HAMP - Health Alliance Medical Plan – Commercial
HAMP - Health Alliance Primary Alt Descriptions HCPCS Codes Medical Plan - Administration Technique Drug Class Commercial 5-Fluorouracil 5FU, Adrucil J9190 Y INJECTABLE Primary
Ado-Trastuzumab Emtansine Kadcyla J9354 Y INJECTABLE Primary
Aldesleukin Proleukin, Interleukin-2 J9015 Y INJECTABLE Primary
Arsenic Trioxide Trisenox J9017 Y INJECTABLE Primary
Asparaginase Erwinaze J9019 Y INJECTABLE Primary
Atezolizumab Tecentriq J9022 Y INJECTABLE Primary
Avelumab Bavencio J9023 Y INJECTABLE Primary
Azacitidine Vidaza J9025 Y INJECTABLE Primary
BCG TheraCys, Tice J9031 Y INJECTABLE Primary
Belinostat Beleodaq J9032 Y INJECTABLE Primary
Bendamustine Bendamustine (Not otherwise specified) C9399 Y INJECTABLE Primary
Bendamustine Bendamustine (Not otherwise specified) J9999 Y INJECTABLE Primary
Bendamustine Treanda J9033 Y INJECTABLE Primary
Bendamustine HCL Belrapzo C9042 Y INJECTABLE Primary
Bendamustine HCL Bendeka J9034 Y INJECTABLE Primary
Bevacizumab Avastin J9035 Y INJECTABLE Primary
Bevacizumab-awwb (not currently Mvasi Q5107 Y INJECTABLE Primary available on the market) Bleomycin Blenoxane J9040 Y INJECTABLE Primary
Blinatumomab Blincyto J9039 Y INJECTABLE Primary
Bortezomib Velcade J9041 Y INJECTABLE Primary
Bortezomib Bortezomib (not otherwise specified) J9044 Y INJECTABLE Primary
Brentuximab Vedotin Adcetris J9042 Y INJECTABLE Primary
Cabazitaxel Jevtana J9043 Y INJECTABLE Primary
Calaspargase pegol-mknl Asparlas J3490 Y INJECTABLE Primary
Calaspargase pegol-mknl Asparlas J3590 Y INJECTABLE Primary
Carboplatin Paraplatin J9045 Y INJECTABLE Primary
Carfilzomib Kyprolis J9047 Y INJECTABLE Primary
Carmustine BiCNU, BCNU J9050 Y INJECTABLE Primary
Cemiplimab-rwlc Libtayo C9399 Y INJECTABLE Primary
Cemiplimab-rwlc Libtayo J9999 Y INJECTABLE Primary
Cemiplimab-rwlc Libtayo C9044 Y INJECTABLE Primary
Cetuximab Erbitux J9055 Y INJECTABLE Primary
Cisplatin Platinol J9060 Y INJECTABLE Primary
Page 1 of 8 HAMP - Health Alliance Primary Alt Descriptions HCPCS Codes Medical Plan - Administration Technique Drug Class Commercial Cladribine Leustatin J9065 Y INJECTABLE Primary
Clofarabine Clolar J9027 Y INJECTABLE Primary
Copanlisib Aliqopa J9057 Y INJECTABLE Primary
Cyclophosphamide - inj Cytoxan, Endoxan-Asta J9070 Y INJECTABLE Primary
Cytarabine Ara-C J9100 Y INJECTABLE Primary
Cytarabine-Liposome DepoCyt J9098 Y INJECTABLE Primary
Dacarbazine DTIC-Dome J9130 Y INJECTABLE Primary
Dactinomycin Cosmegen, Actinomycin J9120 Y INJECTABLE Primary
Daratumumab Darzalex J9145 Y INJECTABLE Primary
Daunorubicin Cerubidine J9150 Y INJECTABLE Primary
Decitabine Dacogen J0894 Y INJECTABLE Primary
Degarelix Firmagon J9155 Y INJECTABLE Primary
Denosumab Xgeva, Prolia J0897 Y INJECTABLE Primary
Dinutuximab Unituxin C9399 Y INJECTABLE Primary
Dinutuximab Unituxin J9999 Y INJECTABLE Primary
Docetaxel Taxotere J9171 Y INJECTABLE Primary
Doxorubicin HCL Adriamycin J9000 Y INJECTABLE Primary
Doxorubicin HCL (liposomal) Lipodox Q2049 Y INJECTABLE Primary
Doxorubicin HCL (liposomal) Doxil Q2050 Y INJECTABLE Primary
Durvalumab Imfinzi J9173 Y INJECTABLE Primary
