October 2019 ges.com
Specialty Medication List
October 2019
We provide a patient-centric model that drives improved clinical outcomes, positive experiences, and low prices. We are dedicated to empowering patients to choose healthy behaviors and live better. This specialty pharmacy medication list includes the specialty medications available through our Walmart retail pharmacies or Specialty Pharmacy in Orlando, Florida.
ACROMEGALY Sandostatin Sandostatin LAR Depot Somatuline Depot*
ALCOHOL/OPIOID DEPENDENCY Vivitrol
ANTICOAGULANT Arixtra Fragmin
ATRIAL FIBRILLATION/ FLUTTER Tikosyn
BACTERIAL INFECTION Bicillin Coly-Mycin M Cubicin Dificid Invanz Sivextro
CROHN'S DISEASE Entocort EC
CROHN'SULCERATIVE COLITIS Uceris
CYSTIC FIBROSIS Bethkis* Pulmozyme Tobi* Tobi Podhaler*
CYTOMEGALY VIRUS Cytovene Valcyte
DERMATOLOGY Adult Acnomel Dupixent Elidel Cream
Fluoroplex Hylatopic Plus Rezamid Tazorac
DIAGNOSTIC AID E-Z-HD MD-Gastroview Readi-Cat 2 R-Gene 10 Tagitol V Thyrogen*^
ENDOMETRIOSIS LSuypnaanreelta
FERTILITY Cetrotide Chorionic-Gonadotropin Crinone Desogen Endometrin Follistim AQ Ganirelix Acetate Gonal-F RFF Menopur Novarel Ovidrel Pregnyl
FUNGAL INFECTION Abelcet Ambisome Vfend
GAUCHER DISEASE Cerezyme* Vpriv*
GROWTH HORMONE Gentropin Humatrope Norditropin Flexpro Nutropin AQ Nuspin Omnitrope Saizen Saizenprep Zomacton Zorbtive
GOUT Colcigel
HEMATOLOGY Aranesp Epogen Granix Neulasta Neupogen NPlate^ Procrit Promacta^ Rhogam^ Rhophylac^ Soliris*^ Vidaza Zarxio
HEMOPHILIA Amicar* Advate*^ Adynovate*^ Alphanate*^ Alphanine*^ Alprolix*^ Benefix*^ Eloctate*^ Helixate FS*^ Hemlibra* Hemofil Humate Koate-D Kogenate FS*^ Monoclate-P*^ Mononine*^ Novoseven RT*^ Novoeight^ Profilnine*^ Recombinate* Riastap*^ Rixubis*^ Stimate*^ Tretten*^ Wilate*^ Xyntha*^
HEPATIC ENCEPHALOPATHY - IBS Xifaxan
HEPATITIS Baraclude Daklinza Epclusa Harvoni
Hepsera Mavyret Pegasys Rebetol Ribaspehere Sovaldi Technivie Vemlidy Viekira Pak Viread Vosevi Zepatier
HEREDITARY
ANGIOEDEMA
Firazyr
HIV Aptivus Atripla Biktarvy Combivir Complera Crixivan Dapsone Descovy Edurant Emtriva Epivir Epzicom Evotaz Fuzeon Genvoya Intelence Invirase Isentress Juluca Kaletra Lexiva Mycobutin Mytesi Norvir Odefsey Prezcobix Prezista Rescriptor Retrovir Reyataz Selzentry Stribild Sustiva Tivicay Triumeq Trizivir Truvada Tybost
Videx Viracept Viramune Viread Zerit Ziagen
HORMONE REPLACEMENT Delestrogen Depo-Estradiol Progesterone IM Oil Prometrium
HYPER-IMMUNES Hizentra*
HYPERLIPIDEMIA Praluent Repatha
HYPERPARATHYROIDISM Sensipar Zemplar
IMMUNOGLOBULINS NABI-HB
IMPOTENCE Caverject Edex
INTERSTITIAL CYSTITIS Rimso-50
IRON OVERLOAD Desferal Exjade*^
IRON-DEFICIENCY ANEMIA Feraheme Ferrlecit Venofer
METABOLIC MODIFIERS Aldurazyme* Elaprase* Fabrazyme*
*Indicates LDD ^Biologic +Prescriber required to fill out Statement of Medical Necessity (SMN) Form
These medications are available at Walmart retail locations or Walmart Specialty Pharmacy in Orlando, FL. This list is subject to change. This document is proprietary
to Walmart. A patient's insurance benefit design may limit the dispensing of these medications to certain pharmacies or not cover these or other specialty medications
not listed. These medications are dispensed by Walmart in accordance with federal and state pharmacy regulations.
For more information, call Walmart Specialty Pharmacy at: 1-877-453-4566. ?2019 Walmart Inc.
