Comprehensive Specialty Pharmacy Drug List - Caremark

October 2019

Comprehensive Specialty Pharmacy Drug List

Providing one of the broadest offerings of specialty pharmaceuticals in the industry

The Comprehensive Specialty Pharmacy Drug List is a guide of medications available through CVS Specialty?. Our goal is to help make your life better. With more than 40 years of experience, CVS Specialty provides quality care and service. We have a network of pharmacies that includes those with Joint Commission and URAC accreditation. The Joint Commission and URAC are nationally recognized symbols of quality that reflect an organization's commitment to meet high standards of quality and safety. This list represents brand-name products in CAPS and generic products in lowercase italics.

Please note: If you are a plan member or a health care provider, please visit , fax 1-800-323-2445 or call 1-800-237-2767 for specific information regarding medications available through CVS Specialty. e-Prescribe specialty prescription(s) to CVS Specialty Pharmacy.

ACROMEGALY octreotide acetate (SANDOSTATIN) SANDOSTATIN LAR SOMATULINE DEPOT* SOMAVERT*

ALPHA-1 ANTITRYPSIN DEFICIENCY ARALAST NP* GLASSIA* ZEMAIRA*

AMYLOIDOSIS ONPATTRO* VYNDAMAX* VYNDAQEL*

ANEMIA ARANESP EPOGEN PROCRIT RETACRIT

ASTHMA CINQAIR* DUPIXENT FASENRA* NUCALA* XOLAIR*

ATOPIC DERMATITIS DUPIXENT

CARDIAC DISORDERS dofetilide (TIKOSYN)

COAGULATION DISORDERS CEPROTIN*

CRYOPYRIN-ASSOCIATED PERIODIC SYNDROMES ARCALYST* ILARIS*

CYSTIC FIBROSIS BETHKIS*

KITABIS PAK* PULMOZYME TOBI PODHALER* tobramycin nebulizer (TOBI*)

ELECTROLYTE DISORDERS SAMSCA*

GASTROINTESTINAL DISORDERS ?

OTHER GATTEX* OCALIVA* SOLESTA*

GOUT KRYSTEXXA*

GROWTH HORMONE & RELATED DISORDERS Growth Hormone Disorders GENOTROPIN HUMATROPE NORDITROPIN NUTROPIN AQ OMNITROPE SAIZEN SEROSTIM* ZOMACTON ZORBTIVE

IGF-1 Deficiency INCRELEX*

HEMATOPOIETICS MOZOBIL*

HEMOPHILIA, VON WILLEBRAND DISEASE & RELATED BLEEDING DISORDERS ADVATE ADYNOVATE AFSTYLA ALPHANATE ALPHANINE SD ALPROLIX BEBULIN

BENEFIX COAGADEX* CORIFACT* ELOCTATE FEIBA FIBRYGA HELIXATE FS HEMLIBRA HEMOFIL M HUMATE-P IDELVION IXINITY JIVI KOATE KOATE-DVI KOGENATE FS KOVALTRY MONONINE NOVOEIGHT* NOVOSEVEN RT NUWIQ OBIZUR* PROFILNINE PROFILNINE SD REBINYN RECOMBINATE RIASTAP RIXUBIS STIMATE TRETTEN* VONVENDI* WILATE XYNTHA

HEPATITIS adefovir dipivoxil (HEPSERA) entecavir (BARACLUDE) EPCLUSA HARVONI INTRON-A* lamivudine (EPIVIR, EPIVIR HBV) LEDIPASVIR/SOFOSBUVIR MAVYRET PEGASYS PEGINTRON REBETOL SOLUTION

ribasphere RIBASPHERE RIBAPAK ribavirin caps (ribasphere,

REBETOL) ribavirin tabs (ribasphere,

MODERIBA) SOFOSBUVIR/VELPATASVIR SOVALDI tenofovir disoproxil fumarate

(VIREAD) VEMLIDY VIEKIRA PAK VOSEVI ZEPATIER

HEREDITARY ANGIOEDEMA BERINERT* CINRYZE* HAEGARDA* icatibant acetate (FIRAZYR*) KALBITOR* RUCONEST* TAKHZYRO*

HIV MEDICATIONS abacavir tab (ZIAGEN) abacavir/lamivudine (EPZICOM) abacavir/lamivudine/zidovudine

tab (TRIZIVIR) APTIVUS atazanavir sulfate (REYATAZ) ATRIPLA BIKTARVY CIMDUO COMPLERA CRIXIVAN DELSTRIGO DESCOVY didanosine (VIDEX, VIDEX EC) DOVATO EDURANT efavirenz (SUSTIVA) EGRIFTA*

Products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may change from time to time. In addition, a

member's specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.

