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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.

Antiemtics

Bone Resorption Inhibitors (osteoporsosi)

Bendamustines

Botulinum Toxins

Colony-Stimulating Factors (Short Acting)

Colony-Stimulating Factors (Long Acting)

Contraceptives

Enzyme Replacement Therapy (Gaucher’s)

Erythropoiesis-Stimulating Agents

Folinic Acid

Intravenous Immune Globulin

Iron, Intravenous

Oncology/Bevacizumab

Oncology/Rituximab

Oncology/Taxanes

Oncology/Trastuzumab

Ophthalmic Injections

Viscosupplemtation

The drugs on this list may be subject to change. This content was last reviewed on August 25, 2021.

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

Drug Status

Trademark

Kytril

J1626

Preferred

Kytril ®

Zofran

J2405

Preferred

Zofran ®

Aloxi

J2469

Non-preferred

Aloxi ®

Sustol

J1627

Non-preferred

Sustol ®

Bone Resorption Inhibitors: (Osteoporosis)

Drug Name

HCPCS

Drug Status

Trademark

Reclast

J3489

Preferred

Reclast ®

Boniva

J1740

Non-preferred

Boniva ®

Forteo

J3110

Non-preferred

Forteo®

Prolia

J0897

Non-preferred

Prolia ®

Bendamustines

Drug Name

HCPCS

Drug Status

Trademark

Belrapzo

J0586

Preferred

Belrapzo ®

Bendeka

J0587

Preferred

Bendeka®

Treanda

J0585

Non-preferred

Treanda ®

Botulinum Toxins

Drug Name

HCPCS

Drug Status

Trademark

Botox

J0585

Preferred

Botox ®

Dysport

J0586

Non-preferred

Dysport ®

Myobloc

J0587

Non-preferred

Myobloc ®

Xeomin

J0588

Non-preferred

Xeomin ®

Colony-Stimulating Factors (Short Acting)

Drug Name

HCPCS

Drug Status

Trademark

Granix

J1447

Preferred

Granix ®

Zarxio

Q5101

Preferred

Zarxio ®

Neupogen

J1442

Non-preferred

Neupogen ®

Nivestym

Q5110

Non-preferred

Nivestym ®

Colony-Stimulating Factors (Long Acting)

Drug Name

HCPCS

Drug Status

Trademark

Fulphila

Q5108

Preferred

Fulphila ®

Neulasta

J2505

Preferred

Neulasta ®

Udenyca

Q5111

Preferred

Udenyca ®

Nyvepria

Q5122

Non-preferred

Nyvepria™

Ziextenzo

Q5120

Non-preferred

Ziextenzo™

Contraceptives

Drug Name

HCPCS

Drug Status

Trademark

Kyleena

J7296

Preferred

Kyleena®

Mirena

J7298

Preferred

Mirena®

Skyla

J7301

Preferred

Skyla®

Liletta

J7297

Non-preferred

Liletta®

Paragard

J7300

Non-preferred

Paragrad®

Enzyme Replacement Therapy (Gaucher’s)

Drug Name

HCPCS

Drug Status

 

Cerdelga

NOC

Preferred

Cerdelga®

Cerezyme

J1786

Preferred

Cerezyme ®

Elelyso

J3060

Non-preferred

Elelyso®

Vpriv

J3385

Non-preferred

Vpriv®

Zavesca

NOC

Non-preferred

Zavesca®

Erythropoiesis-Stimulating Agents

Drug Name

HCPCS

Drug Status

Trademark

Retacrit

Q5106

Preferred

Retacrit ®

Retacrit (ESRD)

Q5105

Preferred

Retacrit® (ESRD)

Aranesp

J0881

Non-preferred

Aranesp®

Aranesp (ESRD)

J0882

Non-preferred

Aranesp® (ESRD)

Mircera

J0888

Non-preferred

Mircera®

Mircera (ESRD)

J0887

Non-preferred

Mircera ®(ESRD)

Procrit/Epogen

J0885

Non-preferred

Procrit/Epogen®

Procrit/Epogen (ESRD)

