Comprehensive Specialty Pharmacy Drug List

October 2014
Comprehensive Specialty Pharmacy Drug List
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 toll-free at 1-800-237-2767
or visit www.cvscaremarkspecialtyrx.com. With nearly 35 years of experience, CVS Caremark Specialty Pharmacy provides quality care and
service. We have a network of pharmacies which includes those with Joint Commission and URAC accreditation. The Joint Commission and URAC
are nationally-recognized symbols of quality which reflects an organization’s commitment to meet high standards of quality and safety.
ACROMEGALY
octreotide acetate
(SANDOSTATIN)1
Sandostatin LAR
Somatuline Depot*
Somavert*
ALCOHOL / OPIOID
DEPENDENCY
Vivitrol
ALLERGEN
IMMUNOTHERAPY
Oralair*
ALLERGIC ASTHMA
Xolair*
ALPHA-1 ANTITRYPSIN
DEFICIENCY
Aralast2*
Glassia*
Zemaira*
ANEMIA
Aranesp2
Epogen
Procrit
BOTULINUM
TOXINS
Botox
Dysport
Myobloc
Xeomin*
CARDIAC DISORDERS
Tikosyn
COAGULATION
DISORDERS
Ceprotin*
CONTRACEPTIVES
Implanon*
Mirena*
Nexplanon*
Skyla*
CRYOPYRIN-
ASSOCIATED PERIODIC
SYNDROMES
Arcalyst*
Ilaris*
CYSTIC FIBROSIS
Bethkis*
Kalydeco*
Pulmozyme
TOBI Podhaler*
tobramycin nebulizer
(TOBI*)1
DUPUYTREN’S
CONTRACTURE
Xiaflex*
ELECTROLYTE
DISORDERS
Samsca
GASTROINTESTINAL
DISORDERS-OTHER
Gattex*
Solesta*
GOUT
Krystexxa*
GROWTH HORMONE
& RELATED DISORDERS
GH Disorders
Genotropin2
Humatrope
Norditropin2
Nutropin2
Omnitrope
Saizen2
Serostim*
Tev-Tropin
Zorbtive
IGF-1 Deficiency
Increlex*
HEMATOPOIETICS
Mozobil*
Neumega
HEMOPHILIA,
VON WILLEBRAND
DISEASE & RELATED
BLEEDING DISORDERS
Advate
Alphanate
AlphaNine SD
Alprolix
Bebulin2
BeneFIX
Corifact*
Eloctate
Feiba NF
Feiba VH
Helixate FS
Hemofil M
Humate-P
Koate-DVI
Kogenate FS
Monoclate-P
Mononine
NovoSeven2
Profilnine SD
Recombinate
Refacto
RiaSTAP
Rixubis
Stimate
Tretten*
Wilate
Xyntha2
HEPATITIS
adefovir (HEPSERA)1
Baraclude Solution
entecavir (BARACLUDE) 1,2
Incivek
Infergen
Intron-A*
lamivudine (EPIVIR HBV)1,2
Olysio
Pegasys2
PegIntron2
Rebetol Solution
RibaPak
Ribasphere
RibaTab
ribavirin caps
(REBETOL)1
ribavirin tabs
(COPEGUS)1
HEPATITIS cont.
Sovaldi
Tyzeka
Victrelis
Viread
HEREDITARY
ANGIOEDEMA
Berinert*
Cinryze*
Firazyr*
Kalbitor*
Ruconest*
HIV MEDICATIONS
abacavir tab (ZIAGEN)1,2
abacavir/lamivudine/zidovudine tab (TRIZIVIR)1
Aptivus
Atripla
Complera
Crixivan
didanosine cap / DR cap
(VIDEX, VIDEX EC)1,2
Edurant
Egrifta*
Emtriva
Epzicom
Fuzeon
Intelence
Invirase
Isentress
Kaletra
lamivudine (EPIVIR)1
lamivudine/zidovudine
(COMBIVIR)1
Lexiva
nevirapine (VIRAMUNE)1,2
Norvir
Prezista
Rescriptor
Retrovir Injectable
Reyataz
Selzentry
stavudine (ZERIT)1
Stribild
Sustiva
Tivicay
Triumeq
Truvada
Videx Solution
HIV MEDICATIONS cont.
