Lumicera Specialty Drug List
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Lumicera Specialty Drug List The Lumicera Specialty Drug list is a guide to medications distributed through Lumicera Specialty Pharmacy. Our mission is to provide exceptional service and comprehensive care so that our members can live happier, better lives. In fact, our dedication has earned us a 99% patient satisfaction rate. We support our prescribers and members with pre-screening therapy, ongoing support and education, clinical monitoring and refill reminders. Condition Brand Name Generic Name Allergy/Asthma, Dermatology, Actemra® tocilizumab Gastroenterology, Rheumatology, Avsola® infliximab - axxq Benlysta® belimumab Cimzia® certolizumab Cosentyx® secukinumab Dupixent® dupilumab Enbrel® etanercept Entyvio® vedolizumab Fasenra®* benralizumab Humira® adalimumab Ilumya® tildrakizumab-asmn Inflectra® infliximab-dyyb Kevzara® sarilumab Nucala® mepolizumab Olumiant® baricitinib Orencia® abatacept Otezla® apremilast Otrexup® methotrexate Rasuvo® methotrexate Remicade® infliximab Renflexis® infliximab-abda *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 1 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Allergy/Asthma, Dermatology, Rinvoq® upadacitinib Gastroenterology, Rheumatology, Siliq® brodalumab Simponi/Simponi Aria® golimumab Skyrizi® risankizumab Soriatane® acitretin Stelara® ustekinumab Talt z ® ixekizumab Tremfya® guselkumab Xeljanz/Xeljanz XR® tofacitinib Xolair® omalizumab Condition Brand Name Generic Name Cystic Fibrosis Cayston® aztreonam Pulmozyme® dornase alfa Tobi/Tobi Podhaler® tobramycin *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 2 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Growth Hormone Genotropin® somatropin Humatrope® somatropin Norditropin® somatropin Nutropin AQ NuSpin® somatropin Omnitrope® somatropin Saizen® somatropin Zomacton® somatropin Zorbtive® somatropin Condition Brand Name Generic Name Hepatitis C Epclusa® velpatasvir/sofosbuvir Harvoni® ledipasvir/sofosbuvir Mavyret® glecaprevir/pibrentasvir Rebetol® ribavirin dasabuvir/ombitasvir/ Viekira Pak® paritaprevir/ritonavir Sofosbuvir/velpatasvir, Vosevi® voxilaprevir Zepatier® elbasvir/grazoprevir *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 3 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Hematology/Oncology Aranesp®** darbapoetin alfa Supplemental Rx Arimidex®** anastrozole Aromasin®** Exemestane Epogen®** epoetin alfa Exjade® deferasirox Femara® letrozole Fulphila® pegfilgrastim-jmdb Granix® tbo-filgrastim Hydrea®** hydroxyurea Jadenu® deferasirox Mesnex® mesna Mozobil® plerixafor Neulasta® pegfilgrastim Neupogen® filgrastim Nivestym® filgrastim-aafi Nolvadex®** tamoxifen Nplate® romiplostim Procrit®** epoetin alfa Promacta® eltrombopag olamine Retacrit® epoetin alfa-epbx Sandostatin/LAR® octreotide Udenyca® pegfilgrastim-cbqv Xgeva® denosumab Zarxio® filgrastim-sndz Ziextenzo® pegfilgrastim-bmez Zirabvex® bevacizumab-bvzr *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 4 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Multiple Sclerosis Aubagio® teriflunomide Avonex® interferon B-1a Betaseron® interferon B-1b Copaxone® glatiramer acetate Ampyra® dalfampridine Extavia® interferon B-1b Gilenya® fingolimod Glatopa® glatiramer acetate Kesimpta® ofatumumab Mayzent® siponimod Plegridy® peginterferon B-1a Rebif® iInterferon B-1a Tecfidera® dimethyl fumarate Vumerity® diroximel fumarate Zeposia® ozanimod Condition Brand Name Generic Name Oncology/Hematology Afinitor® Everolimus Alecensa®* alectinib Alunbrig®* brigatinib Ayvakit®* avapritinib Balversa® erdafitinib Bosulif®* bosutinib Braftovi®* encorafenib Brukinsa®* zanubrutinib Cabometyx®* cabozantinib *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 5 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Oncology/Hematology Calquence®* acalabrutinib Copiktra®* duvelisib Cotellic®* cobimetinib Cytoxan® cyclophosphamide Daurismo®* glasdegib Doptelet®* avatrombopag Eligard® leuprolide Erivedge®* vismodegib