*Indicates Limited Distribution products distributed by CVS Specialty or one of its affiliates, including Coram? CVS Specialty Infusion Services.

Call CVS Specialty at 1-800-237-2767 for specific medications available through CVS Specialty. This document contains confidential and proprietary information of

CVS Specialty and may not be reproduced, distributed or printed without written permission from CVS Specialty. Listing is subject to change. This document contains

references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty.

Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2019 CVS Specialty. All rights reserved. 75-CTC14953D October 2019 v09162019 Comprehensive Specialty Pharmacy Drug List

Page 1 of 7

October 2019

EMTRIVA EVOTAZ fosamprenavir (LEXIVA) FUZEON GENVOYA INTELENCE INVIRASE ISENTRESS JULUCA lamivudine (EPIVIR) lamivudine/zidovudine

(COMBIVIR) LEXIVA lopinavir/ritonavir soln

(KALETRA) nevirapine (VIRAMUNE,

VIRAMUNE XR) ODEFSEY PIFELTRO PREZCOBIX PREZISTA RESCRIPTOR RETROVIR INJECTABLE ritonavir (NORVIR) SELZENTRY stavudine (ZERIT) STRIBILD SYMFI SYMFI LO SYMTUZA tenofovir disoproxil fumarate

(VIREAD) TIVICAY TRIUMEQ TROGARZO* TRUVADA TYBOST VIDEX SOLUTION VIRACEPT zidovudine (RETROVIR)

HORMONAL THERAPIES AVEED* ELIGARD FIRMAGON leuprolide acetate (LUPRON) LUPANETA PACK LUPRON DEPOT NATPARA* SUPPRELIN LA* TRELSTAR VANTAS ZOLADEX

IMMUNE DEFICIENCIES & RELATED DISORDERS BIVIGAM* CUVITRU CYTOGAM GAMASTAN

GAMASTAN S/D GAMMAGARD LIQUID GAMMAGARD S/D GAMMAKED GAMMAPLEX* GAMUNEX C HEPAGAM B HIZENTRA* HYPERHEP B HYPERRHO S/D HYQVIA MICRHOGAM NABI-HB OCTAGAM PANZYGA PRIVIGEN RHOGAM RHOPHYLAC VARIZIG WINRHO SDF

INFECTIOUS DISEASE ? OTHER

ACTIMMUNE* ALFERON N

INFERTILITY CETROTIDE CHORIONIC GONADOTROPIN FOLLISTIM AQ GANIRELIX ACETATE GONAL-F MENOPUR NOVAREL OVIDREL PREGNYL

INFLAMMATORY BOWEL DISEASE CIMZIA ENTYVIO HUMIRA INFLECTRA REMICADE RENFLEXIS* SIMPONI STELARA TYSABRI* XELJANZ

IRON OVERLOAD deferasirox (EXJADE*) deferoxamine (DESFERAL) JADENU*

LYSOSOMAL STORAGE DISORDERS ALDURAZYME* CERDELGA* CEREZYME* CYSTAGON*

ELAPRASE* ELELYSO* FABRAZYME* KANUMA* LUMIZYME* miglustat NAGLAZYME* VIMIZIM* VPRIV*

MENTAL HEALTH CONDITIONS ZULRESSO*

MOVEMENT DISORDERS APOKYN* AUSTEDO INBRIJA* NORTHERA* NUPLAZID* RADICAVA* SOLIRIS* tetrabenazine (XENAZINE*)

MULTIPLE SCLEROSIS AUBAGIO* AVONEX BETASERON dalfampridine ER (AMPYRA*) EXTAVIA GILENYA glatiramer acetate (COPAXONE,

glatopa) LEMTRADA* MAVENCLAD* MAYZENT* mitoxantrone hcl OCREVUS* PLEGRIDY* REBIF TECFIDERA* TYSABRI*

