Aetna Specialty Pharmacy Most Frequently Prescribed Medications

Aetna Specialty Pharmacy® Most Frequently Prescribed Medications‡

PRODUCT NAME GENERIC NAME PRODUCT NAME GENERIC NAME

ALCOHOLISM GROWTH HORMONE Vivatrol naltrexone Genotropin PR SI somatropin Humatrope* PR SI somatropin ALPHA-1 ANTITRYPSIN (AAT) DEFICIENCY Norditropin PR SI somatropin Nutropin PR SI somatropin Aralast alpha 1-proteinase inhibitor Nutropin AQ PR SI somatropin Prolastin alpha 1-proteinase inhibitor Saizen PR SI somatropin Serostim PR SI somatropin ASTHMA Tev-Tropin PR SI somatropin Xolair omalizumab HEMATOLOGY / CARDIOLOGY Brethine terbutaline sulfate Activase alteplase recombinant CHRONIC RENAL Arixtra SI fondaparinux Desferral deferrioxamine mesylate Aranesp darbepoetin alfa Fragmin SI dalteparin sodium Epogen epoetin alfa Heparin heparin sodium Ferrlecit sodium ferric gluconate complex Innohep* SI tinzaparin sodium Procrit* epoetin alfa Lovenox* SI enoxaparin sodium Phentolamine SI phentolamine mesylate CROHN’S DISEASE HEMOPHILIA Remicade inﬂiximab Advate PR SI antihemophilic factor VIII (recombinant) ENDOCRINOLOGY plasma/albumin free Alphanate PR SI antihemophilic factor VIII (human) Cortrosyn cosyntropin AlphaNine SD PR SI coagulation factor IX Dostinex cabergoline Amicar aminocaproic acid Forteo SI teriparatide Autoplex T PR SI anti-inhibitor coagulant complex Miacalcin calcitonin-salmon-synthetic Bebulin VH PR SI factor IX complex BeneFIX PR SI coagulation factor IX (recombinant) ENZYME REPLACEMENT Bioclate PR SI antihemophilic factor VIII (recombinant) DDAVP desmopressin acetate Aldurazyme laronidase FEIBA VH IMMUNO PR anti-inhibitor coagulant complex Helixate FS PR SI antihemophilic factor VIII (recombinate) FABRY DISEASE Hemoﬁl M PR SI antihemophilic factor VIII (human) Humate P PR SI antihemophilic factor/von Willebrand Fabrazyme agalsidase beta Factor complex (human) Hyate: C PR SI antihemophilic factor VIII (porcine) GAUCHER DISEASE Koate DVI PR SI antihemophilic factor VIII (human) Cerezyme imiglucerase

POMPE DISEASE Myozyme alglucosidase alfa

‡ This document is a sample list of medications that are available through Aetna Specialty Pharmacy. This list is subject to change. *Indicates medications that can be ﬁlled through our Ready-To-Inject, pre-ﬁlled syringe dosing program. If you have questions or need more information, please call 1-866-782-ASRX.

