Specialty Comprehensive Drug List

October 2024

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 Alopecia Areata Alpha-1 Antitrypsin Deficiency Amyloidosis Anemia

Asthma

Brand Name

LANREOTIDE SANDOSTATIN SANDOSTATIN LAR SOMATULINE DEPOT SOMAVERT BRIXADI SUBLOCADE VIVITROL ORALAIR XOLAIR LITFULO OLUMIANT ARALAST NP GLASSIA ZEMAIRA AMVUTTRA ONPATTRO VYNDAMAX VYNDAQEL ARANESP ENJAYMO EPOGEN PROCRIT REBLOZYL RETACRIT ZYNTEGLO CINQAIR DUPIXENT FASENRA NUCALA TEZSPIRE XOLAIR

Generic Name octreotide acetate (SANDOSTATIN)

*Indicates Limited Distribution drug distributed only by Coram? CVS Specialty Infusion Services.

Drug Not Stocked

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.

?2024 CVS Specialty. All rights reserved. 75-CTC14953E October 2024 v09302024 CVS Specialty Pharmacy Distribution Drug List

Page 1 of 19

Therapy Class Atopic Dermatitis

Bone Disorders ? Other Botulinum Toxins

Cardiac Disorders Coagulation Disorders Contraceptives

Cryopyrin-Associated Periodic Syndromes Cushing's Cystic Fibrosis

Dermatological Disorders ? Other Dupuytren's Contracture Electrolyte Disorders Endocrine Disorders ? Other Enzyme Deficiency Disorders ? Other Gastrointestinal Disorders ? Other

Gout

Brand Name

ADBRY CIBINQO DUPIXENT EBGLYSS RINVOQ SOHONOS VOXZOGO DAXXIFY DYSPORT MYOBLOC XEOMIN ARCALYST CAMZYOS TIKOSYN CEPROTIN KYLEENA LILETTA MIRENA NEXPLANON SKYLA ARCALYST ILARIS

BETHKIS BRONCHITOL CAYSTON KITABIS PAK PULMOZYME TOBI TOBI PODHALER NEMLUVIO VYJUVEK XIAFLEX

SAMSCA

ACTHAR CORTROPHIN

RYPLAZIM

DUPIXENT GATTEX IQIRVO MYTESI OCALIVA REZDIFFRA SOLESTA ILARIS KRYSTEXXA

October 2024

Updated Quarterly

Generic Name

dofetilide (TIKOSYN)

mifepristone tobramycin (BETHKIS) tobramycin nebulizer (TOBI)

dichlorphenamide tolvaptan (SAMSCA) betaine anhydrous nitisinone

*Indicates Limited Distribution drug distributed only by Coram? CVS Specialty Infusion Services.

Drug Not Stocked

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.

?2024 CVS Specialty. All rights reserved. 75-CTC14953E October 2024 v09302024 CVS Specialty Pharmacy Distribution Drug List

Page 2 of 19

Therapy Class Growth Hormone & Related Disorders

Hematopoietics Hemophilia, Von Willebrand Disease & Related Bleeding Disorders

(Continued on next page)

Brand Name

EGRIFTA SV GENOTROPIN HUMATROPE INCRELEX NGENLA NORDITROPIN NUTROPIN AQ OMNITROPE SAIZEN SEROSTIM SKYTROFA SOGROYA ZOMACTON MOZOBIL ADVATE ADYNOVATE AFSTYLA ALPHANATE ALPHANINE SD ALPROLIX ALTUVIIIO BENEFIX BEQVEZ COAGADEX CORIFACT ELOCTATE ESPEROCT FEIBA FIBRYGA HEMGENIX HEMLIBRA HEMOFIL M HUMATE-P IDELVION IXINITY JIVI KOATE KOATE-DVI KOGENATE FS KOVALTRY NOVOEIGHT NOVOSEVEN RT NUWIQ OBIZUR PROFILNINE PROFILNINE SD REBINYN RECOMBINATE RIASTAP

October 2024

Updated Quarterly

Generic Name

plerixafor (MOZOBIL)

*Indicates Limited Distribution drug distributed only by Coram? CVS Specialty Infusion Services.

Drug Not Stocked

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.

?2024 CVS Specialty. All rights reserved. 75-CTC14953E October 2024 v09302024 CVS Specialty Pharmacy Distribution Drug List

Page 3 of 19

Therapy Class Hemophilia, Von Willebrand Disease & Related Bleeding Disorders (continued) Hepatitis

Hereditary Angioedema Hormonal Therapies

Human Immunodeficiency Virus

(Continued on next page)

Brand Name

RIXUBIS ROCTAVIAN SEVENFACT TRETTEN VONVENDI WILATE XYNTHA BARACLUDE EPCLUSA EPIVIR HBV HARVONI LEDIPASVIR-SOFOSBUVIR MAVYRET PEGASYS SOFOSBUVIR/VELPATASVIR SOVALDI VEMLIDY VIREAD VOSEVI ZEPATIER BERINERT CINRYZE FIRAZYR HAEGARDA KALBITOR RUCONEST TAKHZYRO AVEED ELIGARD FENSOLVI FIRMAGON LUPRON LUPRON DEPOT SUPPRELIN LA TRELSTAR ZOLADEX APRETUDE APTIVUS BIKTARVY CABENUVA CIMDUO COMPLERA DELSTRIGO DESCOVY DOVATO EDURANT EMTRIVA EPIVIR EVOTAZ

October 2024

Updated Quarterly

Generic Name

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

icatibant acetate (FIRAZYR)

leuprolide acetate (LUPRON)

abacavir tab (ZIAGEN) abacavir-lamivudine atazanavir sulfate (REYATAZ) darunavir (PREZISTA) efavirenz (SUSTIVA) efavirenz-emtricitabine-tenofovir df efavirenz-lamivudine-tenofovir df

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

(TRUVADA) etravirine (INTELENCE) fosamprenavir

*Indicates Limited Distribution drug distributed only by Coram? CVS Specialty Infusion Services.

Drug Not Stocked

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.

?2024 CVS Specialty. All rights reserved. 75-CTC14953E October 2024 v09302024 CVS Specialty Pharmacy Distribution Drug List

Page 4 of 19

October 2024

Updated Quarterly

Therapy Class Human Immunodeficiency Virus (continued)

Immune Deficiencies & Related Disorders

(Continued on next page)

Brand Name

FUZEON GENVOYA INTELENCE ISENTRESS JULUCA KALETRA NORVIR ODEFSEY PIFELTRO PREZCOBIX PREZISTA RETROVIR RETROVIR IV REYATAZ RUKOBIA SELZENTRY STRIBILD SUNLENCA SUSTIVA SYMFI SYMFI LO SYMTUZA TIVICAY TRIUMEQ TROGARZO TRUVADA TYBOST VIRACEPT 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

Generic Name

lamivudine (EPIVIR) lamivudine-zidovudine lopinavir-ritonavir (KALETRA) maraviroc (SELZENTRY) nevirapine ritonavir (NORVIR) stavudine tenofovir disoproxil fumarate (VIREAD) zidovudine (RETROVIR)

*Indicates Limited Distribution drug distributed only by Coram? CVS Specialty Infusion Services.

Drug Not Stocked

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.

?2024 CVS Specialty. All rights reserved. 75-CTC14953E October 2024 v09302024 CVS Specialty Pharmacy Distribution Drug List

Page 5 of 19

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