Drug - Brand Name (Generic Name) PA Status Class Drug Notes zafirlukast M90 - PA PA BRONCHODILATORS M90 zaleplon - PA 1 unit/day; See Table 15; See Table 71 PA 1 unit/day SEDATIVES Zaltrap (ziv-aflibercept) MB - PA PA CHEMOTHERAPY MB Zanaflex (tizanidine capsule) A90 - PA PA MUSCLE RELAXANT A90 Zanaflex # (tizanidine tablet) A90 MUSCLE RELAXANT "A90, #" zanamivir - PA 20 inhalations/ claim and PA > 40 inhalations/ 365 days PA 20 inhalations/ claim and PA > 40 inhalations/ 365 days ANTIVIRALS Zanosar (streptozocin) MB CHEMOTHERAPY MB zanubrutinib - PA PA CHEMOTHERAPY Zarontin # (ethosuximide) A90 ANTICONVULSANTS "A90, #" Zarxio (filgrastim-sndz) HEMATINIC AGENT zavegepant - PA PA CALCITONIN GENE-RELATED PEPTIDE INHIBITOR Zavesca (miglustat) BP - PA PA ENZYMES BP Zavzpret (zavegepant) - PA PA CALCITONIN GENE-RELATED PEPTIDE INHIBITOR Zegalogue (dasiglucagon) DIABETIC AGENTS Zegerid (omeprazole / sodium bicarbonate powder for oral suspension) M90 - PA PA ANTI-ULCER PREPARATIONS M90 Zegerid # (omeprazole / sodium bicarbonate capsule) M90 ANTI-ULCER PREPARATIONS "M90, #" Zejula (niraparib) - PA PA CHEMOTHERAPY Zelapar (selegiline orally disintegrating tablet) - PA PA ANTIPARKINSON Zelboraf (vemurafenib) - PA PA CHEMOTHERAPY "Zemaira (alpha-1-proteinase inhibitor, human-Zemaira) MB" ENZYMES MB Zembrace (sumatriptan injection-Zembrace) - PA PA TRIPTAN Zemdri (plazomicin) - PA PA ANTIBIOTICS Zemplar (paricalcitol capsule) M90 - PA PA ELECTROLYTES AND NUTRIENTS M90 Zemplar (paricalcitol injection) MB ELECTROLYTES AND NUTRIENTS MB Zenpep DR (pancrelipase-Zenpep DR) ENZYMES Zepatier (elbasvir / grazoprevir) - PA PA ANTIVIRALS Zeposia (ozanimod for multiple sclerosis) - PA PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR Zeposia (ozanimod for ulcerative colitis) - PA PA SPHINGOSINE 1-PHOSPHATE RECEPTOR MODULATOR Zepzelca (lurbinectedin) - PA PA CHEMOTHERAPY Zerbaxa (ceftolozane / tazobactam) - PA PA ANTIBIOTICS Zerviate (cetirizine ophthalmic solution) - PA PA ANTIHISTAMINES Zestoretic # (lisinopril / hydrochlorothiazide) M90 CARDIOVASCULAR "M90, #" Zestril # (lisinopril) M90 CARDIOVASCULAR "M90, #" Zetia # (ezetimibe) M90 LIPID LOWERING AGENTS "M90, #" Zetonna (ciclesonide 37 mcg nasal aerosol) - PA PA NASAL PREPARATIONS Ziac # (bisoprolol / hydrochlorothiazide) M90 CARDIOVASCULAR "M90, #" Ziagen # (abacavir) A90 ANTIVIRALS "A90, #" Ziana (clindamycin / tretinoin-Ziana) A90 - PA PA DERMATOLOGICAL A90 zidovudine A90 ANTIVIRALS "A90, #" Ziextenzo (pegfilgrastim-bmez) HEMATINIC AGENT zileuton extended-release - PA PA BRONCHODILATORS zileuton - PA PA BRONCHODILATORS Zilretta (triamcinolone extended-release injectable suspension) - PA PA GLUCOCORTICOIDS Zimhi (naloxone 5 mg / 0.5 mL syringe) ANTIDOTES zinc oxide * DERMATOLOGICAL * zinc sulfate A90 