Specialty Medication List

Specialty Medication List

December 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 Advate*^ Adynovate*^ Alphanine*^ Alprolix*^ Amicar* Benefix*^ Corifact Cyklokapron DDAVP Eloctate*^ Feiba NF Helixate FS*^ Hemlibra* Hemofil Humate Ixinity Jivi^ Koate-D Kogenate FS*^ Kovaltry Monoclate-P*^ Mononine*^ Novoeight^ Novoseven RT*^ Nuwiq Profilnine*^ Rebinyn^ 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

HHiYzePnEtrRa*-IMMUNES

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

*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.

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METABOLIC MODIFIERS Aldurazyme* Elaprase* Fabrazyme*

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 Plegridy Rebif Tecfidera* Vumerity*

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 122319

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