Health PULSE + Plus™

PartnerRe Trigger Pharmaceuticals (at 03.20.19) Code Code Description Trade Name C9015 C-1 esterase…………………….Haegarda® J3358 Ustekinumab iv inj, 1 mg...... Stelara® C9399 Cemiplimab-rwlc………………..Libtayo® J3490 Lutetium lu 177 dotatate………..Lutathera® C9399 Iobenguane I 131………………Azedra® J3490 Pegvaliase-pqpz…………………Palynziq® C9399 Mogamulizumab-kpkc (Poteligeo).Poteligeo® J3490 Vestronidase alfa-vjbk…………..Mepsevii® C9399 Moxetumomab pasodutox-tdfk..Lumoxiti® J3590 Unclassified biologicals C9399 Elapegademase-Ivir)…………...Revcovi® J3590 Cemiplimab-rwlc…………………Libtayo® C9399 Lutetium lu 177 dotatate………..Lutathera® J3590 Mogamulizumab-kpkc (Poteligeo).Poteligeo® C9399 Ravulizumab-cwvz……………...Ultomiris® J3590 Moxetumomab pasodutox-tdfk…Lumoxiti® C9399 Emapalumab-szsq……………...Gamifant® J3590 Elapegademase-Ivir)……………Revcovi® C9399 Lanadelumab-flyo……………….Takhzyro® J3590 Ravulizumab-cwvz………………Ultomiris® C9399 Pegvaliase-pqpz………………...Palynziq® J3590 Emapalumab-szsq………………Gamifant® C9399 Vestronidase alfa-vjbk………….Mepsevii® J3590 Ianadelumab-flyo………………..Takhzyro® C9399 Burosumab………………………Crysvita® J3590 Vestronidase alfa-vjbk………….Mepsevii® C9399 Tagraxofusp-erzs……………….Elzonris® J7170 Emicizumab-kxwh………………Hemlibra® C9399 Caplacizumab-yhdp…………….Cablivi® J7175 Inj, factor x, (human), 1iu………Coagadex® J0135 Adalimumab injection…………...Humira® J7178 Human fibrinogen conc inj……..Riastap® J0180 Agalsidase beta injection……….Fabrazyme® J7180 Factor xiii anti-hem factor………Corifact® J0202 Injection, alemtuzumab…………Lemtrada® J7181 Factor xiii recomb a-subunit……Tretten® J0221 Lumizyme injection……………...Lumizyme® J7182 Factor viii recomb……………….NovoEight® J0596 C-1 esterase……………………..Ruconest® J7183 Wilate injection……………….....Wilate® J0597 C-1 esterase……………………..Berinert® J7185 Xyntha inj…………………………Xyntha® J0598 C-1 esterase……………………..Cinryze® J7186 Antihemophilic viii/vwf comp…...Alphanate® J0638 Canakinumab injection………….Ilaris® J7187 Humate-p, inj…………………….Humate-P® J0800 Corticotropin injection…………..Acthar® J7188 Factor viii recomb……………….Obizur Obizur® J1300 Eculizumab injection……………Soliris® J7189 Factor viia………………………..NovoSeven® J1301 Injection, edaravone…………….Radicava® J7190 Factor viii…………………………Koate® J1322 Injection, elosulfase alfa………..Vimizim® J7190 Factor viii antihemophilic factor, J1458 Galsulfase injection……………..Naglazyme® human……………………..Monoclate-P® J1743 Idursulfase injection…………….Elaprase® J7191 Factor viii (porcine)……………..Obizur® J1744 Icatibant injection………………..Firazyr® J7192 Factor viii recombinant nos…….Advate® J2182 Injection, mepolizumab…………Nucala® J7192 Factor viii recombinant nos…….Helixate® J2323 Natalizumab injection…………..Tysabri® J7192 Factor viii recombinant nos…….Hemofil® J2326 Inj, nusinersen, 0.1mg………….Spinraza® J7192 Factor viii recombinant nos…….Jivi® J2350 Injection, ocrelizumab…………..Ocrevus® J7192 Factor viii recombinant nos…….Kogenate® J2840 Sebelipase Alfa………………….Kanuma® J7192 Factor viii recombinant nos…….Recombinate® J2860 Injection, siltuximab……………..Sylvant® J7192 Factor viii recombinant nos…….Esperoct® J3357 Injection, ustekinumab, 1mg…...Stelara® J7193 Factor ix non-recombinant……..AlphaNine® J7193 Factor ix non-recombinant……..Mononine®

PartnerRe Health is a division of PartnerRe Ltd. In the US, PartnerRe America Insurance Company. coverage is underwritten by PartnerRe America Insurance Phone +1 415 354 1551 Company. This literature is descriptive only. Actual coverage is subject to the language of the policies or agreements as issued. www.partnerre.com/health

