AllianceRx Walgreens Pharmacy list of specialty medications

AllianceRx Walgreens Pharmacy list of specialty medications

Members can receive these drugs through the mail from Alliance Rx (Walgreens Specialty) Pharmacy (866.515.1355) or at a retail pharmacy. Prescriptions will always be filled with a generic, if available, keeping your copayment low. If you desire a brand name drug when a generic is available, you may be responsible for costs over and above your copayment amount. The additional costs may be significant. If your doctor feels there is a medical necessity for a brand name, ask your doctor to contact the Pharmacy Clinical Help Desk for an exception based on medical necessity. For a full description of your benefits, please refer to your prescription plan booklet.

**Indicates that the drug is limited to a 15-day supply under the Specialty Drug Limitation Program

Listing as of April 2024 (This list may change from time to time.)

Antineoplastics (cancer drugs) Actimmune? Afinitor?** Afinitor Disperz?** Alecensa? Bosulif?** BraftoviTM BynfeziaTM CabometyxTM** CotellicTM DaurismoTM** ErivedgeTM** ErleadaTM Farydak? GavretoTM** Gleevec? Hycamtin? Ibrance? Idhifa? Inlyta?** Intron? A JakafiTM** Kisqali? Kisqali Femara Co-pack? LenvimaTM** Lorbrena?** Lonsurf? Lurpon Depot? Matulane? Mekinist? Mektovi? Nexavar?** Ninlaro? NubeqaTM** Odomzo?** Onureg?

Piqray? Pomalyst Purixan? RetevmoTM** Revlimid? Rozlytrek? Rydapt? Sandostatin? Scemblix? Sprycel?** Stivarga? Sutent?** Sylatron? TabrectaTM** Tafinlar? Talzenna?** Tarceva?** Targretin?** Tasigna?** Temodar? Thalomid? Tykerb? VerzenioTM** Vijoice? Vizimpro?** VotrientTM** Xalkori?** Xeloda? Xtandi?** YonsaTM ZelborafTM** Zolinza?** ZykadiaTM** ZytigaTM

Antineoplastic Support medication (chemotherapy) Arenesp? Epogen? FulphilaTM Fylnetra? Granix? Jylamvo Leukine? Neulasta? Neumega? Neupogen? Nivestym? NyvepriaTM Procrit? Releuko? RolvedonTM Stimufend? Udenyca ? XatmepTM Zarxio? Ziextenzo?

Antivirus/hepatitis Baraclude? Copegus? DaklinzaTM Epclusa? Harvoni? Hepsera? Intron? A MavyretTM ModeribaTM Pegasys? PegIntron? Rebetol? Ribasphere? Ribasphere -

Ribapak? Ribatab? SovaldiTM Tyzeka? Vemlidy? Viekira PakTM Viekira XR Vosevi? ZepatierTM

Chronic kidney failure/dialysis Aranesp? Epogen? Procrit? RetacritTM Sensipar?

Cystic fibrosis Bethkis? Bronchitol? Cayston? KalydecoTM Kitabis Pak? OrkambiTM Pulmozyme? Symdeko? Tobi? Tobi? Podhaler TrikaftaTM

Enzyme Replacement Therapy CerdelgaTM

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Growth disorders BynfeziaTM Genotropin? Humatrope? Increlex? Norditropin?(all forms) Nutropin? (all forms) Omnitrope? Saizen? Sandostatin? Serostim? SkytrofaTM Sogroya Somavert? Zomacton? Zorbitive?

Hematological (blood disorder) Inqovi? Inrebic?** JynarqueTM Mircera? Mulpleta? Promacta? Samsca?

Hereditary angioedema Firazyr? Haegarda?

Idiopathic pulmonary fibrosis Esbrie Ofev?

Immune globulin CuvitruTM Gammagard? liquid GammakedTM Gamunex C? HizentraTM Hyqvia

Inflammatory diseases Actemra

Cibinqo Cimzia? Enbrel? Humira Kevzara? Olumiant? Orencia? Otezla? OtrexupTM RasuvoTM RediTrex? RinvoqTM SimponiTM Stelara? Tezspire? XatmepTM XeljanzTM Xeljanz XRTM

Infertility Bravelle? Cetrotide? Chorionic gonadotropin Follistim AQ? Ganirelix Acetate? Gonal-F? Menopur? Novarel? Ovidrel? Pregnyl? Repronex?

Iron overload Exjade?** Jadenu?** Jadenu? Sprinkles**

Miscellaneous Actimmune? AdbryTM Arcalyst? Austedo? Austedo XR? Benlysta? CamzyosTM

CloviqueTM CystaranTM Dupixent? EgriftaTM EnspryngTM EulexinTM**

Fasenra Pen? GalafoldTM Glassia?

HetliozTM

HyftorTM

Ingrezza?

Litfulo

Lupeneta PackTM

Natpara?

NitisinoneTM

NortheraTM OcalivaTM Palforzia Ravicti? Syprine? VyndamaxTM Vyndaqel? Xenazine? Xolair?

Multiple sclerosis Avonex? AmpyraTM Aubagio? BafiertamTM Betaseron? Copaxone? Extavia? Gilenya? GlatopaTM Mavenclad? Mayzent? PlegridyTM PonvoryTM Rebif? TecfideraTM VumerityTM Zeposia?