NEUTROPENIA FULPHILA GRANIX LEUKINE NEULASTA NEUPOGEN NIVESTYM UDENYCA ZARXIO

OCULAR DISORDERS EYLEA* ILUVIEN* LUCENTIS* MACUGEN* OZURDEX* RETISERT* VISUDYNE*

ONCOLOGY ? INJECTABLE

ADCETRIS* ARZERRA* AVASTIN azacitidine (VIDAZA) BAVENCIO* BELEODAQ* BELRAPZO* BENDAMUSTINE

HYDROCHLORIDE BENDEKA* BLINCYTO* BORTEZOMIB CYRAMZA* DARZALEX* decitabine (DACOGEN) ELZONRIS* EMPLICITI* ERBITUX EVOMELA* FOLOTYN FUSILEV GAZYVA* HALAVEN HERCEPTIN HERCEPTIN HYLECTA IMFINZI* INTRON A* ISTODAX* IXEMPRA JEVTANA KADCYLA KANJINTI* KEYTRUDA* KHAPZORY* KYPROLIS* LEVOLEUCOVORIN LUMOXITI* mitoxantrone MVASI* ONCASPAR OPDIVO* PERJETA* POLIVY* PORTRAZZA* POTELIGEO* PROLEUKIN RITUXAN RITUXAN HYCELA* ROMIDEPSIN SYLATRON* SYLVANT* TECENTRIQ* TEMODAR temsirolimus (TORISEL) TEPADINA THYROGEN* TREANDA valrubicin (VALSTAR) VECTIBIX

Products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may change from time to time. In addition, a

member's specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.

*Indicates Limited Distribution products distributed by CVS Specialty or one of its affiliates, including Coram? CVS Specialty Infusion Services.

Call CVS Specialty at 1-800-237-2767 for specific medications available through CVS Specialty. This document contains confidential and proprietary information of

CVS Specialty and may not be reproduced, distributed or printed without written permission from CVS Specialty. Listing is subject to change. This document contains

references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty.

Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2019 CVS Specialty. All rights reserved. 75-CTC14953D October 2019 v09162019 Comprehensive Specialty Pharmacy Drug List

Page 2 of 7

October 2019

VELCADE XGEVA YERVOY YONDELIS* ZALTRAP* zoledronic acid (ZOMETA)

ONCOLOGY ? ORAL/TOPICAL

abiraterone acetate (ZYTIGA*) AFINITOR ALECENSA* ALUNBRIG* bexarotene (TARGRETIN) BOSULIF CABOMETYX* capecitabine (XELODA) COMETRIQ* COTELLIC* DAURISMO* ERIVEDGE* ERLEADA* erlotinib hydrochloride (TARCEVA*) FARYDAK* HYCAMTIN IBRANCE* IDHIFA* imatinib mesylate (GLEEVEC) INREBIC* INLYTA* IRESSA* JAKAFI* KISQALI KISQALI FEMARA CO-PACK LENVIMA* LONSURF* LORBRENA* LYNPARZA* MEKINIST* MUGARD NERLYNX* NEXAVAR* NINLARO* NUBEQA* ODOMZO* PIQRAY POMALYST* PURIXAN* REVLIMID* ROZLYTREK* RUBRACA* RYDAPT SPRYCEL STIVARGA* SUTENT TAFINLAR* TAGRISSO* TALZENNA* TASIGNA temozolomide (TEMODAR) THALOMID

TYKERB* VERZENIO* VITRAKVI* VIZIMPRO* VOTRIENT* XALKORI* XTANDI* YONSA* ZELBORAF* ZOLINZA ZYKADIA*

OSTEOPOROSIS EVENITY FORTEO PROLIA TYMLOS zoledronic acid (RECLAST)

PAROXYSMAL NOCTURNAL HEMOGLOBINURIA SOLIRIS* ULTOMIRIS*

PHENYLKETONURIA KUVAN* PALYNZIQ*

PRE-TERM BIRTH hydroxyprogesterone capro

(MAKENA*)

