2012 AZ Non-Formulary drug Request form
2012 AZ Specialty General Request Form
2012 AZ Tier Exception Request Form
Adagen-pegademase bovine
Adcirca-tadalafil
Afinitor-everolimus
Aldurazyme-laronidase
Alimta-pemetrexed
Anadrol-50-oxymetholone
Arcalyst-rilonacept
Avastin-bevacizumad
Avonex-interferon beta 1a
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az_prior_auth_criteria_2012
B vs. D Amifostine-amifostine
B vs. D Cerezyme-imiglucerase
B vs. D Gammagard-immune globulin
B vs. D Gamunex-immune globulin
B vs. D Imovax Rabies vaccine
B vs. D Mitoxantrone-mitoxantrone
B vs. D Ravebert Rabies vaccine
B vs. D Tetanus Toxoid Adsorbed
B vs. D Vidaza-azacitidine
B vs. D Zometa-zoledronic acid
B vs. D-Anti-Cancer
B vs. D-Engreix-B-hepatitis B vaccine
B vs. D-Immunosuppressants
B vs. D-Oral Anti-Emetics
B vs. D-Recombivax HB-hepatitis B vaccine
Betaseron-interferon beta 1b
Byetta-exenatide
Campath-alemtuzumab
Cancidas-caspofungin
Copaxone-glatiramer
Dronabinol-dronabinol
Emend-aprepitant
Enbrel-etanercept
Entocort EC-budesonide
Erivedge-vismodegib
Erwinaze-asparaginaze erwinia chrysanthemi
Fentanyl citrate lozenges-fentanyl citrate
Forteo-teriparatide
Genotropin-somatropin
Gilenya-fingolimod
Gleevec-imatinib
Humatrope-somatropin recombinant
Humira Crohns-adalimumab
Humira-adalimumab
Increlex-mecasermine
Inlyta-axitinib
Jakafi-ruxolitinib
Leukine-sargramostim
Lyrica-pregabalin
Miacalcin Inject-calcitonin salmon
Naglazyme-galsulfase
Neumega-oprelvekin
Neupogen-filgrastim
Nexavar-sorafenib
Noxafil-posaconazole
Orfadin-nitisinone
Oxandrolone-oxandrolone
Peg Intron-peginterferon alfa
Pegasys-interferon alfa-2a
Procrit-epoetin alfa
Prolastin Prolastin C-Alpha 1-Proteinase Inhibitor Human
Promacta-eltrombopag
Provigil-modafinil
Qualaquin-qualaquin
Ranexa- ranolazine
Relistor-methylnaltrexone
Remicade-infliximab
Remodulin-treprostinil
Restasis-cyclosporine ophthalmic emulsion
Revatio-sildenafil citrate
Somatuline Depot-lanreotide
Somavert-pegvisomant
Soriatane
Sprycel-dasatinib
Strattera-atomoxetine
Sutent-sunitinib
Symlin and Symlinpen-pramlintide acetate
Targretin-bexarotene
Tasigna-nilotinib
Thalomid-thalidomide
Thioguanine-thioguanine
Tykerb-lapatinib
Vancocin-vancomycin
Vandetanib Caprelsa-vandetanib
Velcade-bortezomib
Victoza-liraglutide
Victrelis-boceprevir
Votrient-pazopanib
Xalkori-crizotinib
Xenazine-tetrabenazine
Zavesca-miglustat
Zelboraf-vemurafenib
Zolinza-vorinostat
Zytiga-aberaterone acetate
Physician Coverage Determination Link