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