Elotuzumab Empliciti J9176 Y INJECTABLE Primary
Epirubicin Ellence J9178 Y INJECTABLE Primary
Eribulin mesylate Halaven J9179 Y INJECTABLE Primary
Etoposide - inj Toposar, VePesid, Etopophos J9181 Y INJECTABLE Primary
Floxuridine FUDR J9200 Y INJECTABLE Primary
Fludarabine Phosphate Fludara, Oforta J9185 Y INJECTABLE Primary
Fulvestrant Faslodex J9395 Y INJECTABLE Primary
Gemcitabine Gemzar J9201 Y INJECTABLE Primary
Gemcitabine HCL - NACL Infugem J3490 Y INJECTABLE Primary
Gemcitabine HCL - NACL Infugem J9999 Y INJECTABLE Primary
Gemtuzumab Ozogamicin Mylotarg J9203 Y INJECTABLE Primary
Goserelin acetate implant Zoladex J9202 Y INJECTABLE Primary
Histrelin Implant Vantas J9225 Y INJECTABLE Primary
Idarubicin HCL - inj Idamycin J9211 Y INJECTABLE Primary
Ifosfamide Ifex, Mitoxana J9208 Y INJECTABLE Primary
Inotuzumab Ozogamicin Besponsa J9229 Y INJECTABLE Primary
Page 2 of 8 HAMP - Health Alliance Primary Alt Descriptions HCPCS Codes Medical Plan - Administration Technique Drug Class Commercial Interferon, alfa-2b, recombinant Intron A J9214 Y INJECTABLE Primary
Interferon, alfa-n3 Alferon N J9215 Y INJECTABLE Primary
Interferon, gamma-1b Actimmune J9216 Y INJECTABLE Primary
Ipilumumab Yervoy J9228 Y INJECTABLE Primary
Irinotecan Camptosar J9206 Y INJECTABLE Primary
Irinotecan Liposome Onivyde J9205 Y INJECTABLE Primary
Ixabepilone Ixempra J9207 Y INJECTABLE Primary
Lanreotide Somatuline Depot J1930 Y INJECTABLE Primary
Leucovorin - inj Leucovorin J0640 Y INJECTABLE Primary
Leuprolide Acetate Eligard, Lupron Depot, Lupron, J1950 Y INJECTABLE Primary Leuprolide Acetate Leuprolide Acetate Eligard, Lupron Depot, Lupron, J9217 Y INJECTABLE Primary Leuprolide Acetate Leuprolide Acetate Eligard, Lupron Depot, Lupron, J9218 Y INJECTABLE Primary Leuprolide Acetate Levoleucovorin Fusilev J0641 Y INJECTABLE Primary
Levoleucovorin Khapzory J3490 Y INJECTABLE Primary
Levoleucovorin Khapzory C9399 Y INJECTABLE Primary
Levoleucovorin Khapzory C9043 Y INJECTABLE Primary
Liposome-encapsulated Vyxeos J9153 Y INJECTABLE Primary combination of Daunorubicin and Cytarabine Mechlorethamine HCL Mustragen J9230 Y INJECTABLE Primary
Melphalan HCL - inj Alkeran J9245 Y INJECTABLE Primary
Mitomycin Mutamycin J9280 Y INJECTABLE Primary
Mitoxantrone HCL Novantrone J9293 Y INJECTABLE Primary
Moxetumomab pasudotox-tdfk Lumoxiti J9999 Y INJECTABLE Primary
Moxetumomab pasudotox-tdfk Lumoxiti C9045 Y INJECTABLE Primary
Mogamulizumab-kpkc Poteligeo J9999 Y INJECTABLE Primary
Mogamulizumab-kpkc Poteligeo C9038 Y INJECTABLE Primary
Necitumumab Portrazza J9295 Y INJECTABLE Primary
Nelarabine Arranon J9261 Y INJECTABLE Primary
Nivolumab Opdivo J9299 Y INJECTABLE Primary
Obinutuzumab Gazyva J9301 Y INJECTABLE Primary
Octreotide depot Sandostatin J2353 Y INJECTABLE Primary
Octreotide non-depot Sandostatin J2354 Y INJECTABLE Primary
Ofatumumab Arzerra J9302 Y INJECTABLE Primary
Olaratumab Lartruvo J9285 Y INJECTABLE Primary
Omacetaxine Synribo J9262 Y INJECTABLE Primary
Page 3 of 8 HAMP - Health Alliance Primary Alt Descriptions HCPCS Codes Medical Plan - Administration Technique Drug Class Commercial Oxaliplatin Eloxatin J9263 Y INJECTABLE Primary
