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Specialty List Harness Health Pharmacy For participants in the Medical Plan, specialty medications are prescribed to treat complex diseases. Many are available through Harness Health Pharmacy. Participants are limited to 30- day supplies of these specialty drugs. Some medications may require prior authorization. Generics may be available for some medications, and a brand-name version may not be covered under certain plans. This list does not denote coverage or formulary status, merely access.

- On the following pages, use Control and F to search the Disease State (such as Asthma or Rheumatology) or the generic name or brand name for any drug. - See the last page for Limited Distribution Drugs available from other pharmacies.

If you have questions, call Harness Health Pharmacy at 866-775-5767 (press option 6 for the Specialty staff) weekdays 8 a.m. - 4:30 p.m. (ET).

Effective 01/01/2021 Specialty Medications List - Limited Distribution Drugs available through MedImpact Specialty Pharmacy Network AMPYRA EYLEA KUVAN PLEGRIDY TRACLEER APOKYN FERRIPROX KYNAMRO POMALYST TYSABRI ARALAST NP FLOLAN LEMTRADA PROCYSBI TYVASO ARCALYST GATTEX LETAIRIS PURIXAN VELETRI AUBAGIO HETLIOZ MACUGEN RAVICTI VENTAVIS BOSULIF IBRANCE MEKTOVI REMODULIN XALKORI BRAFTOVI ICLUSIG MATULANE REVLIMID XENAZINE BUPHENYL ILARIS METOPIRONE SABRIL ZEMAIRA CAPRELSA IMBRUVICA MYOZYME SIGNIFOR CARBAGLU INCRELEX NAGLAZYME SILIQ CAYSTON INLYTA NORTHERA SUCRAID CERDELGA JUXTAPID OFEV SUTENT CEREZYME KALBITOR OPSUMIT SYMDECO CHOLBAM KALYDECO ORENITRAM ER TECFIDERA CYSTADANE KITABIS PAK ORKAMBI THALOMID Available only through the extended Medimpact Specialty Pharmacy Network (including US Bioservices, Humana Specialty Pharmacy, Kroger Specialty Pharmacy and Accredo.) Call 800-788- 2949. Participants are limited to 30-day supplies of these specialty drugs. Some medications may require prior authorization.

Effective: 01/01/2021 Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Acromegaly LANREOTIDE ACETATE SOMATULINE DEPOT Acromegaly OCTREOTIDE ACETATE BYNFEZIA Acromegaly OCTREOTIDE ACETATE OCTREOTIDE ACETATE Acromegaly OCTREOTIDE ACETATE SANDOSTATIN Acromegaly OCTREOTIDE ACETATE,MI-SPHERES SANDOSTATIN LAR Acromegaly PEGVISOMANT SOMAVERT /Opioid Dependency NALTREXONE MICROSPHERES VIVITROL Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR GLASSIA Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR ARALAST NP Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR PROLASTIN C Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR ZEMAIRA IN POLYSORBAT ARANESP Anemia EPOGEN Anemia EPOETIN ALFA PROCRIT Anemia EPOETIN ALFA-EPBX RETACRIT Anemia FERRIC CARBOXYMALTOSE INJECTAFER Anemia FERUMOXYTOL FERAHEME Anemia IRON SUCROSE COMPLEX VENOFER Anemia METHOXY PEG- MIRCERA Anticoagulants FONDAPARINUX SODIUM ARIXTRA Anticoagulants FONDAPARINUX SODIUM FONDAPARINUX SODIUM Asthma BENRALIZUMAB FASENRA Asthma MEPOLIZUMAB NUCALA Asthma OMALIZUMAB XOLAIR Asthma RESLIZUMAB CINQAIR Behavioral Health ABILIFY MAINTENA Behavioral Health ARISTADA Behavioral Health ARIPIPRAZOLE LAUROXIL,SUBMICR. ARISTADA INITIO Behavioral Health FANAPT Behavioral Health PAMOATE ZYPREXA RELPREVV Behavioral Health PALMITATE INVEGA SUSTENNA Behavioral Health PALIPERIDONE PALMITATE INVEGA TRINZA Behavioral Health NUPLAZID Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Behavioral Health PERSERIS Behavioral Health RISPERIDONE MICROSPHERES RISPERDAL CONSTA Botulinum Toxins ABOBOTULINUMTOXINA DYSPORT Botulinum Toxins INCOBOTULINUMTOXINA XEOMIN Botulinum Toxins ONABOTULINUMTOXINA BOTOX Botulinum Toxins RIMABOTULINUMTOXINB MYOBLOC Chronic Pain/Non Opioid Analgesic ZICONOTIDE ACETATE PRIALT Congenital Deficiency FIBRINOGEN CONCENTRATE (HUMAN) FIBRYGA Cystic Fibrosis AZTREONAM CAYSTON Cystic Fibrosis IVACAFTOR KALYDECO Cystic