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July 2021 Updated Quarterly

CVS Specialty® Distribution List Providing one of the broadest offerings of specialty pharmaceuticals in the industry

The CVS Specialty Pharmacy Distribution Drug List is a guide of 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 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 Care (ACHC). These nationally recognized symbols reflect an ’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 /Opioid Dependency PROBUPHINE IMPLANT KIT SUBLOCADE VIVITROL Allergen ORALAIR

PALFORZIA Alpha-1 Antitrypsin Deficiency ARALAST NP GLASSIA ZEMAIRA Amyloidosis ONPATTRO VYNDAMAX VYNDAQEL ARANESP EPOGEN PROCRIT REBLOZYL RETACRIT Asthma CINQAIR DUPIXENT FASENRA NUCALA XOLAIR Atopic 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 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 BETHKIS tobramycin (BETHKIS) BRONCHITOL tobramycin nebulizer (TOBI) CAYSTON KITABIS PAK PULMOZYME TOBI TOBI PODHALER Electrolyte Disorders SAMSCA tolvaptan (SAMSCA) Deficiency Disorders - Other Gastrointestinal Disorders - Other GATTEX MYTESI

OCALIVA SOLESTA KRYSTEXXA & 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 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 caps (ribasphere, REBETOL) INTRON A ribavirin tabs (ribasphere, MODERIBA) LEDIPASVIR- 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 BERINERT acetate (FIRAZYR) CINRYZE FIRAZYR HAEGARDA KALBITOR RUCONEST TAKHZYRO Hormonal AVEED leuprolide acetate (LUPRON) ELIGARD FENSOLVI FIRMAGON LUPANETA PACK LUPRON LUPRON DEPOT NATPARA SUPPRELIN LA TRELSTAR VANTAS ZOLADEX 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 (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- (KALETRA) INVIRASE (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 ALFERON N NUZYRA

XENLETA Infertility CETROTIDE CHORIONIC GONADOTROPIN FOLLISTIM AQ GANIRELIX ACETATE GONAL-F MENOPUR NOVAREL OVIDREL PREGNYL Inflammatory Bowel Disease AVSOLA CIMZIA ENTYVIO HUMIRA INFLECTRA REMICADE RENFLEXIS SIMPONI ARIA STELARA IV TYSABRI XELJANZ ZEPOSIA Overload DESFERAL (EXJADE, JADENU) EXJADE deferiprone (FERRIPROX) JADENU (DESFERAL) Lysosomal Storage Disorders ALDURAZYME CERDELGA CEREZYME CYSTAGON ELAPRASE ELELYSO FABRAZYME KANUMA LUMIZYME NAGLAZYME VIMIZIM VPRIV Mental Health Conditions SPRAVATO ZULRESSO Migraine AIMOVIG AJOVY EMGALITY Movement Disorders APOKYN (NORTHERA) AUSTEDO tetrabenazine (XENAZINE) DUOPA

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 6 of 17

July 2021 Updated Quarterly

Therapy Class Brand Name Generic Name Movement Disorders (cont.) NORTHERA NOURIANZ NUPLAZID RADICAVA SOLIRIS XENAZINE AMPYRA dalfampridine ER (AMPYRA) AUBAGIO (TECFIDERA) AVONEX (COPAXONE, BAFIERTAM glatopa) BETASERON hcl COPAXONE EXTAVIA GILENYA KESIMPTA LEMTRADA MAVENCLAD MAYZENT OCREVUS PLEGRIDY PONVORY REBIF TECFIDERA TYSABRI VUMERITY ZEPOSIA Neurological Disorders ADUHELM FULPHILA GRANIX LEUKINE NEULASTA NEUPOGEN NIVESTYM NYVEPRIA UDENYCA ZARXIO ZIEXTENZO Ocular Disorders BEOVU DURYSTA EYLEA ILUVIEN LUCENTIS MACUGEN OZURDEX RETISERT TEPEZZA VISUDYNE – Injectable ADCETRIS azacitidine (VIDAZA) ARZERRA decitabine (DACOGEN) ASPARLAS levoleucovorin calcium AVASTIN mitoxantrone hcl

