Pharmacy Benefit Limitations List Welcome to Cox Healthplans! We Appreciate the Opportunity to Provide Health Care Coverage to the Members of Your Plan

THINKING HEALTH FORWARD

Pharmacy Benefit Limitations List Welcome to Cox HealthPlans! We appreciate the opportunity to provide health care coverage to the members of your plan. This list of medications is provided for your review and for review with your physician. These medications may require additional information or assistance from your physician prior to your first fill under your new benefits. Please review this list for any medications plan members are taking. These medications may require additional medical information, may require the use of a lower cost alternative before your current medication may be covered, or may be limited in quantity for coverage under your health plan. If you need assistance transitioning to a formulary medication, please contact your physician or complete the Self-Referral Case Management form for assistance from our medical staff in our Welcome Aboard program. Please note: Medications prescribed by your physician may be filled with the medication and dosage indicated. However, certain medications may not be covered in full or in part by your health insurance coverage. This medication list and the full formulary list do not imply all medications listed are covered benefits. Please consult your Schedule of Benefits for coverage information. Full formulary and additional information regarding each medication may be obtained at www.coxhealthplans.com or by contacting Catamaran at 888.341.8578.

Step Therapy Coverage may depend on previous use or trial of another drug. Medication Name Medication Class Preferred Products ANDRODERM Androgens Must try Androgel TESTIM Androgens Must try Androgel Axiron Androgens Must try Androgel Fortesta Androgens Must try Androgel Striant Androgens Must try Androgel Lamisil Antifungal If patient has HIV, Cancer, or Diabetes Tier 2, all other Tier 3 Sporanox Antifungal If patient has HIV, Cancer, or Diabetes Tier 2, all other Tier 3 ABILIFY Antipsychotics Must try 2 of the following: risperidone, Geodon, Seroquel/-XR, Zyprexa ABILIFY Antipsychotics Must try 2 of the following: risperidone, Geodon, Seroquel/-XR, Zyprexa FANAPT Antipsychotics Must try 2 of the following: risperidone, Geodon, Seroquel/-XR, Zyprexa INVEGA Antipsychotics Must try 2 of the following: risperidone, Geodon, Seroquel/-XR, Zyprexa SAPHRIS Antipsychotics Must try 2 of the following: risperidone, Geodon, Seroquel/-XR, Zyprexa Atacand/-HCT ARB Must try 2 of the following: generics, Diovan/-HCT, Micardis/-HCT, losartan/-HCT Benicar/-HCT ARB Must try 2 of the following: generics, Diovan/-HCT, Micardis/-HCT, losartan/-HCT Teveten/-HCT ARB Must try 2 of the following: generics, Diovan/-HCT, Micardis/-HCT, losartan/-HCT Edarbi/Edarbyclor ARB Must try 2 of the following: generics, Diovan/-HCT, Micardis/-HCT, losartan/-HCT Actonel Bisphosphonates Must try one of the following: alendronate or ibandronate Atelvia Bisphosphonates Must try one of the following: alendronate or ibandronate Altoprev Cholesterol Generic Statin and then Crestor