specialty drug listing for hd 1.15.19 specialty drug list ver 10262017.pdf · 'du]doh[...

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Drug Name Strength Dosage Form *Actemra 80 MG/4ML SOLN *Actemra 200 MG/10ML SOLN *Actemra 400 MG/20ML SOLN *Actemra 162 MG/0.9ML SOSY Abacavir Sulfate 300 MG TABS Abilify Maintena 400 MG 400 MG SRER ABRAXANE 100 MG SUSR Absorica 10 MG CAPS Absorica 20 MG CAPS Absorica 25 MG CAPS Absorica 30 MG CAPS Absorica 35 MG CAPS Absorica 40 MG CAPS Acthar HP Gel 80 UNIT/ML GEL ActHIB SOLR Acthrel 100 MCG SOLR Actimmune 2000000 SOLN Activase 50 MG SOLR Activase 100 MG SOLR Adagen 250 UNIT/ML SOLN Adcetris 50 MG SOLR Adcirca 20 MG TABS Adefovir Dipivoxil 10 MG TABS ADEMPAS 0.5 MG TABS ADEMPAS 1 MG TABS ADEMPAS 1.5 MG TABS ADEMPAS 2 MG TABS ADEMPAS 2.5 MG TABS Adriamycin 2 MG/ML SOLN Adriamycin 10 MG SOLR Adriamycin 50 MG SOLR Adrucil 500 MG/10ML SOLN Adrucil 2.5 GM/50ML SOLN Adrucil 5 GM/100ML SOLN Advate 1000 UNIT 1000 UNIT SOLR Advate 1500 UNIT 1500 UNIT SOLR Advate 2000 UNIT 2000 UNIT SOLR Advate 250 UNIT 250 UNIT SOLR Advate 3000 UNIT 3000 UNIT SOLR Advate 4000 UNIT 4000 UNIT SOLR Advate 500 UNIT 500 UNIT SOLR Adynovate 250 UNIT SOLR Adynovate 500 UNIT SOLR Specialty Drug Listing Executed: 1/15/2019

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Page 1: Specialty Drug Listing for HD 1.15.19 Specialty Drug List ver 10262017.pdf · 'du]doh[ ghflwdelqh pj 0* 62/5 'dxqr;rph 0* 0/ ,1-'hihur[dplqh 0hv\odwh 0* 62/5 'hihur[dplqh 0hv\odwh

Drug Name StrengthDosageForm

*Actemra 80 MG/4ML SOLN*Actemra 200 MG/10ML SOLN*Actemra 400 MG/20ML SOLN*Actemra 162 MG/0.9ML SOSYAbacavir Sulfate 300 MG TABSAbilify Maintena 400 MG 400 MG SRERABRAXANE 100 MG SUSRAbsorica 10 MG CAPSAbsorica 20 MG CAPSAbsorica 25 MG CAPSAbsorica 30 MG CAPSAbsorica 35 MG CAPSAbsorica 40 MG CAPSActhar HP Gel 80 UNIT/ML GELActHIB SOLRActhrel 100 MCG SOLRActimmune 2000000 SOLNActivase 50 MG SOLRActivase 100 MG SOLRAdagen 250 UNIT/ML SOLNAdcetris 50 MG SOLRAdcirca 20 MG TABSAdefovir Dipivoxil 10 MG TABSADEMPAS 0.5 MG TABSADEMPAS 1 MG TABSADEMPAS 1.5 MG TABSADEMPAS 2 MG TABSADEMPAS 2.5 MG TABSAdriamycin 2 MG/ML SOLNAdriamycin 10 MG SOLRAdriamycin 50 MG SOLRAdrucil 500 MG/10ML SOLNAdrucil 2.5 GM/50ML SOLNAdrucil 5 GM/100ML SOLNAdvate 1000 UNIT 1000 UNIT SOLRAdvate 1500 UNIT 1500 UNIT SOLRAdvate 2000 UNIT 2000 UNIT SOLRAdvate 250 UNIT 250 UNIT SOLRAdvate 3000 UNIT 3000 UNIT SOLRAdvate 4000 UNIT 4000 UNIT SOLRAdvate 500 UNIT 500 UNIT SOLRAdynovate 250 UNIT SOLRAdynovate 500 UNIT SOLR

Specialty Drug ListingExecuted: 1/15/2019

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Specialty Drug ListingExecuted: 1/15/2019

ADYNOVATE 750 UNIT SOLRAdynovate 1000 UNIT SOLRADYNOVATE 1500 UNIT SOLRAdynovate 2000 UNIT SOLRADYNOVATE 3000 UNIT SOLRAfinitor 10 MG - TABS 10 MG TABSAfinitor 2.5 MG - TABS 2.5 MG TABSAfinitor 5 MG - TABS 5 MG TABSAfinitor 7.5 MG - TABS 7.5 MG TABSAfinitor Disperz 2 MG 2 MG TBSOAfinitor Disperz 3 MG 3 MG TBSOAfinitor Disperz 5 MG 5 MG TBSOAfstyla 250 UNIT KITAfstyla 500 UNIT KITAfstyla 1000 UNIT KITAfstyla 2000 UNIT KITAfstyla 3000 UNIT KITAimovig 70 MG/ML SOAJAimovig 140 Dose 70 SOAJAlbenza 200 MG TABSAlbuked 25 0.25 Unit SOLNAlbuked 5 0.05 Unit SOLNAldurazyme 2.9 MG/5ML SOLNAlecensa 150 MG - CAPS 150 MG CAPSAlferon N 5000000 UNIT/ML SOLNAlimta 100 MG SOLRAlimta 500 MG SOLRAliqopa 60 MG SOLRAlkeran 2 MG TABSAlkeran 50 MG SOLRAloxi 0.25 MG/5ML SOLNAlphanate/VWF Complex/Human 1000 1000 UNIT SOLRAlphanate/VWF Complex/Human 1500 1500 UNIT SOLRAlphanate/VWF Complex/Human 2000 2000 UNIT SOLRAlphanate/VWF Complex/Human 250 250 UNIT SOLRAlphanate/VWF Complex/Human 500 500 UNIT SOLRAlphaNine SD 500 UNIT SOLRAlphaNine SD 1000 UNIT SOLRAlphaNine SD 1500 UNIT SOLRAlprolix 4000 UNIT SOLRAlprolix 1000 UNIT 1000 UNIT SOLRAlprolix 2000 UNIT 2000 UNIT SOLRAlprolix 250 UNIT 250 UNIT SOLRAlprolix 3000 UNIT 3000 UNIT SOLRAlprolix 500 UNIT 500 UNIT SOLR

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Specialty Drug ListingExecuted: 1/15/2019

Alsuma 6 MG/0.5ML SOAJAlunbrig 30 MG TABSALUNBRIG 90 MG TABSALUNBRIG 180 MG TABSALUNBRIG 90 & 180 MG TABSAmifostine 500 MG SOLRAmnesteem 10 MG CAPSAmnesteem 20 MG CAPSAmnesteem 40 MG CAPSAmpyra 10 MG - TB12 10 MG TB12Amvisc 12 MG/ML SOLNAmvisc Plus 16 MG/ML SOLNAmyvid 500-1900 SOLNAnastrozole 1 MG TABSAnastrozole POWDAnzemet 50 MG TABSAnzemet 100 MG TABSAnzemet 20 MG/ML SOLNAPLENZIN 522 MG TB24Apokyn 30 MG/3ML SOCTAptivus 250 MG CAPSAptivus 100 MG/ML SOLNAralast NP 400 MG SOLRAralast NP 500 MG SOLRAralast NP 800 MG SOLRAralast NP 1000 MG SOLRAranesp (Albumin Free) 300 MCG/ML SOLNAranesp (Albumin Free) 10 MCG/0.4ML SOLNAranesp (Albumin Free) 25 MCG/0.42ML SOSYAranesp 100 MCG/0.5ML 100 MCG/0.5ML SOSYAranesp 100 MCG/ML 100 MCG/ML SOLNAranesp 150 MCG/0.3ML 150 MCG/0.3ML SOSYAranesp 200 MCG/0.4ML 200 MCG/0.4ML SOSYAranesp 200 MCG/ML 200 MCG/ML SOLNAranesp 25 MCG/ML 25 MCG/ML SOLN

Aranesp 300 MCG/0.6ml 300 MCG/0.6ML SOSY

Aranesp 300 MCG/0.6ML 300 MCG/0.6ML SOSYAranesp 40 MCG/0.4ML 40 MCG/0.4ML SOSYAranesp 40 MCG/ML 40 MCG/ML SOLNAranesp 500 MCG/ML 500 MCG/ML SOSYAranesp 60 MCG/0.3ML 60 MCG/0.3ML SOSYAranesp 60 MCG/ML 60 MCG/ML SOLNArcalyst 220 MG SOLR

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Specialty Drug ListingExecuted: 1/15/2019

Arestin 1 MG 1 MG MISCArgatroban 250 MG/2.5ML SOLNArgatroban 125 MG/125ML SOLNArgatroban in Sodium Chloride 250 MG/250ML SOLNArimidex 1 MG TABSAristada 441 MG/1.6ML PRSYAristada 662 MG/2.4ML PRSYAristada 882 MG/3.2ML PRSYArixtra 2.5 MG/0.5ML SOLNArixtra 5 MG/0.4ML SOLNArixtra 7.5 MG/0.6ML SOLNArixtra 10 MG/0.8ML SOLNAromasin 25 MG - TABS 25 MG TABSArranon 5 MG/ML SOLNArzerra 100 MG/5ML CONCArzerra 1000 MG/50ML CONCAsacol HD 800 MG TBECAstagraf XL 0.5 MG CP24Astagraf XL 1 MG CP24Astagraf XL 5 MG CP24Atgam 50 MG/ML INJAtripla 600-200-300 MG - TABS 600-200-300 MG TABSAubagio 14 MG - TABS 14 MG TABSAubagio 7 MG - TABS 7 MG TABSAustedo 6 MG TABSAustedo 9 MG TABSAustedo 12 MG TABSAvastin 100 MG/4ML SOLNAvastin 400 MG/16ML - SOLN 400 MG/16ML SOLNAveed 750 MG/3ML SOLNAvonex 30 MCG - KIT 30 MCG KITAvonex Pen 30 MCG/0.5ML AJKTAvonex Prefilled 30 MCG/0.5ML PSKTAvonex Prefilled 30 MCG/0.5ML 30 MCG KITAzasan 75 MG TABSAzasan 100 MG TABSAzaTHIOprine POWDAzaTHIOprine Sodium 100 MG SOLRBanzel 200 MG - TABS 200 MG TABSBanzel 40 MG/ML - SUSP 40 MG/ML SUSPBanzel 400 MG - TABS 400 MG TABSBaraclude 0.05 MG/ML SOLNBaraclude (generic available) 0.5 MG TABSBaraclude (generic available) 1 MG TABSBAVENCIO 200 MG/10ML SOLN

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Specialty Drug ListingExecuted: 1/15/2019

Bebulin 200-1200 UNIT 200-1200 UNIT SOLRBeleodaq 500 MG 500 MG SOLRBendeka 100 MG/4ML SOLNBeneFIX 250 UNIT KITBeneFIX 500 UNIT KITBeneFIX 1000 UNIT KITBeneFIX 2000 UNIT KITBeneFIX 3000 UNIT KITBeneFIX 1000 UNIT 1000 UNIT SOLRBeneFIX 2000 UNIT 2000 UNIT SOLR