Fibrosis LUMACAFTOR/IVACAFTOR ORKAMBI Cystic Fibrosis TEZACAFTOR/IVACAFTOR SYMDEKO Cystic Fibrosis TOBRAMYCIN/NEBULIZER BETHKIS Cystic Fibrosis TOBRAMYCIN (CAP FOR INHALATION) TOBI PODHALER Cystic Fibrosis TOBRAMYCIN IN 0.225% SOD CHLOR TOBI Cystic Fibrosis TOBRAMYCIN/NEBULIZER KITABIS PAK Cystic Fibrosis TOBRAMYCIN/NEBULIZER TOBRAMYCIN Cystic Fibrosis DORNASE ALFA/ NEBULIZER PULMOZYME Dermatology ACITRETIN ACITRETIN Dermatology ACITRETIN SORIATANE Dermatology ADALIMUMAB HUMIRA PEN PSORIASIS-UVEITIS Dermatology APREMILAST OTEZLA Dermatology BRODALUMAB SILIQ Dermatology DUPILUMAB DUPIXENT Dermatology GUSELKUMAB TREMFYA Dermatology INGENOL MEBUTATE PICATO Dermatology IXEKIZUMAB TALTZ Dermatology SECUKINUMAB COSENTYX Dermatology CERTOLIZUMAB PEGOL CIMZIA Dermatology INFLIXIMAB-DYYB INFLECTRA Dermatology INFLIXIMAB REMICADE Dermatology INFLIXIMAB-ABDA RENFLEXIS Dermatology INFLIXIMAB-AXXQ AVSOLA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Dermatology USTEKINUMAB STELARA Dermatology RISANKIZUMAB SKYRIZI Dermatology TILDRAKIZUMAB ILUMYA Dermatology ENBREL Dupuytren's Contracture COLLAGENASE CLOSTRIDIUM HIST. XIAFLEX Electrolyte Disorders PATIROMER CALCIUM SORBITEX VELTASSA Electrolyte Disorders SODIUM ZIRCONIUM CYCLOSILICATE LOKELMA Electrolyte Disorders TOLVAPTAN JYNARQUE Electrolyte Disorders TOLVAPTAN SAMSCA Endocrine CINACALCET CINACALCET Endocrine CINACALCET SENSIPAR Endocrine ETELCALCETIDE HYDROCHLORIDE PARSABIV Endocrine HISTRELIN ACETATE SUPPRELIN LA Endocrine HISTRELIN ACETATE VANTAS Endocrine METYRAPONE METOPIRONE Endocrine MIFEPRISTONE KORLYM Endocrine PARATHYROID HORMONE NATPARA Endocrine PASIREOTIDE DIASPARTATE SIGNIFOR Endocrine PASIREOTIDE PAMOATE SIGNIFOR LAR Replacement PEGADEMASE BOVINE ADAGEN Enzyme Replacement SUCRAID Endometriosis ELAGOLIX ORILISSA Endometriosis NAFARELIN SYNAREL Fertility CETRORELIX ACETATE CETROTIDE Fertility CHORIOGONADOTROPIN ALFA OVIDREL Fertility CHORIONIC GONADOTROPIN, HUMAN CHORIONIC GONADOTROPIN Fertility CHORIONIC GONADOTROPIN, HUMAN NOVAREL Fertility CHORIONIC GONADOTROPIN, HUMAN PREGNYL Fertility FOLLITROPIN ALFA, RECOMBINANT GONAL-F Fertility FOLLITROPIN BETA,RECOMB FOLLISTIM AQ Fertility GANIRELIX ACETATE GANIRELIX ACETATE Fertility MENOTROPINS MENOPUR Fertility MENOTROPINS REPRONEX Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Fertility UROFOLLITROPIN BRAVELLE Gastroenterology ADALIMUMAB HUMIRA Gastroenterology CERTOLIZUMAB PEGOL CIMZIA Gastroenterology NATALIZUMAB TYSABRI Gastroenterology INFLIXIMAB-DYYB INFLECTRA Gastroenterology INFLIXIMAB REMICADE Gastroenterology INFLIXIMAB-ABDA RENFLEXIS Gastroenterology INFLIXIMAB-AXXQ AVSOLA Gastroenterology GATTEX Gastroenterology USTEKINUMAB STELARA Gastroenterology VEDOLIZUMAB ENTYVIO Gastroenterology CITRATE XELJANZ Genetics MIGLUSTAT Genetics MIGLUSTAT ZAVESCA Gout PEGLOTICASE KRYSTEXXA Growth Hormone and Related Disorders MECASERMIN INCRELEX Growth Hormone and Related Disorders SOMATROPIN GENOTROPIN Growth Hormone and Related Disorders SOMATROPIN HUMATROPE Growth Hormone and Related Disorders SOMATROPIN NORDITROPIN Growth Hormone and Related Disorders SOMATROPIN NORDITROPIN NORDIFLEX Growth Hormone and Related Disorders SOMATROPIN NUTROPIN AQ NUSPIN Growth Hormone and Related Disorders SOMATROPIN NUTROPIN AQ Growth Hormone and Related Disorders SOMATROPIN NUTROPIN Growth Hormone and Related Disorders SOMATROPIN OMNITROPE Growth Hormone and Related Disorders SOMATROPIN SAIZEN Growth Hormone and Related Disorders SOMATROPIN SAIZEN-SAIZENPREP Growth Hormone and Related Disorders SOMATROPIN SEROSTIM Growth Hormone and Related Disorders SOMATROPIN TEV-TROPIN Growth Hormone and Related Disorders SOMATROPIN ZOMACTON Growth Hormone and Related Disorders SOMATROPIN ZORBTIVE Heavy Metal Toxicity PENICILLAMINE CUPRIMINE Heavy Metal Toxicity PENICILLAMINE DEPEN Heavy Metal Toxicity TRIENTINE