SRX0319 1 of 2 Health PULSE + Plus™

PartnerRe Trigger Pharmaceuticals (at 03.20.19) Code Code Description Trade Name J8999 Abemaciclib………………………Verzenio® J8999 Olaparib…………………………..Lynparza® J7194 Factor ix complex………………Profilnine® J8999 Alectinib…………………………..Alecensa® J7194 Factor ix antihemophilic factor..Profilnine® J8999 Niraparib………………………….Zejula® J7195 Factor ix recombinant nos…….Benefix® J8999 Acalabrutinib……………………..Calquence® J7196 Antithrombin recombinant…….Atryn® J8999 Ibrutinib……………………………Imbruvica® J7197 Antithrombin iii injection……….Thrombate® J8999 Enasidenib………………………..Idhifa® J7198 Anti-inhibitor…………………….Autoplex T® J8999 Gilteritinib…………………………Xospata® J7198 Anti-inhibitor coagulant complex J8999 Glasdegib………………………...Daurismo® (Feiba NF)………………..Feiba NF® J9022 Injection, atezolizumab…………Tecentriq® J7199 Hemophilia clot factor noc J9023 Injection, avelumab……………..Bavencio® J7200 Factor ix recombinant………….Rixubis® J9035 Bevacizumab injection………….Avastin® J7201 Factor ix alprolix recomb………Alprolix® J9039 Inj, Blinatumomab……………….Blincyto® J7202 Idelvion, 1 i.u……………………Idelvion® J9042 Brentuximab vedotin inj…………Adcetris® J7203 Factor ix antihemophilic factor..Rebinyn® J9055 Cetuximab injection……………..Erbitux® J7205 Factor viii (eloctate)…………….Eloctate® J9145 Injection, daratumumab………...Darzalex® J7207 Adynovate factor viii recom…...Adynovate® J9173 Injection, durvalumab……………Imfinzi® J7207 Factor viii pegylated recomb….Adnoyvate® J9176 Injection, elotuzumab……………Empliciti® J7209 Nuwiq factor viii recomb……….Nuwiq® J9203 Gemtuzumab ozogamicin 0.1 mg.Mylotarg® J7210 Afstyla factor viii recomb………Afstyla® J9216 Interferon gamma-1b (Actimmune).Actimmune® J7211 Inj, kovaltry, 1 i.u……………….Kovaltry® J9228 Ipilimumab injection……………..Yervoy® J7599 Emapalumab-szsq……………..Gamifant® J9229 Inj. inotuzumab ozogamicin…….Besponsa® J7639 Dornase alfa…………………….Pulmozyme® J9255 Injection, necitumumab…………Portrazza® J8499 Metyrosine………………………Demser® J9271 Injection, pembrolizumab……….Keytruda® J8499 Mifepristone……………………..Korlym® J9285 Injection, olaratumab…………….Lartruvo® J8499 Glycerol phenylbutyrate………..Ravicti® J9299 Injection, nivolumab……………..Opdivo® J8499 Carglumic acid………………….Carbaglu® J9300 Gemtuzumab ozogamicin inj…..Mylotarg® J8499 Migalastat……………………….Galafold® J9302 Ofatumumab injection…………..Arzerra® J8499 Tezacaftor/ivacaftor and ivacaftor.Symdeko® J9303 Panitumumab injection…………Vectibix® J8499 Ivacaftor…………………………Kalydeco® J9306 Injection, pertuzumab, 1 mg……Perjeta® J8499 Amifampridine…………………..Firdapse® J9307 Ppralatrexate…………………….Folotyn® J8999 Regorafenib……………………..Stivarga® J9308 Injection, ramucirumab…………Cyramza® J8999 Larotrectinib……………………..Vitrakvi® J9325 Inj talimogene laherparepvec…..Imlygic® J8999 Cabozantinib…………………….Cabometyx® J9354 Injection, ado-trastuzumab emtasine.Kadcyla® J8999 Brigatinib………………………...Alunbrio® J9355 Injection, trastuzumab…………..Herceptin® J8999 Dacomitinib……………………...Vizimpro® J9999 Chemotherapy drug Q2041 J8999 Lorlatinib…………………………Lorbrena® Axicabtagene ciloleucel….Yescarta® J8999 Trametinib……………………….Mekenist® Q2042 Tisagenlecleucel…………………Kymriah® J8999 Dabrafenib………………………Tafinlar® J8999 Vemurafenib…………………….Zelboraf®

PartnerRe Health is a division of PartnerRe Ltd. In the U.S, coverage is PartnerRe America Insurance Company. underwritten by PartnerRe America Insurance Company. This literature is Phone +1 415 354 1551 descriptive only. Actual coverage is subject to the language of the policies or agreements as issued. www.partnerre.com/health

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