Current Specialty Pharmacy Drugs (as of July 1, 2021*) New drugs indicated in red

BRAND NAME INGREDIENT CLASS CLASS ABECMA Idecabtagene vicleucel Miscellaneous ABILIFY MAINTENA Aripiprazole Long Acting Anti-Psychotics ABRAXANE Paclitaxel protien bound Oncology ACTEMRA Tocilizumab Immunomodulator ACTHAR Corticotropin Endocrine/Metabolic ADAGEN Pegademase bovine Enzyme Replacement ADAKVEO Crizanlizumab-tmca Miscellaneous ADECETRIS Brentuximab Oncology ADRIAMYCIN Doxorubicin HCl Oncology ADRUCIL Fluorouracil Oncology AJOVY Fremanezumab-vfrm Migraine ALDURAZYME Laronidase Enzyme Replacement ALFERON N Interferon alfa-n3 Immunomodulator ALIMTA Pemtrexed disodium Oncology ALIQOPA Copanlisib dihydrochloride Oncology ALKERAN Melphalan hydrochloride Oncology AMONDYS 45 Casimersen Miscellaneous ANDEXXA Coagulation factor XA Hematological ANJESO Meloxicam Pain ARALAST Alpha - 1 proteinase inhibitor Enzyme Replacement ARANESP Darbepoetin alfa Anemia/Renal Disorders ARCALYST Rilonacept Miscellaneous AREDIA Pamidronate disodium Endocrine/Metabolic ARISTADA Aripiprazole Lauroxil Long Acting Anti-Psychotics ARISTADA INITIO Aripiprazole Lauroxil Long Acting Anti-Psychotics ARRANON Nelarabine Oncology ARZERRA Ofatumumab Oncology ASCENIV Immune Globulin Intravenous; Human-slra Immune Globulin ASPARLAS Calaspargase pegol-mknl Oncology ATGAM Antithymocyte globulin Miscellaneous AVASTIN Bevaciz+B75umab Oncology AVSOLA Infliximab-axxq Immunomodulator BAVENCIO Avelumab Oncology BCG VACCINE BCG Live intravesical Oncology BELEODAQ Belinostat Oncology BELRAPZO Bendamustine hydrochloride Oncology BENDEKA Bendamustine Oncology BENLYSTA Belimumab Immunomodulator BEOVU Brolucizumab-dbll Oncology BERINERT C1 esterase inhibitor human Miscellaneous BESPONSA Inotuzumab ozogamicin Oncology BICNU Carmustine Oncology BIVIGAM Immune globulin Immune Globulin BLENOXANE Bleomycin sulfate Oncology BLENREP Belantamab Oncology BLINCYTO Blinatumomab Oncology BORTEZOMIB Bortezomib Oncology BOTOX Onabotulinum toxin A Botulinum Toxin BREYANZI Lisocabtagene maraleucel Oncology BRINEURA Cerlipoinase Alfa Enzyme replacement BUSULFEX Busulfan Oncology CABENUVA Cabotegravir/rilpivirine Antiviral CALCIJEX Calcitriol Miscellaneous CAMPTOSAR Irinotecan HCl Oncology CARIMUNE NF Immune globulin intravenous Immune Globulin CAYSTON Aztreonam Respiratory CEPROTIN Protein C concentrate human, Blood Modifier CEREZYME Imiglucerase Enzyme Replacement CERUBIDINE Daunorubicin; Daunorubicin citrate Oncology CHIRHOSTIM Secretin, synthetic, human Miscellaneous CIMZIA Certolizumab pegol Autoimmune CINQAIR Reslizumab Respiratory

