Antineoplastic Agents

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NAME
ALSO KNOW AS
DRUG CATEGORY
FORMULARY CATEGORY
WHAT WE COVER
COST SHARE
Abiraterone Acetate Tabs 250Mg (Generic)

Zytiga Tabs 250 Mg (Brand)
Antineoplastic Agents
1
Generic
$14
Ado-Trastuzumab Emtansine Solr 100Mg (Generic)

Kadcyla Solr 100 Mg (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Ado-Trastuzumab Emtansine Solr 160Mg (Generic)

Kadcyla Solr 160 Mg (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Afinitor Disperz Tbso 2 Mg (Brand)

Everolimus Tbso 2Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Afinitor Disperz Tbso 3 Mg (Brand)

Everolimus Tbso 3Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Afinitor Disperz Tbso 5 Mg (Brand)

Everolimus Tbso 5Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Afinitor Tabs 10 Mg (Brand)

Everolimus Tabs 10Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Afinitor Tabs 2.5 Mg (Brand)

Everolimus Tabs 2.5Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Afinitor Tabs 5 Mg (Brand)

Everolimus Tabs 5Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Afinitor Tabs 7.5 Mg (Brand)

Everolimus Tabs 7.5Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Aldesleukin Solr 22000000Unit (Generic)

Proleukin Solr 22000000 Unit (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Alecensa Caps 150 Mg (Brand)

Alectinib Hcl Caps 150Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Alunbrig Tabs 180 Mg (Brand)

Brigatinib Tabs 180Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Alunbrig Tabs 30 Mg (Brand)

Brigatinib Tabs 30Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Alunbrig Tabs 90 Mg (Brand)

Brigatinib Tabs 90Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Alunbrig Tbpk 90 & 180 Mg (Brand)

Brigatinib Tbpk (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Anastrozole Tabs 1Mg (Generic)

Arimidex Tabs 1 Mg (Brand)
Antineoplastic Agents
1
Generic
$14
Arimidex Tabs 1 Mg (Brand)

Anastrozole Tabs 1Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Aromasin Tabs 25 Mg (Brand)

Exemestane Tabs 25Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Arsenic Trioxide Soln 10Mg/10Ml (Generic)

Trisenox Soln 10 Mg/10Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Arsenic Trioxide Soln 12Mg/6Ml (Generic)

Arsenic Trioxide Soln 12 Mg/6Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Arsenic Trioxide Soln 12Mg/6Ml (Generic)

Trisenox Soln 12 Mg/6Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Atezolizumab Soln 1200Mg/20Ml (Generic)

Tecentriq Soln 1200 Mg/20Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Atezolizumab Soln 840Mg/14Ml (Generic)

Tecentriq Soln 840 Mg/14Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Avelumab Soln 200Mg/10Ml (Generic)

Bavencio Soln 200 Mg/10Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Balversa Tabs 3 Mg (Brand)

Erdafitinib Tabs 3Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Balversa Tabs 4 Mg (Brand)

Erdafitinib Tabs 4Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Balversa Tabs 5 Mg (Brand)

Erdafitinib Tabs 5Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Bcg Vaccine Inj (Generic)

Bcg Vaccine Inj (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Belinostat Solr 500Mg (Generic)

Beleodaq Solr 500 Mg (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Bendamustine Hcl Soln 100Mg/4Ml (Generic)

Belrapzo Soln 100 Mg/4Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Bendamustine Hcl Soln 100Mg/4Ml (Generic)

Bendamustine Hcl Soln 100 Mg/4Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Bendamustine Hcl Soln 100Mg/4Ml (Generic)

Bendeka Soln 100 Mg/4Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Besremi Sosy 500 Mcg/Ml (Brand)

Ropeginterferon alfa-2b Sosy 500 Mcg/Ml (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Bevacizumab Soln 100Mg/4Ml (Generic)

Avastin Soln 100 Mg/4Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
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