BeneFIX 250 UNIT 250 UNIT SOLR

BeneFIX 3000 UNIT 3000 UNIT SOLRBeneFIX 500 UNIT 500 UNIT SOLRbenlysta 100 MG/4ML SOLNBENLYSTA 200 MG/ML SAOJBenlysta 120 MG 120 MG SOLRBenlysta 120mg 120 MG SOLRBenlysta 400 MG 120 MG SOLRBenlysta 400mg 400 MG SOLRBerinert 500 UNIT - KIT 500 UNIT KITBetaseron 0.3 MG - KIT 0.3 MG KITBethkis 300 MG/4ML NEBUBexarotene 75 MG 75 MG CAPSBicalutamide 50 MG TABSBiCNU 100 MG SOLRBiktarvyBIVAGAM 5 GM/50 ML SOLNBIVAGAM 10 GM/100 ML SOLNBleomycin Sulfate 15 UNIT SOLRBleomycin Sulfate 30 UNIT SOLRBlincyto 35 MCG SOLRBOSULIF 400 MG TABSBosulif 100 MG - TABS 100 MG TABSBosulif 500 MG - TABS 500 MG TABSBotox 100 UNIT (non cosmetic use only) 100 UNIT SOLRBotox 200 UNIT (non cosmetic use only) 200 UNIT SOLRBotox Cosmetic 50 UNIT SOLRBotox Cosmetic 100 UNIT SOLRBravelle 75 UNIT SOLRBUPHENYL 500 MG TABSBUPHENYL 3 GM/TSP POWDBusulfex 6 MG/ML SOLNBydureon 2 MG PEN

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Specialty Drug ListingExecuted: 1/15/2019

Bydureon 2 MG - SRER 2 MG SRERBydureon BCise 2 MG/0.85 ML AUIJByetta 10 MCG Pen 10 MCG/0.04ML 10 MCG/0.04ML SOPNByetta 5 MCG Pen 5 MCG/0.02ML 5 MCG/0.02ML SOPNCABOMETYX 20 MG TABSCabometyx 40 MG TABSCABOMETYX 60 MG TABSCalcium Folinate 100 MG/10ML SOLNCalquence 100 CAPSCampath 30 MG/ML SOLNCamptosar 40 MG/2ML SOLNCamptosar 100 MG/5ML SOLNCamptosar 300 MG/15ML SOLNCapecitabine (xeloda) 150mg 500 MG TABSCapecitabine (xeloda) 500mg 150 MG TABSCaprelsa 100 MG TABSCaprelsa 300 MG TABSCarbaglu 200 MG TABSCARBOplatin 50 MG/5ML SOLNCARBOplatin 150 MG/15ML SOLNCARBOplatin 450 MG/45ML SOLNCARBOplatin 600 MG/60ML SOLNCarimune NF 12 GM 12 GM SOLRCarimune NF 6 GM 6 GM SOLRCasodex 50 MG TABSCathflo Activase 2 MG SOLRCeeNU 10 MG CAPSCeeNU 40 MG CAPSCeeNU 100 MG CAPSCellCept 200 MG/ML - SUSR 200 MG/ML SUSRCellCept 250 MG 250 MG CAPSCellCept 500 MG 500 MG TABSCellCept Intravenous 500 MG - SOLR 500 MG SOLRCeprotin 500 UNIT SOLR

Ceprotin 1000 UNIT SOLRCERDELGA 84 MG CAPSCerezyme 400 UNIT SOLRCetrotide 0.25 MG - KIT 0.25 MG KITChemet 100 MG CAPSChenodal 250 MG TABSChorionic Gonadotropin 10000 UNIT SOLRCidofovir 75 MG/ML SOLNCimzia 2 X 200 MG - KIT 2 X 200 MG KITCimzia Prefilled 2 X 200 MG/ML 2 X 200 MG/ML KIT

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Specialty Drug ListingExecuted: 1/15/2019

Cimzia Starter Kit 6 X 200 MG/ML 6 X 200 MG/ML KITCinqair 100 MG/10ML SOLNCinryze 500 UNIT 500 UNIT SOLRCISplatin 50 MG/50ML SOLNCISplatin 100 MG/100ML SOLNCISplatin 200 MG/200ML SOLNCladribine 10 MG/10ML SOLNClaravis 10 MG CAPSClaravis 20 MG CAPSClaravis 30 MG CAPSClaravis 40 MG CAPS

Clolar 1 MG/ML SOLNClomid 50 MG TABSClomiPHENE Citrate 50 MG TABSCoagadex 250 UNIT SOLRCoagadex 500 UNIT SOLRCombivir 150-300 MG - TABS 150-300 MG TABSCometriq (100 mg Daily Dose) 1 X 80 & 1 X 20 KITCometriq (140 mg Daily Dose) 1 X 80 & 3 X 20 KITCometriq (60 mg Daily Dose) 20 MG KITComplera 200-25-300 MG - TABS 200-25-300 MG TABSComvax 7.5-5 MCG/0.5ML SUSPCopaxone 20mg 20 MG/ML SOSYCopaxone 40mg 40 MG/ML SOSYCopegus 200 MG TABSCorifact 1000-1600 UNIT KITCorlopam 10 MG/ML SOLNCorlopam 20 MG/2ML SOLNCortrosyn 0.25 MG SOLRCosentyx 150 MG/ML SOSYCosentyx Sensoready Pen 150 MG/ML SOAJCosmegen 0.5 MG SOLRCosyntropin 0.25 MG SOLRCotellic 20 MG - TABS 20 MG TABSCreon 12000 UNIT 12000 UNIT CPEPCreon 24000 UNIT 24000 UNIT CPEPCreon 3000-9500 UNIT 3000-9500 UNIT CPEPCreon 36000 UNIT 36000 UNIT CPEPCreon 6000 UNIT 6000 UNIT CPEPCrinone Gel 4 % GELCrinone Gel 8 % GELCrixivan 200 MG - CAPS 200 MG CAPSCrixivan 400 MG - CAPS 400 MG CAPSCRYSVITA 10 MG/ML

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Specialty Drug ListingExecuted: 1/15/2019

CRYSVITA 20 MG/MLCRYSVITA 30 MG/MLCuprimine 250 MG - CAPS 250 MG CAPSCuvitru 8 GM/40ML SOLNCyclophosphamide 500 MG SOLRCyclophosphamide 1 GM SOLRCyclophosphamide 2 GM SOLRCycloSPORINE 25 MG CAPSCycloSPORINE 100 MG CAPSCycloSPORINE 50 MG/ML SOLNCycloSPORINE Modified 50 MG CAPSCyklokapron 1000 MG/10ML SOLNCyramza 100 MG/10ML SOLNCyramza 500 MG/50ML SOLNCystadane POWDCystagon 50 MG CAPSCystagon 150 MG CAPSCystaran 0.0044 Unit SOLNCytarabine 20 MG/ML SOLNCytarabine (PF) 20 MG/ML SOLNCytarabine (PF) 100 MG/ML SOLNCytogam 50 MG/ML INJCytovene 500 MG SOLRD.H.E. 45 1 MG/ML SOLNDacarbazine 100 MG SOLRDacarbazine 200 MG SOLRDaklinza 30 MG - TABS 30 MG TABSDaklinza 60 MG - TABS 60 MG TABSDaklinza 90 MG - TABS 90 MG TABSDARAPRIM 25 MG TABSDarzalex 100 MG/5ML SOLNDarzalex 400 MG/20ML SOLNDarzalex (decitabine)50mg 50 MG SOLRDaunoXome 2 MG/ML INJDeferoxamine Mesylate 500 MG SOLRDeferoxamine Mesylate 2 GM SOLRDelestrogen 10 MG/ML OILDelestrogen 20 MG/ML OILDelestrogen 40 MG/ML OILDepen Titratabs 250 MG TABSDepoCyt 50 MG/5ML SUSPDescovy 200-25mg 200-25 MG TABSDesferal 500 MG SOLRDesferal 2 GM SOLRDexrazoxane 250 MG SOLR

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Specialty Drug ListingExecuted: 1/15/2019

Dexrazoxane 500 MG SOLRDibenzyline 10 MG - CAPS 10 MG CAPSDificid 200 MG TABSDihydroergotamine Mesylate 1 MG/ML SOLNDihydroergotamine Mesylate 4 MG/ML SOLNDocefrez 20 MG SOLRDOCEtaxel 20 MG/ML CONCDOCEtaxel 80 MG/4ML CONCDOCEtaxel 140 MG/7ML CONCDOCEtaxel 160 MG/8ML CONCDOCEtaxel 20 MG/0.5ML CONCDOCEtaxel 80 MG/2ML CONCDOCEtaxel 20 MG/2ML SOLNDOCEtaxel 80 MG/8ML SOLNDOCEtaxel 160 MG/16ML SOLNDOCEtaxel 200 MG/20ML SOLNDOCEtaxel (Non-Alcohol) 20 MG/ML SOLNDOCEtaxel (Non-Alcohol) 80 MG/4ML SOLNDOCEtaxel (Non-Alcohol) 160 MG/8ML SOLNDoxercalciferol 0.5 MCG CAPSDoxercalciferol 1 MCG CAPSDoxercalciferol 2.5 MCG CAPSDoxercalciferol 4 MCG/2ML SOLNDoxil 2 MG/ML INJDOXOrubicin HCl 2 MG/ML SOLNDOXOrubicin HCl 10 MG SOLRDOXOrubicin HCl 50 MG SOLRDOXOrubicin HCl Liposomal 2 MG/ML INJDronabinol 2.5 MG CAPSDronabinol 5 MG CAPSDronabinol 10 MG CAPSDuoDote 2.1-600 MG SOAJDuopa 4.63-20 MG/ML SUSPDupixent 300 MG/2ML SOSYDysport 300 unit 300 UNIT SOLRDysport 500 unit 500 UNIT SOLREdecrin 25 MG TABSEdurant 25 MG - TABS 25 MG TABSEfudex 0.05 Unit CREAEgrifta 1 MG SOLREgrifta 2 MG SOLRElaprase 6 MG/3ML SOLNElelyso 200 UNIT SOLREligard 7.5 MG KITEligard 22.5 MG KIT

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Specialty Drug ListingExecuted: 1/15/2019