*Specialty Pharmacy Network providers should reference their Network Participation Agreement for specific effective dates. 1 Current Specialty Pharmacy Drugs (as of July 1, 2021*) BRAND NAME New drugsINGREDIENT indicated CLASS in red CLASS CINRYZE C1 esterase inhibitor human Miscellaneous CLOLAR Clofarabine Oncology COSELA Trilaciclib Blood Modifier COSMEGEN Dactinomycin Oncology CRYSVITA Burosumab-twza Miscellaneous CUTAQUIG Immune Globulin (SClg) Immune Globulin CUVITRU Cuvitru Immune Globulin CYKLOKAPRON Tranexamic acid Miscellaneous CYRAMZA Ramucirumab Oncology CYTARABINE Gytarabine Oncology CYTOGAM Cytomegalovirus immune globulin intravenous CMV-IVIG Immune Globulin CYTOVENE Ganciclovir sodium Antiviral CYTOXAN Cyclophosphamide Oncology DACOGEN Decitabine Oncology DANYELZA Naxitamab-gqgk Oncology DARZALEX Daratumumab Oncology DARZALEX FASPRO Daratumumab, hyaluronidase Oncology DEPO PROVERA Medroxyprogesterone acetate 400mg strength only Contraception DEPOCYT Cytarabine liposome Oncology DESFERAL Deferoxamine mesylate Miscellaneous DEXFERRUM Iron dextran Blood modifier DOXIL Doxorubicin HCl liposome Oncology DOXORUBICIN Doxorubicin HCl Oncology DUROLANE Hyaluronan Physical Adjuncts DURYSTA Bimatoprost Implant Opthalmology DYSPORT AbobotulinumtoxinA Botulinum Toxin EGIRIFTA Tesamorelin Endocrine/Metabolic ELAPRASE Idursulfase Enzyme Replacement ELELYSO Taliglucerase alfa Enzyme Replacement ELIGARD Leuprolide acetate depot Oncology ELITEK Rasburicase Oncology ELLENCE Epirubicin HCL Oncology ELOXATIN Oxaliplatin Oncology ELZONRIS Tagraxofusp-erzs Oncology EMPLICITI Elotuzumab Oncology ENHERTU Fam-trastuzumab deruxtecan-nxki Oncology ENTYVIO Vedolizumab Immunomodulator EPOGEN Epoetin alfa, recombinant Anemia/Renal Disorders ERBITUX Cetuximab Oncology ERWINAZE Asparaginase erwinia chrysanthemi Oncology ETHYOL Amifostine Oncology ETOPOPHOS Etoposide; Etoposide phosphate Oncology EUFLEXXA Sodium hyaluranate Physical Adjuncts EVENITY Romosozumab-aqqg Osteoporosis EVKEEZA Evinacumab-dgnb Miscellaneous EVOMELA Melphalan Oncology EXONDYS 51 eteplirsen Enzyme replacement EYLEA Aflibercept Miscellaneous FABRAZYME Agalsidase beta Enzyme Replacement FASENRA Benralizumab Respiratory FASLODEX Fulvestrant Oncology FENSOLVI Leuprolide acetate Endocrine/Metabolic FERAHEME Ferumoxytol Iron FERRLECIT Sodium ferric gluconate complex Iron FIRAZYR Icatibant Hereditary Angioedema FIRMAGON Degarelix Oncology FLEBOGAMMA Immune globulin intravenous Immune Globulin FLOLAN Epoprostenol sodium Cardiovascular FLUDARA Fludarabine phosphate Oncology FOLOTYN Pralatrexate Oncology FOSCAVIR Foscarnet sodium Antiviral FUDR Floxuridine Oncology FULPHILA Injection, fulphila Blood modifier FUSILEV Levoleucovorin calcium Oncology

