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Drug Specialty Drug Group Code Specialty Disease State Brand Name Generic Name Product Type SPECIALTY - ONCOLOGY ONCOLOGY See Oncology Coverage Policy SPECIALTY - HIV HIV ABACAVIR ABACAVIR SULFATE Generic SPECIALTY - HIV HIV ABACAVIR- ABACAVIR SULFATE/LAMIVUDINE Generic SPECIALTY - HIV HIV ABACAVIR-LAMIVUDINE-ZIDOVUDINE ABACAVIR/LAMIVUDINE/ZIDOVUDINE Generic SPECIALTY - BEHAVIORAL HEALTH BEHAVIORAL HEALTH ABILIFY MAINTENA SS Brand SPECIALTY - BEHAVIORAL HEALTH BEHAVIORAL HEALTH ABILIFY MYCITE ARIPIPRAZOLE SS Brand SPECIALTY - CORE AUTOIMMUNE ACITRETIN ACITRETIN Generic SPECIALTY - CORE AUTOIMMUNE ACTEMRA TOCILIZUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE ACTEMRA ACTPEN TOCILIZUMAB SS Brand SPECIALTY - CORE MISCELLANEOUS ACTHAR CORTICOTROPIN SS Brand SPECIALTY - CORE AUTOIMMUNE ACTIMMUNE GAMMA-1B,RECOMB. SS Brand SPECIALTY - CORE REPLACEMENT ADAGEN PEGADEMASE BOVINE SS Brand SPECIALTY - BEHAVIORAL HEALTH BEHAVIORAL HEALTH ADASUVE SS Brand SPECIALTY - CORE PAH ADCIRCA TADALAFIL MS Brand SPECIALTY - CORE B DIPIVOXIL ADEFOVIR DIPIVOXIL Generic SPECIALTY - CORE PAH ADEMPAS RIOCIGUAT SS Brand SPECIALTY - CORE HEMOPHILIA ADVATE ANTIHEMOPH.FVIII,FULL LENGTH SS Brand SPECIALTY - CORE HEMOPHILIA ADVATE ANTIHEMOPH.FVIII PLAS/ALB FREE SS Brand SPECIALTY - CORE HEMOPHILIA ADYNOVATE ANTIHEMO.FVIII,FULL LENGTH PEG SS Brand SPECIALTY - CORE HEMOPHILIA AFSTYLA ANTIHEM.FVIII,SIN-CHN,B-DM TRU SS Brand SPECIALTY - ANTICOAG ANTICOAG AGGRASTAT TIROFIBAN HCL M-HYDRATE SS Brand SPECIALTY - ANTICOAG ANTICOAG AGGRASTAT TIROFIBAN HCL M-HYDRATE/NS SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA AGRYLIN ANAGRELIDE HCL MS Brand SPECIALTY - CORE ENZYME REPLACEMENT ALDURAZYME LARONIDASE SS Brand SPECIALTY - CORE AUTOIMMUNE ALFERON N INTERFERON ALFA-N3 SS Brand SPECIALTY - CORE HEMOPHILIA ALPHANATE AHF,HUMAN/VWF,HUMAN SS Brand SPECIALTY - CORE HEMOPHILIA ALPHANINE SD FACTOR IX SS Brand SPECIALTY - CORE HEMOPHILIA ALPROLIX FACTOR IX REC, FC FUSION PROTN SS Brand SPECIALTY - CORE PAH ALYQ TADALAFIL Generic SPECIALTY - CORE PAH AMBRISENTAN AMBRISENTAN Generic SPECIALTY - CORE MULTIPLE SCLEROSIS AMPYRA FAMPRIDINE (4-AMINOPYRIDINE) MS Brand SPECIALTY - CORE CARDIOVASCULAR/ LOWERING ANDEXXA FACTOR XA,INACTIVATED-ZHZO SS Brand SPECIALTY - ANTICOAG ANTICOAG ANGIOMAX BIVALIRUDIN MS Brand SPECIALTY - CORE MISCELLANEOUS APOKYN HCL SS Brand SPECIALTY - HIV HIV APTIVUS TIPRANAVIR/VITAMIN E TPGS SS Brand SPECIALTY - HIV HIV APTIVUS TIPRANAVIR SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS ARALAST NP ALPHA-1-PROTEINASE INHIBITOR SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA ARANESP DARBEPOETIN ALFA IN POLYSORBAT SS Brand SPECIALTY - CORE AUTOIMMUNE ARCALYST RILONACEPT SS Brand SPECIALTY - CORE MISCELLANEOUS ARESTIN MINOCYCLINE HCL MICROSPHERES SS Brand SPECIALTY - ANTICOAG ANTICOAG ARGATROBAN ARGATROBAN SS Brand SPECIALTY - ANTICOAG ANTICOAG ARGATROBAN-0.9% NACL ARGATROBAN IN 0.9 % SOD CHLOR SS Brand SPECIALTY - ANTICOAG ANTICOAG ARGATROBAN-SODIUM CHLORIDE ARGATROBAN IN SALINE, ISO-OSMO SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS ARIKAYCE AMIKACIN LIPOSOMAL/NEB.ACCESSR SS Brand SPECIALTY - BEHAVIORAL HEALTH BEHAVIORAL HEALTH ARISTADA SS Brand SPECIALTY - ANTICOAG ANTICOAG ARIXTRA FONDAPARINUX SODIUM MS Brand SPECIALTY - TRANSPLANT TRANSPLANT ASTAGRAF XL TACROLIMUS SS Brand SPECIALTY - HIV HIV ATAZANAVIR SULFATE ATAZANAVIR SULFATE Generic SPECIALTY - TRANSPLANT TRANSPLANT ATGAM LYMPHOCYTE IMMUNE GLOBULIN SS Brand SPECIALTY - HIV HIV ATRIPLA /EMTRICITAB/TENOFOVIR SS Brand SPECIALTY - CORE MISCELLANEOUS ATRYN ANTITHROMBIN ALFA (HUM RECOM) SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS AUBAGIO TERIFLUNOMIDE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS AUSTEDO DEUTETRABENAZINE SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS AVONEX INTERFERON BETA-1A/ALBUMIN SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS AVONEX INTERFERON BETA-1A SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS AVONEX PEN INTERFERON BETA-1A SS Brand SPECIALTY - CORE BARACLUDE MS Brand SPECIALTY - CORE HEPATITIS B BARACLUDE ENTECAVIR SS Brand SPECIALTY - CORE HEMOPHILIA BEBULIN FACTOR IX COMPLEX HUMAN SS Brand SPECIALTY - CORE HEMOPHILIA BENEFIX FACTOR IX HUMAN RECOMBINANT SS Brand SPECIALTY - CORE HAE BERINERT COMPLEMENT C1 ESTERASE INHIB SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS BETASERON INTERFERON BETA-1B SS Brand SPECIALTY - CORE BETHKIS TOBRAMYCIN SS Brand SPECIALTY - HIV HIV BIKTARVY BICTEGRAV/EMTRICIT/TENOFOV ALA SS Brand SPECIALTY - ANTICOAG