Specialty Medications List 2021
SPECIALTY MEDICATIONSEffective July 1, 2021Specialty medications are treated differently because they require special handling and often areassociated with more complex dosing or need extra treatment support, and are typically moreexpensive.Our specialty pharmacy partner is here to support you with the care and medications you need everystep of the way. The list of medications provided below includes those medication that are part of ourSpecialty Patient Care Program.If you are approved to start or are already taking a specialty medication on this list you can sign up forthe Specialty Patient Care Program to receive complimentary treatment support: A Patient Care Specialist will reach out to you to coordinate support. Reimbursement specialists, clinical pharmacists, dietitians, and other care support professionalsare available as appropriate to meet your needs. Shipments of your medication will be scheduled to be delivered to your door at a time that worksfor you.How do I get my Specialty Patient Care Program Started?Call (206) 413-9371 to connect with our Specialty Patient CareProgram delivered by our Specialty Pharmacy partner.Note: Some specialty medications are only available through a small number of pharmacies. If themedication you need cannot be provided through Amber Pharmacy, an Amber Pharmacy Patient CareSpecialty will assist in transferring the prescription to the correct specialty pharmacy.Approval Requirements for Specialty MedicationsAll specialty medications require a prior authorization review by Prescryptive before these medicationscan be dispensed and your Specialty Patient Care Program can get started. Only a written approval willguarantee coverage of medications requiring prior authorization.How Do I Get a Prior Authorization Review Started?To initiate prior authorization, your health care provider needs to initiate the request by downloadingand filling out the Prior Authorization Request Form found at www.prescryptive.com/prescriber.Your prior authorization review will be initiated once the form is faxed into our secure system. 2021 PRESCRYPTIVE. ALL RIGHTS RESERVED.2021.03pg. 1www.prescryptive.com
SPECIALTY MEDICATION REFERENCE LISTBelow is a list of specialty medications covered by your plan after a prior authorization review. Quantitylimits may also apply. This list is intended only as a guide to coverage. We encourage you to talk toyour doctor about all your treatment options.Your benefit plan may have a different co-pay or co-insurance coverage for specialty medications. Tolearn more about your benefit plan coverage, check your specific plan documents available by loggingin to your member portal at www.prescryptive.com/member.Tier LevelDescriptionGeneric Specialty MedicationsGeneric drugs are listed in bolded italics.Preferred Specialty MedicationsPreferred brand drugs are listed in bold.Non-preferred Specialty MedicationsNon-preferred drugs are listed without bold.* (asterisk following a drug name)Indicates drug not available through Amber Pharmacy.Amber will assist in transferring the prescription to anin-network pharmacy provider.Please note: Pharmacy products and services covered by a plan member’s benefit plan may changefrom time to time. Some products and services may not be covered under a specific member’s plandesign. The information provided here is for general information purposes only and does not guaranteecoverage. Some pharmacy products and services require prior authorization before they are covered.Only a written prior authorization approval will guarantee coverage for such products and services. Toensure coverage, members should reference their specific plan documents at www.prescryptive.comor contact Prescryptive Member Services at the phone number on their member ID temraadefovir dipivoxilAdempas *AfinitorAlecensaAlferon NAlunbrig *ambrisentan *Anadrol-50Generic PreferredNon-PreferredGeneric rredGeneric PreferredPreferredApokyn *AranespArcalyst *ArikayceAubagio -PreferredPreferredPreferred 2021 PRESCRYPTIVE. ALL RIGHTS RESERVED.2021.03pg. 2www.prescryptive.com
