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Preferred Medical Drugs

Horizon BCBSNJ maintains the following medical drugs as part of our Preferred Medical Drug Initiative.

Based on the guidelines within our online Medical Policy Manual, members, in some cases, must first try a preferred drug in the categories below before we will consider a non-preferred medical drug in that category. We strongly encourage you to review the medical policy content for these drugs for full details.

Select a category to review the preferred/non-preferred medical drugs information.

Bone Resorption Inhibitors (osteoporosis)

Botulinum Toxins

Colony-Stimulating Factors (Long Acting)

Colony-Stimulating Factors (Short Acting)

Complement Inhibitors - NMOSD

Enzyme Replacement Therapy (Gaucher's)

Erythropoiesis-Stimulating Agents

Generalized Myasthenia Gravis

Intravenous Immune Globulin

Iron, Intravenous

Oncology/Bevacizumab

Oncology/Rituximab

Oncology/Taxanes

Oncology/Trastuzumab

Ophthalmic Injections

Viscosupplementation

The drugs on this list may be subject to change. This content was last reviewed on January 27, 2023.

This webpage contains prescription brand name drugs that are registered marks or trademarks of pharmaceutical manufacturers that are not affiliated with either Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross Blue Shield Association.

Antiemetics

Drug Name	HCPCS	Manufacturer	Drug Status
Kytril®	J1626	Generic	Preferred
Zofran®	J2405	Generic	Preferred
Aloxi®	J2469	Helsinn	Non-preferred
Sustol®	J1627	Heron	Non-preferred

Bendamustines

Drug Name	HCPCS	Manufacturer	Drug Status
Belrapzo®	J0586	Eagle	Preferred
Bendeka®	J0587	Teva	Preferred
Treanda®	J0585	Cephalon	Non-preferred
Vivimusta	J9999	Slayback	Non-preferred

Bone Resorption Inhibitors (Osteoporosis)

Drug Name	HCPCS	Manufacturer	Drug Status
Reclast®	J3489	Generic	Preferred
Boniva®	J1740	Generic	Non-preferred
Forteo®	J3110	Lilly	Non-preferred
Prolia®	J0897	Amgen	Non-preferred

Botulinum Toxins

Drug Name	HCPCS	Manufacturer	Drug Status
Botox®	J0585	Allergan	Preferred
Dysport®	J0586	Ipsen	Non-preferred
Myobloc®	J0587	Solstice	Non-preferred
Xeomin®	J0588	Merz	Non-preferred

Colony-Stimulating Factors (Long Acting)

Drug Name	HCPCS	Manufacturer	Drug Status
Fulphila®	Q5108	Mylan	Preferred
Neulasta®	J2505	Amgen	Preferred
Udenyca®	Q5111	Coherus	Preferred
Fylnetra®	J3590	Amneal	Non-preferred
Nyvepria®	Q5122	Pfizer	Non-preferred
Fylnetra®	J3590	Amneal	Non-preferred
Rolvedon™	J3590	Spectrum	Non-preferred
Stimufend®	J3590	Fresnius Kabi	Non-preferred
Ziextenzo™	Q5120	Sandoz	Non-preferred

Colony-Stimulating Factors (Short Acting)

Drug Name	HCPCS	Manufacturer	Drug Status
Granix®	J1447	Teva	Preferred
Zarxio®	Q5101	Sandoz	Preferred
Neupogen®	J1442	Amgen	Non-preferred
Nivestym®	Q5110	Pfizer	Non-preferred
Releuko®	J3590	Amneal	Non-preferred

Complement Inhibitors – NMOSD

Drug Name	HCPCS	Manufacturer	Drug Status
Ultomiris®	J1303	Alexion	Preferred
Soliris®	J1300	Alexion	Non-preferred
Uplizna®	J1823	Horizon	Non-preferred

Contraceptives

Drug Name	HCPCS	Manufacturer	Drug Status
Kyleena®	J7296	Bayer	Preferred
Mirena®	J7298	Bayer	Preferred
Skyla®	J7301	Bayer	Preferred
Liletta®	J7297	Allergan	Non-preferred
Paragard®	J7300	Teva	Non-preferred

Enzyme Replacement Therapy (Gaucher's)

Drug Name	HCPCS	Manufacturer	Drug Status
Cerdelga®	NOC	Genzyme	Preferred
Cerezyme®	J1786	Genzyme	Preferred
Elelyso®	J3060	Pfizer	Non-preferred
Vpriv®	J3385	Shire	Non-preferred
Zavesca®	NOC	Actelion	Non-preferred

Erythropoiesis-Stimulating Agents

Drug Name	HCPCS	Manufacturer	Drug Status
Retacrit®	Q5106	Pfizer	Preferred
Retacrit® (ESRD)	Q5105	Pfizer	Preferred
Aranesp®	J0881	Amgen	Non-preferred
Aranesp® (ESRD)	J0882	Amgen	Non-preferred
Epogen®	J0885	Amgen	Non-preferred
Epogen® (ESRD)	Q4081	Amgen	Non-preferred
Mircera®	J0888	Roche	Non-preferred
Mircera® (ESRD)	J0887	Roche	Non-preferred
Procrit®	J0885	Janssen	Non-preferred
Procrit® (ESRD)	Q4081	Janssen	Non-preferred

