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Harness Health Specialty Pharmacy Specialty Pharmacy Drug List Specialty List

For participants in the Medical Plan, specialty medications are prescribed to treat complex diseases. Many are available through Harness Health Pharmacy. Participants are limited to 30-day supplies of these specialty drugs. Some medications may require prior authorization. Generics may be available for some medications, and a brand-name version may not be covered under certain plans. This list does not denote coverage or formulary status, merely access.

• On the following pages, use Control and F to search the Disease State (such as Asthma or Rheumatology) or the generic name or brand name for any drug. • See the last page for Limited Distribution Drugs available from other pharmacies.

If you have questions, call Harness Health Pharmacy at 866-775-5767 (press option 6 for the Specialty staff) weekdays 8 a.m. - 4:30 p.m. (ET).

Effective 01/01/2021 Specialty Medications List - Limited Distribution Drugs available through MedImpact Specialty Pharmacy Network AMPYRA EYLEA KUVAN PLEGRIDY TRACLEER APOKYN FERRIPROX KYNAMRO POMALYST TYSABRI ARALAST NP FLOLAN LEMTRADA PROCYSBI TYVASO ARCALYST GATTEX LETAIRIS PURIXAN VELETRI AUBAGIO HETLIOZ MACUGEN RAVICTI VENTAVIS BOSULIF IBRANCE MEKTOVI REMODULIN XALKORI BRAFTOVI ICLUSIG MATULANE REVLIMID XENAZINE BUPHENYL ILARIS METOPIRONE SABRIL ZEMAIRA CAPRELSA IMBRUVICA MYOZYME SIGNIFOR CARBAGLU INCRELEX NAGLAZYME SILIQ CAYSTON INLYTA NORTHERA SUCRAID CERDELGA JUXTAPID OFEV SUTENT CEREZYME KALBITOR OPSUMIT SYMDECO CHOLBAM KALYDECO ORENITRAM ER TECFIDERA CYSTADANE KITABIS PAK ORKAMBI THALOMID Available only through the extended Medimpact Specialty Pharmacy Network (including US Bioservices, Humana Specialty Pharmacy, Kroger Specialty Pharmacy and Accredo.) Call 800-788- 2949. Participants are limited to 30-day supplies of these specialty drugs. Some medications may require prior authorization.

Effective: 01/01/2021 Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Acromegaly ACETATE SOMATULINE DEPOT Acromegaly ACETATE BYNFEZIA Acromegaly OCTREOTIDE ACETATE OCTREOTIDE ACETATE Acromegaly OCTREOTIDE ACETATE SANDOSTATIN Acromegaly OCTREOTIDE ACETATE,MI-SPHERES SANDOSTATIN LAR Acromegaly SOMAVERT Alcohol/Opioid Dependency NALTREXONE MICROSPHERES VIVITROL Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR GLASSIA Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR ARALAST NP Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR PROLASTIN C Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR ZEMAIRA IN POLYSORBAT ARANESP Anemia EPOGEN Anemia EPOETIN ALFA PROCRIT Anemia EPOETIN ALFA-EPBX RETACRIT Anemia FERRIC CARBOXYMALTOSE INJECTAFER Anemia FERUMOXYTOL FERAHEME Anemia IRON SUCROSE COMPLEX VENOFER Anemia METHOXY PEG-EPOETIN BETA MIRCERA Anticoagulants FONDAPARINUX SODIUM ARIXTRA Anticoagulants FONDAPARINUX SODIUM FONDAPARINUX SODIUM Asthma FASENRA Asthma NUCALA Asthma XOLAIR Asthma CINQAIR Behavioral Health ABILIFY MAINTENA Behavioral Health ARISTADA Behavioral Health ARIPIPRAZOLE LAUROXIL,SUBMICR. ARISTADA INITIO Behavioral Health FANAPT Behavioral Health PAMOATE ZYPREXA RELPREVV Behavioral Health PALMITATE INVEGA SUSTENNA Behavioral Health PALIPERIDONE PALMITATE INVEGA TRINZA Behavioral Health PIMAVANSERIN NUPLAZID Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Behavioral Health PERSERIS Behavioral Health RISPERIDONE MICROSPHERES RISPERDAL CONSTA Botulinum Toxins ABOBOTULINUMTOXINA DYSPORT Botulinum Toxins INCOBOTULINUMTOXINA XEOMIN Botulinum Toxins ONABOTULINUMTOXINA BOTOX Botulinum Toxins RIMABOTULINUMTOXINB MYOBLOC Chronic Pain/Non Opioid ACETATE PRIALT Congenital Deficiency FIBRINOGEN CONCENTRATE (HUMAN) FIBRYGA AZTREONAM CAYSTON Cystic Fibrosis IVACAFTOR KALYDECO Cystic Fibrosis LUMACAFTOR/IVACAFTOR ORKAMBI Cystic Fibrosis TEZACAFTOR/IVACAFTOR SYMDEKO Cystic Fibrosis TOBRAMYCIN/ BETHKIS Cystic Fibrosis TOBRAMYCIN (CAP FOR INHALATION) TOBI PODHALER Cystic Fibrosis TOBRAMYCIN IN 0.225% SOD CHLOR TOBI Cystic Fibrosis TOBRAMYCIN/NEBULIZER KITABIS PAK Cystic Fibrosis TOBRAMYCIN/NEBULIZER TOBRAMYCIN Cystic Fibrosis DORNASE ALFA/ NEBULIZER PULMOZYME Dermatology ACITRETIN ACITRETIN Dermatology ACITRETIN SORIATANE Dermatology HUMIRA PEN PSORIASIS-UVEITIS Dermatology OTEZLA Dermatology SILIQ Dermatology DUPIXENT Dermatology TREMFYA Dermatology INGENOL MEBUTATE PICATO Dermatology TALTZ Dermatology COSENTYX Dermatology CIMZIA Dermatology -DYYB INFLECTRA Dermatology INFLIXIMAB REMICADE Dermatology INFLIXIMAB-ABDA RENFLEXIS Dermatology INFLIXIMAB-AXXQ AVSOLA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Dermatology STELARA Dermatology SKYRIZI Dermatology ILUMYA Dermatology ENBREL Dupuytren's Contracture COLLAGENASE CLOSTRIDIUM HIST. XIAFLEX Electrolyte Disorders PATIROMER SORBITEX VELTASSA Electrolyte Disorders SODIUM ZIRCONIUM CYCLOSILICATE LOKELMA Electrolyte Disorders JYNARQUE Electrolyte Disorders TOLVAPTAN SAMSCA Endocrine CINACALCET CINACALCET Endocrine CINACALCET SENSIPAR Endocrine ETELCALCETIDE HYDROCHLORIDE PARSABIV Endocrine ACETATE SUPPRELIN LA Endocrine HISTRELIN ACETATE VANTAS Endocrine METYRAPONE METOPIRONE Endocrine MIFEPRISTONE KORLYM Endocrine PARATHYROID HORMONE NATPARA Endocrine DIASPARTATE SIGNIFOR Endocrine PASIREOTIDE PAMOATE SIGNIFOR LAR Replacement PEGADEMASE BOVINE ADAGEN Enzyme Replacement SUCRAID ORILISSA Endometriosis SYNAREL Fertility ACETATE CETROTIDE Fertility CHORIOGONADOTROPIN ALFA OVIDREL Fertility CHORIONIC , HUMAN CHORIONIC GONADOTROPIN Fertility CHORIONIC GONADOTROPIN, HUMAN NOVAREL Fertility CHORIONIC GONADOTROPIN, HUMAN PREGNYL Fertility FOLLITROPIN ALFA, RECOMBINANT GONAL-F Fertility FOLLITROPIN BETA,RECOMB FOLLISTIM AQ Fertility ACETATE GANIRELIX ACETATE Fertility MENOPUR Fertility MENOTROPINS REPRONEX Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Fertility BRAVELLE Gastroenterology ADALIMUMAB HUMIRA Gastroenterology CERTOLIZUMAB PEGOL CIMZIA Gastroenterology TYSABRI Gastroenterology INFLIXIMAB-DYYB INFLECTRA Gastroenterology INFLIXIMAB REMICADE Gastroenterology INFLIXIMAB-ABDA RENFLEXIS Gastroenterology INFLIXIMAB-AXXQ AVSOLA Gastroenterology GATTEX Gastroenterology USTEKINUMAB STELARA Gastroenterology ENTYVIO Gastroenterology CITRATE XELJANZ Genetics MIGLUSTAT Genetics MIGLUSTAT ZAVESCA PEGLOTICASE KRYSTEXXA and Related Disorders INCRELEX Growth Hormone and Related Disorders SOMATROPIN GENOTROPIN Growth Hormone and Related Disorders SOMATROPIN HUMATROPE Growth Hormone and Related Disorders SOMATROPIN NORDITROPIN Growth Hormone and Related Disorders SOMATROPIN NORDITROPIN NORDIFLEX Growth Hormone and Related Disorders SOMATROPIN NUTROPIN AQ NUSPIN Growth Hormone and Related Disorders SOMATROPIN NUTROPIN AQ Growth Hormone and Related Disorders SOMATROPIN NUTROPIN Growth Hormone and Related Disorders SOMATROPIN OMNITROPE Growth Hormone and Related Disorders SOMATROPIN SAIZEN Growth Hormone and Related Disorders SOMATROPIN SAIZEN-SAIZENPREP Growth Hormone and Related Disorders SOMATROPIN Growth Hormone and Related Disorders SOMATROPIN TEV-TROPIN Growth Hormone and Related Disorders SOMATROPIN ZOMACTON Growth Hormone and Related Disorders SOMATROPIN ZORBTIVE Heavy Metal Toxicity PENICILLAMINE CUPRIMINE Heavy Metal Toxicity PENICILLAMINE DEPEN Heavy Metal Toxicity TRIENTINE SYPRINE Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Heavy Metal Toxicity TRIENTINE HCL TRIENTINE HCL Hematopoietics PLERIXAFOR MOZOBIL Hemophilia & Bleeding Disorders