05.03.350.1 (11/06) PRODUCT NAME GENERIC NAME PRODUCT NAME GENERIC NAME

Kogenate FS PR SI antihemophilic factor VIII (recombinate) MACULAR DEGENERATION Monarc M PR SI antihemophilic factor VIII (human) Monoclate P PR SI antihemophilic factor VIII (human) Macugen pegaptanib sodium Mononine PR coagulation Factor IX Visudyne verteporfin NovoSeven PR coagulation Factor VIIa (recombinant) Profilnine SD PR factor IX complex NEUROLOGY / MULTIPLE SCLEROSIS Proplex T PR factor IX complex Recombinate PR antihemophilic factor VIII (recombinate) Avonex* SI interferon beta-1a Refacto PR antihemophilic factor VIII (recombinate) Betaseron SI interferon beta-1b Stimate desmopressin acetate Botox botulinum toxin type A Copaxone SI glatiramer acetate HEPATITIS Myobloc botulinum toxin type B Rebif SI interferon beta-1a BayHep B hepatitis B immune globulin Tysabri natalizumab Copegus ribavirin tablets Engerix-B hepatitis B vaccine recombinant ONCOLOGY Havrix hepatitis A vaccine inactivated Hepsera adefovir dipivoxil Adriamycin doxorubicin HCL Infergen PR SI interferon alfacon-1 Alferon N SI interferon alpha-N3 Nabi-HB hepatitis B immune globulin Alkeran melphalan Peg-Intron* PR SI peginterferon alfa 2b Aredia pamidronate disodium Pegasys* PR SI peginterferon alfa 2a Arimidex anastrozole Rebetol ribavirin capsules Aromasin exemestane Twinrix hepatitis A (inactive)/hepatitis B BCG Live bacillus calmette guerin (recombinate) Hepatitis B Vaccine BiCNU carmustine Recombinant Blenoxane bleomycin sulfate Bleomycin bleomycin sulfate HIV & AIDS CamPath alemtuzumab Camptosar irinotecan Fuzeon SI enfuvirtide Casodex bicalutamide CeeNU lomustine IMMUNE SYSTEM / IVIG Cerubidine daunorubicin HCL Cisplatin cisplatin Cosmegen dactinomycin BayRho-D Rho (D) immune globulin Cytadren aminoglutethimide Carimune NF PR immune globulin intraveous Cytarabine cytarabine CellCept mycophenolate mofetil Cytoxan cyclophosphamide CytoGam cytomegalovirus immune globulin Dacarbazine dacarbazine Depo-Medrol methylprednisolone Daunorubicin daunorubicin Flebogamma immune globulin intraveous DaunoXome daunorubicin citrate liposomal Gamastan immune globulin-intramuscular Delestrogen hormones endocrinology Gammagard S/D PR immune globulin intraveous Depo-Estradiol hormones endocrinology Gamunex PR immune globulin intraveous Depo-Testosterone hormones endocrinology Iveegam PR immune globulin intraveous Doxil doxorubicin liposomal Medrol methylprednisolone tablets Doxorubicin doxorubicin Octagam immune globulin intraveous Eligard leuprolide acetate Panglobulin NF PR immune globulin intraveous Ellence epirubicin Pentamidine pentamidine isethionate Eloxatin oxaliplatin Polygam SD PR immune globulin intraveous Elspar asparaginase Prograf tacrolimus Emcyt estramustine phosphate sodium RhoGam Rho (D) immune globulin Ethyol amifostine Sandimmune cyclosporine Etopophos etoposide Solu-Cortef hydrocortisone sodium sccinate Etoposide etoposide Venoglobulin-S PR SI immune globulin intraveous Eulexin flutamide Fareston toremifene citrate INFERTILITY Faslodex fulvestrant Femara letrozole Fludara fludarabine phosphate Bravelle PR SI urofollitropin PR Fluorouracil fluorouracil Cetrotide cetrorelix Gemzar gemcitabine HCL Chorionic PR PR SI Gleevec imatinib mesylate Gonadotropin chorionic gonadotropin Herceptin trastuzumab Clomid clomiphene citrate PR Hexalen altretamine Factrel gonadorelin Hycamtin topotecan Fertinex PR SI urofollitropin PR SI Idamycin idarubicin Follistim follitropin beta Idarubicin idarubicin Follistim AQ PR SI follitropin beta PR SI Ifex/Mesnex ifosfamide/mesna Ganirelix ganirelix acetate PR SI PR Intron A interferon alfa 2b Gonal-F follitropin alfa PR PR SI Iressa gefitinib HCG human chorionic gonadotropin Leukeran chlorambucil Humegon PR SI menotropins SI Leukine* sargramostim Lupron Depot leuprolide acetate Leuprolide leuprolide acetate Novarel PR SI chorionic gonadotropin PR SI Leustatin cladribine Ovidrel choriogonadotropin alfa Lupron leuprolide acetate Pergonal PR SI menotropins PR SI Lysodren mitotane Pregnyl human chorionic gonadotropin Matulane procarbazine Profasi HP human chorionic gonadotropin Mesnex mesna Progesterone progesterone PR SI Methotrexate methotrexate Repronex menotropins Mitomycin mitomycin PRODUCT NAME GENERIC NAME PRODUCT NAME GENERIC NAME

