*NOTE: Please use the Non-Preferred Medication Form for drugs included on the Statewide PDL that do not have a corresponding drug-specific or PDL class-specific form in the list below.

• Acne Agents, Oral Form
  
• Acne Agents, Topical Form
  
• Analgesics, Non-Opioid Barbiturate Combinations Form
• Analgesics, Opioids Long-Acting Form
  
• Analgesics, Opioids Short-Acting Form
  
• Androgenic Agents Form
  
• Antibiotics, GI and Related Agents Form
  
• Antidepressants, Other Form
  
• Antifibrotic Respiratory Agents
  
• Antihemophilia Agents Form
  
• Antihyperuricemics - Krystexxa Form
  
• Antipsychotics Form
  
• Antivirals, CMV Form
  
• Benzodiazepines Form
  
• Bile Salts - Cholbam and Ocaliva Form
  
• Blood Glucose Meters and Test Strips Form
• Bone Density Regulators Form
  
• Botulinum Toxins Form
  
• Colony Stimulating Factors Form
  
• Continuous Glucose Monitoring Products Form
  
• COPD Agents - Daliresp Form
• Cytokine and CAM Antagonists Form
  
• Dupixent Form
  
• Enzyme Replacements, Gaucher Disease Form
• Erythropoiesis Stimulating Agents Form
  
• Estrogens Form
  
• GI Motility, Chronic
  
• Growth Hormones Form
  
• Hepatitis C Agents Form
  
• Hereditary Angioedema Agents Form
  
• Hypoglycemics, Incretin Mimetics-Enhancers Form
  
• Immunomodulators, Atopic Dermatitis
  
• Immunosuppressives, Oral - Lupkynis Form
  
• Intra-Articular Hyaluronates Form
• Iron Chelating Agents Form
  
• Lipotropics, Other Form
  
• Macular Degeneration Agents Form
  
• Migraine Acute Treatment Agents Form
  
• Migraine Prevention Agents Form
  
• Monoclonal Antibodies - Anti-IL, Anti-IgE, Anti-TSLP Form
  
• Multiple Sclerosis Agents Form
  
• Natalizumab Form
  
• NSAIDs - Ketorolac Form
  
• Obesity Treatment Agents Form
  
• Oncology Agents, Oral Form
  
• Opioid Use Disorder Treatments Form
  
• Pituitary Suppressive Agents, LHRH Form
  
• Potassium Removing Agents Form
  
• Proton Pump Inhibitors < 6 Years of Age Form
• Pulmonary Hypertension Agents, Oral and Inhaled Form
  
• Sickle Cell Anemia Agents Form
• Stimulants and Related Agents Form
• Stimulants and Related Agents - Provigil, Nuvigil, Sunosi, and Wakix Form
• Thalidomide and Derivatives Form
• Thrombopoietics Form
  
• Ulcerative Colitis Agents Form
  
• Urea Cycle Disorder Agents Form
• VMAT2 Inhibitors Form