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 7 of 17

July 2021 Updated Quarterly

Therapy Class Brand Name Generic Name Oncology – Injectable (cont.) BAVENCIO (TORISEL) BELEODAQ valrubicin (VALSTAR) BELRAPZO zoledronic acid BENDAMUSTINE HCL BENDEKA BESPONSA BLINCYTO BORTEZOMIB CYRAMZA DACOGEN DARZALEX DARZALEX FASPRO EMPLICITI ENHERTU ERBITUX ERWINAZE EVOMELA FOLOTYN FUSILEV GAZYVA HALAVEN HERCEPTIN HERCEPTIN HYLECTA HERZUMA IMFINZI INTRON A ISTODAX IXEMPRA JEMPERLI JEVTANA KADCYLA KANJINTI KEYTRUDA KHAPZORY KYPROLIS LUMOXITI MARGENZA MVASI MYLOTARG OGIVRI ONCASPAR ONTRUZANT OPDIVO PADCEV PERJETA PHESGO POLIVY PORTRAZZA POTELIGEO PROLEUKIN RIABNI

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 8 of 17

July 2021 Updated Quarterly

Therapy Class Brand Name Generic Name Oncology – Injectable (cont.) RITUXAN RITUXAN HYCELA RUXIENCE RYBREVANT SARCLISA SYLVANT SYNRIBO TECENTRIQ TEMODAR TEPADINA THYROGEN TORISEL TRAZIMERA TREANDA TRUXIMA VALSTAR VECTIBIX VELCADE VIDAZA VYXEOS XGEVA YERVOY YONDELIS ZALTRAP ZEPZELCA ZIRABEV Oncology – Oral/Topical AFINITOR abiraterone acetate (ZYTIGA) ALECENSA bexarotene (TARGRETIN) ALUNBRIG capecitabine (XELODA) BOSULIF erlotinib hydrochloride BRAFTOVI (AFINITOR) CABOMETYX imatinib mesylate (GLEEVEC) COMETRIQ lapatinib ditosylate (TYKERB) COTELLIC temozolomide (TEMODAR) DAURISMO ERIVEDGE ERLEADA FARYDAK GLEEVEC HYCAMTIN IBRANCE IDHIFA INLYTA INQOVI INREBIC IRESSA JAKAFI KISQALI KISQALI FEMARA LENVIMA

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 9 of 17

July 2021 Updated Quarterly

Therapy Class Brand Name Generic Name Oncology – Oral/Topical (cont.) LONSURF LORBRENA LUMAKRAS LYNPARZA MEKINIST MEKTOVI NERLYNX NEXAVAR NINLARO NUBEQA ODOMZO ONUREG PIQRAY POMALYST PURIXAN RETEVMO REVLIMID ROZLYTREK RUBRACA RYDAPT SPRYCEL STIVARGA SUTENT TABRECTA TAFINLAR TAGRISSO TALZENNA TARGRETIN TASIGNA TEMODAR THALOMID TYKERB VERZENIO VITRAKVI VIZIMPRO VOTRIENT XALKORI XELODA XTANDI YONSA ZELBORAF ZOLINZA ZYDELIG ZYKADIA ZYTIGA Osteoarthritis DUROLANE EUFLEXXA GEL-ONE GELSYN-3 GENVISC 850 HYALGAN