SYPRINE Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Heavy Metal Toxicity TRIENTINE HCL TRIENTINE HCL Hematopoietics PLERIXAFOR MOZOBIL Hemophilia & Bleeding Disorders ANTIHEM.FVIII,SIN-CHN,B-DM TRU AFSTYLA Hemophilia & Bleeding Disorders ANTIHEMO.FVIII,FULL LENGTH PEG ADYNOVATE Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII REC,FC FUSION ELOCTATE Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,B-DOM TRUNCAT NOVOEIGHT Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,B-DOMAIN DEL XYNTHA Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,FULL LENGTH ADVATE Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,FULL LENGTH KOGENATE FS Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,HEK B-DELETE NUWIQ Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII,FULL LENGTH ADVATE Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII,FULL LENGTH HELIXATE FS Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII,FULL LENGTH KOVALTRY Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII REC,B-DOM DELET PEG-AUCL JIVI Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUM REC RECOMBINATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUMAN HEMOFIL M Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUMAN KOATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUMAN MONOCLATE-P Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR/VWF ALPHANATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR/VWF HUMATE-P Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR/VWF WILATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FVIII,REC PORC OBIZUR Hemophilia & Bleeding Disorders ANTI-INHIBITOR COAGULANT COMP. FEIBA NF Hemophilia & Bleeding Disorders FACTOR VIIA,RECOMB NOVOSEVEN RT Hemophilia & Bleeding Disorders COAGULATION COAGADEX Hemophilia & Bleeding Disorders DESMOPRESSIN ACETATE STIMATE Hemophilia & Bleeding Disorders EMICIZUMAB-KXWH HEMLIBRA Hemophilia & Bleeding Disorders FACTOR IX ALPHANINE SD Hemophilia & Bleeding Disorders FACTOR IX MONONINE Hemophilia & Bleeding Disorders FACTOR IX CPLX(PCC)NO4,3FACTOR PROFILNINE Hemophilia & Bleeding Disorders FACTOR IX CPLX(PCC)NO6,3FACTOR BEBULIN Hemophilia & Bleeding Disorders FACTOR IX HUMAN REC,PEGYLATED REBINYN Hemophilia & Bleeding Disorders FACTOR IX HUMAN RECOMB,THR 148 IXINITY Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Hemophilia & Bleeding Disorders FACTOR IX HUMAN RECOMBINANT BENEFIX Hemophilia & Bleeding Disorders FACTOR IX HUMAN RECOMBINANT RIXUBIS Hemophilia & Bleeding Disorders FACTOR IX REC, FC FUSION PROTN ALPROLIX Hemophilia & Bleeding Disorders FACTOR IX RECOM,ALBUMIN FUSION IDELVION Hemophilia & Bleeding Disorders FACTOR XA,INACTIVATED-ZHZO ANDEXXA Hemophilia & Bleeding Disorders FACTOR XIII CORIFACT Hemophilia & Bleeding Disorders FACTOR XIII A-SUBUNIT,RECOMB TRETTEN Hemophilia & Bleeding Disorders HUMAN PROTHROMIN COMPLEX (PCC) KCENTRA Hemophilia & Bleeding Disorders VON WILLEBRAND FACTOR VONVENDI Hepatitis ADEFOVIR DIPIVOXIL ADEFOVIR DIPIVOXIL Hepatitis ADEFOVIR DIPIVOXIL HEPSERA Hepatitis DACLATASVIR DIHYDROCHLORIDE DAKLINZA Hepatitis ELBASVIR/GRAZOPREVIR ZEPATIER Hepatitis ENTECAVIR BARACLUDE Hepatitis ENTECAVIR ENTECAVIR Hepatitis GLECAPREVIR/PIBRENTASVIR MAVYRET Hepatitis EPIVIR HBV Hepatitis LAMIVUDINE LAMIVUDINE HBV Hepatitis LEDIPASVIR/SOFOSBUVIR HARVONI Hepatitis OMBITA/PARITAP/RITON/DASABUVIR VIEKIRA Hepatitis OMBITASVIR/PARITAPREV/RITONAV TECHNIVIE Hepatitis PEGINTERFERON ALFA-2A PEGASYS PROCLICK Hepatitis PEGINTERFERON ALFA-2A PEGASYS Hepatitis RIBAVIRIN COPEGUS Hepatitis RIBAVIRIN MODERIBA Hepatitis RIBAVIRIN REBETOL Hepatitis RIBAVIRIN RIBASPHERE RIBAPAK Hepatitis RIBAVIRIN RIBASPHERE Hepatitis RIBAVIRIN RIBATAB Hepatitis RIBAVIRIN RIBAVIRIN Hepatitis RIBAVIRIN VIRAZOLE Hepatitis SIMEPREVIR SODIUM OLYSIO Hepatitis SOFOSBUVIR SOVALDI Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Hepatitis