Specialty Medications, Attachment A Effective 11/14/2018
Brand Name Generic Name ACTEMRA Tocilizumab injection ACTHAR H.P. Repository Corticotropin injection ACTIMMUNE Interferon Gamma-1b injection ADAGEN pegademase bovine injection ADCETRIS brentuximab vedotin injection ALECENSA alectinib hydrochloride capsule ALFERON N interferon alfa-n3 injection AMPYRA dalfampridine tablet, film coated, extended release APOKYN apomorphine hydrochloride injection ARALAST alpha.1-proteinase inhibitor human ARZERRA ofatumumab injection AUBAGIO teriflunomide tablet AVASTIN bevacizumab injection AVEED testosterone undecanoate injection BENDEKA bendamustine hydrochloride injection BENLYSTA belimumab injection BERINERT human c1-esterase inhibitor BETHKIS tobramycin solution for inhalation BOSULIF bosutinib monohydrate tablet BUPHENYL sodium phenylbutyrate tablet, powder CABOMETYX cabozantinib tablet CAYSTON aztreonam solution for inhalation CERDELGA eliglustat capsule COPEGUS ribavirin tablet COSENTYX secukinumab injection COTELLIC cobimetinib tablet CYSTARAN cysteamine hydrochloride ophth soln. DACOGEN decitabine injection DAKLINZA daclatasvir tablet DARAPRIM pyrimethamine tablet DARZALEX daratumumab injection EGRIFTA tesamorelin injection EPCLUSA velpatasvir and sofosbuvir tablet ERGOMAR ergotamine tartrate tablet ERIVEDGE vismodegib capsule ESBRIET pirfenidone capsule & tablets EXJADE deferasirox tablet, for suspension EYLEA aflibercept injection
Brand Name Generic Name FARYDAK panobinostat capsule GAZYVA obinutuzumab injection GEL-ONE hyaluronate sod, cross-linked, injection GILOTRIF afatinib tablet GLASSIA alpha-1-proteinase inhibitor (human) injection HARVONI ledipasvir and sofosbuvir tablet HEMANGEOL propranolol hydrochloride oral olution HEMLIBRA Emicizumab-kxwh injection HERCEPTIN trastuzumab injection HETLIOZ tasimelteon capsule HIZENTRA human immunoglobulin g liquid HUMIRA SYRINGEKIT adalimumab injection human immuneglobulin g and hyaluronidase (human HYQVIA recombinant) injection IBRANCE palbociclib capsule ILARIS canakinumab injection ILUVIEN fluocinolone acetonide intravitreal implant INCIVEK telaprevir tablets INCRELEX mecasermin injection INFERGEN interferon alfacon-1 injection INLYTA axitinib tablet INTRON-A interferon alfa-2b injection IRESSA gefitinib tablet JADENU deferasirox tablet JAKAFI ruxolitinib tablet JETREA ocriplasmin injection KADCYLA ado-trastuzumab emtansine injection KALYDECO ivacaftor tablet KANUMA sebelipase alfa injection KITABIS PAK tobramycin solution for inhalation KUVAN sapropterin dihydrochloride tablet and pwd for oral soln. KYLEENA levonorgestrel intrauterine device KYNAMRO mipomersen sodium injection KYPROLIS carfilzomib injection LEMTRADA alemtuzumab injection LETAIRIS ambrisentan tablet LONSURF trifluridine and tipiracil tablet LUCENTIS ranibizumab intravitreal injection LUMIZYME alglucosidase alfa injection LYNPARZA olaparib capsule, tablets
Brand Name Generic Name MACUGEN pegaptanib sodium intravitreal injection MAKENA hydroxyprogesterone caproate injection MATULANE procarbazine hydrochloride capsule MAVYRET glecaprevir and pibrentasvir tablet MIRENA levonorgestrel intrauterine device MUGARD glycerine/carb h. polymer A/potassium hydroxide NAGLAZYME galsulfase solution for IV infusion NATPARA parathyroid hormone injection NEXAVAR sorafenib tablet NINLARO ixazomib capsule NORTHERA droxidopa capsule NUCALA mepolizumab injection NUPLAZID pimavanserin tartrate tablet NUTROPIN somatropin injection NUWIQ antihemophilic factor (recombinant) OCALIVA obeticholic acid tablet OCREVUS ocrelizumab injection OFEV nintedanib capsule OLYSIO simeprevir capsule OPSUMIT macitentan tablet ORALAIR allergen pollen extracts, SL tablets ORKAMBI lumacaftor and ivacaftor tablet OTEZLA apremilast tablet PEGASYS peginterferon alfa-2a injection PEG-INTRON peginterferon alfa-2b injection PERJETA pertuzumab injection PLEGRIDY peginterferon beta-1a injection POMALYST pomalidomide capsule PURIXAN purixan oral suspension QUTENZA capsaicin patch RAVICTI glycerol phenylbutyrate oral liquid REVLIMID lenalidomide capsule RIASTAP fibrinogen human injection RIBASPHERE 200 ribavirin capsule RIBAVIRIN ribavirin capsule, tablets RITUXAN rituximab injection RUCONEST c1 esterase inhibitor recombinant injection SABRIL vigabatrin tablet, pwd for susp. SAMSCA tolvaptan tablet
Brand Name Generic Name SIMPONI golimumab solution (SQ or IV infusion) SKYLA levonorgestrel intrauterine device SOLESTA dextranomer microspheres/sodium hyaluronate SOLIRIS eculizumab injection SOMAVERT pegvisomant injection SOVALDI sofosbuvir tablet STIVARGA regorafenib tablet SUPPRELIN LA histrelin acetate implant SUTENT sunitinib malate capsule SYLATRON peginterferon alfa-2b injection SYNAGIS palivizumab injection SYNRIBO omacetaxine mepesuccinate injection TAGRISSO osimertinib tablet TALTZ ixekizumab injection TARCEVA erlotinib hydrochloride tablet TECENTRIQ atezolizumab injection TECFIDERA dimethyl fumarate capsule TECHNIVIE ombitasvir/paritaprevir/ritonavir tablets TESTOPEL testosterone pellet THALOMID thalidomide capsule THIOLA tiopronin tablet TOBI tobramycin solution for inhalation TOBI PODHALER tobramycin capsule for inhalation TRACLEER bosentan tablet TYSABRI natalizumab injection VARITHENA polidocanol injection VECAMYL mecamylamine hydrochloride tablet VICTRELIS boceprevir capsule
VIEKIRA PAK dasabuvir tablets and ombitasvir,/paritaprevir/ritonavir tablets VIGABATRIN Vigabatrin powder packet for oral solution VIMIZIM elosulfase alfa injection VISUDYNE verteporfin for injection VOSEVI sofosbuvir/velpatasvir/voxilaprevir tablet VPRIV velaglucerase alfa injection XALKORI crizotinib capsule XENAZINE tetrabenazine tablet XOLAIR omalizumab injection XTANDI enzalutamide capsule YERVOY ipilimumab injection
Brand Name Generic Name YONDELIS trabectedin injection ZEPATIER elbasvir/grazoprevir tablet ZELBORAF vemurafenib tablet ZINBRYTA daclizumab injection ZYKADIA ceritinib capsule ZYTIGA abiraterone acetate tablet