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 10 of 17

July 2021 Updated Quarterly

Therapy Class Brand Name Generic Name Osteoarthritis (cont.) HYMOVIS MONOVISC ORTHOVISC SODIUM HYALURONATE SUPARTZSYNVISC SYNVISC ONE TRILURON TRIVISC VISCO-3 Osteoporosis EVENITY zoledronic acid (RECLAST) FORTEO PROLIA RECLAST TYMLOS Paroxysmal Nocturnal SOLIRIS Hemoglobinuria ULTOMIRIS KUVAN sapropterin dihydrochloride (KUVAN) PALYNZIQ Pre-Term Birth MAKENA hydroxyprogesterone capro (MAKENA) AVSOLA CIMZIA COSENTYX ENBREL HUMIRA ILUMYA INFLECTRA OTEZLA OTREXUP RASUVO REMICADE RENFLEXIS SILIQ SKYRIZI STELARA TALTZ TREMFYA XELJANZ Pulmonary Arterial ADCIRCA (LETAIRIS) ADEMPAS (TRACLEER) FLOLAN epoprostenol sodium (FLOLAN, LETAIRIS VELETRI) OPSUMIT sildenafil citrate (REVATIO) ORENITRAM tadalafil (ADCIRCA, alyq) REMODULIN treprostinil sodium (REMODULIN) REVATIO TRACLEER TYVASO REMODULIN REVATIO TRACLEER

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 11 of 17

July 2021 Updated Quarterly

Therapy Class Brand Name Generic Name Pulmonary Arterial Hypertension TYVASO (cont.) UPTRAVI VELETRI VENTAVIS Pulmonary Disorders - Other ESBRIET OFEV Rare Disorders - Other CRYSVITA DOJOLVI ENSPRYNG GAMIFANT Renal Disease PARSABIV cinacalcet hydrochloride (SENSIPAR) SENSIPAR tiopronin (THIOLA) THIOLA Respiratory Syncytial Virus SYNAGIS Rheumatoid Arthritis ACTEMRA AVSOLA CIMZIA ENBREL HUMIRA INFLECTRA KEVZARA OLUMIANT ORENCIA OTREXUP RASUVO REMICADE RENFLEXIS RIABNI RINVOQ RITUXAN RUXIENCE SIMPONI SIMPONI ARIA XELJANZ Disorders ACTHAR vigabatrin pwd (SABRIL PWD) EPIDIOLEX vigabatrin tabs (SABRIL TABS) SABRIL PWD SABRIL TABS ADAKVEO OXBRYTA Sleep Disorders WAKIX Systemic Erythematosus BENLYSTA DOPTELET MULPLETA NPLATE PROMACTA

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 12 of 17

July 2021 Updated Quarterly

Therapy Class Brand Name Generic Name Transplant ASTAGRAF XL cyclosporine (gengraf, NEORAL, CELLCEPT SANDIMMUNE) CELLCEPT INJ everolimus (ZORTRESS) ENVARSUS XR mycophenolate mofetil (CELLCEPT, MYFORTIC CELLCEPT INJECTABLE) NEORAL dr (MYFORTIC) NULOJIX (RAPAMUNE) PROGRAF (PROGRAF) PROGRAF INJECTABLE RAPAMUNE SANDIMMUNE ZORTRESS Cycle Disorders BUPHENYL (BUPHENYL) RAVICTI Wilson’s Disease CLOVIQUE (CUPRIMINE, DEPEN CUPRIMINE TITRA) DEPEN TITRA trientine (CLOVIQUE, SYPRINE) SYPRINE

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 13 of 17

July 2021 Updated Quarterly

Alphabetical Index CVS Specialty Pharmacy Distribution Drug List

A B 21. CORIFACT 9. ELIGARD abacavir tab 1. BAFIERTAM 22. COSENTYX 10. ELOCTATE abacavir-lamivudine 2. BARACLUDE 23. COTELLIC 11. EMGALITY abacavir sulfate- 3. BAVENCIO 24. CRIXIVAN 12. EMPLICITI lamivudine- 4. BEBULIN 25. CRYSVITA 13. emtricitabine zidovudine 5. BELEODAQ 26. CUPRIMINE emtricitabine- abiraterone acetate 6. BELRAPZO 27. CUTAQUIG tenofovir df ACTEMRA 7. BENDAMUSTINE 28. CUVITRU 14. EMTRIVA ACTHAR HYDROCHLORIDE 29. cyclosporine 15. ENBREL ACTIMMUNE 8. BENDEKA 30. CYRAMZA 16. ENHERTU

