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GE Specialty Drug List

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GE Specialty Drug List GE Specialty Drug List Biotech/Specialty Drug Classification Specialty Drug Name Alpha-1 Antitrypsin Deficiency ARALAST Alpha-1 Antitrypsin Deficiency GLASSIA Alpha-1 Antitrypsin Deficiency PROLASTIN Alpha-1 Antitrypsin Deficiency PROLASTIN-C Alpha-1 Antitrypsin Deficiency ZEMAIRA Asthma XOLAIR Cystic Fibrosis CAYSTON Cystic Fibrosis PULMOZYME Cystic Fibrosis TOBI Gout KRYSTEXXA Hematopoietics ARANESP Hematopoietics EPOGEN Hematopoietics LEUKINE Hematopoietics MOZOBIL Hematopoietics NEULASTA Hematopoietics NEUMEGA Hematopoietics NEUPOGEN Hematopoietics PROCRIT Hemophilia ADVATE Hemophilia ALPHANATE Hemophilia ALPHANINE SD Hemophilia BEBULIN VH Hemophilia BENEFIX Hemophilia CORTIFACT Hemophilia FEIBA VH Hemophilia HELIXATE FS Hemophilia HEMOFIL-M Hemophilia HUMATE-P Hemophilia KOATE-DVI Hemophilia KOGENATE FS Hemophilia MONOCLATE-P Hemophilia MONONINE Hemophilia NOVOSEVEN Hemophilia PROFILNINE SD Hemophilia RECOMBINATE Hemophilia REFACTO Hemophilia RIASTAP Hemophilia STIMATE Hemophilia WILATE Hemophilia XYNTHA Hepatitis B BARACLUDE Hepatitis B EPIVIR HBV Hepatitis B HEPSERA Hepatitis B TYZEKA Hepatitis C COPEGUS Hepatitis C INCIVEK Hepatitis C INFERGEN Hepatitis C PEGASYS Hepatitis C PEG-INTRON Hepatitis C REBETOL Hepatitis C RIBAPAK * Applies to injectable formulation only This list will change and expand from time to time. 1 Updated 09/01/2011 GE Specialty Drug List Biotech/Specialty Drug Classification Specialty Drug Name Hepatitis C RIBASPHERE Hepatitis C RIBAVIRIN Hepatitis C VICTRELIS Hereditary Angioedema BERINERT Hereditary Angioedema CINRYZE Hereditary Angioedema KALBITOR Hormonal Therapies ACTHAR HP Hormonal Therapies DEGARELIX Hormonal Therapies ELIGARD Hormonal Therapies FIRMAGON Hormonal Therapies LEUPROLIDE Hormonal Therapies LUPRON DEPOT Hormonal Therapies LUPRON DEPOT-PED Hormonal Therapies SUPPRELIN LA Hormonal Therapies TRELSTAR Hormonal Therapies TRELSTAR DEPOT Hormonal Therapies TRELSTAR LA Hormonal Therapies TRELSTAR MIXJECT Hormonal Therapies VANTAS Hormonal Therapies ZOLADEX Human Growth Hormone GENOTROPIN Human Growth Hormone HUMATROPE Human Growth Hormone INCRELEX Human Growth Hormone NORDITROPIN Human Growth Hormone NUTROPIN Human Growth Hormone OMNITROPE Human Growth Hormone SAIZEN Human Growth Hormone SEROSTIM Human Growth Hormone TEV-TROPIN Human Growth Hormone ZORBTIVE Human Immunodeficiency Virus AGENERASE Human Immunodeficiency Virus APTIVUS Human Immunodeficiency Virus ATRIPLA Human Immunodeficiency Virus COMBIVIR Human Immunodeficiency Virus COMPLERA Human Immunodeficiency Virus CRIXIVAN Human Immunodeficiency Virus DIDANOSINE Human Immunodeficiency Virus EDURANT Human Immunodeficiency Virus EGRIFTA Human Immunodeficiency Virus EMTRIVA Human Immunodeficiency Virus EPIVIR Human Immunodeficiency Virus EPIVIR HBV Human Immunodeficiency Virus EPZICOM Human Immunodeficiency Virus FORTOVASE Human Immunodeficiency Virus FUZEON Human Immunodeficiency Virus HIVID Human Immunodeficiency Virus INTELENCE Human Immunodeficiency Virus INVIRASE Human Immunodeficiency Virus ISENTRESS Human Immunodeficiency Virus KALETRA Human Immunodeficiency