Comprehensive Specialty Pharmacy Drug List
DECEMBER 2017
Providing one of the broadest offerings of specialty pharmaceuticals in the industry If you are a plan member or health care provider, please contact Specialty Customer Care at (800) 237-2767 or visit CVSspecialty.com. With more than 40 years of experience, CVS Specialty ® provides quality care and service. We have a network of pharmacies that includes those with Joint Commission and URAC accreditation. The Joint Commission and URAC are nationally recognized symbols of quality that reflect an organization’s commitment to meet high standards of quality and safety. A abacavir tab (ZIAGEN) abacavir/lamivudine/ zidovudine (TRIZIVIR) Actemra2 Acthar H.P.Gel Actimmune3 Adcetris3 Adcirca adefovir (HEPSERA) Adempas Advate Adynovate Afinitor3 Afstyla Aldurazyme Alferon N Alphanate AlphaNine SD Alprolix Alunbrig 3 Ampyra Apokyn Aptivus Aralast NP Aranesp3 Arcalyst Arzerra3 Astagraf XL Atripla Aubagio Avastin3 Aveed Avonex1,2 azacitidine (VIDAZA)3 B Baraclude Bavencio3 Bebulin Beleodaq3 BeneFIX Benlysta Berinert Betaseron Bethkis bexarotene (TARGRETIN) Bivigam Blincyto3 bortezomib (VELCADE)3 Bosulif 3 Buphenyl C Cabometyx
capecitabine (XELODA)3 Carimune NF CellCept Ceprotin Cerdelga Cerezyme Cimzia2 Cinqair Cinryze Combivir Complera Copaxone Copegus Corifact Cosentyx2 Cotellic 3 Crixivan Cuvitru cyclosporine (GENGRAF, NEORAL, SANDIMMUNE) Cyramza3 Cystagon Cytogam D Dacogen3 Daklinza Darzalex3 decitabine (DACOGEN)3 deferoxamine (DESFERAL) Descovy Desferal didanosine (VIDEX, VIDEX EC) dofetilide (TIKOSYN) Dupixent E Edurant Egrifta Elaprase Elelyso Eligard3 Eloctate Elspar Empliciti 3 Emtriva Enbrel 2 entecavir (BARACLUDE) Entyvio2 Envarsus XR Epclusa Epivir
Epivir HBV solution Epogen3 epoprostenol sodium (FLOLAN, VELETRI) Epzicom Erbitux3 Erivedge3 Esbriet Evomela Evotaz Exjade Extavia1,2 Eylea F Fabrazyme Farydak3 Fasenra Feiba NF Feiba VH Firazyr Firmagon3 Flebogamma Flebogamma DIF Flolan Folotyn3 Forteo fosamprenavir (LEXIVA) Fusilev3 Fuzeon G GamaSTAN S/D Gammagard Liquid Gammagard S/D Gammaked Gammaplex Gamunex C Gattex Gazyva3 Gengraf Genotropin1 Genvoya Gilenya Glassia glatiramer acetate (COPAXONE, GLATOPA) Glatopa Gleevec3 Granix3 H H. P. Acthar Gel Haegarda Halaven3
Harvoni Helixate FS Hemlibra Hemofil M HepaGam B Hepsera Herceptin3 Hizentra Humate-P Humatrope Humira 2 Hycamtin HyperHEP B HyperRHO S/D HyQvia I Ibrance3 Idelvion Idhifa Ilaris Iluvien imatinib mesylate (GLEEVEC) Imfinzi 3 Increlex Inflectra Inlyta3 Intelence Intron A3 Invirase Iressa3 Isentress Istodax3 Ixempra3 Ixinity J Jadenu Jakafi3 Jevtana3 Juluca K Kadcyla3 Kalbitor Kanuma Kaletra Kevzara Keytruda3 Kisqali 3 Kisqali/Femara Kitabis Pak Koate-DVI Kogenate FS
Kovaltry Krystexxa Kuvan Kynamro Kyprolis3 L lamivudine (EPIVIR, EPIVIR HBV) lamivudine/zidovudine (COMBIVIR) Lemtrada Letairis Leukine3 leuprolide acetate (LUPRON) 3 levoleucovorin calcium Lexiva Lonsurf 3 lopinavir/ritonavir (KALETRA) Lucentis Lumizyme Lupaneta Pack Lupron3 Lupron Depot3 M Macugen Makena Mavyret Mekinist3 melphalan hydrochloride (EVOMELA) MICRhoGAM mitoxantrone 3 Moderiba Monoclate-P Mononine Mozobil3 Mugard mycophenolate mofetil (CELLCEPT) mycophenolate sodium DR (MYFORTIC) Myfortic Myozyme N Nabi-HB Naglazyme Natpara Neoral Nerlynx Neulasta3
Neumega3 Neupogen3 nevirapine (VIRAMUNE, VIRAMUNE XR) Nexavar3 Ninlaro 3 Norditropin Northera Norvir NovoEight NovoSeven RT Nplate Nucala Nulojix Nuplazid Nutropin1 Nuwiq O Obizur Ocaliva Ocrevus Octagam octreotide acetate (SANDOSTATIN) Odefsey Odomzo 3 Ofev Olysio Omnitrope1 Oncaspar3 Opdivo3 Opsumit Orencia2 Orenitram Otezla2 Otrexup Ozurdex P Parsabiv Pegasys PegIntron Perjeta3 phenylbutyrate sodium (BUPHENYL) Plegridy1,2 Pomalyst3 Portrazza Praluent1 Prezcobix Prezista Privigen Procrit3 Profilnine SD Prograf Proleukin3 Prolia Promacta Pulmozyme Purixan3