MedicationStatusMedicationStatusBafiertam *Balversa *BenlystaBetaseronbexarotenebosentanBosulif *Braftovi *Brukinsa *BynfeziaCabometyx *Calquence *CaprelsaCarbaglu *Cayston *Cerdelga ra *CosentyxCotellicCresembaCrysvita *CystadaneCystadropsCystagonCystaran *DaklinzaDaurismo *Deferasiroxdeferiprone *dimethyl fumarateDojolvi *Doptelet PreferredGeneric PreferredGeneric redPreferredPreferredPreferredNon-PreferredGeneric redNon-PreferredPreferredGeneric PreferredGeneric PreferredGeneric entEgrifta, SV *ElmironEmcytEmflazaEmpaveliEnbrelEndari tinibEsbriet *etoposideEvenity *Evrysdi Firdapse *ForteoFotivdaFulphilaGalafold *Gattex *GavretoGenotropinGilenyaGilotrif *GimotiglatiramerGeneric redPreferredPreferredPreferredPreferredGeneric PreferredPreferredGeneric PreferredPreferredPreferredNon-PreferredGeneric dPreferredPreferredGeneric Preferred 2021 PRESCRYPTIVE. ALL RIGHTS RESERVED.2021.03pg. 3www.prescryptive.com
rda ric eneric gesteronecaproateIbrance *icatibantIclusigIdhifa *Ilaris *IlumyaImbruvica *ImcivreeInbrija *Increlex *IngrezzaInlyta *Inqovi *InrebicIntron AIressa *Isturisa *JakafiJuxtapid *Jynarque *Kalydeco *KesimptaKeveyisKevzaraKineretKisqaliKitabis *KorlymGeneric PreferredPreferredGeneric ferredNon-PreferredNon-PreferredPreferredGeneric PreferredPreferredKoselugo *Kynmobi *lapatinibledipasvir-sofosbuvirLenvimaLetairis *LeukineLokelmaLonsurf *Lorbrena *LucemyraLumakrasLupkynisLynparza *LysodrenMakenaMatulane *MavencladMavyretMayzentMekinistMektovi lpletaMyalept *MycapssaMyfembreeNatpara *Nerlynx *NeulastaNeupogenNexavar *NinlaronitisinonePreferredPreferredGeneric PreferredPreferredPreferredGeneric eferredPreferredGeneric PreferredGeneric redNon-PreferredPreferredPreferredGeneric Preferred 2021 PRESCRYPTIVE. ALL RIGHTS RESERVED.2021.03pg. 4www.prescryptive.com
MedicationStatusMedicationStatusNityr *NivestymNorditropinNorthera *Nourianz *NoxafilNplateNubeqa *NucalaNuedextaNuplazid *Nutropin AQNyvepriaOcaliva *octreotideOdomzoOfev *OlumiantOmn
to connect with our Specialty Patient Care Program delivered by our Specialty Pharmacy partner. Note: Some specialty medications are only available through a small number of pharmacies. If the . Forteo Preferred
For most BCBSAZ members, specialty copay tiers (A, B, C, or D) apply. Tier Description A Specialty Medications, Low Cost Share B Specialty Medications, Moderate Cost Share C Specialty Medications, Moderately High Cost Share D Specialty Medications, Highest Cost Share Plans may include specialty medications at varying cost share tiers. Questions?
About one quarter of total pharmaceutical spending in the commercial market is devoted to specialty medications. 3. If current trends hold, spending on specialty medications may comprise half of all pharmaceutical spending by 2018 for commercial health care plans. 4. These trends have invited the scrutiny of plan sponsors.
Generic medications contain the same active ingredients (what makes the medication work) as brand-name medications, but they often cost less. Once the patent of a brand-name medication ends, the FDA can approve a generic version with the same active ingredients. These types of medications are known as generic medications.
Specialty Patient Care Program. If you are approved to start or are already taking a specialty medication on this list you can sign up for the Specialty Patient Care Program to receive complimentary treatment
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"Specialty contractor" is defined in AS 08.18.171(9). The following specialty contractor trades are the trades recognized by the department for the purposes of specialty contractor registration under AS 08.18.021, and are the trade designations that will appear on a specialty contractor certificate of registration issued by the department:
Doctor. PRN medications are taken “as needed” to treat a specific symptom. PRN medications include both prescription and over-the-counter medications. PRN medications must always be ordered by a doctor. The doctor’s order should include the minimum and maximum number of doses, the
186 References 17. Bonet, J. and Wood, R. D. (1997). Nonlinear continuum mechanics for finite element anal-ysis. Cambridge University Press. 18.