Lescol XL Cholesterol Generic Statin and then Crestor Vytorin Cholesterol Generic Statin and then Crestor Byetta Diabetes Requires trial of metformin, sulfonylurea, or TZD prior to approval Symlin Diabetes Requires usage of another insulin Antara Fenofibrates Generic fenofibrates or gemfibrozil Fenoglide Fenofibrates Generic fenofibrates or gemfibrozil Fibricor Fenofibrates Generic fenofibrates or gemfibrozil Lipofen Fenofibrates Generic fenofibrates or gemfibrozil Step Therapy (Continued) Medication Name Medication Class Preferred Products Tricor Fenofibrates Generic fenofibrates or gemfibrozil Triglide Fenofibrates Generic fenofibrates or gemfibrozil Trilipix Fenofibrates Generic fenofibrates or gemfibrozil Must try one of the following: estazolam, zaleplon, zolpidem, temazepam, Edluar Hypnotics flurazepam, triazolam Must try one of the following: estazolam, zaleplon, zolpidem, temazepam, Intermezzo Hypnotics flurazepam, triazolam Must try one of the following: estazolam, zaleplon, zolpidem, temazepam, Rozerem Hypnotics flurazepam, triazolam Must try one of the following: estazolam, zaleplon, zolpidem, temazepam, Silenor Hypnotics flurazepam, triazolam Must try one of the following: estazolam, zaleplon, zolpidem, temazepam, Zolpimist Hypnotics flurazepam, triazolam Beconase AQ Nasal Steroids Must try one of the following: flunisolide, fluticasone, Nasonex Dymista Nasal Steroids Must try one of the following: flunisolide, fluticasone, Nasonex Qnasl Nasal Steroids Must try one of the following: flunisolide, fluticasone, Nasonex NASACORT AQ Nasal Steroids Must try one of the following: flunisolide, fluticasone, Nasonex OMNARIS Nasal Steroids Must try one of the following: flunisolide, fluticasone, Nasonex RHINOCORT AQUA Nasal Steroids Must try one of the following: flunisolide, fluticasone, Nasonex Zetonna Nasal Steroids Must try one of the following: flunisolide, fluticasone, Nasonex VERAMYST Nasal Steroids Must try one of the following: flunisolide, fluticasone, Nasonex Aciphex PPI Excluded, must try omeprazole product then Prevacid Lansoprazole (Prevacid) PPI Must try Prilosec OTC or omeprazole Nexium PPI Excluded, must try omeprazole product then Prevacid Pantoprazole (Protonix) PPI Excluded, must try omeprazole product then Prevacid Zegerid PPI Excluded, must try omeprazole product then Prevacid Chantix Smoking Cessation Must try Nicotrol Inhaler/Spray or Nicotine Gum/Lozenge/Transdermal or Bupropion Must try Citalopram and one of the following: paroxetine, fluvoxamine, LEXAPRO SSRI fluoxetine, sertraline Must try Citalopram and one of the following: paroxetine, fluvoxamine, LUVOX CR SSRI fluoxetine, sertraline Must try Citalopram and one of the following: paroxetine, fluvoxamine, PEXEVA SSRI fluoxetine, sertraline AXERT Triptans Must try one of the following: naratriptan, sumatriptan, rizatriptan, zolmitriptan, Relpax FROVA Triptans Must try one of the following: naratriptan, sumatriptan, rizatriptan, zolmitriptan, Relpax SUMAVEL Triptans Must try one of the following: naratriptan, sumatriptan, rizatriptan, zolmitriptan, Relpax TREXIMET Triptans Must try one of the following: naratriptan, sumatriptan, rizatriptan, zolmitriptan, Relpax