| Section | Status | HCD | Name |
| 11.08.02 | Restricted Use |  |
Aflibercept Eylea® |
| 05.03.03.02 | Restricted Use | |
Boceprevir Victrellis® |
| 03.04.03 | Restricted Use | |
C1 Esterase Inhibitor Berinert® |
| 05.03.03.02 | Restricted Use | |
Daclatasvir Daklinza® |
| 05.03.03.02 | Restricted Use | |
Dasabuvir Exviera® |
| 08.01.05 | Restricted Use | |
Dasatinib Sprycel® |
| 05.03.03.02 | Restricted Use | |
Elbasvir-grazoprevir Zepatier® |
| 05.03.03.01 | Restricted Use | |
Entecavir Baraclude® |
| 14.05.01 | Restricted Use | |
Normal Immunoglobulin Iqymune®, Privigen®, Gammaplex®, Intratect®. and others |
| 05.03.03.02 | Restricted Use | |
Ombistavir/paritaprevir/ritonavir Viekirax® |
| 08.02.04 | Formulary | |
Panobinostat Farydak® |
| 08.01.05 | Restricted Use | |
Pertuzumab Perjeta® |
| 09.01.07 | Restricted Use | |
Plerixafor Mozobil® |
| 11.08.02 | Restricted Use | |
Ranibizumab Lucentis® |
| 05.03.03.02 | Restricted Use | |
Simeprevir Olysio® |
| 05.03.03.02 | Restricted Use | |
Sofosbuvir Sovaldi® |
| 05.03.03.02 | Restricted Use | |
Sofosbuvir/ledipasvir Harvoni® |
| 05.03.03.02 | Restricted Use | |
Telaprevir Incivo® |