CVS Specialty® Pharmacy Distribution Drug List

October 2021

Updated Quarterly

CVS Specialty? Pharmacy Distribution Drug List

Providing one of the broadest offerings of specialty pharmaceuticals in the industry

The CVS Specialty Pharmacy Distribution Drug List is a guide of medications available and distributed through CVS Specialty. Our goal is to help make your life better. With more than 40 years of experience, CVS Specialty provides quality care and service. Our network of pharmacies includes certifications and accreditations from the Joint Commission, Utilization Review Accreditation Commission (URAC), the National Association of Boards of Pharmacy (NABP) and the Accreditation Commission for Health Care (ACHC). These nationally recognized symbols reflect an organization's commitment to meet highest standards of quality, compliance and safety. This list is updated quarterly. Below brand-name products are in CAPS, and generic products are shown in lowercase italics.

Prospective Patients: Ready to get started? Enroll to get your medications from CVS Specialty.

Health Care Providers: Visit the CVS Specialty website to download enrollment forms or call 1-800-237-2767 (TTY: 711).

Therapy Class Acromegaly

Alcohol/Opioid Dependency Allergen Immunotherapy Alpha-1 Antitrypsin Deficiency Amyloidosis Anemia

Asthma

Atopic Dermatitis Botulinum Toxins Cardiac Disorders

Brand Name

BYNFEZIA PEN SANDOSTATIN SANDOSTATIN LAR SOMATULINE DEPOT SOMAVERT SUBLOCADE VIVITROL ORALAIR PALFORZIA ARALAST NP GLASSIA ZEMAIRA ONPATTRO VYNDAMAX VYNDAQEL ARANESP EPOGEN PROCRIT REBLOZYL RETACRIT CINQAIR DUPIXENT FASENRA NUCALA XOLAIR DUPIXENT DYSPORT MYOBLOC XEOMIN ARCALYST TIKOSYN

Generic Name octreotide acetate (SANDOSTATIN)

dofetilide (TIKOSYN)

Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may

change from time to time. In addition, a member's specific benefit plan design may not cover certain products or categories, regardless of their

appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject

to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical

manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2021 CVS Specialty. All rights reserved. 75-CTC14953E October 2021 v10072021 CVS Specialty Pharmacy Distribution Drug List

Page 1 of 17

October 2021

Updated Quarterly

Therapy Class

Brand Name

Coagulation Disorders

CEPROTIN

Contraceptives

KYLEENA

LILETTA

MIRENA

NEXPLANON

SKYLA

Cryopyrin-Associated Periodic

ARCALYST

Syndromes

ILARIS

Cystic Fibrosis

BETHKIS

BRONCHITOL

CAYSTON

KITABIS PAK

PULMOZYME

TOBI

TOBI PODHALER

Electrolyte Disorders

SAMSCA

Enzyme Deficiency Disorders - Other

Gastrointestinal Disorders - Other

GATTEX

MYTESI

OCALIVA

SOLESTA

Gout

KRYSTEXXA

Growth Hormone & Related Disorders EGRIFTA

EGRIFTA SV

GENOTROPIN

HUMATROPE

INCRELEX

MACRILEN

NORDITROPIN

NUTROPIN AQ

OMNITROPE

SAIZEN

SEROSTIM

ZOMACTON

ZORBTIVE

Hematopoietics

MOZOBIL

Hemophilia, Von Willebrand Disease ADVATE

& Related Bleeding Disorders

ADYNOVATE

AFSTYLA

ALPHANATE

ALPHANINE SD

ALPROLIX

BENEFIX

COAGADEX

CORIFACT

ELOCTATE

ESPEROCT

FEIBA

FIBRYGA

HEMLIBRA

HEMOFIL M

Generic Name

tobramycin (BETHKIS) tobramycin nebulizer (TOBI)

tolvaptan (SAMSCA) nitisinone

Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may

change from time to time. In addition, a member's specific benefit plan design may not cover certain products or categories, regardless of their

appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject

to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical

manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2021 CVS Specialty. All rights reserved. 75-CTC14953E October 2021 v10072021 CVS Specialty Pharmacy Distribution Drug List

Page 2 of 17

Therapy Class Hemophilia, Von Willebrand Disease & Related Bleeding Disorders (cont.)

