Specialty Pharmacy Drug List
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Specialty Pharmacy Drug List Our Specialty Pharmacy provides patients with comprehensive support services and coordinated delivery related to high-cost oral, inhaled or injectable specialty medications, used to treat complex conditions. We are your single source for high-touch patient care management to control side effects, patient support and education to ensure compliance or continued treatment, and specialized handling and distribution of medications directly to the patient or care provider. Specialty medications may be covered under either the medical or pharmacy benefit. Please consult your insurance documentation to determine which benefit covers these medications. We offer a broad specialty medication list containing nearly 500 drugs, covering 42 therapeutic categories and specialty disease states. This list is updated with new information each quarter. Characteristics of Specialty Medications “Specialty” medications are defined as high-cost oral or injectable medications used to treat complex chronic conditions. These are highly complex medications, typically biology-based, that structurally mimic compounds found within the body. High-touch patient care management is usually required to control side effects and ensure compliance. Specialized handling and distribution are also necessary to ensure appropriate medication administration. Medications must have at least one of the following characteristics in order to be classified as a specialty medication by Magellan Rx Management. High Cost High-cost medications are typically priced at more than $1,000 per 30-day supply; including self-administered injectables, professionallyadministered† injectables/ infusions, and oral medications High Complexity • Biotechnology products¥ • Orphan or Ultra-Orphan drugs • Medications that are included in a specialty therapeutic drug class strategy Generics: Lower case italic. For example, dexferrum Brands: All capital letters. For example, HUMIRA QL: Quantity Limits apply under some benefits. Check your plan document for coverage details. PA: Prior Authorization needed under some benefits. Check your plan document for coverage details. Anemia Asthma ARANESP ‡ PA dexferrum EPOGEN PA FERAHEME ferrlecit MIRCERA PA OMONTYS PROCRIT ‡ PA sodium ferric gluconate VENOFER XOLAIR PA Anticoagulants ADEMPAS PA ARIXTRA enoxaparin IPRIVASK fondaparinux FRAGMIN INNOHEP LOVENOX Antilipemic Agents KYNAMRO PA JUXTAPID PA PRALUENT ‡ PA, QL REPATHA ‡ PA, QL TIKOSYN Birth Control IMPLANON MIRENA NEXPLANON PARAGARD T 380-A SKYLA Cancer/Chemotherapy ABRAXANE PA ADCETRIS PA adriamycin adrucil AFINITOR PA ALIMTA PA ALKERAN amifostine ARRANON ARZERRA PA AVASTIN PA azacitidine BELEODAQ PA BEXXAR BICNU bleomycin sulfate BOSULIF PA BUSULFEX CAMPATH PA † Administered by a healthcare professional or in a healthcare setting ¥ Protein or protein-based molecular entities ‡ Preferred Specialty Product © 2016 Magellan Rx Management. All rights expressly reserved. This publication may not be reproduced in whole or part by any means whatsoever without express written permission of the copyright owner. MRX0367_0116 High Touch • Medications that require temperature control or other special handling/shipping requirements (i.e., refrigerated or frozen shipping) • Medications that require ongoing drug management by a pharmacist and/or physician specializing in treating the member’s condition • Medications that require focused, in-depth member education, compliance monitoring, side effect management and, often, injection technique education CAMPTOSAR capecitabine CAPRELSA PA carboplatin CERUBIDINE cisplatin cladribine CLOLAR COMETRIQ PA COSMEGEN cyclophosphamide CYRAMZA PA cytarabine dacarbazine DACOGEN DACTINOMYCIN daunorubicin DAUNOXOME decitabine DEPOCYT dexrazoxane PA DOCEFREZ docetaxel DOXIL doxorubicin hcl ELLENCE ELOXATIN ELSPAR EMCYT epirubicin ERBITUX PA ERIVEDGE PA ERWINAZE ETHYOL ETOPOPHOS etoposide FARYDAK PA FASLODEX FIRMAGON PA floxuridine FLUDARA fludarabine fluorouracil FOLOTYN PA FUSILEV GABLOFEN GAZYVA PA gemcitabine GEMZAR GILOTRIF PA GLEEVEC* ‡ PA HALAVEN PA HERCEPTIN PA HYCAMTIN PA IBRANCE ‡ PA ICLUSIG PA IDAMYCIN PFS idarubicin hcl IFEX ifosfamide IMBRUVICA PA INLYTA PA IRESSA PA, QL irinotecan ISTODAX PA IXEMPRA JAKAFI PA JEVTANA PA KADCYLA PA KEYTRUDA PA KYPROLIS PA LENVIMA ‡ PA, QL LEUCOVORIN CALCIUM INJ LEUSTATIN LYNPARZA PA lipodox MARQIBO PA MATULANE MEKINIST PA melphalan mercaptopurine mesna MESNEX mitomycin mitoxantrone MOZOBIL PA MUSTARGEN MYLERAN NAVELBINE NEXAVAR ‡ PA, QL NILANDRON PA, QL NIPENT ODOMZO PA, QL ONCASPAR OPDIVO PA oxaliplatin paclitaxel pentostatin PERJETA PA PHOTOFRIN POMALYST PA, QL PROLEUKIN PA PROVENGE PA PURIXAN PA REVLIMID PA, QL RITUXAN PA SIGNIFOR LAR PA SPRYCEL PA, QL STIVARGA PA, QL SUPPRELIN LA SUTENT PA, QL SYLATRON PA SYNRIBO PA TABLOID TAFINLAR PA, QL TARCEVA PA, QL TARGRETIN PA TARGRETIN GEL TASIGNA ‡ PA, QL TAXOTERE TEMODAR ‡ PA temozolomide PA teniposide THALOMID PA, QL THERACYS THIOTEPA TICE BCG toposar topotecan TORISEL PA, QL TOTECT PA TREANDA PA tretinoin PA, QL TRISENOX PA TYKERB ‡ PA, QL UNITUXIN ‡ PA UVADEX VALCHLOR PA, QL VALSTAR VANTAS VECTIBIX PA VELCADE PA VESANOID VIDAZA vinblastine sulfate vincasar pfs vincristine sulfate vinorelbine tartrate VORAXAZE VOTRIENT PA, QL VUMON XALKORI PA, QL XELODA ‡ XGEVA PA, QL XOFIGO PA XTANDI PA, QL YERVOY PA ZALTRAP PA ZANOSAR ZELBORAF PA, QL ZEVALIN ZINECARD PA ZOLADEX ‡ PA ZOLINZA PA, QL ZYDELIG PA, QL ZYKADIA PA, QL ZYTIGA ‡ PA Crohn’s Disease CIMZIA PA, QL HUMIRA ‡ PA, QL REMICADE ‡ PA TYSABRI PA Cystic Fibrosis BETHKIS PA CAYSTON ESBRIETA PA KALYDECO