ELECTROLYTES AND NUTRIENTS A90 Zinecard # (dexrazoxane) ANTIDOTES # Zinplava (bezlotoxumab) - PA PA BIOLOGICAL "Zioptan (tafluprost) BP, M90 - PA" PA OPHTHALMIC PREPARATIONS "BP, M90" ziprasidone capsule A90 - PA 2 units/day; See Table 24; See Table 71 PA 2 units/day ANTIPSYCHOTIC "A90, #" ziprasidone injection ANTIPSYCHOTIC # Zipsor (diclofenac 25 mg capsule) A90 - PA PA NONSTEROIDAL ANTI-INFLAMMATORY A90 Zirabev (bevacizumab-bvzr) MB - PA PA CHEMOTHERAPY MB Zirgan (ganciclovir ophthalmic gel) OPHTHALMIC PREPARATIONS Zithromax (azithromycin powder packet) A90 - PA PA ANTIBIOTICS A90 Zithromax # (azithromycin) A90 ANTIBIOTICS "A90, #" "Zithromax # (azithromycin injection, suspension, tablet) A90" ANTIBIOTICS "A90, #" ziv-aflibercept MB - PA PA CHEMOTHERAPY MB "Zocor # (simvastatin 5 mg, 10 mg, 20 mg, 40 mg) M90 - PA > 1.5 units/day" PA > 1.5 units/day LIPID LOWERING AGENTS "M90, #" Zocor # (simvastatin 80 mg) M90 - PA > 1 unit/day PA > 1 unit/day LIPID LOWERING AGENTS "M90, #" "Zofran # (ondansetron 4 mg, 8 mg tablet) A90" ANTIEMETICS "A90, #" Zokinvy (lonafarnib) - PA PA UNCLASSIFIED DRUG PRODUCTS zoledronic acid 4 mg MB ELECTROLYTES AND NUTRIENTS MB zoledronic acid 5 mg MB ELECTROLYTES AND NUTRIENTS MB "Zolgensma (onasemnogene abeparvovec-xioi) CO, PD, MB - PA" PA GENE THERAPY "CO, PD, MB" Zolinza (vorinostat) CHEMOTHERAPY zolmitriptan nasal spray A90 - PA PA TRIPTAN A90 zolmitriptan orally disintegrating tablet A90 - PA PA TRIPTAN A90 zolmitriptan tablet A90 - PA > 18 units/30 days PA > 18 units/30 days TRIPTAN "A90, #" "Zoloft # (sertraline oral concentrate, tablet) A90 - PA < 6 years; See Table 17; See Table 71" PA ANTIDEPRESSANTS "A90, #" "zolpidem 1.75 mg, 3.5 mg sublingual tablet - PA; See Table 15; See Table 71" PA SEDATIVES zolpidem 10 mg tablet - PA 1 unit/day; See Table 15; See Table 71 PA 1 unit/day SEDATIVES # "zolpidem 5 mg, 10 mg sublingual tablet - PA; See Table 15; See Table 71" PA SEDATIVES zolpidem 5 mg tablet - PA 1.5 units/day; See Table 15; See Table 71 PA 1.5 units/day SEDATIVES # zolpidem 7.5 mg capsule - PA; See Table 15; See Table 71 PA SEDATIVES zolpidem extended-release tablet - PA 1 unit/day; See Table 15; See Table 71 PA 1 unit/day SEDATIVES # Zomacton (somatropin-Zomacton) - PA PA HORMONE AGENTS Zomig (zolmitriptan nasal spray) A90 - PA PA TRIPTAN A90 Zomig # (zolmitriptan tablet) A90 - PA > 18 units/30 days PA > 18 units/30 days TRIPTAN "A90, #" Zomig ZMT (zolmitriptan orally disintegrating tablet) A90 - PA PA TRIPTAN A90 Zonalon (doxepin cream-Zonalon) - PA PA DERMATOLOGICAL Zonisade (zonisamide suspension) - PA PA ANTICONVULSANTS zonisamide capsule A90 ANTICONVULSANTS A90 zonisamide suspension - PA PA ANTICONVULSANTS Zontivity (vorapaxar) - PA PA ANTIPLATELET AGENT "Zortress # (everolimus 0.25 mg, 0.5 mg, 0.75 