SOFOSBUVIR/VELPATAS/VOXILAPREV VOSEVI Hepatitis SOFOSBUVIR/VELPATASVIR EPCLUSA Hereditary Angioedema C1 ESTERASE INHIBITOR BERINERT Hereditary Angioedema C1 ESTERASE INHIBITOR CINRYZE Hereditary Angioedema C1 ESTERASE INHIBITOR HAEGARDA Hereditary Angioedema C1 ESTERASE INHIBITOR, RECOMB RUCONEST Hereditary Angioedema ECALLANTIDE KALBITOR Hereditary Angioedema ICATIBANT ACETATE ICATIBANT Hereditary Angioedema ICATIBANT ACETATE FIRAZYR Hereditary Angioedema LANADELUMAB-FLYO TAKHZYRO Homocystinuria Disorders BETAINE CYSTADANE Hormonal Therapies LEUPROLIDE FENSOLVI Hormonal Therapies LEUPROLIDE/NORETHINDRONE ACET LUPANETA PACK Hyperammoniaemia CARBAGLU HIV SULFATE ABACAVIR HIV ABACAVIR SULFATE ZIAGEN HIV ABACAVIR SULFATE/LAMIVUDINE ABACAVIR-LAMIVUDINE HIV ABACAVIR SULFATE/LAMIVUDINE EPZICOM HIV ABACAVIR//LAMIVUDI TRIUMEQ HIV ABACAVIR/LAMIVUDINE/ ABACAVIR-LAMIVUDINE-ZIDOVUDINE HIV ABACAVIR/LAMIVUDINE/ZIDOVUDINE TRIZIVIR HIV SULFATE ATAZANAVIR SULFATE HIV ATAZANAVIR SULFATE REYATAZ HIV ATAZANAVIR SULFATE/ EVOTAZ HIV BICTEGRAV/EMTRICIT/TENOFOV ALA BIKTARVY HIV COBICISTAT TYBOST HIV ETHANOLATE PREZISTA HIV DARUNAVIR/COB/EMTRI/TENOF ALAF SYMTUZA HIV DARUNAVIR/COBICISTAT PREZCOBIX HIV DELAVIRDINE MESYLATE RESCRIPTOR HIV PIFELTRO HIV DORAVIRINE/LAMIVU/TENOFOV DISOP DELSTRIGO HIV VIDEX Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

HIV DOLUTEGRAVIR SODIUM TIVICAY HIV DOLUTEGRAVIR/LAMIVUDINE DOVATO HIV DOLUTEGRAVIR/ JULUCA HIV EFAVIRENZ HIV EFAVIRENZ SUSTIVA HIV EFAVIRENZ/EMTRICIT/TENOFOVR DF ATRIPLA HIV EFAVIRENZ/LAMIVU/TENOFOV DISOP SYMFI HIV ELVITEG/COB/EMTRI/TENOF ALAFEN GENVOYA HIV ELVITEG/COB/EMTRI/TENOFO DISOP STRIBILD HIV VITEKTA HIV EMTRICITA/RILPIVIRINE/TENOF DF COMPLERA HIV EMTRICITAB/RILPIVIRI/TENOF ALA ODEFSEY HIV EMTRIVA HIV EMTRICITABINE/TENOFOV ALAFENAM DESCOVY HIV EMTRICITABINE/TENOFOVIR TRUVADA HIV FUZEON HIV INTELENCE HIV CALCIUM FOSAMPRENAVIR CALCIUM HIV FOSAMPRENAVIR CALCIUM LEXIVA HIV SULFATE CRIXIVAN HIV LAMIVUDINE EPIVIR HIV LAMIVUDINE LAMIVUDINE HIV LAMIVUDINE/TENOFOVIR DISOP FUM CIMDUO HIV LAMIVUDINE/ZIDOVUDINE COMBIVIR HIV LAMIVUDINE/ZIDOVUDINE LAMIVUDINE-ZIDOVUDINE HIV / KALETRA HIV LOPINAVIR/RITONAVIR LOPINAVIR-RITONAVIR HIV SELZENTRY HIV/ID VIRAMUNE XR HIV MESYLATE VIRACEPT HIV NEVIRAPINE VIRAMUNE HIV POTASSIUM ISENTRESS HIV RILPIVIRINE HCL EDURANT Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

HIV RITONAVIR NORVIR HIV MESYLATE INVIRASE HIV STAVUDINE HIV STAVUDINE ZERIT HIV FUMARATE VEMLIDY HIV FUMARATE VIREAD HIV APTIVUS HIV VALGANCICLOVIR HCL VALCYTE HIV ZIDOVUDINE RETROVIR HIV Support TESAMORELIN ACETATE EGRIFTA ID/Osteopetrosis GAMMA-1B,RECOMB. ACTIMMUNE Idiopathic Pulmonary Fibrosis (IPF) PIRFENIDONE ESBRIET Idiopathic Pulmonary Fibrosis (IPF) NINTEDANIB ESYLATE OFEV Immune Globumin Therapy CYTOMEGALOVIRUS IMMUNE GLOBULN CYTOGAM Immune Globumin Therapy , HUMAN RECOMB. HYQVIA Immune Globumin Therapy IMM GLOB G (IGG)/SORB/IGA 0-50 FLEBOGAMMA DIF Immune Globumin Therapy IMMUN GLOB G (IGG)/GLY/IGA 50+ GAMUNEX Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA 0-50 GAMMAPLEX Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA OV50 BIVIGAM Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA OV50 CUVITRU Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA OV50 GAMMAGARD LIQUID Immune Globumin Therapy IMMUN GLOB G(IGG)/GLY/IGA OV50 HYQVIA IG COMPONENT Immune Globumin Therapy IMMUN GLOB G(IGG)-HIPP/MALTOSE CUTAQUIG Immune Globumin Therapy IMMUN GLOB G(IGG)/PRO/IGA 0-50 HIZENTRA Immune Globumin Therapy IMMUN GLOB G(IGG)/PRO/IGA 0-50 PRIVIGEN Immune Globumin Therapy IMMUN GLOB G(IGG)-IFAS/GLYCINE PANZYGA Immune Globumin Therapy IMMUN GLOB G/GLY/GLUC/IGA 0-50 GAMMAGARD S-D Immune Globumin Therapy IMMUN GLOBG(IGG)/MALT/IGA OV50 OCTAGAM Immune Globumin Therapy IMMUN GLOBG(IGG)/SUCR/IGA OV50 CARIMUNE NF Immune Globumin Therapy IMMUNE GLOB/PLASMA FRA BOVINE ENTERAGAM Immune