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  • Analgesic, Anti-Inflammatory Or Antipyretic
  • Anesthetics
  • Anorectal Preparations
  • Antidotes And Other Reversal Agents
  • Anti-Infective Agents
  • Antineoplastics
  • Antiseptics And Disinfectants
  • Biologicals
  • Cardiovascular Therapy Agents
  • Central Nervous System Agents
  • Chemical Dependency, Agents To Treat
  • Chemicals-Pharmaceutical Adjuvants
  • Cognitive Disorder Therapy
  • Contraceptives
  • Dermatological
  • Diagnostic Agents
  • Drugs To Treat Erectile Dysfunction
  • Electrolyte Balance-Nutritional Products
  • Endocrine
  • Gastrointestinal Therapy Agents
  • Genitourinary Therapy
  • Gout And Hyperuricemia Therapy
  • Hematological Agents
  • Hepatobiliary System Treatment Agents
  • Immunosuppressive Agents
  • Locomotor System
  • Medical Supplies And Durable Medical Equipment (Dme)
  • Medical Supply, Fdb Superset
  • Metabolic Disease Enzyme Replacement Agents
  • Metabolic Modifiers
  • Mouth-Throat-Dental - Preparations
  • Multiple Sclerosis Agents
  • Ophthalmic Agents
  • Organ Preservation Solutions
  • Otic (Ear)
  • Renal Replacement Therapy
  • Respiratory Therapy Agents
  • Vaginal Products
  • Weight Loss/Gain Agents
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Disclaimer
Formulary Id: 11704
Formulary Effective Date: 12/13/2024
Updated:
12/2024
CMS Approval Date:
12/13/2024
CMS Version:
6

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