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2021 Aetna Specialty Drug List

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2021 Aetna Specialty Drug List Specialty Drug List 2021 Aetna Specialty Drug List 05.03.949.1I (01/21) How to use this guide You may fill these drugs at an in-network specialty pharmacy. Look up your plan documents for specialty drug coverage details. You’ll also learn more about the requirements and limitations of your pharmacy benefits and insurance plan. What is a specialty drug? Key Specialty drugs treat complex, chronic conditions. A nurse or pharmacist UPPERCASE Brand-name medicine will often support their use during treatment. These drugs may be injected, infused or taken by mouth. You may need to refrigerate them. They are lowercase italics Generic medicine often expensive and may not be available at retail pharmacies. Category Drug class Analgesics Viscosupplements DUROLANE GELSYN-3 EUFLEXXA SUPARTZ FX Anti-Infectives Antiretroviral Agents abacavir-lamivudine ODEFSEY Antiretroviral Combinations § lamivudine-zidovudine PREZCOBIX ATRIPLA SYMFI BIKTARVY SYMFI LO CIMDUO SYMTUZA DESCOVY TEMIXYS DOVATO TRIUMEQ EVOTAZ TRUVADA GENVOYA Antiretroviral Agents FUZEON Fusion Inhibitors Antiretroviral Agents ISENTRESS Integrase Inhibitors TIVICAY Antiretroviral Agents efavirenz EDURANT Non-Nucleoside Reverse Transcriptase Inhibitors § nevirapine INTELENCE nevirapine ext-rel Antiretroviral Agents abacavir tablet stavudine Nucleoside Reverse Transcriptase Inhibitors § didanosine zidovudine lamivudine EMTRIVA Antiretroviral Agents tenofovir disoproxil fumarate Nucleotide Reverse Transcriptase Inhibitors § Health benefits and health insurance plans are offered, underwritten and/or administered by Aetna Health Inc., Aetna Health Insurance Company of New York, Aetna HealthAssurance Pennsylvania Inc., Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Florida by Aetna Health Inc. and/or Aetna Life Insurance Company. In Utah and Wyoming by Aetna Health of Utah Inc. and/or Aetna Life Insurance Company. In Maryland by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products. 2021 Aetna Specialty Drug List (01/2021) Category Drug class Antiretroviral Agents atazanavir NORVIR Protease Inhibitors § lopinavir-ritonavir solution PREZISTA KALETRA TABLET Antivirals entecavir BARACLUDE SOLUTION Hepatitis B Agents § lamivudine VEMLIDY tenofovir disoproxil fumarate Antivirals ribavirin HARVONI (genotypes 1, 4, 5, 6) 2 Hepatitis C Agents § EPCLUSA (genotypes 1, 2, 3, 4, 5, 6) VOSEVI Antineoplastic Agents Alkylating Agents § temozolomide Antimetabolites § capecitabine Hormonal Antineoplastic Agents abiraterone XTANDI Antiandrogens § ERLEADA YONSA NUBEQA Hormonal Antineoplastic Agents leuprolide acetate Luteinizing Hormone-Releasing Hormone (LHRH) ELIGARD Agonists § Kinase Inhibitors § erlotinib KISQALI imatinib mesylate KISQALI FEMARA AFINITOR CO-PACK ALECENSA RYDAPT ALUNBRIG SPRYCEL BOSULIF SUTENT CABOMETYX TYKERB COPIKTRA VOTRIENT IBRANCE XOSPATA IRESSA Multiple Myeloma REVLIMID Immunomodulators THALOMID Multiple Myeloma NINLARO Proteasome Inhibitors VELCADE Miscellaneous § bexarotene capsule PHESGO ERIVEDGE RUBRACA LYNPARZA ZEJULA ODOMZO ZOLINZA PERJETA Cardiovascular