Folinic Acids

Drug Name	HCPCS	Manufacturer	Drug Status
Leucovorin®	J0640	Generic	Preferred
Fusilev®	J0641	Generic	Non-preferred
Khapzory™	J0642	Acrotech	Non-preferred

Generalized Myasthenia Gravis

Drug Name	HCPCS	Manufacturer	Drug Status
Vyvgart	J9332	Argenx	Preferred
Ultomiris	J1303	Alexion	Non-preferred

Infliximabs

Drug Name	HCPCS	Manufacturer	Drug Status
Avsola™	Q5121	Amgen	Preferred
Inflectra®	Q5103	Pfizer	Preferred
Remicade®	J1745	Janssen	Preferred
Renflexis®	Q5104	Merck	Preferred

Intravenous Immune Globulin

Drug Name	HCPCS	Manufacturer	Drug Status
Bivigam®	J1556	Biotest	Preferred
Flebogamma®	J1572	Grifols	Preferred
Gammagard® Liquid	J1569	Baxalta	Preferred
Gammagard® S/D	J1566	Baxalta	Preferred
Gammaked™	J1561	Kedrion	Preferred
Gamunex-C®	J1561	Grifols	Preferred
Gammaplex®	J1557	Bio Products	Preferred
Octagam®	J1568	Octapharma	Preferred
Privigen®	J1459	CSL Behring	Preferred
Asceniv™	J1554	Adma	Non-preferred

Iron, Intravenous

Drug Name	HCPCS	Manufacturer	Drug Status
Dexferrum®	J1750	American Reagent	Preferred
Feraheme®	Q0138	AMAG	Preferred
Feraheme® (ESRD)	Q0139	AMAG	Preferred
Ferrlecit®	J2916	Sanofi	Preferred
Infed®	J1750	Allergan	Preferred
Injectafer®	J1439	American Reagent	Preferred
Venofer®	J1756	American Reagent	Preferred

Oncology/Bevacizumab

Drug Name	HCPCS	Manufacturer	Drug Status
Mvasi™	Q5107	Amgen	Preferred
Zirabev™	Q5118	Pfizer	Preferred
Alymsys®	J9999	Amneal	Non-preferred
Avastin®	J9035	Genentech	Non-preferred
Vegzelma®	J9999	Celltrion	Non-preferred

Oncology/Rituximab

Drug Name	HCPCS	Manufacturer	Drug Status
Ruxience™	Q5119	Pfizer	Preferred
Truxima®	Q5115	Teva	Preferred
Riabni™	NOC	Amgen	Non-preferred
Rituxan®	J9312	Genentech	Non-preferred

Oncology/Taxanes

Drug Name	HCPCS	Manufacturer	Drug Status
Taxol®	J9267	Generic	Preferred
Taxotere®	J9171	Generic	Preferred
Abraxane®	J9264	Celgene	Non-preferred

Oncology/Trastuzumab

Drug Name	HCPCS	Manufacturer	Drug Status
Kanjinti™	Q5117	Amgen	Preferred
Trazimera™	Q5116	Pfizer	Preferred
Herceptin®	J9355	Genentech	Non-preferred
Herzuma®	Q5113	Teva	Non-preferred
Ogivri®	Q5114	Mylan	Non-preferred
Ontruzant®	Q5112	Merck	Non-preferred

Ophthalmic Injections

Drug Name	HCPCS	Manufacturer	Drug Status
Avastin®	C9257	Genentech	Preferred
Beovu®	J0179	Novartis	Preferred
Eylea®	J0178	Regeneron	Preferred
Lucentis®	J2778	Genentech	Preferred
Byooviz™	Q5124	Biogen	Preferred
Cimerli™	J3590	Coherus	Preferred
Susvimo™	J2779	Genentech	Non-preferred
Vabysmo™	C9097	Genentech	Non-preferred

Viscosupplementation

Drug Name	HCPCS	Manufacturer	Drug Status
Euflexxa®	J7323	Ferring	Preferred
Monovisc	J7327	Depuy	Preferred
Orthovisc®	J7324	Depuy	Preferred
Synvisc®/One	J7325	Genzyme	Preferred
Durolane®	J7318	Bioventus	Non-preferred
Gel-One®	J7326	Zimmer	Non-preferred
Gelsyn™-3	J7328	Bioventus	Non-preferred
GenVisc® 850	J7320	OrthogenRx	Non-preferred
Hyalgan®	J7321	Fidia	Non-preferred
Hymovi®s	J7322	Fidia	Non-preferred
Supartz®	J7321	Bioventus	Non-preferred
TriVisc®	J7329	OrthogenRx	Non-preferred
Visco-3™	J7321	Zimmer	Non-preferred