specialty pharmacy drug list - amazon web services · 2018-01-09 · uc fvc_010518_1 ia (01052018)...

UC FVC_010518_1 IA (01052018) Updated 12/2017 U7486 (01/18)

Specialty Pharmacy Drug List Specialty medicines are usually prescribed by doctors who treat chronic and complex disease. These medications usually require a higher degree of management, are high in cost and are generally not stocked at retail pharmacies. Most specialty medications can be filled at Fairview Specialty Pharmacy for UCare Choices and Fairview UCare Choices members:

• Phone: 612-672-5260 • Fax: 866-347-4939

This list applies to UCare Choices and Fairview UCare Choices only and is updated regularly. Drugs with a Non-Formulary status may be covered under your medical benefit. Please go to uCare.org to review coverage criteria.

DRUG FORMULARY STATUS

ABRAXANE 100 MG VIAL N

ACTEMRA 162 MG/0.9 ML SYRINGE

Y

ACTEMRA 200 MG/10 ML VIAL Y



ACTIMMUNE 100 MCG/0.5 ML VIAL

Y

ADCETRIS 50 MG VIAL N

ADCIRCA 20 MG TABLET Y

ADEFOVIR DIPIVOXIL 10 MG TAB

Y

ADVATE 1,201-1,800 UNIT VIAL

N


N


N

ADVATE 200-400 UNIT VIAL N


N

ADVATE 401-800 UNIT VIAL N

ADVATE 801-1,200 UNIT VIAL N

AFINITOR 10 MG TABLET Y

AFINITOR 2.5 MG TABLET Y

AFINITOR 5 MG TABLET Y

AFINITOR 7.5 MG TABLET Y

AFINITOR DISPERZ 2 MG TABLET

N


N


N

AFSTYLA 1,000 UNIT VIAL N

AFSTYLA 1,500 UNIT RANGE VIAL

N


AFSTYLA 2,500 UNIT RANGE VIAL

N

AFSTYLA 250 UNIT VIAL N


AFSTYLA 500 UNIT VIAL N

ALDURAZYME 2.9 MG/5 ML VIAL

Y

ALECENSA 150 MG CAPSULE Y

ALFERON N 5 MILLION UNITS VIAL

N

ALIMTA 100 MG VIAL Y

ALIMTA 500 MG VIAL Y

ALKERAN 2 MG TABLET N

ALKERAN 50 MG VIAL N

ALPHANATE 1,000-400 UNIT VIAL

N


N


N

ALPHANATE 250-100 UNIT VIAL

N

ALPHANATE 500-200 UNIT VIAL

N

ALPHANINE SD 1,000 UNITS VIAL

N

ALPHANINE SD 1,500 UNITS VIAL

N

ALPHANINE SD 500 UNITS VIAL

N

ARALAST NP 1,000 MG VIAL N

ARALAST NP 500 MG VIAL Y

ARANESP 10 MCG/0.4 ML SYRINGE

Y


Y

ARANESP 100 MCG/ML VIAL Y


Y

ARANESP 150 MCG/0.75 ML VIAL

Y


Y