Globumin Therapy IMMUNE GLOBUL G (IGG)/GLYCINE GAMASTAN Immune Globumin Therapy IMMUNE GLOBUL G/GLY/IGA AVG 46 GAMMAKED Immune Globumin Therapy IMMUNE GLOBUL G/GLY/IGA AVG 46 GAMUNEX-C Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Immune Globumin Therapy LYMPHOCYTE IMMUNE GLOBULIN ATGAM Immune Globumin Therapy RHO(D) IMMUNE GLOBULIN/MALTOSE WINRHO SDF Injection adjuvant HYALURONIDASE AMPHADASE Injection adjuvant HYALURONIDASE, HUMAN RECOMB. HYLENEX Injection adjuvant HYALURONIDASE,OVINE VITRASE Iron Overload DEFERASIROX EXJADE Iron Overload DEFERASIROX JADENU Iron Overload DEFERIPRONE FERRIPROX ITP OLAMINE PROMACTA Disorders ALIROCUMAB PRALUENT Lipid Disorders EVOLOCUMAB REPATHA Lipid Disorders LOMITAPIDE MESYLATE JUXTAPID Lipid Disorders MYALEPT Lipid Disorders MIPOMERSEN SODIUM KYNAMRO Liver Disorders CHENODIOL CHENODAL Liver Disorders CHOLIC ACID CHOLBAM Liver Disorders OBETICHOLIC ACID OCALIVA Liver Disorders TRIENTINE HCL SYPRINE Liver Disorders TRIENTINE HCL TRIENTINE HCL Liver Disorders PENICILLAMINE CUPRIMINE Liver Disorders PENICILLAMINE DEPEN Lysosomal Storage Disorders AGALSIDASE BETA FABRAZYME Lysosomal Storage Disorders LUMIZYME Lysosomal Storage Disorders ALGLUCOSIDASE ALFA MYOZYME Lysosomal Storage Disorders BITARTRATE CYSTAGON Lysosomal Storage Disorders CYSTEAMINE BITARTRATE PROCYSBI Lysosomal Storage Disorders TARTRATE CERDELGA Lysosomal Storage Disorders ELOSULFASE ALFA VIMIZIM Lysosomal Storage Disorders GALSULFASE NAGLAZYME Lysosomal Storage Disorders ELAPRASE Lysosomal Storage Disorders CEREZYME Lysosomal Storage Disorders LARONIDASE ALDURAZYME Lysosomal Storage Disorders KANUMA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Lysosomal Storage Disorders VPRIV Migraine ERENUMAB-AOOE AIMOVIG AUTOINJECTOR Migraine FREMANEZUMAB-VFRM AJOVI Migraine GALCANEZUMAB-GNLM EMGALITY Migraine UBROGEPANT UBRELVY Movement Disorders HCL APOKYN Movement Disorders DEFLAZACORT EMFLAZA Movement Disorders DICHLORPHENAMIDE KEVEYIS Movement Disorders NORTHERA Movement Disorders DEUTETRABENAZINE AUSTEDO Movement Disorders ECULIZUMAB SOLIRIS Movement Disorders EDARAVONE RADICAVA Movement Disorders RILUZOLE RILUTEK Movement Disorders RILUZOLE RILUZOLE Movement Disorders RILUZOLE TIGLUTIK Movement Disorders TETRABENAZINE TETRABENAZINE Movement Disorders TETRABENAZINE XENAZINE Movement Disorders VALBENAZINE TOSYLATE INGREZZA Movement Disorders VIGABATRIN SABRIL Movement Disorders VIGABATRIN VIGABATRIN Movement Disorders VIGABATRIN VIGADRONE Multiple Sclerosis DALFAMPRIDINE AMPYRA Multiple Sclerosis DALFAMPRIDINE DALFAMPRIDINE ER Multiple Sclerosis DIMETHYL FUMARATE TECFIDERA Multiple Sclerosis DIMETHYL FUMARATE DIMETHYL FUMARATE Multiple Sclerosis FINGOLIMOD HCL GILENYA Multiple Sclerosis GLATIRAMER ACETATE COPAXONE Multiple Sclerosis GLATIRAMER ACETATE GLATIRAMER ACETATE Multiple Sclerosis GLATIRAMER ACETATE GLATOPA Multiple Sclerosis INTERFERON BETA-1A/ALBUMIN AVONEX Multiple Sclerosis INTERFERON BETA-1A/ALBUMIN REBIF Multiple Sclerosis INTERFERON BETA-1B BETASERON Multiple Sclerosis INTERFERON BETA-1B EXTAVIA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Multiple Sclerosis MITOXANTRONE HCL MITOXANTRONE HCL Multiple Sclerosis PEGINTERFERON BETA-1A PLEGRIDY Multiple Sclerosis OCRELIZUMAB OCREVUS Multiple Sclerosis TERIFLUNOMIDE AUBAGIO Neutropenia NEUPOGEN Neutropenia FILGRASTIM-AAFI NIVESTYM Neutropenia FILGRASTIM-SNDZ ZARXIO Neutropenia NEULASTA Neutropenia PEGFILGRASTIM-APGF NYVEPRIA Neutropenia PEGFILGRASTIM-CBQV UDENYCA Neutropenia PEGFILGRASTIM-JMDB FULPHILA Neutropenia TBO-FILGRASTIM GRANIX Oncology ABEMACICLIB VERZENIO Oncology ABIRATERONE ACETATE ZYTIGA Oncology ABIRATERONE ACET,SUBMICRONIZED YONSA Oncology ACALABRUTINIB CALQUENCE Oncology ADO-TRASTUZUMAB EMTANSINE KADCYLA Oncology AFATINIB DIMALEATE GILOTRIF Oncology ALDESLEUKIN PROLEUKIN Oncology ALECTINIB HCL ALECENSA