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OptumRx | optumrx.com
BriovaRx®, the OptumRx® specialty pharmacy, provides comprehensive support services, including access to pharmacists around the clock, for high-cost oral and injectable medications used to treat rare and complex conditions. In addition, your medications will be shipped to you at no extra cost.
Specialty pharmacy drug list
Effective January 1, 2017
Characteristics of specialty medications
“Specialty” medications are defined as high-cost oral or injectable medications used to treat rare and complex conditions. These are highly complex medications, typically biology-based, that structurally mimic compounds found within the body. Medications must have at least one of the following characteristics in order to be classified as a specialty medication by BriovaRx:
High cost• Typically priced at more than $1,000 per 30-day supply.
High complexity• Biotechnology products†
• Medications that treat ultra rare conditions
• Medications that are included in a specialty therapeutic drug class strategy
High-touch medications that require:• Temperature control or other special handling and shipping requirements
(e.g., refrigerated or frozen shipping)
• Ongoing management by a pharmacist and/or physician specializing in treating the condition
• Focused, in-depth education including how to administer injections, adhere to the treatment protocol, and manage side effects
† Protein or protein-based molecular entities
Specialty pharmacy drug list
Specialty pharmacy drug list
Alpha-1
Glassia PA
Ammonia detoxicants
Ravicti PA
Antilipemic agents
Juxtapid PA
Kynamro PA
Repatha PA, ST
Antiviral
ActimmuneAdefov DipivAlferon NBaracludeCopegus PA
Daklinza PA, ST
Epclusa PA, ST
HepseraInfergen PA
Intron-A PA
Olysio PA, ST * Pegasys PA *
Peg-Intron PA Rebetol PA Ribapak PA Ribasphere PA Ribatab PA Ribavirin PA * Sovaldi PA, ST * Synagis PA
Tyzeka Victrelis PA, ST
Viekira XR PA
Zepatier PA
Asthma
Xolair PA
Birth control
Implanon Mirena Nexplanon
Cancer
Abraxane
Adcetris PA Adriamyc Adriamycin Adrucil Afinitor PA Afinitor Dis PA Alecensa PA Alimta Alkeran Amifostine Arranon Arzerra PA
Avastin Azacitidine Bendeka Bicnu
Bleomycin Bosulif ST Busulfex Cabometyx PA
Camptosar
Capecitabine Caprelsa PA Carboplatin Cerubidine Cisplatin Cladribine Clolar Cometriq PA Cosmegen Cyclophosph Cyclophospha Cytarabine Dacarbazine Dacogen PA Dactinomycin Daunorubicin Daunoxome Decitabine PA Dexrazoxane Docefrez Docetaxel Doxil Doxorubicin Eligard PA, ST Ellence Eloxatin Elspar Epirubicin Erbitux PA
Erivedge PA
ErwinazeEthyolEtopophosEtoposideEvomela FaslodexFirmagon PA
FloxuridineFludara
FludarabineFluorouracilFolotyn PA
FusilevGablofenGemcitabineGemzarGilotrif PA
Gleevec PA *
Halaven PA
Herceptin PA
HycamtinIclusig PA, ST
Idamycin PFSIdarubicinIfexIfosfamideInlyta PA
IrinotecanIstodax PA
Ixempra KitJakafi PA
Jevtana PA
Kadcyla PA
KepivanceKyprolis PA
Lenvima PA
Leuprolide PA
