Specialty Medications List Harness Health Pharmacy For participants in the Medical Plan, specialty medications are prescribed to treat complex diseases. Many are available through Harness Health Pharmacy. Participants are limited to 30- day supplies of these specialty drugs. Some medications may require prior authorization. Generics may be available for some medications, and a brand-name version may not be covered under certain plans. This list does not denote coverage or formulary status, merely access. - On the following pages, use Control and F to search the Disease State (such as Asthma or Rheumatology) or the generic name or brand name for any drug. - See the last page for Limited Distribution Drugs available from other pharmacies. If you have questions, call Harness Health Pharmacy at 866-775-5767 (press option 6 for the Specialty staff) weekdays 8 a.m. - 4:30 p.m. (ET). Effective 01/01/2021 Specialty Medications List - Limited Distribution Drugs available through MedImpact Specialty Pharmacy Network AMPYRA EYLEA KUVAN PLEGRIDY TRACLEER APOKYN FERRIPROX KYNAMRO POMALYST TYSABRI ARALAST NP FLOLAN LEMTRADA PROCYSBI TYVASO ARCALYST GATTEX LETAIRIS PURIXAN VELETRI AUBAGIO HETLIOZ MACUGEN RAVICTI VENTAVIS BOSULIF IBRANCE MEKTOVI REMODULIN XALKORI BRAFTOVI ICLUSIG MATULANE REVLIMID XENAZINE BUPHENYL ILARIS METOPIRONE SABRIL ZEMAIRA CAPRELSA IMBRUVICA MYOZYME SIGNIFOR CARBAGLU INCRELEX NAGLAZYME SILIQ CAYSTON INLYTA NORTHERA SUCRAID CERDELGA JUXTAPID OFEV SUTENT CEREZYME KALBITOR OPSUMIT SYMDECO CHOLBAM KALYDECO ORENITRAM ER TECFIDERA CYSTADANE KITABIS PAK ORKAMBI THALOMID Available only through the extended Medimpact Specialty Pharmacy Network (including US Bioservices, Humana Specialty Pharmacy, Kroger Specialty Pharmacy and Accredo.) Call 800-788- 2949. Participants are limited to 30-day supplies of these specialty drugs. Some medications may require prior authorization. Effective: 01/01/2021 Specialty Medications List Harness Health Pharmacy Disease State Generic Name Brand Name Acromegaly LANREOTIDE ACETATE SOMATULINE DEPOT Acromegaly OCTREOTIDE ACETATE BYNFEZIA Acromegaly OCTREOTIDE ACETATE OCTREOTIDE ACETATE Acromegaly OCTREOTIDE ACETATE SANDOSTATIN Acromegaly OCTREOTIDE ACETATE,MI-SPHERES SANDOSTATIN LAR Acromegaly PEGVISOMANT SOMAVERT Alcohol/Opioid Dependency NALTREXONE MICROSPHERES VIVITROL Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR GLASSIA Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR ARALAST NP Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR PROLASTIN C Alpha-1 Antitrypsin Deficiency ALPHA-1-PROTEINASE INHIBITOR ZEMAIRA Anemia DARBEPOETIN ALFA IN POLYSORBAT ARANESP Anemia EPOETIN ALFA EPOGEN Anemia EPOETIN ALFA PROCRIT Anemia EPOETIN ALFA-EPBX RETACRIT Anemia FERRIC CARBOXYMALTOSE INJECTAFER Anemia FERUMOXYTOL FERAHEME Anemia IRON SUCROSE COMPLEX VENOFER Anemia METHOXY PEG-EPOETIN BETA MIRCERA Anticoagulants FONDAPARINUX SODIUM ARIXTRA Anticoagulants FONDAPARINUX SODIUM FONDAPARINUX SODIUM Asthma BENRALIZUMAB FASENRA Asthma MEPOLIZUMAB NUCALA Asthma OMALIZUMAB XOLAIR Asthma RESLIZUMAB CINQAIR Behavioral Health ARIPIPRAZOLE ABILIFY MAINTENA Behavioral Health ARIPIPRAZOLE LAUROXIL ARISTADA Behavioral Health