PA, QL KITABIS PA OFEV PA, QL PULMOZYME PA, QL TOBI TOBI PODHALER tobramycin nebu soln Cytomegalovirus Vaccines Growth Hormone and Related Disorders ACTHREL PA AVEED PA KORLYM PA LYSODREN MYALEPT PA EGRIFTA PA, QL octreotide PA SAMSCA PA, QL SANDOSTATIN PA SANDOSTATIN LAR PA SENSIPAR SIGNIFOR PA SOMATULINE PA SOMAVERT PA SYNAREL TESTOPEL PA THYROGEN GENOTROPIN PA HUMATROPE PA INCRELEX PA NORDITROPIN ‡ PA NOVOEIGHT PA NUTROPIN PA NUTROPIN AQ PA OMNITROPE PA SAIZEN PA SEROSTIM PA, QL SOMAVERT TECHNIVIE PA, QL TEV-TROPIN PA ZOMACTON ‡ PA ZORBTIVE PA, QL Enzyme Replacement (Alpha 1) ADAGEN ALDURAZYME PA ARALAST PA ELAPRASE PA ELELYSO PA GLASSIA PA FABRAZYME PA KUVAN PA, QL LUMIZYME PA MYOZYME PA NAGLAZYME PA NATPARA ‡ PA ORFADIN PA ORKAMBI ‡ PA, QL PROCYSBI PROLASTIN PA SOLESTA VIMIZIM ZEMAIRA PA Gastrointestinal Agents CYTOGAM CHOLBAM ‡ PA, QL GATTEX PA SUCRAID Dystonia Gaucher Disease BOTOX PA DYSPORT PA MYOBLOC PA XIAFLEX zoledronic © 2016 Magellan Rx Management. All rights expressly reserved. This publication may not be reproduced in whole or part by any means whatsoever without express written permission of the copyright owner. MRX0367_0116 Endocrine and Metabolic Agents CERDELGA PA, QL CEREZYME PA VPRIV PA ZAVESCA PA Hemophilia and Related Bleeding Disorders ACTIVASE ADVATE ALPHANATE ALPHANINE S/D ALPROLIX PA ATRYN PA BEBULIN VH BENEFIX BERINERT PA CINRYZE PA CORIFACT CYKLOKAPRON ELOCTATE PA FEIBA NF FIRAZYR PA HELIXATE FS HEMOFIL-M HUMATE-P IXINITY PA KALBITOR PA KOATE-DVI KOGENATE FS LYSTEDA QL MONOCLATE-P MONONINE NOVOSEVEN RT OBIZUR PROFILNINE RECOMBINATE RECOTHROM RIASTAP RIXUBIS RUCONEST PA STIMATE THROMBATE III tranexamic acid TRETTEN PA WILATE XYNTHA ‡ Hepatitis B adefovir dipivoxil BARACLUDE QL entecavir QL EPIVIR HBV ‡ lamivudine tab NABI-HB THROMBATE III HEPAGAM B HYPERHEP B S-D HEPSERA ‡ TYZEKA Hepatitis C ACTIMMUNE ALFERON N COPEGUS PA DAKLINZA PA, QL HARVONI ‡ PA, QL INCIVEK ‡ PA, QL INFERGEN PA INTRON A PA moderiba PA OLYSIO PA, QL PEG INTRON ‡ PA PEGASYS PA REBETOL PA ribatab PA ribapak tablets kit PA ribasphere PA ribavirin PA SOVALDI ‡ PA, QL TECHNIVIE PA, QL VIEKIRA PA, QL VICTRELIS PA, QL HIV/AIDS abacavir abacavir sulfate abacavir sulfate/lamivudine/ zidovudine APTIVUS ‡ ATRIPLA ‡ COMBIVIR COMPLERA ‡ CRIXIVAN ‡ didanosine EDURANT ‡ EMTRIVA ‡ EPIVIR ‡ EPZICOM ‡ FUZEON QL INTELENCE ‡ INVIRASE ‡ ISENTRESS ‡ KALETRA ‡ lamivudine lamivudine/ zidovudine LEXIVA ‡ nevirapine NORVIR PREZISTA ‡ RESCRIPTOR RETROVIR REYATAZ ‡ SELZENTRY ‡ PA stavudine STRIBILD SUSTIVA ‡ TIVICAY TRIUMEQ PA TRIZIVIR TRUVADA ‡ TYBOST ‡ PA VIDEX ‡ VIDEX EC VIRACEPT ‡ VIRAMUNE VIRAMUNE XR ‡ VIREAD ‡ VITEKTA ‡ PA, QL ZERIT ZIAGEN ‡ zidovudine Hormone Therapy ELIGARD PA FIRMAGON PA leuprolide PA LUPANETA PA LUPRON LUPRON DEPOT PA LUPRON DEPOT-PED ‡ TRELSTAR DEPOT TRELSTAR LA Hormone Therapy — Corticotropin ACTHAR