ANTICOAG BIVALIRUDIN BIVALIRUDIN Generic SPECIALTY - ANTICOAG ANTICOAG BIVALIRUDIN-0.9% NACL BIVALIRUDIN/0.9 % SODIUM CHLOR SS Brand SPECIALTY - CORE IMMUNOGLOBULIN BIVIGAM IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE PAH BOSENTAN Generic SPECIALTY - CORE BOTULINUMTOXIN BOTOX BOTULINUM TOXIN TYPE A SS Brand SPECIALTY - FERTILITY FERTILITY BRAVELLE UROFOLLITROPIN (FSH) SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS BRINEURA CERLIPONASE ALFA SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS BUPHENYL MS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS CARBAGLU SS Brand SPECIALTY - CORE IMMUNOGLOBULIN CARIMUNE NF NANOFILTERED IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE CYSTIC FIBROSIS CAYSTON AZTREONAM SS Brand SPECIALTY - TRANSPLANT TRANSPLANT CELLCEPT MYCOPHENOLATE MOFETIL HCL MS Brand Drug Specialty Drug Group Code Specialty Disease State Brand Name Generic Name Product Type SPECIALTY - CORE OTHER ORPHAN DRUGS CEPROTIN PROTEIN C CONCENTRATE, HUMAN SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS CERDELGA TARTRATE SS Brand SPECIALTY - CORE ENZYME REPLACEMENT CEREZYME SS Brand SPECIALTY - FERTILITY FERTILITY CETROTIDE CETRORELIX ACETATE SS Brand SPECIALTY - CORE MISCELLANEOUS CHENODAL CHENODIOL SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS CHOLBAM CHOLIC ACID SS Brand SPECIALTY - HIV HIV CIMDUO LAMIVUDINE/TENOFOVIR DISOP FUM SS Brand SPECIALTY - CORE AUTOIMMUNE CIMZIA CERTOLIZUMAB PEGOL SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS CINACALCET HCL CINACALCET HCL Generic SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS CINQAIR RESLIZUMAB SS Brand SPECIALTY - CORE HAE CINRYZE COMPLEMENT C1 ESTERASE INHIB SS Brand SPECIALTY - CORE HEMOPHILIA COAGADEX COAGULATION FACTOR X SS Brand SPECIALTY - HIV HIV COMBIVIR LAMIVUDINE/ZIDOVUDINE MS Brand SPECIALTY - HIV HIV COMPLERA EMTRICITAB/RILPIVIRINE/TENOFOV SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS COPAXONE GLATIRAMER ACETATE MS Brand SPECIALTY - CORE HEMOPHILIA CORIFACT FACTOR XIII SS Brand SPECIALTY - CORE AUTOIMMUNE COSENTYX (2 SYRINGES) SECUKINUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE COSENTYX PEN SECUKINUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE COSENTYX PEN (2 PENS) SECUKINUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE COSENTYX SYRINGE SECUKINUMAB SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS CRYSVITA BUROSUMAB-TWZA SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS CUPRIMINE PENICILLAMINE SS Brand SPECIALTY - CORE IMMUNOGLOBULIN CUTAQUIG IMMUN GLOB G(IGG)-HIPP/MALTOSE SS Brand SPECIALTY - CORE IMMUNOGLOBULIN CUVITRU IMMUN GLOB G (IGG)/GLY/IGA 50+ SS Brand SPECIALTY - TRANSPLANT TRANSPLANT CYCLOSPORINE CYCLOSPORINE Generic SPECIALTY - TRANSPLANT TRANSPLANT CYCLOSPORINE MODIFIED CYCLOSPORINE, MODIFIED Generic SPECIALTY - CORE ENZYME REPLACEMENT CYSTADANE BETAINE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS CYSTAGON BITARTRATE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS CYSTARAN CYSTEAMINE HYDROCHLORIDE SS Brand SPECIALTY - CORE IMMUNOGLOBULIN CYTOGAM IMMUNE GLOB SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS D-PENAMINE PENICILLAMINE Generic SPECIALTY - CORE HEPATITIS C DAKLINZA DACLATASVIR DIHYDROCHLORIDE SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS DALFAMPRIDINE ER FAMPRIDINE (4-AMINOPYRIDINE) Generic SPECIALTY - CORE MISCELLANEOUS DARAPRIM PYRIMETHAMINE SS Brand SPECIALTY - CORE MISCELLANEOUS DEFERASIROX DEFERASIROX Generic SPECIALTY - HIV HIV DELSTRIGO DORAVIRINE/LAMIVU/TENOFOV DISO SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS DEPEN PENICILLAMINE SS Brand SPECIALTY - HIV HIV DESCOVY EMTRICITABINE/TENOFOV ALAFENAM SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS DIACOMIT STIRIPENTOL SS Brand SPECIALTY - CORE CARDIOVASCULAR/LIPID LOWERING DIBENZYLINE PHENOXYBENZAMINE HCL MS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS DOPTELET AVATROMBOPAG MALEATE SS Brand SPECIALTY - HIV HIV DOVATO DOLUTEGRAVIR SODIUM/LAMIVUDINE SS Brand SPECIALTY - CORE MISCELLANEOUS DUOPA CARBIDOPA/LEVODOPA SS Brand SPECIALTY - CORE MISCELLANEOUS DUPIXENT DUPILUMAB SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS DUPIXENT DUPILUMAB SS Brand SPECIALTY - CORE BOTULINUMTOXIN DYSPORT ABOBOTULINUMTOXINA SS Brand SPECIALTY - HIV HIV EDURANT RILPIVIRINE HYDROCHLORIDE SS Brand SPECIALTY - HIV HIV EFAVIRENZ EFAVIRENZ Generic SPECIALTY - CORE GROWTH HORMONE EGRIFTA TESAMORELIN ACETATE SS Brand SPECIALTY - CORE ENZYME REPLACEMENT ELAPRASE SS Brand SPECIALTY - CORE ENZYME REPLACEMENT ELELYSO SS Brand SPECIALTY - CORE HEMOPHILIA ELOCTATE FACTOR VIII REC,FC FUSION PROT SS Brand SPECIALTY - CORE AUTOIMMUNE ENBREL ETANERCEPT SS Brand SPECIALTY - CORE AUTOIMMUNE ENBREL MINI ETANERCEPT SS Brand SPECIALTY - CORE AUTOIMMUNE ENBREL SURECLICK ETANERCEPT SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS ENDARI SS Brand SPECIALTY - ANTICOAG ANTICOAG ENOXAPARIN SODIUM ENOXAPARIN SODIUM Generic SPECIALTY - CORE HEPATITIS B ENTECAVIR ENTECAVIR Generic SPECIALTY - CORE AUTOIMMUNE ENTYVIO VEDOLIZUMAB SS Brand SPECIALTY - TRANSPLANT TRANSPLANT ENVARSUS XR TACROLIMUS SS Brand SPECIALTY - CORE HEPATITIS C EPCLUSA SOFOSBUVIR/VELPATASVIR MS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS EPIDIOLEX (CBD) EXTRACT SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA EPOGEN EPOETIN ALFA SS Brand SPECIALTY - CORE PAH EPOPROSTENOL SODIUM EPOPROSTENOL NA Generic SPECIALTY - ANTICOAG ANTICOAG EPTIFIBATIDE EPTIFIBATIDE Generic SPECIALTY - HIV HIV EPZICOM ABACAVIR SULFATE/LAMIVUDINE MS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS ESBRIET PIRFENIDONE SS Brand SPECIALTY - HIV HIV EVOTAZ ATAZANAVIR SULFATE/COBICISTAT SS Brand SPECIALTY - CORE MISCELLANEOUS EXJADE DEFERASIROX SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS EXTAVIA INTERFERON BETA-1B SS Brand SPECIALTY - CORE EYE DISORDERS EYLEA AFLIBERCEPT SS Brand SPECIALTY - CORE ENZYME REPLACEMENT FABRAZYME AGALSIDASE BETA SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS FASENRA BENRALIZUMAB SS Brand SPECIALTY - CORE HEMOPHILIA FEIBA NF ANTI-INHIBITOR COAGULANT COMP. SS Brand SPECIALTY - CORE MISCELLANEOUS FERRIPROX DEFERIPRONE SS Brand SPECIALTY - CORE HAE FIRAZYR ICATIBANT ACETATE SS Brand Drug Specialty Drug Group Code Specialty Disease State Brand Name Generic Name Product Type SPECIALTY - CORE OTHER ORPHAN DRUGS FIRDAPSE AMIFAMPRIDINE SS Brand SPECIALTY - CORE IMMUNOGLOBULIN FLEBOGAMMA DIF IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE PAH FLOLAN EPOPROSTENOL NA MS Brand SPECIALTY - FERTILITY FERTILITY FOLLISTIM AQ FOLLITROPIN BETA,RECOMB SS Brand SPECIALTY - ANTICOAG ANTICOAG FONDAPARINUX SODIUM FONDAPARINUX SODIUM Generic SPECIALTY - CORE OSTEOPOROSIS FORTEO TERIPARATIDE SS Brand SPECIALTY - HIV HIV FOSAMPRENAVIR CALCIUM FOSAMPRENAVIR CALCIUM Generic SPECIALTY - ANTICOAG ANTICOAG FRAGMIN DALTEPARIN SODIUM,PORCINE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS FUSILEV LEVOLEUCOVORIN CALCIUM MS Brand SPECIALTY - HIV HIV FUZEON ENFUVIRTIDE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS GALAFOLD MIGALASTAT HCL SS Brand SPECIALTY - CORE IMMUNOGLOBULIN GAMASTAN IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE IMMUNOGLOBULIN GAMASTAN S-D IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE IMMUNOGLOBULIN GAMMAGARD LIQUID IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE IMMUNOGLOBULIN GAMMAGARD S-D IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE IMMUNOGLOBULIN GAMMAKED IMMUNE GLOB,GAM CAPRYLATE(IGG) SS Brand SPECIALTY - CORE IMMUNOGLOBULIN GAMMAPLEX IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE IMMUNOGLOBULIN GAMMAPLEX IMMUN GLOB G(IGG)/GLY/IGA 0-50 SS Brand SPECIALTY - CORE IMMUNOGLOBULIN GAMUNEX-C IMMUNE GLOB,GAM CAPRYLATE(IGG) SS Brand SPECIALTY - FERTILITY FERTILITY GANIRELIX ACETATE GANIRELIX ACETATE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS GATTEX SS Brand SPECIALTY - TRANSPLANT TRANSPLANT GENGRAF CYCLOSPORINE, MODIFIED Generic SPECIALTY - CORE GROWTH HORMONE GENOTROPIN SOMATROPIN SS Brand SPECIALTY - HIV HIV GENVOYA ELVITEG/COBI/EMTRIC/TENOFO ALA SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS GILENYA FINGOLIMOD HYDROCHLORIDE SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS GLASSIA ALPHA-1-PROTEINASE INHIBITOR SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS GLATIRAMER ACETATE GLATIRAMER ACETATE Generic SPECIALTY - CORE MULTIPLE SCLEROSIS GLATOPA GLATIRAMER ACETATE Generic SPECIALTY - FERTILITY FERTILITY GONAL-F FOLLITROPIN ALPHA,RECOMB SS Brand SPECIALTY - FERTILITY FERTILITY GONAL-F RFF FOLLITROPIN ALPHA,RECOMB SS Brand SPECIALTY - FERTILITY FERTILITY GONAL-F RFF REDI-JECT FOLLITROPIN ALPHA,RECOMB SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA GRANIX TBO-FILGRASTIM SS Brand SPECIALTY - CORE MISCELLANEOUS H.P. ACTHAR CORTICOTROPIN SS Brand SPECIALTY - CORE HAE HAEGARDA COMPLEMENT C1 ESTERASE INHIB SS Brand SPECIALTY - CORE HEPATITIS C HARVONI LEDIPASVIR/SOFOSBUVIR MS Brand SPECIALTY - CORE HEMOPHILIA HELIXATE FS ANTIHEMOPH.FVIII,FULL LENGTH SS Brand SPECIALTY - CORE HEMOPHILIA HELIXATE FS ANTIHEMOPHILIC FACTOR, HUM REC SS Brand SPECIALTY - CORE HEMOPHILIA HEMLIBRA