritonavir packet, solution)" ANTIVIRALS Nebusal (sodium chloride 6% for inhalation) - Non-Drug Product NON-DRUG PRODUCT Ngenla (somatrogon-ghla) - PA PA HORMONE AGENTS Norditropin (somatropin-Norditropin) - PA PA HORMONE AGENTS Nutropin AQ (somatropin-Nutropin AQ) - PA PA HORMONE AGENTS Nucynta (tapentadol) - PA PA OPIOID ANALGESICS Nucynta ER (tapentadol extended-release) - PA PA OPIOID ANALGESICS Natesto (testosterone nasal gel) - PA PA HORMONE REPLACEMENT THERAPY Norpramin (desipramine) A90 - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 Northera (droxidopa) A90 - PA PA ADRENERGICS A90 Nalfon (fenoprofen capsule) A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 Nourianz (istradefylline) A90 - PA PA ANTIPARKINSON A90 Namenda (memantine titration pack) A90 - PA 49 units/28 days; See Table 56; See Table 71 PA 49 units/28 days ALZHEIMER'S THERAPY A90 "nabumetone 500 mg, 750 mg A90" NONSTEROIDAL ANTI-INFLAMMATORY A90 naftifine A90 - PA PA FUNGICIDES A90 Naftin (naftifine) A90 - PA PA FUNGICIDES A90 naltrexone tablet A90 - PA < 6 years; See Table 36; See Table 71 PA ALCOHOL AND DRUG CESSATION AGENT A90 naphazoline / pheniramine A90 OPHTHALMIC PREPARATIONS A90 Naphcon-A (naphazoline / pheniramine) A90 OPHTHALMIC PREPARATIONS A90 naproxen controlled-release A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 Naprelan CR (naproxen controlled-release) A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 naproxen enteric coated A90 NONSTEROIDAL ANTI-INFLAMMATORY A90 naproxen suspension A90 - PA ≥ 13 years PA ≥ 13 years NONSTEROIDAL ANTI-INFLAMMATORY A90 naratriptan A90 - PA > 18 units/30 days PA > 18 units/30 days TRIPTAN A90 nefazodone A90 - PA < 6 years; See Table 17; See Table 71 PA ANTIDEPRESSANTS A90 neomycin / bacitracin / polymyxin B / hydrocortisone ophthalmic ointment A90 OPHTHALMIC PREPARATIONS A90 neomycin / bacitracin / polymyxin B ophthalmic ointment A90 OPHTHALMIC PREPARATIONS A90 "neomycin / fluocinolone cream, cream kit A90 - PA" PA GLUCOCORTICOIDS A90 neomycin / polymyxin B / gramicidin A90 OPHTHALMIC PREPARATIONS A90 neomycin / polymyxin B / hydrocortisone ophthalmic suspension A90 - PA PA OPHTHALMIC PREPARATIONS A90 neomycin / polymyxin B / hydrocortisone otic A90 OTIC PREPARATIONS A90 nevirapine A90 ANTIVIRALS A90 nevirapine extended-release A90 - PA PA ANTIVIRALS A90 nilutamide A90 CHEMOTHERAPY A90 nitrofurantoin 25 mg/5 mL suspension A90 - PA PA ANTIBIOTICS A90 nitrofurantoin 50 mg/5 mL suspension A90 - PA PA ANTIBIOTICS A90 nonoxynol-9 A90 CONTRACEPTIVES A90 norethindrone 5 mg A90 HORMONE REPLACEMENT THERAPY A90 "nystatin / triamcinolone cream, ointment A90" FUNGICIDES A90 "nystatin cream, ointment, 100,000 powder A90" FUNGICIDES A90 nystatin oral suspension A90 FUNGICIDES A90 Natroba (spinosad) A90 - PA PA ANTIPARASITICS A90 Neoral # (cyclosporine modified) A90 IMMUNOMODULATOR "A90, #" Norpace # (disopyramide immediate-release) A90 CARDIOVASCULAR "A90, #" Namenda XR # (memantine extended-release) A90 - PA 1 unit/day; See Table 56; See Table 71 PA 1 unit/day ALZHEIMER'S THERAPY "A90, #" Namenda # (memantine tablet) A90 - PA 2 units/day; See Table 56; See Table 71 PA 2 units/day ALZHEIMER'S THERAPY "A90, #" Neptazane # (methazolamide) A90 CARDIOVASCULAR "A90, #" naproxen / esomeprazole A90 - PA <60 years PA NONSTEROIDAL ANTI-INFLAMMATORY "A90, #" "neomycin / polymyxin B / dexamethasone ophthalmic ointment, suspension A90" OPHTHALMIC PREPARATIONS "A90, #" nitisinone A90 ENDOCRINE/METABOLIC AGENTS "A90, #" nitrofurantoin macrocrystals A90 ANTIBIOTICS "A90, #" nitrofurantoin monohydrate / macrocrystals A90 ANTIBIOTICS "A90, #" nitroglycerin 2% ointment A90 CARDIOVASCULAR "A90, #" Nitro-Bid # (nitroglycerin 2% ointment) A90 CARDIOVASCULAR "A90, #" nitroglycerin sublingual tablet A90 CARDIOVASCULAR "A90, #" Nitrostat # (nitroglycerin sublingual