H.P. PA Hunter’s Syndrome ELAPRASE PA XENAZINE PA Hyperparathyroidism Infertility Narcolepsy Pain Management doxercalciferol HECTOROL ZEMPLAR BRAVELLE PA CETROTIDE ‡ PA CHORIONIC GONADOTROPIN PA BENLYSTA PA ENDOMETRIN VAGINAL ‡ GANIRELIX GONAL-F ‡ PA GONAL-F RFF ‡ PA MAKENA ‡ PA MENOPUR PA novarel PA OVIDREL ‡ PA pregnyl PA REPRONEX PA XYREM PA, QL LIORESAL INT PRIALT QUTENZA Immune Deficiency BIVIGAM PA CARIMUNE NF PA FLEBOGAMMA PA GAMASTAN S/D PA GAMMAGARD PA GAMMAGARD SD PA GAMMAKED PA GAMMAPLEX PA GAMUNEX PA HIZENTRA PA HYPERRAB S/D HYPERRHO S/D HYPERTET S/D HYQVIA PA IMOGAM RABIES MICRHOGAM PL OCTAGAM PA PRIVIGEN PA SOLIRIS Immune Globulins — Obstetrics RHOGAM PLUS RHOPHYLAC WINRHO SDF Immunosuppressant — Transplant ASTAGRAF ATGAM CELLCEPT* ‡ CELLCEPT IV cyclosporine ENVARSUS XR PA, QL gengraf hecoria mycophenolate MYFORTIC NEORAL NULOJIX PA PROGRAF RAPAMUNE SANDIMMUNE ‡ sirolimus tab tacrolimus ZORTRESS PA Immunostimulant MOZOBIL PA © 2016 Magellan Rx Management. All rights expressly reserved. This publication may not be reproduced in whole or part by any means whatsoever without express written permission of the copyright owner. MRX0367_0116 Iron Overload EXJADE FERRIPROX PA Miscellaneous AMYVID BENLYSTA PA CARBAGLU cidofovir CRESEMBA INJ ‡ PA CYSTAGON CYTOVENE ELITEK ENTYVIO PA HETLIOZ PA, QL JADENU ‡ PA KEPIVANCE KRYSTEXXA PA, QL NORTHERA PA, QL ONFI PA SABRIL PA, QL SYLVANT PA VIVITROL PA XIAFLEX Multiple Sclerosis AMPYRA ‡ PA, QL AUBAGIO PA, QL AVONEX ‡ PA, QL BETASERON ‡ PA, QL COPAXONE ‡ PA, QL EXTAVIA PA, QL GILENYA PA, QL LEMTRADA PA PLEGRIDY ‡ PA, QL REBIF PA, QL TECFIDERA ‡ PA, QL TYSABRI PA Nausea AKYNZEO PA ALOXI ANZEMET QL CESAMET PA EMEND QL granisetron ONDANSETRON HCL INJ SANCUSCO QL ZOFRAN INJ Neuromuscular Blocking Agent XEOMIN PA Neutropenia GRANIX PA LEUKINE PA NEULASTA‡ PA NEUPOGEN‡ PA ZARXIO PA, QL Ophthalmic EYLEA JETREA PA LUCENTIS MACUGEN OZURDEX RETISERT VISUDYNE Osteoarthritis EUFLEXXA‡ PA GEL-ONE PA HYALGAN PA MONOVISC PA ORTHOVISC PA SUPARTZ PA SYNVISC‡ PA SYNVISC-ONE‡ PA Osteoporosis and Bone Disorders BONIVA INJ FORTEO ‡ PA ibandronate MIACALCIN pamidronate disodium PROLIA PA, QL RECLAST zoledronic acid ZOMETA Parkinson Disease APOKYN PA Psoriasis COSENTYX PA ENBREL ‡ PA, QL HUMIRA ‡ PA, QL REMICADE ‡ PA RASUVO PA,QL STELARA PA, QL Pulmonary Hypertension ADCIRCA PA, QL epoprostenol PA FLOLAN PA LETAIRIS ‡ PA, QL OPSUMIT PA, QL ORENITRAM PA REMODULIN PA REVATIO PA, QL sildenafil 20mg PA, QL TRACLEER ‡ PA, QL TYVASO PA, QL VELETRI PA VENTAVIS PA, QL Respiratory Syncytial Virus (RSV) SYNAGIS PA Rheumatic Diseases ARCALYST PA ACTEMRA PA CIMZIA PA, QL ENBREL ‡ PA, QL HUMIRA ‡ PA, QL ILARIS PA, QL KINERET PA, QL ORENCIA PA, QL OTEZLA PA, QL RITUXAN PA SIMPONI PA, QL SIMPONI ARIA QL XELJANZ PA, QL Thrombolytic ACTIVASE Thrombocytopenia NEUMEGA PA NPLATE PA PROMACTA PA
