Walgreens Specialty Medication List

AllianceRx (Walgreens specialty) pharmacy list of specialty medications Members can receive these drugs through the mail from Alliance Rx (Walgreens Specialty) Pharmacy (866.515.1355) or at a retail pharmacy. Prescriptions will always be filled with a generic, if available, keeping your copayment low. If you desire a brand name drug when a generic is available, you may be responsible for costs over and above your copayment amount. The additional costs may be significant. If your doctor feels there is a medical necessity for a brand name, ask your doctor to contact the Pharmacy Clinical Help Desk for an exception based on medical necessity. For a full description of your benefits, please refer to your prescription plan booklet.

Listing as of January 2018 (This list may change from time to time.) Anticoagulants Rydapt® Antivirus/Hepatitis Orkambi™ Arixtra® Sandostatin® Baraclude® Pulmozyme® Fragmin® Sandostatin LAR® Copegus® Tobi® Heparin Sandostatin LAR® Depot Daklinza™ Iprivask® Sprycel® Harvoni® Enzyme Replacement Lovenox® Stivarga® Hepsera® Therapy Sutent® Epculsa® Cerdelga™ Antineoplastics Sylatron® Incivek™ Kynamro™ (cancer drugs) Tafinlar® Infergen® Vimizim™ Actimmune® Tarceva® Intron® A Afinitor® Targretin® Moderiba™ Growth disorders Afinitor Disperz® Tasigna® Olysio™ Genotropin® Alecensa® Temodar® Pegasys® Geref® Bosulif® Thalomid® PegIntron® Humatrope® Cabometyx™ Trelstar® Rebetol® Increlex® Cotellic™ Trelstar Depot® Ribapak® Norditropin®(all forms) Eligard® Trelstar LA® Ribasphere® Nutropin® (all forms) Erivedge™ Tykerb® Ribatab® Omnitrope® Farydak® Votrient™ Sovaldi™ Saizen® Gleevec® Xalkori® Technivie™ Sandostatin® Hycamtin® Xeloda® Tyzeka® Sandostatin LAR® Ibrance® Xtandi® Vemlidy® Sandostatin LAR® Depot Idhifa® Zykadia™ Victrelis™ Serostim® Inlyta® Zelboraf™ Viekira Pak™ Somatuline Depot® Intron® A Zoladex™ Viekira XR™ Somavert® Jakafi™ Zolinza® Zepatier™ Tev-Tropin® Kisqali Zytiga™ Zomacton® Kisqali Femara Co-pack ® Chronic kidney Zorbitive® Lonsurf® Antineoplastic Failure/dialysis Lupron Depot® Support medication Hematological (Blood) Lynparza® chemotherapy Aranesp® disorder Matulane® Arenesp® Epogen® Kuvan® Mekinist™ Granix® Sensipar® Mircera® Nexavar® Leukine® Promacta® Ninlaro® Neulasta® Cystic Fibrosis Samsca® Odomzo® Neumega® Bethkis® Pamalyst® Neupogen® Cayston® Purixan® Procrit® Kalydeco™ Revlimid® Zarxio® Kitabis Pak®

Hereditary angiodema Iron overload Organ transplant/anti- Limited Distribution Firazyr® Exjade® Rejection continued These drugs are available Ruconest® Jadenu™ Rapamune® only from Accredo – Sandimmune® Express Scripts’ specialty Hyperlipidemia Miscellaneous Zortress® pharmacy. Members and Praluent® Actimmune® prescribers can contact Repatha™ Apokyn® Osteoporosis Accredo directly at Cystadane® Forteo™ 800.803.2523 to order Idiopathic pulmonary Cystaran™ Tymlos™ these specific drugs. Fibrosis Daraprim® Esbriet® Dupixent® Psoriasis Adempas® Ofev® Egrifta™ Enbrel® Alunbrig® Gattex® Humira® Arcalyst® Immune globulin Glassia® Stelara® Carbaglu® Cuvitru™ Hetlioz™ Taltz® Duopa™ Gammagard® Liquid Lupaneta Pack™ Tremfya™ Gilotrif™ Gammaked™ Natpara® Iressa® Gamunex®-C Northera™ Pulmonary arterial Lenvima™ Hizentra™ Ocaliva™ Hypertension Myalept™ Hyqvia™ Ravicti® Adcirca™ Orenitram ER™ Stimate® Latairis™ Procysbi™ Inflammatory diseases Syprine® Opsumit® Remodulin® Actemra® Xenazine® Traceleer® Signifor® Cimzia® Signifor LAR® Cosentyx™ Multiple sclerosis Seizure disorders Tagrisso™ Enbrel® Avonex® Acthar H.P. ® Tyvaso™ Humira® Ampyra™ Sabril® Uptravi® Orencia® Syringe Aubagio® Valchlor™ Otezla® Betaseron® Exclusive limited Ventavis® Otrexup™ Copaxone® distribution Rasuvo™ Extavia® Please speak with your Limited distribution Gilenya® Physician about obtaining drugs Simponi™ Glatiramer Acetate™ One of the following drugs Stelara® Glatopa™ Austedo® These drugs are available Xeljanz™ Plegridy™ Caprelsa® only at Diplomat Xeljanz XR™ Rebif® Cholbam™ Pharmacy. Members and Tecfidera™ Cystagon® prescribers can contact Infertility Zinbryta™ Emflaza® Diplomat directly at Bravelle® Ferripox® 877.977.9118 to order these Cetrotide® Organ transplant/anti- Iclusig™ specific drugs. Chorionic gonadotropin rejection Ingrezza® Follistim/Follistim AQ® Astagraf XL™ Juxtapid® Ganirelix Acetate® Cellcept® Keveyis™ Cometriq® Gonal-F® Cyclosporine® Kineret® Imbruvica® Menopur® Envarsus® Korlym® Xyrem® Venclexta™ Novarel® Gengraf® Orfadin® Zavesca® Xermelo™ Ovidrel® Hecoria® Rubraca® Zydelig™ Pregnyl® Myfortic® Strensiq™ Repronex® Neoral® Succraid® Prograf® Vistogard® Xuridan®