PartnerRe Trigger Pharmaceuticals (at 5.21.21) Code Brand Name Generic Name Code Brand Name Generic Name J3590 Abecma®...... idecabtagene vicleucel J8999 Daurismo®...... glasdegib J0800 Acthar® ...... repository corticotropin injection J8499 Demser®...... metyrosine J9216 Actimmune®...... interferon gamma-1B J1743 Elaprase® ...... idursulfase J9042 Adcetris®...... brentuximab vedotin J3060 Elelyso® ...... taliglucerace alfa J7192 Advate®...... factor viii recombinant nos J7205 Eloctate®...... antihemophilic factor viii J7207 Adynovate®...... antihemophilia factor viii, pegylated J3590 Elzonris® ...... tagraxofusp-erzs J7210 Afstyla®...... recombinant human factor viii J3490 Empaveli®...... pegcetacoplan J1931 Aldurazyme® ...... laronidase J9176 Empliciti®...... elotuzumab J8999 Alecensa®...... alectinib J3590 Enspryng®...... satralizumab-mwge

J7186 Alphanate®...... von Willebrand Factor Complex/antihemophilic J9055 Erbitux®...... cetuximab J7201 Alprolix®...... factor ix recombinant J7192 Esperoct®...... factor viii recombinant nos J8999 Alunbrig®...... brigatinib J3590 Evkeeza®...... evinacumab-dgnb J3490 Amondys 45®...... casimersen J3590 Evrysdi® ...... risdiplam J2793 Arcalyst®...... rilonacept J1428 Exondys 51® ...... eteplirsen J9302 Arzerra®...... ofatumumab J0180 Fabrazyme®...... agalsidase beta J1599 Asceniv®...... immune globulin, intravenous-slra J7198 Feiba NF®...... anti-inhibitor coagulant complex* J7196 Atryn®...... antithrombin recombinant J1744 Firazyr®...... icatibant J7198 Autoplex T F®.....factor ix anti-inhibitor coagulant complex J8499 Firdapse® ...... amifampridine J9035 Avastin®...... bevacizumab J9307 Folotyn® ...... pralatrexate J8999 Ayvakit®...... avapritinib J8999 Fotivda®...... tivozanib C9399 Azedra® ...... Iobenguane I 131 J8499 Galafold® ...... migalastat J8999 Balversa® ...... erdafitinib J3590 Gamifant® ...... emapalumab-izsg

J9032 Beleodaq®...... belinostat J1569 Gammagard Liquid®...... IVIG Immune globulin, human J7195 BeneFIX®...... factor ix recombinant J1566 Gammagard®...... IVIG Immune globulin, human J0597 Berinert® ...... C1 esterase inhibitor concentrate J1561 Gammaked®...... IVIG Immune globulin, human J7599 Blenrep® ...... belantamab mafodotin-blmf J1557 Gammaplex®...... IVIG Immune globulin, human J9039 Blincyto®...... blinatomumab J1561 Gamunex-C®...... IVIG Immune globulin, human J3590 Breyanzi®...... lisocabtagene maraleucel J3490 Gattex® ...... teduglutide J0567 Brineura®...... cerliponase alfa C9056 Givlaari®...... givosiran J8999 Brukinsa® ...... zanubrubtinib J0599 Haegarda® ...... C1 esterase inhibitor subcutaneous J3590 Cablivi® ...... caplacizumab-yhdp J7192 Helixate®...... factor viii recombinant nos J8999 Cabometyx®...... cabozantinib J7170 Hemlibra®...... emicizumab-kxwh J8999 Calquence®...... acalabrutinib J1559 Hizentra®/Hizentra 20%...... immune globulin subcutaneous J8499 Carbaglu® ...... carglumic acid J7187 Humate-P® ...... von Willebrand Factor Complex/ J1566 Carimune NF®...... IVIG immune globulin, nanofiltered antihemophilic J8499 Cerdelga® ...... eliglustat J7202 Idelvion®...... factor ix recombinant J1786 Cerezyme® ...... imiglucerase J8999 Idhifa®...... enasidenib J8499 Chenodal® ...... chenodiol J0638 Ilaris®...... canakinumab J8499 Cholbam® ...... cholic acid J8999 Imbruvica®...... ibrutinib J0598 Cinryze® ...... C1 esterase inhibitor J3490 Imcivree®...... setmalanotide J7175 Coagadex®...... coagulation factor X [human] J9173 Imfinzi®...... durvalumab J7180 Corifact®...... factor xiii antihemophilic factor J8999 Inqovi®...... decitabine and cedazuridine J0584 Crysvita®...... burosumab-twza J8999 Inrebic®...... fedratinib J8499 Cuprimine®...... penicillamine J9315 Istodax® ...... romidepsin J9308 Cyramza®...... ramucirumab J9280 Jelmyto®...... mitomycin/mitomycin-C J3590 Danyelza®...... naxitamab-gqgk J7599 Jemperli®...... dostarlimab-gxly J9145 Darzalex®...... daratumumab J7208 Jivi®...... factor viii recombinant nos

