Specialty Pharmacy Drug List
Specialty Pharmacy Drug List
Specialty Pharmacy Drug List
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April 2013<br />
<strong>Specialty</strong> <strong>Pharmacy</strong> <strong>Drug</strong> <strong>List</strong><br />
Providing one of the broadest offerings of specialty pharmaceuticals in the industry<br />
If you are a plan member or health care provider, please contact <strong>Specialty</strong> Customer Care toll-free at 1-800-237-2767<br />
or visit www.cvscaremarkspecialtyrx.com.<br />
With nearly 35 years of experience, CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong> provides quality care and service. We have a network of pharmacies which<br />
includes those with Joint Commission and URAC accreditation. The Joint Commission and URAC are nationally-recognized symbols of quality which<br />
reflects an organization’s commitment to meet high standards of quality and safety.<br />
ACROMEGALY<br />
octreotide acetate<br />
(SANDOSTATIN) 1<br />
Sandostatin LAR<br />
Somatuline Depot*<br />
Somavert*<br />
ALCOHOL<br />
DEPENDENCY<br />
Vivitrol<br />
ALLERGIC ASTHMA<br />
Xolair*<br />
ALPHA-1 ANTITRYPSIN<br />
DEFICIENCY<br />
Aralast 2 *<br />
Glassia*<br />
ANEMIA<br />
Aranesp 2<br />
Epogen<br />
Procrit<br />
BOTULINUM<br />
TOXINS<br />
Botox<br />
Dysport<br />
Myobloc<br />
Xeomin*<br />
CONTRACEPTIVES<br />
Implanon*<br />
Mirena*<br />
Nexplanon*<br />
Skyla*<br />
CRYOPYRIN-<br />
ASSOCIATED PERIODIC<br />
SYNDROMES<br />
Arcalyst*<br />
Ilaris*<br />
CYSTIC FIBROSIS<br />
Kalydeco*<br />
Pulmozyme<br />
TOBI*<br />
DUPUYTREN’S<br />
CONTRACTURE<br />
Xiaflex*<br />
GASTROINTESTINAL<br />
DISORDERS-OTHER<br />
Solesta*<br />
GOUT<br />
Krystexxa*<br />
GROWTH HORMONE<br />
& RELATED<br />
DISORDERS<br />
GH Disorders<br />
Genotropin 2<br />
Humatrope<br />
Norditropin 2<br />
Nutropin 2<br />
Omnitrope<br />
Saizen 2<br />
Serostim*<br />
Tev-Tropin<br />
Zorbtive<br />
IGF-1 Deficiency<br />
Increlex*<br />
HEMATOPOIETICS<br />
Mozobil*<br />
Neumega<br />
HEMOPHILIA,<br />
VON WILLEBRAND<br />
DISEASE & RELATED<br />
BLEEDING DISORDERS<br />
Advate<br />
Alphanate<br />
AlphaNine SD<br />
Bebulin 2<br />
BeneFIX<br />
Corifact*<br />
Feiba NF<br />
Feiba VH<br />
Helixate FS<br />
Hemofil M<br />
Humate-P<br />
Koate-DVI<br />
HEMOPHILIA, cont..<br />
Kogenate FS<br />
Monoclate-P<br />
Mononine<br />
NovoSeven 2<br />
Profilnine SD<br />
Proplex T<br />
Recombinate<br />
Refacto<br />
RiaSTAP<br />
Stimate<br />
Wilate<br />
Xyntha 2<br />
HEPATITIS<br />
Baraclude<br />
Epivir HBV 2<br />
Hepsera<br />
Incivek<br />
Infergen<br />
Pegasys 2<br />
PegIntron 2<br />
Rebetol Solution<br />
RibaPak<br />
Ribasphere<br />
RibaTab<br />
ribavirin caps<br />
(REBETOL) 1<br />
ribavirin tabs<br />
(COPEGUS) 1<br />
Tyzeka<br />
Victrelis<br />
Viread<br />
HEREDITARY<br />
ANGIOEDEMA<br />
Berinert*<br />
Cinryze*<br />
Firazyr*<br />
HIV MEDICATIONS<br />
abacavir tab (ZIAGEN) 1,2<br />
Aptivus<br />
Atripla<br />
Complera<br />
Crixivan<br />
didanosine (VIDEX,<br />
VIDEX EC) 1,2<br />
Edurant<br />