LipodoxLipodox 50Lupaneta Kit PA
Lupr Dep-Ped PA *
Lupron Depot PA *
MarqiboMekinist PA
MelphalanMercaptopuriMesnaMesnex
3PA – Prior authorization required • ST – Step therapy • * – Preferred
Harvoni PA
Aniparasite
Daraprim
Bleo 15K
4 OptumRx | optumrx.com
Specialty pharmacy drug list
Specialty pharmacy drug list
MitomycinMitomycin CMitoxantron PA
MustargenNavelbineNexavar PA
NipentOncasparOxaliplatinPaclitaxelPamidronatePentostatinPerjeta PA
PhotofrinPomalyst PA
Portrazza PA
ProleukinprovengeRevlimid PA
Rituxan PA, ST
Sprycel PA, ST
Stivarga PA
Supprelin LASutent PA
Sylatron PA
Synribo PA
Tafinlar PA
Tarceva PA
Targretin PA
Tasigna PA, ST *
TaxotereTecentriq PA
Temodar PA
Temozolomide PA
TeniposideThalomid PA
TheracysThiotepaTice BcgToposarTopotecanToriselTotectTreanda PA
Trelstar LA ST
Trelstar Mix ST
TretinoinTrisenoxTykerb PA
Vantas ST
VectibixVelcade PA
Venclexta PA
VidazaVinblastineVincasar PFSVincristineVinorelbineVotrient PA
Xalkori PA
XelodaXgeva PA
Xtandi PA, ST
Yervoy PA
Zaltrap PA
ZanosarZelboraf PA
ZevalinZinecardZoladex *
Zolinza PA
Zytiga PA
Chemotherapy Protectant
Xuriden PA
Enzyme replacement/modifiersCarbaglu Kanuma PA
Orfadin
Enzyme therapy
AdagenAldurazyme PA
Aralast NP PA
Cerezyme PA
Elaprase PA
Elelyso PA
Fabrazyme PA
KuvanKuvan PowderLumizyme PA
Myozyme PA
Naglazyme PA
ProcysbiProlastin-C PA
Vimizim InjVpriv PA
Zavesca PA
Zemaira PA
Gastrointestinal agents
Gattex PA
Ocaliva PA SolestaSucraid
Gout
Krystexxa PA
Growth hormone
Genotropin PA, ST
Humatrope PA, ST
Increlex PA
Norditropin PA, ST
Nutropin PA, ST *
Nutropin AQ PA, ST *
Omnitrope PA, ST
Saizen PA, ST *
Serostim PA
Tev-Tropin PA, ST *
Zorbtive PA
Hematological agents
AdvateAlphanateAlphanine SDAranesp PA *
AfstylaBebulinBebulin VHBenefixBerinert PA
Cinryze PA
CorifactEpogen PA
Feiba NFFeiba VHFirazyr PA
IdelvionHelixate FSHemofil M
5
Humate-PKalbitor PA
Koate-DVIKogenate FSLeukine PA
Monoclate-PMononineMozobil PA
Neulasta PA
Neumega PA
Neupogen PA
Novoseven RTNplate PA
Omontys PA
Procrit PA *
ProfilninePromacta PA
RecombinateRixubisTretten InjWilateXynthaXyntha Solof
Hemophilia
Afstyla Vonvendi
HIV
Abacavir *
Aptivus *
Atripla *
Combivir
Complera *
Crixivan *
Didanosine *
Descovy Edurant *
Egrifta PA
Emtriva *
EpivirEpivir HBV *
Epzicom *
FuzeonIntelence *
Invirase *
Isentress *
Kaletra *
Lamivud/Zido *
Lamivudine *
Lexiva *
Nevirapine *
Norvir *
OdefseyPrezista *
Rescriptor *
RetrovirReyataz *
Selzentry PA *
Stavudine *
Stribild *
Sustiva *
Tivicay *
TrizivirTruvada *
Videx *
Videx EC
Viracept *
ViramuneViramune XRViread *
ZeritZiagenZidovudine *
Hormones and hormone modifiers
Acthar HP PA
ActhrelOctreotide PA
SamscaSandostatin PA
SensiparSignifor PA
Somatuline PA
Somavert PA
Thyrogen
Huntington’s disease
Xenazine PA
Immune globulin
AtgamBivigam PA
Carimune NF PA
CytogamFlebogamma PA
Gamastan S/D PA
Gammagard PA
Gammagard SD PA
Gammaked PA
Gammaplex PA
Gamunex-C PA
Hizentra PA
Hyperrab S/DHyperrho S/DImogam RabieMicrhogam PLOctagam PA