PartnerRe American Insurance Company PartnerRe Health is a division of ParterRe Ltd. In the US, coverage is underwritten by 6900 Wedgewood Road North ParterRe America Insurance Company. This literature is descriptive only. Actual Maple Grove, MN 55311 USA coverage is subject to the language of the policies or agreements as issued Phone +1 612 234 4920 www.partnerre.com/health TPW0521 | 1 of 3 PartnerRe Trigger Pharmaceuticals (at 5.21.21) Code Brand Name Generic Name Code Brand Name Generic Name J8499 Juxtapid®...... lomitapide J9295 Portrazza®...... necitumumab J9354 Kadcyla®...... ado-trastuzumab emtansine J9204 Poteligeo® ...... mogamulizumab-kpkc J1290 Kalbitor® ...... ecallantide J1459 Privigen®...... IVIG Immune globulin, human J8499 Kalydeco® ...... ivacaftor J7194 Profilnine®...... factor ix complex J2840 Kanuma®...... sebelipase alfa J8999 Qinlock®...... ripretinib J9271 Keytruda®...... pembrolizumab J1301 Radicava®...... edaravone J7190 Koate®...... factor viii J8499 Ravicti® ...... glycerol phenylbutyrate J7192 Kogenate®...... factor viii recombinant nos J7203 Rebinyn®...... factor ix antihemophilic factor J8499 Korlym®...... mifepristone J7192 Recombinate® ...... factor viii recombinant nos J8499 Koselugo®...... selumetinib J8999 Retevmo®...... selpercatinib J7211 Kovaltry®...... recombinant human factor viii J3590 Revcovi® ...... elapegademase-lvlr J2507 Krystexxa®...... pegloticase J7178 Riastap®...... fibrinogen concentrage [human] Q2042 Kymriah® ...... tisagenlecleucel J7200 Rixubis® ...... factor ix recombinant J9285 Lartruvo®...... olaratumab J7185 Roctavian®...... valoctocogene roxaparvovec J3590 Libtayo® ...... cemiplimab-rwlc J0596 Ruconest® ...... C1 esterase inhibitor recombinant J8999 Lorbrena®...... lorlatinib J8499 Ruzurgi®...... amifampridine J0221 Lumizyme®...... alglucosidase alfa J8499 Sabril®...... vigabatrin J3590 Lumoxiti®...... moxetumomab pasudotox-tdfk J9227 Sarclisa ®...... isatuximab-irfc J8499 Lupkynis®...... voclosporin J3590 Sogroya®...... somapacitan-beco J3490 Lutathera®...... lutetium lu 177 dotatate J1300 Soliris® ...... eculizumab J3398 Luxturna® ...... voretigene neparvovec-rzyl J2326 Spinraza® ...... nusinersen J8999 Lynparza®...... olaparib J3357 Stelara®...... ustekinumab J8999 Mekinist®...... trametinib J8999 Stivarga®...... regorafenib J3397 Mepsevii® ...... vestronidase alfa-vjbk J3590 Strensiq® ...... asfotase alfa J7599 Monjuvi®...... tafasitamab-cxix J2860 Sylvant®...... siltuximab J7190 Monoclate-P®...... factor viii, human J8499 Symdeko®...... tezacaftor/ivacaftor and ivacaftor Q5107 Mvasi®...... bevacizumab awwb J8999 Tabrecta®...... capmatinib hydrochloride J3590 Myalept® ...... metreleptin J3590 Tafamidis®...... Vyndaqel J1458 Naglazyme®...... galsulfase J8999 Tafinlar®...... dabrafenib mesylate J7182 NovoEight®...... factor viiii recombinant J3590 Takhzyro® ...... lanadelumab-flyo J7189 NovoSeven RT®...... recombinant human factor viia J8999 Targretin® ...... bexarotene J2796 Nplate®...... romiplostim J8999 Tazverik®...... tazemetostat hydrobromide J2182 Nucala®...... mepolizumab J3590 Tecartus®...... brexucabtagene autoleucel J3490 Nulibry®...... fosdenopterin J9022 Tecentriq®...... atezolizumab J7209 Nuwiq®...... factor viii recombinant J3490 Tegsedi®...... inotersen J7188 Obizur®...... antihemophilia factor, recombinant J8999 Tepezza®...... teprotumumab-trbw J1568 Octagam®...... IVIG Immune globulin, human J8999 Tepmetko®...... tepotinib hydrochloride hydrate J3590 Onpattro®...... patisiran J7197 Thrombate®...... antithrombin III, human J8999 Onureg®...... azacitidine J8999 Tibsovo® ...... ivosidenib J9299 Opdivo®...... nivolumab J7181 Tretten®...... factor xiii recombinant J8499 Orfadin®...... nitisinone J8499 Trikafta®...... elexacaftor/tezacaftor/ivacaftor J8499 Orkambi®...... lumacaftor/ivacaftor J9317 Trodelvy®...... sacituzumab govitecan-hziy J8499 Orladeyo® ...... berotrastat J8999 Tukysa®...... tucatinib J8999 Oxlumo®...... lumasiran J8999 Turalio®...... pexidartinib J3490 Palynziq®...... pegvalise-pqpz J7686 Tyvaso®...... treprostinil J8999 Pemazyre®...... pemigatinib J8999 Ukoniq®...... umbralisib J9999 Pepaxto®...... melphalan flufenamide hydrochloride J1303 Ultomiris® ...... ravulizumab-cwvz

