Click on the Drug Class to see the Criteria In Use by Medical Mutual for coverage approval.

Drug Class  Drugs in Class 
 ACL Inhibitors  Nexletol, Nexlizet
 Acthar  Acthar Gel
 Acute Oral CGRP Antagonists  Nurtec ODT, Ubrelvy
 Acyclovir Topicals  Acyclovir 5% ointment, Zovirax 5% cream
 Adakveo  Adakveo
 Addyi  Addyi
 Afinitor  Afinitor, Afinitor Disperz, everolimus
 Alunbrig  Alunbrig
 Ampyra  Ampyra
 Androgens-Anabolic Steroids  Androl-50, Danazol, Nandrolone, Oxandrin
 Anticoagulants  Eliquis, Pradaxa, Savaysa, Xarelto
 Antipsoriatic Agents  Otezla, Stelara, Taltz, Tremfya
 Apokyn, Kynmobi  Apokyn, Kynmobi
 Attention Deficit Hyperactivity Disorder Non-Stimulant Medications  Atomoxetine, Clonidine ER, Guanfacine ER, Intuniv, Kapvay, Strattera
 Austedo  Austedo
 Auvi-Q  Auvi-Q
 Ayvakit  Ayvakit
 Bafiertam  Bafiertam
 Balversa  Balversa
 Benlysta  Benlysta
 Botulinum Toxin  Botox, Botox Cosmetic, Dysport, Myobloc, Xeomin
 Braftovi  Braftovi
 Branded Riluzole Products  Exservan, Rilutek, Tiglutik Kit
 Bronchitol  Bronchitol
 Bynfezia  Bynfezia
 Cabenuva  Cabenuva
 Cablivi  Cablivi
 Cabometyx  Cabometyx
 Calcitonin Gene-Related Peptide (CGRP) Antagonist  Aimovig (erenumab-aooe), Ajovy (fremanezumab-vfrm), Emgality (galcanezumab-gnlm)
 Cayston  Cayston
 Cequa  Cequa
 Cholbam  Cholbam
 Cialis  Cialis (2.5 & 5 MG)
 Colony Stimulating Factors  Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo, Leukine, Granix, Neupogen, Nivestym and Zarxio
 Cometriq  Cometriq
 Continuous Glucose Monitors  Dexcom G4, Dexcom G5, Enlite, Freestyle Navigator, Guardian, Minlink Real-Time, Minimed 630G Guardian, Paradigm Real-Time, Seven System, SOF , Eversense, Freestyle Libre, Dexcom G6
 Contraceptive Agents  All contraceptive agents not being prescribed for contraceptive purposes
 Corlanor  Corlanor
 Cosentyx  Cosentyx
 Crysvita  Crysvita
 Cuprimine  Cuprimine
 Daliresp  Daliresp
 Daurismo  Daurismo
 Diacomit  Diacomit
 Diclegis and Bonjesta  Diclegis and Bonjesta
 Dojolvi  Dojolvi
 Doptelet  Doptelet
 Dupixent  Dupixent
 Egrifta  Egrifta
 Emflaza  Emflaza
 Endari  Endari
 Enspryng  Enspryng
 Entresto  Entresto
 Entyvio  Entyvio
 Epidiolex  Epidiolex
 Erleada  Erleada
 Erythroid Stimulants  Aranesp, Epogen, Procrit and RetacritMircera
 Esbriet  Esbriet
 Evenity  Evenity
 Evkeeza  Evkeeza
 Evrysdi  Evrysdi
 Eysuvis  Eysuvis
 Fasenra  Fasenra
 Fintepla  Fintepla
 Firdapse and Ruzurgi  Firdapse and Ruzurgi
 Forteo, Bonsity   Forteo, Bonsity
 Galafold  Galafold
 Gamifant  Gamifant
 Gattex  Gattex
 Gaucher Disease Agents  Cerdelga, Miglustat , Zavesca
 General Oncology  Alecensa, Bosulif, Brukinsa, Calquence, Caprelsa, Copiktra, Cotellic, Darzalex Faspro, Eligard, Erivedge, Farydak, Firmagon, Fotivda, Gavreto, Gilotrif, Iclusig, Idhifa, Inqovi, Inlyta, Iressa, Lapatinib, Lenvima, Libtayo, Lorbrena, Lynparza, Margenza, Mekinist, Nexavar, Ninlaro, Nubeqa, Odomzo, Onureg, Orgovyx, Panretin, Pepaxto, Retevmo, Rubraca, Tafinlar, Tagrisso, Talzenna, Tarceva, Targretin Gel, Tasigna, Tazveric, Temodar, Temozolomide, Tepmetko, Trelstar, Turalio, Tykerb, Udenyca, Ukoniq, Venclexta, Vizimpro, Votrient, Xalkori, Xtandi, Zejula, Zelboraf, Zolinza, Zydelig, Zykadia
 Givlaari  Givlaari
 Gleevec  Gleevec, Imatinib
 Global Prior Authorization  Accrufer, Azstarys, Esperoct, Klisyri, Macrilen, Spritam