ARANESP 25 MCG/0.42 ML SYRING

Y



Y



Y


ARANESP 500 MCG/1 ML SYRINGE

Y


Y


ARIXTRA 10 MG/0.8 ML SYRINGE

Y

ARIXTRA 2.5 MG/0.5 ML SYRINGE

N

ARIXTRA 5 MG/0.4 ML SYRINGE

Y

ARIXTRA 7.5 MG/0.6 ML SYRINGE

Y

ARRANON 250 MG/50 ML VIAL N

ARZERRA 1,000 MG/50 ML VIAL

N

ARZERRA 100 MG/5 ML VIAL N

ASTAGRAF XL 0.5 MG CAPSULE

N

ASTAGRAF XL 1 MG CAPSULE N

ASTAGRAF XL 5 MG CAPSULE N

ATGAM 50 MG/ML AMPUL Y

AVASTIN 100 MG/4 ML VIAL Y

AVASTIN 400 MG/16 ML VIAL Y

AVONEX 30 MCG VIAL KIT Y

AVONEX PEN 30 MCG/0.5 ML KIT

Y

AVONEX PREFILLED SYR 30 MCG

Y

AVONEX PREFILLED SYR 30 MCG KT

Y

BARACLUDE 0.05 MG/ML SOLUTION

Y

BARACLUDE 0.5 MG TABLET N

BARACLUDE 1 MG TABLET N

BCG (TICE STRAIN) VIAL N

BCG VACCINE (TICE STRAIN) VIAL

Y

BEBULIN 200-1,200 UNITS VIAL

N

BENEFIX 1,000 UNIT RANGE N


BENEFIX 250 UNIT RANGE N


BENEFIX 500 UNIT RANGE N

BENLYSTA 120 MG VIAL Y

BENLYSTA 200 MG/ML AUTOINJECT

N

BENLYSTA 200 MG/ML SYRINGE

N

BENLYSTA 400 MG VIAL Y

BERINERT 500 UNIT KIT N

BETASERON 0.3 MG KIT Y

BETHKIS 300 MG/4 ML AMPULE

N

BICNU 100 MG VIAL N

BIVIGAM LIQUID 10% VIAL N

BOTOX 100 UNITS VIAL N

BOTOX 200 UNITS VIAL N

BOTOX COSMETIC 100 UNITS VIAL

N

BOTOX COSMETIC 50 UNITS VIAL

N

BRAVELLE 75 UNIT VIAL N

BUSULFEX 60 MG/10 ML VIAL N

CALCIUM FOLINATE 10 MG/ML VIAL

Y

CALCIUM FOLINATE POWDER N

CAMPTOSAR 100 MG/5 ML VIAL

N

CAMPTOSAR 300 MG/15 ML VIAL

N

CAMPTOSAR 40 MG/2 ML VIAL N

CAPECITABINE 150 MG TABLET

N

CAPECITABINE 500 MG TABLET

N

CARIMUNE NF 12 GM VIAL Y

CARIMUNE NF 6 GM VIAL Y

CELLCEPT 200 MG/ML ORAL SUSP

N

CELLCEPT 250 MG CAPSULE N

CELLCEPT 500 MG TABLET N

CELLCEPT 500 MG VIAL N

CEREZYME 400 UNITS VIAL Y

CETROTIDE 0.25 MG KIT N

CIMZIA 200 MG VIAL KIT Y

CIMZIA 200 MG/ML STARTER KIT

Y

CIMZIA 200 MG/ML SYRINGE KIT

Y

CLOLAR 20 MG/20 ML VIAL N

COPAXONE 20 MG/ML SYRINGE

N

COPAXONE 40 MG/ML SYRINGE

N

COPEGUS 200 MG TABLET N

COSENTYX 150 MG/ML PEN INJECT

Y

COSENTYX 150 MG/ML SYRINGE

Y

COSENTYX 300 MG DOSE-2 PENS

Y