*Specialty Pharmacy Network providers should reference their Network Participation Agreement for specific effective dates. 2 Current Specialty Pharmacy Drugs (as of July 1, 2021*) BRAND NAME New drugsINGREDIENT indicated CLASS in red CLASS GAMIFANT Emapalumab-lzsg Oncology GAMMAGARD Immune globulin intravenous Immune Globulin GAMMAKED Immune globulin intravenous Immune Globulin GAMMAPLEX Immune globulin intravenous Immune Globulin GAMUNEX / GAMUNEX C Immune globulin; Immune globulin intravenous Immune Globulin GAZYVA Obinutuzumab Oncology GEL-ONE Cross-linked hyaluronate Physical Adjuncts GELSYN 3 Hyaluronan Physical Adjuncts GEMZAR Gemcitabine Oncology GENVISC 850 hyaluronan physical adjuncts GIVLAARI Givosiran Miscellaneous GLASSIA Alpha - 1 proteinase inhibitor, Human Enzyme Replacement GRANIX Tbo-filgrastim Blood Modifier HALAVEN Eribulin mesylate Oncology HERCEPTIN Trastuzumab Oncology HERCEPTIN HYLECTRA Trastuzumab/hyaluronidase-oysk Oncology HERZUMA Trastuzumab-pkrb Oncology HIZENTRA Immune globulin subcutaneous Immune Globulin HYALGAN Sodium hyaluranate Physical Adjuncts HYCAMTIN Topotecan HCl Oncology HYLENEX Recombinant hyaluronidase human Miscellaneous HYMOVIS hyaluronan physical adjuncts HYPERRHO / HYPERRHO S-D Rho (D) Immune globulin human Immune Globulin HYQVIA Immune globulin/hyaluronidase Immune Globulin IDAMYCIN PFS Idarubicin hydrochloride Oncology IFEX Ifosfamide Oncology ILARIS Canakinumab Miscellaneous ILUMYA Tildrakizumab-asmn Immunomodulator IMFINZI Durvalumab Oncology IMLYGIC Talimogene laherparepvec Oncology INFED Iron dextran Blood Modifier INFLECTRA Infliximab Autoimmune INFUGEM Gemcitabine hydrochloride Oncology INJECTAFER Ferric carboxymaltose Iron INTRON-A Interferon alfa-n3 Immunomodulator INVEGA SUSTENNA Paliperidone palmitate Long Acting Anti-Psychotics INVEGA TRINZA Paliperidone palmitate Long Acting Anti-Psychotics ISTODAX Romidepsin Oncology IXEMPRA Ixabepilone Oncology JELMYTO Mitomycin instillation Oncology JEMPERLI Dostarlimab-gxly Oncology JETREA Carfilzomib Opthalmology JEUVEAU Prabotulinumtoxina-xvfs Botulinum Toxin JEVTANA Carbaxitaxel Oncology KADCYLA Ado-trastuzumab emtansine Oncology KALBITOR Ecallantide Miscellaneous KANJINTI Trastuzumab-anns Oncology KANUMA Sebelipase alfa Enzyme Replacement KEPIVANCE Palifermin Oncology KEYTRUDA Pembrolizumab Oncology KITABIS PAK Tobramycin nebu soln 300 MG/5ML Respiratory KRYSTEXXA Pegloticase Endocrine/Metabolic KYLEENA Levonorgestrel-releasing IUD Contraception KYPROLIS Carfilzomib Oncology LEMTRADA Alemtuzumab Immunomodulator LEUKINE Sargramostim Blood Modifier LEUSTATIN Cladribine Oncology LIBTAYO Cemiplimab-rwlc Oncology LILETTA Levonorgestrel - releasing intrauterine contraceptive Contraception LIPODOX Liposomal doxorubicin hydrochloride Oncology LUCENTIS Ranibizumab Opthalmology LUMIZYME Alglucosidase alfa Enzyme Replacement LUMOXITI Moxetumomab pasudotox-tdfk Oncology LUPRON DEPOT / LUPRON DEPOT-PEDLeuprolide acetate depot Oncology