tablet) A90 CARDIOVASCULAR "A90, #" nortriptyline A90 - PA < 6 years; See Table 17; See Table 71 PA ANTIDEPRESSANTS "A90, #" Nebupent # (pentamidine) A90 ANTIPARASITICS "A90, #" Nardil # (phenelzine) A90 - PA < 6 years; See Table 17; See Table 71 PA ANTIDEPRESSANTS "A90, #" Noxafil # (posaconazole tablet) A90 FUNGICIDES "A90, #" Navane # (thiothixene) A90 - PA < 6 years; See Table 24; See Table 71 PA ANTIPSYCHOTIC "A90, #" "Nexium (esomeprazole magnesium 2.5 mg, 5 mg suspension) M90 - PA" PA PROTON PUMP INHIBITORS M90 nateglinide M90 DIABETIC AGENTS M90 niacin extended-release tablet M90 LIPID LOWERING AGENTS M90 nicardipine capsule M90 - PA PA CARDIOVASCULAR M90 nifedipine capsule M90 CARDIOVASCULAR M90 nifedipine tablet M90 CARDIOVASCULAR M90 nisoldipine M90 - PA PA CARDIOVASCULAR M90 nizatidine 150 mg capsule M90 - PA > 2 units/day PA > 2 units/day H2 ANTAGONISTS M90 nizatidine 300 mg capsule M90 - PA > 1 unit/day PA > 1 unit/day H2 ANTAGONISTS M90 norgestrel / ethinyl estradiol 0.3/0.03 mg M90 CONTRACEPTIVES M90 Norvasc # (amlodipine) M90 CARDIOVASCULAR "M90, #" Nexium # (esomeprazole magnesium capsule) M90 - PA > 1 unit/day PA > 1 unit/day PROTON PUMP INHIBITORS "M90, #" Nuvaring # (etonogestrel / ethinyl estradiol) M90 CONTRACEPTIVES "M90, #" nadolol M90 CARDIOVASCULAR "M90, #" nifedipine extended-release M90 CARDIOVASCULAR "M90, #" nitroglycerin patch M90 CARDIOVASCULAR "M90, #" Nitro-Dur # (nitroglycerin patch) M90 CARDIOVASCULAR "M90, #" norethindrone 0.35 mg M90 CONTRACEPTIVES "M90, #" naloxone 8 mg nasal spray PD ANTIDOTES PD naltrexone injection PD ALCOHOL AND DRUG CESSATION AGENT PD Nurtec (rimegepant) PD - PA PA CALCITONIN GENE-RELATED PEPTIDE INHIBITOR PD Neupro (rotigotine transdermal system) BP - PA > 1 unit/day PA > 1 unit/day ANTIPARKINSON BP "nitroglycerin lingual spray BP, A90 - PA" PA CARDIOVASCULAR "BP, A90" "Nitrolingual (nitroglycerin lingual spray) BP, A90 - PA" PA CARDIOVASCULAR "BP, A90" "Noxafil (posaconazole injection, suspension) BP, A90 - PA" PA FUNGICIDES "BP, A90" "Nexavar (sorafenib) BP, A90 - PA" PA CHEMOTHERAPY "BP, A90" "Nesina (alogliptin) BP, M90 - PA" PA DIABETIC AGENTS "BP, M90" "Nexium (esomeprazole magnesium 10 mg, 20 mg, 40 mg suspension) BP, M90" PROTON PUMP INHIBITORS "BP, M90" "nebivolol BP, M90" CARDIOVASCULAR "BP, M90" "Norvir (ritonavir tablet) BP, PD, A90" ANTIVIRALS "BP, PD, A90" Nuvigil # (armodafinil) - PA 1 unit/day; See Table 50; See Table 71 PA 1 unit/day NARCOLEPSY AGENTS # "Neurontin # (gabapentin capsule, solution, tablet) - PA 3600 mg/day; See Table 20; See Table 71" PA 3600 mg/day ANTICONVULSANTS # Nexobrid (anacaulase-bcdb) MB - PA PA ENZYMES MB Nexviazyme (avalglucosidase alfa-ngpt) MB - PA PA ENZYMES MB Nesacaine (chloroprocaine vial) MB ANESTHETICS MB Nulibry (fosdenopterin) MB - PA PA ENZYMES MB Naglazyme (galsulfase) MB - PA PA ENZYMES MB nadofaragene firadenovec-vncg MB - PA PA ANTINEOPLASTICS MB naxitamab-gqgk MB - PA PA CHEMOTHERAPY MB nelarabine MB - PA PA CHEMOTHERAPY MB nivolumab MB - PA PA CHEMOTHERAPY MB nivolumab / relatlimab-rmbw MB - PA PA CHEMOTHERAPY MB nusinersen MB - PA PA BIOLOGICAL MB Nipent (pentostatin) MB CHEMOTHERAPY MB Nplate (romiplostim) MB - PA PA HEMATINIC AGENT MB Naropin (ropivacaine) MB ANESTHETICS MB naloxone 4 mg nasal spray * ANTIDOTES * Narcan (naloxone 4 mg nasal spray) * ANTIDOTES * naphazoline * OPHTHALMIC PREPARATIONS * nicotinic acid * LIPID LOWERING AGENTS * "naproxen capsule, tablet *, A90" NONSTEROIDAL ANTI-INFLAMMATORY "*, A90" "neomycin *, A90" ANTIBIOTICS "*, A90" "neomycin / bacitracin / polymyxin B topical ointment *, A90" ANTIBIOTICS "*, A90" "nicotine gum, lozenge, patch *, A90" SMOKING CESSATION "*, A90" "niacin *, M90; See Table 6; See Table 13" ELECTROLYTES AND NUTRIENTS "*, M90" "niacinamide *, M90; See Table 6; See Table 13" ELECTROLYTES AND NUTRIENTS "*, M90"