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Home , Enasidenib, Pegfilgrastim, Romiplostim, Umbralisib

Oncology Drug Reference Guide

To assure safe and quality care, specialty drugs require a prior authorization and must be obtained from the KSP Specialty pharmacy, 1-833-KSP-4-YOU (1.833.577.4968) BREAST LUNG Send To KSP Send To KSP Send To KSP Send to KSP Afinitor® () Lynparza® () Alunbrig® () Tagrisso® () Arimidex® (anastrozole) Nerlynx® () Gilotrif® () Tarceva® () Aromasin® (exemestane) Piqray® () Gilotrif® (afatinib) Tepmetko®() Faslodex® (fulvestrant) Talzenna® () Hycamtin® () Vizimpro® () Femara® (letrozole) Tukysa®() Iressa® () Xalkori® () Ibrance® () Tykerb® () Lorbrena® () Zykadia® () Kisqali® () Verzenio® () Mekinist® () Send to External pharmacy Xeloda® () Retevmo™ () Alecensa® () HEMATOLOGIC Tabrecta®() Rozlytrek® () Send to KSP Send to KSP MELANOMA Aranesp® (darbopoetin alfa) Promacta® () Send to KSP Send to KSP Bosulif® () Rydapt® () Braftovi® (encorafenib) Zelboraf® (vemurafenib) Brukinsa® () Sprycel® () Mekinist® (trametinib) Send to External pharmacy Calquence® () Tasigna® () Mektovi® () Cotellic® () Doptelet® () Tavalisse® () Tafinlar® (dabrafenib) Endari® (glutamine) Tazverik® (tazemetostat) GASTRO/GYN AND OTHER CANCERS Gleevec® () Tibsovo® (ivosidenib) Afinitor® (everolimus) Rubraca® () Hydrea®(hydroxyurea) Ukoniq®(umbralisib) Arimidex® (anastrozole) Stivarga® () Iclusig® () Venclexta® (venotoclax) Balversa® () Sutent® () Idhifa® (enasidenib) Xospata® (gilterinib) Braftovi® (encorafenib) Tarceva® (erlotinib) Imbruvica® () Xpovio® (selinexor) Cabometyx® () Tazverik®(tazemetostat) Jakafi® () Zolinza® () Gleevec® (imatinib) Votrient® () Ninlaro® () Zydelig® () Hycamtin® (topotecan) Xeloda® (capecitabine) Nplate®() Send to External pharmacy Lenvima® () Xermelo® (tekitrustat) Oxbtryta® (voxeletor) Pomalyst® (pomalidomide) Lonsurf® (trifluridine) Zejula® () Revlimid® (lenalidomide) Lynparza® (olaparib) Send to External pharmacy PROSTATE Nexavar® () Qinlock®() Send to KSP Send to KSP SUPPORTIVE Casodex® (bicalutamide) Nubeqa® (darolutamide) Aranesp® (darbopoetin alfa) Nplate® (romiplostim) Erleada® (apalutamide) Rubraca® (rucaparib) Arixtra® (fondaparinux) Prevymis® (letermovir) Eulexin® (flutamide) Xtandi® (enzalutamide) Doptelet® (avatrombopag) Procrit® () Lynparza® (olaparib) Zytiga® (abiraterone acetate) Emend® (aprepitant) Promacta® (eltrombopag) RENAL CELL Exjade®(deferasirox) Sancuso® (granisetron) Send to KSP Lenvima® (lenvatinib) Jadenu® (deferasirox) Tavalisse®(fostamatinib) Afinitor® (everolimus) Nexavar® (sorafenib) Lovenox® (enoxaparin) Udenyca () Cabometyx® (cabozantinib) Sutent® (sunitinib) Neulasta® (pegfilgrastim) Xgeva® () Fotivda® () Tarceva® (erlotinib) Neupogen® () Zarxio® (filgrastim) Inlyta® () Votrient® (pazopanib) NeupogenOnpro®(filgrastim) Zoladex (goserelin) Product with asterisk * = New indication Bolded items are new additions to access list

711 Stephenson Highway, Troy, Michigan 48083 | 1-833-KSP-4-YOU (1-833-577-4968) | [email protected] (rev 7/07/21) Non-Oncology Drug Reference Guide