*Specialty Pharmacy Network providers should reference their Network Participation Agreement for specific effective dates. 3 Current Specialty Pharmacy Drugs (as of July 1, 2021*) BRAND NAME New drugsINGREDIENT indicated CLASS in red CLASS LUTATHERA Utetium LU 177 dotatate Radiotherapy LUXTURNA Oretigene neparvovec-rzyl Gene Therapy MACUGEN Pegaptanib sodium Opthalmology MAKENA Hydroxyprogesterone caproate Endocrine/Metabolic MARGENZA Margetuximab-cmkb Oncology MARQIBO Vincristine liposome Oncology MEPSEVII Vestronidase alfa-vjbk Enzyme Replacement MESNEX Mesna Oncology MICRHOGAM Rho (D) Immune globulin human Immune Globulin MIRCERA Epoetin-beta Anemia/Renal Disorders MIRENA Levonorgestrel - releasing intrauterine contraceptive Contraception MITOMYCIN Mitomycin Oncology MONJUVI Tafastamab-cxix Oncology MONVISC Hyaluronan Physical Adjuncts MOZOBIL Plerixafor Hematological MUSTARGEN Mechlorethamine hydrochloride Oncology MVASI Bevacizumab-awwb Oncology MYALEPT Metreleptin Endocrine/Metabolic MYLOTARG Gemtuzumab ozogamicin Oncology MYOBLOC Rimabotulinum toxin B Botulinum Toxin NAGLAZYME Galsulfase Enzyme Replacement NAVELBINE Vinorelbine tartrate Oncology NEULASTA Pegfilgrastim Blood Modifier NEUPOGEN Filgrastim Blood Modifier NEXPLANON Etonogestrel Implant; etonogestrel Contraception NIPENT Pentostatin Oncology NIVESTYM Nivestym Blood Modifier NOVANTRONE Mitoxantrone HCl Oncology NPLATE Romiplostim Hematological NUCALA Mepolizumab Oncology NULIBRY Fosdenopterin Miscellaneous NULOJIX Belatacept Immunosuppresive NYVEPRIA Pegfilgrastim-apgf Blood Modifier OCREVUS Ocrelizumab Multiple Sclerosis OCTAGAM Immune globulin human Immune Globulin OGIVRI Trastuzumab-dkst Oncology ONCASPAR Pegaspargase Oncology ONIVYDE Inrinotecan liposomal Oncology ONPATTRO Patisiran Miscellaneous ONTRUZANT Trastuzumab-dttb Oncology ONXOL Paclitaxel Oncology OPDIVO Nivolumab Oncology ORENCIA Abatecept Immunomodulator ORTHOVISC Hyaluronan Physical Adjuncts OXLUMO Lumasiran High Cost Other PADCEV Enfortumab vedotin-ejfv Oncology PANZYGA Immune globulin (IgIV) Immune Globulin PARAGUARD IUD Intrauterine copper contraceptive Contraception PARAPLATIN Carboplatin aqueous solution Oncology PARSABIV Etelcalcetide Endocrine/metabolic PEPAXTO Melphalan flufenamide Oncology PERJETA Pertuzumab Oncology PERSERIS Risperidone Anti-psychotic PHESGO Pertuzumab, trastuzumab and hyaluronidase-zzxf Oncology PHOTOFRIN Porfimer sodium Oncology PLATINOL AQ Cisplatin Oncology POLIVY Polatuzumab vedotin-piiq Oncology PORTRAZZA Ecitumumab Oncology POTELIGEO Mogamulizumab-kpkc Miscellaneous PREVYMIS Letermovir Antiviral PRIALT Ziconotide Miscellaneous PRIVIGEN Immune globulin intravenous Immune Globulin PROCRIT Epoetin alfa Anemia/Renal Disorders PROLASTIN-C Alpha - 1 proteinase inhibitor Enzyme Replacement

