Specialty Comprehensive Drug List

July 2022

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

Brand Name

BYNFEZIA PEN LANREOTIDE SANDOSTATIN SANDOSTATIN LAR SOMATULINE DEPOT SOMAVERT SUBLOCADE VIVITROL ORALAIR PALFORZIA ARALAST NP GLASSIA ZEMAIRA AMVUTTRA ONPATTRO VYNDAMAX VYNDAQEL ARANESP ENJAYMO EPOGEN PROCRIT REBLOZYL RETACRIT CINQAIR DUPIXENT FASENRA NUCALA TEZSPIRE XOLAIR ADBRY CIBINQO DUPIXENT RINVOQ

Generic Name octreotide acetate (SANDOSTATIN)

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.

?2022 CVS Specialty. All rights reserved. 75-CTC14953E July 2022 v06302022 CVS Specialty Pharmacy Distribution Drug List

Page 1 of 17

July 2022

Updated Quarterly

Therapy Class

Brand Name

Bone Disorders ? Other

VOXZOGO

Botulinum Toxins

DYSPORT

MYOBLOC

XEOMIN

Cardiac Disorders

ARCALYST

CAMZYOS

TIKOSYN

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

Endocrine Disorders ? Other

ACTHAR

CORTROPHIN

Electrolyte Disorders

SAMSCA

Enzyme Deficiency Disorders ?

Other

Gastrointestinal Disorders ? Other

DUPIXENT

GATTEX

MYTESI

OCALIVA

SOLESTA

Gout

KRYSTEXXA

Growth Hormone & Related Disorders EGRIFTA

EGRIFTA SV

GENOTROPIN

HUMATROPE

INCRELEX

MACRILEN

NORDITROPIN

NUTROPIN AQ

OMNITROPE

SAIZEN

SEROSTIM

SKYTROFA

ZOMACTON

ZORBTIVE

Hematopoietics

MOZOBIL

Hemophilia, Von Willebrand Disease ADVATE

& Related Bleeding Disorders

ADYNOVATE

AFSTYLA

Generic Name dofetilide (TIKOSYN)

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.

?2022 CVS Specialty. All rights reserved. 75-CTC14953E July 2022 v06302022 CVS Specialty Pharmacy Distribution Drug List

Page 2 of 17

July 2022

Updated Quarterly

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

Hepatitis

Brand Name

ALPHANATE ALPHANINE SD ALPROLIX BENEFIX COAGADEX CORIFACT ELOCTATE ESPEROCT FEIBA FIBRYGA HEMLIBRA HEMOFIL M 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 SOFOSBUVIR/VELPATASVIR SOVALDI VEMLIDY VIEKIRA PAK

Generic Name

adefovir dipivoxil (HEPSERA) entecavir (BARACLUDE) lamivudine hbv (EPIVIR HBV) ribavirin caps 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.

?2022 CVS Specialty. All rights reserved. 75-CTC14953E July 2022 v06302022 CVS Specialty Pharmacy Distribution Drug List

Page 3 of 17

July 2022

Updated Quarterly

Therapy Class Hepatitis (cont.) Hereditary Angioedema

Hormonal Therapies

Human Immunodeficiency Virus

Brand Name

VIREAD VOSEVI ZEPATIER BERINERT CINRYZE FIRAZYR HAEGARDA KALBITOR RUCONEST TAKHZYRO AVEED ELIGARD FENSOLVI FIRMAGON LUPRON LUPRON DEPOT NATPARA SUPPRELIN LA TRELSTAR ZOLADEX APRETUDE APTIVUS 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

Generic Name

icatibant acetate (FIRAZYR)

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 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) maraviroc (SELZENTRY) 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.

?2022 CVS Specialty. All rights reserved. 75-CTC14953E July 2022 v06302022 CVS Specialty Pharmacy Distribution Drug List

Page 4 of 17

July 2022

Updated Quarterly

Therapy Class Human Immunodeficiency Virus (cont.)

Immune Deficiencies & Related Disorders

Brand Name

RETROVIR IV 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 VARIZIG WINRHO SDF

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.