Antilipemics PRALUENT PCSK9 Inhibitors Pulmonary Arterial Hypertension ambrisentan Endothelin Receptor Antagonists § bosentan OPSUMIT Pulmonary Arterial Hypertension sildenafil Phosphodiesterase Inhibitors § tadalafil Pulmonary Arterial Hypertension UPTRAVI Prostacyclin Receptor Agonists 2021 Aetna Specialty Drug List (01/2021) Category Drug class Pulmonary Arterial Hypertension ORENITRAM Prostaglandin Vasodilators Pulmonary Arterial Hypertension ADEMPAS Soluble Guanylate Cyclase Stimulators Central Nervous System Anticonvulsants § vigabatrin Antiparkinsonian Agents INBRIJA Movement Disorders § tetrabenazine AUSTEDO INGREZZA Multiple Sclerosis Agents § dimethyl fumarate KESIMPTA delayed-rel MAYZENT glatiramer OCREVUS AUBAGIO REBIF BETASERON TYSABRI COPAXONE VUMERITY GILENYA ZEPOSIA Endocrine and Metabolic Acromegaly SOMATULINE DEPOT Calcium Regulators Antagonists § cinacalcet Calcium Regulators FORTEO Parathyroid Hormones TYMLOS Calcium Regulators PROLIA Miscellaneous Contraceptives KYLEENA Progestin Intrauterine Devices MIRENA SKYLA Fertility Regulators CETROTIDE GNRH / LHRH Antagonists Fertility Regulators GONAL-F Ovulation Stimulants, Gonadotropins OVIDREL Gaucher Disease CERDELGA CEREZYME Hereditary Tyrosinemia Type 1 Agents ORFADIN Human Growth Hormones NORDITROPIN Polyneuropathy TEGSEDI Urea Cycle Disorders § sodium phenylbutyrate Miscellaneous CYSTAGON 2021 Aetna Specialty Drug List (01/2021) Category Drug class Hematologic Hematopoietic Growth Factors ARANESP RETACRIT NIVESTYM ZIEXTENZO Hemophilia A Agents ADYNOVATE KOVALTRY JIVI NOVOEIGHT KOGENATE FS NUWIQ Hemophilia B Agents REBINYN Thrombocytopenia Agents DOPTELET MULPLETA Immunologic Agents Allergenic Extracts ORALAIR Autoimmune Agents* COSENTYX Ankylosing Spondylitis ENBREL HUMIRA Autoimmune Agents* HUMIRA Crohn's Disease STELARA SUBCUTANEOUS # Autoimmune Agents* HUMIRA STELARA SUBCUTANEOUS Psoriasis OTEZLA TALTZ SKYRIZI TREMFYA Autoimmune Agents* COSENTYX HUMIRA Psoriatic Arthritis ENBREL OTEZLA Autoimmune Agents* ENBREL ORENCIA SUBCUTANEOUS Rheumatoid Arthritis HUMIRA RINVOQ KEVZARA XELJANZ ORENCIA CLICKJECT XELJANZ XR Autoimmune Agents* HUMIRA XELJANZ # Ulcerative Colitis STELARA SUBCUTANEOUS # XELJANZ XR # Autoimmune Agents* ENBREL All Other Conditions HUMIRA Disease-Modifying Antirheumatic RASUVO Drugs (DMARDs) Hereditary Angioedema FIRAZYR RUCONEST TAKHZYRO Immunosuppressants mycophenolate mofetil Antimetabolites § mycophenolate sodium Immunosuppressants cyclosporine Calcineurin Inhibitors § cyclosporine, modified tacrolimus Immunosuppressants everolimus Rapamycin Derivatives § sirolimus * See Table 1 For Indication Based Coverage Details # After Failure Of Humira 2021 Aetna Specialty Drug List (01/2021) Category Drug class Respiratory Alpha-1 Antitrypsin Deficiency Agents PROLASTIN-C Cystic Fibrosis § tobramycin inhalation solution BETHKIS Pulmonary Fibrosis Agents ESBRIET OFEV Severe Asthma Agents DUPIXENT NUCALA FASENRA XOLAIR Topical Dermatology DUPIXENT Atopic Dermatitis Mouth/Throat/Dental Agents MUGARD Protectants Ophthalmic EYLEA Retinal Disorders LUCENTIS 2021 Aetna Specialty Drug List (01/2021) Quick reference drug list. A ERIVEDGE N SYMFI abacavir tablet ERLEADA nevirapine SYMFI LO abacavir tablet erlotinib