ANTIHEM.FVIII,SIN-CHN,B-DM TRU AFSTYLA Hemophilia & Bleeding Disorders ANTIHEMO.FVIII,FULL LENGTH PEG ADYNOVATE Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII REC,FC FUSION ELOCTATE Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,B-DOM TRUNCAT NOVOEIGHT Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,B-DOMAIN DEL XYNTHA Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,FULL LENGTH ADVATE Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,FULL LENGTH KOGENATE FS Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,HEK B-DELETE NUWIQ Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII,FULL LENGTH ADVATE Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII,FULL LENGTH HELIXATE FS Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII,FULL LENGTH KOVALTRY Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII REC,B-DOM DELET PEG-AUCL JIVI Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUM REC RECOMBINATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUMAN HEMOFIL M Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUMAN KOATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUMAN MONOCLATE-P Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR/VWF ALPHANATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR/VWF HUMATE-P Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR/VWF WILATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FVIII,REC PORC OBIZUR Hemophilia & Bleeding Disorders ANTI-INHIBITOR COAGULANT COMP. FEIBA NF Hemophilia & Bleeding Disorders FACTOR VIIA,RECOMB NOVOSEVEN RT Hemophilia & Bleeding Disorders COAGULATION COAGADEX Hemophilia & Bleeding Disorders ACETATE STIMATE Hemophilia & Bleeding Disorders EMICIZUMAB-KXWH HEMLIBRA Hemophilia & Bleeding Disorders FACTOR IX ALPHANINE SD Hemophilia & Bleeding Disorders FACTOR IX MONONINE Hemophilia & Bleeding Disorders FACTOR IX CPLX(PCC)NO4,3FACTOR PROFILNINE Hemophilia & Bleeding Disorders FACTOR IX CPLX(PCC)NO6,3FACTOR BEBULIN Hemophilia & Bleeding Disorders FACTOR IX HUMAN REC,PEGYLATED REBINYN Hemophilia & Bleeding Disorders FACTOR IX HUMAN RECOMB,THR 148 IXINITY Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Hemophilia & Bleeding Disorders FACTOR IX HUMAN RECOMBINANT BENEFIX Hemophilia & Bleeding Disorders FACTOR IX HUMAN RECOMBINANT RIXUBIS Hemophilia & Bleeding Disorders FACTOR IX REC, FC FUSION PROTN ALPROLIX Hemophilia & Bleeding Disorders FACTOR IX RECOM,ALBUMIN FUSION IDELVION Hemophilia & Bleeding Disorders FACTOR XA,INACTIVATED-ZHZO ANDEXXA Hemophilia & Bleeding Disorders FACTOR XIII CORIFACT Hemophilia & Bleeding Disorders FACTOR XIII A-SUBUNIT,RECOMB TRETTEN Hemophilia & Bleeding Disorders HUMAN PROTHROMIN COMPLEX (PCC) KCENTRA Hemophilia & Bleeding Disorders VONVENDI Hepatitis ADEFOVIR DIPIVOXIL ADEFOVIR DIPIVOXIL Hepatitis ADEFOVIR DIPIVOXIL HEPSERA Hepatitis DACLATASVIR DIHYDROCHLORIDE DAKLINZA Hepatitis ELBASVIR/GRAZOPREVIR ZEPATIER Hepatitis ENTECAVIR BARACLUDE Hepatitis ENTECAVIR ENTECAVIR Hepatitis GLECAPREVIR/PIBRENTASVIR MAVYRET Hepatitis EPIVIR HBV Hepatitis LAMIVUDINE LAMIVUDINE HBV Hepatitis LEDIPASVIR/SOFOSBUVIR HARVONI Hepatitis OMBITA/PARITAP/RITON/DASABUVIR VIEKIRA Hepatitis OMBITASVIR/PARITAPREV/RITONAV TECHNIVIE Hepatitis PEGINTERFERON ALFA-2A PEGASYS PROCLICK Hepatitis PEGINTERFERON ALFA-2A PEGASYS Hepatitis RIBAVIRIN COPEGUS Hepatitis RIBAVIRIN MODERIBA Hepatitis RIBAVIRIN REBETOL Hepatitis RIBAVIRIN RIBASPHERE RIBAPAK Hepatitis RIBAVIRIN RIBASPHERE Hepatitis RIBAVIRIN RIBATAB Hepatitis RIBAVIRIN RIBAVIRIN Hepatitis RIBAVIRIN VIRAZOLE Hepatitis SIMEPREVIR SODIUM OLYSIO Hepatitis SOFOSBUVIR SOVALDI Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Hepatitis SOFOSBUVIR/VELPATAS/VOXILAPREV VOSEVI Hepatitis SOFOSBUVIR/VELPATASVIR EPCLUSA