Egrifta*<br />
Emtriva<br />
Epzicom<br />
Fuzeon<br />
Intelence<br />
Invirase<br />
Isentress<br />
Kaletra<br />
lamivudine (EPIVIR) 1<br />
lamivudine/zidovudine<br />
(COMBIVIR) 1<br />
Lexiva<br />
nevirapine<br />
(VIRAMUNE) 1,2<br />
Norvir<br />
Prezista<br />
Rescriptor<br />
Retrovir Injectable<br />
Reyataz<br />
Selzentry<br />
stavudine (ZERIT) 1,2<br />
Stribild<br />
Sustiva<br />
Trizivir<br />
Truvada<br />
Videx Solution<br />
Viracept<br />
Viramune XR<br />
Viread<br />
Ziagen Solution<br />
zidovudine (RETROVIR) 1,2<br />
HORMONAL<br />
THERAPIES<br />
Eligard<br />
Firmagon<br />
leuprolide acetate<br />
(LUPRON) 1<br />
Lupron Depot 2<br />
Supprelin LA*<br />
Trelstar 2<br />
Vantas<br />
Viadur<br />
Zoladex<br />
IMMUNE DEFICIENCIES<br />
& RELATED<br />
DISORDERS<br />
Carimune NF<br />
Cytogam<br />
Flebogamma 2<br />
GamaSTAN S/D<br />
Gammagard<br />
Gammagard S/D<br />
Gammaked<br />
Gammaplex*<br />
Gamunex<br />
HepaGam B<br />
Hizentra*<br />
HyperHEP B<br />
HyperRHO S/D<br />
Immune Globulin<br />
MICRhoGAM 2<br />
Nabi-HB<br />
Octagam<br />
Privigen<br />
RhoGAM 2<br />
Rhophylac<br />
Vivaglobin*<br />
WinRho SDF<br />
IMMUNE (IDIOPATHIC)<br />
THROMBOCYTOPENIC<br />
PURPURA<br />
Nplate<br />
Promacta*<br />
Products distributed by CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong>, as well as products covered by a plan member’s prescription or medical benefit plan may change from time to time. In addition, a plan member’s<br />
specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.<br />
©2013 Caremark. All rights reserved. 75-CTC14953c 03252013 <strong>Specialty</strong> <strong>Pharmacy</strong> <strong>Drug</strong> <strong>List</strong>
April 2013<br />
INFECTIOUS DISEASE<br />
Actimmune*<br />
INFERTILITY<br />
Bravelle<br />
Cetrotide<br />
chorionic gonadotropin<br />
(novarel, pregnyl) 1<br />
Follistim AQ<br />
ganirelix acetate 1<br />
Gonal-F 2<br />
Luveris<br />
Menopur<br />
Ovidrel<br />
Repronex<br />
INFLAMMATORY<br />
BOWEL DISEASE<br />
Cimzia<br />
Humira<br />
Remicade<br />
Tysabri*<br />
IRON OVERLOAD<br />
deferoxamine<br />
(DESFERAL) 1<br />
Exjade*<br />
LIPID DISORDERSS<br />
Kynamro*<br />
LYSOSOMAL STORAGE<br />
DISORDERS<br />
Aldurazyme*<br />
Cerezyme*<br />
Cystagon*<br />
Elaprase*<br />
Fabrazyme*<br />
Lumizyme*<br />
Myozyme*<br />
Naglazyme*<br />
VPRIV*<br />
RETINAL DISORDERS ONCOLOGY –<br />
Eylea*<br />
ORAL/TOPICAL<br />
Lucentis*<br />
Afinitor<br />
Macugen*<br />
Bosulif<br />
Ozurdex*<br />
Erivedge*<br />
Retisert*<br />
Gleevec<br />
Visudyne*<br />
Hycamtin*<br />
Inclusig<br />
MOVEMENT<br />
Inlyta*<br />
DISORDERS<br />
Jakafi*<br />
Apokyn*<br />
Nexavar*<br />
Xenazine*<br />
Oforta*<br />
Pomalyst*<br />
MULTIPLE SCLEROSIS Revlimid*<br />
Ampyra*<br />
Sprycel<br />
Aubagio*<br />
Stivarga*<br />
Avonex 2<br />
Sutent<br />
Betaseron<br />
Tarceva<br />
Copaxone<br />
Targretin 2<br />
Extavia<br />
Tasigna<br />
Gilenya<br />
Temodar<br />
Rebif 2<br />
Thalomid<br />
Tysabri*<br />
Tykerb*<br />
Votrient*<br />
NEUTROPENIA<br />
Xalkori*<br />
