Specialty Pharmacy Drug Management List
Definition of specialty medications: Specialty medications are generally prescribed for people with complex or ongoing medical conditions such as multiple sclerosis, hemophilia, hepatitis C and rheumatoid arthritis. These high cost medications also have one or more of the following characteristics: injected or infused, but some may be taken by mouth; unique storage or shipment requirements; additional education and support required from a health care professional; and usually not stocked at retail pharmacies.
Antihypertensive
- KEVEYIS*
Autoimmune
- ACTEMRA SC
- ADBRY
- ARCALYST*
- BENLYSTA
- CIBINQO
- CIMZIA
- COSENTYX
- DUPIXENT
- ENBREL
- FIRDAPSE*
- HUMIRA
- KEVZARA
- KINERET*
- OLUMIANT
- ORENCIA
- OTEZLA
- RINVOQ
- RUZURGI*
- SILIQ
- SIMPONI
- SKYRIZI
- STELARA
- TALTZ
- TREMFYA
- XELJANZ
Blood Modifiers
- ARANESP
- CABLIVI*
- DOPTELET
- EPOGEN
- FULPHILA
- GRANIX
- LEUKINE
- MIRCERA*
- MULPLETA
- NEULASTA
- NEUPOGEN
- NIVESTYM
- NYVEPRIA
- PROCRIT
- PROMACTA
- RETACRIT
- ROLVEDON
- UDENYCA
- ZARXIO
- ZIEXTENZO
Cancer– Injectable
- DEPOT / LA / MIX
- BESREMI*
Cancer – Oral
- abiraterone acetate
- AFINITOR
- ALECENSA
- ALUNBRIG
- AYVAKIT*
- BALVERSA*
- bexarotene
- BOSULIF
- BRAFTOVI
- BRUKINSA*
- CABOMETYX
- CALQUENCE*
- capecitabine
- CAPRELSA*
- COMETRIQ
- COPIKTRA*
- COTELLIC
- DAURISMO
- ERIVEDGE
- ERLEADA
- erlotinib hydrochloride
- ETOPOSIDE
- EULEXIN*
- everolimus
- EXKIVITY*
- FORIVDA*
- GAVRETO
- GLEEVEC
- HEXALEN
- HYCAMTIN
- IBRANCE
- ICLUSIG*
- IDHIFA
- IMBRUVICA*
- imatinib mesylate
- INLYTA
- INQOVI
- INREBIC
- IRESSA
- JAKAFI
- KISQALI
- KISQALI FEMARA
- KOSELUGO*
- KRAZATI*
- lapatinib ditosylate
- lenalidomide*
- LENVIMA*
- LONSURF
- LORBRENA
- LUMAKRAS
- LYNPARZA
- LYSODREN*
- LYTGOBI*
- MATULANE*
- MEKINIST
- MEKTOVI
- NERLYNX
- NEXAVAR
- NINLARO
- NUBEQA
- ODOMZO
- ONUREG
- ORGOVYX*
- OXBRYTA
- PEMAZYRE*
- PIQRAY
- POMALYST*
- QINLOCK*
- RETEVMO
- REVLIMID
- REZLIDHIA*
- ROZLYTREK
- RUBRACA
- RYDAPT
- SCEMBLIX
- sorafenib
- SPRYCEL
- STIVARGA
- sunitinib
- SUTENT
- TABRECTA
- TAFINLAR
- TAGRISSO*
- TALZENNA
- TARCEVA
- TARGRETIN
- TASIGNA
- TAZVERIK*
- TEMODAR
- temozolomide
- TEPMETKO*
- THALOMID
- TIBSOVO*
- TRUSELTIQ*
- TUKYSA*
- TURALIO*
- TYKERB
- UKONIQ*
- VENCLEXTA*
- VERZENIO
- VITRAKVI*
- VIZIMPRO
- VONJO*
- VOTRIENT
- WELIREG*
- XALKORI
- XELODA
- XOSPATA*
- XPOVIO*
- XTANDI
- YONSA
- ZEJULA
- ZELBORAF
- ZOKINVY*
- ZOLINZA
- ZYDELIG
- ZYKADIA
- ZYTIGA
Cystic Fibrosis
- BETHKIS
- BRONCHITOL
- CAYSTON*
- KALYDECO*
- KITABIS PAK
- ORKAMBI
- PULMOZYME
- SYMDEKO
- TOBI
- TOBI PODHALER
- tobramycin
- TRIKAFTA
Endocrine
- BYNFEZIA PEN
- FENSOLVI
- FORTEO
- ISTURISA*
- JYNARQUE*
- LUPANETA PACK
- LUPRON DEPOT
- MYCAPSSA
- NATPARA*
- octreotide acetate
- RECORLEV*
- SAMSCA
- SANDOSTATIN
- SIGNIFOR*
- SOMAVERT
- TOLVAPTAN
- VOXZOGO
Enzyme Deficiencies
- betaine
- BUPHENYL*
- CARBAGLU*
- carglumic*
- CERDELGA
- CYSTAGON*
- GALAFOLD
- javygtor*
- KUVAN *
- miglustat
- NITYR
- ORFADIN*
- NEXVIAZYME
- nitisinone
- PALYNZIQ
- PHEBURANE
- RAVICTI
- REVCOVI*
- sapropterin dihydrochloride
- sodium phenylbutyrate*
- STRENSIQ*
- SUCRAID*
- ZAVESCA*
Growth Hormones
- GENOTROPIN
- HUMATROPE
- INCRELEX
- NORDITROPIN
- NUTROPIN AQ
- OMNITROPE
- SAIZEN
- SEROSTIM*
- SKYTROFA*
- TEV-TROPIN