Q4081

Non-preferred

Procrit/Epogen (ESRD)®

Folinic Acids

Drug Name

HCPCS

Drug Status

Trademark

Avsola

Q5121

Preferred

Avsola™

Inflectra

Q5103

Preferred

Inflectra®

leucovorin

J0640

Preferred

leucovorin®

Remicade

J1745

Preferred

Remicade®

Renflexis

Q5104

Preferred

Renflexis®

Fusilev

J0641

Non-preferred

Fusilev®

Khapzory

J0642

Non-preferred

Khapzory™

Intravenous Immune Globulin

Drug Name

HCPCS

Drug Status

Trademark

Bivigam

J1556

Preferred

Bivigam®

Flebogamma

J1572

Preferred

Flebogamma®

Gammagard Liquid

J1569

Preferred

Gammagard® Liquid

Gammagard S/D; Carimune NF

J1566

Preferred

Gammagard® S/D; Carimune® NF

Gammaked; Gamunex-C

J1561

Preferred

Gammaked™

Gamunex-C®

Gammaplex

J1557

Preferred

Gammaplex®

Octagam

J1568

Preferred

Octagam®

Privigen

J1459

Preferred

Privigen®

Iron, Intravenous

Drug Name

HCPCS

Drug Status

Trademark

Dexferrum; Infed

J1750

Preferred

Dexferrum®

Infed®

Feraheme

Q0138

Preferred

Feraheme®

Feraheme (ESRD)

Q0139

Preferred

Feraheme® (ESRD)

Ferrlecit

J2916

Preferred

Ferrlecit®

Injectafer

J1439

Preferred

Injectafer®

Venofer

J1756

Preferred

Venofer®

Oncology/Bevacizumab

Drug Name

HCPCS

Drug Status

Trademark

Mvasi

Q5107

Preferred

Mvasi™

Zirabev

Q5118

Preferred

Zirabev™

Avastin

J9035

Non-preferred

Avastin®

Oncology/Rituximab

Drug Name

HCPCS

Drug Status

Trademark

Ruxience

Q5119

Preferred

Ruxience™

Truxima

Q5115

Preferred

Truxima®

Riabni

NOC

Non-preferred

Riabni™

Rituxan

J9312

Non-preferred

Rituxan®

Oncology/Taxanes

Drug Name

HCPCS

Drug Status

Trademark

Taxol

J9267

Preferred

Taxol®

Taxotere

J9171

Preferred

Taxotere®

Abraxane

J9264

Non-preferred

Abraxane®

Oncology/Trastuzumab

Drug Name

HCPCS

Drug Status

Trademark

Kanjinti

Q5117

Preferred

Kanjinti™

Ogivri

Q5114

Preferred

Ogivri®

Trazimera

Q5116

Preferred

Trazimera™

Herceptin

J9355

Non-preferred

Herceptin®

Herzuma

Q5113

Non-preferred

Herzuma®

Ontruzant

Q5112

Non-preferred

Ontruzant®

Ophthalmic Injections

Drug Name

HCPCS

Drug Status

Trademark

Avastin

C9257

Preferred

Avastin®

Beovu

J0179

Preferred

Beovu®

Eylea

J0178

Preferred

Eylea®

Lucentis

J2778

Preferred

Lucentis®

Macugen

J2503

Preferred

Macugen®

Viscosupplementation

Drug Name

HCPCS

Drug Status

Trademark

Euflexxa

J7323

Preferred

Euflexxa®

Monovisc

J7327

Preferred

Monovisc™

Orthovisc

J7324

Preferred

Orthovisc®

Synvisc/One

J7325

Preferred

Synvisc®/One

Durolane

J7318

Non-preferred

Durolane®

Gel-One

J7326

Non-preferred

Gel-One®

Gelsyn-3

J7328

Non-preferred

Gelsyn™-3

GenVisc 850

J7320

Non-preferred

GenVisc® 850

Hyalgan/Supartz

J7321

Non-preferred

Hyalgan®/Supartz®

Hymovis

J7322

Non-preferred

Hymovis®

TriVisc

J7329

Non-preferred

TriVisc®

Visco-3

J7321

Non-preferred

Visco-3™