COSENTYX 300 MG DOSE-2 SYRINGE

Y

COSMEGEN 0.5 MG VIAL N

CYTOGAM 2.5 GM/50 ML VIAL N

DACOGEN 50 MG VIAL N

DAKLINZA 30 MG TABLET N



DAUNOXOME 50 MG (2 MG/ML) VIAL

N

DDAVP 0.01% NASAL SPRAY N

DDAVP 0.1 MG TABLET N

DDAVP 0.2 MG TABLET N

DDAVP 10 MCG/0.1 ML SOLUTION

N

DDAVP 4 MCG/ML AMPUL N

DDAVP 4 MCG/ML VIAL N

DEPOCYT 50 MG/5 ML VIAL N

DESFERAL 2 GRAM VIAL N

DESFERAL MESYLATE 500 MG VL

N

DOCEFREZ 20 MG VIAL N

DOCEFREZ 80 MG VIAL N

DOXIL 2 MG/ML VIAL N

DUPIXENT 300 MG/2 ML SAFE SYRG

Y

DYSPORT 300 UNIT VIAL Y

DYSPORT 500 UNITS VIAL Y

ELAPRASE 6 MG/3 ML VIAL Y

ELIGARD 22.5 MG SYRINGE KIT

N

ELIGARD 30 MG SYRINGE KIT N

ELIGARD 45 MG SYRINGE KIT N

ELIGARD 7.5 MG SYRINGE KIT N

ELITEK 1.5 MG VIAL Y

ELITEK 7.5 MG VIAL Y

ELLENCE 2 MG/ML VIAL N

ELOCTATE 1,000 UNIT NOMINAL

N


N


N

ELOCTATE 250 UNIT NOMINAL

N


N


N


N


N


N


N

ELOXATIN 100 MG/20 ML VIAL N

ELOXATIN 50 MG/10 ML VIAL N

ELSPAR 10,000 UNITS VIAL N

ENBREL 25 MG KIT Y

ENBREL 25 MG/0.5 ML SYRINGE

Y

ENBREL 50 MG/ML MINI CARTRIDGE

Y

ENBREL 50 MG/ML SURECLICK SYR

Y

ENBREL 50 MG/ML SYRINGE Y

ENTECAVIR 0.5 MG TABLET Y

ENTECAVIR 1 MG TABLET Y

ENTYVIO 300 MG VIAL N

ENVARSUS XR 0.75 MG TABLET

N

ENVARSUS XR 1 MG TABLET N

ENVARSUS XR 4 MG TABLET N

EPCLUSA 400 MG-100 MG TABLET

Y

EPIVIR HBV 100 MG TABLET N

EPIVIR HBV 25 MG/5 ML SOLN Y

EPOGEN 10,000 UNITS/ML VIAL

Y

EPOGEN 2,000 UNITS/ML VIAL Y

EPOGEN 20,000 UNITS/2 ML VIAL

Y

EPOGEN 20,000 UNITS/ML VIAL

Y



ERBITUX 100 MG/50 ML VIAL N

ERBITUX 200 MG/100 ML VIAL N

ESBRIET 267 MG CAPSULE Y

ESBRIET 267 MG TABLET Y

ESBRIET 801 MG TABLET Y

ETOPOPHOS 100 MG VIAL N

EUFLEXXA 20 MG/2 ML SYRINGE

N

EVOMELA 50 MG VIAL N

EXJADE 125 MG TABLET Y



EXTAVIA 0.3 MG KIT Y

EXTAVIA 0.3 MG VIAL Y

FABRAZYME 35 MG VIAL Y

FABRAZYME 5 MG VIAL Y

FASLODEX 250 MG/5 ML SYRINGE

Y

FEIBA NF 1,000 UNIT (NOMINAL)

N

FEIBA NF 1,750-3,250 UNIT VIAL

N

FEIBA NF 2,500 UNIT (NOMINAL)

N

FEIBA NF 400-650 UNIT VIAL N

FEIBA NF 500 UNIT (NOMINAL)