nevirapine ext-rel SYMTUZA ESBRIET abacavir-lamivudine NINLARO T abiraterone EUFLEXXA NIVESTYM ADEMPAS everolimus NORDITROPIN tacrolimus ADYNOVATE EVOTAZ NORVIR tadalafil AFINITOR EYLEA NOVOEIGHT TAKHZYRO F ALECENSA NUBEQA TALTZ FASENRA ALUNBRIG NUCALA TEGSEDI ambrisentan FIRAZYR NUWIQ TEMIXYS ARANESP FORTEO O temozolomide atazanavir FUZEON OCREVUS ATRIPLA G ODEFSEY tenofovir disoproxil fumarate AUBAGIO GELSYN-3 ODOMZO tetrabenazine AUSTEDO GENVOYA OFEV THALOMID B GILENYA OPSUMIT TIVICAY glatiramer BARACLUDE SOLUTION ORALAIR tobramycin inhalation BETASERON GONAL-F ORENCIA CLICKJECT solution BETHKIS H ORENCIA SUBCUTANEOUS bexarotene capsule HARVONI ORENITRAM TREMFYA BIKTARVY HUMIRA ORFADIN TRIUMEQ bosentan I OTEZLA TRUVADA BOSULIF IBRANCE OVIDREL TYKERB C imatinib mesylate P TYMLOS INBRIJA CABOMETYX PERJETA TYSABRI capecitabine INGREZZA PHESGO U CERDELGA INTELENCE PRALUENT CEREZYME IRESSA PREZCOBIX UPTRAVI CETROTIDE ISENTRESS PREZISTA V CIMDUO J PROLASTIN-C VELCADE cinacalcet JIVI PROLIA VEMLIDY COPAXONE K R vigabatrin COPIKTRA KALETRA TABLET RASUVO 2 COSENTYX KESIMPTA REBIF VOSEVI cyclosporine KEVZARA REBINYN VOTRIENT cyclosporine, modified KISQALI RETACRIT VUMERITY CYSTAGON KISQALI FEMARA CO-PACK REVLIMID X D KOGENATE FS ribavirin DESCOVY KOVALTRY RINVOQ XELJANZ didanosine KYLEENA RUBRACA XELJANZ XR dimethyl fumarate L RUCONEST XOLAIR delayed-rel lamivudine RYDAPT XOSPATA DOPTELET lamivudine-zidovudine S XTANDI DOVATO leuprolide acetate sildenafil Y DUPIXENT lopinavir-ritonavir solution sirolimus DUROLANE LUCENTIS SKYLA YONSA E LYNPARZA SKYRIZI Z EDURANT M sodium phenylbutyrate ZEJULA efavirenz MAYZENT SOMATULINE DEPOT ZEPOSIA ELIGARD MIRENA SPRYCEL zidovudine EMTRIVA MUGARD stavudine ENBREL MULPLETA STELARA SUBCUTANEOUS ZIEXTENZO entecavir mycophenolate mofetil SUPARTZ FX ZOLINZA EPCLUSA mycophenolate sodium SUTENT 2021 Aetna Specialty Drug List (01/2021) Preferred options for excluded specialty medications3 Drug name(s) Preferred option(s)* ADCIRCA sildenafil, tadalafil ALIQOPA COPIKTRA ALPROLIX Consult doctor APOKYN INBRIJA ARALAST NP PROLASTIN-C ASTAGRAF XL TACROLIMUS AVONEX dimethyl fumarate delayed-rel, glatiramer, AUBAGIO, BETASERON, COPAXONE, GILENYA, KESIMPTA, MAYZENT, OCREVUS, REBIF, TYSABRI, VUMERITY, ZEPOSIA BARACLUDE TABLET entecavir, lamivudine, tenofovir disoproxil fumarate, BARACLUDE SOLUTION, VEMLIDY BERINERT FIRAZYR, RUCONEST BORTEZOMIB NINLARO, VELCADE BUPHENYL SODIUM PHENYLBUTYRATE CELLCEPT mycophenolate mofetil, mycophenolate sodium CHORIONIC GONADOTROPIN OVIDREL COMPLERA ATRIPLA, BIKTARVY, GENVOYA, ODEFSEY, SYMFI, SYMFI LO, SYMTUZA, TRIUMEQ ELELYSO CERDELGA, CEREZYME ELOCTATE ADYNOVATE, JIVI, KOGENATE FS, KOVALTRY, NOVOEIGHT, NUWIQ ENVARSUS XR tacrolimus EPIVIR HBV entecavir, lamivudine, tenofovir disoproxil fumarate, BARACLUDE SOLUTION, VEMLIDY EPOGEN ARANESP, RETACRIT EXTAVIA DIMETHYL FUMARATE DELAYED-REL, GLATIRAMER, AUBAGIO, BETASERON, COPAXONE, GILENYA, KESIMPTA, MAYZENT, OCREVUS, REBIF, TYSABRI, VUMERITY, ZEPOSIA FOLLISTIM AQ GONAL-F FULPHILA ZIEXTENZO GEL-ONE DUROLANE, EUFLEXXA, GELSYN-3, SUPARTZ FX GENOTROPIN NORDITROPIN GLASSIA PROLASTIN-C GLEEVEC imatinib mesylate, BOSULIF, SPRYCEL GRANIX NIVESTYM
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