Drug List - H

H
Drug Name Tier Restrictions
HALFLYTELY BOWL PREP 2
HALOBETASOL PROP. 1 Quantity limit
HALOPERIDOL 1
HALOPERIDOL DECANOATE INJ 1
HARVONI 3 Prior authorization
HC BUTYRATE CRE 0.1% 1
HC PRAMOXINE CRE 1
HC VALERATE 1
HC/ACET ACID SOL OTIC 1
HELIDAC MIS NC Prior authorization, Step therapy
HEMATOGEN 3
HEPARIN SOD INJ 5000/ML 1
HEPARIN SODIUM INJ 5000U/ML 1
HEPSERA 2
HIBICLENS NC Quantity limit
HIPREX 3
HIZENTRA INJ 3 Prior Authorization
HOMATROPINE DROPS 1
HORIZANT 3 Prior authorization
HUMALOG MIX PEN 2
HUMALOG MIX VIAL 2
HUMALOG PEN 2
HUMALOG VIAL 2
HUMATROPE 3 Prior authorization, Step therapy
HUMIRA 2
HUMULIN 70/30 VIAL 1
HUMULIN R U-500 1
HUMULIN-N U-100 INJ 1
HUMULIN-N U-100 PEN 2
HYALGAN INJ 3 Quantity limit, Step therapy
HYDRALAZINE HC 1
HYDRO 40 FOAM 3 Prior authorization, Quantity limit
HYDROCHLOROTHIAZIDE 1
HYDROCODONE/ACETAMINOPHEN 1
HYDROCODONE/HOMATROPINE 1
HYDROCODONE/IBUPROFEN 1
HYDROCODONE/IODO CRM 1 Quantity limit
HYDROCORTISONE 1 Quantity limit
HYDROCORTISONE 1% CREAM NC Over-the-counter, Quantity limit
HYDROCORTISONE BUTYRATE 1 Quantity limit
HYDROCORTISONE VALERATE 1 Quantity limit
HYDROMET SYP 5-1.5/5 1
HYDROMORPHONE HCL 1
HYDROQUINONE NC
HYDROQUINONE/SUNSCREENS NC
HYDROXYCHLOROQUINE 1
HYDROXYUREA 1 Quantity limit
HYDROXYZINE HCL 1
HYDROXYZINE PAMOATE 1
HYOMAX-SR 3 Prior authorization
HYOSCYAMINE SULFATE IR/HYOS 1
HYPER-SAL NEB UD 1
HYPERCARE 1 Quantity limit
HYTRIN 3
HYZAAR 3 Prior authorization