Hepatitis

Brand Name

HUMATE-P IDELVION IXINITY JIVI KOATE KOATE-DVI KOGENATE FS KOVALTRY MONONINE NOVOEIGHT NOVOSEVEN RT NUWIQ OBIZUR PROFILNINE PROFILNINE SD REBINYN RECOMBINATE RIASTAP RIXUBIS SEVENFACT STIMATE TRETTEN VONVENDI WILATE XYNTHA BARACLUDE EPCLUSA EPIVIR HBV HARVONI HEPSERA INTRON A LEDIPASVIR-SOFOSBUVIR MAVYRET PEGASYS PEGINTRON REBETOL REBETOL SOLUTION SOFOSBUVIR/VELPATASVIR SOVALDI VEMLIDY VIEKIRA PAK VIREAD VOSEVI ZEPATIER

October 2021

Updated Quarterly

Generic Name

adefovir dipivoxil (HEPSERA) entecavir (BARACLUDE) lamivudine hbv (EPIVIR HBV) ribavirin caps (REBETOL) ribavirin tabs tenofovir disoproxil fumarate (VIREAD)

Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may

change from time to time. In addition, a member's specific benefit plan design may not cover certain products or categories, regardless of their

appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject

to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical

manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2021 CVS Specialty. All rights reserved. 75-CTC14953E October 2021 v10072021 CVS Specialty Pharmacy Distribution Drug List

Page 3 of 17

October 2021

Updated Quarterly

Therapy Class Hereditary Angioedema Hormonal Therapies

Human Immunodeficiency Virus

Brand Name

BERINERT CINRYZE FIRAZYR HAEGARDA KALBITOR RUCONEST TAKHZYRO AVEED ELIGARD FENSOLVI FIRMAGON LUPANETA PACK LUPRON LUPRON DEPOT NATPARA SUPPRELIN LA TRELSTAR VANTAS ZOLADEX APTIVUS ATRIPLA BIKTARVY CABENUVA CIMDUO COMBIVIR COMPLERA CRIXIVAN DELSTRIGO DESCOVY DOVATO EDURANT EMTRIVA EPIVIR EPZICOM EVOTAZ FUZEON GENVOYA INTELENCE INVIRASE ISENTRESS JULUCA KALETRA LEXIVA NORVIR ODEFSEY PIFELTRO PREZCOBIX PREZISTA RESCRIPTOR RETROVIR RETROVIR IV

Generic Name icatibant acetate (FIRAZYR, sajazir)

leuprolide acetate (LUPRON)

abacavir tab (ZIAGEN) abacavir-lamivudine (EPZICOM) abacavir sulfate-lamivudine-zidovudine

(TRIZIVIR) atazanavir sulfate (REYATAZ) didanosine (VIDEX, VIDEX EC) efavirenz (SUSTIVA) efavirenz-emtricitabine-tenofovir df

(ATRIPLA) efavirenz-lamivudine-tenofovir df

(SYMFI, SYMFI LO) emtricitabine (EMTRIVA) emtricitabine-tenofovir df

(TRUVADA) etravirine (INTELENCE) fosamprenavir (LEXIVA) lamivudine (EPIVIR) lamivudine-zidovudine (COMBIVIR) lopinavir-ritonavir (KALETRA) nevirapine (VIRAMUNE, VIRAMUNE XR) ritonavir (NORVIR) stavudine tenofovir disoproxil fumarate (VIREAD) zidovudine (RETROVIR)

Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may

change from time to time. In addition, a member's specific benefit plan design may not cover certain products or categories, regardless of their

appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject

to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical

manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2021 CVS Specialty. All rights reserved. 75-CTC14953E October 2021 v10072021 CVS Specialty Pharmacy Distribution Drug List

Page 4 of 17

Therapy Class Human Immunodeficiency Virus (cont.)

Immune Deficiencies & Related Disorders

Brand Name

REYATAZ RUKOBIA SELZENTRY STRIBILD SUSTIVA SYMFI SYMFI LO SYMTUZA TEMIXYS TIVICAY TRIUMEQ TRIZIVIR TROGARZO TRUVADA TYBOST VIDEX VIDEX EC VIDEX SOL VIRACEPT VIRAMUNE VIRAMUNE XR VIREAD ZIAGEN ASCENIV BIVIGAM CUTAQUIG CUVITRU CYTOGAM FLEBOGAMMA DIF GAMASTAN GAMASTAN S/D GAMMAGARD LIQUID GAMMAGARD S/D GAMMAKED GAMMAPLEX GAMUNEX C HEPAGAM B HIZENTRA HYPERHEP B S/D HYPERRHO S/D HYQVIA MICRHOGAM NABI-HB OCTAGAM PANZYGA PRIVIGEN RHOGAM RHOPHYLAC

October 2021

Updated Quarterly

Generic Name

Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member's prescription or medical benefit plan, may

change from time to time. In addition, a member's specific benefit plan design may not cover certain products or categories, regardless of their

appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject

to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical

manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.

?2021 CVS Specialty. All rights reserved. 75-CTC14953E October 2021 v10072021 CVS Specialty Pharmacy Distribution Drug List

Page 5 of 17

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