 Gonadotropin-Releasing Hormone Agonists for Central Precocious Puberty  Fensolvi, Lupron Depot-Ped, Triptodur
 Gonadotropin-Releasing Hormone Agonists Long-Acting Agents  Lupaneta Pack, Lupron-Depot
 Growth Hormones  Genotropin, Humatrope, Increlex, Norditropin, Nutropin, Omnitrope, Saizen, Serostim, Zomacton, Zorbtive
 HAE (Hereditary Angioedema) Agents  Berinert, Cinryze and Haegarda, Firazyr and Icatibant Kalbitor, Ruconest, Takhzyro
 Hemlibra  Hemlibra
 Hepatitis C  Epclusa, Harvoni, Mavyret, Sovaldi, Viekira, Vosevi, Zepatier
 Hepatitis C Preferred Specialty Management  Epclusa, sofosbuvir/velpatasvir, Harvoni, ledipasvir/sofosbuvir, Mavyret, Sovaldi, Vosevi, Zepatier
 Hetlioz  Hetlioz
 Ibrance  Ibrance
 Ibsrela  Ibsrela
 Ilaris  Ilaris
 Ilumya  Ilumya
 Imbruvica  Imbruvica
 Imcivree  Imcivree
 Imvexxy  Imvexxy
 Inbrija  Inbrija
 Inflammatory Care  Actemra, Cosentyx, Humira, Skyrizi, Stelara, Ilumya, Olumiant, Orencia SC, Otezla, Enbrel, Cimzia, Simponi SC, Kevzara, Kineret, Siliq, Taltz, Tremfya , Xeljanz/Xeljanz XR
 Ingrezza  Ingrezza
 InPen Smart Insulin Pen  InPen Smart Insulin Pen
 Inrebic  Inrebic
 Intrarosa  Intrarosa
 Iron Chelators - Oral   Deferasirox, Exjade, Ferriprox, Jadenu, Jadenu Sprinkle
 Isturisa  Isturisa
 Jakafi  Jakafi
 Juxtapid  Juxtapid
 Jynarque and Samsca  Jynarque and Samsca
 Kalydeco  Kalydeco
 Kesimpta  Kesimpta
 Kevzara  Kevzara
 Kisqali  Kisqali
 Korlym  Korlym
Koselugo   Koselugo
 Kuvan  Kuvan
 Lacrisert  Lacrisert
 Leuprolide IR  Immediate Release Leuprolide products
 Lidocaine Patch  Lidoderm or Lidocaine Patch, ZTlido
 Linzess  Linzess
 Lonsurf  Lonsurf
 Lupkynis  Lupkynis
 Luzu (luliconazole)  Luzu (luliconazole)
 Lyrica CR  Lyrica CR
 Mavenclad  Mavenclad
 Medical Device  V-Go Disposable Insulin Delivery Device
 Mektovi  Mektovi
 Motegrity  Motegrity
 Mulpleta  Mulpleta
 Multiple Sclerosis  Aubagio, Copaxone/Glatopa (glatiramer), Gilenya, Interferon Beta Injectables, Mayzent, Dimethyl fumarate & Tecfidera
 Multiple Sclerosis Care Value  Aubagio, Avonex, Betaseron, Copaxone, Extavia, Gilenya, Glatopa, Mavenclad, Mayzent, Plegridy, Rebif, Tecfidera, Vumerity, Zeposia
 Myalept  Myalept
 Mycapssa  Mycapssa
 Narcolepsy Products  Wakix, Xyrem, Xywav
 Natpara  Natpara
Nayzilam  Nayzilam
 Nerlynx  Nerlynx
 Noctiva and Nocdurna  Noctiva and Nocdurna
 Northera  Northera
 Nourianz  Nourianz
 Nucala  Nucala
 Nuedexta  Nuedexta
 Nulibry  Nulibry
 Nuplazid  Nuplazid
 Ocaliva  Ocaliva
Ocrevus  Ocrevus
 Ofev  Ofev
 Olumiant  Olumiant
 Omega-3 Fatty Acid Products  Lovaza, Omega-3-Acid Ethyl Esters, Vascepa
 Ongentys  Ongentys
 Onpattro  Onpattro
 Opioid Induced Constipation  Amitiza, Movantik, Relistor, Symproic
 Opioids  Extended Use Opioids (all opioid products not used for substance abuse treatment), Morphine Equivalent Dose, Oxycontin (Oxycodone ER) 80 mg
 Orencia SC  Orencia
 Orfadin and Nityr  Orfadin, Nityr
 Oriahnn  Oriahnn
 Orilissa  Orilissa
 Orkambi  Orkambi
 Orladeyo  Orladeyo
 Osphena  Osphena
 Oxaydo  Oxaydo
 Oxbryta  Oxbryta
 Oxervate  Oxervate
 Oxlumo  Oxlumo
 Palforzia  Palforzia
 Palynziq  Palynziq
 PCSK9 Inhibitors  Praluent, Repatha
 Pemazyre  Pemazyre
 Pheochromocytoma  Demser, Dibenzyline, Metyrosine
 Phesgo  Phesgo
 Phexxi  Phexxi
 Piqray  Piqray