Hereditary Angioedema C1 INHIBITOR BERINERT Hereditary Angioedema C1 ESTERASE INHIBITOR CINRYZE Hereditary Angioedema C1 ESTERASE INHIBITOR HAEGARDA Hereditary Angioedema C1 ESTERASE INHIBITOR, RECOMB RUCONEST Hereditary Angioedema ECALLANTIDE KALBITOR Hereditary Angioedema ICATIBANT ACETATE ICATIBANT Hereditary Angioedema ICATIBANT ACETATE FIRAZYR Hereditary Angioedema LANADELUMAB-FLYO TAKHZYRO Disorders BETAINE CYSTADANE Hormonal Therapies LEUPROLIDE FENSOLVI Hormonal Therapies LEUPROLIDE/NORETHINDRONE ACET LUPANETA PACK Hyperammoniaemia CARGLUMIC CARBAGLU HIV ABACAVIR SULFATE ABACAVIR HIV ABACAVIR SULFATE ZIAGEN HIV ABACAVIR SULFATE/LAMIVUDINE ABACAVIR-LAMIVUDINE HIV ABACAVIR SULFATE/LAMIVUDINE EPZICOM HIV ABACAVIR/DOLUTEGRAVIR/LAMIVUDI TRIUMEQ HIV ABACAVIR/LAMIVUDINE/ZIDOVUDINE ABACAVIR-LAMIVUDINE-ZIDOVUDINE HIV ABACAVIR/LAMIVUDINE/ZIDOVUDINE TRIZIVIR HIV SULFATE ATAZANAVIR SULFATE HIV ATAZANAVIR SULFATE REYATAZ HIV ATAZANAVIR SULFATE/COBICISTAT EVOTAZ HIV BICTEGRAV/EMTRICIT/TENOFOV ALA BIKTARVY HIV COBICISTAT TYBOST HIV DARUNAVIR ETHANOLATE PREZISTA HIV DARUNAVIR/COB/EMTRI/TENOF ALAF SYMTUZA HIV DARUNAVIR/COBICISTAT PREZCOBIX HIV MESYLATE RESCRIPTOR HIV DORAVIRINE PIFELTRO HIV DORAVIRINE/LAMIVU/TENOFOV DISOP DELSTRIGO HIV DIDANOSINE VIDEX Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

HIV DOLUTEGRAVIR SODIUM TIVICAY HIV DOLUTEGRAVIR/LAMIVUDINE DOVATO HIV DOLUTEGRAVIR/RILPIVIRINE JULUCA HIV EFAVIRENZ EFAVIRENZ HIV EFAVIRENZ SUSTIVA HIV EFAVIRENZ/EMTRICIT/TENOFOVR DF ATRIPLA HIV EFAVIRENZ/LAMIVU/TENOFOV DISOP SYMFI HIV ELVITEG/COB/EMTRI/TENOF ALAFEN GENVOYA HIV ELVITEG/COB/EMTRI/TENOFO DISOP STRIBILD HIV ELVITEGRAVIR VITEKTA HIV EMTRICITA/RILPIVIRINE/TENOF DF COMPLERA HIV EMTRICITAB/RILPIVIRI/TENOF ALA ODEFSEY HIV EMTRICITABINE EMTRIVA HIV EMTRICITABINE/TENOFOV ALAFENAM DESCOVY HIV EMTRICITABINE/TENOFOVIR TRUVADA HIV FUZEON HIV ETRAVIRINE INTELENCE HIV FOSAMPRENAVIR CALCIUM FOSAMPRENAVIR CALCIUM HIV FOSAMPRENAVIR CALCIUM LEXIVA HIV SULFATE CRIXIVAN HIV LAMIVUDINE EPIVIR HIV LAMIVUDINE LAMIVUDINE HIV LAMIVUDINE/TENOFOVIR DISOP FUM CIMDUO HIV LAMIVUDINE/ZIDOVUDINE COMBIVIR HIV LAMIVUDINE/ZIDOVUDINE LAMIVUDINE-ZIDOVUDINE HIV LOPINAVIR/RITONAVIR KALETRA HIV LOPINAVIR/RITONAVIR LOPINAVIR-RITONAVIR HIV MARAVIROC SELZENTRY HIV/ID NEVIRAPINE VIRAMUNE XR HIV NELFINAVIR MESYLATE VIRACEPT HIV NEVIRAPINE VIRAMUNE HIV RALTEGRAVIR POTASSIUM ISENTRESS HIV RILPIVIRINE HCL EDURANT Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

HIV RITONAVIR NORVIR HIV SAQUINAVIR MESYLATE INVIRASE HIV STAVUDINE STAVUDINE HIV STAVUDINE ZERIT HIV TENOFOVIR ALAFENAMIDE FUMARATE VEMLIDY HIV TENOFOVIR DISOPROXIL FUMARATE VIREAD HIV TIPRANAVIR APTIVUS HIV VALGANCICLOVIR HCL VALCYTE HIV ZIDOVUDINE RETROVIR HIV Support TESAMORELIN ACETATE EGRIFTA ID/Osteopetrosis GAMMA-1B,RECOMB. ACTIMMUNE Idiopathic Pulmonary Fibrosis (IPF) ESBRIET Idiopathic Pulmonary Fibrosis (IPF) ESYLATE OFEV Immune Globumin Therapy CYTOMEGALOVIRUS IMMUNE GLOBULN CYTOGAM Immune Globumin Therapy HYALURONIDASE, HUMAN RECOMB. HYQVIA Immune Globumin Therapy IMM GLOB G (IGG)/SORB/IGA 0-50 FLEBOGAMMA DIF Immune Globumin Therapy IMMUN GLOB G (IGG)/GLY/IGA 50+ GAMUNEX Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA 0-50 GAMMAPLEX Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA OV50 BIVIGAM Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA OV50 CUVITRU Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA OV50 GAMMAGARD LIQUID Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA OV50 HYQVIA IG COMPONENT Immune Globumin Therapy IMMUN GLOB G(IGG)-HIPP/MALTOSE CUTAQUIG Immune Globumin Therapy IMMUN GLOB G(IGG)/PRO/IGA 0-50 HIZENTRA Immune Globumin Therapy IMMUN GLOB G(IGG)/PRO/IGA 0-50 PRIVIGEN Immune Globumin Therapy IMMUN GLOB