Paclitaxel Nov-Onxol, Taxol J9267 Y INJECTABLE Primary
Paclitaxel (albumin-bound) Abraxane J9264 Y INJECTABLE Primary
Panitumumab Vectibix J9303 Y INJECTABLE Primary
Pegaspargase Oncaspar J9266 Y INJECTABLE Primary
Peginterferon, alfa-2a Pegasys J3590 Y INJECTABLE Primary
Peginterferon, alfa-2a Pegasys S0145 Y INJECTABLE Primary
Peginterferon, alfa-2b PegIntron J3590 Y INJECTABLE Primary
Peginterferon, alfa-2b PegIntron S0148 Y INJECTABLE Primary
Peginterferon, alfa-2b Sylatron C9399 Y INJECTABLE Primary
Peginterferon, alfa-2b Sylatron J9999 Y INJECTABLE Primary
Pembrolizumab Keytruda J9271 Y INJECTABLE Primary
Pemetrexed Alimta J9305 Y INJECTABLE Primary
Pentostatin Nipent J9268 Y INJECTABLE Primary
Pertuzumab Perjeta J9306 Y INJECTABLE Primary
Porfimer Sodium Photofrin J9600 Y INJECTABLE Primary
Pralatrexate Folotyn J9307 Y INJECTABLE Primary
Ramucirumab Cyramza J9308 Y INJECTABLE Primary
Rituximab Rituxan J9312 Y INJECTABLE Primary
Rituximab-abbs Truxima C9399 Y INJECTABLE Primary
Rituximab-abbs Truxima J3490 Y INJECTABLE Primary
Rituximab-abbs Truxima J3590 Y INJECTABLE Primary
Rituximab-abbs Truxima J9999 Y INJECTABLE Primary
Rituximab and Hyaluronidase Rituxan Hycela J9311 Y INJECTABLE Primary Human Romidepsin Istodax J9315 Y INJECTABLE Primary
Siltuximab Sylvant J2860 Y INJECTABLE Primary
Sipuleucel-T Provenge Q2043 Y INJECTABLE Primary
Streptozocin Zanosar J9320 Y INJECTABLE Primary
Tagraxofusp-erzs (not available to Elzonris C9399 Y INJECTABLE Primary market yet) Tagraxofusp-erzs (not available to Elzonris J9999 Y INJECTABLE Primary market yet) Talimogene Laherparepvec Imlygic J9325 Y INJECTABLE Primary
Temozolomide - inj Temodar J9328 Y INJECTABLE Primary
Temsirolimus Torisel J9330 Y INJECTABLE Primary
Teniposide Vumon Q2017 Y INJECTABLE Primary
Thiotepa Thioplex J9340 Y INJECTABLE Primary
Page 4 of 8 HAMP - Health Alliance Primary Alt Descriptions HCPCS Codes Medical Plan - Administration Technique Drug Class Commercial Topotecan - inj Hycamtin J9351 Y INJECTABLE Primary
Trabectedin Yondelis J9352 Y INJECTABLE Primary
Trastuzumab Herceptin J9355 Y INJECTABLE Primary
Trastuzumab-dkst (Not currently on Ogiviri J3490 Y INJECTABLE Primary the Market) Trastuzumab-dkst (Not currently on Ogiviri J3590 Y INJECTABLE Primary the Market) Trastuzumab-dkst (Not currently on Ogiviri J9999 Y INJECTABLE Primary the Market) Trastuzumab-dttb (Not currently on Ontruzant J3490 Y INJECTABLE Primary the Market) Trastuzumab-dttb (Not currently on Ontruzant J3590 Y INJECTABLE Primary the Market) Trastuzumab-pkrb Herzuma J3490 Y INJECTABLE Primary
Trastuzumab-pkrb Herzuma J3590 Y INJECTABLE Primary
Trastuzumab-qyyp Trazimera J3490 Y INJECTABLE Primary
Trastuzumab-qyyp Trazimera J3590 Y INJECTABLE Primary
Trastuzumab and hyaluronidase- Herceptin Hylecta J3490 Y INJECTABLE Primary oysk Trastuzumab and hyaluronidase- Herceptin Hylecta J3590 Y INJECTABLE Primary oysk Triptorelin Pamoate Trelstar J3315 Y INJECTABLE Primary
Valrubicin Valstar J9357 Y INJECTABLE Primary
Vinblastine Sulfate Velban J9360 Y INJECTABLE Primary