ADAKVEO 9. BENEFIX 31. CYSTAGON 17. ENSPRYNG ADCETRIS 10. BENLYSTA 32. CYTOGAM 18. entecavir ADCIRCA 11. BEOVU 19. ENTYVIO adefovir 12. BERINERT D 20. ENVARSUS XR ADEMPAS 13. BESPONSA 1. DACOGEN 21. EPCLUSA ADUHELM 14. BETASERON 2. dalfampridine ER 22. EPIDIOLEX ADVATE 15. BETHKIS 3. DARZALEX 23. EPIVIR ADYNOVATE 16. bexarotene 4. DARZALEX FASPRO 24. EPIVIR HBV AFINITOR 17. BIKTARVY 5. DAURISMO 25. EPOGEN AFSTYLA 18. BIVIGAM 6. decitabine 26. epoprostenol sodium AIMOVIG 19. BLINCYTO 7. deferasirox 27. EPZICOM AJOVY 20. BORTEZOMIB deferiprone 28. ERBITUX ALDURAZYME 21. bosentan 8. deferoxamine 29. ERIVEDGE ALECENSA 22. BOSULIF 9. DELSTRIGO 30. ERLEADA ALFERON N 23. BRAFTOVI 10. DEPEN TITRA erlotinib ALPHANATE 24. BRONCHITOL 11. DESCOVY hydrochloride ALPHANINE SD BUPHENYL 12. DESFERAL 31. ERWINAZE ALPROLIX BYNFEZIA PEN 13. didanosine 32. ESBRIET ALUNBRIG 14. dimethyl fumarate 33. ESPEROCT 34. etravirine alyq C 15. dofetilide 35. EUFLEXXA ambrisentan 1. CABENUVA 16. DOJOLVI AMPYRA 17. DOPTELET 36. EVENITY 2. CABOMETYX 37. everolimus APOKYN 3. capecitabine 18. DOVATO APTIVUS 19. droxidopa 38. EVOMELA 4. CAYSTON 39. EVOTAZ ARALAST NP 5. CELLCEPT 20. (NORTHERA) ARANESP 21. DUOPA 40. EXJADE 6. CEPROTIN 41. EXTAVIA ARCALYST 7. CERDELGA 22. DUPIXENT ARZERRA 23. DUROLANE 42. EYLEA 8. CEREZYME ASCENIV 9. CETROTIDE 24. DURYSTA F ASPARLAS 10. CHORIONIC 25. DYSPORT ASTAGRAF XL GONADOTROPIN 1. FABRAZYME atazanavir sulfate 11. CIMDUO E 2. FARYDAK ATRIPLA 12. CIMZIA 1. EDURANT 3. FASENRA AUBAGIO 13. cinacalcet 2. efavirenz 4. FEIBA AUSTEDO hydrochloride 3. efavirenz- 5. FENSOLVI AVASTIN 14. CINQAIR emtricitabine- 6. FERRIPROX AVEED 15. CINRYZE tenofovir df 7. FIBRYGA AVONEX CLOVIQUE 4. efavirenz-lamivudine- 8. FIRAZYR AVSOLA 16. COAGADEX tenofovir df 9. FIRMAGON azacitidine 17. COMBIVIR 5. EGRIFTA 10. FLOLAN 18. COMETRIQ 6. EGRIFTA SV 11. FOLLISTIM AQ 19. COMPLERA 7. ELAPRASE 12. FOLOTYN 20. COPAXONE 8. ELELYSO 13. FORTEO