G(IGG)-IFAS/ PANZYGA Immune Globumin Therapy IMMUN GLOB G/GLY/GLUC/IGA 0-50 GAMMAGARD S-D Immune Globumin Therapy IMMUN GLOBG(IGG)/MALT/IGA OV50 OCTAGAM Immune Globumin Therapy IMMUN GLOBG(IGG)/SUCR/IGA OV50 CARIMUNE NF Immune Globumin Therapy IMMUNE GLOB/PLASMA FRA BOVINE ENTERAGAM Immune Globumin Therapy IMMUNE GLOBUL G (IGG)/GLYCINE GAMASTAN Immune Globumin Therapy IMMUNE GLOBUL G/GLY/IGA AVG 46 GAMMAKED Immune Globumin Therapy IMMUNE GLOBUL G/GLY/IGA AVG 46 GAMUNEX-C Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Immune Globumin Therapy LYMPHOCYTE IMMUNE GLOBULIN ATGAM Immune Globumin Therapy RHO(D) IMMUNE GLOBULIN/MALTOSE WINRHO SDF adjuvant HYALURONIDASE AMPHADASE Injection adjuvant HYALURONIDASE, HUMAN RECOMB. HYLENEX Injection adjuvant HYALURONIDASE,OVINE VITRASE Iron Overload DEFERASIROX EXJADE Iron Overload DEFERASIROX JADENU Iron Overload DEFERIPRONE FERRIPROX ITP OLAMINE PROMACTA Disorders ALIROCUMAB PRALUENT Lipid Disorders EVOLOCUMAB REPATHA Lipid Disorders LOMITAPIDE MESYLATE JUXTAPID Lipid Disorders MYALEPT Lipid Disorders MIPOMERSEN SODIUM KYNAMRO Disorders CHENODIOL CHENODAL Liver Disorders CHOLIC ACID CHOLBAM Liver Disorders OBETICHOLIC ACID OCALIVA Liver Disorders TRIENTINE HCL SYPRINE Liver Disorders TRIENTINE HCL TRIENTINE HCL Liver Disorders PENICILLAMINE CUPRIMINE Liver Disorders PENICILLAMINE DEPEN Lysosomal Storage Disorders AGALSIDASE BETA FABRAZYME Lysosomal Storage Disorders LUMIZYME Lysosomal Storage Disorders ALGLUCOSIDASE ALFA MYOZYME Lysosomal Storage Disorders BITARTRATE CYSTAGON Lysosomal Storage Disorders CYSTEAMINE BITARTRATE PROCYSBI Lysosomal Storage Disorders CERDELGA Lysosomal Storage Disorders ELOSULFASE ALFA VIMIZIM Lysosomal Storage Disorders GALSULFASE NAGLAZYME Lysosomal Storage Disorders ELAPRASE Lysosomal Storage Disorders CEREZYME Lysosomal Storage Disorders LARONIDASE ALDURAZYME Lysosomal Storage Disorders KANUMA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Lysosomal Storage Disorders VPRIV Migraine ERENUMAB-AOOE AIMOVIG AUTOINJECTOR Migraine FREMANEZUMAB-VFRM AJOVI Migraine GALCANEZUMAB-GNLM EMGALITY Migraine UBROGEPANT UBRELVY Movement Disorders HCL APOKYN Movement Disorders DEFLAZACORT EMFLAZA Movement Disorders DICHLORPHENAMIDE KEVEYIS Movement Disorders NORTHERA Movement Disorders DEUTETRABENAZINE AUSTEDO Movement Disorders SOLIRIS Movement Disorders EDARAVONE RADICAVA Movement Disorders RILUZOLE RILUTEK Movement Disorders RILUZOLE RILUZOLE Movement Disorders RILUZOLE TIGLUTIK Movement Disorders TETRABENAZINE TETRABENAZINE Movement Disorders TETRABENAZINE XENAZINE Movement Disorders VALBENAZINE TOSYLATE INGREZZA Movement Disorders VIGABATRIN SABRIL Movement Disorders VIGABATRIN VIGABATRIN Movement Disorders VIGABATRIN VIGADRONE Multiple Sclerosis DALFAMPRIDINE AMPYRA Multiple Sclerosis DALFAMPRIDINE DALFAMPRIDINE ER Multiple Sclerosis TECFIDERA Multiple Sclerosis DIMETHYL FUMARATE DIMETHYL FUMARATE Multiple Sclerosis HCL GILENYA Multiple Sclerosis COPAXONE Multiple Sclerosis GLATIRAMER ACETATE GLATIRAMER ACETATE Multiple Sclerosis GLATIRAMER ACETATE GLATOPA Multiple Sclerosis INTERFERON BETA-1A/ALBUMIN AVONEX Multiple Sclerosis INTERFERON BETA-1A/ALBUMIN REBIF Multiple Sclerosis INTERFERON BETA-1B BETASERON Multiple Sclerosis INTERFERON BETA-1B EXTAVIA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Multiple Sclerosis HCL MITOXANTRONE HCL Multiple Sclerosis PEGINTERFERON BETA-1A PLEGRIDY Multiple Sclerosis OCREVUS Multiple Sclerosis AUBAGIO Neutropenia NEUPOGEN Neutropenia FILGRASTIM-AAFI NIVESTYM Neutropenia FILGRASTIM-SNDZ ZARXIO Neutropenia NEULASTA Neutropenia PEGFILGRASTIM-APGF NYVEPRIA Neutropenia PEGFILGRASTIM-CBQV UDENYCA Neutropenia PEGFILGRASTIM-JMDB FULPHILA Neutropenia TBO-FILGRASTIM GRANIX Oncology