mg, 1 mg) A90" IMMUNOMODULATOR "A90, #" "Zorvolex (diclofenac 18 mg, 35 mg capsule) A90 - PA" PA NONSTEROIDAL ANTI-INFLAMMATORY A90 Zoryve (roflumilast cream) - PA PA DERMATOLOGICAL "zoster vaccine recombinant, adjuvanted - PA < 50 years" PA BIOLOGICAL Zosyn # (piperacillin / tazobactam) ANTIBIOTICS # "Zovirax (acyclovir cream) BP, A90" ANTIVIRALS "BP, A90" Zovirax # (acyclovir ointment) ANTIVIRALS # Zovirax # (acyclovir suspension) A90 ANTIVIRALS "A90, #" Ztalmy (ganaxolone) - PA PA PSYCHOSTIMULANTS-ANTIDEPRESSANTS Ztlido (lidocaine 1.8% patch) - PA PA ANESTHETICS Zubsolv (buprenorphine / naloxone sublingual tablet-Zubsolv) - PA PA ALCOHOL AND DRUG CESSATION AGENT Zulresso (brexanolone) MB - PA PA ANTIDEPRESSANTS MB zuranolone - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS Zurzuvae (zuranolone) - PA; See Table 17; See Table 71 PA ANTIDEPRESSANTS Zyban # (bupropion hydrochloride sustained-release-Zyban) A90 - PA < 6 years PA SMOKING CESSATION "A90, #" "Zyclara (imiquimod 2.5%, 3.75% cream) BP, A90 - PA" PA DERMATOLOGICAL "BP, A90" Zydelig (idelalisib) - PA PA CHEMOTHERAPY Zyflo (zileuton) - PA PA BRONCHODILATORS Zykadia (ceritinib) - PA PA CHEMOTHERAPY Zylet (tobramycin / loteprednol ophthalmic suspension) OPHTHALMIC PREPARATIONS "Zyloprim # (allopurinol 100 mg, 300 mg tablet) M90" GOUT AGENTS "M90, #" Zymaxid # (gatifloxacin ophthalmic solution) A90 OPHTHALMIC PREPARATIONS "A90, #" Zynlonta (loncastuximab tesirine-lpyl) - PA PA CHEMOTHERAPY Zynrelef (bupivacaine / meloxicam) MB ANESTHETIC LOCAL TOPICAL MB "Zynteglo (betibeglogene autotemcel) CO, PD, MB - PA" PA HEMATINICS & BLOOD CELL STIMULATORS "CO, PD, MB" Zynyz (retifanlimab-dlwr) MB - PA PA CHEMOTHERAPY MB Zypitamag (pitavastatin magnesium) - PA PA LIPID LOWERING AGENTS Zyprexa # (olanzapine injection) ANTIPSYCHOTIC # Zyprexa # (olanzapine tablet) A90 - PA 2 units/day; See Table 24; See Table 71 PA 2 units/day ANTIPSYCHOTIC "A90, #" "Zyprexa Relprevv (olanzapine 210 mg, 300 mg extended-release injection) - PA 2 injections/28 days; See Table 24; See Table 71" PA 2 injections/28 days ANTIPSYCHOTIC Zyprexa Relprevv (olanzapine 405 mg extended-release injection) - PA 1 injection/28 days; See Table 24; See Table 71 PA 1 injection/28 days ANTIPSYCHOTIC Zyprexa Zydis # (olanzapine 15 mg orally disintegrating tablet) A90 - PA 2 units/day; See Table 24; See Table 71 PA 2 units/day ANTIPSYCHOTIC "A90, #" "Zyprexa Zydis # (olanzapine 5 mg, 10 mg, 20 mg orally disintegrating tablet) A90 - PA 1 unit/day; See Table 24; See Table 71" PA 1 unit/day ANTIPSYCHOTIC "A90, #" "Zytiga (abiraterone 250 mg, 500 mg) A90 - PA" PA CHEMOTHERAPY A90 Zyvox (linezolid injection) - PA PA ANTIBIOTICS Zyvox (linezolid suspension) A90 - PA PA ANTIBIOTICS A90 Zyvox # (linezolid tablet) A90 ANTIBIOTICS "A90, #"