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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