Viracept
Viramune XR
Viread
Ziagen Solution
zidovudine (RETROVIR)1,2
HORMONAL THERAPIES
Aveed*
Eligard
Firmagon
leuprolide acetate (LUPRON)1
Lupaneta Pack
Lupron Depot2
Supprelin LA*
Trelstar2
Vantas
Viadur
Zoladex
IMMUNE DEFICIENCIES &
RELATED DISORDERS
Bivigam*
Carimune NF
Cytogam
Flebogamma2
GamaSTAN S/D
Gammagard
Gammagard S/D
Gammaked
Gammaplex*
Gamunex 2
HepaGam B
Hizentra*
HyperHEP B
HyperRHO S/D
HyQvia
MICRhoGAM2
Nabi-HB
Octagam
Privigen
RhoGAM2
Rhophylac
VARIZIG
Vivaglobin*
WinRho SDF
IMMUNE (IDIOPATHIC)
THROMBOCYTOPENIA
PURPURA
Nplate
Promacta*
Products distributed by CVS Caremark Specialty Pharmacy, 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
specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.
©2014 Caremark. All rights reserved. 75-CTC14953d October 2014 v10_01_2014 Comprehensive Specialty Pharmacy Drug List
October 2014
INFECTIOUS DISEASE
Actimmune*
Alferon N
INFERTILITY
Bravelle
Cetrotide
chorionic gonadotropin
(novarel, pregnyl)1
Follistim AQ
ganirelix acetate1
Gonal-F2
Luveris
Menopur
Ovidrel
Repronex
INFLAMMATORY
BOWEL DISEASE
Cimzia
Entyvio
Humira
Remicade
Simponi
Tysabri*
IRON OVERLOAD
deferoxamine
(DESFERAL)1
Exjade*
LIPID DISORDERS
Kynamro*
LYSOSOMAL STORAGE
DISORDERS
Aldurazyme*
Cerdelga*
Cerezyme*
Cystagon*
Elaprase*
Fabrazyme*
Lumizyme*
Myozyme*
Naglazyme*
Vimizim*
VPRIV*
MOVEMENT DISORDERS
Apokyn*
Northera*
Xenazine*
MULTIPLE SCLEROSIS
Ampyra*
Aubagio*
Avonex2
Betaseron
Copaxone
Extavia
Gilenya
mitoxantrone
(NOVANTRONE)1
Rebif2
Tecfidera*
Tysabri*
NEUTROPENIA
Granix
Leukine
Neulasta
Neupogen
ONCOLOGY –
INJECTABLE4
Adcetris*
Arzerra*
Avastin
azacitidine (VIDAZA)1
Beleodaq*
decitabine (DACOGEN)1
Elspar
Erbitux
Folotyn
Fusilev
Gazyva*
Halaven
Herceptin
Intron A*
Istodax*
Ixempra
Jevtana
Kadcyla
Keytruda*
Kyprolis*
mitoxantrone
(NOVANTRONE)1
Oncaspar
Perjeta
Proleukin
Rituxan
Sylatron*
Synribo
Temodar
Thyrogen*
Torisel
Treanda
Valstar
ONCOLOGY –
INJECTABLE4 cont.
