Aetna Specialty Pharmacy® Most Frequently Prescribed Medications† Product Name Generic Name Product Name Generic Name ALCOHOLISM FABRY DISEASE Vivitrol naltrexone Fabrazyme agalsidase beta ASTHMA GAUCHER DISEASE Xolair omalizumab Cerezyme imiglucerase ANEMIA/CHRONIC RENAL FAILURE POMPE DISEASE Aranesp darbepoetin alfa Myozyme alglucosidase alfa Epogen epoetin alfa Ferrlecit sodium ferric gluconate complex GROWTH HORMONE/ENDOCRINOLOGY Infed iron dextran Procrit* epoetin alfa Humatrope* PR SI somatropin Venofer iron sucrose injection Lupron Pediatric leuprolide acetate for depot suspension Nutropin PR SI somatropin PR SI COMPOUNDED PRODUCTS Nutropin AQ somatropin Tev-Tropin PR SI somatropin Bi-est/Progesterone/Testosterone Capsules GYNECOLOGY Hydroxyprogesterone injectables Intrathecal sterile compounds Delestrogen estradiol valerate injection, USP Progesterone capsules/suppositories/injectables Depo Estradiol estradiol cypionate injection, USP Tablets Depo Provera medroxyprogesterone acetate Testosterone creams Lupron leuprolide acetate CROHN’S DISEASE HEMATOLOGY / CARDIOLOGY Humira adalimumab Arixtra SI fondaparinux Remicade infliximab Desferral deferrioxamine mesylate Fragmin SI dalteparin sodium DIABETES Heparin heparin sodium Innohep* SI tinzaparin sodium Byetta exenatide Lovenox* SI enoxaparin sodium ENZYME REPLACEMENT Aldurazyme laronidase * Indicates medications that can be filled through our Ready-To-Inject, pre-filled syringe dosing program. †This document is a sample list of medications that are available through Aetna Specialty Pharmacy. This list is subject to change. If you have questions or need more information, please call 1-866-782-ASRX. 05.03.350.1 (7/07) Product Name Generic Name Product Name Generic Name HEMOPHILIA Pergonal PR SI menotropins Pregnyl PR SI human chorionic gonadotropin Advate PR SI antihemophilic factor VIII (recombinant) Progesterone progesterone plasma/albumin free Repronex PR SI menotropins Alphanate PR SI antihemophilic factor VIII (human) PR SI AlphaNine SD coagulation factor IX MACULAR DEGENERATION Amicar aminocaproic acid BeneFIX PR SI coagulation factor IX (recombinant) Avastin bevacizumab DDAVP desmopressin acetate Lucentis ranibizumab FEIBA VH IMMUNO PR anti-inhibitor coagulant complex Macugen pegaptanib sodium Helixate FS PR SI antihemophilic factor VIII (recombinate) Visudyne verteporfin Hemofil M PR SI antihemophilic factor VIII (human) PR SI Humate P antihemophilic factor/von Willebrand NEUROLOGY/MULTIPLE SCLEROSIS Factor complex (human) Kogenate FS PR SI antihemophilic factor VIII (recombinate) Acthar corticotropin Monarc M PR SI antihemophilic factor VIII (human) Avonex* SI interferon beta-1a Monoclate P PR SI antihemophilic factor VIII (human) Betaseron SI interferon beta-1b Mononine PR coagulation Factor IX Botox botulinum toxin type A NovoSeven PR coagulation Factor VIIa (recombinant) Copaxone SI glatiramer acetate Recombinate PR antihemophilic factor VIII (recombinate) Myobloc botulinum toxin type B Refacto PR antihemophilic factor VIII (recombinate) Rebif SI interferon beta-1a Stimate desmopressin acetate Solu Medrol Methylprednisolone Tysabri natalizumab HEPATITIS ONCOLOGY BayHep B hepatitis B immune globulin Copegus ribavirin tablets Adriamycin doxorubicin HCL Engerix-B hepatitis B vaccine recombinant Alferon N SI interferon alpha-N3 Havrix hepatitis A vaccine inactivated Aredia pamidronate disodium (adjunct) Hepsera adefovir dipivoxil Arimidex anastrozole Infergen PR SI interferon alfacon-1 BCG Live bacillus calmette guerin Nabi-HB hepatitis B immune globulin BiCNU carmustine Peg-Intron* PR SI peginterferon alfa 2b Bleomycin bleomycin sulfate Pegasys* PR SI peginterferon alfa 2a Camptosar irinotecan Ribavirin ribavirin capsules and tablets CeeNU lomustine Twinrix hepatitis A (inactive)/hepatitis B Cisplatin cisplatin (recombinate) Hepatitis B Vaccine Cosmegen dactinomycin Recombinant Cytarabine cytarabine Cytoxan cyclophosphamide HIV & AIDS Dacarbazine dacarbazine Daunorubicin daunorubicin Fuzeon SI enfuvirtide Doxil doxorubicin liposomal Serostim somatropin Doxorubicin doxorubicin Eligard leuprolide acetate IMMUNE SYSTEM / IVIG Ellence epirubicin Eloxatin oxaliplatin BayRho-D Rho (D) immune globulin Emcyt estramustine phosphate sodium Carimune NF PR immune globulin intraveous Erbitux cetuximab CellCept mycophenolate mofetil Ethyol amifostine CytoGam cytomegalovirus immune globulin Etopophos etoposide Depo-Medrol methylprednisolone Etoposide etoposide Flebogamma immune globulin intraveous Eulexin flutamide Gamastan immune globulin-intramuscular Faslodex fulvestrant Gammagard S/D PR immune