R Rapamune Rasuvo Ravicti Rebetol Rebif Rebinyn Reclast Recombinate Remicade2 Remodulin Renflexis Repatha Rescriptor Retisert Retrovir Retrovir injection Revatio Revlimid 3 Reyataz RhoGAM Rhophylac RiaSTAP RibaPak Ribasphere Ribatab ribavirin caps (REBETOL) ribavirin tabs (COPEGUS, MODERIBA) Rituxan3 Rituxan Hycela3 Rixubis Rubraca3 Ruconest Rydapt 3 S Sabril tabs Sabril pwd Saizen1 Samsca Sandostatin3 Sandostatin LAR Sandimmune Selzentry Sensipar Serostim sildenafil citrate (REVATIO) Siliq Simponi 2 Simponi ARIA2 sirolimus tab (RAPAMUNE) Solesta Soliris Somatuline Depot3 Somavert Sovaldi Sprycel3 stavudine (ZERIT)
Stelara2 Stelara IV Stimate Stivarga3 Stribild Supprelin LA Sustiva Sutent 3 Sylatron 3 Sylvant 3 Synagis T tacrolimus (PROGRAF) Tafinlar3 Tagrisso3 Taltz 2 Tarceva3 Targretin3 Tasigna3 Tecentriq3 Tecfidera Technivie Temodar3 temozolomide (TEMODAR)3 Tepadina3 tetrabenazine (XENAZINE) Tev-Tropin1 Thalomid 3 Thyrogen Tikosyn Tivicay TOBI TOBI Podhaler tobramycin nebulizer (TOBI) Torisel 3 Tracleer Treanda Trelstar3 Tremfy Tretten Triumeq Trizivir Truvada Tybost Tykerb3 Tymlos Tysabri2 Tyvaso V Valstar3 Vantas3 Varizig Vectibix3 Velcade3 Veletri Vemlidy Ventavis
Verzenio Vidaza Videx Videx EC Viekira Pak1 vigabatrin pwd (SABRIL) Vimizim Viracept Viramune Viramune XR Viread Visudyne Vivitrol Vosevi Votrient3 VPRIV W Wilate WinRho SDF X Xalkori 3 Xeljanz 2 Xeloda 3 Xenazine Xgeva3 Xolair Xtandi3 Xyntha Y Yervoy3 Yondelis3 Z Zaltrap3 Zarxio3 Zelboraf 3 Zemaira Zepatier Zerit Ziagen zidovudine (RETROVIR) Zinbryta Zoladex3 zoledronic acid (RECLAST, ZOMETA)3 Zolinza3 Zomacton Zometa3 Zorbtive Zortress Zykadia3 Zytiga3 Limited Distribution Specialty Medicines Only Available Through Other Providers Adagen
Aliqopa Apligraf Austedo Besponsa3 Caprelsa3 Carbaglu Cayston Cholbam Coagadex Cometriq3 Cystadane Cystaran Duopa Emflaza Erwinaze3 Exondys 51 Ferriprox Gilotrif 3 Hetlioz Iclusig3 Imbruvica3 Imlygic3 Jetrea Juxtapid Kalydeco Keveyis Kineret 2 Korlym Lartruvo Lenvima Lynparza3 Marqibo Mircera Myalept Omontys Onivyde3 Orfadin Orkambi Prialt Procysbi Prolastin Prolastin-C Qutenza Radicava Signifor Signifor LAR Strensiq Synribo3 Unituxin3 Valchlor3 Varithena Venclexta3 Vistogard Voraxaze Xiaflex Xuriden Zavesca Zejula3 Zydelig3
1 This medicine will not be covered without prior authorization for medical necessity. 2 This medicine is subject to step therapy. The use of a preferred agent will be required for certain diagnoses prior to allowing coverage for this non-preferred agent. 3 Non-surgical cancer treatment requiring a review by eviti. Bolded medicines are available exclusively through CVS Specialty. Italicized medicines require prior authorization. Lowercase type indicates generic name and availability; lowercase type within parentheses indicates trademark generics listed only when no brand is available; medicines in all capital letters within parentheses indicate brand-names of generic medicines. Products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document. This document contains confidential and proprietary information of CVS Specialty and may not be reproduced, distributed or printed without written permission from CVS Specialty. This list is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty. ©2018 CVS Specialty. All rights reserved. 75-32603A 011518 December 2017 v04 Comprehensive Specialty Pharmacy Medicine List
