Specialty Pharmacy Medication List
ALLERGY & IMMUNOLOGY ENDOCRINE (CONT) NEUROLOGY (CONT) Specialty Medications Retail Plus Medications Retail Plus Medications Adalimumab (Humira) Leuprolide (Lupron Depot) Clobazam (Onfi) Apremilast (Otezla) Erenumab-aooe (Aimovig) Dupilumab (Dupixent) GASTROENTEROLOGY Felbamate (Felbatol) Etanercept (Enbrel) Specialty Medications Fremanezumab (Ajovay) Icatibant (Firazyr) Adalimumab (Humira) Galcanezumab (Emgality) Interferon Gamma-1b (Actimmune) Certolizumab (Cimzia) Perampanel (Fycompa) Peginterferon alfa-2a (Pegasys, Pegasys Entecavir (Baraclude) ProClick) Golimumab (Simponi) ONCOLOGY Peginterferon alfa-2b (Peg-Intron) Glecaprevir-Pibrentasvir (Mevyret) Specialty Medications Ruxolitinib (Jakafi) Ledipasvir-Sofusbuvir (Harvoni) Bexarotene (Targretin) Tocilizumab (Actemra) Somatropin (Genotropin, Humatrope, Capecitabine (Xeloda) Ustekinumab (Stelara) Norditropin, Nutropin, Omnitrope, Cobimetinib (Cotellic) Retail Plus Medications Saizen, Serostim, Tevtropin, Dabrafenib (Tafinlar) Isavuconazole (Cresemba) Zomacton, Zorbtive) Dasatinib (Sprycel) Posaconazole (Noxafil) Tenofovir (Viread) Everolimus (Afinitor) Valganciclovir (Valcyte) Trientine (Clovique, Syprine) Ibrutinib (Imbruvica) Voriconazole (VFend) Ustekinumab (Stelara) Imatinib (Gleevec) Retail Plus Medications Larotrectinib (Vitrakvi) COMPLEX CARE Budesonide (Uceris) Mercaptopurine (Purixan only) Specialty Medications Pancrelipase (Creon, Viokase, Zenpep, Midostaurin (Rydapt) Aztreonam inhaled (Cayston) Pertzye, Pancrease) Nilotinib (Tasigna) Dornase Alfa (Pulmozyme) Valganciclovir (Valcyte) Pazopanib (Votrient) Fingolimod (Gilenya) Ruxolitinib (Jakafi) Glatiramer Acetate (Copaxone) HEMATOLOGY Selumetinib (Koselugo) Interferon Beta-1b (Betaseron, Extavia) Specialty Medications Sirolimus (Rapamune) Sildenafil (Revatio) Deferasirox (Exjade, Jadenu) Sorafenib (Nexavar) Tadalafil (Adcirca, Cialis) Eltrombopag (Promacta) Temozolomide (Temodar) Tetrabenazine - Generic only Filgrastim (Neupogen, Granix, Zarxio) Trametinib (Mekinist) Tobramycin (Bethkis, Kitabis, TOBI) Imatinib (Gleevec) Tretinoin (ATRA) Retail Plus Medications Interferon Alfa-2b (Sylatron) Vemurafenib (Zelboraf) Amikacin inhaled (Amikin) Romiplostim (NPlate) Venetoclax (Venclexa) Amphotericin B inhaled (Fungizone) Sirolimus (Rapamune) Retail Plus Medications Clobazam (Onfi) Trametinib (Mekinist) Etoposide (Toposar) Colistimethate inhaled (Colistin) Voxelotor (Oxbryta) Gentamicin injection for inhalation Retail Plus Medications PULMONARY Felbamate (Felbatol) Glutamine Powder (Endari) Specialty Medications Tobramycin injection for inhalation Aztreonam inhaled (Cayston) MULTIPLE SCLEROSIS Dornase Alfa (Pulmozyme) DERMATOLOGY Specialty Medications Dupilumab (Dupixent) Specialty Medications Fingolimod (Gilenya) Ivacaftor (Kalydeco)* Adalimumab (Humira) Glatiramer Acetate (Copaxone) Ivacaftor-Elexacaftor-Tezacaftor Apremilast (Otezla) Interferon Beta-1a (Avonex, Rebif) (Trikafta)* Dupilumab (Dupixent) Interferon Beta-1b (Betaseron, Extavia) Ivacaftor-Lumacaftor (Orkambi)* Etanercept (Enbrel) Ivacaftor-Tezacaftor (Symdeko)* NEUROLOGY Pirfenidone (Esbriet) ENDOCRINE Specialty Medications Tobramycin (Bethkis, Kitabis, TOBI) Specialty Medications Cannibidiol (Epidiolex) *These medications require review and approval by Somatropin (Genotropin, Humatrope, Everolimus (Afinitor) clinic pharmacist for dispensing via TCH specialty prior to initial fill Norditropin, Nutropin, Omnitrope, Tetrabenazine - Generic only Saizen, Serostim, Tevtropin, Zomacton, Zorbtive) Effective Date: October 7, 2020 Specialty Pharmacy Medication List