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 14 of 17

July 2021 Updated Quarterly

14. fosamprenavir I lamivudine- 3. NATPARA 15. FULPHILA 1. IBRANCE zidovudine 4. NEORAL 16. FUSILEV 2. icatibant acetate 3. lapatinib ditosylate 5. NERLYNX 17. FUZEON 3. IDELVION 4. LEDIPASVIR- 6. NEULASTA 4. IDHIFA SOFOSBUVIR 7. NEUPOGEN G 5. ILARIS 5. LEMTRADA 8. nevirapine 1. GAMASTAN 6. ILUMYA 6. LENVIMA 9. NEXAVAR 2. GAMASTAN S/D 7. ILUVIEN 7. LETAIRIS 10. NEXPLANON 3. GAMIFANT 8. imatinib mesylate 8. LEUKINE 11. NINLARO 4. GAMMAGARD 9. IMFINZI 9. leuprolide acetate 12. nitisinone LIQUID 10. INCRELEX levoleucovorin 13. NIVESTYM 5. GAMMAGARD S/D 11. INFLECTRA calcium 14. NORDITROPIN

6. GAMMAKED 12. INLYTA 10. LEXIVA 15. NORTHERA 7. GAMMAPLEX 13. INQOVI 11. LILETTA 16. NORVIR 8. GAMUNEX C 14. INREBIC 12. LONSURF 17. NOURIANZ 9. GANIRELIX ACETATE 15. INTELENCE 13. lopinavir-ritonavir 18. NOVAREL 10. GATTEX 16. INTRON A 14. LORBRENA 19. NOVOEIGHT 11. GAZYVA 17. INVIRASE 15. LUCENTIS 20. NOVOSEVEN RT 12. GEL-ONE 18. IRESSA 16. LUMAKRAS 21. NPLATE 13. GELSYN-3 19. ISENTRESS 17. LUMIZYME 22. NUBEQA 14. gengraf 20. ISTODAX 18. LUMOXITI 23. NUCALA 15. GENOTROPIN 21. IXEMPRA 19. LUPANETA PACK 24. NULOJIX 16. GENVISC 850 22. IXINITY 20. LUPRON 25. NUPLAZID 17. GENVOYA 21. LUPRON DEPOT 26. NUTROPIN AQ 22. LYNPARZA 27. NUWIQ 18. GILENYA J 28. NUZYRA 19. GLASSIA 1. JADENU 20. glatiramer acetate M 29. NYVEPRIA 2. JAKAFI 21. glatopa 1. MACRILEN 3. JEMPERLI O 22. GLEEVEC 4. JEVTANA 2. MACUGEN 23. GONAL-F 5. JIVI 3. MAKENA 1. OBIZUR 24. GRANIX 6. JULUCA 4. MARGENZA 2. OCALIVA 5. MAVENCLAD 3. OCREVUS 6. MAVYRET 4. OCTAGAM H K 7. MAYZENT 5. octreotide acetate 1. HAEGARDA 1. KADCYLA 2. HALAVEN 8. MEKINIST 6. ODEFSEY 2. KALBITOR 9. MEKTOVI 7. ODOMZO 3. HARVONI 3. KALETRA 4. HELIXATE FS 10. MENOPUR 8. OFEV 4. KANJINTI 11. MICRHOGAM 9. OGIVRI 5. HEMLIBRA 5. KANUMA 6. HEMOFIL M 12. miglustat 10. OLUMIANT 6. KESIMPTA 13. MIRENA 11. OMNITROPE 7. HEPAGAM B 7. KEVZARA 8. HEPSERA 14. mitoxantrone hcl 12. ONCASPAR 8. KEYTRUDA 15. MODERIBA 13. ONPATTRO 9. HERCEPTIN 9. KHAPZORY 10. HERCEPTIN 16. MONONINE 14. ONTRUZANT 10. KISQALI 17. MONOVISC 15. ONUREG HYLECTA 11. KISQALI FEMARA 11. HERZUMA 18. MOZOBIL 16. OPDIVO 12. KITABIS PAK 19. MULPLETA 17. OPSUMIT 12. HIZENTRA 13. KOATE 13. HUMATE-P 20. MVASI 18. ORALAIR 14. KOATE-DVI 21. mycophenolate 19. ORENCIA 14. HUMATROPE 15. KOGENATE FS 15. HUMIRA mofetil 20. ORENITRAM 16. KOVALTRY 22. mycophenolic acid dr 21. ORTHOVISC 16. HYALGAN 17. KRYSTEXXA 17. HYCAMTIN 23. MYFORTIC 22. OTEZLA 18. KUVAN 24. MYLOTARG 23. OTREXUP 18. hydroxyprogesterone 19. KYLEENA capro 25. MYOBLOC 24. OVIDREL 20. KYPROLIS 26. MYTESI 25. OXBRYTA 19. HYMOVIS 20. HYPERHEP B S/D 26. OZURDEX L 21. HYPERRHO S/D N 22. HYQVIA 1. lamivudine 1. NABI-HB P 2. lamivudine hbv 2. NAGLAZYME 1. PADCEV

