Specialty Pharmacy Drug List - Magellan Rx Management
Specialty Pharmacy Drug List
Our Specialty Pharmacy provides patients with comprehensive support services and coordinated delivery related to high-cost oral, inhaled or injectable specialty medications, used to treat complex conditions. We are your single source for high-touch patient care management to control side effects, patient support and education to ensure compliance or continued treatment, and specialized handling and distribution of medications directly to the patient or care provider. Specialty medications may be covered under either the medical or pharmacy benefit. Please consult your insurance documentation to determine which benefit covers these medications. We offer a broad specialty medication list containing nearly 500 drugs, covering 42 therapeutic categories and specialty disease states. This list is updated with new information each quarter.
Characteristics of Specialty Medications "Specialty" medications are defined as high-cost oral or injectable medications used to treat complex chronic conditions. These are highly complex medications, typically biology-based, that structurally mimic compounds found within the body. High-touch patient care management is usually required to control side effects and ensure compliance. Specialized handling and distribution are also necessary to ensure appropriate medication administration. Medications must have at least one of the following characteristics in order to be classified as a specialty medication by Magellan Rx Management.
High Cost
High Complexity
High-cost medications are typically priced at more than $1,000 per 30-day supply; including self-administered injectables, professionallyadministered injectables/ infusions, and oral medications
? Biotechnology products? ? Orphan or Ultra-Orphan drugs ? Medications that are included
in a specialty therapeutic drug class strategy
Generics: Lower case italic. For example, dexferrum Brands: All capital letters. For example, HUMIRA QL: Quantity Limits apply under some benefits. Check your plan document for coverage details. PA: Prior Authorization needed under some benefits. Check your plan document for coverage details.
High Touch ? Medications that require temperature control or other special
handling/shipping requirements (i.e., refrigerated or frozen shipping)
? Medications that require ongoing drug management by a pharmacist and/or physician specializing in treating the member's condition
? Medications that require focused, in-depth member education, compliance monitoring, side effect management and, often, injection technique education
Anemia
ARANESP PA dexferrum EPOGEN PA FERAHEME ferrlecit MIRCERA PA OMONTYS PROCRIT PA sodium ferric gluconate VENOFER
Anticoagulants
ADEMPAS PA ARIXTRA enoxaparin IPRIVASK fondaparinux FRAGMIN INNOHEP LOVENOX
Antilipemic Agents
KYNAMRO PA JUXTAPID PA PRALUENT PA, QL REPATHA PA, QL TIKOSYN
Asthma
XOLAIR PA
Birth Control
IMPLANON MIRENA NEXPLANON PARAGARD T 380-A SKYLA
Cancer/Chemotherapy
ABRAXANE PA ADCETRIS PA adriamycin adrucil AFINITOR PA ALIMTA PA ALKERAN amifostine ARRANON ARZERRA PA AVASTIN PA azacitidine BELEODAQ PA BEXXAR BICNU bleomycin sulfate BOSULIF PA BUSULFEX CAMPATH PA
CAMPTOSAR capecitabine CAPRELSA PA carboplatin CERUBIDINE cisplatin cladribine CLOLAR COMETRIQ PA COSMEGEN cyclophosphamide CYRAMZA PA cytarabine dacarbazine DACOGEN DACTINOMYCIN daunorubicin DAUNOXOME decitabine DEPOCYT dexrazoxane PA DOCEFREZ docetaxel DOXIL doxorubicin hcl ELLENCE ELOXATIN ELSPAR EMCYT
epirubicin ERBITUX PA ERIVEDGE PA ERWINAZE ETHYOL ETOPOPHOS etoposide FARYDAK PA FASLODEX FIRMAGON PA floxuridine FLUDARA fludarabine fluorouracil FOLOTYN PA FUSILEV GABLOFEN GAZYVA PA gemcitabine GEMZAR GILOTRIF PA GLEEVEC* PA HALAVEN PA HERCEPTIN PA HYCAMTIN PA IBRANCE PA ICLUSIG PA IDAMYCIN PFS idarubicin hcl
IFEX ifosfamide IMBRUVICA PA INLYTA PA IRESSA PA, QL irinotecan ISTODAX PA IXEMPRA JAKAFI PA JEVTANA PA KADCYLA PA KEYTRUDA PA KYPROLIS PA LENVIMA PA, QL LEUCOVORIN CALCIUM INJ LEUSTATIN LYNPARZA PA lipodox MARQIBO PA MATULANE MEKINIST PA melphalan mercaptopurine mesna MESNEX mitomycin mitoxantrone MOZOBIL PA MUSTARGEN
Administered by a healthcare professional or in a healthcare setting ? Protein or protein-based molecular entities Preferred Specialty Product
? 2016 Magellan Rx Management. All rights expressly reserved. This publication may not be reproduced in whole or part by any means whatsoever without express written permission of the copyright owner.