*Specialty Pharmacy Network providers should reference their Network Participation Agreement for specific effective dates. 4 Current Specialty Pharmacy Drugs (as of July 1, 2021*) BRAND NAME New drugsINGREDIENT indicated CLASS in red CLASS PROLEUKIN Aldesleukin Oncology PROLIA Denosumab Endocrine/Metabolic PROVENGE Sipuleucel-T Oncology QUTENZA Capsaicin Miscellaneous RADICAVA Edaravone Misc REBLOZYL Luspatercept-aamt Blood Modifier RECLAST Zoledronic acid Endocrine/Metabolic REMICADE Infliximab Immunomodulator REMODULIN Treprostinil injection Cardiovascular RENFLEXIS Infliximab Autoimmune RETACRIT Epoetin alfa Anemia RETISERT Fluocinolone acetonide Opthalmology REVCOVI Elapegademase-Ivlr Miscellaneous RHOGAM ULTRA-FILTERED PLUS Rho (D) Immune globulin Immune Globulin RHOPHYLAC Rho (D) Immune globulin human Immune Globulin RIABNI Rituximab-arrx Immunomodulator/ Oncology RIASTAP Human fibrinogen concentrate Miscellaneous RIPERIDAL CONSTA Risperidone Long Acting Anti-Psychotics RITUXAN Rituximab Immunomodulator/ Oncology RITUXAN HYCELA Rituximab and hyaluronidase human Immunomodulator/ Oncology ROMIDEPSIN Romidepsin Oncology RUCONEST Recombinant human C1 esterase inhibitor (rhC1INH) Miscellaneous RUXIENCE Rituximab-pvvr Immunomodulator/ Oncology SANDIMMUNE Cyclosporine Immunosuppresive SANDOSTATIN Octreotide non-depot Miscellaneous SANDOSTATIN LAR Octreotide depot Miscellaneous SARCLISA Isatuximab-irfc Oncology SCENESSE Afamelanotide Miscellaneous SIGNIFOR LAR Pasireotide long acting Endocrine/Metabolic SIMPONI ARIA Golimumab Immunomodulator SIMULECT Basililiximab Miscellaneous SKYLA IUD Levonorgestrel Contraception SOLIRIS Eculizumab Miscellaneous SOMATULINE DEPOT Lanreotide Miscellaneous SPINRAZA Nusinersin Neurology SPRAVATO Esketamine hydrochloride Depression STELARA Ustekinumab Immunomodulator STELARA IV Ustekinumab Immunomodulator SUBLOCADE Burprenorphine Miscellaneous SUPARTZ Sodium hyaluronate Physical Adjuncts SUPPRELIN LA Histrelin acetate implant Hormone SYLATRON Peginterferon Alfa-2b Immunomodulator SYLVANT Siltuximab Miscellaneous SYNAGIS Palivizumab Immune Globulin SYNAREL Nafarelin Miscellaneous SYNOJOYNT Hyaluronan or derivative, synojoynt Osteoarthritis SYNVISC / SYNVISC ONE Hylan Polymers Physical Adjuncts TAKHZYRO Lanadelumab-flyo Hereditary Angioedema TAXOL Paclitaxel Oncology TAXOTERE Docetaxel Oncology TECARTUS Brexucabtagene-autoleucel Oncology TECENTRIQ Atezolizumab Oncology TEMODAR Temozolomide Oncology TEPADINA Thiotepa Oncology TEPEZZA Teprotumumab-trbw Miscellaneous THERACYS BCG Live intravesical Oncology THYMOGLOBULIN Lymphocyte immune globulin Miscellaneous THYROGEN Thyrotropin alfa Miscellaneous TIGULUTIK KIT Riluzole Oncology TOPOSAR Etoposide Oncology TORISEL Temsirolimus Oncology TOTECT Dexrazoxane hydrochloride Oncology TRAZIMERA Trastuzumab-qyyp Oncology

