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Specialty Drug List 2019

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2019 Specialty Drug List

DRUG NAME

Abilify Maintena

Abraxane

Actemra

Actemra ACTPen

Acthrel

Activase

Adcetris

Adcirca

adefovir

Afinitor

Afinitor Disperz

Aimovig Autoinjector

Ajovy

Aldurazyme

Alecensa

Alferon N

Alimta

Aliqopa

Alunbrig

amifostine crystalline

Ampyra

Andexxa

Aranesp

Arikayce

Aristada

Aristada Initio

arsenic trioxide

Arzerra

Astagraf XL

Atgam

Aubagio

Austedo

Avastin

Avonex

Avycaz

azacitidine

Azedra Dosimetric

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DRUG NAME

Azedra Therapeutic

BabyBIG

Balversa

Bavencio

Beleodaq

Bendeka

Besponsa

Betaseron

bevacizumab

BiCNU

Bivigam

bleomycin

Blincyto

bortezomib

Botox

Botox Cosmetic

Bravelle

Brineura

Busulfex

Calquence

Camptosar

carboplatin

Carimune NF Nanofiltered

Cathflo Activase

Cerdelga

Cerezyme

Cholbam

cidofovir

Cimzia

Cimzia Powder for Reconst

Cinvanti

cisplatin

colistin

Copaxone

Copiktra

Cosentyx

Cosentyx Pen

Cosmegen

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DRUG NAME

Cotellic

Cresemba

Crysvita

Cubicin

Cuprimine

Cutaquig

Cuvitru

cyclophosphamide

cytarabine

cytarabine (PF)

CytoGam

dacarbazine

Daklinza

Dalvance

daptomycin

Darzalex

daunorubicin

Daurismo

Demser

dexrazoxane HCl

Diacomit

Dificid

Docefrez

docetaxel

Doptelet

doxorubicin

doxorubicin, peg-liposomal

Dupixent

Durolane

Dysport

Egrifta

Elaprase

Eligard

Eligard (3 month)

Eligard (4 month)

Eligard (6 month)

Elitek

Emcyt

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DRUG NAME

Emgality Pen

Emgality Syringe

Empliciti

Enbrel

Enbrel Mini

Enbrel SureClick

Endari

Entyvio

Envarsus XR

Epclusa

Epidiolex

epirubicin

Epogen

Erbitux

Erivedge

Erleada

erlotinib

Esbriet

Etopophos

etoposide

Euflexxa

Evenity

Evomela

Exjade

Exondys 51

Extavia

Fabrazyme

Fareston

Farydak

Faslodex

Feraheme

Ferrlecit

Firdapse

Firmagon

Firmagon kit

Flebogamma DIF

floxuridine

flucytosine

Page 5 www.performrx.com

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DRUG NAME

fludarabine

Follistim AQ

Folotyn

fondaparinux

Forteo

Fragmin

Fulphila

Gablofen

GamaSTAN S/D

Gamifant

Gammagard Liquid

Gammagard S-D

Gammaplex

Gammaplex (with sorbitol)

Gamunex-C

ganirelix

Gazyva

Gel-One

Gelsyn-3

gemcitabine

Gemzar

Genotropin

Genotropin MiniQuick

GenVisc 850

Gilenya

glatiramer

Glatopa

Gleostine

Gonal-F

Gonal-F RFF

Gonal-F RFF Redi-Ject

Granix

Halaven

Harvoni

Hemlibra

HepaGam B

Herceptin

Herceptin Hylecta

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DRUG NAME

Hexalen

Hizentra

Humira

Humira Pediatric Crohns Start

Humira Pen

Humira Pen Crohns-UC-HS Start

Humira Pen Psor-Uveits-Adol HS

Humira(CF)

Humira(CF) Pedi Crohns Starter

Humira(CF) Pen

Humira(CF) Pen Crohns-UC-HS

Humira(CF) Pen Psor-Uv-Adol HS

Hyalgan

Hycamtin

hydroxyprogest(PF)(preg presv)

hydroxyprogesterone caproate

HyperHEP B S/D

Hyperhep B S-D Neonatal

HyQvia

ibandronate

idarubicin

Idhifa

Ifex

ifosfamide

ifosfamide-mesna

Ilumya

Imfinzi

Imlygic

Infed

Inflectra

Infugem

Ingrezza

Injectafer

Intron A

Invanz

Invega Sustenna

Invega Trinza

irinotecan

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DRUG NAME

Ixempra

Jadenu

Jadenu Sprinkle

Jevtana

Jynarque

Kadcyla

Kanjinti

Kanuma

Kepivance

Kevzara

Keytruda

Khapzory

Kisqali

Kisqali Femara Co-Pack

Kitabis Pak

Krystexxa

Kymriah

leucovorin calcium

Leukeran

Leukine

leuprolide

levoleucovorin calcium

Libtayo

Lioresal

Lonsurf

Lorbrena

Lucentis

Lumizyme

Lumoxiti

Lupaneta Pack

Lupron Depot

Lupron Depot-Ped

Lutathera

Luxturna

Lysodren

Macrilen

Makena

Makena (PF)

