| Alefacept |
15 mg |
Injection |
Y43.4 |
| Baricitinib |
2 mg |
Tablet |
|
| Basiliximab |
10mg/Vial, 20mg/Vial |
Injection |
Y43.4 |
| Belimumab |
120mg per vial, 400mg per vial |
Injection |
Y43.4 |
| Ciclosporin |
|
|
Y43.4 |
| Cyclosporine |
25mg, 100mg, 50ml, 50mg/5ml |
Capsules, Oral Solution , Injection |
Y43.4 |
| Cytomegalovirus Immune Globulin |
50mL |
Injection |
Y43.4 |
| Daclizumab |
25mg/5ml |
Injection |
Y43.4 |
| Everolimus |
0.25 mg, 0.5 mg, and 0.75 mg |
Tablets |
Y43.4 |
| Fingolimod |
0.5 mg |
Capsules |
Y43.4 |
| Lymphocyte immune globulin/anti-thymocyte |
|
|
Y43.4 |
| Muromonab CD 3 |
|
|
Y43.4 |
| Mycophenolate Mofetil |
250 mg |
Capsule, Suspension, Injection |
(Y42.5-Y42.6) |
| Mycophenolatemofetil |
|
|
Y43.4 |
| Mycophenolic Acid |
180mg, 250mg, 360mg, 500mg 500mg |
Tablet Capsule |
Y43.4 |
| Natalizumab |
20mg/mL |
Injection |
Y43.4 |
| Respiratory Syncitial Virus Immuneglobulin |
|
|
Y43.4 |
| Sirolimus |
60mg per 60 mL, 0.5mg, 1mg, 2mg |
Oral Solution and Tablets |
Y43.4 |
| Tacrolimus |
30gm/0.03%, 60gm/.01, 0.5mg, 1mg, 5mg |
Capsules, Ointment |
Y43.4 |
| Thymoglobulin |
|
|
Y43.4 |