ABEMACICLIB VERZENIO Oncology ABIRATERONE ACETATE ZYTIGA Oncology ABIRATERONE ACET,SUBMICRONIZED YONSA Oncology ACALABRUTINIB CALQUENCE Oncology ADO-TRASTUZUMAB EMTANSINE KADCYLA Oncology AFATINIB DIMALEATE GILOTRIF Oncology ALDESLEUKIN PROLEUKIN Oncology ALECTINIB HCL ALECENSA Oncology CAMPATH Oncology ALEMTUZUMAB LEMTRADA Oncology ALPELISIB PIQRAY Oncology ALTRETAMINE HEXALEN Oncology * ARIMIDEX* Oncology APALUTAMIDE ERLEADA Oncology ARSENIC TRIOXIDE ARSENIC TRIOXIDE Oncology ATEZOLIZUMAB TECENTRIQ Oncology AXITINIB INLYTA Oncology BAVENCIO Oncology BELEODAQ Oncology BENDAMUSTINE HCL BENDAMUSTINE Oncology BENDAMUSTINE HCL BENDEKA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology BENDAMUSTINE HCL TREANDA Oncology BEVACIZUMAB AVASTIN Oncology BEVACIZUMAB-AWWB MVASI Oncology BEXAROTENE Oncology BEXAROTENE TARGRETIN Oncology BINIMETINIB MEKTOVI Oncology BLINATUMOMAB BLINCYTO Oncology BORTEZOMIB BORTEZOMIB Oncology BORTEZOMIB VELCADE Oncology BOSUTINIB BOSULIF Oncology BRENTUXIMAB VEDOTIN ADCETRIS Oncology BRIGATINIB ALUNBRIG Oncology BUSULFAN MYLERAN Oncology CABAZITAXEL JEVTANA Oncology CABOZANTINIB S-MALATE CABOMETYX Oncology CABOZANTINIB S-MALATE COMETRIQ Oncology CAPECITABINE CAPECITABINE Oncology CAPECITABINE XELODA Oncology CARFILZOMIB KYPROLIS Oncology CARMUSTINE BICNU Oncology CEMIPLIMAB-RWLC LIBTAYO Oncology CERITINIB ZYKADIA Oncology ERBITUX Oncology CHLORAMBUCIL LEUKERAN Oncology COBIMETINIB FUMARATE COTELLIC Oncology CRIZOTINIB XALKORI Oncology COBIMETINIB COTELLIC Oncology CYCLOPHOSPHAMIDE CYTOXAN Oncology CYTARABINE CYTARABINE Oncology CAPMATINIB TABRECTA Oncology DABRAFENIB MESYLATE TAFINLAR Oncology DACOMITINIB VIZIMPRO Oncology DACARBAZINE DACARBAZINE Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology DARATUMUMAB DARZALEX Oncology DAROLUTAMIDE NUBEQA Oncology SPRYCEL Oncology DECITABINE DACOGEN Oncology DECITABINE DECITABINE Oncology XGEVA Oncology DOXORUBICIN DOXORUBICIN Oncology DURVALUMAB IMFINZI Oncology DUVELISIB COPIKTRA Oncology ELOTUZUMAB EMPLICITI Oncology ELTROMBOPAG OLAMINE PROMACTA Oncology ENASIDENIB MESYLATE IDHIFA Oncology ENCORAFENIB BRAFTOVI Oncology ENTRECTINIB ROZLYTREK Oncology XTANDI Oncology ERIBULIN MESYLATE HALAVEN Oncology ERLOTINIB HCL TARCEVA Oncology ESTRAMUSTINE SODIUM EMCYT Oncology ETOPOSIDE ETOPOSIDE Oncology ETOPOSIDE TOPOSAR Oncology AFINITOR Oncology * AROMASIN* Oncology FEDRATINIB INREBIC Oncology FLUOROURACIL ADRUCIL Oncology FLUOROURACIL FLUOROURACIL Oncology FULVESTRANT FASLODEX Oncology GEFITINIB IRESSA Oncology GEMTUZUMAB OZOGAMICIN MYLOTARG Oncology GILTERITINIB FUMARATE XOSPATA Oncology ACETATE ZOLADEX Oncology HYDROXYUREA HYDREA Oncology IBRUTINIB IMBRUVICA Oncology IDELALISIB ZYDELIG Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology MESYLATE GLEEVEC Oncology IMATINIB MESYLATE IMATINIB MESYLATE Oncology -2B,RECOMB. INTRON A Oncology INTERFERON ALFACON-1 INFERGEN Oncology YERVOY Oncology IVOSIDENIB TIBSOVO Oncology IXABEPILONE IXEMPRA Oncology IXAZOMIB CITRATE NINLARO Oncology LAPATINIB DITOSYLATE TYKERB Oncology LAPATINIB DITOSYLATE LAPATINIB DITOSYLATE Oncology REVLIMID Oncology LAROTRECTINIB VITRAKVI Oncology LENVATINIB MESYLATE LENVIMA Oncology LETROZOLE* FEMARA* Oncology LEUPROLIDE ACETATE ELIGARD Oncology LEUPROLIDE ACETATE LUPANETA Oncology LEUPROLIDE ACETATE LUPRON DEPOT Oncology LOMUSTINE CEENU Oncology LOMUSTINE GLEOSTINE Oncology LOMUSTINE LOMUSTINE Oncology LORLATINIB LORBRENA Oncology LURBINECTEDIN ZEPZELCA Oncology MECHLORETHAMINE HCL VALCHLOR Oncology MELPHALAN ALKERAN Oncology MELPHALAN HCL MELPHALAN Oncology MERCAPTOPURINE MERCAPTOPURINE Oncology MERCAPTOPURINE PURINETHOL Oncology MERCAPTOPURINE PURIXAN Oncology SODIUM METHOTREXATE Oncology METHOTREXATE SODIUM/PF METHOTREXATE SODIUM