Drug List - N

N
Drug Name Tier Restrictions
NA BICARBONATE 1
NABUMETONE 1
NAFTIFINE CRE HCL
NAFTIN 3 Prior authorization, Quantity limit, Step therapy
NAFTIN GEL 3 Quantity limit, Step therapy
NALOXONE INJ 0.4MG/ML 1
NALTREXONE HCL 1
NAMENDA 3 Prior authorization
NAMENDA TITRATION PAK 3 Prior authorization
NAPROXEN NC
NARATRIPTAN TAB 1
NARCAN SPR 3
NARDIL 3 Prior authorization
NASACORT NC
NASAREL NC
NASCOBAL 3 Prior authorization, Step therapy
NASCOBAL SPR 500MCG 3 Prior Authorization
NASONEX NC
NATEGLINIDE TAB 60MG 1
NATURE-THROI TAB 1
NECON 0.5/35MG 2 1*
NECON 1/35 1*
NECON 7/7/7 1*
NEEDLES (VARIOUS) 1
NEFAZODONE HCL 1
NEO/POLY/CORT 1
NEO/POLY/DEX 1
NEOBENZ MICRO 3 Prior authorization, Step therapy
NEOMYCIN 1
NEOMYCIN SULFATE 1
NEOMYCIN/POLYMIXIN/DEXAMETH 1
NEOMYCIN/POLYMYXIN/HYDROCOR 1
NEORAL $0
NESINA $3 Step therapy
NEULASTA INJ 6MG/0.6M 2 Quantity limit
NEUPOGEN PFS 2 Prior authorization, Quantity limit
NEUPRO DIS 2 Prior authorization
NEURONTIN 3
NEUTRA PHOS-K 3
NEUTRA-PHOS 3
NEVANAC 3
NEVIRAPINE 1
NEXIUM NC
NEXPLANON IMP 68MG 3*
NIACIN ER 1
NIASPAN 3
NICORELIEF GUM NC* Over-the-counter
NICORETTE LOZ 4MG MINT NC*
NICOTINAMIDE W/ZINC OXIDE/C 3 Prior authorization
NICOTINE POL GUM ORIG NC*
NICOTINE POLACRILEX GUM NC* Over-the-counter
NICOTINE TRANSDERMAL SYSTEM NC* Over-the-counter
NICOTROL INHALER 3 Prior authorization
NIFEDICAL XL 1
NIFEDIPINE 1
NIFEDIPINE ER 1
NIFEREX GOLD 2
NIFEREX-150 2
NIFEREX-150 FORTE 2
NILANDRON 2
NINLARO CAP 3MG 3 Prior authorization
NISOLDIPINE 1
NITRO-DUR DIS 3 Prior authorization
NITROBID 2
NITROFURAN MACROCRYSTAL 1
NITROFURAN MONOHY 1
NITROGLYCERIN TRANSDERMAL 1
NITROLINGUAL PUMPSPRAY 3 Step therapy
NITROSTAT SUB 2
NIZATIDINE CAP 1
NORA-BE 1*
NORDITROPIN 2 Prior authorization
NORETHINDRON TAB 0.35MG 1*
NORETHINDRONE 5MG 1
NORGEST/ETHI TAB ESTRADIO 1
NORITATE 3 Quantity limit
NORPACE CR 3 Prior authorization
NORPRAMIN 3 Prior authorization, Step therapy
NORTREL 0.5/35 2 1*
NORTREL 7/7/7 1*
NORTRIPTYLINE HCL 1
NORVASC 3 Prior authorization
NORVIR 2
NOTREL 1/35 1*
NOVAREL INJ 10000U 3 Prior authorization
NOVOFINE MIS 1
NOVOLIN 70/30 PEN 2
NOVOLIN-70/30 VIALS 2
NOVOLIN-N VIALS 2
NOVOLIN-R PEN 2
NOVOLIN-R VIAL 2
NOVOLOG INJ FLEXPEN 2
NOVOLOG MIX 70/30 2
NOVOLOG MIX 70/30 PEN 2
NOVOLOG VIALS 2
NP THYROID TAB 30MG 1
NUCALA INJ 100MG 3 Prior authorization
NUCYNTA TAB 3
NUEDEXTA CAP 20-10MG 3 Prior authorization
NULYTELY 3 Prior authorization
NUQUIN HP 1 Quantity limit
NUTRINATE 3
NUTROPIN 3 Prior authorization, Step therapy
NUVARING MIS 2
NUVIGIL 3 Prior authorization
NYSTATIN CREAM 1 Quantity limit
NYSTATIN SUSPENSION 1 Quantity limit
NYSTATIN TABLETS 1
NYSTATIN/TRIAMCINOLONE 1 Quantity limit
NYSTOP 1 Quantity limit