Eligard 30 MG KITEligard 45 MG KITElitek 1.5 MG SOLRElitek 7.5 MG SOLREllence 50 MG/25ML SOLNEllence 200 MG/100ML SOLNEloctate 1000 UNIT 1000 UNIT SOLREloctate 1500 UNIT 1500 UNIT SOLREloctate 2000 UNIT 2000 UNIT SOLREloctate 250 UNIT 250 UNIT SOLREloctate 3000 UNIT 3000 UNIT SOLREloctate 500 UNIT 500 UNIT SOLREloctate 750 UNIT 750 UNIT SOLREloxatin 50 MG/10ML SOLNEloxatin 100 MG/20ML SOLNEmcyt 140 MG CAPSEmend 125 MG 125 MG CAPSEmend 150 MG - SOLR 150 MG SOLREmend 40 MG 40 MG CAPSEmend 80 & 125 MG - CAPS 80 & 125 MG CAPSEmend 80 MG 80 MG CAPSEmgality 120 MG/MLEmpliciti 300 MG 300 MG SOLREmpliciti 400 MG 400 MG SOLREmtriva 200 MG CAPSEmtriva 10 MG/ML - SOLN 10 MG/ML SOLNEmverm 100 MG CHEWEnbrel 25 MG/0.5ML - SOSY 25 MG/0.5ML SOSYEnbrel 50 MG/ML - SOSY 50 MG/ML SOSYEnbrel Mini 50 MG/ML SOCTEnbrel SureClick 50 MG/ML - SOAJ 50 MG/ML SOAJEndometrin 100 MG 100 MG INSTEnoxaparin Sodium 30 MG/0.3ML SOLNEnoxaparin Sodium 40 MG/0.4ML SOLNEnoxaparin Sodium 60 MG/0.6ML SOLNEnoxaparin Sodium 80 MG/0.8ML SOLNEnoxaparin Sodium 100 MG/ML SOLNEnoxaparin Sodium 120 MG/0.8ML SOLNEnoxaparin Sodium 150 MG/ML SOLNEnoxaparin Sodium 300 MG/3ML SOLNEntyvio 300 MG 300 MG SOLREnvarsus XR 0.75 MG - TB24 0.75 MG TB24Envarsus XR 1 MG - TB24 1 MG TB24Envarsus XR 4 MG - TB24 4 MG TB24Epclusa 400-100 MG - TABS 400-100 MG TABS

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Specialty Drug ListingExecuted: 1/15/2019

EpiRUBicin HCl 50 MG/25ML SOLNEpiRUBicin HCl 200 MG/100ML SOLNEpivir 10 MG/ML SOLNEpivir 150 MG - TABS 150 MG TABSEpivir 300 MG - TABS 300 MG TABSEpivir HBV 100 MG - TABS 100 MG TABSEpivir HBV 5 MG/ML - SOLN 5 MG/ML SOLNEpivir HBV*Generic Available 150 MG TABSEpoprostenol Sodium 0.5 MG SOLREpoprostenol Sodium 1.5 MG SOLREpzicom 600-300 MG - TABS 600-300 MG TABSErbitux 100 MG/50ML SOLNErbitux 200 MG/100ML SOLNERGOMAR 2 MG SUBLErivedge 150 MG - CAPS 150 MG CAPSERLEADA 60 MG TABSErwinaze 10000 UNIT SOLREsbriet 267 MG CAPSEsbriet 267 MG CAPSESBRIET 267 MG TABSESBRIET 801 MG TABSEsbriet 267 MG - CAPS 267 MG CAPSEstradiol Valerate 10 MG/ML OILEstradiol Valerate 20 MG/ML OILEstradiol Valerate 40 MG/ML OILEthacrynate Sodium 50 MG SOLREthacrynic Acid 25 MG TABSEthyol 500 MG SOLREtopophos 100 MG SOLREtoposide 50 MG CAPSEtoposide 100 MG/5ML SOLNEtoposide 500 MG/25ML SOLNEtoposide 1 GM/50ML SOLNEuflexxa 20 MG/2ML 20 MG/2ML SOSYEvomela 50 MG SOLREvotaz 300-150 MG - TABS 300-150 MG TABSEvzio 0.4 MG/0.4ML SOAJEvzio 0.4 MG/0.4ML 0.4 MG/0.4ML SOAJExjade 125 MG TBSOExjade 250 MG TBSOExjade 500 MG TBSOExondys 51 100 MG/2ML SOLNExondys 51 500 MG/10ML SOLNExtavia 0.3 MG - KIT 0.3 MG KITEylea 2 MG/0.05ML - SOLN 60 MG TABS

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Specialty Drug ListingExecuted: 1/15/2019

Eylea 2 MG/0.05ML - SOLN 2 MG/0.05ML SOLNFabrazyme 5 MG SOLRFabrazyme 35 MG SOLRFarydak 10 MG CAPSFarydak 15 MG CAPSFarydak 20 MG CAPSFasenra 30MG/ML SubcutaneousFaslodex 250 MG/5ML SOLNFeiba NF SOLRFemara 2.5 MG TABSFenoldopam Mesylate 10 MG/ML SOLNFenoldopam Mesylate 20 MG/2ML SOLNFerrlecit 12.5 MG/ML SOLNFirazyr 30 MG/3ML - SOLN 30 MG/3ML SOLNFirmagon 80 MG SOLRFirmagon 120 MG SOLRFirst-Progesterone VGS 100 100 MG SUPPFirst-Progesterone VGS 200 200 MG SUPPFirst-Progesterone VGS 25 25 MG SUPPFirst-Progesterone VGS 400 400 MG SUPPFirst-Progesterone VGS 50 50 MG SUPPFlebogamma DIF 0.5 GM/10ML SOLNFlolan 0.5 MG SOLRFlolan 1.5 MG SOLRFloxuridine 0.5 GM SOLRFludara 50 MG SOLRFludarabine Phosphate 50 MG/2ML SOLNFludarabine Phosphate 50 MG SOLRFluoroplex 0.01 Unit CREAFluorouracil 500 MG/10ML SOLNFluorouracil 1 GM/20ML SOLNFluorouracil 2.5 GM/50ML SOLNFluorouracil 5 GM/100ML SOLNFlutamide 125 MG CAPSFollistim AQ 300 UNT/0.36ML SOLNFollistim AQ 900 UNT/1.08ML SOLNFollistim AQ 150 UNT/0.5ML 150 UNT/0.5ML SOLNFollistim AQ 600 UNT/0.5ML 600 UNT/0.72ML SOLNFollistim AQ 75 UNT/0.5ML 75 UNT/0.5ML SOLNFollistim AQ 900 UNT/0.5ML 75 UNT/0.5ML SOLNFolotyn 20 MG/ML SOLNFolotyn 40 MG/2ML SOLNFondaparinux Sodium 2.5 MG/0.5ML SOLNFondaparinux Sodium 5 MG/0.4ML SOLNFondaparinux Sodium 7.5 MG/0.6ML SOLN

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Specialty Drug ListingExecuted: 1/15/2019

Fondaparinux Sodium 10 MG/0.8ML SOLNForteo 600 MCG/2.4ML - SOLN 600 MCG/2.4ML SOLNFoscavir 6000 MG/250ML SOLNFragmin 10000 UNIT/ML SOLNFragmin 2500 UNIT/0.2ML SOLNFragmin 5000 UNIT/0.2ML SOLNFragmin 7500 UNIT/0.3ML SOLNFragmin 12500 UNIT/0.5ML SOLNFragmin 15000 UNIT/0.6ML SOLNFragmin 18000 SOLNFragmin 95000 UNIT/3.8ML SOLNFusilev 50 MG 50 MG SOLRFuzeon 90 MG SOLRGablofen 50 MCG/ML SOSYGablofen 10000 MCG/20ML SOSYGablofen 20000 MCG/20ML SOSYGablofen 40000 MCG/20ML SOSYGamaSTAN S/D INJGammagard 1 GM/10ML 1 GM/10ML SOLNGammagard 10 GM/100ML 10 GM/100ML SOLNGammagard 2.5 GM/25ML 2.5 GM/25ML SOLNGammagard 20 GM/200ML 20 GM/200ML SOLNGammagard 30 GM/300ML 30 GM/300ML SOLNGammagard 5 GM/50ML 5 GM/50ML SOLNGammagard S/D 10 GM 10 GM SOLRGammagard S/D 5 GM 5 GM SOLRGAMMAPLEX 5 GM/50 ML SOLNGAMMAPLEX 10 GM/100 ML SOLNGAMMAPLEX 20 GM/200 ML SOLNGammaplex 10 GM/200ML 10 GM/200ML SOLNGammaplex 2.5 GM/50ML 2.5 GM/50ML SOLNGammaplex 20 GM/400ML 20 GM/400ML SOLNGammaplex 5 GM/100ML 5 GM/100ML SOLNGamunex-C 1 GM/10ML SOLNGamunex-C 2.5 GM/25ML SOLNGamunex-C 5 GM/50ML SOLNGamunex-C 10 GM/100ML SOLNGamunex-C 20 GM/200ML SOLNGamunex-C 40 GM/400ML SOLNGanciclovir Sodium 500 MG SOLRGanirelix Acetate 250 MCG/0.5ML 250 MCG/0.5ML SOLNGattex 5 MG KITGazyva 1000 MG/40ML SOLNGel-One 30 MG/3ML PRSYGelsyn-3 16.8 MG/2ML SOSY

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Specialty Drug ListingExecuted: 1/15/2019

Gemcitabine HCl 200 MG/5.26ML SOLNGemcitabine HCl 1 GM/26.3ML SOLNGemcitabine HCl 2 GM/52.6ML SOLNGemcitabine HCl 200 MG SOLRGemcitabine HCl 1 GM SOLRGemcitabine HCl 2 GM SOLRGemzar 200 MG SOLRGemzar 1 GM SOLRGenotropin 5 MG SOLRGenotropin 12 MG SOLRGenotropin 12 MG 1.4 MG SOLRGenotropin 5 MG 1.2 MG SOLRGenotropin MiniQuick 0.2 MG SOLRGenotropin MiniQuick 0.4 MG SOLRGenotropin MiniQuick 0.6 MG SOLRGenotropin MiniQuick 0.8 MG SOLRGenotropin MiniQuick 1 MG SOLRGenotropin MiniQuick 0.2 MG 1.6 MG SOLRGenotropin MiniQuick 0.4 MG 1.8 MG SOLRGenotropin MiniQuick 0.6 MG 2 MG SOLRGenotropin MiniQuick 0.8 MG 1.2 MG SOLRGenotropin MiniQuick 1.0 MG 1.4 MG SOLRGenotropin MiniQuick 1.2 MG 1.2 MG SOLRGenotropin MiniQuick 1.4 MG 1.4 MG SOLRGenotropin MiniQuick 1.6 MG 1.6 MG SOLRGenotropin MiniQuick 1.8 MG 1.8 MG SOLR

Genotropin MiniQuick 2 MG 2 MG SOLR

GenVisc 850 25 MG/2.5ML SOSYGenvoya 150-150-200-10 TABSGilenya 0.5 MG - CAPS 0.5 MG CAPSGilotrif 20 MG TABSGilotrif 30 MG TABSGilotrif 40 MG TABSGlassia 1000 MG/50ML SOLNGleevec 100 MG TABSGLEEVEC 400 MG TABSGleevec (Generic Available) 300 UNIT/0.5ML SOLNGleevec (Generic Available) 450 UNT/0.75ML SOLNGleostine 5 MG CAPSGleostine 10 MG CAPSGleostine 40 MG CAPSGleostine 100 MG CAPSGliadel Wafer 7.7 MG WAFR

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Specialty Drug ListingExecuted: 1/15/2019

Glumetza 500 MG TB24Glumetza 1000 MG TB24Gocovri 68.5 MG - CP24 CAPSGocovri 137 MG - CP24 CAPS

