Specialty, infused and injectible prescription drugs

Members on one of the following specialty medications must use CVS Caremark Specialty Mail Order Pharmacy to get their medicine. (This does not apply to our Fallon Senior Plan or Medicaid members.)

Specialty drug list

ACROMEGALY

• octreotide acetate (SANDOSTATIN)^1†
• Sandostatin LAR^†
• Somatuline Depot*^†
• Somavert*^†

ALCOHOL DEPENDENCY

• Vivitrol^†

ALLERGIC ASTHMA

• Xolair*^†

ALPHA-1 ANTITRYPSIN DEFICIENCY

• Aralast2*^†
• Glassia*^†

ANEMIA

• Aranesp²
• Epogen
• Procrit

BOTULINUM TOXINS

• Botox^†
• Dysport^†
• Myobloc^†
• Xeomin*^†

CONTRACEPTIVES

• Implanon*^†
• Nexplanon*^†
• Mirena*^†

CRYOPYRINASSOCIATED PERIODIC SYNDROMES

• Arcalyst*^†
• Ilaris*^†

CYSTIC FIBROSIS

• Pulmozyme
• TOBI

DUPUYTREN’S CONTRACTURE

• Xiaflex*^†

GOUT

• Krystexxa

GROWTH HORMONE & RELATED DISORDERS

Growth Hormone

• 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
• Bebulin²
• BeneFIX
• Corifact*
• Feiba VH
• Feiba NF
• Helixate FS
• Hemofil M
• Humate-P
• Koate-DVI
• Kogenate FS
• Monarc M
• Monoclate-P
• Mononine
• NovoSeven²
• Profilnine SD
• Proplex T
• Recombinate
• Refacto
• RiaSTAP
• Stimate
• Wilate
• Xyntha

HEPATITIS C

• Incivek
• Infergen
• Pegasys²
• PEGIntron²
• Rebetol Solution
• ribavirin caps (REBETOL)¹
• ribavirin tabs (COPEGUS)¹
• Victrelis

HEREDITARY ANGIODEMA^†

• Berinert*
• Cinryze*
• Firazyr*

HIV MEDICATIONS

• Egrifta*^†
• Fuzeon

HORMONAL THERAPIES

• Eligard
• Firmagon
• H.P. Acthar Gel*
• leuprolide acetate (LUPRON)¹
• Lupron Depot^{2 †}
• Supprelin LA*^†
• Trelstar^{2 †}
• Vantas^†
• Viadur^†
• Zoladex^†

IMMUNE DEFICIENCIES & RELATED DISORDERS^†

• Carimune NF
• Cytogam
• Flebogamma²
• GamaSTAN S/D
• Gammagard²
• Gammaked
• Gammaplex*
• Gamunex
• HepaGam B
• Hizentra*
• HyerpHEP B
• HyperRHO S/D
• Iveegam EN
• MICRhoGAM²
• Octagam
• Panglobulin
• Polygam S/D
• Privigen
• RhoGAM^{2 †}
• Rhophylac
• Vivaglobin*
• WinRho SDF

IMMUNE (IDIOPATHIC) THROMBOCYTOPENIC PURPURA

• Nplate^†
• Promacta*^†

INFECTIOUS DISEASE

• Actimmune*^†

INFERTILITY

• Bravelle
• Cetrotide
• chorionic gonadotropin (novarel, pregnyl)¹
• Follistim AQ
• ganirelix acetate¹
• Gonal-F2²
• Luveris
• Menopur
• Ovidrel
• Repronex

INFLAMMATORY BOWEL DISEASE

• Cimzia*^†
• Humira
• Remicade^†
• Tysabri*^†

IRON OVERLOAD

• deferoxamine
  (DESFERAL)^1†
• Exjade*^†

LYSOSOMAL STORAGE DISORDERS

• Aldurazyme*
• Cerezyme*
• Cystagon*
• Elaprase *
• Fabrazyme*
• Lumizyme*
• Myozyme*
• Naglazyme*
• VPRIV*

MACULAR DEGENERATION

• Lucentis*^†
• Macugen*^†
• Visudyne*^†

MOVEMENT DISORDERS

• Apokyn*^†
• Xenazine*^†

MULTIPLE SCLEROSIS

• Ampyra*^†
• Avonex
• Betaseron
• Copaxone
• Extavia
• Gilenya
• Rebif
• Tysabri*^†

NEUTROPENIA

• Leukine
• Neulasta
• Neupogen

ONCOLOGY - INJECTABLE³

• Thyrogen*^†
• Xgeva^†
• Zometa^†

ONCOLOGY - ORAL

• Afinitor
• Gleevec
• Hycamtin*^†
• Nexavar*^†
• Oforta*^†
• Revlimid*^†
• Sprycel
• Sutent
• Tarceva
• Targentin²
• Tasigna
• Temodar
• Thalomid
• Tykerb*^†
• Votrient*^†
• Xalkori*^†
• Xeloda
• Zelboraf*^†
• Zolinza
• Zytiga

OSTEOARTHRITIS

• Euflexxa^†
• Hyalgan^†
• Orthovisc^†
• Supartz^†
• Synvisc^†
• Synvisc One^†

OSTEOPOROSIS

• Forteo
• Prolia^†
• Reclast^†

PAROXYSMAL NOCTURNAL HEMOGLOBINURIA

• Soliris*^†

PHENYLKETONURIA

• Kuvan*^†

PRE-TERM BIRTH

• Makena*^†

PSORIASIS

• Amevive^†
• Enbrel
• Humira
• Remicade^†
• Stelara^†

PULMONARY ARTERIAL HYPERTENSION^†

• Adcirca
• epoprostenol sodium¹*
• Letairis*
• Remodulin*
• Revatio
• Tracleer*
• Tyvaso*
• Ventavis*

RENAL DISEASE

• Sensipar

RESPIRATORY SYNCYTIAL VIRUS

• Synagis^†

RHEUMATOID ARTHRITIS

• Acternra^†
• Cimzia*^†
• Enbrel
• Humira
• Kineret^†
• Orencia^†
• Remicade^†
• Simponi

SEIZURE DISORDERS

• H.P. Acthar Gel*
• Sabril*^†

SYSTEMIC LUPUS ERYTHEMATOSUS

• Benlysta^†

 

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 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.

* Indicates Limited Distribution products distributed by CVS Caremark Specialty Pharmacy. Limited Distribution defined as less than 15 pharmacy providers.

† Therapy class or product is part of CVS Caremark's Specialty Select offering.

Products distributed by CVS Caremark Specialty Pharmacy, as well as products covered by a plan member’s prescription benefit plan, may change from time to time. In addition, a plan member’s specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance on this document at any time.