Vectibix
Velcade
Vidaza
Xgeva
Yervoy
Zaltrap
zoledronic acid
(ZOMETA)1
OSTEOPOROSIS
Forteo
Prolia
zoledronic acid
(RECLAST)1
ONCOLOGY –
ORAL/TOPICAL
Afinitor2
Bosulif
capecitabine (XELODA)
Erivedge*
Gleevec
Hycamtin*
Inlyta*
Jakafi*
Mekinist*
Mugard*
Nexavar*
Pomalyst*
Revlimid*
Sprycel
Stivarga*
Sutent
Tafinlar*
Tarceva*
Targretin2
Tasigna
temozolomide
(TEMODAR)1
Thalomid
Tykerb*
Votrient*
Xalkori*
Xtandi*
Zelboraf*
Zolinza
Zykadia*
Zytiga
PHENYLKETONURIA
Kuvan*
OSTEOARTHRITIS
Euflexxa
Gel-One*
Hyalgan
Monovisc
Orthovisc
Supartz
Synvisc
Synvisc One
PAROXYSMAL
NOCTURNAL
HEMOGLOBINURIA
Soliris*
PRE-TERM BIRTH
Makena*
PSORIASIS
Amevive
Enbrel
Humira
Otezla*
Otrexup
Rasuvo
Remicade
Stelara
PULMONARY ARTERIAL
HYPERTENSION
Adcirca
Adempas*
epoprostenol sodium*1
Letairis*
Opsumit*
Orenitram*
Remodulin*
sildenafil citrate
(REVATIO)1
Tracleer*
Tyvaso*
Veletri*
Ventavis*
RENAL DISEASE
Sensipar
RESPIRATORY
SYNCYTIAL VIRUS
Synagis
RHEUMATOID ARTHRITIS
Actemra*,2
Cimzia
Enbrel
Humira
Kineret
Orencia2
Otezla*
Otrexup
Remicade
Rituxan
Simponi
Simponi ARIA*
Xeljanz
SEIZURE DISORDERS
H. P. Acthar Gel *
Sabril*
SYSTEMIC LUPUS
ERYTHEMATOSUS
Benlysta
TRANSPLANT
Astagraf XL
CellCept Injectable
CellCept Suspension
cyclosporine (gengraf,
NEORAL,
SANDIMMUNE)1,2
mycophenolate mofetil
(CELLCEPT)1,2
mycophenolate sodium DR
(Myfortic)1
Nulojix
Prograf Injectable
Rapamune Solution
sirolimus tab (RAPAMUNE)
tacrolimus
(PROGRAF)1,2
Zortress
UREA CYCLE
DISORDERS
phenylbutyrate sodium
(BUPHENYL)2
Ravicti*
VENOUS INSUFFICIENCY
Varithena*
RETINAL DISORDERS
Eylea*
Lucentis*
Macugen*
Ozurdex*
Retisert*
Visudyne*
If you are a plan member or health care provider, please contact Specialty Customer Care toll-free at 1-800-237-2767 or visit www.cvscaremarkspecialtyrx.com.
1 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
indicate brand-names of generic products.
2 Multiple dosage formulations and/or injectable devices are available.
3 Call CVS Caremark toll-free at 1-800-237-2767 for specific medications available through CVS Caremark Specialty Pharmacy. Listing is subject to change. Fax: 1-800-323-2445
* Indicates Limited Distribution products distributed by CVS Caremark Specialty Pharmacy.
©2014 Caremark. All rights reserved. 75-CTC14953d October 2014 v10_01_2014 Comprehensive Specialty Pharmacy Drug List
October 2014
Comprehensive Specialty Pharmacy Drug List
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 toll-free at 1-800-237-2767
or visit www.cvscaremarkspecialtyrx.com. With nearly 35 years of experience, CVS Caremark Specialty Pharmacy provides quality care and
service. We have a network of pharmacies which includes those with Joint Commission and URAC accreditation. The Joint Commission and URAC
are nationally-recognized symbols of quality which reflects an organization’s commitment to meet high standards of quality and safety.
