Fertility 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.

Fertility and Pregnancy

CETROTIDE
cetrorelix
chorionic gonadotropin
clomiphene citrate
FOLLISTIM AQ
FYREMADEL
GANIRELIX AC
GONAL-F
leuprolide acetate
MENOPUR
novarel
OVIDREL
pregnyl

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 prescribed 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