ZOMIG Triptans Must try one of the following: naratriptan, sumatriptan, rizatriptan, zolmitriptan, Relpax Alsumat Triptans Must try one of the following: naratriptan, sumatriptan, rizatriptan, zolmitriptan, Relpax PRISTIQ SNRI Must try a generic SSRI and venlafaxine ER Victoza GLP Must try Byetta or Bydureon Humalog/Humulin Insulin Must try Novolin or Novolog Levemir Insulin Must try Lantus Ascensia Test Strip Mus try Accucheck or One Touch Breeze Test Strip Mus try Accucheck or One Touch Contour Test Strip Mus try Accucheck or One Touch Freestyle Test Strip Mus try Accucheck or One Touch Precision Test Strip Mus try Accucheck or One Touch Lumigan Ophtalmic Must try latanoprost, travapost, Travatan Z Rescula Ophtalmic Must try latanoprost, travapost, Travatan Z Zioptan Ophtalmic Must try latanoprost, travapost, Travatan Z Flovent Asthma Must try Asmanex, Pulmicort, Qvar Proventil Asthma Must try ProAir Ventolin Asthma Must try ProAir Quantity Limited Coverage may be limited to specific quantities per prescription and for time period. Medication Name Medication Class Quantity Limit Time Frame Bupropion (Wellbutrin 100mg) Antidepressant 90 Every 30 days Bupropion (Wellbutrin 75mg) Antidepressant 120 Every 30 days Bupropion (Wellbutrin SR) Antidepressant 60 Every 30 days Bupropion (Wellbutrin XL) Antidepressant 30 Every 30 days Citalopram (Celexa) Antidepressant 30 Every 30 days Cymbalta Antidepressant 60 Every 30 days Fluoxetine (Sarafem) Antidepressant 30 Every 30 days Lexapro Antidepressant 30 Every 30 days Paroxetine (Paxil) Antidepressant 30 Every 30 days Paroxetine CR (Paxil CR) Antidepressant 30 Every 30 days Sertraline (Zoloft) Antidepressant 30 Every 30 days fluconazole (Diflucan) Antifungal 4 Every 30 days Actonel 35mg Bisphosphonate 4 Every 30 days Actonel 5/30mg Bisphosphonate 30 Every 30 days Actonel with Calcium Bisphosphonate 28 Every 30 days Boniva 150mg Bisphosphonate 1 Every 30 days Boniva 2.5mg Bisphosphonate 30 Every 30 days Fosamax 35/70mg Bisphosphonate 4 Every 30 days Fosamax 5/10/40mg Bisphosphonate 30 Every 30 days Fosamax Plus D Bisphosphonate 4 Every 30 days Fosamax Solution Bisphosphonate 300 Every 30 days Advicor Cholesterol 30 Every 30 days Altocor Cholesterol 30 Every 30 days Crestor Cholesterol 30 Every 30 days Lescol Cholesterol 30 Every 30 days Lescol XL Cholesterol 30 Every 30 days Lipitor Cholesterol 30 Every 30 days lovastatin (Mevacor) Cholesterol 30 Every 30 days pravastatin (Pravachol) Cholesterol 30 Every 30 days simvastatin (Zocor) Cholesterol 30 Every 30 days Vytorin Cholesterol 30 Every 30 days Zetia Cholesterol 30 Every 30 days Tussionex Cough and Cold 120 Every 30 days Glucagon, Glucagen Diabetes 2 Every 365 days Insulin Injecting Devices Diabetes 2 Every 365 days Cialis Eryctile Dysfunction 6 Every 30 days Levitra Eryctile Dysfunction 6 Every 30 days Muse/Edex/Caverject Eryctile Dysfunction 6 Every 30 days Viagra Eryctile Dysfunction 6 Every 30 days Depo Provera Family Planning/Hormone Replacement 1 Every 90 days Estring Family Planning/Hormone Replacement 1 Every 90 days Femring Family Planning/Hormone Replacement 1 Every 90 days Lunelle