EMICIZUMAB-KXWH SS Brand SPECIALTY - CORE HEMOPHILIA HEMOFIL M ANTIHEMOPHILIC FACTOR,HUMAN SS Brand SPECIALTY - CORE HEPATITIS B HEPSERA ADEFOVIR DIPIVOXIL MS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS HETLIOZ TASIMELTEON SS Brand SPECIALTY - CORE IMMUNOGLOBULIN HIZENTRA IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE HEMOPHILIA HUMATE-P AHF,HUMAN/VWF,HUMAN SS Brand SPECIALTY - CORE GROWTH HORMONE HUMATROPE SOMATROPIN SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA ADALIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA PEDIATRIC CROHN'S ADALIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA PEN ADALIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA PEN CROHN'S-UC-HS ADALIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA PEN PSOR-UVEITS-ADOL HS ADALIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA(CF) ADALIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA(CF) PEDIATRIC CROHN'S ADALIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA(CF) PEN ADALIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA(CF) PEN CROHN'S-UC-HS ADALIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE HUMIRA(CF) PEN PSOR-UV-ADOL HS ADALIMUMAB SS Brand SPECIALTY - CORE MISCELLANEOUS HYDROXYPROGESTERONE CAPROATE HYDROXYPROGESTERONE CAPROAT/PF Generic SPECIALTY - CORE MISCELLANEOUS HYDROXYPROGESTERONE CAPROATE HYDROXYPROGESTERONE CAPROATE Generic SPECIALTY - CORE IMMUNOGLOBULIN HYQVIA IGG/HYALURONIDASE,RECOMBINANT SS Brand SPECIALTY - CORE IMMUNOGLOBULIN HYQVIA IG COMPONENT IMMUN GLOB G(IGG)/GLY/IGA 0-50 SS Brand SPECIALTY - CORE HEMOPHILIA IDELVION FACTOR IX RECOM,ALBUMIN FUSION SS Brand SPECIALTY - CORE AUTOIMMUNE ILARIS CANAKINUMAB/PF SS Brand SPECIALTY - CORE AUTOIMMUNE ILUMYA TILDRAKIZUMAB-ASMN SS Brand SPECIALTY - CORE MISCELLANEOUS INBRIJA LEVODOPA SS Brand SPECIALTY - CORE GROWTH HORMONE INCRELEX MECASERMIN SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA INJECTAFER FERRIC CARBOXYMALTOSE SS Brand SPECIALTY - ANTICOAG ANTICOAG INTEGRILIN EPTIFIBATIDE MS Brand SPECIALTY - HIV HIV INTELENCE ETRAVIRINE SS Brand SPECIALTY - CORE AUTOIMMUNE INTRON A INTERFERON ALFA-2B,RECOMB. SS Brand SPECIALTY - BEHAVIORAL HEALTH BEHAVIORAL HEALTH INVEGA SUSTENNA PALMITATE SS Brand SPECIALTY - BEHAVIORAL HEALTH BEHAVIORAL HEALTH INVEGA TRINZA PALIPERIDONE PALMITATE SS Brand SPECIALTY - HIV HIV INVIRASE SAQUINAVIR MESYLATE SS Brand SPECIALTY - ANTICOAG ANTICOAG IPRIVASK DESIRUDIN SS Brand SPECIALTY - HIV HIV ISENTRESS RALTEGRAVIR POTASSIUM SS Brand SPECIALTY - HIV HIV ISENTRESS HD RALTEGRAVIR POTASSIUM SS Brand SPECIALTY - CORE HEMOPHILIA IXINITY FACTOR IX HUMAN RECOMB,THR 148 SS Brand SPECIALTY - CORE MISCELLANEOUS JADENU DEFERASIROX SS Brand SPECIALTY - CORE MISCELLANEOUS JADENU SPRINKLE DEFERASIROX SS Brand Drug Specialty Drug Group Code Specialty Disease State Brand Name Generic Name Product Type SPECIALTY - CORE HEMOPHILIA JIVI FVIII REC,B-DOM DELET PEG-AUCL SS Brand SPECIALTY - HIV HIV JULUCA DOLUTEGRAVIR/RILPIVIRINE SS Brand SPECIALTY - CORE CARDIOVASCULAR/LIPID LOWERING JUXTAPID LOMITAPIDE MESYLATE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS JYNARQUE TOLVAPTAN SS Brand SPECIALTY - CORE HAE KALBITOR ECALLANTIDE SS Brand SPECIALTY - HIV HIV KALETRA LOPINAVIR/RITONAVIR SS Brand SPECIALTY - HIV HIV KALETRA LOPINAVIR/RITONAVIR MS Brand SPECIALTY - CORE CYSTIC FIBROSIS KALYDECO IVACAFTOR SS Brand SPECIALTY - CORE ENZYME REPLACEMENT KANUMA SS Brand SPECIALTY - CORE HEMOPHILIA KCENTRA HUMAN PROTHROMIN COMPLEX (PCC) SS Brand SPECIALTY - CORE MISCELLANEOUS KEPIVANCE PALIFERMIN SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS KEVEYIS DICHLORPHENAMIDE SS Brand SPECIALTY - CORE AUTOIMMUNE KEVZARA SARILUMAB SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS KHAPZORY LEVOLEUCOVORIN SS Brand SPECIALTY - CORE AUTOIMMUNE KINERET ANAKINRA SS Brand SPECIALTY - CORE CYSTIC FIBROSIS KITABIS PAK TOBRAMYCIN/NEBULIZER MS Brand SPECIALTY - CORE HEMOPHILIA KOATE ANTIHEMOPHILIC FACTOR,HUMAN SS Brand SPECIALTY - CORE HEMOPHILIA KOATE-DVI ANTIHEMOPHILIC FACTOR,HUMAN SS Brand SPECIALTY - CORE HEMOPHILIA KOGENATE FS ANTIHEMOPHILIC FACTOR, HUM REC SS Brand SPECIALTY - CORE HEMOPHILIA KOGENATE FS ANTIHEMOPH.FVIII,FULL LENGTH SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS KORLYM MIFEPRISTONE SS Brand SPECIALTY - CORE HEMOPHILIA KOVALTRY ANTIHEMOPH.FVIII,FULL LENGTH SS Brand SPECIALTY - CORE HEMOPHILIA KOVALTRY ANTIHEMOPHILIC FACTOR, HUM REC SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS KUVAN SAPROPTERIN DIHYDROCHLORIDE SS Brand SPECIALTY - CORE CARDIOVASCULAR/LIPID LOWERING KYNAMRO