Page 8 www.performrx.com

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DRUG NAME

Mavenclad

Mavyret

Mayzent

Mekinist

melphalan

melphalan HCl

Menopur

Mepsevii

Mesnex

methoxsalen

Miacalcin

Mircera

mitomycin

mitoxantrone

Moderiba Dose Pack

Monovisc

Mozobil

Mustargen

Mvasi

mycophenolate mofetil HCl

Mylotarg

Myobloc

Nabi-HB

Natpara

Nebupent

Nerlynx

Neulasta

Neupogen

Nilandron

nilutamide

Ninlaro

Nipent

Nityr

Nivestym

Norditropin FlexPro

Novarel

Nplate

Nubeqa

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DRUG NAME

Nucala

Nulojix

Nutropin AQ Nuspin

Nuzyra

Ocaliva

Ocrevus

Octagam

octreotide acetate

Odomzo

Olumiant

Omnitrope

Oncaspar

Onivyde

Opdivo

Orencia

Orencia (with maltose)

Orencia ClickJect

Orenitram

OrthoVisc

Otezla

Ovidrel

oxaliplatin

Oxervate

Ozurdex

paclitaxel

Palynziq

pamidronate

Panhematin

Panzyga

Parsabiv

Pegasys

Pegasys ProClick

PegIntron

Perjeta

Perseris

Piqray

Polivy

Praluent Pen

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DRUG NAME

Prevymis

Prialt

Privigen

Procrit

Proleukin

Prolia

Promacta

Pulmozyme

Radicava

Ravicti

Rebetol

Rebif (with albumin)

Rebif Rebidose

Rebif Titration Pack

Remicade

Renflexis

Repatha Pushtronex

Repatha SureClick

Repatha Syringe

Retacrit

Retisert

Revatio

Revcovi

RhoGAM Ultra-Filtered PLUS

Rhophylac

Ribasphere

Ribasphere RibaPak

ribavirin

Risperdal Consta

Rituxan

Rituxan Hycela

romidepsin

Rydapt

Saizen

Sandostatin

Sandostatin LAR Depot

Serostim

Siliq

Page 11 www.performrx.com

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DRUG NAME

Simponi

Simponi ARIA

Simulect

Sivextro

Skyrizi

Soliris

Somatuline Depot

Sovaldi

Spinraza (PF)

Spravato

Sprycel

Stelara

Steritalc

Supartz FX

Supprelin LA

Sustol

Sylatron

Sylvant

Symdeko

Sympazan

Synagis

Synribo

Synvisc

Synvisc-One

Tabloid

Tafinlar

Taltz Autoinjector

Taltz Syringe

Tarceva

Targretin

Tasigna

Tavalisse

Tecentriq

Technivie

Teflaro

Temodar

teniposide

Tepadina

Page 12 www.performrx.com

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DRUG NAME

tetrabenazine

Thiola EC

thiotepa

Thymoglobulin

Thyrogen

Tice BCG

Tiglutik

Tobi Podhaler

tobramycin with nebulizer

Tolsura

topotecan

Totect

Tracleer

Treanda

Trelstar

Tremfya

tretinoin (chemotherapy)

trientine

Trisenox

Tygacil

Tykerb

Tymlos

Udenyca

Ultomiris

Unituxin

valganciclovir

Valstar

Vantas

Vectibix

Velcade

Venofer

Verzenio

Viekira Pak

Viekira XR

vinblastine

vincristine

vinorelbine

Vitrakvi

Page 13 www.performrx.com

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DRUG NAME

Vivitrol

Vizimpro

Voraxaze

Vosevi

Votrient

VPRIV

Vyndaqel

Vyxeos

WinRho SDF

Xeljanz

Xeljanz XR

Xeomin

Xgeva

Xolair

Xospata

Yervoy

Yescarta

Yondelis

Yonsa

Zaltrap

Zarxio

Zejula

Zelboraf

Zemdri

Zepatier

Zerbaxa

Zoladex

zoledronic acid

Zolgensma

Zolinza

Zomacton

Zometa

Zortress

Zykadia

Zyprexa Relprevv

Zytiga