Family Planning/Hormone Replacement 1 Every 30 days Nuvaring Family Planning/Hormone Replacement 1 Every 30 days Amerge Migraine 18 Per month (Whole Class) Axert Migraine 18 Per month (Whole Class) Frova Migraine 18 Per month (Whole Class) Maxalt/-MLT Migraine 18 Per month (Whole Class) Relpax Migraine 18 Per month (Whole Class) Sumatriptan (Imitrex) Migraine 18 Per month (Whole Class) Zomig/-ZMT Migraine 18 Per month (Whole Class) Quantity Limited (Continued) Medication Name Medication Class Quantity Limit Time Frame Allegra D 12hr Non Sedating Antihistamines 60 Every 30 days Allegra D 24 hr Non Sedating Antihistamines 30 Every 30 days Cetirizine (Zyrtec) Non Sedating Antihistamines 30 Every 30 days Cetirizine /-D (Zyrtec/-D) Non Sedating Antihistamines 60 Every 30 days Clarinex/-D Non Sedating Antihistamines 30 Every 30 days Fexofenadine 180mg (Allegra) Non Sedating Antihistamines 30 Every 30 days Fexofenadine 30mg/60mg (Allegra) Non Sedating Antihistamines 60 Every 30 days Xyzal Non Sedating Antihistamines 30 Every 30 days Celebrex 100/200mg NSAID 60 Every 30 days Celebrex 400mg NSAID 30 Every 30 days Lansoprazole (Prevacid) PPI 30 Every 30 days Omeprazole 40mg (Prilosec) PPI 30 Every 30 days Adcirca Pulmonary Arterial Hypertension 90 Every 30 days Revatio Pulmonary Arterial Hypertension 90 Every 30 days Advair Respiratory 60 Every 30 days Aerobid Respiratory 14 Every 30 days Aerochamber, Inspirease Respiratory 1 Every 365 days Alupent Respiratory 28 Every 30 days Atrovent Respiratory 30 Every 30 days Atrovent HFA Respiratory 26 Every 30 days Azmacort Respiratory 41 Every 30 days Combivent Respiratory 30 Every 30 days Epi-Pen, Epi-Pen JR Respiratory 2 Every 365 days Flovent HFA Respiratory 26 Every 30 days Flovent Rotadisk Respiratory 120 Every 30 days Intal Respiratory 30 Every 30 days Maxair Autohaler Respiratory 28 Every 30 days Proventil HFA/Ventolin HFA Respiratory 18 Every 30 days Proventil/Ventolin Respiratory 51 Every 30 days Pulmicort Respules Respiratory 140 Every 30 days Pulmicort Turbohaler Respiratory 2 Every 30 days Qvar Respiratory 16 Every 30 days Serevent Diskus Respiratory 120 Every 30 days Tilade Respiratory 34 Every 30 days Twinject Respiratory 2 Every 365 days Every 30 days for all sleep Ambien CR Sleep Aid 15 aids combined Every 30 days for all sleep Lunesta Sleep Aid 15 aids combined Every 30 days for all sleep Rozerem Sleep Aid 15 aids combined Every 30 days for all sleep Zaleplon (Sonata) Sleep Aid 15 aids combined Every 30 days for all sleep Zolpidem (Ambien) Sleep Aid 15 aids combined Chantix Smoking Cessation 2 Cycles 6 months total Prior Authorization Requires specific physician request process. Medication Name Medication Class Rationale ADHD Stimulant Class (Ritalin, Adderall, etc) ADHD Stimulant Class Require PA for members 19 and older Bupropion (Wellbutrin) Antidepression Not for use in smoking cessation or weight loss Approved for FDA Indications of: Narcolepsy, Idiopathic Hypersomnia, Nuvigil Antinarcolepsy OSAHS, SWSD, Fatigue due to MS. Approved for FDA Indications of: Narcolepsy, Idiopathic Hypersomnia, Provigil/Modafanil Antinarcolepsy OSAHS, SWSD, Fatigue due to MS. Also requires trial of Nuvigil prior to approval. Requires trial of 2 antidepressants prior to approval for depression. Abilify Antipsychotic For use in Autisim, requires trial of risperidone. Viracept HIV Cannot be pregnant Viagra, Cialis, Levitra, Muse Erectile Dysfunction Requires diagnosis Solodyn Acne Products Requires trial of minocycline Doryx Acne Products Requires trial of doxycycline