N

FIRAZYR 30 MG/3 ML SYRINGE

Y

FIRMAGON 2 X 120 MG KIT N

FIRMAGON 2 X 120 MG VIALS N

FIRMAGON 80 MG KIT N

FIRMAGON 80 MG VIAL N

FLEBOGAMMA DIF 10% VIAL N

FLEBOGAMMA DIF 5% VIAL N

FLOXURIDINE 500 MG VIAL N

FLOXURIDINE POWDER N

FOLLISTIM AQ 150 UNIT VIAL N

FOLLISTIM AQ 300 UNIT CARTRIDG

N


N

FOLLISTIM AQ 75 UNIT VIAL N


N

FOLOTYN 20 MG/ML VIAL N

FOLOTYN 40 MG/2 ML VIAL N

FORTEO 600 MCG/2.4 ML PEN INJ

Y

FRAGMIN 10,000 UNITS/ML SYRING

Y

FRAGMIN 12,500 UNITS/0.5 ML Y

FRAGMIN 15,000 UNITS/0.6 ML Y

FRAGMIN 18,000 UNITS/0.72 ML

Y

FRAGMIN 2,500 UNITS/0.2 ML SYR

Y

FRAGMIN 25,000 UNITS/ML VIAL

Y


Y


Y

FRAGMIN 95,000 UNITS/3.8 ML VL

Y

FUZEON 90 MG VIAL N

GAMASTAN S-D VIAL Y

GAMMAGARD LIQUID 10% VIAL

Y

GAMMAGARD S-D 10 G (IGA<1) SOL

N

GAMMAGARD S-D 5 G (IGA<1) SOLN

N

GAMMAKED 1 GRAM/10 ML VIAL

N


N

GAMMAKED 2.5 GRAM/25 ML VIAL

N


N


N

GAMMAPLEX 10 GRAM/100 ML VIAL

N


N

GAMMAPLEX 2.5 GRAM/50 ML VIAL

N


N


N


N


N

GAMUNEX-C 1 GRAM/10 ML VIAL

N


N

GAMUNEX-C 2.5 GRAM/25 ML VIAL

N


N


N


N

GANIRELIX ACET 250 MCG/0.5 ML

N

GAZYVA 1,000 MG/40 ML VIAL N

GEL-ONE 30 MG/3 ML SYRINGE

N

GEMZAR 1 GRAM VIAL N

GEMZAR 200 MG VIAL N

GENOTROPIN 12 MG CARTRIDGE

Y

GENOTROPIN 5 MG CARTRIDGE

Y

GENOTROPIN MINIQUICK 0.2 MG

Y


Y


Y


Y

GENOTROPIN MINIQUICK 1 MG

Y


Y


Y


Y


Y

GENOTROPIN MINIQUICK 2 MG

Y

GILENYA 0.5 MG CAPSULE Y

GLATIRAMER 20 MG/ML SYRINGE

Y

GLATIRAMER 40 MG/ML SYRINGE

Y

GLATOPA 20 MG/ML SYRINGE Y

GLEEVEC 100 MG TABLET N

GLEEVEC 400 MG TABLET N

GONAL-F 1,050 UNITS VIAL N

GONAL-F 450 UNITS VIAL N

GONAL-F RFF 75 UNITS VIAL N

GONAL-F RFF REDI-JECT 300 UNIT

N


N


N

GRANIX 300 MCG/0.5 ML SAFE SYR

N

GRANIX 300 MCG/0.5 ML SYRINGE

N

GRANIX 480 MCG/0.8 ML SAFE SYR

N

GRANIX 480 MCG/0.8 ML SYRINGE

N

HALAVEN 1 MG/2 ML VIAL Y

HARVONI 90-400 MG TABLET N

HELIXATE FS 1,000 UNIT VIAL N

HELIXATE FS 2,000 UNIT VIAL N

HELIXATE FS 250 UNIT VIAL N

HELIXATE FS 3,000 UNITS VIAL

N

HELIXATE FS 500 UNIT VIAL N

HEMOFIL M 1,000 UNIT NOMINAL

N

HEMOFIL M 1,700 UNIT NOMINAL

N

HEMOFIL M 250 UNIT NOMINAL

N

HEMOFIL M 500 UNIT NOMINAL

N

HEPSERA 10 MG TABLET Y

HERCEPTIN 150 MG VIAL N

HERCEPTIN 440 MG VIAL N

HIZENTRA 1 GRAM/5 ML VIAL N

HIZENTRA 10 GRAM/50 ML VIAL

N


N


N

HP ACTHAR GEL 80 UNIT/ML VIAL

N

HUMATE-P 1,200 UNIT VWF:RCO

N

HUMATE-P 2,400 UNIT VWF:RCO

N

HUMATE-P 600 UNIT VWF:RCO N

HUMATROPE 12 MG CARTRIDGE

Y


Y

HUMATROPE 5 MG VIAL Y


Y

HUMIRA 10 MG/0.2 ML SYRINGE

Y


Y

HUMIRA 40 MG/0.8 ML PEN Y


Y

HUMIRA PEDIATRIC CROHN'S START

Y

HUMIRA PEN CROHN-UC-HS STARTER

Y

HUMIRA PEN PSORIASIS-UVEITIS

Y

HYALGAN 20 MG/2 ML SYRINGE

N

HYALGAN 20 MG/2 ML VIAL N

HYCAMTIN 0.25 MG CAPSULE Y

HYCAMTIN 1 MG CAPSULE Y

HYCAMTIN 4 MG VIAL N

HYPERHEP B S-D NEONATAL SYRIN.