Oncology RYDAPT Oncology NERATINIB MALEATE NERLYNX Oncology NECITUMUMAB PORTRAZZA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology NILOTINIB HCL TASIGNA Oncology NILUTAMIDE NILUTAMIDE Oncology NIRAPARIB TOSYLATE ZEJULA Oncology NIVOLUMAB OPDIVO Oncology GAZYVA Oncology OCTREOTIDE ACETATE BYNFEZIA Oncology OCTREOTIDE ACETATE OCTREOTIDE ACETATE Oncology OFATUMUMAB KESIMPTA Oncology OLAPARIB LYNPARZA Oncology OLARATUMAB LARTRUVO Oncology OMACETAXINE MEPESUCCINATE SYNRIBO Oncology OSIMERTINIB MESYLATE TAGRISSO Oncology PACLITAXEL ONXOL Oncology PACLITAXEL -BOUND ABRAXANE Oncology PALBOCICLIB IBRANCE Oncology PANITUMUMAB VECTIBIX Oncology LACTATE FARYDAK Oncology PAZOPANIB HCL VOTRIENT Oncology PEGINTERFERON ALFA-2B SYLATRON Oncology PEMBROLIZUMAB KEYTRUDA Oncology PERTUZUMAB PERJETA Oncology PERTUZUMAB, TRASTUZUMAB, HYALURONIDASE PHESGO Oncology POMALYST Oncology PONATINIB HCL ICLUSIG Oncology HCL MATULANE Oncology POLATUZUMAB POLIVY Oncology RAMUCIRUMAB CYRAMZA Oncology REGORAFENIB STIVARGA Oncology ORGOVYX Oncology RIBOCICLIB SUCCINATE KISQALI Oncology RIBOCICLIB SUCCINATE/LETROZOLE KISQALI FEMARA CO-PACK Oncology RITUXAN Oncology RITUXIMAB/HYALURONIDASE,HUMAN RITUXAN HYCELA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology ISTODAX Oncology ROMIDEPSIN ROMIDEPSIN Oncology NPLATE Oncology RUCAPARIB CAMSYLATE RUBRACA Oncology JAKAFI Oncology SELPERCATINIB RETEVMO Oncology SONIDEGIB PHOSPHATE ODOMZO Oncology TOSYLATE NEXAVAR Oncology MALATE SUTENT Oncology TAFASITAMAB MONJUVI Oncology TALAZOPARIB TOSYLATE TALZENNA Oncology CITRATE NOLVADEX Oncology TAMOXIFEN CITRATE SOLTAMOX Oncology TAMOXIFEN CITRATE TAMOXIFEN CITRATE Oncology TEMODAR Oncology TEMOZOLOMIDE TEMOZOLOMIDE Oncology TORISEL Oncology TEMSIROLIMUS TORISEL Oncology THALOMID Oncology THIOGUANINE TABLOID Oncology THYROTROPIN ALFA THYROGEN Oncology TOPOTECAN HCL HYCAMTIN Oncology TOPOTECAN HCL TOPOTECAN HCL Oncology TOREMIFENE CITRATE TOREMIFENE Oncology TRAMETINIB DIMETHYL MEKINIST Oncology TRASTUZUMAB HERCEPTIN Oncology TRASTUZUMAB/HYALURONIDASE HERCEPTIN HYLECTA Oncology TRETINOIN TRETINOIN Oncology TRETINOIN VESANOID Oncology TRIFLURIDINE/TIPIRACIL HCL LONSURF Oncology VALRUBICIN VALSTAR Oncology VANDETANIB CAPRELSA Oncology VEMURAFENIB ZELBORAF Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology VENETOCLAX VENCLEXTA Oncology VINBLASTINE VINBLASTINE Oncology VINCRISTINE VINCRISTINE Oncology VISMODEGIB ERIVEDGE Oncology ZOLINZA Oncology Supportive Therapies DALTEPARIN SODIUM,PORCINE FRAGMIN Oncology Supportive Therapies MESNA MESNA Oncology Supportive Therapies MESNA MESNEX Oncology Supportive Therapies LEUKINE Oncology Supportive Therapies TELOTRISTAT ETIPRATE XERMELO Ophthalmology EYLEA Ophthalmology BEVACIZUMAB AVASTIN Ophthalmology HYALURONATE SODIUM AMVISC Ophthalmology HYALURONATE SODIUM BIOLON Ophthalmology HYALURONATE SODIUM HEALON Ophthalmology HYALURONATE SODIUM HEALON5 Ophthalmology HYALURONATE SODIUM PROVISC Ophthalmology OCRIPLASMIN/PF JETREA Ophthalmology PEGAPTANIB SODIUM MACUGEN Ophthalmology RANIBIZUMAB LUCENTIS Ophthalmology ZIV-AFLIBERCEPT ZALTRAP Opioid Induced Constipation METHYLNALTREXONE BROMIDE RELISTOR Osteoarthritis HYALURONATE SODIUM EUFLEXXA Osteoarthritis HYALURONATE SODIUM GELSYN-3 Osteoarthritis HYALURONATE SODIUM GENVISC 850 Osteoarthritis HYALURONATE SODIUM HYALGAN Osteoarthritis HYALURONATE SODIUM ORTHOVISC Osteoarthritis HYALURONATE SODIUM SUPARTZ Osteoarthritis HYALURONATE SODIUM TRIVISC Osteoarthritis HYALURONATE SODIUM VISCO-3 Osteoarthritis HYALURONATE SODIUM, STABILIZED DUROLANE Osteoarthritis HYALURONATE SODIUM, STABILIZED MONOVISC Osteoarthritis HYALURONATE,MOD.,NON-CROSSLINK HYMOVIS Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Osteoarthritis HYLAN G-F 20 