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CVS Specialty® Pharmacy Distribution Drug List Providing One of the Broadest Offerings of Specialty Pharmaceuticals in the Industry

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CVS Specialty® Pharmacy Distribution Drug List Providing One of the Broadest Offerings of Specialty Pharmaceuticals in the Industry July 2021 Updated Quarterly CVS Specialty® Pharmacy Distribution Drug List Providing one of the broadest offerings of specialty pharmaceuticals in the industry The CVS Specialty Pharmacy Distribution Drug List is a guide of medications available and distributed through CVS Specialty. Our goal is to help make your life better. With more than 40 years of experience, CVS Specialty provides quality care and service. Our network of pharmacies includes certifications and accreditations from the Joint Commission, Utilization Review Accreditation Commission (URAC), the National Association of Boards of Pharmacy (NABP) and the Accreditation Commission for Health Care (ACHC). These nationally recognized symbols reflect an organization’s commitment to meet highest standards of quality, compliance and safety. This list is updated quarterly. Below brand-name products are in CAPS, and generic products are shown in lowercase italics. Prospective Patients: Ready to get started? Enroll to get your medications from CVS Specialty. Health Care Providers: Visit the CVS Specialty website to download enrollment forms or call 1-800-237-2767 (TTY: 711). Therapy Class Brand Name Generic Name Acromegaly BYNFEZIA PEN octreotide acetate (SANDOSTATIN) SANDOSTATIN SANDOSTATIN LAR SOMATULINE DEPOT SOMAVERT Alcohol/Opioid Dependency PROBUPHINE IMPLANT KIT SUBLOCADE VIVITROL Allergen Immunotherapy ORALAIR PALFORZIA Alpha-1 Antitrypsin Deficiency ARALAST NP GLASSIA ZEMAIRA Amyloidosis ONPATTRO VYNDAMAX VYNDAQEL Anemia ARANESP EPOGEN PROCRIT REBLOZYL RETACRIT Asthma CINQAIR DUPIXENT FASENRA NUCALA XOLAIR Atopic Dermatitis DUPIXENT Botulinum Toxins DYSPORT MYOBLOC XEOMIN Cardiac Disorders ARCALYST dofetilide (TIKOSYN) TIKOSYN Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy. ©2021 CVS Specialty. All rights reserved. 75-CTC14953E July 2021 v06152021 CVS Specialty Pharmacy Distribution Drug List Page 1 of 17 July 2021 Updated Quarterly Therapy Class Brand Name Generic Name Coagulation Disorders CEPROTIN Contraceptives KYLEENA LILETTA MIRENA NEXPLANON SKYLA Cryopyrin-Associated Periodic ARCALYST Syndromes ILARIS Cystic Fibrosis BETHKIS tobramycin (BETHKIS) BRONCHITOL tobramycin nebulizer (TOBI) CAYSTON KITABIS PAK PULMOZYME TOBI TOBI PODHALER Electrolyte Disorders SAMSCA tolvaptan (SAMSCA) Enzyme Deficiency Disorders - Other nitisinone Gastrointestinal Disorders - Other GATTEX MYTESI OCALIVA SOLESTA Gout KRYSTEXXA Growth Hormone & Related Disorders EGRIFTA EGRIFTA SV GENOTROPIN HUMATROPE INCRELEX MACRILEN NORDITROPIN NUTROPIN AQ OMNITROPE SAIZEN SEROSTIM ZOMACTON ZORBTIVE Hematopoietics MOZOBIL Hemophilia, Von Willebrand Disease ADVATE & Related Bleeding Disorders ADYNOVATE AFSTYLA ALPHANATE ALPHANINE SD ALPROLIX BEBULIN BENEFIX COAGADEX CORIFACT ELOCTATE ESPEROCT FEIBA FIBRYGA HELIXATE FS Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy. ©2021 CVS Specialty. All rights reserved. 