Gonal-f 450 UNIT SOLR

Gonal-f 1050 UNIT SOLR

Gonal-f RFF 1 MG/2ML SOLN

Gonal-f RFF 75 UNIT 75 UNIT SOLR

Gonal-f RFF Pen 300 UNT/0.5ML 300 UNIT/0.5ML SOLN

Gonal-f RFF Pen 450 UNT/0.75ML 450 UNT/0.75ML SOLNGonal-f RFF Pen 900 UNIT/1.5ML 900 UNIT/1.5ML SOLNGonal-f RFF Rediject 450 UNT/0.75M 450 UNT/0.75ML SOLNGralise 300 MG - TABS 300 MG TABSGralise 600 MG - TABS 600 MG TABSGralise Starter 300 & 600 MG 300 & 600 MG MISCGranisetron HCl 1 MG TABSGranisetron HCl 0.1 MG/ML SOLNGranisetron HCl 1 MG/ML SOLNGranisetron HCl 4 MG/4ML SOLNGranix 300 MCG/0.5ML SOSYGranix 480 MCG/0.8ML SOSYGrastek 2800 BAU SUBLHalaven 1 MG/2ML - SOLN 1 MG/2ML SOLNHarvoni 90-400 MG - TABS 90-400 MG TABSHealon 10 MG/ML SOLNHealon GV 14 MG/ML SOLNHealon5 23 MG/ML SOLNHectorol 0.5 MCG CAPSHectorol 1 MCG CAPSHectorol 2.5 MCG CAPSHectorol 2 MCG/ML SOLNHectorol 4 MCG/2ML SOLNHelixate FS 1000 UNIT - KIT 250 UNIT KITHelixate FS 2000 UNIT - KIT 250 UNIT KITHelixate FS 250 UNIT - KIT 250 UNIT KITHelixate FS 3000 UNIT - KIT 250 UNIT KITHelixate FS 500 UNIT - KIT 250 UNIT KITHemangeol 4.28MG/ML SOLNHemlibra 30MG/ML Subcutaneous

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Specialty Drug ListingExecuted: 1/15/2019

Hemlibra 60 MG/0.4 ML SubcutaneousHemlibra 105 MG/0.7 ML SubcutaneousHemlibra 150 MG/ML SubcutaneousHemofil M 220-400 UNIT SOLRHemofil M 250 UNIT SOLRHemofil M 401-800 UNIT SOLRHemofil M 500 UNIT SOLRHemofil M 1000 UNIT SOLRHemofil M 1700 UNIT SOLRHemofil M 801-1500 UNIT SOLRHemofil M 1501-2000 UNIT SOLRHemofil M 1000 UNIT 250 UNIT KITHemofil M 1501-2000 UNIT 250 UNIT KIT

Hemofil M 1700 UNIT 250 UNIT KIT

Hemofil M 220-400 UNIT 250 UNIT KITHemofil M 250 UNIT 250 UNIT KITHemofil M 401-800 UNIT 250 UNIT KITHemofil M 500 UNIT 250 UNIT KITHemofil M 801-1500 UNIT 250 UNIT KITHepaGam B SOLNHepsera 10 MG TABSHERCEPTIN 150 MG SOLRHerceptin 440 MG SOLRHerceptin 440 MG 250 UNIT KITHetlioz 20 MG CAPS

Hexalen 50 MG CAPS

Hiberix 10 MCG SOLRHizentra 1 GM/5ML 1 GM/5ML SOLNHizentra 10 GM/50ML 10 GM/50ML SOLNHizentra 2 GM/10ML 2 GM/10ML SOLN

Hizentra 4 GM/20ML 4 GM/20ML SOLN

HP Acthar 80 UNIT/ML - GEL 80 UNIT/ML GELHumate-P 250-600 UNIT SOLRHumate-P 500-1200 UNIT SOLRHumate-P 1000-2400 UNIT SOLRHumatrope 12 MG 12 MG SOLRHumatrope 24 MG 24 MG SOLRHumatrope 5 MG 5 MG SOLRHumatrope 6 MG 6 MG SOLR

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Specialty Drug ListingExecuted: 1/15/2019

Humira 10 MG/0.2ML - PSKT 10 MG/0.2ML PSKTHumira 20 MG/0.4ML - PSKT 20 MG/0.4ML PSKTHumira Pediatric Crohns Start 40 M… 40 MG/0.8ML PSKTHumira Pen 40 MG/0.8ML - PNKT 40 MG/0.8ML PNKTHyalgan 20 MG/2ML SOLNHycamtin 0.25 MG CAPSHycamtin 1 MG CAPSHycamtin 4 MG SOLRHYDROXYprogesterone Caproate 1.25 GM/5ML SOLNHymovis 24 MG/3ML SOSYHyperHEP B S/D SOLNHyperRHO S/D 250 UNIT SOSYHyperRHO S/D 1500 UNIT SOSYHyperTET S/D 250 UNIT/ML INJHyqvia 10 GM/25ML - KIT 10 GM/100ML KITHyqvia 2.5 GM/25ML - KIT 2.5 GM/25ML KITHyqvia 20 GM/25ML - KIT 20 GM/200ML KITHyqvia 30 GM/25ML - KIT 30 GM/300ML KITHyqvia 5 GM/25ML - KIT 5 GM/50ML KITIbrance 100 MG - CAPS 100 MG CAPSIbrance 125 MG - CAPS 125 MG CAPSIbrance 75 MG - CAPS 75 MG CAPSIclusig 15 MG TABSIclusig 45 MG TABSIdamycin PFS 5 MG/5ML SOLNIdamycin PFS 10 MG/10ML SOLNIdamycin PFS 20 MG/20ML SOLNIDArubicin HCl 5 MG/5ML SOLN

IDArubicin HCl 10 MG/10ML SOLN

IDArubicin HCl 20 MG/20ML SOLNIdelvion 250 UNIT SOLRIdelvion 500 UNIT SOLRIdelvion 1000 UNIT SOLRIdelvion 2000 UNIT SOLRIDHIFA 50 MG TABSIDHIFA 100 MG TABSIfex 1 GM SOLRIfex 3 GM SOLRIfosfamide 1 GM/20ML SOLNIfosfamide 3 GM/60ML SOLNIfosfamide 1 GM SOLRIfosfamide 3 GM SOLRILARIS 150 MG/ML SOLN

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Specialty Drug ListingExecuted: 1/15/2019

ILARIS 150 MG

Iluvien 0.19 MG IMPL

Imatinib Mesylate 400 MG 400 MG TABSImatinib Mesylate 400 MG 400 MG TABSImbruvica 140 MG - CAPS 140 MG CAPSIMFINZI 500 MG/10ML SOLNImipenem-Cilastatin 250 MG SOLRImipenem-Cilastatin 500 MG SOLRImitrex 6 MG/0.5ML SOLNImitrex STATdose System 4 MG/0.5ML SOAJImitrex STATdose System 6 MG/0.5ML SOAJImlygic 100000000 SUSPImlygic 1000000 UNIT/ML 1000000 UNIT/ML SUSPImplanon 68 MG IMPLIncivek 375 MG TABSIncrelex 40 MG/4ML SOLNINFINZI 120 MG/2.4ML SOLNInflectra 100 MG SOLRIngrezza 40 MG CAPSInlyta 1 MG TABSInlyta 5 MG TABSInlyta 1 MG - TABS 1 MG TABSInlyta 5 MG - TABS 5 MG TABSIntelence 100 MG - TABS 100 MG TABSIntelence 200 MG - TABS 200 MG TABSIntelence 25 MG - TABS 25 MG TABSIntron A 10000000 UNIT - SOLR 10000000 UNIT SOLRIntron A 10000000 UNIT/ML 10000000 SOLNIntron A 18000000 UNIT - SOLR 18000000 UNIT SOLRIntron A 50000000 UNIT - SOLR 50000000 UNIT SOLRIntron A 6000000 UNIT/ML - SOLN 6000000 UNIT/ML SOLNInvega 1.5 MG TB24Invega 3 MG TB24Invega 6 MG TB24Invega 9 MG TB24Invega Sustenna 117 MG/0.75ML - SU… 117 MG/0.75ML SUSPInvega Sustenna 156 MG/ML - SUSP 156 MG/ML SUSPInvega Sustenna 234 MG/1.5ML - SUSP 234 MG/1.5ML SUSPInvega Sustenna 39 MG/0.25ML - SUSP 39 MG/0.25ML SUSPInvega Sustenna 39 MG/0.25ML - SUSP 39 MG/0.25ML SUSPInvega Sustenna 78 MG/0.5ML - SUSP 78 MG/0.5ML SUSPInvega Trinza 273 MG/0.875ML SUSPInvega Trinza 410 MG/1.315ML SUSP

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Specialty Drug ListingExecuted: 1/15/2019

Invega Trinza 546MG/1.75ML SUSPInvega Trinza 819MG/2.625ML SUSPInvirase 200 MG CAPSInvirase 500 MG TABSIprivask 15 MG SOLRIressa 250 MG TABSIrinotecan HCl 40 MG/2ML SOLNIrinotecan HCl 100 MG/5ML SOLNIrinotecan HCl 500 MG/25ML SOLNIsentress 100 MG PACKIsentress 100 MG - CHEW 100 MG CHEWIsentress 25 MG - CHEW 25 MG CHEWIsentress 400 MG - TABS 400 MG TABSIxempra Kit 15 MG 15 MG SOLRIxempra Kit 45 MG 45 MG SOLRIxinity 1500 UNIT SOLRIxinity 500 UNIT 500 UNIT SOLRJadenu 180 MG - TABS 180 MG TABSJadenu 360 MG - TABS 360 MG TABSJadenu 90 MG - TABS 90 MG TABSJADENU SPRINKLE 90 MG PACKJADENU SPRINKLE 180 MG PACKJADENU SPRINKLE 360 MG PACKJakafi 20 MG TABSJakafi 10 MG 10 MG TABSJakafi 15 MG 15 MG TABSJakafi 25 MG 25 MG TABSJakafi 5 MG 5 MG TABSJETREA 0.375 MG/0.3ML SOLNJetrea 0.5 MG/0.2ML SOLNJevtana 60 MG/1.5ML SOLNJuluca 50-25 MG TABSJuxtapid 5 MG CAPSJuxtapid 10 MG CAPSJuxtapid 20 MG CAPSJuxtapid 30 MG CAPSJuxtapid 40 MG CAPSJuxtapid 60 MG CAPSJynarque 45 & 15 MGJynarque 60 & 30 MGJynarque 90 & 30 MGKadcyla 160 MG SOLRKadcyla 100 MG 100 MG SOLRKalbitor 10 MG/ML SOLNKaletra 100-25 MG 100-25 MG TABS

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Specialty Drug ListingExecuted: 1/15/2019

