HealthTeam Advantage 2023 Prior Authorization Forms A B C D E F G H I J K L M N O P Q R S T U V W X Z abiraterone Accutane Actimmune Adbry Adempas Afinitor Disperz Aimovig Autoinjector Aldurazyme Alecensa alosetron Alunbrig Alyq ambrisentan Amnesteem Anadrol-50 Androderm Arcalyst armodafinil Asceniv Aubagio Auryxia Austedo Avonex Ayvakit Bafiertam Balversa Benlysta Besremi Betaseron bexarotene Bivigam bosentan Bosulif Braftovi Briviact Brukinsa Cablivi Cabometyx Calquence (acalabrutinib mal) Calquence Camzyos Caplyta Caprelsa Carimune NF Nanofiltered Cayston Cerdelga Cholbam Cibinqo Ciclodan ciclopirox Cimzia Cimzia Starter Kit Cinryze Claravis Clovique Cometriq Copiktra Corlanor Cosentyx Cosentyx Pen Cosentyx Pen (2 Pens) Cosentyx (2 Syringes) Cotellic Cutaquig Cuvitru Cystaran dalfampridine Daliresp Danyelza Darzalex Faspro Daurismo deferasirox deferiprone Diacomit diclofenac sodium dihydroergotamine dimethyl fumarate dronabinol droxidopa Dupixent Pen Dupixent Syringe Elaprase Emgality Pen Emgality Syringe Empaveli Enbrel Enbrel Mini Enbrel SureClick Enjaymo Entyvio Epidiolex Epoprostenol Epoprostenol (glycine) Erivedge Erleada Erlotinib Esbriet Eucrisa everolimus (antineoplastic) Evrysdi Exkivity Fabrazyme Farydak Fasenra Fasenra Pen Fensolvi fentanyl citrate fingolimod Fintepla Firmagon kit with diluent syringe Forteo Fotivda Fyarro GamaSTAN GamaSTAN SD Gammaked Gamunex-C Gattex 30 Gattex One-Vial Gavreto Genotropin Genotropin MiniQuick Gilenya Gilotrif glatiramer glycopyrrolate Glydo Hizentra Humira Humira Pen Humira Pen Crohns-UC-HS Start Humira Pen Psor-Uveits-Adol HS Humira(CF) Humira(CF) Pedi Crohns Starter Humira(CF) Pen Humira(CF) Pen Crohns-UC-HS Humira(CF) Pen Pediatric UC Humira(CF) Pen Psor-Uv-Adol HS HyQvia Ibrance icatibant Iclusig icosapent ethyl Idhifa Igalmi Ilaris (PF) Ilumya imatinib Imbruvica Inbrija Increlex Inflectra infliximab Ingrezza Inlyta Inqovi Inrebic Intron A Iressa isotretinoin itraconazole ivermectin Jakafi Jemperli Juxtapid Kalydeco Kanjinti Kanuma Kerendia Kesimpta Pen Kimmtrak Kisqali Kisqali Femara Co-Pack Korlym Korsuva Koselugo Kynmobi lanreotide lapatinib Lemtrada lenalidomide Lenvima leuprolide lidocaine HCl lidocaine lidocaine-prilocaine Livmarli Lonsurf Lorbrena Lumakras Lumizyme Lupron Depot Lupron Depot (3 month) Lupron Depot (4 month) Lupron Depot (6 Month) Lupron Depot-Ped Lupron Depot-Ped (3 month) Lynparza Lytgobi Makena (PF) Mavyret Mayzent Mayzent Starter(for 1mg maint) Mayzent Starter(for 2mg maint) megestrol Mekinist Mektovi metyrosine miglustat modafinil Monjuvi Mvasi Myfembree Myorisan Naglazyme Natpara Nerlynx Neulasta Neulasta Onpro Nexletol Nexlizet Ninlaro Noxafil Nubeqa Nucala Nuedexta Nuplazid Ocrevus Octagam octreotide acetate Odomzo Ofev Onureg Opdualag Opsumit Opzelura Orenitram Orgovyx Orilissa Orkambi Osmolex ER Osphena oxandrolone Oxbryta Oxlumo Panzyga Pegasys Pemazyre Phesgo Piqray pirfenidone Plegridy Polivy Pomalyst posaconazole Praluent Pen Privigen Procrit Prolastin-C Promacta Pulmozyme pyrimethamine Pyrukynd Qinlock quinine sulfate Radicava ORS Radicava ORS Starter Kit Susp Rebif (with albumin) Rebif Rebidose Rebif Titration Pack Relyvrio Remicade Renflexis Repatha Pushtronex Repatha SureClick Repatha Syringe Retacrit Retevmo Revcovi Revlimid Rezurock riluzole Rinvoq roflumilast Rolvedon romidepsin Rozlytrek Rubraca Ruxience Rybrevant Rydapt Sajazir Saphnelo sapropterin Sarclisa Scemblix Signifor Signifor LAR sildenafil (pulm.hypertension) Skyrizi Skytrofa sodium oxybate sofosbuvir-velpatasvir Somatuline Depot Somavert sorafenib Spravato Sprycel Stelara Stivarga Strensiq sunitinib Supprelin LA Symdeko SymlinPen 60 SymlinPen 120 Synagis Synribo Tabrecta tadalafil tadalafil (pulm. hypertension) Tafinlar Tagrisso Talzenna Tarpeyo Tasigna Tavalisse Tavneos Tazverik Tegsedi Tepmetko teriparatide testosterone testosterone cypionate testosterone enanthate tetrabenazine Tezspire Thalomid Tibsovo Tivdak Trazimera Trelstar tretinoin trientine Trikafta Triptodur Trodelvy Truseltiq Tukysa Turalio Tymlos Tysabri Ubrelvy Udenyca Vabysmo Valchlor Varizig Venclexta Venclexta Starting Pack Ventavis Verzenio vigabatrin Vigadrone Vijoice Vimizim Vitrakvi Vizimpro Vonjo Voquezna Dual Pak Voquezna Triple Pak voriconazole Vosevi Votrient Voxzogo Vumerity Vyndamax Vyvgart Welireg Xalkori Xcopri Xcopri Maintenance Pack Xcopri Titration Pack Xeljanz Xeljanz XR Xembify Xenpozyme Xermelo Xgeva Xifaxan Xolair Xospata Xpovio Xtandi Xyrem Zejula Zelboraf Zenatane Zeposia Zeposia Starter Kit Zeposia Starter Pack Zepzelca Zirabev Zokinvy Zoladex Zolinza Zorbtive Ztalmy Zydelig Zykadia Zynlonta Back to top Take Your Health Risk Assessment