A
abacavir tab (ZIAGEN)1,2
abacavir/lamivudine/zidovudine tab (TRIZIVIR)1
Actemra2*
Acthar H.P.Gel*
Actimmune*
Adcetris*
Adcirca
adefovir (HEPSERA)1
Adempas*
Advate
Afinitor2
Aldurazyme*
Alferon N
Alphanate
AlphaNine SD
Alprolix
Amevive
Ampyra*
Apokyn*
Aptivus
Aralast2*
Aranesp2
Arcalyst*
Arzerra*
Astagraf XL
Atripla
Aubagio*
Avastin
Aveed*
Avonex2
azacitidine (VIDAZA)1
B
Baraclude
Bebulin2
Beleodaq*
BeneFIX
Benlysta
Berinert*
Betaseron
Bethkis*
Bivigam
Bosulif
Botox
Bravelle
Buphenyl2
C
capecitabine (XELODA)
Carimune NF
CellCept1,2
Ceprotin*
Cerdelga*
Cerezyme*
Cetrotide
chorionic gonadotropin
(novarel, pregnyl)1
Cimzia
Cinryze*
Combivir1
Complera
Copaxone
Copegus
Corifact*
Crixivan
cyclosporine (gengraf,
NEORAL,
SANDIMMUNE)1,2
Cystagon*
Cytogam
D
Dacogen1
decitabine (DACOGEN)1
deferoxamine (DESFERAL)1
Desferal1
didanosine (VIDEX, VIDEX
EC)1,2
Dysport
E
Edurant
Egrifta*
Elaprase*
Eligard
Eloctate
Elspar
Emtriva
Enbrel
entecavir (BARACLUDE)1,2
Entyvio
Epivir1
Epivir HBV1,2
Epogen
epoprostenol sodium*1
Epzicom
Erbitux
Erivedge*
Euflexxa
Exjade*
Extavia
Eylea*
F
Fabrazyme*
Feiba NF
Feiba VH
Firazyr*
Firmagon
Flebogamma2
Follistim AQ
Folotyn
Forteo
Fusilev
Fuzeon
G
GamaSTAN S/D
Gammagard
Gammagard S/D
Gammaked
Gammaplex*
Gamunex
ganirelix acetate1
Gattex*
Gazyva*
Gel-One*
Gengraf1,2
Genotropin2
Gilenya
Glassia*
Gleevec
Gonal-F2
Granix
H
H. P. Acthar Gel *
Halaven
Helixate FS
Hemofil M
HepaGam B
Hepsera1
Herceptin
Hizentra*
Humate-P
Humatrope
Humira
Hyalgan
Hycamtin*
HyperHEP B
HyperRHO S/D
HyQvia
I
Ilaris*
Implanon*
Incivek
Increlex*
Infergen
Inlyta*
Intelence
Intron A*
Invirase
Isentress
Istodax*
Ixempra
J
Jakafi*
Jevtana
K
Kadcyla
Kalbitor*
Kaletra
Kalydeco*
Keytruda*
Kineret
Koate-DVI
Kogenate FS
Krystexxa*
Kuvan*
Kynamro*
Kyprolis*
©2014 Caremark. All rights reserved. 75-CTC14953d October 2014 v10_01_2014 Comprehensive Specialty Pharmacy Drug List
L
lamivudine (EPIVIR)1
lamivudine (EPIVIR HBV)1,2
lamivudine/zidovudine
(COMBIVIR)1
Letairis*
Leukine
leuprolide acetate
(LUPRON)1
Lexiva
Lucentis*
Lumizyme*
Lupaneta Pack
Lupron1
Lupron Depot2
Luveris
M
Macugen*
Makena*
Mekinist*
Menopur
MICRhoGAM2
Mirena*
mitoxantrone
(NOVANTRONE)1
Monoclate-P
Mononine
Monovisc
Mozobil*
Mugard*
mycophenolate mofetil
(CELLCEPT)1,2
mycophenolate sodium DR
(Myfortic)1
Myfortic
Myobloc
Myozyme*
N
Nabi-HB
Naglazyme*
Neoral1,2
Neulasta
Neumega
Neupogen
nevirapine (VIRAMUNE)1,2
Nexavar*
Nexplanon*
Norditropin2
Northera*
Norvir
October 2014
N cont.