ARIPIPRAZOLE LAUROXIL,SUBMICR. ARISTADA INITIO Behavioral Health ILOPERIDONE FANAPT Behavioral Health OLANZAPINE PAMOATE ZYPREXA RELPREVV Behavioral Health PALIPERIDONE PALMITATE INVEGA SUSTENNA Behavioral Health PALIPERIDONE PALMITATE INVEGA TRINZA Behavioral Health PIMAVANSERIN NUPLAZID Specialty Medications List Harness Health Pharmacy Disease State Generic Name Brand Name Behavioral Health RISPERIDONE PERSERIS Behavioral Health RISPERIDONE MICROSPHERES RISPERDAL CONSTA Botulinum Toxins ABOBOTULINUMTOXINA DYSPORT Botulinum Toxins INCOBOTULINUMTOXINA XEOMIN Botulinum Toxins ONABOTULINUMTOXINA BOTOX Botulinum Toxins RIMABOTULINUMTOXINB MYOBLOC Chronic Pain/Non Opioid Analgesic ZICONOTIDE ACETATE PRIALT Congenital Fibrinogen Deficiency FIBRINOGEN CONCENTRATE (HUMAN) FIBRYGA Cystic Fibrosis AZTREONAM LYSINE CAYSTON Cystic Fibrosis IVACAFTOR KALYDECO Cystic Fibrosis LUMACAFTOR/IVACAFTOR ORKAMBI Cystic Fibrosis TEZACAFTOR/IVACAFTOR SYMDEKO Cystic Fibrosis TOBRAMYCIN/NEBULIZER BETHKIS Cystic Fibrosis TOBRAMYCIN (CAP FOR INHALATION) TOBI PODHALER Cystic Fibrosis TOBRAMYCIN IN 0.225% SOD CHLOR TOBI Cystic Fibrosis TOBRAMYCIN/NEBULIZER KITABIS PAK Cystic Fibrosis TOBRAMYCIN/NEBULIZER TOBRAMYCIN Cystic Fibrosis DORNASE ALFA/ NEBULIZER PULMOZYME Dermatology ACITRETIN ACITRETIN Dermatology ACITRETIN SORIATANE Dermatology ADALIMUMAB HUMIRA PEN PSORIASIS-UVEITIS Dermatology APREMILAST OTEZLA Dermatology BRODALUMAB SILIQ Dermatology DUPILUMAB DUPIXENT Dermatology GUSELKUMAB TREMFYA Dermatology INGENOL MEBUTATE PICATO Dermatology IXEKIZUMAB TALTZ Dermatology SECUKINUMAB COSENTYX Dermatology CERTOLIZUMAB PEGOL CIMZIA Dermatology INFLIXIMAB-DYYB INFLECTRA Dermatology INFLIXIMAB REMICADE Dermatology INFLIXIMAB-ABDA RENFLEXIS Dermatology INFLIXIMAB-AXXQ AVSOLA Specialty Medications List Harness Health Pharmacy Disease State Generic Name Brand Name Dermatology USTEKINUMAB STELARA Dermatology RISANKIZUMAB SKYRIZI Dermatology TILDRAKIZUMAB ILUMYA Dermatology ETANERCEPT ENBREL Dupuytren's Contracture COLLAGENASE CLOSTRIDIUM HIST. XIAFLEX Electrolyte Disorders PATIROMER CALCIUM SORBITEX VELTASSA Electrolyte Disorders SODIUM ZIRCONIUM CYCLOSILICATE LOKELMA Electrolyte Disorders TOLVAPTAN JYNARQUE Electrolyte Disorders TOLVAPTAN SAMSCA Endocrine CINACALCET CINACALCET Endocrine CINACALCET SENSIPAR Endocrine ETELCALCETIDE HYDROCHLORIDE PARSABIV Endocrine HISTRELIN ACETATE SUPPRELIN LA Endocrine HISTRELIN ACETATE VANTAS Endocrine METYRAPONE METOPIRONE Endocrine MIFEPRISTONE KORLYM Endocrine PARATHYROID HORMONE NATPARA Endocrine PASIREOTIDE DIASPARTATE SIGNIFOR Endocrine PASIREOTIDE PAMOATE SIGNIFOR LAR Enzyme Replacement PEGADEMASE BOVINE ADAGEN Enzyme Replacement SACROSIDASE SUCRAID Endometriosis ELAGOLIX ORILISSA Endometriosis NAFARELIN SYNAREL Fertility CETRORELIX ACETATE CETROTIDE Fertility CHORIOGONADOTROPIN ALFA OVIDREL Fertility CHORIONIC GONADOTROPIN, HUMAN CHORIONIC GONADOTROPIN Fertility CHORIONIC GONADOTROPIN, HUMAN NOVAREL Fertility CHORIONIC GONADOTROPIN, HUMAN PREGNYL Fertility FOLLITROPIN ALFA, RECOMBINANT GONAL-F Fertility FOLLITROPIN BETA,RECOMB FOLLISTIM AQ Fertility GANIRELIX ACETATE GANIRELIX ACETATE Fertility MENOTROPINS MENOPUR Fertility MENOTROPINS