Oncology ALEMTUZUMAB CAMPATH Oncology ALEMTUZUMAB LEMTRADA Oncology ALPELISIB PIQRAY Oncology ALTRETAMINE HEXALEN Oncology ANASTROZOLE* ARIMIDEX* Oncology APALUTAMIDE ERLEADA Oncology ARSENIC TRIOXIDE ARSENIC TRIOXIDE Oncology ATEZOLIZUMAB TECENTRIQ Oncology AXITINIB INLYTA Oncology AVELUMAB BAVENCIO Oncology BELINOSTAT BELEODAQ Oncology BENDAMUSTINE HCL BENDAMUSTINE Oncology BENDAMUSTINE HCL BENDEKA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology BENDAMUSTINE HCL TREANDA Oncology BEVACIZUMAB AVASTIN Oncology BEVACIZUMAB-AWWB MVASI Oncology BEXAROTENE BEXAROTENE Oncology BEXAROTENE TARGRETIN Oncology BINIMETINIB MEKTOVI Oncology BLINATUMOMAB BLINCYTO Oncology BORTEZOMIB BORTEZOMIB Oncology BORTEZOMIB VELCADE Oncology BOSUTINIB BOSULIF Oncology BRENTUXIMAB VEDOTIN ADCETRIS Oncology BRIGATINIB ALUNBRIG Oncology BUSULFAN MYLERAN Oncology CABAZITAXEL JEVTANA Oncology CABOZANTINIB S-MALATE CABOMETYX Oncology CABOZANTINIB S-MALATE COMETRIQ Oncology CAPECITABINE CAPECITABINE Oncology CAPECITABINE XELODA Oncology CARFILZOMIB KYPROLIS Oncology CARMUSTINE BICNU Oncology CEMIPLIMAB-RWLC LIBTAYO Oncology CERITINIB ZYKADIA Oncology CETUXIMAB ERBITUX Oncology CHLORAMBUCIL LEUKERAN Oncology COBIMETINIB FUMARATE COTELLIC Oncology CRIZOTINIB XALKORI Oncology COBIMETINIB COTELLIC Oncology CYCLOPHOSPHAMIDE CYTOXAN Oncology CYTARABINE CYTARABINE Oncology CAPMATINIB TABRECTA Oncology DABRAFENIB MESYLATE TAFINLAR Oncology DACOMITINIB VIZIMPRO Oncology DACARBAZINE DACARBAZINE Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology DARATUMUMAB DARZALEX Oncology DAROLUTAMIDE NUBEQA Oncology SPRYCEL Oncology DECITABINE DACOGEN Oncology DECITABINE DECITABINE Oncology XGEVA Oncology DOXORUBICIN DOXORUBICIN Oncology DURVALUMAB IMFINZI Oncology DUVELISIB COPIKTRA Oncology ELOTUZUMAB EMPLICITI Oncology ELTROMBOPAG OLAMINE PROMACTA Oncology ENASIDENIB MESYLATE IDHIFA Oncology ENCORAFENIB BRAFTOVI Oncology ENTRECTINIB ROZLYTREK Oncology ENZALUTAMIDE XTANDI Oncology ERIBULIN MESYLATE HALAVEN Oncology ERLOTINIB HCL TARCEVA Oncology ESTRAMUSTINE SODIUM EMCYT Oncology ETOPOSIDE ETOPOSIDE Oncology ETOPOSIDE TOPOSAR Oncology EVEROLIMUS AFINITOR Oncology EXEMESTANE* AROMASIN* Oncology FEDRATINIB INREBIC Oncology FLUOROURACIL ADRUCIL Oncology FLUOROURACIL FLUOROURACIL Oncology FULVESTRANT FASLODEX Oncology GEFITINIB IRESSA Oncology GEMTUZUMAB OZOGAMICIN MYLOTARG Oncology GILTERITINIB FUMARATE XOSPATA Oncology GOSERELIN ACETATE ZOLADEX Oncology HYDROXYUREA HYDREA Oncology IBRUTINIB IMBRUVICA Oncology IDELALISIB ZYDELIG Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology MESYLATE GLEEVEC Oncology IMATINIB MESYLATE IMATINIB MESYLATE Oncology -2B,RECOMB. INTRON A Oncology INTERFERON ALFACON-1 INFERGEN Oncology IPILIMUMAB YERVOY Oncology IVOSIDENIB TIBSOVO Oncology IXABEPILONE IXEMPRA Oncology IXAZOMIB CITRATE NINLARO Oncology LAPATINIB DITOSYLATE TYKERB Oncology LAPATINIB DITOSYLATE LAPATINIB DITOSYLATE Oncology REVLIMID Oncology LAROTRECTINIB VITRAKVI Oncology LENVATINIB MESYLATE LENVIMA Oncology LETROZOLE* FEMARA* Oncology LEUPROLIDE ACETATE ELIGARD Oncology LEUPROLIDE ACETATE LUPANETA Oncology LEUPROLIDE ACETATE LUPRON DEPOT Oncology LOMUSTINE CEENU Oncology LOMUSTINE GLEOSTINE Oncology LOMUSTINE LOMUSTINE Oncology LORLATINIB LORBRENA Oncology LURBINECTEDIN ZEPZELCA Oncology MECHLORETHAMINE HCL VALCHLOR Oncology MELPHALAN ALKERAN Oncology MELPHALAN HCL MELPHALAN Oncology MERCAPTOPURINE MERCAPTOPURINE Oncology MERCAPTOPURINE PURINETHOL Oncology MERCAPTOPURINE PURIXAN Oncology METHOTREXATE SODIUM METHOTREXATE Oncology METHOTREXATE SODIUM/PF METHOTREXATE SODIUM Oncology RYDAPT Oncology NERATINIB MALEATE NERLYNX Oncology NECITUMUMAB PORTRAZZA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology NILOTINIB HCL TASIGNA Oncology NILUTAMIDE NILUTAMIDE Oncology NIRAPARIB TOSYLATE ZEJULA Oncology NIVOLUMAB OPDIVO Oncology OBINUTUZUMAB