*Specialty Pharmacy Network providers should reference their Network Participation Agreement for specific effective dates. 5 Current Specialty Pharmacy Drugs (as of July 1, 2021*) BRAND NAME New drugsINGREDIENT indicated CLASS in red CLASS TREANDA Bendamustine; Bendamustine HCL Oncology TREFYA Guselkumab Immunomodulator TRELSTAR DEPOT, LA, Mixject Triptorelin pamoate Oncology TRILURON Hyaluronan or derivative, triluron Osteoarthritis TRIPTODUR Triptorelin Oncology TRISENOX Arsenic trioxide Oncology TRIVISC Hyaluronan Physical Adjuncts TRODELVY Sacituzumab govitecan-hziy Oncology TROGARZO Ibalizumab-uiyk HIV TRUXIMA Rituximab-abbs Oncology TYSABRI Natalizumab Immunomodulator TYVASO Treprostinil Cardiovascular UDENYCA Pegfilgrastim-cbqv Blood Modifier ULTOMIRIS Ravulizumab-cwvz Enzyme Replacement UNITUXIN Dinutuximab Oncology UPLIZNA Inebilizumab-cdon High Cost Other VALCHLOR Mechlorethamine Oncology VALSTAR Valrubicin Oncology VANTAS Histrelin acetate implant Oncology VECTIBIX Panitumumab Oncology VELBAN Vinblastine sulfate Oncology VELCADE Bortezomib Oncology VELETRI Epoprosteno Cardiovascular VENOFER Iron sucrose Blood Modifier VENTAVIS Iloprost Cardiovascular VIDAZA Azacitidine Oncology VILTEPSO Vitolarsen High Cost Other VIMIZIM Elosulfase alfa Enzyme Replacement VINCASAR Vincristine sulfate Oncology VIRAZOLE Ribavirin Antiviral VISCO-3 Hyaluronan or derivative Physical Adjuncts VISTIDE Cidofovir Antiviral VISUDYNE Verteporfin Opthalmology VITRASE Hyaluronidase ovine Miscellaneous VIVITROL Naltrexone Miscellaneous VOCABRIA Cabotegravir Antiviral VPRIV Velaglucerase alfa Blood Modifier VUMON Teniposide Oncology VYEPTI Eptinezumab-jjmr Neurology VYONDYS 53 Golodirsen Enzyme Replacement VYXEOS Daunorubicin and cytarabine Oncology WINRHO SDF Rho (D) Immune globulin human Immune Globulin XARACOLL Bupivacaine hydrochloride High Cost Other XEMBIFY Immune Globulin (SClg) Immune Globulin XEOMIN IncobotulinumtoxinA Botulinum Toxin XGEVA Denosumab Oncology XIAFLEX Collagenase colistridium histolyticum Miscellaneous XOLAIR Omalizumab Respiratory YERVOY Ipilimumab Oncology YESCARTA Axicabtagene ciloleucel Oncology YONDELIS Trabectedin Oncology YONSA Abiraterone acetate Oncology YUTIQ Fluocinolone acetonide Opthalmology ZALTRAP Aiv-afilbercept Oncology ZANOSAR Streptozocin Oncology ZARXIO filgrastim-sndz Blood modifier ZEMAIRA Alpha - 1 proteinase inhibitor Enzyme Replacement ZEPZELCA Lurbinectedin Oncology ZIEXTENZO Pegfilgrastim-bmez Blood Modifier ZINECARD Dexrazoxane hydrochloride Oncology ZINPLAVA Bezlotoxumab Miscellaneous ZIRABEV Bevacizumab-bvzr Oncology ZOLADEX Goserelin acetate implant Oncology ZOMETA Zoledronic acid Endocrine/Metabolic

*Specialty Pharmacy Network providers should reference their Network Participation Agreement for specific effective dates. 6 Current Specialty Pharmacy Drugs (as of July 1, 2021*) BRAND NAME New drugsINGREDIENT indicated CLASS in red CLASS ZULRESSO Brexanolone Depression ZYNLONTA Loncastuximab tesirine-lpyl Oncology ZYTIGA Abiraterone acetate Oncology

*Specialty Pharmacy Network providers should reference their Network Participation Agreement for specific effective dates. 7