Kaletra 200-50 MG 200-50 MG TABSKaletra 400-100 MG/5ML 400-100 MG/5ML SOLNKalydeco 150 MG TABSKALYDECO 50 MG PACKKALYDECO 75 MG PACKKanuma 20 MG/10ML SOLNKepivance 6.25 MG SOLRKerzara 150 MG/1.14ML 150 MG/1.14ML SOSYKEVZARA 150MG/1.14MLKEVZARA 200MG/1.14MLKevzara 200 MG/1.14ML SOSYKevzara 150 MG/1.14ML 150 MG/1.14ML SOSYKeytruda 100 MG/4ML SOLNKeytruda 50 MG SOLRKeytruda 50 MG 50 MG SOLRKineret 100 MG/0.67ML SOSYKisqaliKisqali FemaraKitabis Pak 300 MG/5ML NEBUKoate 250 UNIT SOLRKoate 500 UNIT SOLRKoate 1000 UNIT SOLRKoate-DVI 250 UNIT SOLRKoate-DVI 500 UNIT SOLRKoate-DVI 1000 UNIT SOLRKogenate FS 1000 UNIT - KIT 1000 UNIT KITKogenate FS 2000 UNIT - KIT 2000 UNIT KITKogenate FS 250 UNIT - KIT 250 UNIT KITKogenate FS 3000 UNIT - KIT 3000 UNIT KITKogenate FS 500 UNIT - KIT 500 UNIT KITKovaltry 1000 UNIT 1000 UNIT SOLRKovaltry 2000 UNIT 2000 UNIT SOLRKovaltry 250 UNIT 250 UNIT SOLRKovaltry 3000 UNIT 3000 UNIT SOLRKovaltry 500 UNIT 500 UNIT SOLRKrystexxa 8 MG/ML - SOLN 8 MG/ML SOLNKuvan 100 MG PACKKuvan 500 MG PACKKuvan 100 MG TBSOKyleena 19.5 MG IUDKynamro 200 MG/ML SOSYKyprolis 30 MG SOLRKyprolis 60 MG SOLRLamiVUDine 10 MG/ML SOLNLartruvo 190 MG/19ML SOLN

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Specialty Drug ListingExecuted: 1/15/2019

Lartruvo 500 MG/50ML SOLNLemtrada 12 MG/1.2ML - SOLN 12 MG/1.2ML SOLNLenvima 8MG Daily Dose 4 CPPKLenvima 10MG DailyDose CPPKLenvima 20MG DailyDose CPPKLenvima 14MG DailyDose CPPKLenvima 18MG Daily Dose CPPKLenvima 24MG DailyDose CPPKLetairis 10 MG - TABS 10 MG TABSLetairis 5 MG - TABS 5 MG TABSLetrozole 2.5 MG TABSLeucovorin Calcium 50 MG SOLRLeucovorin Calcium 100 MG SOLRLeucovorin Calcium 200 MG SOLRLeucovorin Calcium 350 MG SOLRLeucovorin Calcium 500 MG SOLRLeukeran 2 MG TABSLeukine 250 MCG SOLRLeuprolide Acetate 1 MG/0.2ML KITLEVOleucovorin Calcium 175 MG/17.5ML SOLNLEVOleucovorin Calcium PF 250 MG/25ML SOLNLexiva 50 MG/ML - SUSP 50 MG/ML SUSPLexiva 700 MG - TABS 700 MG TABSLialda 1.2 GM - TBEC 1.2 GM TBECLiletta (52 MG) 18.6 IUDLioresal 0.05 MG/ML SOLNLioresal 10 MG/20ML SOLNLioresal 10 MG/5ML SOLNLioresal 40 MG/20ML SOLNLipodox 2 MG/ML INJLipodox 50 2 MG/ML INJLomustine 10 MG CAPSLomustine 40 MG CAPSLomustine 100 MG CAPSLonsurf 15-6.14 MG TABSLonsurf 20-8.19 MG TABSLovenox 30 MG/0.3ML SOLNLovenox 40 MG/0.4ML SOLNLovenox 60 MG/0.6ML SOLNLovenox 80 MG/0.8ML SOLNLovenox 100 MG/ML SOLNLovenox 120 MG/0.8ML SOLNLovenox 150 MG/ML SOLNLovenox 300 MG/3ML SOLNLUCENTIS 0.3 MG/0.05ML

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Specialty Drug ListingExecuted: 1/15/2019

Lucentis 0.5 MG/0.05ML SOSYLucentis 0.3 MG/0.05ML - SOLN 0.3 MG/0.05ML SOLNLucentis 0.5 MG/0.05ML - SOLN 0.5 MG/0.05ML SOLNLumizyme 50 MG SOLRLupaneta Pack 3.75 & 5 MG KITLupaneta Pack 11.25 & 5 MG KITLupron Depot 3.75 MG KITLupron Depot-Ped 11.25 MG (Ped) KITLupron Depot-Ped 30 MG (Ped) KITLupron injection 7.5 MG KITLupron injection 22.5 MG KITLupron injection 30 MG KITLupron injection 45 MG KITLupron injection 7.5 MG KITLupron injection 11.25 MG KITLupron injection 15 MG KITLupron injection Depot 3 month 11.25 MG KITLYNPARZA 100 MG TABSLYNPARZA 150 MG TABSLysodren 500 MG TABSMacugen 0.3 MG SOLNMakena 250 MG/ML - OIL 250 MG/ML OILMarinol 2.5 MG CAPSMarinol 5 MG CAPSMarinol 10 MG CAPSMarqibo 5 MG/31ML SUSPMatulane 50 MG CAPSMavyret 100-40 MG TABSMekinist 0.5 MG - TABS 0.5 MG TABSMekinist 2 MG - TABS 2 MG TABSMelphalan HCl 50 MG SOLRMenopur 75 UNIT 75 UNIT SOLRMepsevii 10 MG/5ML SOLNMesalamine 800 MG TBECMesna 100 MG/ML SOLNMesnex 400 MG TABSMesnex 100 MG/ML SOLNMethotrexate Sodium 50 MG/2ML SOLNMethotrexate Sodium 250 MG/10ML SOLNMethotrexate Sodium 1 GM SOLRMethotrexate Sodium (PF) 50 MG/2ML SOLNMethotrexate Sodium (PF) 100 MG/4ML SOLNMethotrexate Sodium (PF) 200 MG/8ML SOLNMethotrexate Sodium (PF) 250 MG/10ML SOLNMethotrexate Sodium (PF) 1 GM/40ML SOLN

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Specialty Drug ListingExecuted: 1/15/2019

Miacalcin 200 UNIT/ML SOLNMICRhoGAM Ultra-Filtered Plus 250 UNIT SOSYMigranal 4 MG/ML SOLNMircera 30 MCG/0.3ML SOSYMircera 50 MCG/0.3ML SOSYMircera 75 MCG/0.3ML SOSYMircera 100 MCG/0.3ML SOSYMircera 150 MCG/0.3ML SOSYMircera 200 MCG/0.3ML SOSYMirena (52 MG) 20 IUDMitoMYcin 5 MG SOLRMitoMYcin 20 MG SOLRMitoMYcin 40 MG SOLRMitoXANTRONE HCl 20 MG/10ML CONCMitoXANTRONE HCl 25 MG/12.5ML CONCMitoXANTRONE HCl 30 MG/15ML CONCModeriba 600 MG TABSMonoclate-P 1000 UNIT KITMonoclate-P 1500 UNIT KITMononine 500 UNIT SOLRMononine 1000 UNIT SOLRMonovisc 88 MG/4ML SOSYMozobil 24 MG/1.2ML SOLNMuGard LIQD LIQDMustargen 10 MG SOLRMyalept 11.3 MG SOLRMyfortic 180 MG 180 MG TBECMyfortic 360 MG 360 MG TBECMyleran 2 MG TABSMylotarg 4.5 mg SOLRMyobloc 2500 UNIT/0.5ML SOLNMyobloc 5000 UNIT/ML SOLNMyobloc 10000 UNIT/2ML SOLNMyorisan 10 MG CAPSMyorisan 20 MG CAPSMyorisan 30 MG CAPSMyorisan 40 MG CAPSMyozyme 50 MG SOLRNa Ferric Gluc Cplx in Sucrose 12.5 MG/ML SOLNNabi-HB SOLNNaglazyme 1 MG/ML SOLNNatpara 25 MCG CARTNatpara 50 MCG CARTNatpara 75 MCG CARTNatpara 100 MCG CART

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Specialty Drug ListingExecuted: 1/15/2019

Navelbine 10 MG/ML SOLNNavelbine 50 MG/5ML SOLNNeoral 100 MG - CAPS 100 MG CAPSNeoral 100 MG/ML - SOLN 100 MG/ML SOLNNeoral 25 MG - CAPS 25 MG CAPSNerlynx 40 MG TABSNeulasta 6 MG/0.6ML 6 MG/0.6ML SOSYNeulasta Onpro 6 MG/0.6ML - PSKT 6 MG/0.6ML PSKTNeumega 5 MG SOLRNeupogen 300 MCG/0.5ML - 300 MCG/0.5ML SOSYNeupogen 300 MCG/ML 300 MCG/ML SOLNNeupogen 480 MCG/0.8ML 480 MCG/0.8ML SOSYNeupogen 480 MCG/1.6ML - 480 MCG/1.6ML SOLNNevirapine 200 MG TABSNevirapine 50 MG/5ML SUSPNevirapine ER 100 MG TB24Nevirapine ER 400 MG TB24NexAVAR 200 MG 200 MG TABSNexPlanon 68 MG IMPLNilandron 150 MG TABSNinlaro 2.5mg 2.3 MG CAPSNinlaro 3mg 3 MG CAPSNinlaro 4mg 4 MG CAPSNipent 10 MG SOLRNitronal 1 MG/ML SOLNNorditropin FlexPro 10 MG/1.5ML 10 MG/1.5ML SOLNNorditropin FlexPro 15 MG/1.5ML 15 MG/1.5ML SOLNNorditropin FlexPro 5 MG/1.5ML 5 MG/1.5ML SOLNNorditropin inj 80 MG/ML SOLNNorditropin NordiFlex Pen 30 MG/3M 30 MG/3ML SOLNNorthera 100 MG 100 MG CAPSNorthera 200 MG 200 MG CAPSNorthera 300 MG 300 MG CAPSNorvir 100 MG - CAPS 100 MG CAPSNorvir 100 MG - TABS 100 MG TABSNorvir 80 MG/ML - SOLN 80 MG/ML SOLNNovarel 10000 UNIT SOLRNOVOEIGHT 250 UNITNOVOEIGHT 500 UNITNOVOEIGHT 1000 UNITNovoeight 1500 UNIT SOLRNOVOEIGHT 2000 UNITNOVOEIGHT 3000 UNITNovoSeven RT 1 MG SOLRNovoSeven RT 2 MG SOLR

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Specialty Drug ListingExecuted: 1/15/2019

NovoSeven RT 5 MG SOLRNovoSeven RT 8 MG SOLRNoxafil 100 MG TBECNplate 250 MCG 250 MCG SOLRNplate 500 MCG 500 MCG SOLRNucala 100 MG SOLRNulojix 250 MG 250 MG SOLR