PSORIASIS CIMZIA COSENTYX* ENBREL HUMIRA ILUMYA* INFLECTRA OTEZLA OTREXUP RASUVO REMICADE RENFLEXIS* SILIQ SKYRIZI STELARA TALTZ* TREMFYA XELJANZ

PULMONARY ARTERIAL HYPERTENSION ADEMPAS* ambrisentan* (LETAIRIS*) bosentan (TRACLEER*) epoprostenol sodium

(FLOLAN, VELETRI)* OPSUMIT* ORENITRAM* sildenafil citrate (REVATIO) tadalafil (ADCIRCA, alyq) treprostinil sodium* (REMODULIN*) TYVASO* UPTRAVI* VENTAVIS*

PULMONARY DISORDERS ?

OTHER ESBRIET* OFEV*

RARE DISORDERS ? OTHER

CRYSVITA* GAMIFANT*

RENAL DISEASE cinacalcet hydrochloride

(SENSIPAR) PARSABIV

RESPIRATORY SYNCYTIAL VIRUS SYNAGIS

RHEUMATOID ARTHRITIS ACTEMRA* CIMZIA ENBREL HUMIRA INFLECTRA KEVZARA* OLUMIANT* ORENCIA OTREXUP RASUVO REMICADE RENFLEXIS* RINVOQ RITUXAN SIMPONI SIMPONI ARIA XELJANZ

SEIZURE DISORDERS EPIDIOLEX* H. P. ACTHAR * vigabatrin pwd* (SABRIL PWD*) vigabatrin tabs* (SABRIL TABS*)

SYSTEMIC LUPUS ERYTHEMATOSUS BENLYSTA*

THROMBOCYTOPENIA DOPTELET* MULPLETA NPLATE PROMACTA*

TRANSPLANT ASTAGRAF XL cyclosporine (gengraf,

NEORAL, SANDIMMUNE) ENVARSUS XR mycophenolate mofetil

(CELLCEPT) mycophenolic acid dr (MYFORTIC) NULOJIX PROGRAF INJECTABLE RAPAMUNE SOLUTION sirolimus tab (RAPAMUNE) tacrolimus (PROGRAF) ZORTRESS

UREA CYCLE DISORDERS RAVICTI* sodium phenylbutyrate

(BUPHENYL*)

Products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may change from time to time. In addition, a

member's specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.

*Indicates Limited Distribution products distributed by CVS Specialty or one of its affiliates, including Coram? CVS Specialty Infusion Services.

Call CVS Specialty at 1-800-237-2767 for specific medications available through CVS Specialty. This document contains confidential and proprietary information of

CVS Specialty and may not be reproduced, distributed or printed without written permission from CVS Specialty. Listing is subject to change. This document contains

references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty.

Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2019 CVS Specialty. All rights reserved. 75-CTC14953D October 2019 v09162019 Comprehensive Specialty Pharmacy Drug List

Page 3 of 7

October 2019

INDEX

A abacavir tab (ZIAGEN) abacavir/lamivudine

(EPZICOM) abacavir/lamivudine/

zidovudine tab (TRIZIVIR) abiraterone acetate (ZYTIGA*) ACTEMRA* ACTHAR H.P. GEL* ACTIMMUNE* ADCETRIS* ADCIRCA adefovir (HEPSERA) ADEMPAS* ADVATE ADYNOVATE AFINITOR AFSTYLA ALDURAZYME* ALECENSA* ALFERON N ALPHANATE ALPHANINE SD ALPROLIX ALUNBRIG* alyq (ADCIRCA, tadalafil) ambrisentan* (LETAIRIS*) AMPYRA* APOKYN* APTIVUS ARALAST NP* ARANESP ARCALYST* ARZERRA* ASTAGRAF XL atazanavir sulfate (REYATAZ) ATRIPLA AUBAGIO* AUSTEDO AVASTIN AVEED* AVONEX azacitidine (VIDAZA)

B BARACLUDE BAVENCIO* BEBULIN BELEODAQ* BELRAPZO* BENDAMUSTINE

HYDROCHLORIDE BENDEKA* BENEFIX BENLYSTA* BERINERT* BETASERON BETHKIS*

bexarotene (TARGRETIN) BIKTARVY BIVIGAM* BLINCYTO* BORTEZOMIB bosentan (TRACLEER*) BOSULIF BUPHENYL*

