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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.

Antiemetics

Bendamustines

Bone Resorption Inhibitors (osteoporosis)

Botulinum Toxins

Colony-Stimulating Factors (Long Acting)

Colony-Stimulating Factors (Short Acting)

Complement Inhibitors - NMOSD

Contraceptives

Enzyme Replacement Therapy (Gaucher's)

Erythropoiesis-Stimulating Agents

Folinic Acids

Generalized Myasthenia Gravis

Infliximabs

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