Nuplazid 17 MG - TABS 17 MG TABSNutropin 10 MG - SOLR 10 MG SOLRNutropin AQ NuSpin 10 10 MG/2ML 10 MG/2ML SOLNNutropin AQ NuSpin 20 20 MG/2ML 20 MG/2ML SOLNNutropin AQ NuSpin 5 5 MG/2ML 5 MG/2ML SOLNNuwiq 250 UNIT SOLRNuwiq 500 UNIT SOLRNuwiq 1000 UNIT SOLRNuwiq 2000 UNIT SOLRNUWIQ 2500 UNIT SOLRNUWIQ 3000 UNIT SOLRNUWIQ 4000 UNITNuwiq 250 UNIT KITNuwiq 500 UNIT KITNuwiq 1000 UNIT KITNuwiq 2000 UNIT KITNUWIQ 2500 UNIT KITNUWIQ 3000 UNIT KITNUWIQ 4000 UNIT KITObizur 500 UNIT SOLROcaliva 5 MG TABSOCALIVA 10 MG TABSOctagam 1 GM/20ML SOLNOctagam 25 GM/500ML SOLNOctagam 2 GM/20ML SOLNOctreotide Acetate 100 MCG/ML SOLNOctreotide Acetate 200 MCG/ML SOLNOctreotide Acetate 200 MCG/ML SOLNOdefsey 200-25-25 MG TABSODOMZO 200 MG CAPSOfev 100 MG - CAPS 100 MG CAPSOfev 150 MG - CAPS 150 MG CAPSOLANZapine 10 MG SOLROlysio 150 MG CAPSOlysio 150 MG - CAPS 150 MG CAPSOmnitrope 10 MG/1.5ML - SOLN 10 MG/1.5ML SOLNOmnitrope 5 MG/1.5ML - SOLN 5 MG/1.5ML SOLN

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Specialty Drug ListingExecuted: 1/15/2019

Omnitrope 5.8 MG - SOLR 5.8 MG SOLROmontys 10 MG/ML SOLNOmontys 20 MG/2ML SOLNOncaspar 750 UNIT/ML SOLNOnfi 10 MG TABSOnfi 20 MG TABSOnfi 2.5 MG/ML SUSPOnivyde 43 MG/10ML INJOnmel 200mg - tabs 200 MG TABSOpdivo 40 MG/4ML SOLNOpdivo 100 MG/10ML SOLNOPDIVO 240 MG/24 ML SOLNOpsumit 10 MG TABSOralair 300 IR SUBLOralair Childrens Sample Kit 100(3) & 300(6) IR THPKOralair Childrens Starter Pack 100 IR SUBLOrencia 50 MG/0.4ML SOSYOrencia 87.5 MG/0.7ML SOSYOrencia 125 MG/ML 125 MG/ML SOSYOrencia 250 MG 250 MG SOLROrencia ClickJect 125 MG/ML 125 MG/ML SOAJORENITRAM 0.125 MGORENITRAM 0.25 MGORENITRAM 1 MGORENITRAM 2.5 MGORENITRAM 5 MGOrfadin 2 MG CAPSOrfadin 5 MG CAPSOrfadin 10 MG CAPSOrfadin 20 MG CAPSOrfadin 4 MG/ML SUSPORKAMBI 100-125 MG TABSOrkambi 200-125 MG 200-125 MG TABSOrthoVisc 30 MG/2ML SOSYOtezla 10 & 20 & 30 MG - TBPK 10 & 20 & 30 MG TBPKOtezla 10 & 20 & 30 MG - TBPK 10 & 20 & 30 MG TBPKOtezla 30 MG - TABS 30 MG TABSOtrexup 7.5 MG/0.4ML SOAJOtrexup 10 MG/0.4ML SOAJOtrexup 12.5 MG/0.4ML SOAJOtrexup 15 MG/0.4ML SOAJOtrexup 17.5 MG/0.4ML SOAJOtrexup 22.5 MG/0.4ML SOAJOtrexup 25 MG/0.4ML SOAJOvidrel 250 MCG/0.5ML 250 MCG/0.5ML INJ

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Specialty Drug ListingExecuted: 1/15/2019

Oxaliplatin 50 MG/10ML SOLNOxaliplatin 100 MG/20ML SOLNOxaliplatin 50 MG SOLROxaliplatin 100 MG SOLROxsoralen 0.01 Unit LOTNOzurdex 0.7 MG IMPLPACLitaxel 30 MG/5ML CONCPACLitaxel 100 MG/16.7ML CONCPACLitaxel 150 MG/25ML CONCPACLitaxel 300 MG/50ML CONCPamidronate Disodium 30 MG/10ML SOLNPamidronate Disodium 6 MG/ML SOLNPamidronate Disodium 90 MG/10ML SOLNPamidronate Disodium 30 MG SOLRPamidronate Disodium 90 MG SOLRPancreaze 4200 UNIT CPEPPancreaze 10500 UNIT CPEPPancreaze 16800 UNIT CPEPPancreaze 21000 UNIT CPEPPanretin 0.001 Unit GELParagard Intrauterine Copper IUD

Paricalcitol 2 MCG/ML SOLNParicalcitol 5 MCG/ML SOLNPegasys 135 MCG/0.5ML SOLN

Pegasys 180 MCG/0.5ML SOLNPegasys 180 MCG/0.5ML SOLNPegIntron 50 MCG/0.5ML KITPegIntron 80 MCG/0.5ML KITPegIntron 120 MCG/0.5ML KITPegIntron 150 MCG/0.5ML KITPeg-Intron 50 MCG/0.5ML KIT

Peg-Intron 80 MCG/0.5ML KITPeg-Intron 120 MCG/0.5ML KIT

Peg-Intron 150 MCG/0.5ML KITPeg-Intron Redipen 50 MCG/0.5ML KITPeg-Intron Redipen 80 MCG/0.5ML KITPeg-Intron Redipen 120 MCG/0.5ML KITPeg-Intron Redipen 150 MCG/0.5ML KITPeg-Intron Redipen Pak 4 50 MCG/0.5ML KITPeg-Intron Redipen Pak 4 80 MCG/0.5ML KITPeg-Intron Redipen Pak 4 120 MCG/0.5ML KIT

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Specialty Drug ListingExecuted: 1/15/2019

Peg-Intron Redipen Pak 4 150 MCG/0.5ML KITPerjeta 420 MG/14ML SOLNPertzye 4000 UNIT CPEPPertzye 8000 UNIT CPEPPertzye 16000 UNIT CPEPPhotofrin 75 MG SOLRPicato 0.015 % - GEL 0.015 % GELPicato 0.05 % - GEL 0.05 % GELPifeltro 100 MG TABSPlegridy 125 MCG/0.5ML SOPNPlegridy 63 & 94 SOPNPLEGRIDY 125 MCG/0.5ML SOSYPlegridy 63 & 94 SOSYPomalyst 4 MG CAPSPomalyst 1 MG - CAPS 1 MG CAPSPomalyst 2 MG - CAPS 2 MG CAPSPomalyst 3 MG - CAPS 3 MG CAPSPortrazza 800 MG/50ML SOLNPralidoxime Chloride 600 MG/2ML SOAJPraluent 150 MG/ML SOPNPraluent 75 MG/ML SOSYPraluent 150mg 150 MG/ML SOSYPraluent 75mg 75 MG/ML SOPNPregnyl 10000 UNIT SOLRPrevymis 240 MG TABSPrevymis 480 MG TABSPrevymis 240 MG/12 ML SOLNPrevymis 480MG/24 ML SOLNPrezcobix 800-150 MG - TABS 800-150 MG TABSPrezista 100 MG/ML - SUSP 100 MG/ML SUSPPrezista 150 MG 150 MG TABSPrezista 150 MG - TABS 150 MG TABSPrezista 600 MG 600 MG TABSPrezista 600 MG - TABS 600 MG TABSPrezista 75 MG 75 MG TABSPrezista 75 MG - TABS 75 MG TABSPrezista 800 MG 800 MG TABSPrezista 800 MG - TABS 800 MG TABSPrialt 500 MCG/20ML SOLNPrialt 100 MCG/ML SOLNPrialt 500 MCG/5ML SOLNPrivigen 10 GM/50ML - SOLN 10 GM/100ML SOLNPrivigen 20 GM/50ML - SOLN 20 GM/200ML SOLNPrivigen 40 GM/50ML - SOLN 40 GM/400ML SOLNPrivigen 5 GM/50ML - SOLN 5 GM/50ML SOLN

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Specialty Drug ListingExecuted: 1/15/2019

Procrit 10000 UNIT/ML 10000 UNIT/ML SOLNProcrit 2000 UNIT/ML 2000 UNIT/ML SOLNProcrit 20000 UNIT/ML 20000 UNIT/ML SOLNProcrit 3000 UNIT/ML 3000 UNIT/ML SOLNProcrit 4000 UNIT/ML 4000 UNIT/ML SOLNProcrit 40000 UNIT/ML 40000 UNIT/ML SOLNPROCYSBI 25 MG CPDRPROCYSBI 75 MG CPDRProfilnine 500 UNIT SOLRProfilnine 1000 UNIT SOLRProfilnine 1500 UNIT SOLRProfilnine SD 500 UNIT SOLRProfilnine SD 1000 UNIT SOLRProfilnine SD 1500 UNIT SOLRProgesterone 50 MG/ML OILPrograf 0.5 MG - CAPS 0.5 MG CAPSPrograf 1 MG - CAPS 1 MG CAPSPrograf 5 MG - CAPS 5 MG CAPSPrograf 5 MG/ML - SOLN 5 MG/ML SOLNProlastin 500 MG SOLRProlastin 1000 MG SOLRPROLASTIN-C 1000 MG/20ML SOLNProlastin-C 1000 MG SOLRProleukin 22000000 UNIT SOLRProlia 60 MG/ML - SOLN 60 MG/ML SOLNPromacta 12.5mg 12.5 MG TABSPromacta 25mg 25 MG TABSPromacta 50mg 50 MG TABSPromacta 75mg 75 MG TABSProThelial 0.1 Unit PSTEProvenge SUSPProvisc 10 MG/ML SOLNPulmozyme 1 MG/ML - SOLN 1 MG/ML SOLNPurinethol 50 MG TABSPURIXAN 2000 MG/100ML SUSPQutenza 8 % KITQutenza (2 Patch) 8 % KIT

RadicavaRagwitek 12 AMB A 1-U SUBLRapamune 0.5 MG TABSRapamune 1 MG TABSRapamune 2 MG TABSRapamune 1 MG/ML SOLNRasuvo 30 MG/0.6ML SOAJ

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Specialty Drug ListingExecuted: 1/15/2019

Rasuvo 10 MG/0.2ML 10 MG/0.2ML SOAJRasuvo 12.5 MG/0.25ML 12.5 MG/0.25ML SOAJRasuvo 15 MG/0.3ML 15 MG/0.3ML SOAJRasuvo 17.5 MG/0.35ML 17.5 MG/0.35ML SOAJRasuvo 20 MG/0.4ML 20 MG/0.4ML SOAJRasuvo 22.5 MG/0.45ML 22.5 MG/0.45ML SOAJRasuvo 25 MG/0.5ML 25 MG/0.5ML SOAJRasuvo 27.5 MG/0.55ML 27.5 MG/0.55ML SOAJRasuvo 7.5 MG/0.15ML 7.5 MG/0.15ML SOAJRAVICTI 1.1 GM/ML LIQDRebetol 200 MG CAPSRebetol 40 MG/ML SOLNRebif 22 MCG/0.5ML 22 MCG/0.5ML SOSYRebif 44 MCG/0.5ML 44 MCG/0.5ML SOSYRebif Rebidose 22 MCG/0.5ML 22 MCG/0.5ML SOAJRebif Rebidose 44 MCG/0.5ML 44 MCG/0.5ML SOAJRebif Rebidose Titration Pack 6X8.8 & 6X22 SOAJRebif Titration Pack 6X8.8 & 6X22 6X8.8 & 6X22 SOSYReclast 5 MG/100ML SOLNRecombinate 220-400 UNIT SOLRRecombinate 401-800 UNIT SOLRRecombinate 801-1240 UNIT SOLRRecombinate 1241-1800 UNIT SOLRRecombinate 1801-2400 UNIT SOLRRediject 300 units/0.5ml 300 UNIT/0.5ML SOLNRediject 450 units/0.75ml 450 UNT/0.75ML SOLNRediject 900 units/1.5ml 900 UNIT/1.5ML SOLNRelistor 12 MG/0.6ML SOLN