Specialty Medications Requiring prior authorization. Medication Name Medication Class Medication Name Medication Class Medication Name Medication Class ARANESP ALBUMIN FREE 5-FLUOROURACIL Specialty Specialty CALCIUM FOLINATE Specialty SURECLICK 8-MOP Specialty ARCALYST Specialty CALCIUM LEVULINATE Specialty

ABRAXANE Specialty AREDIA Specialty CALOMEL Specialty

ACTEMRA Specialty ARIXTRA Specialty CAMPATH Specialty

ACTHAR HP Specialty ASTAGRAF XL Specialty CAMPTOSAR Specialty

ACTIMMUNE Specialty ATROPINE METHONITRATE Specialty CAPRELSA Specialty ADCETRIS Specialty AUBAGIO Specialty CARBAGLU Specialty ADCIRCA Specialty AUTOPLEX T Specialty CARBOPLATIN Specialty ADEFOVIR DIPIVOXIL Specialty AVASTIN Specialty CARIMUNE Specialty ADEMPAS Specialty AVONEX Specialty CARIMUNE NANOFILTERED Specialty ADRIAMYCIN Specialty AVONEX PEN Specialty CAYSTON Specialty ADRUCIL Specialty AZACITIDINE Specialty CEFOTAXIME SODIUM Specialty ADVATE Specialty BARACLUDE Specialty CEREDASE Specialty AFINITOR Specialty BAYGAM Specialty CEREZYME Specialty ALCLOMETASONE Specialty BAYRHO-D Specialty CERIUM OXALATE Specialty DIPROPIONATE ALDURAZYME Specialty BEBULIN Specialty CETROTIDE Specialty ALFERON N Specialty BEBULIN VH Specialty CETYLPYRIDINIUM CHLORIDE Specialty ALIMTA Specialty BENEFIX Specialty CHLOROTHYMOL Specialty ALKERAN Specialty BENLYSTA Specialty CHLORPROMAZINE Specialty ALOXI Specialty BERINERT Specialty CHLORPROPAMIDE Specialty ALPHANATE Specialty BETASERON Specialty CHOREX-10 Specialty ALPHANATE/VON WILLEBRAND FACTOR Specialty BETHKIS Specialty CHORIONIC GONADOTROPIN Specialty COMPLEX/HUMAN CHORIONIC GONADOTROPIN ALPHANINE SD Specialty BICNU Specialty Specialty (HUMAN) CHORIONIC GONADOTROPIN AMEVIVE Specialty BIVIGAM Specialty Specialty W/DILUENT AMIFOSTINE Specialty BLENOXANE Specialty CIDOFOVIR Specialty AMPYRA Specialty BLEOMYCIN SULFATE Specialty CIMZIA Specialty ANZEMET Specialty BONIVA Specialty CIMZIA STARTER KIT Specialty APOKYN Specialty BOSULIF Specialty CINRYZE Specialty ARALAST Specialty BOTOX Specialty CISPLATIN Specialty ARALAST NP Specialty BRAVELLE Specialty CLADRIBINE Specialty ARANESP ALBUMIN FREE Specialty BUSULFEX Specialty COLISTIMETHATE SODIUM Specialty Specialty Medications (Continued) Medication Name Medication Class Medication Name Medication Class Medication Name Medication Class COLISTIN Specialty ETHYLPARABEN Specialty GLASSIA Specialty METHANESULFONATE COLY-MYCIN M Specialty ETHYOL Specialty GLEEVEC Specialty COLY-MYCIN-M Specialty ETOPOPHOS Specialty GONAL-F Specialty COMETRIQ Specialty ETOPOSIDE Specialty GONAL-F RFF Specialty COPAXONE Specialty EUFLEXXA Specialty GONAL-F RFF PEN Specialty COPEGUS Specialty EULEXIN Specialty GONAL-F RFF REDIJECT Specialty CORIFACT Specialty EXJADE Specialty GRANISETRON HCL