PULMONARY (CONT) RETROVIROLOGY (CONT) Retail Plus Medications Specialty Medications Amikacin inhaled (Amikin) Elviteg-Cobic-Emtricitabine-Tenofovir Amphotericin B inhaled (Fungizone) (Genvoya) Colistimethate inhaled (Colistin) Emtricitabine-Rilpivirine-Tenofovir Gentamicin injection for inhalation Alafenamide (Odefsey) Pancrelipase (Creon, Viokase, Zenpep, Emtricitabine-Tenofovir (Descovy, Pertzye, Pancrease) Truvada) Tobramycin injection for inhalation Etravirine (Intelence) Vancomycin inhaled (Vancocin) Nevirapine (Viramune) Voriconazole inhaled (VFend) Raltegravir Potassium (Isentress) Rilpivirine (Edurant) PULMONARY HYPERTENSION Ritonavir (Norvir) Specialty Medications Tenofovir Disoproxil Fumarate (Viread) Sildenafil (Revatio) Zidovudine (Retrovir)# Tadalafil (Adcirca) #Patients will NOT be enrolled for zidovudine monotherapy, zodovudine must be part of combination therapy for enrollment. This RENAL medication requires review by a pharmacist prior to Specialty Medications determination of opportunity. Cinacalcet (Sensipar) Darbepoetin Alfa (Aranesp) RHEUMATOLOGY Epoetin Alfa (Epogen, Procrit) Specialty Medications Mycophenolate Mofetil (Cellcept) Abatacept (Orencia) Mycophenolic acid (Myfortic) Adalimumab (Humira) Somatropin (Norditropin) Anakinra (Kineret) Tacrolimus (Prograf, Astagraf) Canakinumab (Ilaris) Retail Plus Medications Etanercept (Enbrel) Indomethacin susp. (Indocin) Golimumab (Simponi) Metyrosine (Demser) Methotrexate (Otrexup, Rasuvo) Phenoxybenzamine (Dibenzyline) Mycophenolate Mofetil (Cellcept) Sevelamer (Renagel, Renvela) Mycophenolic acid (Myfortic) Ruxolitinib (Jakafi) RETROVIROLOGY Toclizumab (Actemra) Specialty Medications Tofacitinib (Xeljanz) Abacavir (Ziagen) Ustekinumab (Stelara) Abacavir-Lamivudine (Epzicom) Abacavir-Dolutegravir-Lamivudine TRANSPLANT (Triumeq) Specialty Medications Atazanavir-Cobicistat (Evotaz) Cyclosporine (Sandimmune) Atazanavir (Reyataz) Cyclosporine modified (Neoral, Bictegravir-Emtricitabine-Tenofovir Gengraf) Alafenamide (Biktarvy) Everolimus (Zortress) Darunavir (Prezista) Mycophenolate Mofetil (Cellcept) Darunavir-Cobicistat (Prezcobix) Mycophenolic acid (Myfortic) Darunavir-Cobicistat-Emtricitabine- Sirolimus (Rapamune) Tenofovir (Symtuza) Tacrolimus (Prograf, Astagraf) Dolutegravir Sodium (Tivicay, Tivicay Retail Plus Medications PD) Azathioprine (Imuran) Dolutegravir-Rilpivirine (Juluca) Tedizolid (Sivextro) Efavirenz (Sustiva) Valganciclovir (Valcyte) Efavirenz-Emtricitabine-Tenofovir Voriconazole (VFend) (Atripla)
Effective Date: October 7, 2020 Specialty Pharmacy Medication List
Limited Distribution Drugs (LDD) not currently available via TCH Specialty Pharmacy:
ENDOCRINE Lanreotide (Somatuline) Mecasermin (Increlex) Nafarelin (Synarel)
GASTROENTEROLOGY Miglustat (Zavesca)
HEMATOLOGY Deferiprone (Ferriprox)
MULTIPLE SCLEROSIS Dalfampridine (Ampyra) Dimethyl Fumarate (Tecfidera) Peginterferon beta-1a (Avonex, Pegridy, Rebif) Peginterferon beta-1b (Betaseron, Extavia) Teriflunomide (Aubagio)
NEUROLOGY Repository Corticotropin (HP Acthar®) Vigabatrin (Sabril®) Tetrabenazine (Xenazine) Brand name only
ONCOLOGY Crizotinib (Xalkori) Sunitinib Malate (Sutent)
PULMONARY HYPERTENSION Ambreisentan (Letairis) Bosentan (Tracleer) Iloprost (Ventavis) Macitenan (Opsumit) Treprostinil (Orenitram, Remodulin, Tyvaso)
RENAL Cysteamine (Cystagon, Procysbi)
Effective Date: October 7, 2020