?2022 CVS Specialty. All rights reserved. 75-CTC14953E July 2022 v06302022 CVS Specialty Pharmacy Distribution Drug List

Page 5 of 17

July 2022

Updated Quarterly

Therapy Class Immune Deficiencies & Related Disorders (cont.) Infectious Disease ? Other Infertility

Inflammatory Bowel Disease

Iron Overload Lysosomal Storage Disorders

Mental Health Conditions Migraine

Brand Name

XEMBIFY

ACTIMMUNE ALFERON N NUZYRA XENLETA CETROTIDE CHORIONIC GONADOTROPIN FOLLISTIM AQ GANIRELIX ACETATE GONAL-F MENOPUR NOVAREL OVIDREL PREGNYL AVSOLA CIMZIA ENTYVIO HUMIRA INFLECTRA INFLIXIMAB REMICADE RENFLEXIS SIMPONI ARIA SKYRIZI STELARA IV TYSABRI XELJANZ ZEPOSIA DESFERAL EXJADE JADENU ALDURAZYME CERDELGA CEREZYME CYSTAGON ELAPRASE ELELYSO FABRAZYME KANUMA LUMIZYME NAGLAZYME NEXVIAZYME VIMIZIM VPRIV SPRAVATO ZULRESSO ZYPREXA RELPREVV AIMOVIG AJOVY EMGALITY

Generic Name fyremadel (GANIRELIX ACETATE)

deferasirox (EXJADE, JADENU) deferiprone deferoxamine (DESFERAL) miglustat

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.

?2022 CVS Specialty. All rights reserved. 75-CTC14953E July 2022 v06302022 CVS Specialty Pharmacy Distribution Drug List

Page 6 of 17

July 2022

Updated Quarterly

Therapy Class Movement Disorders

Multiple Sclerosis

Neurological Disorders Neuromuscular Neutropenia

Ocular Disorders

Brand Name

APOKYN AUSTEDO DUOPA INGREZZA KYNMOBI NORTHERA NOURIANZ NUPLAZID RADICAVA (IV) RADICAVA ORS SOLIRIS XENAZINE ACTHAR AMPYRA AUBAGIO AVONEX BAFIERTAM BETASERON COPAXONE CORTROPHIN EXTAVIA GILENYA KESIMPTA LEMTRADA MAVENCLAD MAYZENT OCREVUS PLEGRIDY PONVORY REBIF TECFIDERA TYSABRI VUMERITY ZEPOSIA ADUHELM ULTOMIRIS VYVGART FULPHILA GRANIX LEUKINE NEULASTA NEUPOGEN NIVESTYM NYVEPRIA RELEUKO UDENYCA ZARXIO ZIEXTENZO BEOVU BYOOVIZ DURYSTA

Generic Name droxidopa (NORTHERA) tetrabenazine (XENAZINE)

dalfampridine ER (AMPYRA) dimethyl fumarate (TECFIDERA) glatiramer acetate (COPAXONE,

glatopa) mitoxantrone hcl

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.

?2022 CVS Specialty. All rights reserved. 75-CTC14953E July 2022 v06302022 CVS Specialty Pharmacy Distribution Drug List

Page 7 of 17

July 2022

Updated Quarterly

Therapy Class Ocular Disorders (cont.)

Oncology ? Injectable

Brand Name

EYLEA ILUVIEN LUCENTIS MACUGEN OZURDEX RETISERT SUSVIMO TEPEZZA VABYSMO VISUDYNE ABRAXANE ADCETRIS AKYNZEO IV ALYMSYS ARZERRA ASPARLAS AVASTIN BAVENCIO BELEODAQ BELRAPZO BENDAMUSTINE HCL BENDEKA BESPONSA BLINCYTO BORTEZOMIB CYRAMZA DACOGEN DARZALEX DARZALEX FASPRO EMPLICITI ENHERTU ERBITUX EVOMELA FOLOTYN GAZYVA HALAVEN HERCEPTIN HERCEPTIN HYLECTA HERZUMA IMFINZI INTRON A ISTODAX IXEMPRA JEMPERLI JEVTANA KADCYLA KANJINTI KEYTRUDA KHAPZORY KYPROLIS LUMOXITI

Generic Name

azacitidine (VIDAZA) decitabine (DACOGEN) levoleucovorin calcium mitoxantrone hcl paclitaxel protein-bound (ABRAXANE) temsirolimus (TORISEL) valrubicin (VALSTAR) zoledronic acid

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.

?2022 CVS Specialty. All rights reserved. 75-CTC14953E July 2022 v06302022 CVS Specialty Pharmacy Distribution Drug List

Page 8 of 17

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