Specialty Drugs & Specialty Pharmacy ListingOctober 2014 CuraScript Pharmacy – Division of Express Scripts- 1-866-848-9870 www.curascript.com Medications listed must be obtained through CuraScript. Blood Modifiers Cancer Chemotherapy Aranesp®, Epogen®, Procrit®, Neupogen®, Neulasta®, Neumega®, Leukine®, Promacta® Afinitor®, Bosulif®, Erivedge®, Gleevec®, Gilotrif®, Hycamtin ®caps, Iclusig®, Inlyta®, Jakafi®, Mekinist®, capecitabine, Nexavar®, octreotide injection, Oforta®, Pomalyst®, Revlimid®, Sprycel®, Stivarga®, Sutent®, Sylatron®, Tafinlar® Tarceva®, Tasigna®, temozolomide, Thalomid®, Tykerb®, Valchlor®, Vidaza®, Votrient®, Xalkori®, Xtandi®, Zelboraf®, Zolinza®, Zytiga®, Zykadia, Purixan® Susp Growth Hormone Disorders Hemophilia, von Willebrand Disease and Related Bleeding Disorders Norditropin®, Nutropin®, Nutropin AQ®, Omnitrope®, Humatrope®, Genotropin®, Increlex®, Saizen®, Serostim®, Zorbtive®, Tev-Tropin®, Somavert® Advate®, AlphaNine SD®, Alprolix®, Bebulin VH®, Benefix®, Corifact®, desmopressin injection, Feiba NF®, Feiba VH®, Helixate FS®, Hemofil M®, Humate P®,Koate DVI®, Kogenate FS®, Mononine®, Monoclate P®, Novoseven RT®, Profilinine SD®, Recombinate®, ® Rixubis, Tretten , Xyntha®, Wilate® Hepatitis C Metabolic Disorders Intron A®, Peg-Intron®, Pegasys®, Infergen®, Ribasphere®, ® Ribavirin®, Incivek®, Victrelis®, Olysio®, Sovaldi Aldurazyme®, Carbaglu®, Cerdelga®,Cerezyme®, Cystadane®, Elaprase®, Fabrazyme®, Kuvan®, Kynamro®, Lumizyme®, Myozyme®, Naglazyme®, Orfadin®, Procysbi®, Signifor®, Ravicti®, Vpriv®, Zavesca® ,Vimizim® Multiple Sclerosis Rheumatoid Arthritis Ampyra®, Aubagio®, Avonex®, Betaseron®, Copaxone®, Extavia®, Gilenya®, Rebif®, Tecfidera® Actemra (subcutaneous inj), Cimzia®, Enbrel®, Humira®, Kineret®, Simponi®, (subcutaneous injection, not Simponi Aria®), Orencia® (subcutaneous injection, not infusion), Otezla®, Xeljanz® Pulmonary Arterial Hypertension Medications Pulmonary Medications Adcirca®, Adempas®, epoprostenol sodium, Flolan®, Letairis®, Opsumit®, Orenitram®, Remodulin®, sildenafil oral, Tracleer®, Tyvaso®, Veletri®, Ventavis® Aralast NP®, Arcalyst®, Bethkis®,Glassia®, Pulmozyme®, Tobi®, Tobi Podhaler®, Zemaira® ® Miscellaneous Acthar H.P. Gel®, Actimmune®, Apokyn®, Berinert®,Bicillin CR®, Bicillin LA®, Cinryze®, Egrifta®, Exjade®, Firazyr®, Forteo®, Gattex®, Hizentra®, Ilaris®, Implanon®, Iprivask ®, Kynamro®, Makena®, MuGard®, Myalept®, Nexplanon®, Orafate® Qsymia®,Prothelial®, Sabril®, Samsca®, Sensipar®, Sucraid®, Xenazine®,Xyrem®, Ruconest® Limited Distribution Products¹ Other Specialty Network Pharmacies Biologics, Inc. -(800)850-4306 Caprelsa® ® ® Caremark - (800)237-2767 Cystagon , Mirena ® Centric Health Resources - Chenodal (866) 785-7068, ® ® ® Elelyso (855) 353-5976, Ferriprox and Juxtapid (855) 898-2743, ® Korlym® (866) 758-7138, Prolastin (800)305-7881, Vecamyl® (855) 832-2695 ® CF Services, Inc - (877)722-9786 Cayston ® Diplomat Specialty Pharmacy -(877) 830-3797 Cuvposa and ®, ® Cometriq (877) 977-9118 Imbruvica , (877) 977-9118 Zydelig® Freedom Fertility Pharmacy- Division of Express Scripts www.freedomfertility.com (800)660-4283 Ganirelix®, Follistim AQ®, Gonal F®, Cetrotide®, Bravelle®, Profasi®, Ovidrel®, Novarel®, Repronex®, Synarel®, Pregnyl®, HCG, leuprolide injection, Menopur®, Progesterone in oil® Walgreens’ Specialty Pharmacy (888) 347-3416 Adagen®, Cystaran®, Matulane®, Kalydeco® ¹ The manufacturers of the following medications have determined that they be made available through specified Pharmacies. These “Limited Distribution” medications must be obtained through the designated pharmacy. Blue Cross of Northeastern Pennsylvania provides prescription drug coverage with administrative assistance from Express Scripts, Inc., an independent pharmacy benefit management company not affiliated with the Blue Cross and Blue Shield Association.