REPRONEX Specialty Medications List Harness Health Pharmacy Disease State Generic Name Brand Name Fertility UROFOLLITROPIN BRAVELLE Gastroenterology ADALIMUMAB HUMIRA Gastroenterology CERTOLIZUMAB PEGOL CIMZIA Gastroenterology NATALIZUMAB TYSABRI Gastroenterology INFLIXIMAB-DYYB INFLECTRA Gastroenterology INFLIXIMAB REMICADE Gastroenterology INFLIXIMAB-ABDA RENFLEXIS Gastroenterology INFLIXIMAB-AXXQ AVSOLA Gastroenterology TEDUGLUTIDE GATTEX Gastroenterology USTEKINUMAB STELARA Gastroenterology VEDOLIZUMAB ENTYVIO Gastroenterology TOFACITINIB CITRATE XELJANZ Genetics MIGLUSTAT MIGLUSTAT Genetics MIGLUSTAT ZAVESCA Gout PEGLOTICASE KRYSTEXXA Growth Hormone and Related Disorders MECASERMIN INCRELEX Growth Hormone and Related Disorders SOMATROPIN GENOTROPIN Growth Hormone and Related Disorders SOMATROPIN HUMATROPE Growth Hormone and Related Disorders SOMATROPIN NORDITROPIN Growth Hormone and Related Disorders SOMATROPIN NORDITROPIN NORDIFLEX Growth Hormone and Related Disorders SOMATROPIN NUTROPIN AQ NUSPIN Growth Hormone and Related Disorders SOMATROPIN NUTROPIN AQ Growth Hormone and Related Disorders SOMATROPIN NUTROPIN Growth Hormone and Related Disorders SOMATROPIN OMNITROPE Growth Hormone and Related Disorders SOMATROPIN SAIZEN Growth Hormone and Related Disorders SOMATROPIN SAIZEN-SAIZENPREP Growth Hormone and Related Disorders SOMATROPIN SEROSTIM Growth Hormone and Related Disorders SOMATROPIN TEV-TROPIN Growth Hormone and Related Disorders SOMATROPIN ZOMACTON Growth Hormone and Related Disorders SOMATROPIN ZORBTIVE Heavy Metal Toxicity PENICILLAMINE CUPRIMINE Heavy Metal Toxicity PENICILLAMINE DEPEN Heavy Metal Toxicity TRIENTINE SYPRINE Specialty Medications List Harness Health Pharmacy Disease State Generic Name Brand Name Heavy Metal Toxicity TRIENTINE HCL TRIENTINE HCL Hematopoietics PLERIXAFOR MOZOBIL Hemophilia & Bleeding Disorders ANTIHEM.FVIII,SIN-CHN,B-DM TRU AFSTYLA Hemophilia & Bleeding Disorders ANTIHEMO.FVIII,FULL LENGTH PEG ADYNOVATE Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII REC,FC FUSION ELOCTATE Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,B-DOM TRUNCAT NOVOEIGHT Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,B-DOMAIN DEL XYNTHA Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,FULL LENGTH ADVATE Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,FULL LENGTH KOGENATE FS Hemophilia & Bleeding Disorders ANTIHEMOPH.FVIII,HEK B-DELETE NUWIQ Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII,FULL LENGTH ADVATE Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII,FULL LENGTH HELIXATE FS Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII,FULL LENGTH KOVALTRY Hemophilia & Bleeding Disorders ANTIHEMOPHIL.FVIII REC,B-DOM DELET PEG-AUCL JIVI Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUM REC RECOMBINATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUMAN HEMOFIL M Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUMAN KOATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR, HUMAN MONOCLATE-P Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR/VWF ALPHANATE Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR/VWF HUMATE-P Hemophilia & Bleeding Disorders ANTIHEMOPHILIC FACTOR/VWF