Specialty CRINONE Specialty EYLEA Specialty GRANISOL Specialty CYCLOPHOSPHAMIDE Specialty FABRAZYME Specialty HALAVEN Specialty CYSTAGON Specialty FASLODEX Specialty HELIXATE FS Specialty CYTARABINE Specialty FEIBA NF Specialty HEMOFIL M Specialty CYTARABINE AQUEOUS Specialty FEIBA VH IMMUNO Specialty HEPSERA Specialty CYTOVENE Specialty FERRIC PHOSPHATE Specialty HERCEPTIN Specialty CYTOXAN Specialty FERRIC PYROPHOSPHATE Specialty HEXALEN Specialty DACARBAZINE Specialty FERRIPROX Specialty HIZENTRA Specialty DACOGEN Specialty FIRAZYR Specialty HUMATE-P Specialty DAUNOXOME Specialty FLEBOGAMMA Specialty HUMATROPE Specialty DDAVP Specialty FLEBOGAMMA DIF Specialty HUMATROPE COMBO PACK Specialty DECITABINE Specialty FLOLAN Specialty HUMIRA Specialty DELESTROGEN Specialty FLOXURIDINE Specialty HUMIRA PEN Specialty HUMIRA PEN-CROHNS DESMOPRESSIN ACETATE Specialty FLUDARA Specialty Specialty DISEASESTARTER DIHYDROXYALUMINUM HUMIRA PEN-PSORIASIS Specialty FLUDARABINE PHOSPHATE Specialty Specialty AMINOACETATE STARTER DOCEFREZ Specialty FLUOROURACIL Specialty HYALGAN Specialty DOCETAXEL Specialty FLUTAMIDE Specialty HYCAMTIN Specialty DOXIL Specialty FOLLISTIM AQ Specialty HYDROCORTISONE VALERATE Specialty HYDROCORTISONE VALERATE DOXORUBICIN HCL Specialty FONDAPARINUX SODIUM Specialty Specialty MICRONIZED DOXORUBICIN HCL LIPOSOME Specialty FORTEO Specialty HYPERRHO S/D Specialty D-THYROXINE SODIUM Specialty FRAGMIN Specialty ICLUSIG Specialty DTIC-DOME Specialty FUDR Specialty IFEX Specialty DYSPORT Specialty FUZEON Specialty IFOSFAMIDE Specialty EFUDEX Specialty GAMASTAN S/D Specialty ILARIS Specialty EGRIFTA Specialty GAMIMUNE N Specialty IMMUNE GLOBULIN Specialty ELAPRASE Specialty GAMMAGARD LIQUID Specialty INCIVEK Specialty ELELYSO Specialty GAMMAGARD S/D Specialty INCRELEX Specialty GAMMAGARD S/D IGA LESS ELIGARD Specialty Specialty INFERGEN Specialty THAN 1MCG/ML ELLENCE Specialty GAMMAKED Specialty INLYTA Specialty ELOXATIN Specialty GAMMAPLEX Specialty INNOHEP Specialty ELSPAR Specialty GAMMAR-P I.V. Specialty INTRON-A Specialty EMCYT Specialty GAMUNEX Specialty INTRON-A W/DILUENT Specialty ENBREL Specialty GAMUNEX-C Specialty IPRIVASK Specialty ENBREL SURECLICK Specialty GANCICLOVIR Specialty IRESSA Specialty ENOXAPARIN SODIUM Specialty GANIRELIX ACETATE Specialty IRINOTECAN Specialty EPIRUBICIN HCL Specialty GATTEX Specialty IVEEGAM EN Specialty EPIVIR HBV Specialty GEMCITABINE HCL Specialty IXEMPRA KIT Specialty EPOGEN Specialty GEMZAR Specialty JAKAFI Specialty EPOPROSTENOL SODIUM Specialty GENARC Specialty JETREA Specialty ERBITUX Specialty GENOTROPIN Specialty JEVTANA Specialty ERIVEDGE Specialty GENOTROPIN INTRA-MIX Specialty JUXTAPID Specialty ERWINAZE Specialty GENOTROPIN MINIQUICK Specialty KADCYLA Specialty ESTRADIOL VALERATE Specialty GILENYA Specialty KALBITOR Specialty ETHYL PARABEN Specialty GILOTRIF Specialty KALYDECO Specialty Specialty Medications (Continued) Medication Name Medication Class Medication Name Medication Class Medication Name Medication Class KINERET Specialty NEULASTA Specialty PEGASYS PROCLICK Specialty KOATE-DVI Specialty NEUMEGA Specialty PEG-INTRON Specialty KOGENATE FS