- ZOMACTON
- ZORBTIVE
Hematological
- EMPAVELI*
- icatibant acetate
- FIRAZYR
- ORLADEYO*
- PYRUKYND*
- sajazir*
- TAVNEOS*
Hemophilia
- ADVATE
- ADYNOVATE
- ALPHANATE VW
- ALPHANINE SD
- ALPROLIX
- BEBULIN
- BENEFIX
- CORIFACT
- ELOCTATE
- ESPEROCT
- FEIBA
- HEMLIBRA
- HEMOFIL M
- HUMATE-P
- IDELVION
- IXINITY
- JIVI
- KOATE
- KOGENATE FS
- KOVALTRY
- MONOCLATE-P
- MONONINE
- NOVOEIGHT
- NUWIQ
- OBIZUR*
- PROFILNINE
- REBINYN
- RECOMBINATE
- RIXUBIS
- TRETTEN
- WILATE
Hepatitis C
- COPEGUS
- EPCLUSA
- HARVONI
- INTRON-A
- LEDIPASVIR/SOFOSBUVIR
- MAVYRET
- MODERIBA
- OLYSIO
- PEGASYS
- PEG-INTRON
- REBETOL
- ribavirin
- SOFOSBUVIR
- /VELPATASVIR
- SOVALDI
- TECHNIVIE
- VIEKIRA
- VOSEVI
- ZEPATIER
HIV
- EGRIFTA
- FUZEON
- SUNLENCA*
Lung Disorders
- ESBRIET
- FASENRA
- OFEV
- pirfenidone
- NUCALA
- XOLAIR
Multiple Sclerosis
- AMPYRA
- AUBAGIO
- AVONEX
- BAFIERTAM
- BETASERON
- COPAXONE
- dalfampridine
- dimethyl fumarate
- EXTAVIA
- fingolimod
- glatiramer acetate
- GILENYA
- GLATOPA
- KESIMPTA
- MAVENCLAD
- MAYZENT
- PLEGRIDY
- PONVORY
- REBIF
- TECFIDERA
- VUMERITY
- ZEPOSIA
Pulmonary
- Hypertension
- ADCIRCA
- ADEMPAS*
- alyq*
- ambrisentan
- LETAIRIS
- OPSUMIT*
- ORENITRAM*
- REVATIO
- sildenafil
- tadalafil
- TADLIQ
- TRACLEER
- TYVASO DPI
- UPTRAVI*
Others
- ABILIFY MYCITE*
- ACTIMMUNE*
- APOKYN *
- apomorphine*
- ARIKAYCE*
- AUSTEDO
- bosentan
- BYLVAY
- CAMZYOS
- CHENODAL*
- CHOLBAM *
- clovique
- CYSTADANE
- CYSTADROPS*
- DARAPRIM*
- deferasirox
- deferiprone*
- DIACOMIT*
- DOJOLVI
- DROXIA
- droxidopa
- ELIGARD
- EMFLAZA
- ENDARI*
- ENSPRYNG
- EPIDIOLEX
- EVRYSDI*
- EXJADE
- EXSERVAN*
- FERRIPROX*
- FINTEPLA*
- FUROSCIX
- GOCOVRI*
- HAEGARDA
- HEMADY
- IMCIVREE*
- INBRIJA*
- INGREZZA*
- JADENU
- JUXTAPID*
- KORLYM*
- KYNAMRO*
- leuprolide acetate
- LIVMARLI*
- LIVTENCITY*
- LUPKYNIS*
- OCALIVA
- OXERVATE
- PROCYSBI*
- pyrimethamin*
- NORTHERA
- NOURIANZ*
- NUPLAZID
- PALFORZIA*
- RADICAVA ORS
- RELYVRIO
- REZUROCK*
- RILUTEK
- riluzole
- SABRIL
- SIKLOS
- SIRTURO*
- SYPRINE
- TAKHZYRO
- TAVALISSE*
- TEGSEDI
- TIGLUTIK*
- tetrabenazine
- trientine hydrochloride
- TYMLOS
- VALCHLOR*
- VECAMYL*
- vigabatrin
- VIJOICE*
- VISTOGARD*
- VYLEESI*
- VYNDAMAX
- VYNDAQEL
- XENAZINE*
- XERMELO*
- XURIDEN*
- ZTALMY*
Sleep Disorder
- HETLIOZ
- WAKIX*
- XYREM
- XYWAV
Key
Prime Limited Distribution Network
Products flagged as limited distribution may not be available at all network specialty pharmacies.
Medical Necessity Determination (MND) Required
Select drugs or drug categories may require MND. If MND is required, it is important that you or your doctor initiate a review as soon as possible. To start your review, please have your doctor fax 1-877-243-6930.
Dispensing Limits Apply
Horizon BCBSNJ monitors claims for certain drugs to ensure that they are pre- scribed and dispensed within the proper safety standards for dosage and/or the length of time you use the drug. These standards are established from a number of sources, such as Food and Drug Administration product labeling, medical literature, dispensing patterns and generally accepted standards of medical practice. If your specialty medication prescription requires you to exceed the dispensing limit, you will be notified. You or your doctor can request an exception.
Revised on: March 13, 2023