C CABOMETYX* capecitabine (XELODA) CELLCEPT CEPROTIN* CERDELGA* CEREZYME* CETROTIDE CHORIONIC

GONADOTROPIN CIMDUO CIMZIA cinacalcet hydrochloride

(SENSIPAR) CINQAIR* CINRYZE* COAGADEX* COMBIVIR COMETRIQ* COMPLERA COPAXONE CORIFACT* COSENTYX* COTELLIC* CRIXIVAN CRYSVITA* CUVITRU cyclosporine (gengraf,

NEORAL, SANDIMMUNE) CYRAMZA* CYSTAGON* CYTOGAM

D DACOGEN dalfampridine ER (AMPYRA*) DARZALEX* DAURISMO* decitabine (DACOGEN) deferasirox (EXJADE*) deferoxamine (DESFERAL) DELSTRIGO DESCOVY DESFERAL didanosine (VIDEX, VIDEX EC) dofetilide (TIKOSYN) DOPTELET* DOVATO DUPIXENT

E EDURANT efavirenz (SUSTIVA) EGRIFTA* ELAPRASE* ELELYSO* ELIGARD ELOCTATE ELZONRIS* EMPLICITI* EMTRIVA ENBREL entecavir (BARACLUDE) ENTYVIO ENVARSUS XR EPCLUSA EPIDIOLEX* EPIVIR EPIVIR HBV EPOGEN epoprostenol sodium

(FLOLAN, VELETRI)* EPZICOM ERBITUX ERIVEDGE* ERLEADA* erlotinib hydrochloride

(TARCEVA*) ESBRIET* EVENITY EVOMELA* EVOTAZ EXJADE* EXTAVIA EYLEA*

F FABRAZYME* FARYDAK* FASENRA* FEIBA FIBRYGA FIRAZYR* FIRMAGON FLOLAN* FOLLISTIM AQ FOLOTYN FORTEO fosamprenavir (LEXIVA) FULPHILA FUSILEV FUZEON

G GAMASTAN GAMASTAN S/D GAMIFANT* GAMMAGARD LIQUID GAMMAGARD S/D

GAMMAKED GAMMAPLEX* GAMUNEX C GANIRELIX ACETATE GATTEX* GAZYVA* gengraf GENOTROPIN GENVOYA GILENYA GLASSIA* glatiramer acetate

(COPAXONE, glatopa) glatopa (COPAXONE,

glatiramer acetate) GLEEVEC GONAL-F GRANIX

H H. P. ACTHAR GEL* HAEGARDA* HALAVEN HARVONI HELIXATE FS HEMLIBRA HEMOFIL M HEPAGAM B HEPSERA HERCEPTIN HERCEPTIN HYLECTA HIZENTRA* HUMATE-P HUMATROPE HUMIRA HYCAMTIN hydroxyprogesterone capro

(MAKENA*) HYPERHEP B HYPERRHO S/D HYQVIA

I IBRANCE* icatibant acetate (FIRAZYR*) IDELVION IDHIFA* ILARIS* ILUMYA* ILUVIEN* imatinib mesylate (GLEEVEC) IMFINZI* INBRIJA* INREBIC* INCRELEX* INFLECTRA INLYTA* INTELENCE INTRON A*

Products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may change from time to time. In addition, a

member's specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.

*Indicates Limited Distribution products distributed by CVS Specialty or one of its affiliates, including Coram? CVS Specialty Infusion Services.

Call CVS Specialty at 1-800-237-2767 for specific medications available through CVS Specialty. This document contains confidential and proprietary information of

CVS Specialty and may not be reproduced, distributed or printed without written permission from CVS Specialty. Listing is subject to change. This document

contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS

Specialty.

Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2019 CVS Specialty. All rights reserved. 75-CTC14953D October 2019 v09162019 Comprehensive Specialty Pharmacy Drug List

Page 4 of 7

October 2019

INVIRASE IRESSA* ISENTRESS ISTODAX* IXEMPRA IXINITY

J JADENU* JAKAFI* JEVTANA JIVI JULUCA

K KADCYLA KALBITOR* KALETRA KANJINTI* KANUMA* KEVZARA* KEYTRUDA* KHAPZORY* KISQALI KISQALI FEMARA CO-PACK KITABIS PAK* KOATE KOATE-DVI KOGENATE FS KOVALTRY KRYSTEXXA* KUVAN* KYPROLIS*

L lamivudine (EPIVIR, EPIVIR HBV) lamivudine/zidovudine

(COMBIVIR) LEDIPASVIR/SOFOSBUVIR LEMTRADA* LENVIMA* LETAIRIS* LEUKINE leuprolide acetate (LUPRON) LEVOLEUCOVORIN LEXIVA LONSURF* lopinavir/ritonavir soln (KALETRA) LORBRENA* LUCENTIS* LUMIZYME* LUMOXITI* LUPANETA PACK LUPRON LUPRON DEPOT LYNPARZA*

M MACUGEN* MAKENA*

MAVENCLAD* MAVYRET MAYZENT* MEKINIST* MENOPUR MICRHOGAM miglustat mitoxantrone MODERIBA MONONINE MOZOBIL* MUGARD MULPLETA MVASI* mycophenolate mofetil

(CELLCEPT) mycophenolic acid dr

(MYFORTIC) MYFORTIC

N NABI-HB NAGLAZYME* NATPARA* NEORAL NERLYNX* NEULASTA NEUPOGEN nevirapine (VIRAMUNE,

VIRAMUNE XR) NEXAVAR* NINLARO* NIVESTYM NORDITROPIN NORTHERA* NORVIR NOVAREL NOVOEIGHT* NOVOSEVEN RT NPLATE NUBEQA* NUCALA* NULOJIX NUPLAZID* NUTROPIN NUWIQ

O OBIZUR* OCALIVA* OCREVUS* OCTAGAM octreotide acetate

(SANDOSTATIN) ODEFSEY ODOMZO* OFEV* OLUMIANT* OMNITROPE

ONCASPAR ONPATTRO* OPDIVO* OPSUMIT* ORENCIA ORENITRAM* OTEZLA OTREXUP OVIDREL OZURDEX*

P PALYNZIQ* PANZYGA PARSABIV PEGASYS PEGINTRON PERJETA* PIFELTRO PIQRAY PLEGRIDY* POLIVY* POMALYST* PORTRAZZA* POTELIGEO* PREGNYL PREZCOBIX PREZISTA PRIVIGEN PROCRIT PROFILNINE PROFILNINE SD PROGRAF PROLEUKIN PROLIA PROMACTA* PULMOZYME PURIXAN*

R RADICAVA* RAPAMUNE RASUVO RAVICTI* REBETOL REBIF REBINYN RECLAST RECOMBINATE REMICADE REMODULIN* RENFLEXIS* RESCRIPTOR RETACRIT RETISERT* RETROVIR RETROVIR INJ REVATIO REVLIMID*

REYATAZ RHOGAM RHOPHYLAC RIASTAP ribasphere RIBASPHERE RIBAPAK ribavirin caps (ribasphere,

REBETOL) ribavirin tabs (ribasphere,

MODERIBA) RINVOQ ritonavir (NORVIR) RITUXAN RITUXAN HYCELA* RIXUBIS ROMIDEPSIN ROZLYTREK* RUBRACA* RUCONEST* RYDAPT

S SABRIL PWD* SABRIL TABS* SAIZEN SAMSCA* SANDIMMUNE SANDOSTATIN SANDOSTATIN LAR SELZENTRY SENSIPAR SEROSTIM* sildenafil citrate (REVATIO) SILIQ SIMPONI SIMPONI ARIA sirolimus tab (RAPAMUNE) SKYRIZI sodium phenylbutyrate

(BUPHENYL*) SOFOSBUVIR/VELPATASVIR SOLESTA* SOLIRIS* SOMATULINE DEPOT* SOMAVERT* SOVALDI SPRYCEL stavudine (ZERIT) STELARA STIMATE STIVARGA* STRIBILD SUPPRELIN LA* SUSTIVA SUTENT SYLATRON* SYLVANT* SYMFI SYMFI LO

Products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may change from time to time. In addition, a

member's specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.