Erleada*® apalutamide Fulphila® pegfilgrastim-jmdb Giotrif®* afatinib Gleevec® imatinib Gleostine® lomustine Herzuma® trastuzumab-pkrb Hycamtin® topotecan Ibrance®* palbociclib Imbruvica®* ibrutinib Inlyta®* axitinib Inqovi®* decitabine/cedazuridine Inrebic® fedratinib Iressa®* gefitinib Jakafi®* ruxolitinib Kanjinti® trastuzumab-anns Kisqali® ribociclib Koselugo®* selumetinib Lenvima®* lenvatinib Leukeran® Chlorambucil *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 6 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Oncology/Hematology Lonsurf®* trifluridine/tipiracil Lorbrena®* lorlatinib Lupron® leuprolide acetate Lynparza®* olaparib Mekinist® trametinib Mozobil® plerixafor Mvasi® bevacizumab-awwb Nerlynx®* neratinib Neulasta® Pegfilgrastim Nexavar®* sorafenib Nilandron® nilutamide Ninlaro®* ixazomib Nplate® romiplostim Nubeqa®* darolutamide Odomzo® sonidegib Ogivri® trastuzumab-dkst Ontruzant® trastuzumab-dttb Onureg® azacitadine Pegasys® Peginterferon A-2a PEGIntron Redipen® Peginterferon A-2b Piqray® alpelisib Promacta® eltrombopag Olamine Retevmo®* selpercatinib Rozlytrek®* entrectinib Rubraca®* rucaparib Rydapt® midostaurin *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 7 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Oncology/Hematology Somatuline Depot® lanreotide Sprycel® dasatinib Stivarga®* regorafenib Sutent®* sunitinib Tabrecta® capmatinib Tafinlar® Dabrafenib Tagrisso®* osimertinib Talzenna®* talazoparib Tarceva® erlotinib Targretin® Bexarotene Targretin Gel® Bexarotene Tasigna® nilotinib Tazverik®* tazemetostat Temodar® Temozolomide Thyrogen® thyrotropin Alfa Tibsovo®* ivosidenib Trazimera® trastuzumab-qyyp Truxima® rituximab-abbs Tukysa®* tucatinib Tykerb® Lapatinib Venclexta®* venetoclax Vepesid® etoposide Verzenio®* abemaciclib Vesanoid® tretinoin (oral) Vitrakvi®* larotrectinib Votrient® Pazopanib *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 8 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Oncology/Hematology Xalkori®* crizotinib Xeloda® Capecitabine Xgeva® Denosumab Xospata®* gilteritinib Xtandi®* enzalutamide Yonsa® abiraterone Zejula®* niraparib Zelboraf®* vemurafenib Zirabvex® bevacizumab-bvzr Zolinza® vorinostat Zometa® zoledronic Acid Zydelig®* idelalisib Zykadia® ceritinib Zytiga®* abiraterone acetate Condition Brand Name Generic Name Osteoporosis Evenity® romosozumab Forteo® teriparatide Prolia® denosumab Reclast® zoledronic Acid Tymlos® abaloparatide *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 9 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Other Abilify Maintena® aripiprazole Adcirca® tadalafil Letairis® ambrisentan Aristada® aripiprazole lauroxil Austedo® deutetrabenazine Beovu® brodlucizumab-dbll Botox® onabotulinumtoxin A Cuprimine® penicillamine Depen® penicillamine Dibenzyline® phenoxybenzamine Durolane® hyaluronic acid Dysport® abobotulinmutoxin A Endari® glutamine Enspryng®* satralizumab Epidiolex® cannabidiol Esbriet® pirfenidone Euflexxa® hyaluronate sodium Firazyr® icatibant acetate Gel-One® hyaluronate sodium *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 10 © 2021 Lumicera Health Services, LLC. All rights reserved. Condition Brand Name Generic Name Other GelSyn-3® hyaluronate sodium GenVisc 850® hyaluronate sodium Hemlibra® emicizumab Hyalgan® hyaluronate sodium Hymovis® hyaluronan Ingrezza®* valbenazine Invega Sustenna® paliperidone palmitate Krystexxa®* pegloticase Leukine® sargramostim leuprolide acetate and Lupaneta® norethindrone acetate Makena® hydroxyprogesterone caproate Monovisc® hyaluronic acid Orthovisc® hyaluronic acid Relistor® methylnaltrexone bromide Supartz FX® hyaluronic acid Synagis® palivizumab Synvisc/Synvisc One® hylan polymers A and B Syprine® trientine hydrochloride Visco-3® hyaluronic acid Vivitrol® naltrexone Vyndaqel®* tafamidis meglumine Xenazine® tetrabenazine Zortress® everolimus *Health Sytem Own Use **Support medications only dispensed with other specialty medications Access Limitations May Apply 11 © 2021 Lumicera Health Services, LLC. All rights reserved..