Novarel1
Novantrone1
NovoSeven2
Nplate
Nulojix
Nutropin2
O
Octagam
octreotide acetate
(SANDOSTATIN)1
Olysio
Omnitrope
Oncaspar
Opsumit*
Oralair*
Orencia2
Orenitram*
Orthovisc
Otezla*
Otrexup
Ovidrel
Ozurdex*
P
Pegasys2
PegIntron2
Perjeta*
phenylbutyrate sodium
(BUPHENYL)2
Pomalyst*
Pregnyl1
Prezista
Privigen
Procrit
Profilnine SD
Prograf
Proleukin
Prolia
Promacta*
Pulmozyme
R
Rapamune
Rasuvo
Ravicti*
Rebetol1,2
Rebif2
Reclast1
Recombinate
Refacto
Remicade
Remodulin*
Repronex
Rescriptor
Retisert*
Retrovir1,2
Revatio1
Revlimid*
Reyataz
RhoGAM2
Rhophylac
RiaSTAP
RibaPak
Ribasphere
RibaTab
ribavirin caps (REBETOL)1
ribavirin tabs (COPEGUS)1
Rituxan
Rixubis
Ruconest*
S
Sabril*
Saizen2
Samsca
Sandostatin1
Sandostatin LAR
Sandimmune1,2
Selzentry
Sensipar
Serostim*
sildenafil citrate (REVATIO)1
Simponi
Simponi ARIA*
Skyla*
Solesta*
Soliris*
Somatuline Depot*
Somavert*
sirolimus tab (RAPAMUNE)
Sovaldi
Sprycel
stavudine (ZERIT)1
Stelara
Stimate
Stivarga*
Stribild
Supartz
Supprelin LA*
Sustiva
Sutent
Sylatron*
Synagis
Synribo
Synvisc
Synvisc One
T
tacrolimus (PROGRAF)1,2
Tafinlar*
Tarceva*
Targretin2
Tasigna
Tecfidera*
Temodar1
temozolomide (TEMODAR)1
Tev-Tropin
Thalomid
Thyrogen*
Tikosyn
Tivicay
TOBI1*
TOBI Podhaler*
tobramycin nebulizer
(TOBI)1
Torisel
Tracleer*
Treanda
Trelstar2
Tretten*
Triumeq
Trizivir1
Truvada
Tykerb*
Tysabri*
Tyvaso*
Tyzeka
V
Valstar
Vantas
Varithena*
Varizig
Vectibix
Velcade
Veletri*
Ventavis*
Victrelis
Viadur
Vidaza1
Videx1,2
Videx EC1,2
Vimizim*
Viracept
Viramune1,2
Viramune XR
Viread
Visudyne*
Vivaglobin*
Vivitrol
Votrient*
VPRIV*
W
Wilate
WinRho SDF
X
Xalkori*
Xeljanz
Xeloda
Xenazine*
Xeomin*
Xgeva
Xiaflex*
Xolair*
Xtandi*
Xyntha2
Y
Yervoy
Z
Zaltrap*
Zelboraf*
Zemaira*
Zerit
Ziagen1,2
zidovudine (RETROVIR)1,2
Zoladex
zoledronic acid (RECLAST,
ZOMETA)1
Zolinza
Zometa1
Zorbtive
Zortress
Zykadia*
Zytiga
If you are a plan member or health care provider, please contact Specialty Customer Care toll-free at 1-800-237-2767 or visit www.cvscaremarkspecialtyrx.com.
1 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
indicate brand-names of generic products.
2 Multiple dosage formulations and/or injectable devices are available.
3 Call CVS Caremark toll-free at 1-800-237-2767 for specific medications available through CVS Caremark Specialty Pharmacy. Listing is subject to change. Fax: 1-800-323-2445
* Indicates Limited Distribution products distributed by CVS Caremark Specialty Pharmacy.
©2014 Caremark. All rights reserved. 75-CTC14953d October 2014 v10_01_2014 Comprehensive Specialty Pharmacy Drug List