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 15 of 17

July 2021 Updated Quarterly

2. PALFORZIA 22. REVLIMID 28. SPRYCEL 35. TRAZIMERA 3. PALYNZIQ 23. REYATAZ 29. stavudine 36. TREANDA 4. PANZYGA 24. RHOGAM 30. STELARA 37. TRELSTAR 5. PARSABIV 25. RHOPHYLAC 31. STELARA IV 38. TREMFYA 6. PEGASYS 26. RIABNI 32. STIMATE 39. treprostinil sodium 7. PEGINTRON 27. RIASTAP 33. STIVARGA 40. TRETTEN 8. penicillamine 28. ribasphere 34. STRIBILD 41. trientine (CLOVIQUE, 9. (CUPRIMINE, 29. RIBASPHERE 35. SUBLOCADE 42. SYPRINE) 10. DEPEN TITRA) RIBAPAK 36. SUPARTZ 43. TRILURON 11. PERJETA 30. ribavirin caps 37. SUPPRELIN LA 44. TRIUMEQ 12. PHESGO 31. ribavirin tabs 38. SUSTIVA 45. TRIVISC 13. PIFELTRO 32. RINVOQ 39. SUTENT 46. TRIZIVIR 14. PIQRAY 33. ritonavir 40. SYLVANT 47. TROGARZO 15. PLEGRIDY 34. RITUXAN 41. SYMFI 48. TRUVADA 16. POLIVY 35. RITUXAN HYCELA 42. SYMFI LO 49. TRUXIMA 17. POMALYST 36. RIXUBIS 43. SYMTUZA 50. TYBOST 18. PONVORY 37. ROMIDEPSIN 44. SYNAGIS 51. TYKERB 19. PORTRAZZA 38. ROZLYTREK 45. SYNRIBO 52. TYMLOS 20. POTELIGEO 39. RUBRACA 46. SYNVISC 53. TYSABRI 21. PREGNYL 40. RUCONEST 47. SYNVISC ONE 54. TYVASO 22. PREZCOBIX 41. RUKOBIA 48. SYPRINE 55. 23. PREZISTA 42. RUXIENCE U 24. PRIVIGEN 43. RYBREVANT T 1. UDENYCA 25. PROBUPHINE 44. RYDAPT 1. TABRECTA 2. ULTOMIRIS IMPLANT KIT 2. tacrolimus 3. UPTRAVI 26. PROCRIT S 3. tadalafil 27. PROFILNINE 1. SABRIL PWD 4. TAFINLAR V 28. PROFILNINE SD 2. SABRIL TABS 5. TAGRISSO 1. valrubicin 29. PROGRAF 3. SAIZEN 6. TAKHZYRO 30. PROGRAF 2. VALSTAR 4. SAMSCA 7. TALTZ 3. VANTAS INJECTABLE 5. SANDIMMUNE 8. TALZENNA 31. PROLEUKIN 4. VARIZIG 6. SANDOSTATIN 9. TARGRETIN 5. VECTIBIX 32. PROLIA 7. SANDOSTATIN LAR 10. TASIGNA 6. VELCADE 33. PROMACTA sapropterin 11. TECENTRIQ 34. PULMOZYME 7. VELETRI dihydrochloride 12. TECFIDERA 8. VEMLIDY 35. PURIXAN 8. SARCLISA 13. TEMIXYS 9. VENTAVIS 9. SELZENTRY 14. TEMODAR (ORAl) R 10. VERZENIO 10. SENSIPAR 15. TEMODAR (INJ) 11. VIDAZA 1. RADICAVA 11. SEROSTIM 16. temozolomide 12. VIDEX 2. RAPAMUNE 12. SEVENFACT 17. temsirolimus 13. VIDEX EC 3. RASUVO 13. sildenafil citrate tenofovir disoproxil 14. VIDEX SOL