To assure safe and quality care, specialty drugs require a prior authorization and must be obtained from the KSP Specialty pharmacy, 1-833-KSP-4-YOU (1.833.577.4968) ARTHRITIS (PSORIATIC & RHEUMATOID) HEMOPHILIA FACTORS Send To KSP Send To KSP Send to KSP Send To KSP Actemra® Orencia® Advate® Koate-DVI® Cimzia® Otezla® Adynovate® Kogenate FS® Cosentyx® Simponi® Afstyla® Kovaltry® Enbrel® Stelara® Alphanate® NovoEight Humira® Taltz® Alphanine SD® Novoseven® Kevzara® Xeljanz Benefix® Nuwiq® Olumiant® Xeljanz XR® Corifact® Profilnine® CROHN'S DISEASE AND ULCERATIVE COLITIS Eloctate® Recombinate® Send to KSP Send To KSP Feiba® Riastap® Cimzia® Stelara® Helixate ® Rixubis® Humira® Xeljanz® Hemilibra® Vovendi® GROWTH /HORMONAL THERAPIES Hemofil® Wilate® Send To KSP Send To KSP Humate-P® Xyntha® Lupron Depot® Nutropin® Idelvion® Norditropin® Zoladex® Jivi® INFERTILITY HEPATITIS C Send To KSP Send to KSP Send To KSP Send To KSP Ganirelix Acetate® Ovidrel® Epclusa® Ribavirin® DERMATOLOGY Harvoni® Sovaldi® Send to KSP Send to KSP Intron A® Vosevi® Cimzia® Otezla® Mavyret® Zepartier® Cosentyx® Remicade® Pegasys® Enbrel® Renflexis® OSTEOPOROSIS Humira® Stelara® Send to KSP Send to KSP Ilumya® Taltz® Forteo® Reclast® Inflectra® Tremfya® Prolia® HYPERLIPIDEMIA TRANSPLANT Send To KSP Send to KSP Send to KSP Send to KSP Praluent® Repatha® Cellcept® Neoral® MISCELLANEOUS Cyclosporine® Prograf® Send to KSP Send to KSP Envarsus XR® Rapamune® Firazyr® Xolair® Gengraf® Sandimmune® Prolia® Mycophenolate Mofetil® Tacrolimus® Myfortic® Zortress®

711 Stephenson Highway, Troy, Michigan 48083 | 1-833-KSP-4-YOU (1-833-577-4968) | [email protected] (rev 7/07/21) Non-Oncology Drug Reference Guide

To assure safe and quality care, specialty drugs require a prior authorization and must be obtained from the KSP Specialty pharmacy, 1-833-KSP-4-YOU (1.833.577.4968) HIV MULTIPLE SCLEROSIS Send To KSP Send To KSP Send to KSP Send to KSP Aptivus® Odefsey® Ampyra® Gilenya® Atripla® Pifeltro® Avonex® Glatopa® Biktarvy® Prezcobix® Betaseron® Rebif® Cimduo® Prezista® Copaxone® Tecfidera® Combivir® Retrovir® Extavia® Tysabri® Complera® Reyataz® Delstrigo® Selzentry® Descovy® Stribild® Dovato® Sustiva® Edurant® Symfi® Emtriva® Symfi Lo® Epivir® Symtuza® Epzicom® Temixys® Evotaz® Tivicay® Fuzeon® Triumeq® Intelence® Trizivir® Invirace® Truvada® Isentress® Tybost® Isentress HD® Viracept® Juluca® Viramune® Kaletra® Viread® Lexiva® Ziagen® Norvir®

711 Stephenson Highway, Troy, Michigan 48083 | 1-833-KSP-4-YOU (1-833-577-4968) | [email protected] (rev 7/07/21) Eli Lilly Drug Reference Guide

To assure safe and quality care, specialty drugs require a prior authorization and must be obtained from the KSP Specialty pharmacy, 1-833-KSP-4-YOU (1.833.577.4968) BONE MUSCLE JOINT DIABETES Send To KSP Send To KSP Send to KSP Forteo® (teriparatide) Baqsimi® Humulin 70/30® CANCER Basaglar® Humulin N® Send to KSP Glucagon® Humulin R® Retevmo® Verzenio®(abemaciclib) Glyxambi® Humulin R U-500® IMMUNOLOGY Humalog Junior KwikPen® Jardiance® Send to KSP Humalog mix 50/50® Jentadueto® Olumiant® Humalog mix 75/25® JentaduetoXR® NEUROSCIENCE Humalog® Lyumje® Send to KSP Humalog KwikPen® Synjardy® Zyprexa® Relprevv® Tradjenta® TrijardyXR® CARDIOVASCULAR Trulicty® Send to KSP PAIN Adcirca®(tadalafil) Send to KSP Send to KSP Emgality® Reyvow®

711 Stephenson Highway, Troy, Michigan 48083 | 1-833-KSP-4-YOU (1-833-577-4968) | [email protected] (rev 2/24/21) Novo Nordisk Drug Reference Guide

To assure safe and quality care, specialty drugs require a prior authorization and must be obtained from the KSP Specialty pharmacy, 1-833-KSP-4-YOU (1.833.577.4968) HAEMOPHILIA DIABETES Send To KSP Send To KSP Send To KSP Send to KSP Esperoct NovoThirteen Actrapid NovoNorm NovoSeven Refixia Fiasp NovoRapid NovoEight Insulatard NovoRapid PumpCart GROWTH DISORDERS Levemir Ozempic Send to KSP Send to KSP Mixtard 30 Rybelsus Macrilen Norditropin Mixtard 40 Ryzodeg 70/30 HORMONE REPLACEMENT THERAPY Mixtard 50 Tresiba Send to KSP Send to KSP NovoMix 30 Victoza Activelle Novofem NovoMix 50 Xultophy Estrofem Trisequens NovoMix 70 Kliogest Vagifem OBESITY Send to KSP Send to KSP Saxenda Wegovy

711 Stephenson Highway, Troy, Michigan 48083 | 1-833-KSP-4-YOU (1-833-577-4968) | [email protected] (rev 7/7/21)