GAZYVA Oncology OCTREOTIDE ACETATE BYNFEZIA Oncology OCTREOTIDE ACETATE OCTREOTIDE ACETATE Oncology OFATUMUMAB KESIMPTA Oncology OLAPARIB LYNPARZA Oncology OLARATUMAB LARTRUVO Oncology OMACETAXINE MEPESUCCINATE SYNRIBO Oncology OSIMERTINIB MESYLATE TAGRISSO Oncology PACLITAXEL ONXOL Oncology PACLITAXEL PROTEIN-BOUND ABRAXANE Oncology PALBOCICLIB IBRANCE Oncology PANITUMUMAB VECTIBIX Oncology PANOBINOSTAT LACTATE FARYDAK Oncology PAZOPANIB HCL VOTRIENT Oncology PEGINTERFERON ALFA-2B SYLATRON Oncology PEMBROLIZUMAB KEYTRUDA Oncology PERTUZUMAB PERJETA Oncology PERTUZUMAB, TRASTUZUMAB, HYALURONIDASE PHESGO Oncology POMALIDOMIDE POMALYST Oncology PONATINIB HCL ICLUSIG Oncology PROCARBAZINE HCL MATULANE Oncology POLATUZUMAB POLIVY Oncology RAMUCIRUMAB CYRAMZA Oncology REGORAFENIB STIVARGA Oncology RELUGOLIX ORGOVYX Oncology RIBOCICLIB SUCCINATE KISQALI Oncology RIBOCICLIB SUCCINATE/LETROZOLE KISQALI FEMARA CO-PACK Oncology RITUXIMAB RITUXAN Oncology RITUXIMAB/HYALURONIDASE,HUMAN RITUXAN HYCELA Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology ROMIDEPSIN ISTODAX Oncology ROMIDEPSIN ROMIDEPSIN Oncology NPLATE Oncology RUCAPARIB CAMSYLATE RUBRACA Oncology JAKAFI Oncology SELPERCATINIB RETEVMO Oncology SONIDEGIB PHOSPHATE ODOMZO Oncology TOSYLATE NEXAVAR Oncology MALATE SUTENT Oncology TAFASITAMAB MONJUVI Oncology TALAZOPARIB TOSYLATE TALZENNA Oncology TAMOXIFEN CITRATE NOLVADEX Oncology TAMOXIFEN CITRATE SOLTAMOX Oncology TAMOXIFEN CITRATE TAMOXIFEN CITRATE Oncology TEMOZOLOMIDE TEMODAR Oncology TEMOZOLOMIDE TEMOZOLOMIDE Oncology TORISEL TEMSIROLIMUS Oncology TEMSIROLIMUS TORISEL Oncology THALIDOMIDE THALOMID Oncology THIOGUANINE TABLOID Oncology THYROTROPIN ALFA THYROGEN Oncology HCL HYCAMTIN Oncology TOPOTECAN HCL TOPOTECAN HCL Oncology TOREMIFENE CITRATE TOREMIFENE Oncology TRAMETINIB DIMETHYL SULFOXIDE MEKINIST Oncology TRASTUZUMAB HERCEPTIN Oncology TRASTUZUMAB/HYALURONIDASE HERCEPTIN HYLECTA Oncology TRETINOIN TRETINOIN Oncology TRETINOIN VESANOID Oncology TRIFLURIDINE/TIPIRACIL HCL LONSURF Oncology VALRUBICIN VALSTAR Oncology VANDETANIB CAPRELSA Oncology VEMURAFENIB ZELBORAF Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Oncology VENETOCLAX VENCLEXTA Oncology VINBLASTINE VINBLASTINE Oncology VINCRISTINE VINCRISTINE Oncology VISMODEGIB ERIVEDGE Oncology VORINOSTAT ZOLINZA Oncology Supportive Therapies DALTEPARIN SODIUM,PORCINE FRAGMIN Oncology Supportive Therapies MESNA MESNA Oncology Supportive Therapies MESNA MESNEX Oncology Supportive Therapies LEUKINE Oncology Supportive Therapies TELOTRISTAT ETIPRATE XERMELO Ophthalmology AFLIBERCEPT EYLEA Ophthalmology BEVACIZUMAB AVASTIN Ophthalmology HYALURONATE SODIUM AMVISC Ophthalmology HYALURONATE SODIUM BIOLON Ophthalmology HYALURONATE SODIUM HEALON Ophthalmology HYALURONATE SODIUM HEALON5 Ophthalmology HYALURONATE SODIUM PROVISC Ophthalmology OCRIPLASMIN/PF JETREA Ophthalmology PEGAPTANIB SODIUM MACUGEN Ophthalmology RANIBIZUMAB LUCENTIS Ophthalmology ZIV-AFLIBERCEPT ZALTRAP Opioid Induced Constipation METHYLNALTREXONE BROMIDE RELISTOR Osteoarthritis HYALURONATE SODIUM EUFLEXXA Osteoarthritis HYALURONATE SODIUM GELSYN-3 Osteoarthritis HYALURONATE SODIUM GENVISC 850 Osteoarthritis HYALURONATE SODIUM HYALGAN Osteoarthritis HYALURONATE SODIUM ORTHOVISC Osteoarthritis HYALURONATE SODIUM SUPARTZ Osteoarthritis HYALURONATE SODIUM TRIVISC Osteoarthritis HYALURONATE SODIUM VISCO-3 Osteoarthritis HYALURONATE SODIUM, STABILIZED DUROLANE Osteoarthritis HYALURONATE SODIUM, STABILIZED MONOVISC Osteoarthritis HYALURONATE,MOD.,NON-CROSSLINK HYMOVIS Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Osteoarthritis HYLAN G-F 20 SYNVISC Osteoarthritis HYLAN G-F 20 SYNVISC-ONE Osteoporosis ABALOPARATIDE TYMLOS Osteoporosis STRENSIQ Osteoporosis ZOLEDRONIC ACID ZOLEDRONIC ACID Osteoporosis ZOLEDRONIC ACID ZOMETA Osteoporosis ZOLEDRONIC ACID/MANNITOL-WATER