SYNVISC Osteoarthritis HYLAN G-F 20 SYNVISC-ONE ABALOPARATIDE TYMLOS Osteoporosis STRENSIQ Osteoporosis ZOLEDRONIC ACID ZOLEDRONIC ACID Osteoporosis ZOLEDRONIC ACID ZOMETA Osteoporosis ZOLEDRONIC ACID/MANNITOL-WATER RECLAST Osteoporosis TERIPARATIDE FORTEO Osteoporosis ROMOSOZUMAB EVENITY Osteoporosis DENOSUMAB PROLIA Periodic Fever Syndromes /PF ILARIS Periodic Fever Syndromes RILONACEPT ARCALYST (PKU) SAPROPTERIN DIHYDROCHLORIDE KUVAN Phenylketonuria (PKU) SAPROPTERIN DIHYDROCHLORIDE SAPROPTERIN DIHYDROCHLORIDE Paroxysmal Nocturnal Hemoglobinuria RAVULIZUMAB ULTOMIRIS Pheocromocytoma HCL PHENOXYBENZAMINE Pre-Term Birth HYDROXYPROGESTERONE CAPROAT/PF HYDROXYPROGESTERONE CAPROATE Pre-Term Birth HYDROXYPROGESTERONE CAPROAT/PF MAKENA Pulmonary Arterial (PAH) LETAIRIS Pulmonary Arterial Hypertension (PAH) TRACLEER Pulmonary Arterial Hypertension (PAH) EPOPROSTENOL SODIUM () VELETRI Pulmonary Arterial Hypertension (PAH) EPOPROSTENOL SODIUM (GLYCINE) EPOPROSTENOL SODIUM Pulmonary Arterial Hypertension (PAH) EPOPROSTENOL SODIUM (GLYCINE) FLOLAN Pulmonary Arterial Hypertension (PAH) TROMETHAMINE VENTAVIS Pulmonary Arterial Hypertension (PAH) OPSUMIT Pulmonary Arterial Hypertension (PAH) ADEMPAS Pulmonary Arterial Hypertension (PAH) UPTRAVI Pulmonary Arterial Hypertension (PAH) CITRATE REVATIO Pulmonary Arterial Hypertension (PAH) ADCIRCA Pulmonary Arterial Hypertension (PAH) TYVASO Pulmonary Arterial Hypertension (PAH) TREPROSTINIL DIOLAMINE ORENITRAM ER Pulmonary Arterial Hypertension (PAH) TREPROSTINIL SODIUM REMODULIN Respiratory Syncytial Virus (RSV) PALIVIZUMAB SYNAGIS Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Rheumatology ORENCIA Rheumatology ADALIMUMAB HUMIRA Rheumatology KINERET Rheumatology AURANOFIN RIDAURA Rheumatology OLUMIANT Rheumatology BENLYSTA Rheumatology CORTICOTROPIN H.P. ACTHAR Rheumatology ETANERCEPT ENBREL Rheumatology SIMPONI ARIA Rheumatology GOLIMUMAB SIMPONI Rheumatology INFLIXIMAB REMICADE Rheumatology INFLIXIMAB-ABDA RENFLEXIS Rheumatology INFLIXIMAB-AXXQ AVSOLA Rheumatology INFLIXIMAB-DYYB INFLECTRA Rheumatology METHOTREXATE OTREXUP Rheumatology METHOTREXATE XATMEP Rheumatology KEVZARA Rheumatology ACTEMRA Rheumatology TOFACITINIB CITRATE XELJANZ Rheumatology TOFACITINIB CITRATE XELJANZ XR Rheumatology USTEKINUMAB STELARA Rheumatology IXEKIZUMAB TALTZ Rheumatology SECUKINUMAB COSENTYX Rheumatology RINVOQ Rheumatology RITUXIMAB RITUXAN Sleep Disorders XYREM Sleep Disorders TASIMELTEON HETLIOZ Thrombocytopenia MULPLETA Thrombocytopenia FOSTAMATINIB TAVALISSE Transplant AZACITIDINE AZACITIDINE Transplant AZACITIDINE VIDAZA Transplant AZASAN Transplant AZATHIOPRINE AZATHIOPRINE Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Transplant AZATHIOPRINE IMURAN Transplant AZATHIOPRINE SODIUM AZATHIOPRINE SODIUM Transplant SIMULECT Transplant CYCLOSPORINE CYCLOSPORINE Transplant CYCLOSPORINE SANDIMMUNE Transplant CYCLOSPORINE, MODIFIED CYCLOSPORINE MODIFIED Transplant CYCLOSPORINE, MODIFIED GENGRAF Transplant CYCLOSPORINE, MODIFIED NEORAL Transplant EVEROLIMUS ZORTRESS Transplant MYCOPHENOLATE MOFETIL CELLCEPT Transplant MYCOPHENOLATE MOFETIL MYCOPHENOLATE MOFETIL Transplant MYCOPHENOLATE MOFETIL HCL CELLCEPT Transplant MYCOPHENOLATE SODIUM Transplant MYCOPHENOLATE SODIUM MYFORTIC Transplant PALIFERMIN KEPIVANCE Transplant RAPAMUNE Transplant SIROLIMUS SIROLIMUS Transplant ASTAGRAF XL Transplant TACROLIMUS ENVARSUS XR Transplant TACROLIMUS HECORIA Transplant TACROLIMUS PROGRAF Transplant TACROLIMUS TACROLIMUS Inhibitor NITYR Tyrosine Metabolism Inhibitor NITISINONE ORFADIN Cycle Disorders RAVICTI Disorders BUPHENYL Urea Cycle Disorders SODIUM PHENYLBUTYRATE SODIUM PHENYLBUTYRATE ACETATE FIRMAGON Urology LEUPROLIDE ACETATE LEUPROLIDE ACETATE Urology THIOLA