4. RAVICTI 14. SILIQ fumarate 15. VIEKIRA PAK 5. REBETOL 15. SIMPONI 18. TEPADINA 16. vigabatrin pwd 6. REBETOL SOLUTION 16. SIMPONI ARIA 19. TEPEZZA 17. vigabatrin tabs 7. REBIF 17. sirolimus 20. TERIPARATIDE 18. VIMIZIM 8. REBINYN 18. SKYLA 21. tetrabenazine 19. VIRACEPT 9. REBLOZYL 19. SKYRIZI 22. THALOMID 20. VIRAMUNE 10. RECLAST 20. SODIUM 23. THIOLA 21. VIRAMUNE XR 11. RECOMBINATE HYALURONATE 24. THYROGEN 22. VIREAD 12. REMICADE sodium 25. TIKOSYN 23. VISCO-3 13. REMODULIN phenylbutyrate 26. tiopronin 24. VISUDYNE 14. RENFLEXIS 21. SOFOSBUVIR- 27. TIVICAY 25. VITRAKVI 15. RESCRIPTOR VELPATASVIR 28. TOBI 26. VIVITROL 16. RETACRIT 22. SOLESTA 29. TOBI PODHALER 27. VIZIMPRO 17. RETEVMO 23. SOLIRIS 30. tobramycin 28. VONVENDI 18. RETISERT 24. SOMATULINE DEPOT 31. tobramycin nebulizer 29. VOSEVI

19. RETROVIR 25. SOMAVERT 32. tolvaptan 30. VOTRIENT 20. RETROVIR INJ 26. SOVALDI 33. TORISEL 31. VPRIV 21. REVATIO 27. SPRAVATO 34. TRACLEER

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 16 of 17

July 2021 Updated Quarterly

32. VUMERITY 4. XEMBIFY Z 14. zoledronic acid 33. VYNDAMAX 5. XENAZINE 1. ZALTRAP 15. ZOLINZA 34. VYNDAQEL 6. XENLETA 2. ZARXIO 16. ZOMACTON 35. VYXEOS 7. XEOMIN 3. ZELBORAF 17. ZORBTIVE 8. XGEVA 4. ZEMAIRA 18. ZORTRESS W 9. XOLAIR 5. ZEPATIER 19. ZULRESSO 1. WAKIX 10. XTANDI 6. ZEPOSIA 20. ZYDELIG 2. WILATE 11. XYNTHA 7. ZEPZELCA 21. ZYKADIA 3. WINRHO SDF 8. ZERIT 22. ZYTIGA Y 9. ZIAGEN X YERVOY 10. zidovudine 1. XALKORI YONDELIS 11. ZIEXTENZO 2. XELJANZ YONSA 12. ZIRABEV 3. XELODA 13. ZOLADEX

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 17 of 17