 Pizensy  Pizensy
 Pomalyst  Pomalyst
 Promacta  Promacta
 Provigil, Nuvigil  Provigil, Nuvigil
 Pulmonary Arterial Hypertension  Adempas, Endothelin Receptor Antagonist (Tracleer, Letairis, Opsumit), Epoprostenol (Veletri, Flolan), Inhaled Prostacyclins (Tyvaso, Ventavis), Orenitram, PDE-5 Inhibitors (Adcirca, Revatio, sildenafil), Uptravi
 Pulmozyme  Pulmozyme
 Qbrexza  Qbrexza
 Qinlock   Qinlock
 Ravicti  Ravicti
 Reblozyl  Reblozyl
 Restasis  Restasis
 Retevmo  Retevmo
 Revcovi  Revcovi
 Revlimid  Revlimid
 Reyvow  Reyvow
 Rheumatological Agents  Actemra SC, Cimzia, Enbrel, Humira, Kineret, Simponi SC, Xeljanz and Xeljanz XR
 Rinvoq  Rinvoq
 Riomet  Riomet
 Rituxan  Rituxan
 Rozlytrek  Rozlytrek
 Rydapt  Rydapt
 Saxenda  Saxenda
 Siliq  Siliq
 Skyrizi  Skyrizi
 Solaraze  Solaraze, diclofenac 3% gel
 Soliris  Soliris
 Soma (carisoprodol)  Soma, carisoprodol, combination carisoprodol products
 Somatostatin Analogs  Sandostatin LAR, Signifor LAR, Somatuline Depot
 Somavert  Somavert
 Spravato  Spravato
 Sprycel  Sprycel
 Stivarga  Stivarga
 Strensiq  Strensiq
 Subcutaneous Immune Globulins  Cutaquig, Cuvitru, Gammagard Liquid, Gammaked, Gamunex-C, Hizentra, HyQvia, Xembify
 Sublingual Immunotherapy (SLIT)  Grastek , Odactra, Oralair, Ragwitek
 Sunosi  Sunosi
 Sutent  Sutent
 Symdeko  Symdeko
 Synarel  Synarel
 Syprine  Syprine
 Tabrecta  Tabrecta
 Targretin Capsules  Targretin (bexarotene)
 Tavalisse  Tavalisse
 Tazverik  Tazverik
 Tegsedi  Tegsedi
 Testosterone Injectables  Aveed (testosterone undecanoate), Delatestryl (testosterone enanthate), Depo®-Testosterone (testosterone cypionate), Testopel (testosterone) pellet, Testosterone Propionate, Testosterone propionate, Xyosted (testosterone enanthate subcutaneous injection)
 Testosterone Topicals  Androderm patch, Androgel® 1.62% gel and Androgel 1% gel (testosterone 1.62% gel and testosterone 1% gel), Android, Methitest, Testred (methyltestosterone) , Androxy (fluoxymesterone) , Axiron™ (testosterone topical solution), Fortesta™ (testosterone 2% topical gel), Jatenzo (testosterone undecanoate), Natesto™ (testosterone nasal gel) , Striant® (testosterone buccal system), Testim® (testosterone 1% gel), Testosterone (generic oral formulations), Vogelxo (testosterone 1% gel)
 Thalomid  Thalomid
 Thiola  Thiola
 Tibsovo  Tibsovo
 Tobi Podhaler  Tobi Podhaler
 Topical Alpha-Adrenergic Agonists for Rosacea  Mirvaso, Rhofade
 Topical Retinoids  Differin, generic adapalene topical, Epiduo, Altreno, Atralin, Avita, Retin-A, Tretin-X, generic topical tretinoin products, Fabior, Tazorac, tazarotene topical, Aklief
 Transmucosal Fentanyl  Abstral, Actiq, fentanyl citrate, Fentora, Lazanda, Subsys
 Trikafta  Trikafta
 Trulance  Trulance
 Tukysa  Tukysa
 Ultomiris  Ultomiris
 Valtoco  Valtoco
 Veregen  Veregen
 Verquvo  Verquvo
 Verzenio  Verzenio
 Viberzi  Viberzi
 Vitrakvi  Vitrakvi
 Vocabria  Vocabria
 Vumerity  Vumerity
 Vyleesi  Vyleesi
 Vyndaqel, Vyndamax  Vyndaqel, Vyndamax
 Winlevi  Winlevi
 Xatmep  Xatmep
 Xcopri  Xcopri
 Xenazine  Xenazine
 Xermelo  Xermelo
 Xgeva  Xgeva
 Xiidra  Xiidra
Xolair  Xolair
 Xospata  Xospata
 Xpovio  Xpovio
 Xuriden and Vistogard  Vistogard, Xuriden
 Yonsa  Yonsa
 Zelnorm  Zelnorm
 Zeposia  Zeposia
 Zokinvy  Zokinvy
 Zulresso  Zulresso
Zytiga  Zytiga