MIPOMERSEN SODIUM SS Brand SPECIALTY - HIV HIV LAMIVUDINE-ZIDOVUDINE LAMIVUDINE/ZIDOVUDINE Generic SPECIALTY - CORE HEPATITIS C LEDIPASVIR-SOFOSBUVIR LEDIPASVIR/SOFOSBUVIR Generic SPECIALTY - CORE MULTIPLE SCLEROSIS LEMTRADA ALEMTUZUMAB SS Brand SPECIALTY - CORE PAH LETAIRIS AMBRISENTAN SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA LEUKINE SARGRAMOSTIM SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS LEVOLEUCOVORIN CALCIUM LEVOLEUCOVORIN CALCIUM Generic SPECIALTY - CORE OTHER ORPHAN DRUGS LEVOLEUCOVORIN CALCIUM LEVOLEUCOVORIN CALCIUM SS Brand SPECIALTY - HIV HIV LEXIVA FOSAMPRENAVIR CALCIUM MS Brand SPECIALTY - HIV HIV LEXIVA FOSAMPRENAVIR CALCIUM SS Brand SPECIALTY - HIV HIV LOPINAVIR-RITONAVIR LOPINAVIR/RITONAVIR Generic SPECIALTY - ANTICOAG ANTICOAG LOVENOX ENOXAPARIN SODIUM MS Brand SPECIALTY - CORE EYE DISORDERS LUCENTIS RANIBIZUMAB SS Brand SPECIALTY - CORE ENZYME REPLACEMENT LUMIZYME SS Brand SPECIALTY - CORE MISCELLANEOUS LUPANETA PACK LEUPROLIDE/NORETHINDRONE ACET SS Brand SPECIALTY - CORE MISCELLANEOUS LUPRON DEPOT LEUPROLIDE ACETATE SS Brand SPECIALTY - CORE MISCELLANEOUS LUPRON DEPOT-PED LEUPROLIDE ACETATE SS Brand SPECIALTY - CORE MISCELLANEOUS MACRILEN MACIMORELIN ACETATE SS Brand SPECIALTY - CORE EYE DISORDERS MACUGEN PEGAPTANIB SODIUM SS Brand SPECIALTY - CORE MISCELLANEOUS MAKENA HYDROXYPROGESTERONE CAPROATE MS Brand SPECIALTY - CORE MISCELLANEOUS MAKENA HYDROXYPROGESTERONE CAPROAT/PF MS Brand SPECIALTY - CORE MISCELLANEOUS MAKENA HYDROXYPROGESTERONE CAPROAT/PF SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS MAVENCLAD CLADRIBINE SS Brand SPECIALTY - CORE HEPATITIS C MAVYRET GLECAPREVIR/PIBRENTASVIR SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS MAYZENT SIPONIMOD SS Brand SPECIALTY - FERTILITY FERTILITY MENOPUR MENOTROPINS SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS MEPSEVII VESTRONIDASE ALFA-VJBK SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS MIGLUSTAT Generic SPECIALTY - CORE HEMOPHILIA MONOCLATE-P ANTIHEMOPHILIC FACTOR,HUMAN SS Brand SPECIALTY - CORE HEMOPHILIA MONONINE FACTOR IX SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS MULPLETA LUSUTROMBOPAG SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS MYALEPT SS Brand SPECIALTY - TRANSPLANT TRANSPLANT MYCOPHENOLATE MOFETIL MYCOPHENOLATE MOFETIL HCL Generic SPECIALTY - TRANSPLANT TRANSPLANT MYFORTIC MYCOPHENOLATE SODIUM MS Brand SPECIALTY - CORE BOTULINUMTOXIN MYOBLOC BOTULINUM TOXIN TYPE B SS Brand SPECIALTY - CORE ENZYME REPLACEMENT NAGLAZYME GALSULFASE SS Brand SPECIALTY - CORE MISCELLANEOUS NATPARA PARATHYROID SS Brand SPECIALTY - TRANSPLANT TRANSPLANT NEORAL CYCLOSPORINE, MODIFIED MS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA NEUMEGA OPRELVEKIN SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA NEUPOGEN FILGRASTIM SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS NITYR SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA NIVESTYM FILGRASTIM-AAFI SS Brand SPECIALTY - CORE GROWTH HORMONE NORDITROPIN FLEXPRO SOMATROPIN SS Brand SPECIALTY - CORE CARDIOVASCULAR/LIPID LOWERING NORTHERA SS Brand SPECIALTY - HIV HIV NORVIR RITONAVIR SS Brand SPECIALTY - HIV HIV NORVIR RITONAVIR MS Brand SPECIALTY - CORE HEMOPHILIA NOVOEIGHT ANTIHEMOPH.FVIII,B-DOM TRUNCAT SS Brand SPECIALTY - CORE HEMOPHILIA NOVOSEVEN RT FACTOR VIIA,RECOMB(BHK CELLS) SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS NPLATE ROMIPLOSTIM SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS NUCALA MEPOLIZUMAB (RECOMBINANT) SS Brand SPECIALTY - TRANSPLANT TRANSPLANT NULOJIX BELATACEPT SS Brand SPECIALTY - CORE GROWTH HORMONE NUTROPIN AQ SOMATROPIN SS Brand Drug Specialty Drug Group Code Specialty Disease State Brand Name Generic Name Product Type SPECIALTY - CORE GROWTH HORMONE NUTROPIN AQ NUSPIN SOMATROPIN SS Brand SPECIALTY - CORE HEMOPHILIA NUWIQ ANTIHEMOPH.FVIII,HEK B-DELETE SS Brand SPECIALTY - CORE CARDIOVASCULAR/LIPID LOWERING NYMALIZE NIMODIPINE SS Brand SPECIALTY - CORE HEMOPHILIA OBIZUR ANTIHEMOPHILIC FVIII,PORCI REC SS Brand SPECIALTY - CORE MISCELLANEOUS OCALIVA OBETICHOLIC ACID SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS OCREVUS OCRELIZUMAB SS Brand SPECIALTY - CORE IMMUNOGLOBULIN OCTAGAM IMM GLOB,GAMM (IGG)/MALTOSE SS Brand SPECIALTY - HIV HIV ODEFSEY EMTRICITAB/RILPIVIRI/TENOF ALA SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS OFEV NINTEDANIB ESYLATE SS Brand SPECIALTY - CORE AUTOIMMUNE OLUMIANT BARICITINIB SS Brand SPECIALTY - CORE HEPATITIS C OLYSIO SIMEPREVIR SODIUM SS Brand SPECIALTY - CORE GROWTH HORMONE OMNITROPE SOMATROPIN SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS ONPATTRO PATISIRAN SODIUM,LIPID COMPLEX SS Brand SPECIALTY - CORE PAH OPSUMIT MACITENTAN SS Brand SPECIALTY - CORE AUTOIMMUNE ORENCIA ABATACEPT/MALTOSE SS Brand SPECIALTY - CORE AUTOIMMUNE ORENCIA ABATACEPT SS Brand SPECIALTY - CORE AUTOIMMUNE ORENCIA CLICKJECT ABATACEPT SS Brand SPECIALTY - CORE PAH ORENITRAM ER TREPROSTINIL DIOLAMINE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS ORFADIN NITISINONE SS Brand SPECIALTY - CORE CYSTIC FIBROSIS ORKAMBI LUMACAFTOR/IVACAFTOR SS Brand SPECIALTY - CORE AUTOIMMUNE OTEZLA APREMILAST SS Brand SPECIALTY - CORE AUTOIMMUNE OTREXUP METHOTREXATE/PF SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS OXERVATE CENEGERMIN-BKBJ SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS PALYNZIQ -PQPZ SS Brand SPECIALTY - CORE MISCELLANEOUS PANHEMATIN HEMIN SS Brand SPECIALTY - CORE MISCELLANEOUS PANRETIN ALITRETINOIN SS Brand SPECIALTY - CORE IMMUNOGLOBULIN PANZYGA IMMUN GLOB G(IGG)-IFAS/GLYCINE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS PARSABIV ETELCALCETIDE HYDROCHLORIDE SS Brand SPECIALTY - CORE HEPATITIS C PEGASYS PEGINTERFERON ALFA-2A SS Brand SPECIALTY - CORE HEPATITIS C PEGASYS PROCLICK PEGINTERFERON ALFA-2A SS Brand SPECIALTY - CORE HEPATITIS C PEGINTRON PEGINTERFERON ALFA-2B SS Brand SPECIALTY - CORE HEPATITIS C PEGINTRON REDIPEN PEGINTERFERON ALFA-2B SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS PENICILLAMINE PENICILLAMINE Generic SPECIALTY - BEHAVIORAL HEALTH BEHAVIORAL HEALTH PERSERIS SS Brand SPECIALTY - CORE CARDIOVASCULAR/LIPID LOWERING PHENOXYBENZAMINE HCL PHENOXYBENZAMINE HCL Generic SPECIALTY - HIV HIV PIFELTRO UNKNOWN SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS PLEGRIDY PEGINTERFERON BETA-1A SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS PLEGRIDY PEN PEGINTERFERON BETA-1A SS Brand SPECIALTY - CORE CARDIOVASCULAR/LIPID LOWERING PRAXBIND IDARUCIZUMAB SS Brand SPECIALTY - CORE MISCELLANEOUS PREVYMIS LETERMOVIR SS Brand SPECIALTY - HIV HIV PREZCOBIX DARUNAVIR/COBICISTAT SS Brand SPECIALTY - HIV HIV PREZISTA DARUNAVIR ETHANOLATE SS Brand SPECIALTY - CORE MISCELLANEOUS PRIALT ZICONOTIDE ACETATE SS Brand SPECIALTY - CORE IMMUNOGLOBULIN PRIVIGEN IMMU GLOBULIN,GAMMA (IGG) SS Brand SPECIALTY - CORE IMMUNOGLOBULIN PRIVIGEN IMMUN GLOB G(IGG)/PRO/IGA 0-50 SS Brand SPECIALTY - CORE MISCELLANEOUS PROBUPHINE BUPRENORPHINE HCL SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA PROCRIT EPOETIN ALFA SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS PROCYSBI CYSTEAMINE BITARTRATE SS Brand SPECIALTY - CORE HEMOPHILIA PROFILNINE FACTOR IX COMPLEX HUMAN SS Brand SPECIALTY - TRANSPLANT TRANSPLANT PROGRAF TACROLIMUS MS Brand SPECIALTY - TRANSPLANT TRANSPLANT PROGRAF TACROLIMUS SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS PROLASTIN C ALPHA-1-PROTEINASE INHIBITOR SS Brand SPECIALTY - CORE OSTEOPOROSIS PROLIA DENOSUMAB SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS PROMACTA ELTROMBOPAG OLAMINE SS Brand SPECIALTY - CORE CYSTIC FIBROSIS PULMOZYME DORNASE ALFA SS Brand SPECIALTY - TRANSPLANT TRANSPLANT RAPAMUNE SIROLIMUS MS Brand SPECIALTY - CORE AUTOIMMUNE RASUVO METHOTREXATE/PF SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS RAVICTI SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS REBIF INTERFERON BETA-1A/ALBUMIN SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS REBIF REBIDOSE INTERFERON BETA-1A/ALBUMIN SS Brand SPECIALTY - CORE HEMOPHILIA REBINYN FACTOR IX HUMAN REC,PEGYLATED SS Brand SPECIALTY - CORE OSTEOPOROSIS RECLAST ZOLEDRONIC ACID/MANNITOL/WATER MS Brand SPECIALTY - CORE HEMOPHILIA RECOMBINATE ANTIHEMOPHILIC FACTOR, HUM REC SS Brand SPECIALTY - CORE PAH REMODULIN TREPROSTINIL SODIUM SS Brand SPECIALTY - CORE AUTOIMMUNE RENFLEXIS INFLIXIMAB-ABDA SS Brand SPECIALTY - ANTICOAG ANTICOAG REOPRO ABCIXIMAB SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA RETACRIT EPOETIN ALFA-EPBX SS Brand SPECIALTY - CORE PAH REVATIO SILDENAFIL CITRATE SS Brand SPECIALTY - CORE ENZYME REPLACEMENT REVCOVI ELAPEGADEMASE-LVLR SS Brand SPECIALTY - HIV HIV REYATAZ ATAZANAVIR SULFATE MS Brand SPECIALTY - HIV HIV REYATAZ ATAZANAVIR SULFATE SS Brand SPECIALTY - CORE AUTOIMMUNE RIDAURA AURANOFIN SS Brand SPECIALTY - BEHAVIORAL HEALTH BEHAVIORAL HEALTH RISPERDAL CONSTA RISPERIDONE MICROSPHERES SS Brand SPECIALTY - HIV HIV RITONAVIR RITONAVIR Generic SPECIALTY - CORE HEMOPHILIA RIXUBIS FACTOR IX HUMAN RECOMBINANT SS Brand SPECIALTY - CORE HAE RUCONEST C1 ESTERASE INHIBITOR, RECOMB SS Brand Drug Specialty Drug Group Code Specialty Disease State Brand Name Generic Name Product Type SPECIALTY - CORE OTHER ORPHAN DRUGS RUZURGI 3,4-DIAMINOPYRIDINE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SABRIL VIGABATRIN SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SABRIL VIGABATRIN MS Brand SPECIALTY - CORE GROWTH HORMONE SAIZEN SOMATROPIN SS Brand SPECIALTY - CORE GROWTH HORMONE SAIZEN-SAIZENPREP SOMATROPIN SS Brand SPECIALTY - CORE MISCELLANEOUS SAMSCA TOLVAPTAN SS Brand SPECIALTY - TRANSPLANT TRANSPLANT SANDIMMUNE CYCLOSPORINE MS Brand SPECIALTY - TRANSPLANT TRANSPLANT SANDIMMUNE CYCLOSPORINE SS Brand SPECIALTY - HIV HIV SELZENTRY MARAVIROC SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SENSIPAR CINACALCET HCL SS Brand SPECIALTY - CORE GROWTH HORMONE SEROSTIM SOMATROPIN SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SIGNIFOR PASIREOTIDE DIASPARTATE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SIGNIFOR LAR PASIREOTIDE PAMOATE SS Brand SPECIALTY - CORE PAH SILDENAFIL CITRATE SILDENAFIL CITRATE Generic SPECIALTY - CORE AUTOIMMUNE SILIQ BRODALUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE SIMPONI GOLIMUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE SIMPONI ARIA GOLIMUMAB SS Brand SPECIALTY - TRANSPLANT TRANSPLANT SIMULECT BASILIXIMAB SS Brand SPECIALTY - TRANSPLANT TRANSPLANT SIROLIMUS SIROLIMUS Generic SPECIALTY - CORE MISCELLANEOUS SIRTURO BEDAQUILINE FUMARATE SS Brand SPECIALTY - CORE AUTOIMMUNE SKYRIZI RISANKIZUMAB-RZAA SS Brand SPECIALTY - CORE AUTOIMMUNE SKYRIZI (2 SYRINGES) KIT RISANKIZUMAB-RZAA SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SODIUM PHENYLBUTYRATE SODIUM PHENYLBUTYRATE Generic SPECIALTY - CORE HEPATITIS C SOFOSBUVIR-VELPATASVIR SOFOSBUVIR/VELPATASVIR Generic SPECIALTY - CORE MISCELLANEOUS SOLESTA DEXTRANOMER/HYALURONATE/SOD CL SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SOLIRIS ECULIZUMAB SS Brand SPECIALTY - CORE GROWTH HORMONE SOMAVERT PEGVISOMANT SS Brand SPECIALTY - CORE AUTOIMMUNE SORIATANE ACITRETIN MS Brand SPECIALTY - CORE HEPATITIS C SOVALDI SOFOSBUVIR SS Brand SPECIALTY - CORE AUTOIMMUNE STELARA USTEKINUMAB SS Brand SPECIALTY - CORE ENZYME REPLACEMENT STRENSIQ SS Brand SPECIALTY - HIV HIV STRIBILD ELVITEGR/COBICIST/EMTRIC/TENOF SS Brand SPECIALTY - CORE MISCELLANEOUS SUBLOCADE BUPRENORPHINE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SUCRAID SS Brand SPECIALTY - HIV HIV SUSTIVA EFAVIRENZ MS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SYLVANT SILTUXIMAB SS Brand SPECIALTY - CORE CYSTIC FIBROSIS SYMDEKO TEZACAFTOR/IVACAFTOR SS Brand SPECIALTY - HIV HIV SYMFI EFAVIRENZ/LAMIVU/TENOFOV DISOP SS Brand SPECIALTY - HIV HIV SYMFI LO EFAVIRENZ/LAMIVU/TENOFOV DISOP SS Brand SPECIALTY - HIV HIV SYMTUZA DARUNAVIR/COB/EMTRI/TENOF ALAF SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS SYNAGIS PALIVIZUMAB SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SYNAREL NAFARELIN ACETATE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS SYPRINE TRIENTINE HCL MS Brand SPECIALTY - TRANSPLANT TRANSPLANT TACROLIMUS TACROLIMUS Generic SPECIALTY - CORE PAH TADALAFIL TADALAFIL Generic SPECIALTY - CORE HAE TAKHZYRO LANADELUMAB-FLYO SS Brand SPECIALTY - CORE AUTOIMMUNE TALTZ AUTOINJECTOR IXEKIZUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE TALTZ AUTOINJECTOR (2 PACK) IXEKIZUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE TALTZ AUTOINJECTOR (3 PACK) IXEKIZUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE TALTZ SYRINGE IXEKIZUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE TALTZ SYRINGE (2 PACK) IXEKIZUMAB SS Brand SPECIALTY - CORE AUTOIMMUNE TALTZ SYRINGE (3 PACK) IXEKIZUMAB SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS TAVALISSE FOSTAMATINIB DISODIUM SS Brand SPECIALTY - CORE MULTIPLE SCLEROSIS TECFIDERA DIMETHYL FUMARATE SS Brand SPECIALTY - CORE HEPATITIS C TECHNIVIE OMBITASVIR/PARITAPREV/RITONAV SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS TEGSEDI INOTERSEN SODIUM SS Brand SPECIALTY - HIV HIV FUMARATE TENOFOVIR DISOPROXIL FUMARATE Generic SPECIALTY - CORE OTHER ORPHAN DRUGS TETRABENAZINE TETRABENAZINE Generic SPECIALTY - CORE OTHER ORPHAN DRUGS THIOLA TIOPRONIN SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS THIOLA EC TIOPRONIN SS Brand SPECIALTY - TRANSPLANT TRANSPLANT THYMOGLOBULIN LYMPHOCYTE IMMU GLOB.,RABBIT SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS TIGLUTIK RILUZOLE SS Brand SPECIALTY - HIV HIV TIVICAY DOLUTEGRAVIR SODIUM SS Brand SPECIALTY - CORE CYSTIC FIBROSIS TOBI TOBRAMYCIN/0.25 NORMAL SALINE MS Brand SPECIALTY - CORE CYSTIC FIBROSIS TOBI PODHALER TOBRAMYCIN SS Brand SPECIALTY - CORE CYSTIC FIBROSIS TOBRAMYCIN TOBRAMYCIN/0.25 NORMAL SALINE