Relistor 8 MG/0.4ML - SOLN 8 MG/0.4ML SOLN

Remicade 100 MG 100 MG SOLR

Remodulin 1 MG/ML SOLNRemodulin 2.5 MG/ML SOLNRemodulin 5 MG/ML SOLNRemodulin 10 MG/ML SOLNRENFLEXIS 100 MGRepatha 140 MG/ML 140 MG/ML SOSYRepatha Pushtronex System 420 MG/3.5 ML SOCTRepatha Pushtronex System 420 MG/3 140 MG/ML SOSY Repatha SureClick 140 MG/ML 140 MG/ML SOAJRescriptor 100 MG TABSRescriptor 200 MG TABSRetisert 0.59 MG IMPL

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Specialty Drug ListingExecuted: 1/15/2019

Retrovir 100 MG CAPSRetrovir 300 MG TABSRetrovir 50 MG/5ML SYRPRetrovir 10 MG/ML SOLNRevatio 20 MG TABSRevatio 10 MG/ML SUSRRevatio 10 MG/12.5ML SOLNRevlimid 15 MG CAPSRevlimid 20 MG CAPSRevlimid 25 MG CAPSRevlimid 10 MG - CAPS 10 MG CAPSRevlimid 15 MG - CAPS 200 MG CAPSRevlimid 2.5 MG - CAPS 2.5 MG CAPSRevlimid 25 MG - CAPS 300 MG CAPSRevlimid 5 MG - CAPS 5 MG CAPSReyataz 150 MG - CAPS 150 MG CAPSReyataz 200 MG - CAPS 200 MG CAPSReyataz 300 MG - CAPS 300 MG CAPSReyataz 50 MG - PACK 50 MG PACKRhoGAM Ultra-Filtered Plus 1500 UNIT SOSYRhophylac 1500 UNIT/2ML SOSYRiaSTAP SOLRRibasphere 200 MG CAPSRibasphere 200 MG TABSRibasphere RibaPak 400 MG - TABS 400 MG TABSRibasphere RibaPak 600 MG - TABS 600 MG TABSRibavirin 200 MG CAPSRibavirin 200 MG TABSRibavirin 6 GM SOLRRisperDAL Consta 12.5 MG 12.5 MG SUSRRisperDAL Consta 25 MG 25 MG SUSRRisperDAL Consta 37.5 MG 37.5 MG SUSRRisperDAL Consta 50 MG 50 MG SUSRRituxan 100 MG/10ML - SOLN 100 MG/10ML SOLNRituxan 500 MG/50ML - SOLN 500 MG/50ML SOLNRituxan Hycela 1400-23400 MG - SOLNRituxan Hycela 1600-26800 MG - SOLNRUBRACA 200 MG TABSRUBRACA 250 MG TABSRUBRACA 300 MG TABSRuconest 2100 UNIT SOLRRyanodex 250 MG SUSRSabril 500 MG TABSSabril 500 MG PACKSaizen 5 MG SOLR

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Specialty Drug ListingExecuted: 1/15/2019

Saizen 8.8 MG SOLRSaizen Click.Easy 8.8 MG SOLRSamsca 15 MG TABSSamsca 30 MG TABSSancuso 3.1 MG/24HR 3.1 MG/24HR PTCHSandIMMUNE 25 MG CAPSSandIMMUNE 100 MG CAPSSandIMMUNE 50 MG/ML SOLNSandIMMUNE 100 MG/ML SOLNSandoSTATIN 100 MCG/ML SOLNSandoSTATIN 200 MCG/ML SOLNSandostatin 1000mcg 1000 MCG/ML SOLNSandostatin 500mcg 500 MCG/ML SOLNSandostatin 50mcg 50 MCG/ML SOLNSandostatin Lar Depot 10mg 10 MG KITSandostatin Lar Depot 20mg 20 MG KITSandoSTATIN LAR Depot 30 mg 30 MG KITSculptra 367.5 MG SUSRSelzentry 150 MG - TABS 150 MG TABSSelzentry 300 MG - TABS 300 MG TABS

Sensipar 30 MG - TABS 30 MG TABS

Sensipar 60 MG - TABS 60 MG TABS

Sensipar 90 MG - TABS 90 MG TABS

Serophene 50 MG TABSSerostim 4 MG - SOLR 4 MG SOLRSerostim 5 MG - SOLR 5 MG SOLRSerostim 6 MG - SOLR 6 MG SOLRShellgel 12 MG/ML SOLNSignifor 0.3 MG/ML SOLNSignifor 0.6 MG/ML SOLNSignifor 0.9 MG/ML SOLNSignifor LAR 20 MG SRERSignifor LAR 40 MG SRERSignifor LAR 60 MG SRERSildenafil Citrate 20 MG TABSSildenafil Citrate 10 MG/12.5ML SOLNSiliq 210 MG/1.5ML SOSYSimponi 100 MG/ML 100 MG/ML SOSYSimponi 50 MG/0.5ML 50 MG/0.5ML SOAJSimponi 50 MG/0.5ML 50 MG/0.5ML SOSYSimponi Aria 100 MG/ML 100 MG/ML SOAJ

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Specialty Drug ListingExecuted: 1/15/2019

Simponi Aria 50 MG/4ML 50 MG/4ML SOLNSimulect 10 MG SOLRSimulect 20 MG SOLRSirolimus 0.5 MG TABSSirolimus 1 MG TABSSirolimus 2 MG TABSSitavig 50 MG TABSSivextro 200 MG SOLRSkyla 13.5 MG IUDSod Hyaluronate-Lidocaine PF 20-1 MG/2ML-% SOSYSod Hyaluronate-Lidocaine PF 30-1 MG/2ML-% SOSYSod Hyaluronate-Lidocaine PF 60-2 MG/3ML-% SOSYSodium Edecrin 50 MG SOLRSolesta 50-15 MG/ML GELSoliris 10 MG/ML SOLNSomatuline Depot 60 MG/0.2ML SOLNSomatuline Depot 90 MG/0.3ML SOLNSomatuline Depot 120 MG/0.5ML SOLNSomavert 10 MG SOLRSomavert 15 MG SOLRSomavert 20 MG SOLRSomavert 25 MG SOLRSomavert 30 MG SOLRSovaldi 400 MG - TABS 400 MG TABSSpinraza 12 MG/5ML SOLNSprix 15.75 MG/SPRAY SOLNSprycel 100 MG - TABS 100 MG TABSSprycel 140 MG - TABS 140 MG TABSSprycel 20 MG - TABS 20 MG TABSSprycel 50 MG - TABS 50 MG TABSSprycel 70 MG - TABS 70 MG TABSSprycel 80 MG - TABS 80 MG TABSStavudine 15 MG CAPSStavudine 20 MG CAPSStavudine 30 MG CAPSStavudine 40 MG CAPSStavudine 1 MG/ML SOLRStelara 130 MG/26ML SOLNStelara 45 MG/0.5ML SOLNStelara 45 MG/0.5ML 45 MG/0.5ML SOSYStelara 90 MG/ML 90 MG/ML SOSYSterile Diluent Flolan pH 12 SOLNSterile Diluent for Flolan SOLNSterile Diluent/Epoprostenol SOLNStimate 1.5 MG/ML - SOLN 1.5 MG/ML SOLN

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Specialty Drug ListingExecuted: 1/15/2019

Stivarga 40mg 40 MG TABSSTODAX - Istodax 10 MG 10 MG SOLRStrensiq 18 MG/0.45ML SOLNStrensiq 28 MG/0.7ML SOLNStrensiq 40 MG/ML SOLNStrensiq 80 MG/0.8ML SOLNStribild 150-150-200-300 MG 150-150-200-300 TABSSublocade 100MG/0.5 ML SOSYSublocade 300 MG/1.5 ML SOSYSucraid 8500 UNIT/ML SOLNSUMAtriptan Succinate 6 MG/0.5ML SOLNSUMAtriptan Succinate 4 MG/0.5ML SOAJSUMAtriptan Succinate 6 MG/0.5ML SOAJSupartz 25 MG/2.5ML SOSYSupartz FX 25 MG/2.5ML SOSYSupprelin LA 50 MG - KIT 50 MG KITSustiva 200 MG - CAPS 200 MG CAPSSustiva 50 MG - CAPS 50 MG CAPSSustiva 600 MG - TABS 600 MG TABSSutent 12.5 MG - CAPS 12.5 MG CAPSSutent 25 MG - CAPS 25 MG CAPSSutent 37.5 MG - CAPS 37.5 MG CAPSSutent 50 MG - CAPS 50 MG CAPSSylatron 200 MCG KITSylatron 300 MCG KITSylatron 600 MCG KITSylatron 4 X 200 MCG KITSylatron 4 X 300 MCG KITSylvant 100 MG SOLRSylvant 400 MG SOLRSymtuza 800-150-200-10 TABSSynagis 100 MG/ML 100 MG/ML SOLNSynagis 50 MG/0.5ML 50 MG/0.5ML SOLNSynarel 2 MG/ML SOLNSynribo 3.5 MG SOLRSynvisc 16 MG/2ML 16 MG/2ML SOSYSynvisc One 48 MG/6ML 48 MG/6ML SOSYSyprine 250 MG CAPSTacrolimus 0.0003 Unit OINTTacrolimus 0.001 Unit OINTTafinlar 50 MG - CAPS 50 MG CAPSTafinlar 75 MG - CAPS 75 MG CAPSTaltz 80 MG/ML 80 MG/ML SOAJTaltz 80mg 80 MG/ML SOSYTarceva 100 MG - TABS 100 MG TABS

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Specialty Drug ListingExecuted: 1/15/2019

Tarceva 150 MG - TABS 150 MG TABSTarceva 25 MG - TABS 25 MG TABSTargretin Capsules 75 MG CAPSTargretin Gel 0.01 Unit GELTasigna 150 MG - CAPS 150 MG CAPSTasigna 200 MG - CAPS 200 MG CAPSTaxotere 20 MG/ML CONCTaxotere 80 MG/4ML CONCTecentriq 1200 MG/20ML SOLNTecfidera 120 & 240 MG 120 & 240 MG MISCTecfidera 120 MG - 120 MG CPDRTecfidera 240 MG 240 MG CPDRTechnivie 12.5-75-50 MG TABSTemodar 5 MG CAPSTemodar 20 MG CAPSTemodar 100 MG CAPSTemodar 140 MG CAPSTemodar 180 MG CAPSTemodar 250 MG CAPSTemodar 100 MG SOLRTemozolomide 5 MG CAPSTemozolomide 20 MG CAPSTemozolomide 100 MG CAPSTemozolomide 140 MG CAPSTemozolomide 180 MG CAPSTemozolomide 250 MG CAPSTeniposide 10 MG/ML SOLNTestopel 75 MG PLLTTetrabenazine 12.5 MG TABSTetrabenazine 25 MG TABSTev-Tropin 5 MG SOLRThalomid 150 MG CAPSThalomid 100 MG - CAPS 100 MG CAPSThalomid 200 MG - CAPS 200 MG CAPSThalomid 50 MG - CAPS 50 MG CAPSTheraCys 81 MG/VIAL SUSRTHIOLA 100 MG TABSThiotepa 15 MG SOLRThrombate III 500 UNIT SOLRThrombate III 1000 UNIT SOLRThymoglobulin 25 MG SOLRThyrogen 1.1 MG SOLRTibsovo 250 MG TABSTice BCG 50 MG SUSRTikosyn 250 MCG CAPS