Privigen PA
Rhogam PlusRhophylacSolirisWinrho SDF
Immunomodulator
Benlysta PA
Infertility
Bravelle PA, ST
CetrotideChor Gonadot PA
Delalutin PA
Follistim AQ PA , ST *
Ganirelix ACGonal-f PA, ST *
Gonal-f RFF PA, ST *
Makena PA *
Menopur PA
Novarel PA
OvidrelPregnyl PA *
Repronex PA
PA – Prior authorization required • ST – Step therapy • * – Preferred
Inflammatory conditions
Actemra PA, ST
Arcalyst PA
Cimzia PA, ST *
Cimzia Prefl PA, ST *
Enbrel PA, ST
Enbrel Srclk PA, ST
Humira PA, ST *
Humira Pen PA, ST *
Ilaris PA
Kineret PA, ST
Orencia PA, ST
Otrexup Injection PA Remicade PA
Simponi PA, ST *
Stelara PA, ST *
Taltz PA, ST
Xeljanz PA, ST
Xeljanz XR PA, ST
Iron overload
ExjadeFerriprox PA
Multiple sclerosis
Ampyra PA *
Aubagio PA, ST
Avonex PA, ST *
Avonex Pen PA, ST *
Avonex Prefl PA, ST *
Betaseron PA, ST *
Copaxone PA, ST *
Extavia PA, ST
Gilenya PA, ST
Rebif PA, ST
Rebif Rebido PA
Rebif Titrtn PA
Tecfidera PA, ST *
Tysabri PA
Zinbryta PA, ST
Musculoskeletal agents
Botox PA
Dysport PA
Myobloc PA
Xeomin PA
XiaflexZoledronicZometa
Narcolepsy
Xyrem PA
Ophthalmic agents
Cystaran PA
EyleaJetreaLucentisMacugenVisudyne
Osteoarthritis
Euflexxa PA
Gelsyn-3 PA
Gel-One PA, ST
Hyalgan PA, ST
Hymovis PA
Orthovisc PA
Supartz PA, ST
Synvisc PA *
Synvisc One PA *
Osteoporosis
Forteo PA *
Prolia PA
Reclast
Pain management
PrialtQutenza
6 OptumRx | optumrx.com
Specialty pharmacy drug list
Specialty pharmacy drug list
Parkinson’s disease
Apokyn PA
Pregnancy
Makena
Pulmonary hypertension
Adcirca PA
Epoprostenol PA
Flolan PA
Letairis PA *
Opsumit PA Remodulin PA
Revatio PA
Sildenafil PA
Tracleer PA *
Tyvaso PA
Tyvaso Refil PA
Tyvaso Start PA
Uptravi PA
Veletri PA
Ventavis PA
Recombinant Human Leptin Analog
Alprolix
Respiratory agents
Bethkis Neb ST Cayston PA
Cinqair PA Kalydeco PA
PulmozymeTobi ST
Tobi Podhalr ST Tobramycin Neb ST
Substance abuse treatment agents
Vivitrol PA
Transplant
Astagraf XLCellceptCellcept IVCyclosporine *
GengrafHecoriaMycophenolate *
MyforticNeoralNulojix PA
PrografRapamuneSandimmuneSirolimus Tabs TacrolimusZortress PA
7PA – Prior authorization required • ST – Step therapy • * – Preferred
About OptumRx
OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. BriovaRx is our specialty pharmacy. Our high-quality, integrated services deliver optimal member outcomes, superior savings and outstanding customer service. We are an OptumTM company — a leading provider of integrated health services. Learn more at optum.com.
To fill a prescription for a specialty medication on this list, please call 1-866-218-7398 or visit optumrx.com.
This specialty pharmacy drug list may not be a complete representation of all available specialty medications; this list is subject to change at any time without prior notice.
Non-specialty alternatives may be a recommended first-line therapy to treat your condition. Please consult your physician.
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Specialty Pharmacy Drug List