globulin intraveous Fludara fludarabine phosphate Gamunex PR immune globulin intraveous Fluorouracil fluorouracil Iveegam PR immune globulin intraveous Gemzar gemcitabine HCL Medrol methylprednisolone tablets Gleevec PR imatinib mesylate Octagam immune globulin intraveous Herceptin trastuzumab Panglobulin NF PR immune globulin intraveous Hycamtin topotecan Pentamidine pentamidine isethionate Ifex/Mesnex ifosfamide/mesna Polygam SD PR immune globulin intraveous Intron A PR SI interferon alfa 2b RhoGam Rho (D) immune globulin Iressa PR gefitinib Solu-Cortef hydrocortisone sodium sccinate Leucovorin leucovorin calcium Venoglobulin-S PR SI immune globulin intraveous Leukeran chlorambucil Vivaglobin immune globulin subcutaneous Leukine* sargramostim Leuprolide leuprolide acetate INFERTILITY Lupron leuprolide acetate Bravelle PR SI urofollitropin Matulane procarbazine Cetrotide PR cetrorelix Mesnex mesna Clomid clomiphene citrate Methotrexate methotrexate Follistim PR SI follitropin beta Mitomycin mitomycin Follistim AQ PR SI follitropin beta Mustargen mechlorethamine HCL Ganirelix PR SI ganirelix acetate Mutamycin mitomycin Gonal-F PR follitropin alfa Navelbine vinorelbine HCG PR SI human chorionic gonadotropin Nexavar sorafenib Lupron Depot 2-week kitSI leuprolide acetate Novantrone mitoxantrone Novarel PR SI chorionic gonadotropin Paclitaxel paclitaxel Ovidrel PR SI choriogonadotropin alfa Paraplatin carboplatin Plenaxis abarelix Product Name Generic Name Product Name Generic Name Proleukin* aldesleukin PARKINSON’S DISEASE Revlimid lenalidomid Rituxan rituximab Apokyn apomorphine Roferon-A* PR SI interferon alfa-2a Sprycel dasatinib POMPE DISEASE Sutent sunitinib malate Tarceva erlotinib Myozyme alglucosidase alfa Taxol paclitaxel Taxotere docetaxel PSORIASIS/PSORIATIC ARTHRITIS Temodar temozolomide Thalomid thalidomide Amevive alefacept Enbrel SI etanercept Vectibix panitumumab SI Velcade bortezomib Raptiva efalizumab Vinblastine vinblastine sulfate Remicade infliximab recombinant Vincristine vincristine sulfate Xeloda capecitabine PULMONARY Zoladex goserelin acetate Actimmune interferon gamma-1b Coly-Mycin M colistimethate sodium ONCOLOGY ADJUNCT Pulmozyme dornase alfa Anzemet QL dolasetron mesylate Tobi tobramycin Aloxi palonosetron Compazine prochlorperazine RESPIRATORY SYNCYTIAL VIRUS (RSV) Emend aprepitant PR Epogen epoetin alfa Synagis palivizumab Kytril QL granisetron HCL Neulasta pegfilgrastim UROLOGY Neumega oprelvekin Neupogen* filgrastim Procrit* epoetin alfa Caverject alprostadil Sandostatin* octreotide acetate Delatestryl testosterone enanthate injection Zofran QL ondansetron HCL Depo Testosterone testosterone cyplonate injection USP Zometa zoledronic acid Edex alprostadil OSTEOARTHRITIS & RHEUMATOID ARTHRITIS TRANSPLANT Enbrel SI etanercept CellCept mycophenolate Euflexxa highly purified hyaluronan Gengraf cyclosporine Humira SI adalimumab Imuran azathioprine Hyalgan sodium hyaluronate Neoral cyclosporine Kineret SI anakinra Prograf tacrolimus Methotrexate methotrexate Rapamune sirolimus Orencia abatacept Sandimmune cyclosporine Orthovisc hyaluronate acid Prednisone prednisone Remicade infliximab recombinant Supartz sodium hyaluronate Synvisc hylan G-F 20 OSTEOPOROSIS Forteo SI teriparatide Boniva ibandronate PAIN MANAGEMENT Buprenex buprenorphine Ketorolac ketorlac tromethamine * Indicates medications that can be filled through our Lioresal baclofen Ready-To-Inject, pre-filled syringe dosing program. Marcaine bupivacaine Nalbuphine nalbuphine If you have questions or need more information, Nubain nalbuphine please call 1-866-782-ASRX. This document is a sample list of medications that are available through Aetna Specialty Pharmacy. This list is subject to change. Key PR = Precertification required under most plans QL = Quantity Limits applies under most plans SI = Self-injectable drug (some plans may cover injectable medications through the medical benefit) Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through mail order. The charges Aetna negotiates with Aetna Specialty Pharmacy may be higher than the cost it pays for the drugs and the costs of its specialty pharmacy services. For these purposes, Aetna Specialty Pharmacy’s cost of purchasing drugs takes into account discounts, credits and other amounts it may receive from wholesalers, manufacturers, suppliers, and distributors. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or administer benefits coverage include: Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Corporate Health Insurance Company and/or Aetna Life Insurance Company. ©2007 Aetna Inc. 05.03.350.1 (7/07) .