Specialty NEUPOGEN Specialty PEG-INTRON REDIPEN Specialty KOGENATE FS BIO-SET Specialty NEXAVAR Specialty PEG-INTRON REDIPEN PAK 4 Specialty KRYSTEXXA Specialty NIACINAMIDE ASCORBATE Specialty PENTAM 300 Specialty NICOTINYL ALCOHOL KUVAN Specialty Specialty PENTAMIDINE ISETHIONATE Specialty TARTRATE KYPROLIS Specialty NIFUROXIME Specialty PENTOSTATIN Specialty KYTRIL Specialty NILANDRON Specialty PERJETA Specialty L-ASPARAGINE Specialty NIPENT Specialty PLATINOL AQ Specialty MONOHYDRATE LETAIRIS Specialty NORDITROPIN CARTRIDGE Specialty POLYGAM S/D Specialty LEUCOVORIN CALCIUM Specialty NORDITROPIN FLEXPRO Specialty POLYOX WSR-301 Specialty NORDITROPIN LEUKINE Specialty Specialty POMALYST Specialty NORDIFLEX PEN PREGNYL W/DILUENT BENZYL LEUPROLIDE ACETATE Specialty NOVANTRONE Specialty Specialty ALCOHOL/NACL LEUSTATIN Specialty NOVAREL Specialty PRIVIGEN Specialty LEVULINIC ACID CALCIUM Specialty NOVOBIOCIN SODIUM Specialty PROCHIEVE Specialty SALT LIPODOX Specialty NOVOSEVEN Specialty PROCRIT Specialty LIPODOX 50 Specialty NOVOSEVEN RT Specialty PROFASI Specialty PROFASI HP W/DILUENT LITHIUM CITRATE Specialty NPLATE Specialty Specialty BENZYL ALCOHOL LOVENOX Specialty NULOJIX Specialty PROFILNINE SD Specialty LUCENTIS Specialty NUTROPIN Specialty PROGESTERONE Specialty LUMIZYME Specialty NUTROPIN AQ Specialty PROGESTERONE MICRONIZED Specialty PROGESTERONE MICRONIZED LUPRON 2 WEEK SUPPLY Specialty NUTROPIN AQ NUSPIN 10 Specialty Specialty (SOY) PROGESTERONE MICRONIZED LUPRON DEPOT Specialty NUTROPIN AQ NUSPIN 20 Specialty Specialty (YAM) PROGESTERONE MICRONIZED LUPRON DEPOT-PED Specialty NUTROPIN AQ NUSPIN 5 Specialty Specialty PREMIUM LUVERIS Specialty NUTROPIN AQ PEN Specialty PROGESTERONE MILLED Specialty PROGESTERONE ULTRA LYSINE ACETATE Specialty OCTAGAM Specialty Specialty MICRONIZED LYSODREN Specialty OCTREOTIDE ACETATE Specialty PROGESTERONE WETTABLE Specialty PROGESTERONE WETTABLE MACUGEN Specialty OFORTA Specialty Specialty (YAM) MAGNESIUM LACTATE Specialty OLYSIO Specialty PROLASTIN Specialty MAKENA Specialty OMNITROPE Specialty PROLASTIN-C Specialty MEDRYSONE Specialty ONCASPAR Specialty PROLEUKIN Specialty MEKINIST Specialty ONDANSETRON HCL Specialty PROLIA Specialty MELPHALAN ONDANSETRON HCL Specialty Specialty PROMACTA Specialty HYDROCHLORIDE DIHYDRATE ONDANSETRON HCL/ PROPLEX T FACTOR IX COMP FACTOR MENOPUR Specialty Specialty Specialty DEXTROSE VII ACTIVITY UNITS 700-3900 MESNA Specialty ONTAK Specialty PROVENGE Specialty MESNEX Specialty ONXOL Specialty PULMOZYME Specialty MITOXANTRONE HCL Specialty OPSUMIT Specialty PYRVINIUM PAMOATE Specialty MONARC-M Specialty ORENCIA Specialty RAVICTI Specialty MONOCLATE-P Specialty ORTHOVISC Specialty REBETOL Specialty MONONINE Specialty OVIDREL Specialty REBIF Specialty MOZOBIL Specialty OXALIPLATIN Specialty REBIF REBIDOSE Specialty REBIF REBIDOSE TITRATION MUSTARGEN Specialty PACLITAXEL Specialty Specialty PACK MYLERAN Specialty PAMIDRONATE DISODIUM Specialty REBIF TITRATION PACK Specialty MYOBLOC Specialty PANGLOBULIN Specialty RECLAST Specialty MYOZYME Specialty PANGLOBULIN NF Specialty RECOMBINATE Specialty NAGLAZYME Specialty PARAPLATIN Specialty REFACTO