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Specialty Drug ListingExecuted: 1/15/2019

Tikosyn 125 MCG - CAPS 125 MCG CAPSTikosyn 500 MCG - CAPS 500 MCG CAPSTivicay 50 MG - TABS 50 MG TABSTobi 300 MG/5ML NEBUTobi Podhaler 28 MG CAPSTobramycin 300 MG/5ML NEBUTobramycin Pak 300 MG/5ML NEBUToposar 100 MG/5ML SOLNToposar 500 MG/25ML SOLNToposar 1 GM/50ML SOLNTopotecan HCl 4 MG/4ML SOLNTopotecan HCl 4 MG SOLRTorisel 25 MG/ML SOLNTotect 500 MG SOLRTracleer 62.5 MG TABSTracleer 125 MG TABSTracleer 32 MG TBSOTranexamic Acid 1000 MG/10ML SOLNTreanda 100 MG 100 MG SOLRTreanda 180 MG/2ML - SOLN 180 MG/2ML SOLNTreanda 25 MG 25 MG SOLRTreanda 45 MG/0.5ML - SOLN 45 MG/0.5ML SOLNTrelstar 11.25 MG - SUSR 11.25 MG SUSRTrelstar 22.5 MG - SUSR 22.5 MG SUSRTrelstar 3.75 MG - SUSR 3.75 MG SUSRTremfya 100 MG/MLTretinoin 10 MG CAPSTretten 2000-3125 UNIT SOLRTrisenox 10 MG/10ML SOLNTriumeq 600-50-300 MG - TABS 600-50-300 MG TABSTrizivir 300-150-300 MG - TABS 300-150-300 MG TABSTruvada 200-300 MG - TABS 200-300 MG TABSTybost 150 MG - TABS 150 MG TABSTykerb 250 MG - TABS 250 MG TABSTysabri 300 MG/15ML 300 MG/15ML CONCTyvaso 0.6 MG/ML SOLNTyzeka 600 MG - TABS 600 MG TABSUltresa 13800 UNIT CPEPUltresa 20700 UNIT CPEPUltresa 23000 UNIT CPEPUnituxin 17.5 MG/5ML SOLNUptravi 200 MCG TABSUptravi 400 MCG TABSUptravi 600 MCG TABSUptravi 800 MCG TABS

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Specialty Drug ListingExecuted: 1/15/2019

Uptravi 1000 MCG TABSUptravi 1200 MCG TABSUptravi 1400 MCG TABSUptravi 1600 MCG TABSUptravi 200 & 800 MCG TBPKUvadex 20 MCG/ML SOLNValchlor Gel 0.016 % GELValcyte 450 MG - TABS 450 MG TABSValcyte 50 MG/ML 50 MG/ML SOLRValstar 40 MG/ML SOLNVandetanib 100 MG TABSVandetanib 300 MG TABSVantas 50 MG KITVARITHENAVarithena 180 MG/18ML FOAMVariZIG 125 UNIT/1.2ML SOLNVariZIG 125 UNIT SOLRVarubi 90 MG TABSVarubi 166.5MG/92.5 ML EMULVECAMYL 2.5 MG TABSVectibix 100 MG/5ML - SOLN 100 MG/5ML SOLNVectibix 400 MG/20ML - SOLN 400 MG/20ML SOLNVelcade 3.5 MG SOLRVeletri 0.5 MG SOLRVeletri 1.5 MG SOLRVeltassa 8.4 GM PACKVeltassa 16.8 GM PACKVeltassa 25.2 GM PACKVemlidy 25 MG TABSVentavis 10 MCG/ML SOLNVentavis 20 MCG/ML SOLNVerzenio 50 MG TABSVerzenio 100 MG TABSVerzenio 21531010000315 TABSVerzenio 200 MG TABSViberzi 75 MG TABSViberzi 100 MG TABSVictoza 18 MG/3ML - 18 MG/3ML SOPNVictrelis 200 MG CAPSVidaza 100 MG 100 MG SUSRVidex 2 GM SOLRVidex 4 GM SOLRVidex EC 125 MG 125 MG CPDRVidex EC 200 MG 200 MG CPDRVidex EC 250 MG 250 MG CPDR

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Specialty Drug ListingExecuted: 1/15/2019

Videx EC 400 MG 400 MG CPDRViekira Pak 12.5-75-50 &250 MG 12.5-75-50 &250 TBPKViekira XR 200-8.33-50- 33.33 MG 200-8.33-50- TB24VIGABATRINVimizim 5 MG/5ML SOLNVinBLAStine Sulfate 1 MG/ML SOLNVincasar PFS 1 MG/ML SOLNVinCRIStine Sulfate 1 MG/ML SOLNVinorelbine Tartrate 10 MG/ML SOLNVinorelbine Tartrate 50 MG/5ML SOLNViokace 10440 UNIT TABSViokace 20880 UNIT TABSViracept 250 MG TABSViracept 625 MG TABSViramune 200 MG TABSViramune 50 MG/5ML SUSPViramune XR 100 MG TB24Viramune XR 400 MG TB24Virazole 6 GM SOLRViread 150 MG - TABS 150 MG TABSViread 200 MG - TABS 200 MG TABSViread 250 MG - TABS 250 MG TABSViread 300 MG - TABS 300 MG TABSViread 40 MG/GM - POWD 40 MG/GM POWDVisudyne 15 MG SOLRVitekta 150 MG - TABS 150 MG TABSVitekta 85 MG - TABS 85 MG TABSVivitrol 380 MG SUSRVolumex 25 MCCI/ML SOSYVonvendi 650 UNIT SOLRVonvendi 1300 UNIT SOLRVoraxaze 1000 UNIT SOLRVotrient 200 MG - TABS 200 MG TABSVpriv 400 UNIT SOLRWilate 500-500 UNIT SOLRWilate 1000-1000 UNIT SOLRWilate 500-500 UNIT KITWilate 1000-1000 UNIT KITWinRho SDF 2500 UNIT/2.2ML SOLNWinRho SDF 5000 UNIT/4.4ML SOLNWinRho SDF 1500 UNIT/1.3ML SOLNWinRho SDF 15000 UNIT/13ML SOLNXalkori 200 MG - CAPS 200 MG CAPSXalkori 250 MG - CAPS 250 MG CAPSXarelto 10 MG TABS

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Specialty Drug ListingExecuted: 1/15/2019

Xarelto 15 MG - TABS 15 MG TABSXarelto 20 MG - TABS 20 MG TABSXeljanz 5 MG - TABS 5 MG TABSXeljanz XR 11 MG - TB24 11 MG TB24Xenazine 12.5 MG TABSXenazine 25 MG TABSXeomin 50 UNIT SOLRXeomin 100 UNIT SOLRXeomin 200 UNIT SOLRXermelo 250 MG TABSXgeva 120 MG/1.7ML - SOLN 120 MG/1.7ML SOLNXIAFLEX 0.9 MG SOLRXiaflex 150 MG SOLRXifaxan 200 MG - TABS 200 MG TABSXifaxan 550 MG - TABS 550 MG TABSXofigo 30 MCCI/ML SOLN

Xolair 150 MG 150 MG SOLRXtandi 40mg 40 MG CAPSXyntha 250 UNIT KITXyntha 500 UNIT KITXyntha 1000 UNIT KITXyntha 2000 UNIT KITXyntha Solofuse 250 UNIT KITXyntha Solofuse 500 UNIT KITXyntha Solofuse 1000 UNIT KITXyntha Solofuse 2000 UNIT KITXyntha Solofuse 3000 UNIT KITXyrem 500 MG/ML SOLNXyrem (CIII) 240 MG TABSYervoy 50 MG/10ML SOLNYervoy 200MG/40ML SOLNYondelis 1 MG SOLRZaltrap 100 MG/4ML SOLNZaltrap 200 MG/8ML - SOLN 200 MG/8ML SOLNZanosar 1 GM SOLRZarxio 300 MCG/0.5ML SOSYZarxio 480 MCG/0.8ML SOSYZavesca 100 MG CAPSZecuity 6.5 MG/4HR - PTCH 6.5 MG/4HR PTCHZelboraf 240 MG - TABS 240 MG TABSZemaira 1000 MG SOLRZEMBRACE SYMTOUCH 3 MG/0.5 ML 3 MG/0.5ML SOAJZemplar 2 MCG/ML SOLNZemplar 5 MCG/ML SOLN

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Specialty Drug ListingExecuted: 1/15/2019

Zenatane 10 MG CAPSZenatane 20 MG CAPSZenatane 30 MG CAPSZenatane 40 MG CAPSZenpep 10000 UNIT - CPEP 10000 UNIT CPEPZenpep 5000 UNIT - CPEP 5000 UNIT CPEPZepatier 50-100 MG - TABS 50-100 MG TABSZerit 15 MG CAPSZerit 20 MG CAPSZerit 30 MG CAPSZerit 40 MG CAPSZerit 1 MG/ML SOLRZevalin Y-90 3.2 MG/2ML KITZiagen 300 MG TABSZiagen 20 MG/ML SOLNZidovudine 100 MG CAPSZidovudine 300 MG TABSZidovudine 50 MG/5ML SYRPZILRETTA 32 MGZinbryta 150 MG/ML SOSYZinecard 250 MG SOLRZinecard 500 MG SOLRZoladex 3.6 MG IMPLZoladex 10.8 MG IMPLZoledronic Acid 4 MG/5ML CONCZoledronic Acid 4 MG/100ML SOLNZoledronic Acid 5 MG/100ML SOLNZoledronic Acid 4 MG SOLRZolinza 100 MG - CAPS 100 MG CAPSZomacton 5 MG SOLRZometa 4 MG/5ML CONCZometa 4 MG/100ML SOLNZorbtive 8.8 MG SOLRZortress 0.25 MG TABSZortress 0.5 MG TABSZortress 0.75 MG TABSZyflo 600 MG TABSZyflo CR 600 MG - TB12 600 MG TB12Zykadia 150 MG - CAPS 150 MG CAPSZynbrynta 150 MG/ML SOSYZyPREXA 10 MG SOLRZyPREXA Relprevv 210 MG SUSRZyPREXA Relprevv 300 MG SUSRZyPREXA Relprevv 405 MG SUSRZytiga 250 MG - TABS 250 MG TABS

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Specialty Drug ListingExecuted: 1/15/2019

Zytiga 500mg 500 MG TABSZyvox 600 MG TABSZyvox 100MG/5ML SUSRZyvox 600 MG/100 ML SOLNZyvox 600 MG/300 ML SOLNZyvox 600 MG/300 ML SOLN