Organ transplant/antirejection Astagra XLTM Cellcept? Cyclosporin e? (oral) Envarsus XR Gengraf? Hecoria? Myfortic? Neoral? Prograf? Rapamune? Sandimmune? Zortress?

Osteoporosis ForteoTM TymlosTM

Psoriasis Enbrel? Humira? Skyrizi? Sotyktu? Stelara? Taltz? TremfyTM

Pulmonary arterial hypertension AdcircaTM LatairisTM TadliqTM Tracleer?

Seizure disorders Acthar H.P.? Epidolex? Sabril?

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Limited distribution These drugs are available only from Accredo Specialty Pharmacy. Members and prescribers can contact Accredo directly at 800.803.2523 to order these specific drugs.

Adempas? Apokyn? Carbaglu? Cometriq?** DojolviTM Doptelet? DuopaTM Emflaza? EvrysdiTM Gattex? GilotrifTM Iressa? Juxtapid? Lynparza? MyaleptTM NityrTM Opsumit? Orenitram ERTM OxbrytaTM OxervateTM PalynziqTM ProcysbiTM Radicava ORS? Remodulin? TagrissoTM TakhzyroTM Tascenso ODTTM TegsediTM Tyvaso? Uptravi? ValchlorTM Ventavis? VimizimTM Vitrakvi? Wakix? Xembify? Xyrem?

XywavTM

Zavesca?

Limited distribution These drugs are available only at Onco360? Oncology Pharmacy at 877.662.6633.

AlunbrigTM BrukinsaTM** Calquence?** CopiktraTM Fotivda? Imbruvica?** KoselugoTM Lytgobi?** LumakrasTM** Nerlynx?** TazverikTM** TukysaTM UkoniqTM** VenclextaTM Xospata? XpovioTM** ZydeligTM

Limited distribution These drugs are available only at Panther Rx Specialty Pharmacy. Members and prescribers can contact directly at 855.726.8479 to order these specific drugs.

Arikayce? AyvakitTM DojolviTM Doptelet? EmpaveliTM ExservanTM ImcivreeTM Joenja? KeveyisTM LupkynisTM QinlockTM Recorlev? RuzurgiTM Strensiq? Tavneos? VigadroneTM VimizimTM Wakix? Zilbrysq?

Limited distribution These drugs are available at Orsini Healthcare at 800.410.8575

Arikayce? DojolviTM Emflaza? Ruconest? TakhzyroTM VimizimTM Ztalmy?

Limited distribution These drugs are available at Acaria Health at 800.511.5144.

IclusigTM** Mycapssa?

Limited distribution These drugs are available at AnovoRx at 844.288.5007.

Carglumic Acid? Cystandane? Cystadrops? DaybueTM Firdapse? Isturisa? Signifor LAR? TiglutikTM

Limited distribution These drugs are available at Biomatrix at 888.662.6779.

Furoscix? Vistogard? Xuriden?

Limited distribution These drugs are available a LeMed Specialty Pharmacy at 844.795.3633.

Sajazir

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Limited distribution These drugs are available at Biologics at 800.850.4306.

AlunbrigTM AyvakitTM Besremi?** BrukinsaTM Cablivi? Calquence? Caprelsa?** ExkivityTM** Fotivda? Imbruvica?** Iressa? Kineret? Krazati?** LivtencityTM LupkynisTM Lynparza? Nerlynx?** OrgovyxTM Pemazyre? Pyrukynd? QinlockTM RezlidhiaTM** RezurockTM Rubraca?** Skyclarys? TagrissoTM** TavalisseTM Tepmetko?** Tibsovo?** TruseltiqTM TukysaTM TuralioTM VenclextaTM VonjoTM WeliregTM** XermeloTM Xospata? XpovioTM** ZejulaTM** ZydeligTM

Limited distribution These drugs are available at Caremark at 800.237.2767.

Adempas? Apokyn? BalversaTM Besremi? CopiktraTM Cystagon? Diacomit? Gattex? Iressa? Kuvan? LumakrasTM** Nerlynx?** Opsumit? Orenitram ERTM OxbrytaTM RelyvrioTM Remodulin? Rubraca? Sucraid? Sunlenca? TakhzyroTM TavalisseTM Treprostinil? Tyvaso? Tyvaso DPITM Uptravi? Ventavis? Vitrakvi? VoxzogoTM ZejulaTM ZokinvyTM

Limited distribution These drugs are available at Eversana at 636.519.2400.

ChenodalTM Cholbam? Ferriprox? LivmarliTM Orfadin? Revcovi?

Limited distribution These drugs are available at Optime Care at 888.287.2017. Daraprim Korlym? OrladeyoTM Limited distribution These drugs are available at US Bioservices at 888.518.7246 BalversaTM ** Besremi?** CopiktraTM Diacomit? Iressa? Rubraca?** Sucraid? TavalisseTM Vitrakvi?** ZejulaTM** ZokinvyTM

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Limited distribution available at Optum Specialty Pharmacy at 855.427.4682.

Apokyn? BylvayTM BrukinsaTM Calquence? Cometriq?** CopiktraTM Cutaquig? Filspari Imbruvica?** Iressa? JavygtorTM Lynparza? Nerlynx?** NityrTM Palynziq TM Pheburane? Rubraca?** SynriboTM TagrissoTM** TakhzyroTM TavalisseTM Tibsovo? ValchlorTM VenclextaTM Xembify? XermeloTM ZejulaTM ZydeligTM

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