Vincristine Sulfate Oncovin, Vincasar PFS J9370 Y INJECTABLE Primary
Vincristine Sulfate Liposome Marqibo J9371 Y INJECTABLE Primary
Vinorelbine Tartrate Navelbine J9390 Y INJECTABLE Primary
Zivafibercept Zaltrap J9400 Y INJECTABLE Primary
Abemaciclib - oral Verzenio C9399 Y ORAL Primary
Abemaciclib - oral Verzenio J8999 Y ORAL Primary
Abiraterone Acetate - oral Zytiga (not interchangeable with Yonsa) J8999 Y ORAL Primary
Abiraterone Acetate - oral (Not Yonsa (not interchangeable with Zytiga) J8999 Y ORAL Primary currently on the market) Acalabrutinib Calquence C9399 Y ORAL Primary
Acalabrutinib Calquence J8999 Y ORAL Primary
Afatinib - oral Gilotrif J8999 Y ORAL Primary
Alectinib - oral Alecensa J8999 Y ORAL Primary
All-trans Retinoic Acid - oral Vesanoid, ATRA, Tretinoin J8999 Y ORAL Primary
Altretamine - oral Hexalen J8999 Y ORAL Primary
Apalutamide - oral Erleada J8999 Y ORAL Primary
Axitinib - oral Inlyta J8999 Y ORAL Primary
Page 5 of 8 HAMP - Health Alliance Primary Alt Descriptions HCPCS Codes Medical Plan - Administration Technique Drug Class Commercial Bexarotene - oral Targretin J8999 Y ORAL Primary
Binimetinib - oral Mektovi J8999 Y ORAL Primary
Bosutinib - oral Bosulif J8999 Y ORAL Primary
Brigatinib - oral Alunbrig J8999 Y ORAL Primary
Cabozantinib - oral Cabometyx J8999 Y ORAL Primary
Cabozantinib - oral Cometriq J8999 Y ORAL Primary
Capecitabine - oral Xeloda (150 mg) J8520 Y ORAL Primary
Capecitabine - oral Xeloda (500 mg) J8521 Y ORAL Primary
Ceritinib - oral Zykadia J8999 Y ORAL Primary
Chlorambucil - oral Leukeran J8999 Y ORAL Primary
Chlorambucil - oral Leukeran S0172 Y ORAL Primary
Cobimetinib - oral Cotellic J8999 Y ORAL Primary
Crizotinib - oral Xalkori J8999 Y ORAL Primary
Cyclophosphamide - oral Cytoxan J8530 Y ORAL Primary
Dabrafenib - oral Tafinlar J8999 Y ORAL Primary
Dacomitinib - oral Vizimpro J8999 Y ORAL Primary
Dasatinib - oral Sprycel J8999 Y ORAL Primary
Duvelisib - oral Copiktra J8999 Y ORAL Primary
Enasidenib - oral IDHIFA J8999 Y ORAL Primary
Encorafenib - oral Braftovi J8999 Y ORAL Primary
Enzalutamide - oral Xtandi J8999 Y ORAL Primary
Erdafitinib Balversa J8999 Y ORAL Primary
Erlotinib - oral Tarceva J8999 Y ORAL Primary
Estramustine - oral Emcyt J8999 Y ORAL Primary
Etoposide - oral Toposar J8560 Y ORAL Primary
Everolimus - oral Afinitor J8999 Y ORAL Primary
Flutamide - oral Eulexin J8999 Y ORAL Primary
Gefitinib - oral Iressa J8565 Y ORAL Primary
Gilteritinib - oral Xospata J8999 Y ORAL Primary
Glasdegib - oral Daurismo J8999 Y ORAL Primary
Ibrutinib - oral Imbruvica J8999 Y ORAL Primary
Idelalisib - oral Zydelig J8999 Y ORAL Primary
Imatinib - oral Gleevec J8999 Y ORAL Primary
Imatinib - oral Gleevec S0088 Y ORAL Primary
Ivosidenib - oral Tibsovo J8999 Y ORAL Primary
Ixazomib - oral Ninlaro J8999 Y ORAL Primary
Page 6 of 8 HAMP - Health Alliance Primary Alt Descriptions HCPCS Codes Medical Plan - Administration Technique Drug Class Commercial Lapatinib - oral Tykerb J8999 Y ORAL Primary
Larotrectinib - oral Vitrakvi J8999 Y ORAL Primary
Lenalidomide - oral Revlimid J8999 Y ORAL Primary
Lenvatinib - oral Lenvima J8999 Y ORAL Primary