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MYLERAN NAVELBINE NEXAVAR PA, QL NILANDRON PA, QL NIPENT ODOMZO PA, QL ONCASPAR OPDIVO PA oxaliplatin paclitaxel pentostatin PERJETA PA PHOTOFRIN POMALYST PA, QL PROLEUKIN PA PROVENGE PA PURIXAN PA REVLIMID PA, QL RITUXAN PA SIGNIFOR LAR PA SPRYCEL PA, QL STIVARGA PA, QL SUPPRELIN LA SUTENT PA, QL SYLATRON PA SYNRIBO PA TABLOID TAFINLAR PA, QL TARCEVA PA, QL TARGRETIN PA TARGRETIN GEL TASIGNA PA, QL TAXOTERE TEMODAR PA temozolomide PA teniposide THALOMID PA, QL THERACYS THIOTEPA TICE BCG toposar topotecan TORISEL PA, QL TOTECT PA TREANDA PA tretinoin PA, QL TRISENOX PA TYKERB PA, QL UNITUXIN PA UVADEX VALCHLOR PA, QL VALSTAR VANTAS VECTIBIX PA VELCADE PA
VESANOID VIDAZA vinblastine sulfate vincasar pfs vincristine sulfate vinorelbine tartrate VORAXAZE VOTRIENT PA, QL VUMON XALKORI PA, QL XELODA XGEVA PA, QL XOFIGO PA XTANDI PA, QL YERVOY PA ZALTRAP PA ZANOSAR ZELBORAF PA, QL ZEVALIN ZINECARD PA ZOLADEX PA ZOLINZA PA, QL ZYDELIG PA, QL ZYKADIA PA, QL ZYTIGA PA
Crohn's Disease
CIMZIA PA, QL HUMIRA PA, QL REMICADE PA TYSABRI PA
Cystic Fibrosis
BETHKIS PA CAYSTON ESBRIETA PA KALYDECO PA, QL KITABIS PA OFEV PA, QL PULMOZYME PA, QL TOBI TOBI PODHALER tobramycin nebu soln
Cytomegalovirus Vaccines
CYTOGAM
Dystonia
BOTOX PA DYSPORT PA MYOBLOC PA XIAFLEX zoledronic
Endocrine and Metabolic Agents
ACTHREL PA AVEED PA KORLYM PA LYSODREN MYALEPT PA EGRIFTA PA, QL octreotide PA SAMSCA PA, QL SANDOSTATIN PA SANDOSTATIN LAR PA SENSIPAR SIGNIFOR PA SOMATULINE PA SOMAVERT PA SYNAREL TESTOPEL PA THYROGEN
Enzyme Replacement (Alpha 1)
ADAGEN ALDURAZYME PA ARALAST PA ELAPRASE PA ELELYSO PA GLASSIA PA FABRAZYME PA KUVAN PA, QL LUMIZYME PA MYOZYME PA NAGLAZYME PA NATPARA PA ORFADIN PA ORKAMBI PA, QL PROCYSBI PROLASTIN PA SOLESTA VIMIZIM ZEMAIRA PA
Gastrointestinal Agents
CHOLBAM PA, QL GATTEX PA SUCRAID
Gaucher Disease
CERDELGA PA, QL CEREZYME PA VPRIV PA ZAVESCA PA
Growth Hormone and Related Disorders
GENOTROPIN PA HUMATROPE PA INCRELEX PA NORDITROPIN PA NOVOEIGHT PA NUTROPIN PA NUTROPIN AQ PA OMNITROPE PA SAIZEN PA SEROSTIM PA, QL SOMAVERT TECHNIVIE PA, QL TEV-TROPIN PA ZOMACTON PA ZORBTIVE PA, QL
Hemophilia and Related Bleeding Disorders