*Indicates Limited Distribution products distributed by CVS Specialty or one of its affiliates, including Coram? CVS Specialty Infusion Services.

Call CVS Specialty at 1-800-237-2767 for specific medications available through CVS Specialty. This document contains confidential and proprietary information of

CVS Specialty and may not be reproduced, distributed or printed without written permission from CVS Specialty. Listing is subject to change. This document

contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS

Specialty.

Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2019 CVS Specialty. All rights reserved. 75-CTC14953D October 2019 v09162019 Comprehensive Specialty Pharmacy Drug List

Page 5 of 7

October 2019

SYMTUZA SYNAGIS

T tacrolimus (PROGRAF) tadalafil (ADCIRCA) TAFINLAR* TAGRISSO* TAKHZYRO* TALTZ* TALZENNA* TARCEVA* TARGRETIN TASIGNA TECENTRIQ* TECFIDERA* TEMODAR temozolomide (TEMODAR) temsirolimus (TORISEL) tenofovir disoproxil fumarate

(VIREAD) TEPADINA tetrabenazine (XENAZINE*) THALOMID THYROGEN* TIKOSYN TIVICAY TOBI* TOBI PODHALER* tobramycin nebulizer (TOBI*) TORISEL TRACLEER* TREANDA TRELSTAR TREMFYA treprostinil sodium*

(REMODULIN*) TRETTEN* TRIUMEQ TRIZIVIR TROGARZO* TRUVADA TYBOST TYKERB* TYMLOS TYSABRI* TYVASO*

U UDENYCA ULTOMIRIS* UPTRAVI*

V valrubicin (VALSTAR) VALSTAR VANTAS VARIZIG VECTIBIX VELCADE

VELETRI* VEMLIDY VENTAVIS* VERZENIO* VIDAZA VIDEX VIDEX EC VIEKIRA PAK vigabatrin pwd* (SABRIL*) vigabatrin tabs* (SABRIL

TABS*) VIMIZIM* VIRACEPT VIRAMUNE VIRAMUNE XR VIREAD VISUDYNE* VITRAKVI* VIZIMPRO* VONVENDI* VOSEVI VOTRIENT* VPRIV* VYNDAMAX* VYNDAQEL*

W WILATE WINRHO SDF

X XALKORI* XELJANZ XELODA XENAZINE* XGEVA XOLAIR* XTANDI* XYNTHA

Y YERVOY YONDELIS* YONSA*

Z ZALTRAP* ZARXIO ZELBORAF* ZEMAIRA* ZEPATIER ZERIT ZIAGEN zidovudine (RETROVIR) ZOLADEX zoledronic acid (RECLAST,

ZOMETA) ZOLINZA ZOMACTON ZOMETA

ZORBTIVE ZORTRESS ZULRESSO* ZYDELIG* ZYKADIA* ZYTIGA*

Products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may change from time to time. In addition, a

member's specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.

*Indicates Limited Distribution products distributed by CVS Specialty or one of its affiliates, including Coram? CVS Specialty Infusion Services.

Call CVS Specialty at 1-800-237-2767 for specific medications available through CVS Specialty. This document contains confidential and proprietary information of

CVS Specialty and may not be reproduced, distributed or printed without written permission from CVS Specialty. Listing is subject to change. This document

contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS

Specialty.

Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2019 CVS Specialty. All rights reserved. 75-CTC14953D October 2019 v09162019 Comprehensive Specialty Pharmacy Drug List

Page 6 of 7

LIMITED DISTRIBUTION* ACTEMRA* ACTHAR H.P. GEL* ACTIMMUNE* ADCETRIS* ADEMPAS* ALDURAZYME* ALECENSA* ALUNBRIG* ambrisentan* (LETAIRIS*) AMPYRA* APOKYN* ARALAST NP* ARCALYST* ARZERRA* AUBAGIO* AVEED* BAVENCIO* BELEODAQ* BELRAPZO* BENDEKA* BENLYSTA* BERINERT* BETHKIS* BIVIGAM* BLINCYTO* BUPHENYL* CABOMETYX* CEPROTIN* CERDELGA* CEREZYME* CINQAIR* CINRYZE* COAGADEX* COMETRIQ* CORIFACT* COSENTYX* COTELLIC* CRYSVITA* CYRAMZA* CYSTAGON* DARZALEX* DAURISMO* DOPTELET* EGRIFTA* ELAPRASE* ELELYSO* ELZONRIS* EMPLICITI* EPIDIOLEX* epoprostenol sodium (FLOLAN,

