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
TAVNEOS*
TREMFYA
XELJANZ

Blood Modifiers

ARANESP
CABLIVI*
DOPTELET
EPOGEN
FULPHILA
GRANIX
LEUKINE
MIRCERA*
MULPLETA
NEULASTA
NEUPOGEN
NIVESTYM
NYVEPRIA
PROCRIT
PROMACTA
RETACRIT
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*
lapatinib ditosylate
lenalidomide*
LENVIMA*
LONSURF
LORBRENA
LUMAKRAS
LYNPARZA
LYSODREN*
MATULANE*
MEKINIST
MEKTOVI
NERLYNX
NEXAVAR
NINLARO
NUBEQA
ODOMZO
ONUREG
ORGOVYX*
OXBRYTA
PEMAZYRE*
PIQRAY
POMALYST*
QINLOCK*
RETEVMO
REVLIMID
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
KUVAN *
Miglustat
NITYR
ORFADIN*
NEXVIAZYME
Nitisinone
PALYNZIQ
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*

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

Lung Disorders

ESBRIET
FASENRA
OFEV
Pirfenidone
NUCALA
XOLAIR

Multiple Sclerosis

AMPYRA
AUBAGIO
AVONEX
BAFIERTAM
BETASERON
COPAXONE
Dalfampridine
dimethyl fumarate
EXTAVIA
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
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*
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
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: November 1, 2022