ACTIVASE ADVATE ALPHANATE ALPHANINE S/D ALPROLIX PA ATRYN PA BEBULIN VH BENEFIX BERINERT PA CINRYZE PA CORIFACT CYKLOKAPRON ELOCTATE PA FEIBA NF FIRAZYR PA HELIXATE FS HEMOFIL-M HUMATE-P IXINITY PA KALBITOR PA KOATE-DVI KOGENATE FS LYSTEDA QL MONOCLATE-P MONONINE NOVOSEVEN RT OBIZUR PROFILNINE RECOMBINATE RECOTHROM RIASTAP RIXUBIS RUCONEST PA STIMATE
THROMBATE III tranexamic acid TRETTEN PA WILATE XYNTHA
Hepatitis B
adefovir dipivoxil BARACLUDE QL entecavir QL EPIVIR HBV lamivudine tab NABI-HB THROMBATE III HEPAGAM B HYPERHEP B S-D HEPSERA TYZEKA
Hepatitis C
ACTIMMUNE ALFERON N COPEGUS PA DAKLINZA PA, QL HARVONI PA, QL INCIVEK PA, QL INFERGEN PA INTRON A PA moderiba PA OLYSIO PA, QL PEG INTRON PA PEGASYS PA REBETOL PA ribatab PA ribapak tablets kit PA ribasphere PA ribavirin PA SOVALDI PA, QL TECHNIVIE PA, QL VIEKIRA PA, QL VICTRELIS PA, QL
HIV/AIDS
abacavir abacavir sulfate abacavir sulfate/lamivudine/ zidovudine APTIVUS ATRIPLA COMBIVIR COMPLERA CRIXIVAN didanosine EDURANT EMTRIVA EPIVIR
? 2016 Magellan Rx Management. All rights expressly reserved. This publication may not be reproduced in whole or part by any means whatsoever without express written permission of the copyright owner.
MRX0367_0116
EPZICOM FUZEON QL INTELENCE INVIRASE ISENTRESS KALETRA lamivudine lamivudine/ zidovudine LEXIVA nevirapine NORVIR PREZISTA RESCRIPTOR RETROVIR REYATAZ SELZENTRY PA stavudine STRIBILD SUSTIVA TIVICAY TRIUMEQ PA TRIZIVIR TRUVADA TYBOST PA VIDEX VIDEX EC VIRACEPT VIRAMUNE VIRAMUNE XR VIREAD VITEKTA PA, QL ZERIT ZIAGEN zidovudine
Hormone Therapy
ELIGARD PA FIRMAGON PA leuprolide PA LUPANETA PA LUPRON LUPRON DEPOT PA LUPRON DEPOT-PED TRELSTAR DEPOT TRELSTAR LA
Hormone Therapy -- Corticotropin
ACTHAR H.P. PA
Hunter's Syndrome
ELAPRASE PA XENAZINE PA
Hyperparathyroidism
doxercalciferol HECTOROL ZEMPLAR
Immune Deficiency
BIVIGAM PA CARIMUNE NF PA FLEBOGAMMA PA GAMASTAN S/D PA GAMMAGARD PA GAMMAGARD SD PA GAMMAKED PA GAMMAPLEX PA GAMUNEX PA HIZENTRA PA HYPERRAB S/D HYPERRHO S/D HYPERTET S/D HYQVIA PA IMOGAM RABIES MICRHOGAM PL OCTAGAM PA PRIVIGEN PA SOLIRIS
Immune Globulins -- Obstetrics
RHOGAM PLUS RHOPHYLAC WINRHO SDF
Immunosuppressant -- Transplant
ASTAGRAF ATGAM CELLCEPT* CELLCEPT IV cyclosporine ENVARSUS XR PA, QL gengraf hecoria mycophenolate MYFORTIC NEORAL NULOJIX PA PROGRAF RAPAMUNE SANDIMMUNE sirolimus tab tacrolimus ZORTRESS PA