VELETRI)* ERIVEDGE*

ERLEADA* ESBRIET* EVOMELA* EXJADE* EYLEA* FABRAZYME* FARYDAK* FASENRA* FIRAZYR* FLOLAN* GAMIFANT* GAMMAPLEX* GATTEX* GAZYVA* GLASSIA* H. P. ACTHAR GEL* HAEGARDA* HIZENTRA* IBRANCE* IDHIFA* ILARIS* ILUMYA* ILUVIEN* IMFINZI* INBRIJA* INREBIC* INCRELEX* INLYTA* INTRON A* IRESSA* ISTODAX* JADENU* JAKAFI* KALBITOR* KANJINTI* KANUMA* KEVZARA* KEYTRUDA* KHAPZORY* KITABIS PAK* KRYSTEXXA* KUVAN* KYPROLIS* LEMTRADA* LENVIMA* LETAIRIS* LONSURF* LORBRENA* LUCENTIS* LUMIZYME* LUMOXITI* LYNPARZA* MACUGEN*

MAKENA* MAVENCLAD* MAYZENT* MEKINIST* MOZOBIL* MVASI* NAGLAZYME* NATPARA* NERLYNX* NEXAVAR* NINLARO* NORTHERA* NOVOEIGHT* NUBEQA* NUCALA* NUPLAZID* OBIZUR* OCALIVA* OCREVUS* ODOMZO* OFEV* OLUMIANT* ONPATTRO* OPDIVO* OPSUMIT* ORENITRAM* OZURDEX* PALYNZIQ* PERJETA* PLEGRIDY* POLIVY* POMALYST* PORTRAZZA* POTELIGEO* PROMACTA* PURIXAN* RADICAVA* RAVICTI* REMODULIN* RENFLEXIS* RETISERT* REVLIMID* RITUXAN HYCELA* ROZLYTREK* RUBRACA* RUCONEST* SABRIL POW* SABRIL TABS* SAMSCA* SEROSTIM* SOLESTA* SOLIRIS* SOMATULINE DEPOT*

October 2019

SOMAVERT* STIVARGA* SUPPRELIN LA* SYLATRON* SYLVANT* TAFINLAR* TAGRISSO* TAKHZYRO* TALTZ* TALZENNA* TARCEVA* TECENTRIQ* TECFIDERA* THYROGEN* TOBI* TOBI PODHALER* TRACLEER* treprostinil sodium*

(REMODULIN*) TRETTEN* TROGARZO* TYKERB* TYSABRI* TYVASO* ULTOMIRIS* UPTRAVI* VELETRI* VENTAVIS* VERZENIO* vigabatrin pwd* (SABRIL PWD*) vigabatrin tabs* (SABRIL TABS*) VIMIZIM* VISUDYNE* VITRAKVI* VIZIMPRO* VONVENDI* VOTRIENT* VPRIV* VYNDAMAX* VYNDAQEL* XALKORI* XENAZINE* XOLAIR* XTANDI* YONDELIS* YONSA* ZALTRAP* ZELBORAF* ZEMAIRA* ZULRESSO* ZYDELIG* ZYKADIA* ZYTIGA*

Products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may change from time to time. In

addition, a member's specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document.

*Indicates Limited Distribution products distributed by CVS Specialty or one of its affiliates, including Coram? CVS Specialty Infusion Services.

Call CVS Specialty at 1-800-237-2767 for specific medications available through CVS Specialty. This document contains confidential and proprietary

information of CVS Specialty and may not be reproduced, distributed or printed without written permission from CVS Specialty. Listing is subject to change.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not

affiliated with CVS Specialty.

Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2019 CVS Specialty. All rights reserved. 75-CTC14953D October 2019 v09162019 Comprehensive Specialty Pharmacy Drug List

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