Lomustine - oral Gleostine, CeeNu, CCNU S0178 Y ORAL Primary
Lorlatinib - oral Lorbrena C9399 Y ORAL Primary
Lorlatinib - oral Lorbrena J8999 Y ORAL Primary
Melphalan - oral Alkeran J8600 Y ORAL Primary
Midostaurin - oral Rydapt J8999 Y ORAL Primary
Mitotane - oral Lysodren J8999 Y ORAL Primary
Neratinib - oral Nerlynx J8999 Y ORAL Primary
Nilotinib - oral Tasigna J8999 Y ORAL Primary
Niraparib - oral Zejula J8999 Y ORAL Primary
Olaparib - oral Lynparza J8999 Y ORAL Primary
Osimertinib - oral Tagrisso J8999 Y ORAL Primary
Palbociclib - oral Ibrance J8999 Y ORAL Primary
Panobinostat - oral Farydak J8999 Y ORAL Primary
Pazopanib - oral Votrient J8999 Y ORAL Primary
Pomalidomide - oral Pomalyst J8999 Y ORAL Primary
Ponatinib - oral Iclusig J8999 Y ORAL Primary
Procarbazine - oral Matulane J8999 Y ORAL Primary
Procarbazine - oral Matulane S0182 Y ORAL Primary
Regorafenib - oral Stivarga J8999 Y ORAL Primary
Ribociclib - oral Kisqali J8999 Y ORAL Primary
Rucaparib - oral Rubraca J8999 Y ORAL Primary
Ruxolitinib - oral Jakafi J8999 Y ORAL Primary
Sonidegib - oral Odomzo J8999 Y ORAL Primary
Sorafenib Tosylate - oral Nexavar J8999 Y ORAL Primary
Sunitinib - oral Sutent J8999 Y ORAL Primary
Talazoparib - oral Talzenna J8999 Y ORAL Primary
Temozolomide - oral Temodar J8700 Y ORAL Primary
Thalidomide - oral Thalomid J8999 Y ORAL Primary
Topotecan - oral Hycamtin J8705 Y ORAL Primary
Toremifene Citrate - oral Fareston J8999 Y ORAL Primary
Trametinib - oral Mekinist J8999 Y ORAL Primary
Trifluridine/Tipiracil - oral Lonsurf J8999 Y ORAL Primary
Page 7 of 8 HAMP - Health Alliance Primary Alt Descriptions HCPCS Codes Medical Plan - Administration Technique Drug Class Commercial Valganciclovir - oral Valcyte J8499 Y ORAL Primary
Vandetanib - oral Caprelsa J8999 Y ORAL Primary
Vemurafenib - oral Zelboraf J8999 Y ORAL Primary
Venetoclax - oral Venclexta J8999 Y ORAL Primary
Vismodegib - oral Erivedge J8999 Y ORAL Primary
Vorinostat - oral Zolinza J8999 Y ORAL Primary
Bexarotene - topical Targretin gel C9399 Y TOPICAL Primary
Bexarotene - topical Targretin gel J3490 Y TOPICAL Primary
Mechlorethamine - topical Valchlor J9999 Y TOPICAL Primary
Darbepoetin alfa Aranesp J0881 Y INJECTABLE Supportive
Denosumab Xgeva, Prolia J0897 Y INJECTABLE Supportive
Epoetin alfa Epogen, Procrit J0885 Y INJECTABLE Supportive
Epoetin alfa-epbx Retacrit Q5106 Y INJECTABLE Supportive
Filgrastim Neupogen J1442 Y INJECTABLE Supportive
Filgrastim-aafi Nivestym Q5110 Y INJECTABLE Supportive
Filgrastim-sndz Zarxio Q5101 Y INJECTABLE Supportive
Octreotide depot Sandostatin J2353 Y INJECTABLE Supportive
Octreotide non-depot Sandostatin J2354 Y INJECTABLE Supportive
Pegfilgrastim Neulasta J2505 Y INJECTABLE Supportive
Pegfilgrastim-cbqv Udenyca Q5111 Y INJECTABLE Supportive
Pegfilgrastim-jmdb Fulphila Q5108 Y INJECTABLE Supportive
Sargramostim Leukine J2820 Y INJECTABLE Supportive
Tbo-filgrastim Granix J1447 Y INJECTABLE Supportive
Zoledronic Acid Zometa J3489 Y INJECTABLE Supportive
Cabergoline - oral Dostinex J8515 Y ORAL Supportive
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