April 2015 NALC Specialty Pharmacy Drug List Providing one of the broadest offerings of specialty pharmaceuticals in the industry
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1 NALC Specialty Pharmacy Drug List Providing one of the broadest offerings of specialty pharmaceuticals in the industry The NALC Specialty Pharmacy Drug List is a guide of medications available through CVS Caremark Specialty Pharmacy. Our goal is to help make your life better. With nearly 40 years of experience, CVS Caremark Specialty Pharmacy provides quality care and service. CVS Caremark has 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. This list represents brand 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 toll-free at or call toll-free at for specific information regarding medications available through CVS Caremark Specialty Pharmacy. e-prescribe specialty prescription(s) to CVS Caremark Specialty Pharmacy. ACROMEGALY octreotide acetate (SANDOSTATIN) SANDOSTATIN LAR ALCOHOL / OPIOID DEPENDENCY VIVITROL ALLERGEN IMMUNOTHERAPY ALLERGIC ASTHMA ALPHA-1 ANTITRYPSIN DEFICIENCY ANEMIA ARANESP EPOGEN PROCRIT BOTULINUM TOXINS BOTOX DYSPORT MYOBLOC CARDIAC DISORDERS TIKOSYN COAGULATION DISORDERS CRYOPYRIN-ASSOCIATED PERIODIC SYNDROMES CYSTIC FIBROSIS KITABIS PAK PULMOZYME tobramycin nebulizer (TOBI*) DUPUYTREN S CONTRACTURE ELECTROLYTE DISORDERS SAMSCA GASTROINTESTINAL DISORDERS-OTHER GOUT GROWTH HORMONE & Growth Hormone Disorders GENOTROPIN HUMATROPE NORDITROPIN NUTROPIN OMNITROPE SAIZEN TEV-TROPIN ZORBTIVE IGF-1 Deficiency HEMATOPOIETICS NEUMEGA HEMOPHILIA, VON WILLEBRAND DISEASE & RELATED BLEEDING DISORDERS ADVATE ALPHANATE ALPHANINE SD ALPROLIX BEBULIN BENEFIX ELOCTATE FEIBA NF FEIBA VH HELIXATE FS HEMOFIL M HUMATE-P KOATE-DVI KOGENATE FS MONOCLATE-P MONONINE NOVOSEVEN PROFILNINE SD RECOMBINATE REFACTO RIASTAP RIXUBIS STIMATE WILATE XYNTHA HEPATITIS adefovir (HEPSERA) BARACLUDE SOLUTION entecavir (BARACLUDE) HARVONI INCIVEK INFERGEN INTRON-A* lamivudine (EPIVIR HBV) OLYSIO PEGASYS PEGINTRON REBETOL SOLUTION RIBAPAK RIBASPHERE RIBATAB ribavirin caps (REBETOL) ribavirin tabs (COPEGUS) SOVALDI TYZEKA VICTRELIS VIEKIRA PAK HEREDITARY ANGIOEDEMA HIV MEDICATIONS abacavir/lamivudine/ zidovudine tab (TRIZIVIR) abacavir tab (ZIAGEN) APTIVUS ATRIPLA COMPLERA CRIXIVAN didanosine cap/ DR cap (VIDEX, VIDEX EC) EDURANT EMTRIVA EPZICOM EVOTAZ FUZEON INTELENCE INVIRASE ISENTRESS KALETRA lamivudine (EPIVIR) lamivudine/zidovudine (COMBIVIR) LEXIVA nevirapine (VIRAMUNE, VIRAMUNE XR) NORVIR PREZCOBIX PREZISTA RESCRIPTOR RETROVIR INJECTABLE REYATAZ SELZENTRY stavudine (ZERIT) STRIBILD SUSTIVA TIVICAY TRIUMEQ TRUVADA TYBOST VIDEX SOLUTION VIRACEPT VITEKTA ZIAGEN SOLUTION zidovudine (RETROVIR) HORMONAL THERAPIES ELIGARD FIRMAGON leuprolide acetate (LUPRON) LUPANETA PACK LUPRON DEPOT TRELSTAR VANTAS VIADUR ZOLADEX IMMUNE DEFICIENCIES & BIVIGAM* CARIMUNE NF CYTOGAM FLEBOGAMMA GAMASTAN S/D