Version 101419
MIGRAINE PROPHYLAXIS Aimovig Emgality
MISCELLANEOUS Celestone Soluspan Cortrosyn Danazol Ddavp Depo-Medrol Depo-Provera Entereg Fusilev^ Galzin Gastrografin Infed Infuvite Kenalog Ketorolac Makena^ Nuedexta Oralair* Osmitrol Panhematin Pertzye Solu-Cortef Solu-Medrol Velphoro Veltassa Xolair*
MOVEMENT DISORDER Austedo^ Botox Dysport^ Myobloc
MUCOSAL PROTECTION Mugard
MULTIPLE SCLEROSIS Avonex Betaseron Copaxone Extavia Gilenya Glatopa Mayzent* Mitoxantrone Rebif
MUSCLE SPASM Lioresal
ONCOLOGY Abraxane Adriamycin Adrucil Afinitor^ Afinitor Disperz^ Agrylin Alecensa*+ Akynzeo Alferon N Alimta Alkeran
Aloxi
Anzemet Aromasin Arzerra Bendeka Bicnu Blenoxane Bleomycin Busulfex Campath Camptosar Carboplatin Casodex Clolar Cosmegen Cotellic*+ Cytoxan Cytosar-U Dactinomycin Darzalex Daunorubicin HCL Demser Dibenzyline Doxil Dtic Eligard Elitek Ellence Emcyt Emend Erbitux Ethyol Etopophos Eulexin Fareston Farydak Faslodex Femara Firmagon Floxuridine Fludarabine Phosphate Folotyn Fusilev Gastrocrom Gemzar Gleevec Hycamtin Capsule Hycamtin SDV Hydrea Idamycin Ifex Intron-A Istodax Ixempra Kit^ Keytruda^ Kisqali Kisqali Femara Leucovorin Leukeran Leukine Leuprolide Acetate Leustatin Lotronex Lupron Megace Mesnex Mitomycin Mitoxantrone Mozobil* Myleran Navelbine
Nilandron Ninlaro Nipent Odomzo^ Oncaspar Opdivo* Oxaliplatin Pamidronate Panretin^ Piqray Platinol Proleukin Purixan^ Rituxan Rydapt Soltamox Sprycel Sylatron Tabloid Tafinlar^ Tarceva* Targretin^ Tasigna^ Taxol Taxotere Temodar Teniposide Theracys Thiotepa Tice BCG Tolak Toposar Torisel Treanda^ Trelstar Trexall Trisenox Tykerb^ Vectibix Vesanoid Vinblastine Sulfate Vincasar PFS Votrient^ Xeloda Xgeva Yondelis^ Zanosar Zelboraf*+ Zinecard Zoladex Zolinza Zometa Zykadia Zytiga
OPHTHALMOLOGY Ozurdex Triesence
OPIOID-INDUCED CONSTIPATION Relistor
ORAL MUCOSITIS Kepivance
OSTEOARTHRITIS Euflexxa Gel-One Hyalgan Monovisc Orthovisc Supartz Synvisc
OSTEOPOROSIS Boniva Evenity Forteo Prolia Reclast Tymlos
PAIN Buprenex Lazanda Nalbuphine Prialt Xadago
PAH Adcirca
PNEUMOCYSTIS JIROVECI PNEUMONIA Pentam
PSORIASIS Cosentyx* Dritho-Cr?me HP Ilumya* Otezla Oxsoralen Ultra Skyrizi Siliq Soriatane Tremfya Taltz* Zithranol
PSYCHIATRY Haldol Decanoate Invega Risperdal Consta
RHEUMATOID ARTHRITIS Actemra*^ Arava Cimzia Depen Titratab Enbrel Humira Kevzara Orencia Otrexup Rasuvo Remicade Rinvoq Simponi Simponi Aria Stelara^ Xeljanz Xeljanz XR
RSV Epinephrine Synagis* Virazole
SICKLE CELL ANEMIA Droxia Siklos
THROMBOLYTIC Cathflo Activase
TRANSPLANT Astagraf XL Atgam Azasan Cellcept Envarsus XR^ Gengraf Imuran Myfortic Neoral Prograf Rapamune Sandimmune Simulect Tepadina Thymoglobulin Zortress
WILSON DISEASE Syprine
*Indicates LDD ^Biologic +Prescriber required to fill out Statement of Medical Necessity (SMN) Form
These medications are available at Walmart retail locations or Walmart Specialty Pharmacy in Orlando, FL. This list is subject to change. This document is proprietary
to Walmart. A patient's insurance benefit design may limit the dispensing of these medications to certain pharmacies or not cover these or other specialty medications
not listed. These medications are dispensed by Walmart in accordance with federal and state pharmacy regulations.
For more information, call Walmart Specialty Pharmacy at: 1-877-453-4566. ?2019 Walmart Inc.
Version 101419
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