Generic SPECIALTY - CORE CYSTIC FIBROSIS TOBRAMYCIN TOBRAMYCIN/NEBULIZER Generic SPECIALTY - CORE PAH TRACLEER BOSENTAN SS Brand SPECIALTY - CORE AUTOIMMUNE TREMFYA GUSELKUMAB SS Brand SPECIALTY - CORE PAH TREPROSTINIL TREPROSTINIL SODIUM Generic SPECIALTY - CORE HEMOPHILIA TRETTEN FACTOR XIII A-SUBUNIT,RECOMB SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS TRIENTINE HCL TRIENTINE HCL Generic SPECIALTY - CORE MISCELLANEOUS TRIPTODUR TRIPTORELIN PAMOATE SS Brand SPECIALTY - HIV HIV TRIUMEQ ABACAVIR/DOLUTEGRAVIR/LAMIVUDI SS Brand SPECIALTY - HIV HIV TRIZIVIR ABACAVIR/LAMIVUDINE/ZIDOVUDINE MS Brand SPECIALTY - HIV HIV TROGARZO IBALIZUMAB-UIYK SS Brand Drug Specialty Drug Group Code Specialty Disease State Brand Name Generic Name Product Type SPECIALTY - HIV HIV TRUVADA EMTRICITABINE/TENOFOVIR SS Brand SPECIALTY - CORE OSTEOPOROSIS TYMLOS ABALOPARATIDE SS Brand SPECIALTY - CORE PAH TYVASO TREPROSTINIL SS Brand SPECIALTY - CORE PAH TYVASO INSTITUTIONAL START KIT TREPROSTINIL/NEBULIZER/ACCESOR SS Brand SPECIALTY - CORE PAH TYVASO REFILL KIT TREPROSTINIL/NEB ACCESSORIES SS Brand SPECIALTY - CORE PAH TYVASO STARTER KIT TREPROSTINIL/NEBULIZER/ACCESOR SS Brand SPECIALTY - CORE HEPATITIS B TYZEKA SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS ULTOMIRIS RAVULIZUMAB-CWVZ SS Brand SPECIALTY - CORE PAH UPTRAVI SELEXIPAG SS Brand SPECIALTY - CORE PAH VELETRI EPOPROSTENOL SODIUM () SS Brand SPECIALTY - CORE HEPATITIS B VEMLIDY FUMARATE SS Brand SPECIALTY - CORE PAH VENTAVIS ILOPROST SS Brand SPECIALTY - CORE HEPATITIS C VIEKIRA PAK OMBITA/PARITAP/RITON/DASABUVIR SS Brand SPECIALTY - CORE HEPATITIS C VIEKIRA XR OMBITA/PARITAP/RITON/DASABUVIR SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS VIGABATRIN VIGABATRIN Generic SPECIALTY - CORE OTHER ORPHAN DRUGS VIGADRONE VIGABATRIN Generic SPECIALTY - CORE ENZYME REPLACEMENT VIMIZIM ELOSULFASE ALFA SS Brand SPECIALTY - HIV HIV VIRACEPT NELFINAVIR MESYLATE SS Brand SPECIALTY - HIV HIV VIREAD TENOFOVIR DISOPROXIL FUMARATE MS Brand SPECIALTY - HIV HIV VIREAD TENOFOVIR DISOPROXIL FUMARATE SS Brand SPECIALTY - CORE EYE DISORDERS VISUDYNE VERTEPORFIN SS Brand SPECIALTY - HIV HIV VITEKTA ELVITEGRAVIR SS Brand SPECIALTY - CORE MISCELLANEOUS VIVITROL NALTREXONE MICROSPHERES SS Brand SPECIALTY - CORE HEMOPHILIA VONVENDI VON WILLEBRAND FACTOR SS Brand SPECIALTY - CORE HEPATITIS C VOSEVI SOFOSBUVIR/VELPATAS/VOXILAPREV SS Brand SPECIALTY - CORE ENZYME REPLACEMENT VPRIV SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS VYNDAQEL TAFAMIDIS MEGLUMINE SS Brand SPECIALTY - CORE HEMOPHILIA WILATE AHF,HUMAN/VWF,HUMAN SS Brand SPECIALTY - CORE IMMUNOGLOBULIN WINRHO SDF RHO(D) IMMUNE GLOBULIN/MALTOSE SS Brand SPECIALTY - CORE AUTOIMMUNE XATMEP METHOTREXATE SS Brand SPECIALTY - CORE AUTOIMMUNE XELJANZ TOFACITINIB CITRATE SS Brand SPECIALTY - CORE AUTOIMMUNE XELJANZ XR TOFACITINIB CITRATE SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS XENAZINE TETRABENAZINE MS Brand SPECIALTY - CORE BOTULINUMTOXIN XEOMIN INCOBOTULINUMTOXINA SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS XERMELO TELOTRISTAT ETIPRATE SS Brand SPECIALTY - CORE OSTEOPOROSIS XGEVA DENOSUMAB SS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS XOLAIR OMALIZUMAB SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS XURIDEN TRIACETATE SS Brand SPECIALTY - CORE HEMOPHILIA XYNTHA ANTIHEMOPHILIC FACTOR,HUMAN SS Brand SPECIALTY - CORE HEMOPHILIA XYNTHA SOLOFUSE ANTIHEMOPHILIC FACTOR,HUMAN SS Brand SPECIALTY - CORE HEMOPHILIA XYNTHA SOLOFUSE ANTIHEMOPH.FVIII PLAS/ALB FREE SS Brand SPECIALTY - CORE HEMOPHILIA XYNTHA SOLOFUSE ANTIHEMOPH.FVIII,B-DOMAIN DEL SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS XYREM SS Brand SPECIALTY - CORE BLOOD MODIFIERS/ANEMIA ZARXIO FILGRASTIM-SNDZ SS Brand SPECIALTY - CORE OTHER ORPHAN DRUGS ZAVESCA MIGLUSTAT MS Brand SPECIALTY - CORE RESPIRATORY/RELATED CONDITIONS ZEMAIRA ALPHA-1-PROTEINASE INHIBITOR SS Brand SPECIALTY - CORE HEPATITIS C ZEPATIER ELBASVIR/GRAZOPREVIR SS Brand SPECIALTY - HIV HIV ZIAGEN ABACAVIR SULFATE MS Brand SPECIALTY - CORE OSTEOPOROSIS ZOLEDRONIC ACID ZOLEDRONIC ACID Generic SPECIALTY - CORE OSTEOPOROSIS ZOLEDRONIC ACID ZOLEDRONIC ACID/MANNITOL/WATER Generic SPECIALTY - CORE GROWTH HORMONE ZOMACTON SOMATROPIN SS Brand SPECIALTY - CORE OSTEOPOROSIS ZOMETA ZOLEDRONIC ACID MS Brand SPECIALTY - CORE OSTEOPOROSIS ZOMETA ZOLEDRONIC ACID/MANNITOL/WATER SS Brand SPECIALTY - CORE GROWTH HORMONE ZORBTIVE SOMATROPIN SS Brand SPECIALTY - TRANSPLANT TRANSPLANT ZORTRESS EVEROLIMUS SS Brand SPECIALTY - BEHAVIORAL HEALTH BEHAVIORAL HEALTH ZYPREXA RELPREVV PAMOATE SS Brand