PartnerRe American Insurance Company PartnerRe Health is a division of ParterRe Ltd. In the US, coverage is underwritten by 6900 Wedgewood Road North ParterRe America Insurance Company. This literature is descriptive only. Actual Maple Grove, MN 55311 USA coverage is subject to the language of the policies or agreements as issued Phone +1 612 234 4920 www.partnerre.com/healt h TPW0521 | 2 of 3 PartnerRe Trigger Pharmaceuticals (at 5.21.21) Code Brand Name Generic Name J3590 Uplizna®...... inebilizumab-cdon J9303 Vectibix®...... panitumumab J8999 Verzenio®...... abemaciclib J3490 Viltepso®...... viltolarsen J1322 Vimizim® ...... elosulfase alfa J8999 Vitrakvi®...... larotrectinib J8999 Vizimpro®...... dacomitinib J3385 VPRIV® ...... velaglucerase alfa/glucocerebrosidase J3490 Vyondys 53®...... golodirsen J7183 Wilate®...... von Willebrand Factor Complex J8999 Xospata® ...... gilteritinib J8999 Xpovio®...... selinexor J8999 Xtandi®...... enzalutamide J7185 Xyntha®...... recombinant human factor viii J9228 Yervoy®...... ipilimumab Q2041 Yescarta® ...... axicabtagene ciloleucel J8499 Zavesca® ...... miglustat J8999 Zejula®...... niraparib J8999 Zelboraf®...... vemurafenib J9999 Zepzelca®...... lurbinectedin J8999 Zokinvy®...... lonafarnib J3590 Zolgensma® ...... onasemnogene abeparvovec-xioi J8999 Zolinza®...... vorinostat J3590 Zynlonta®...... loncastuximab tesirine-lpyl

PartnerRe American Insurance Company PartnerRe Health is a division of ParterRe Ltd. In the US, coverage is underwritten by 6900 Wedgewood Road North ParterRe America Insurance Company. This literature is descriptive only. Actual Maple Grove, MN 55311 USA coverage is subject to the language of the policies or agreements as issued Phone +1 612 234 4920 www.partnerre.com/healt h TPW0521 | 3 of 3