Mustargen mechlorethamine HCL PAIN MANAGEMENT Mutamycin mitomycin Myleran busulfan tablets Buprenex buprenorphine Mylotarg gemtuzumab ozogamicin Imitrex PR QL SI sumatriptan succinate Navelbine vinorelbine Ketorolac ketorlac tromethamine Neosar cyclophosphamide Lioresal baclofen NeuTrexin trimetrexate glucuronate Marcaine bupivacaine Nexavar sorafenib Nalbuphine nalbuphine Nipent pentostatin Nubain nalbuphine Nolvadex tamoxifen citrate tablets Novantrone mitoxantrone PARKINSON’S DISEASE Ontak denileukin diftitox Onxol paclitaxel Apokyn apomorphine Paclitaxel paclitaxel Panretin alitretinoin PSORIASIS Paraplatin carboplatin Photofrin porﬁmer sodium Amevive alefacept Platinol-AQ cisplatin Enbrel SI etanercept Plenaxis abarelix Raptiva SI efalizumab Proleukin* aldesleukin Purinethol mercaptopurine PULMONARY Revlimed lenalidomid Rituxan rituximab Coly-Mycin M colistimethate sodium Roferon-A* PR SI interferon alfa-2a Pulmozyme dornase alfa Sutent sunitinib malate Tobi tobramycin Tamoxifen tamoxifen citrate tablets Tarceva erlotinib RESPIRATORY SYNCYTIAL VIRUS (RSV) Targretin bexarotene PR Taxol paclitaxel Synagis palivizumab Taxotere docetaxel Temodar temozolomide TRANSPLANT Thalomid thalidomide CellCept mycophenolate Thioguanine thioguanine Deltasone prednisone Thioplex thiotepa Gengraf cyclosporine Trisenox arsenic trioxide Imuran azathioprine Velcade bortezomib Neoral cyclosporine VePesid etoposide Prograf tacrolimus Vesanoid tretinoin Rapamune sirolimus Vinblastine vinblastine sulfate Sandimmune cyclosporine Vincristine vincristine sulfate Prednisone prednisone Vumon teniposide Xeloda capecitabine Zanosar streptozocin Zinecard dexrazoxane Zoladex goserelin acetate

ONCOLOGY ADJUNCT Anzemet QL dolasetron mesylate Aloxi palonosetron Compazine prochlorperazine Droperidol droperidol Emend aprepitant Epogen epoetin alfa Kytril QL granisetron HCL Leucovorin leucovorin calcium Neulasta pegfilgrastim *Indicates medications that can be filled through our Neumega oprelvekin Ready-To-Inject, pre-filled syringe dosing program. Neupogen* filgrastim Procrit* epoetin alfa This document is a sample list of medications that are Sandostatin* octreotide acetate available through Aetna Specialty Pharmacy. This list is Zofran QL ondansetron HCL Zometa zoledronic acid subject to change. If you have questions or need more information, OSTEOARTHRITIS & RHEUMATOID ARTHRITIS please call 1-866-782-ASRX.

Hyalgan sodium hyaluronate Supartz sodium hyaluronate Synvisc hylan G-F 20 Acthar corticotropin Key Enbrel SI etanercept Humira SI adalimumab PR = Precertification required under most plans Kineret SI anakinra Methotrexate methotrexate QL = Quantity Limits applies under most plans Myochrysine gold sodium thiomalate SI = Self-injectable drug (some plans may cover injectable Remicade infliximab recombinant medications through the medical benefit) Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through mail order. The charges Aetna negotiates with Aetna Specialty Pharmacy may be higher than the cost it pays for the drugs and the costs of its specialty pharmacy services. For these purposes, Aetna Specialty Pharmacy’s cost of purchasing drugs takes into account discounts, credits and other amounts it may receive from wholesalers, manufacturers, suppliers and distributors.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or administer beneﬁts coverage include: Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Corporate Health Insurance Company and/or Aetna Life Insurance Company.