Immunostimulant
MOZOBIL PA
Infertility
BRAVELLE PA CETROTIDE PA CHORIONIC
GONADOTROPIN PA BENLYSTA PA ENDOMETRIN VAGINAL GANIRELIX GONAL-F PA GONAL-F RFF PA MAKENA PA MENOPUR PA novarel PA OVIDREL PA pregnyl PA REPRONEX PA
Iron Overload
EXJADE FERRIPROX PA
Miscellaneous
AMYVID BENLYSTA PA CARBAGLU cidofovir CRESEMBA INJ PA CYSTAGON CYTOVENE ELITEK ENTYVIO PA HETLIOZ PA, QL JADENU PA KEPIVANCE KRYSTEXXA PA, QL NORTHERA PA, QL ONFI PA SABRIL PA, QL SYLVANT PA VIVITROL PA XIAFLEX
Multiple Sclerosis
AMPYRA PA, QL AUBAGIO PA, QL AVONEX PA, QL BETASERON PA, QL COPAXONE PA, QL EXTAVIA PA, QL GILENYA PA, QL LEMTRADA PA PLEGRIDY PA, QL REBIF PA, QL TECFIDERA PA, QL TYSABRI PA
Narcolepsy
XYREM PA, QL
Nausea
AKYNZEO PA ALOXI ANZEMET QL CESAMET PA EMEND QL granisetron ONDANSETRON HCL INJ SANCUSCO QL ZOFRAN INJ
Neuromuscular Blocking Agent
XEOMIN PA
Neutropenia
GRANIX PA LEUKINE PA NEULASTA PA NEUPOGEN PA ZARXIO PA, QL
Ophthalmic
EYLEA JETREA PA LUCENTIS MACUGEN OZURDEX RETISERT VISUDYNE
Osteoarthritis
EUFLEXXA PA GEL-ONE PA HYALGAN PA MONOVISC PA ORTHOVISC PA SUPARTZ PA SYNVISC PA SYNVISC-ONE PA
Osteoporosis and Bone Disorders
BONIVA INJ FORTEO PA ibandronate MIACALCIN pamidronate disodium PROLIA PA, QL RECLAST zoledronic acid ZOMETA
Pain Management
LIORESAL INT PRIALT QUTENZA
Parkinson Disease
APOKYN PA
Psoriasis
COSENTYX PA ENBREL PA, QL HUMIRA PA, QL REMICADE PA RASUVO PA,QL STELARA PA, QL
Pulmonary Hypertension
ADCIRCA PA, QL epoprostenol PA FLOLAN PA LETAIRIS PA, QL OPSUMIT PA, QL ORENITRAM PA REMODULIN PA REVATIO PA, QL sildenafil 20mg PA, QL TRACLEER PA, QL TYVASO PA, QL VELETRI PA VENTAVIS PA, QL
Respiratory Syncytial Virus (RSV)
SYNAGIS PA
Rheumatic Diseases
ARCALYST PA ACTEMRA PA CIMZIA PA, QL ENBREL PA, QL HUMIRA PA, QL ILARIS PA, QL KINERET PA, QL ORENCIA PA, QL OTEZLA PA, QL RITUXAN PA SIMPONI PA, QL SIMPONI ARIA QL XELJANZ PA, QL
Thrombolytic
ACTIVASE
Thrombocytopenia
NEUMEGA PA NPLATE PA PROMACTA PA
? 2016 Magellan Rx Management. All rights expressly reserved. This publication may not be reproduced in whole or part by any means whatsoever without express written permission of the copyright owner.
MRX0367_0116
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