Specialty NAVELBINE Specialty PARGYLINE HCL Specialty REMICADE Specialty NEBUPENT Specialty PEGASYS Specialty REMODULIN Specialty Specialty Medications (Continued) Medication Name Medication Class Medication Name Medication Class Medication Name Medication Class REPRONEX Specialty SYNVISC Specialty VENTAVIS Specialty RESORCINOL MONOACETATE Specialty SYNVISC ONE Specialty VEPESID Specialty REVATIO Specialty TABLOID Specialty VESANOID Specialty REVLIMID Specialty TAFINLAR Specialty VICTRELIS Specialty RHOGAM HUMAN Specialty TARCEVA Specialty VIDAZA Specialty RHOGAM ULTRA-FILTERED Specialty TARGRETIN Specialty VINBLASTINE SULFATE Specialty PLUS RHOPHYLAC Specialty TASIGNA Specialty VINCASAR PFS Specialty RIASTAP Specialty TAXOL Specialty VINCRISTINE SULFATE Specialty RIBAPAK Specialty TAXOTERE Specialty VINORELBINE TARTRATE Specialty RIBASPHERE Specialty TECFIDERA Specialty VISTIDE Specialty RIBATAB Specialty TECFIDERA STARTER PACK Specialty VISUDYNE Specialty RIBAVIRIN Specialty TEMODAR Specialty VIVAGLOBIN Specialty RITUXAN Specialty TEMOZOLOMIDE Specialty VIVITROL Specialty RIXUBIS Specialty TEV-TROPIN Specialty VOTRIENT Specialty ROFERON-A Specialty THALOMID Specialty VPRIV Specialty THROMBATE III W/10 ML SABRIL Specialty Specialty WILATE Specialty STERILE WATER THROMBATE III W/20 ML SAIZEN Specialty Specialty WINRHO SDF Specialty STERILE WATER SAIZEN CLICK.EASY Specialty THYROGEN Specialty XALKORI Specialty SANDOSTATIN Specialty TIVICAY Specialty XELJANZ Specialty SANDOSTATIN LAR DEPOT Specialty TOBI Specialty XELODA Specialty SENNA LEAF Specialty TOBRAMYCIN Specialty XENAZINE Specialty SENSIPAR Specialty TOPOSAR Specialty XEOMIN Specialty SEROSTIM Specialty TOPOTECAN HCL Specialty XGEVA Specialty SILDENAFIL CITRATE Specialty TORISEL Specialty XIAFLEX Specialty SIMPONI Specialty TRACLEER Specialty XOFIGO Specialty SIMPONI ARIA Specialty TREANDA Specialty XOLAIR Specialty SODIUM GLYCEROPHOSPHATE Specialty TRELSTAR DEPOT Specialty XTANDI Specialty SODIUM PYROPHOSPHATE Specialty TRELSTAR DEPOT MIXJECT Specialty XYNTHA Specialty ANHYDROUS SOLIRIS Specialty TRELSTAR LA Specialty XYNTHA SOLOFUSE Specialty SOMATULINE DEPOT Specialty TRELSTAR LA MIXJECT Specialty XYREM Specialty SOMAVERT Specialty TRELSTAR MIXJECT Specialty YERVOY Specialty SPRYCEL Specialty TRETINOIN Specialty ZALTRAP Specialty STELARA Specialty TYKERB Specialty ZANOSAR Specialty STIMATE Specialty TYSABRI Specialty ZAVESCA Specialty STIVARGA Specialty TYVASO Specialty ZELBORAF Specialty STRIBILD Specialty TYVASO REFILL Specialty ZEMAIRA Specialty SUCRAID Specialty TYVASO STARTER Specialty ZEVALIN IN-111 Specialty SULFACHLORPYRIDAZINE Specialty TYZEKA Specialty ZEVALIN Y-90 Specialty SULFACHLORPYRIDAZINE Specialty VALCHLOR Specialty ZOFRAN Specialty SODIUM SUPARTZ Specialty VALCYTE Specialty ZOLADEX Specialty SUPPRELIN LA Specialty VANDETANIB Specialty ZOLEDRONIC ACID Specialty SUTENT Specialty VANTAS Specialty ZOLINZA Specialty SYLATRON Specialty VECTIBIX Specialty ZOMETA Specialty SYNAGIS Specialty VELCADE Specialty ZORBTIVE Specialty SYNAREL Specialty VELETRI Specialty ZORTRESS Specialty SYNRIBO Specialty VENOGLOBULIN-S Specialty ZYTIGA Specialty