Virus LEXIVA * Applies to injectable formulation only This list will change and expand from time to time. 2 Updated 09/01/2011 GE Specialty Drug List Biotech/Specialty Drug Classification Specialty Drug Name Human Immunodeficiency Virus NORVIR Human Immunodeficiency Virus PREZISTA Human Immunodeficiency Virus RESCRIPTOR Human Immunodeficiency Virus RETROVIR Human Immunodeficiency Virus REYATAZ Human Immunodeficiency Virus SELZENTRY Human Immunodeficiency Virus STAVUDINE Human Immunodeficiency Virus SUSTIVA Human Immunodeficiency Virus TRIZIVIR Human Immunodeficiency Virus TRUVADA Human Immunodeficiency Virus VIDEX Human Immunodeficiency Virus VIDEX EC Human Immunodeficiency Virus VIRACEPT Human Immunodeficiency Virus VIRAMUNE Human Immunodeficiency Virus VIRAMUNE XR Human Immunodeficiency Virus VIREAD Human Immunodeficiency Virus ZERIT Human Immunodeficiency Virus ZIAGEN Human Immunodeficiency Virus ZIDOVUDINE Infertility BRAVELLE Infertility CETROTIDE Infertility CHORIONIC GONADOTROPIN Infertility FOLLISTIM AQ Infertility GANIRELIX Infertility GONAL-F Infertility LUVERIS Infertility MENOPUR Infertility NOVAREL Infertility OVIDREL Infertility PREGNYL Infertility REPRONEX Inflammatory Bowel Disease CIMZIA Lysosomal Storage Disorder ALDURAZYME Lysosomal Storage Disorder CEREDASE Lysosomal Storage Disorder CEREZYME Lysosomal Storage Disorder CYSTAGON Lysosomal Storage Disorder ELAPRASE Lysosomal Storage Disorder FABRAZYME Lysosomal Storage Disorder LUMIZYME Lysosomal Storage Disorder MYOZYME Lysosomal Storage Disorder NAGLAZYME Lysosomal Storage Disorder VPRIV Lysosomal Storage Disorder ZAVESCA Macular Degeneration LUCENTIS Macular Degeneration MACUGEN Macular Degeneration VISUDYNE Miscellaneous ACTIMMUNE Miscellaneous ADAGEN Miscellaneous APLIGRAF Miscellaneous APOKYN Miscellaneous ARCALYST * Applies to injectable formulation only This list will change and expand from time to time. 3 Updated 09/01/2011 GE Specialty Drug List Biotech/Specialty Drug Classification Specialty Drug Name Miscellaneous BOTOX Miscellaneous CEPROTIN Miscellaneous CYSTADANE Miscellaneous CYSTAGON Miscellaneous DESFERAL Miscellaneous DYSPORT Miscellaneous ILARIS Miscellaneous IMPLANON Miscellaneous KUVAN Miscellaneous MIRENA Miscellaneous MYOBLOC Miscellaneous NEXPLANON Miscellaneous NPLATE Miscellaneous OCTREOTIDE Miscellaneous ORFADIN Miscellaneous PRIALT Miscellaneous PROMACTA Miscellaneous SABRIL Miscellaneous SAMSCA Miscellaneous SANDOSTATIN Miscellaneous SOLIRIS Miscellaneous SOMATULINE DEPOT Miscellaneous SOMAVERT Miscellaneous THYROGEN Miscellaneous TIKOSYN Miscellaneous VIVITROL Miscellaneous XENAZINE Miscellaneous XEOMIN Miscellaneous XGEVA Miscellaneous XIAFLEX Multiple Sclerosis AMPYRA Multiple Sclerosis AVONEX Multiple Sclerosis BETASERON Multiple Sclerosis COPAXONE Multiple Sclerosis EXTAVIA Multiple Sclerosis GILENYA Multiple Sclerosis MITOXANTRONE Multiple Sclerosis NOVANTRONE Multiple Sclerosis REBIF Multiple Sclerosis TYSABRI Oncology ZOMETA Oncology ABRAXANE Oncology ADCETRIS Oncology ADRIAMYCIN Oncology ADRUCIL Oncology AFINITOR Oncology ALFERON N Oncology ALIMTA Oncology AMIFOSTINE Oncology ARRANON Oncology ARZERRA * Applies to injectable formulation only This list will change and expand from time to time. 4 Updated 