RECLAST Osteoporosis TERIPARATIDE FORTEO Osteoporosis ROMOSOZUMAB EVENITY Osteoporosis DENOSUMAB PROLIA Periodic Fever Syndromes CANAKINUMAB/PF ILARIS Periodic Fever Syndromes RILONACEPT ARCALYST Phenylketonuria (PKU) SAPROPTERIN DIHYDROCHLORIDE KUVAN Phenylketonuria (PKU) SAPROPTERIN DIHYDROCHLORIDE SAPROPTERIN DIHYDROCHLORIDE Paroxysmal Nocturnal Hemoglobinuria RAVULIZUMAB ULTOMIRIS Pheocromocytoma PHENOXYBENZAMINE HCL PHENOXYBENZAMINE Pre-Term Birth HYDROXYPROGESTERONE CAPROAT/PF HYDROXYPROGESTERONE CAPROATE Pre-Term Birth HYDROXYPROGESTERONE CAPROAT/PF MAKENA Pulmonary Arterial (PAH) AMBRISENTAN LETAIRIS Pulmonary Arterial Hypertension (PAH) BOSENTAN TRACLEER Pulmonary Arterial Hypertension (PAH) EPOPROSTENOL SODIUM (ARGININE) VELETRI Pulmonary Arterial Hypertension (PAH) EPOPROSTENOL SODIUM (GLYCINE) EPOPROSTENOL SODIUM Pulmonary Arterial Hypertension (PAH) EPOPROSTENOL SODIUM (GLYCINE) FLOLAN Pulmonary Arterial Hypertension (PAH) ILOPROST TROMETHAMINE VENTAVIS Pulmonary Arterial Hypertension (PAH) MACITENTAN OPSUMIT Pulmonary Arterial Hypertension (PAH) RIOCIGUAT ADEMPAS Pulmonary Arterial Hypertension (PAH) SELEXIPAG UPTRAVI Pulmonary Arterial Hypertension (PAH) CITRATE REVATIO Pulmonary Arterial Hypertension (PAH) ADCIRCA Pulmonary Arterial Hypertension (PAH) TREPROSTINIL TYVASO Pulmonary Arterial Hypertension (PAH) TREPROSTINIL DIOLAMINE ORENITRAM ER Pulmonary Arterial Hypertension (PAH) TREPROSTINIL SODIUM REMODULIN Respiratory Syncytial Virus (RSV) PALIVIZUMAB SYNAGIS Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Rheumatology ABATACEPT ORENCIA Rheumatology ADALIMUMAB HUMIRA Rheumatology ANAKINRA KINERET Rheumatology AURANOFIN RIDAURA Rheumatology OLUMIANT Rheumatology BENLYSTA Rheumatology CORTICOTROPIN H.P. ACTHAR Rheumatology ETANERCEPT ENBREL Rheumatology GOLIMUMAB SIMPONI ARIA Rheumatology GOLIMUMAB SIMPONI Rheumatology INFLIXIMAB REMICADE Rheumatology INFLIXIMAB-ABDA RENFLEXIS Rheumatology INFLIXIMAB-AXXQ AVSOLA Rheumatology INFLIXIMAB-DYYB INFLECTRA Rheumatology METHOTREXATE OTREXUP Rheumatology METHOTREXATE XATMEP Rheumatology SARILUMAB KEVZARA Rheumatology TOCILIZUMAB ACTEMRA Rheumatology TOFACITINIB CITRATE XELJANZ Rheumatology TOFACITINIB CITRATE XELJANZ XR Rheumatology USTEKINUMAB STELARA Rheumatology IXEKIZUMAB TALTZ Rheumatology SECUKINUMAB COSENTYX Rheumatology RINVOQ Rheumatology RITUXIMAB RITUXAN Sleep Disorders SODIUM OXYBATE XYREM Sleep Disorders TASIMELTEON HETLIOZ Thrombocytopenia LUSUTROMBOPAG MULPLETA Thrombocytopenia TAVALISSE Transplant AZACITIDINE AZACITIDINE Transplant AZACITIDINE VIDAZA Transplant AZATHIOPRINE AZASAN Transplant AZATHIOPRINE AZATHIOPRINE Specialty Medications List Harness Health Pharmacy

Disease State Generic Name Brand Name

Transplant AZATHIOPRINE IMURAN Transplant AZATHIOPRINE SODIUM AZATHIOPRINE SODIUM Transplant BASILIXIMAB SIMULECT Transplant CYCLOSPORINE CYCLOSPORINE Transplant CYCLOSPORINE SANDIMMUNE Transplant CYCLOSPORINE, MODIFIED CYCLOSPORINE MODIFIED Transplant CYCLOSPORINE, MODIFIED GENGRAF Transplant CYCLOSPORINE, MODIFIED NEORAL Transplant EVEROLIMUS ZORTRESS Transplant MYCOPHENOLATE MOFETIL CELLCEPT Transplant MYCOPHENOLATE MOFETIL MYCOPHENOLATE MOFETIL Transplant MYCOPHENOLATE MOFETIL HCL CELLCEPT Transplant MYCOPHENOLATE SODIUM MYCOPHENOLIC ACID Transplant MYCOPHENOLATE SODIUM MYFORTIC Transplant PALIFERMIN KEPIVANCE Transplant SIROLIMUS RAPAMUNE Transplant SIROLIMUS SIROLIMUS Transplant TACROLIMUS ASTAGRAF XL Transplant TACROLIMUS ENVARSUS XR Transplant TACROLIMUS HECORIA Transplant TACROLIMUS PROGRAF Transplant TACROLIMUS TACROLIMUS Inhibitor NITYR Tyrosine Metabolism Inhibitor NITISINONE ORFADIN Disorders RAVICTI Urea Cycle Disorders BUPHENYL Urea Cycle Disorders SODIUM PHENYLBUTYRATE SODIUM PHENYLBUTYRATE Urology DEGARELIX ACETATE FIRMAGON Urology LEUPROLIDE ACETATE LEUPROLIDE ACETATE Urology TIOPRONIN THIOLA