2 IMMUNE DEFICIENCIES & (continued) GAMMAGARD GAMMAGARD S/D GAMMAKED GAMUNEX HEPAGAM B HYPERHEP B HYPERRHO S/D HYQVIA MICRHOGAM NABI-HB OCTAGAM PRIVIGEN RHOGAM RHOPHYLAC VARIZIG WINRHO SDF IMMUNE (IDIOPATHIC) THROMBOCYTOPENIC PURPURA NPLATE INFECTIOUS DISEASE ALFERON N INFLAMMATORY BOWEL DISEASE ENTYVIO IRON OVERLOAD deferoxamine (DESFERAL) LIPID DISORDERS LYSOSOMAL STORAGE DISORDERS VIMIZIM* MOVEMENT DISORDERS MULTIPLE SCLEROSIS AVONEX BETASERON COPAXONE EXTAVIA GILENYA mitoxantrone (NOVANTRONE) REBIF TECFIDERA* NEUTROPENIA GRANIX LEUKINE NEULASTA NEUPOGEN ONCOLOGY-INJECTABLE AVASTIN azacitidine (VIDAZA) decitabine (DACOGEN) ELSPAR ERBITUX FOLOTYN FUSILEV HALAVEN HERCEPTININTRON A* IXEMPRA JEVTANA KADCYLA mitoxantrone (NOVANTRONE) ONCASPAR PERJETA PROLEUKIN SYNRIBO TEMODAR TORISEL TREANDA VALSTAR VECTIBIX VELCADE VIDAZA XGEVA YERVOY ZALTRAP zoledronic acid (ZOMETA) ONCOLOGY ORAL/TOPICAL AFINITOR BOSULIF capecitabine (XELODA) GLEEVEC MUGARD SPRYCEL SUTENT TARGRETIN TASIGNA temozolomide (TEMODAR) THALOMID ZOLINZA ZYTIGA OSTEOARTHRITIS EUFLEXXA HYALGAN MONOVISC ORTHOVISC SUPARTZ SYNVISC SYNVISC ONE OSTEOPOROSIS FORTEO PROLIA zoledronic acid (RECLAST) PAROXYSMAL NOCTURNAL HEMOGLOBINURIA PHENYLKETONURIA PRE-TERM BIRTH PSORIASIS AMEVIVE RASUVO STELARA PULMONARY ARTERIAL HYPERTENSION ADCIRCA sildenafil citrate (REVATIO) PULMONARY DISORDERS OTHER RENAL DISEASE SENSIPAR RESPIRATORY SYNCYTIAL VIRUS SYNAGIS RETINAL DISORDERS OZURDEX* RETISERT* RHEUMATOID ARTHRITIS KINERET ORENCIA ARIA* XELJANZ SEIZURE DISORDERS SYSTEMIC LUPUS ERYTHEMATOSUS BENLYSTA TRANSPLANT ASTAGRAF XL CELLCEPT INJECTABLE CELLCEPT SUSPENSION cyclosporine (GENGRAF, NEORAL, SANDIMMUNE) mycophenolate mofetil (CELLCEPT) mycophenolate sodium DR (MYFORTIC) NULOJIX PROGRAF INJECTABLE RAPAMUNE SOLUTION sirolimus tab (RAPAMUNE) tacrolimus (PROGRAF) ZORTRESS UREA CYCLE DISORDERS phenylbutyrate sodium (BUPHENYL)
3 INDEX A abacavir tab (ZIAGEN) abacavir/lamivudine/ zidovudine tab (TRIZIVIR) ACTHAR H.P. GEL* ADCIRCA adefovir (HEPSERA) ADVATE AFINITOR ALFERON N ALPHANATE ALPHANINE SD ALPROLIX AMEVIVE APTIVUS ARANESP ASTAGRAF XL ATRIPLA AVASTIN AVONEX azacitidine (VIDAZA) B BARACLUDE BEBULIN BENEFIX BENLYSTA BETASERON BIVIGAM BOSULIF BOTOX BUPHENYL C capecitabine (XELODA) CARIMUNE NF CELLCEPT COMBIVIR COMPLERA COPAXONE COPEGUS CRIXIVAN cyclosporine (GENGRAF, NEORAL, SANDIMMUNE) CYTOGAM