75-CTC14953E July 2021 v06152021 CVS Specialty Pharmacy Distribution Drug List Page 2 of 17 July 2021 Updated Quarterly Therapy Class Brand Name Generic Name Hemophilia, Von Willebrand Disease HEMLIBRA & Related Bleeding Disorders HEMOFIL M (cont.) HUMATE-P IDELVION IXINITY JIVI KOATE KOATE-DVI KOGENATE FS KOVALTRY MONONINE NOVOEIGHT NOVOSEVEN RT NUWIQ OBIZUR PROFILNINE PROFILNINE SD REBINYN RECOMBINATE RIASTAP RIXUBIS SEVENFACT STIMATE TRETTEN VONVENDI WILATE XYNTHA Hepatitis BARACLUDE adefovir dipivoxil (HEPSERA) EPCLUSA entecavir (BARACLUDE) EPIVIR HBV lamivudine hbv (EPIVIR HBV) HARVONI ribasphere HEPSERA ribavirin caps (ribasphere, REBETOL) INTRON A ribavirin tabs (ribasphere, MODERIBA) LEDIPASVIR-SOFOSBUVIR tenofovir disoproxil fumarate (VIREAD) MAVYRET MODERIBA PEGASYS PEGINTRON REBETOL REBETOL SOLUTION RIBASPHERE RIBAPAK SOFOSBUVIR/VELPATASVIR SOVALDI VEMLIDY VIEKIRA PAK VIREAD VOSEVI ZEPATIER Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy. ©2021 CVS Specialty. All rights reserved. 75-CTC14953E July 2021 v06152021 CVS Specialty Pharmacy Distribution Drug List Page 3 of 17 July 2021 Updated Quarterly Therapy Class Brand Name Generic Name Hereditary Angioedema BERINERT icatibant acetate (FIRAZYR) CINRYZE FIRAZYR HAEGARDA KALBITOR RUCONEST TAKHZYRO Hormonal Therapies AVEED leuprolide acetate (LUPRON) ELIGARD FENSOLVI FIRMAGON LUPANETA PACK LUPRON LUPRON DEPOT NATPARA SUPPRELIN LA TRELSTAR VANTAS ZOLADEX Human Immunodeficiency Virus APTIVUS abacavir tab (ZIAGEN) ATRIPLA abacavir-lamivudine (EPZICOM) BIKTARVY abacavir sulfate-lamivudine-zidovudine CABENUVA (TRIZIVIR) CIMDUO atazanavir sulfate (REYATAZ) COMBIVIR didanosine (VIDEX, VIDEX EC) COMPLERA efavirenz (SUSTIVA) CRIXIVAN efavirenz-emtricitabine-tenofovir df DELSTRIGO (ATRIPLA) DESCOVY efavirenz-lamivudine-tenofovir df DOVATO (SYMFI, SYMFI LO) EDURANT emtricitabine (EMTRIVA) EMTRIVA emtricitabine-tenofovir df EPIVIR (TRUVADA) EPZICOM etravirine (INTELENCE) EVOTAZ fosamprenavir (LEXIVA) FUZEON lamivudine (EPIVIR) GENVOYA lamivudine-zidovudine (COMBIVIR) INTELENCE lopinavir-ritonavir (KALETRA) INVIRASE nevirapine (VIRAMUNE, VIRAMUNE XR) ISENTRESS ritonavir (NORVIR) JULUCA stavudine (ZERIT) KALETRA tenofovir disoproxil fumarate (VIREAD) LEXIVA zidovudine (RETROVIR) NORVIR ODEFSEY PIFELTRO PREZCOBIX PREZISTA RESCRIPTOR RETROVIR RETROVIR INJECTABLE Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy. ©2021 CVS Specialty. All rights reserved. 75-CTC14953E July 2021 v06152021 CVS Specialty Pharmacy Distribution Drug List Page 4 of 17 July 2021 Updated Quarterly Therapy Class Brand Name Generic Name Human Immunodeficiency Virus REYATAZ (cont.) RUKOBIA SELZENTRY STRIBILD SUSTIVA SYMFI SYMFI LO SYMTUZA TEMIXYS TIVICAY TRIUMEQ TRIZIVIR TROGARZO TRUVADA TYBOST VIDEX VIDEX EC VIDEX SOL VIRACEPT VIRAMUNE VIRAMUNE XR VIREAD ZERIT ZIAGEN Immune Deficiencies & Related ASCENIV Disorders BIVIGAM CUTAQUIG CUVITRU CYTOGAM GAMASTAN GAMASTAN S/D GAMMAGARD LIQUID GAMMAGARD S/D GAMMAKED GAMMAPLEX GAMUNEX C HEPAGAM B HIZENTRA HYPERHEP B S/D HYPERRHO S/D HYQVIA MICRHOGAM NABI-HB OCTAGAM PANZYGA PRIVIGEN RHOGAM RHOPHYLAC Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy. ©2021 CVS Specialty. All rights reserved. 75-CTC14953E July 2021 v06152021 CVS Specialty Pharmacy Distribution Drug List Page 5 of 17 July 2021 Updated Quarterly Therapy Class Brand Name Generic Name Immune Deficiencies & Related VARIZIG Disorders (cont.) WINRHO SDF XEMBIFY Infectious Disease - Other ACTIMMUNE
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