| 10/1/2024 | | 9/1/2024 | Arikayce® | amikacin liposome inhalation suspension | | 10/1/2024 | | 9/1/2024 | Androgel®, Androderm®, Aveed®, Fortesta®, Jatenzo®, Tlando®, Natesto®, Testim®, Vogelxo®, Xyosted™, Kyzatrex®, Methitest® | Testosterone, Testosterone undecanoate, Methyltestosterone, Testosterone enanthate | | 10/1/2024 | | 9/1/2024 | Cayston® | Aztreonam | | 10/1/2024 | | 9/1/2024 | Filsuvez® | birch triterpenes | | 10/1/2024 | | 9/1/2024 | Alvaiz™, Promacta®, Tavalisse™, Doptelet®, Mulpleta® | eltrombopag choline, eltrombopag olamine, fostamatinib disodium, avatrombopag, lusutrombopag | | 10/1/2024 | | 9/1/2024 | Eohilia™ | budesonide | | 10/1/2024 | | 9/1/2024 | Oxervate™ | Cenegermin-bkbj | | 10/1/2024 | | 9/1/2024 | Juxtapid®, Praluent®, Repatha®, Nexletol™, Nexlizet™ | lomitapide, alirocumab, evolocumab, bempedoic acid, bempedoic acid/ezetimibe | | 10/1/2024 | | 9/1/2024 | Compounded products | Compounded products | | 10/1/2024 | | 9/1/2024 | Convenience packs | Convenience packs | | 10/1/2024 | | 9/1/2024 | Verkazia® | Cyclosporine | | 10/1/2024 | | 9/1/2024 | Keveyis®, Ormalvi® | Dichlorphenamide | | 10/1/2024 | | 9/1/2024 | Northera® | Droxidopa | | 10/1/2024 | | 9/1/2024 | claims exceeding $10,000 | claims exceeding $10,000 | | 10/1/2024 | | 9/1/2024 | Agamree® | vamorolone | | 10/1/2024 | | 9/1/2024 | Kerendia® | Finerenone | | 10/1/2024 | | 9/1/2024 | Rukobia®, Fuzeon® | Fostemsavir, Enfuvirtide | | 10/1/2024 | | 9/1/2024 | Corlanor®, Verquvo™ | ivabradine, vericiguat | | 10/1/2024 | | 9/1/2024 | Zepatier®, Harvoni®, Viekira Pak®, Sovaldi®, Epclusa®, Mavyret™, Vosevi® | elbasvir/ grazeprevir, ledipasvir/ sofosbuvir, ombitasvir/ paritaprevir/ ritonavir and dasabuvir, sofosbuvir, velpatasvir/ sofosbuvir, glecaprevir/pibrentasvir, sofosbuvir/velpatasvir/voxilaprevir | | 10/1/2024 | | 9/1/2024 | NA | NA | | 10/1/2024 | | 9/1/2024 | NA | NA | | 10/1/2024 | | 9/1/2024 | ZYMFENTRA INJ 120MG/ML | INFLIXIMAB-DYYB SOLN AUTO-INJECTOR KIT 120 MG/ML, INFLIXIMAB-DYYB SOLN PREFILLED SYRINGE KIT 120 MG/ML | | 10/1/2024 | | 9/1/2024 | NA | NA | | 10/1/2024 | | 9/1/2024 | Xhance® | fluticasone propionate | | 10/1/2024 | | 9/1/2024 | Livmarli® | maralixibat | | 10/1/2024 | | 9/1/2024 | N/A | N/A | | 10/1/2024 | | 9/1/2024 | N/A | N/A | | 10/1/2024 | | 9/1/2024 | N/A | N/A | | 10/1/2024 | | 9/1/2024 | Rivfloza™ | nedosiran | | 10/1/2024 | | 9/1/2024 | N/A | N/A |
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