D DACOGEN decitabine (DACOGEN) deferoxamine (DESFERAL) DESFERAL didanosine cap/dr cap (VIDEX, VIDEX EC) DYSPORT E EDURANT ELIGARD ELOCTATE ELSPAR EMTRIVA entecavir (BARACLUDE) ENTYVIO EPIVIR EPIVIR HBV EPOGEN EPZICOM ERBITUX EUFLEXXA EVOTAZ EXTAVIA F FEIBA NF FEIBA VH FIRMAGON FLEBOGAMMA FOLOTYN FORTEO FUSILEV FUZEON G GAMASTAN S/D GAMMAGARD GAMMAGARD S/D GAMMAKED GAMUNEX GENGRAF GENOTROPIN GILENYA GLEEVEC GRANIX H HALAVEN HARVONI HELIXATE FS HEMOFIL M HEPAGAM B HEPSERA HERCEPTIN HUMATE-P HUMATROPE HYALGAN HYPERHEP B HYPERRHO S/D HYQVIA I INCIVEK INFERGEN INTELENCE INTRON A* INVIRASE ISENTRESS IXEMPRA J JEVTANA K KADCYLA KALETRA KINERET KITABIS PAK KOATE-DVI KOGENATE FS L lamivudine (EPIVIR) lamivudine (EPIVIR HBV) lamivudine/zidovudine (COMBIVIR) LEUKINE leuprolide acetate (LUPRON) LEXIVA LUPANETA PACK LUPRON LUPRON DEPOT M MICRHOGAM mitoxantrone (NOVANTRONE) MONOCLATE-P MONONINE MONOVISC MUGARD* mycophenolate mofetil (CELLCEPT) mycophenolate sodium DR (MYFORTIC) MYFORTIC MYOBLOC N NABI-HB NEORAL NEULASTA NEUMEGA NEUPOGEN nevirapine (VIRAMUNE, VIRAMUNE XR) NORDITROPIN NORVIR NOVANTRONE NOVOSEVEN NPLATE NULOJIX NUTROPIN O OCTAGAM octreotide acetate (SANDOSTATIN) OLYSIO OMNITROPE ONCASPAR ORENCIA ORTHOVISC OZURDEX* P PEGASYS PEGINTRON PERJETA* phenylbutyrate sodium (BUPHENYL) PREGNYL PREZCOBIX PREZISTA PRIVIGEN PROCRIT PROFILNINE SD PROGRAF PROLEUKIN PROLIA
4 P (continued) PULMOZYME R RAPAMUNE RASUVO REBETOL REBIF RECLAST RECOMBINATE REFACTO RESCRIPTOR RETISERT* RETROVIR REVATIO REYATAZ RHOGAM RHOPHYLAC RIASTAP RIBAPAK RIBASPHERE RIBATAB ribavirin caps (REBETOL) ribavirin tabs (COPEGUS) RIXUBIS S SAIZEN SAMSCA SANDOSTATIN SANDOSTATIN LAR SANDIMMUNE SELZENTRY SENSIPAR sildenafil citrate (REVATIO) ARIA* sirolimus tab (RAPAMUNE) SOVALDI SPRYCEL stavudine (ZERIT) STELARA STIMATE STRIBILD SUPARTZ SUSTIVA SUTENT SYNAGIS SYNRIBO SYNVISC SYNVISC ONE T tacrolimus (PROGRAF) TARGRETIN TASIGNA TECFIDERA* TEMODAR temozolomide (TEMODAR) TEV-TROPIN THALOMID TIKOSYN TIVICAY TOBI* tobramycin nebulizer (TOBI) TORISEL TREANDA TRELSTAR TRIUMEQ TRIZIVIR TRUVADA TYBOST TYZEKA V VALSTAR VANTAS VARIZIG VECTIBIX VELCADE VIEKIRA PAK VICTRELIS VIADUR VIDAZA VIDEX VIDEX EC VIMIZIM* VIRACEPT VIRAMUNE VIRAMUNE XR VITEKTA VIVITROL W WILATE WINRHO SDF X XELJANZ XELODA XGEVA XYNTHA Y YERVOY Z ZALTRAP* ZERIT ZIAGEN zidovudine (RETROVIR) ZOLADEX zoledronic acid (RECLAST, ZOMETA) ZOLINZA ZOMETA ZORBTIVE ZORTRESS ZYTIGA LIMITED DISTRIBUTION* ACTHAR H.P. GEL* EGRIFTA* IMPLANON* INTRON A* MIRENA* NEXPLANON* OZURDEX* PERJETA* RETISERT* ARIA* SKYLA*
5 TECFIDERA* TOBI* ZALTRAP*
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