Leukine<br />
Xeloda<br />
Neulasta<br />
Xtandi*<br />
Neupogen<br />
Zelboraf*<br />
Zolinza<br />
ONCOLOGY –<br />
Zytiga<br />
INJECTABLE 4<br />
Synribo<br />
OSTEOARTHRITIS<br />
Thyrogen*<br />
Euflexxa<br />
Xgeva<br />
Hyalgan<br />
zolendronic acid<br />
Orthovisc<br />
(ZOMETA) 1 Supartz<br />
Synvisc<br />
Synvisc One<br />
OSTEOPOROSIS<br />
Forteo<br />
Prolia<br />
Reclast<br />
PAROXYSMAL<br />
NOCTURNAL<br />
HEMOGLOBINURIA<br />
Soliris*<br />
PHEYLKETONURIA<br />
Kuvan*<br />
PRE-TERM BIRTH<br />
Makena*<br />
PSORIASIS<br />
Amevive<br />
Enbrel<br />
Humira<br />
Remicade<br />
Stelara<br />
PULMONARY<br />
ARTERIAL<br />
HYPERTENSION<br />
Adcirca<br />
epoprostenol sodium* 1<br />
Letairis*<br />
Remodulin*<br />
sildenafil citrate<br />
(REVATIO) 1<br />
Tracleer*<br />
Tyvaso*<br />
Ventavis*<br />
RENAL DISEASE<br />
Sensipar<br />
RESPIRATORY<br />
SYNCYTIAL VIRUS<br />
Synagis<br />
RHEUMATOID<br />
ARTHRITIS<br />
Actemra<br />
Cimzia<br />
Enbrel<br />
Humira<br />
Kineret<br />
Orencia<br />
Remicade<br />
Simponi<br />
Xeljanz<br />
SEIZURE DISORDERS<br />
H. P. Acthar Gel *<br />
Sabril*<br />
SYSTEMIC LUPUS<br />
ERYTHEMATOSUS<br />
Benlysta<br />
TRANSPLANT<br />
CellCept Injectable<br />
CellCept Suspension<br />
cyclosporine<br />
(gengraf, NEORAL,<br />
SANDIMMUNE) 1,2<br />
mycophenolate<br />
mofetil (CellCept) 1,2<br />
Myfortic<br />
Nulojix<br />
Prograf Injectable<br />
Rapamune<br />
tacrolimus<br />
(Prograf) 1,2<br />
Zortress<br />
UREA CYCLE<br />
DISORDERS<br />
Ravicti*<br />
If you are a plan member or health care provider, please contact <strong>Specialty</strong> Customer Care toll-free at<br />
1-800-237-2767 or visit www.cvscaremarkspecialtyrx.com.<br />
1<br />
Lowercase type indicates generic name and availability; lowercase type within parentheses indicates trademark generics listed only when no brand is available; products in all capital letters within parentheses<br />
indicate brand-names of generic products.<br />
2<br />
Multiple dosage formulations and/or injectable devices are available.<br />
3<br />
Includes progesterone injectable and intravaginal products. Does not include oral dosage forms.<br />
4<br />
Call CVS Caremark toll-free at 1-800-237-2767 for specific medications available through CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong>. <strong>List</strong>ing is subject to change.<br />
* Indicates Limited Distribution products distributed by CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong>. Limited Distribution defined as less than 15 pharmacy providers.<br />
Products distributed by CVS Caremark <strong>Specialty</strong> <strong>Pharmacy</strong>, as well as products covered by a plan member’s prescription or medical benefit plan may change from time to time. In addition, a plan member’s<br />
specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.<br />
©2013 Caremark. All rights reserved. 75-CTC14953c 03252013 <strong>Specialty</strong> <strong>Pharmacy</strong> <strong>Drug</strong> <strong>List</strong>
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