Antineoplastic Agents

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NAME
ALSO KNOW AS
DRUG CATEGORY
FORMULARY CATEGORY
WHAT WE COVER
COST SHARE
Vincristine Sulfate Liposome Susp 5Mg/31Ml (Generic)

Marqibo Susp 5 Mg/31Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Vitrakvi Caps 100 Mg (Brand)

Larotrectinib Sulfate Caps 100Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Vitrakvi Caps 25 Mg (Brand)

Larotrectinib Sulfate Caps 25Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Vitrakvi Soln 20 Mg/Ml (Brand)

Larotrectinib Sulfate Soln 20Mg/Ml (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Vizimpro Tabs 15 Mg (Brand)

Dacomitinib Tabs 15Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Vizimpro Tabs 30 Mg (Brand)

Dacomitinib Tabs 30Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Vizimpro Tabs 45 Mg (Brand)

Dacomitinib Tabs 45Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Votrient Tabs 200 Mg (Brand)

Pazopanib Hcl Tabs 200Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
WELIREG TABS 40 MG (Brand)

BELZUTIFAN TABS 40 MG (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Xalkori Caps 200 Mg (Brand)

Crizotinib Caps 200Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Xalkori Caps 250 Mg (Brand)

Crizotinib Caps 250Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Xatmep Soln 2.5 Mg/Ml (Brand)

Methotrexate Soln 2.5Mg/Ml (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Xospata Tabs 40 Mg (Brand)

Gilteritinib Fumarate Tabs 40Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Xpovio (100 Mg Once Weekly) Tbpk 20 Mg (Brand)

Selinexor Tbpk 20Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Xpovio (60 Mg Once Weekly) Tbpk 20 Mg (Brand)

Selinexor Tbpk 20Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Xpovio (80 Mg Once Weekly) Tbpk 20 Mg (Brand)

Selinexor Tbpk 20Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Xpovio (80 Mg Twice Weekly) Tbpk 20 Mg (Brand)

Selinexor Tbpk 20Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Xtandi Caps 40 Mg (Brand)

Enzalutamide Caps 40Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Yonsa Tabs 125 Mg (Brand)

Abiraterone Acetate Tabs 125Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Zejula Caps 100 Mg (Brand)

Niraparib Tosylate Caps 100Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Zelboraf Tabs 240 Mg (Brand)

Vemurafenib Tabs 240Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Ziv-Aflibercept Soln 100Mg/4Ml (Generic)

Zaltrap Soln 100 Mg/4Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Ziv-Aflibercept Soln 200Mg/8Ml (Generic)

Zaltrap Soln 200 Mg/8Ml (Brand)
Antineoplastic Agents
MA
Administered in Medical Office
N/A
Zolinza Caps 100 Mg (Brand)

Vorinostat Caps 100Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Zydelig Tabs 100 Mg (Brand)

Idelalisib Tabs 100Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Zydelig Tabs 150 Mg (Brand)

Idelalisib Tabs 150Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Zykadia Caps 150 Mg (Brand)

Ceritinib Caps 150Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Zykadia Tabs 150 Mg (Brand)

Ceritinib Tabs 150Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Zytiga Tabs 250 Mg (Brand)

Abiraterone Acetate Tabs 250Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
Zytiga Tabs 500 Mg (Brand)

Abiraterone Acetate Tabs 500Mg (Generic)
Antineoplastic Agents
3
Non-Formulary Brand
$68
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