09/01/2011 GE Specialty Drug List Biotech/Specialty Drug Classification Specialty Drug Name Oncology AVASTIN Oncology BEXXAR Oncology BICNU Oncology BLEOMYCIN Oncology BUSULFEX Oncology CAMPATH Oncology CAMPTOSAR Oncology CAPRELSA Oncology CARBOPLATIN Oncology CERUBIDINE Oncology CISPLATIN Oncology CLADRIBINE Oncology CLOLAR Oncology COSMEGEN Oncology CYCLOPHOSPHAMIDE* Oncology CYTARABINE Oncology DACARBAZINE Oncology DACOGEN Oncology DAUNORUBICIN Oncology DAUNOXOME Oncology DEPOCYT Oncology DEXRAZOXANE Oncology DOCEFREZ Oncology DOCETAXEL Oncology DOXIL Oncology DOXORUBICIN Oncology ELITEK Oncology ELLENCE Oncology ELOXATIN Oncology ELSPAR Oncology EPIRUBICIN Oncology ERBITUX Oncology ETHYOL Oncology ETOPOPHOS Oncology ETOPOSIDE Oncology FASLODEX Oncology FLOXURIDINE Oncology FLUDARA Oncology FLUDARABINE Oncology FLUOROURACIL* Oncology FOLOTYN Oncology FUDR Oncology FUSILEV Oncology GEMZAR Oncology GLEEVEC Oncology GLIADEL Oncology HALAVEN Oncology HERCEPTIN Oncology HYCAMTIN Oncology IDAMYCIN Oncology IDARUBICIN * Applies to injectable formulation only This list will change and expand from time to time. 5 Updated 09/01/2011 GE Specialty Drug List Biotech/Specialty Drug Classification Specialty Drug Name Oncology IFOSFAMIDE Oncology IFOSFAMIDE/MESNA Oncology INTRON-A Oncology IRESSA Oncology IRINOTECAN Oncology ISTODAX Oncology IXEMPRA Oncology JEVTANA Oncology KEPIVANCE Oncology LEUCOVORIN* Oncology LEUSTATIN Oncology MESNA Oncology MESNEX* Oncology METHOTREXATE* Oncology MITOMYCIN Oncology MYLOTARG Oncology NAVELBINE Oncology NEXAVAR Oncology NIPENT Oncology OFORTA Oncology ONCASPAR Oncology ONTAK Oncology ONXOL Oncology OXALIPLATIN Oncology PACLITAXEL Oncology PENTOSTATIN Oncology PHOTOFRIN Oncology PLENAXIS Oncology PROLEUKIN Oncology QUADRAMET Oncology REVLIMID Oncology RITUXAN Oncology SPRYCEL Oncology SUTENT Oncology SYLATRON Oncology TARCEVA Oncology TARGRETIN Oncology TASIGNA Oncology TAXOTERE Oncology TEMODAR Oncology THALOMID Oncology THERACYS Oncology THIOTEPA Oncology TOPOSAR Oncology TORISEL Oncology TOTECT Oncology TREANDA Oncology TRISENOX Oncology TYKERB Oncology UVADEX Oncology VALSTAR * Applies to injectable formulation only This list will change and expand from time to time. 6 Updated 09/01/2011 GE Specialty Drug List Biotech/Specialty Drug Classification Specialty Drug Name Oncology VECTIBIX Oncology VELCADE Oncology VIDAZA Oncology VINBLASTINE Oncology VINCASAR Oncology VINCRISTINE Oncology VINORELBINE Oncology VOTRIENT Oncology XALKORI Oncology XELODA Oncology YERVOY Oncology ZANOSAR Oncology ZELBORAF Oncology ZINECARD Oncology ZOLINZA Oncology ZYTIGA Osteoarthritis EUFLEXXA Osteoarthritis HYALGAN Osteoarthritis ORTHOVISC Osteoarthritis SUPARTZ Osteoarthritis SYNVISC Osteoporosis FORTEO Osteoporosis PROLIA Osteoporosis RECLAST Pre-Term Birth MAKENA Psoriasis AMEVIVE Psoriasis STELARA Pulmonary Arterial Hypertension ADCIRCA Pulmonary Arterial Hypertension EPOPROSTENOL Pulmonary Arterial Hypertension FLOLAN Pulmonary Arterial Hypertension LETAIRIS Pulmonary Arterial Hypertension REMODULIN Pulmonary Arterial Hypertension REVATIO Pulmonary Arterial Hypertension TRACLEER Pulmonary Arterial Hypertension TYVASO Pulmonary Arterial Hypertension
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