N

HYPERHEP B S-D SYRINGE N

HYPERHEP B S-D VIAL N

HYPERRAB S-D 150 UNITS/ML VIAL

N

HYPERRHO S-D 1500 UNITS SYR

N

HYPERRHO S-D 250 UNITS SYRINGE

N

HYQVIA 10 GM-800 UNIT PACK

Y

HYQVIA 2.5 GM-200 UNIT PACK

Y

HYQVIA 20 GM-1,600 UNIT PACK

Y

HYQVIA 30 GM-2,400 UNIT PACK

Y

HYQVIA 5 GM-400 UNIT PACK Y

IDAMYCIN PFS 1 MG/ML VIAL N

IDELVION 1,000 UNIT VIAL N

IDELVION 2,000 UNIT VIAL N

IDELVION 250 UNIT VIAL N

IDELVION 500 UNIT VIAL N

IFEX 1 GM VIAL N

IFEX 3 GM VIAL N

IMATINIB MESYLATE 100 MG TAB

Y

IMATINIB MESYLATE 400 MG TAB

Y

IMFINZI 120 MG/2.4 ML VIAL Y

IMFINZI 500 MG/10 ML VIAL Y

IMOGAM RABIES-HT 150 UNIT/ML

N

INCIVEK 375 MG TABLET Y

INFLECTRA 100 MG VIAL N

INTRON A 10 MILLION UNITS VIAL

Y

INTRON A 18 MILLION UNIT/3 ML

Y


Y

INTRON A 25 MILLION UNIT/2.5ML

Y


Y

IPRIVASK 15 MG VIAL N

IRESSA 250 MG TABLET Y

ISTODAX 10 MG KIT N

IXEMPRA 15 MG KIT N

IXEMPRA 45 MG KIT N

IXINITY 1,000 UNIT RANGE Y

IXINITY 1,000 UNIT RANGE-2 VLS

Y

IXINITY 1,000 UNIT VIAL Y

IXINITY 1,000 UNIT VIAL -2 VLS

Y


IXINITY 1,500 UNIT RANGE-2 VLS

Y

IXINITY 1,500 UNIT VIAL Y

IXINITY 1,500 UNIT VIAL -2 VLS

Y


IXINITY 250 UNIT RANGE Y


IXINITY 500 UNIT RANGE Y

IXINITY 500 UNIT VIAL Y

JADENU 180 MG TABLET Y



JAKAFI 10 MG TABLET Y





JEVTANA 60 MG/1.5 ML KIT N

KADCYLA 100 MG VIAL Y

KADCYLA 160 MG VIAL Y

KALYDECO 150 MG TABLET Y

KALYDECO 50 MG GRANULES PACKET

N

KALYDECO 75 MG GRANULES PACKET

N

KANUMA 20 MG/10 ML VIAL N

KEVZARA 150 MG/1.14 ML SYRINGE

N

KEVZARA 200 MG/1.14 ML SYRINGE

N

KISQALI 200 MG DAILY DOSE N



KITABIS PAK 300 MG/5 ML N

KOATE 1,000 UNIT VIAL N

KOATE 250 UNIT VIAL N

KOATE 500 UNIT VIAL N

KOATE-DVI 1,000 UNIT VIAL N

KOATE-DVI 250 UNIT VIAL N

KOATE-DVI 500 UNIT VIAL N

KOGENATE FS 1,000 UNIT-BIOSET

N

KOGENATE FS 1,000 UNITS VIAL

N

KOGENATE FS 2,000 UNIT VIAL

N


N

KOGENATE FS 250 UNIT VIAL N

KOGENATE FS 250 UNIT VL-BIOSET

N


N

KOGENATE FS 3,000 UNITS VIAL

N

KOGENATE FS 500 UNIT VIAL N

KOGENATE FS 500 UNIT VL-BIOSET

N

KOVALTRY 1,000 UNIT KIT N

KOVALTRY 1,000 UNIT VIAL N



KOVALTRY 250 UNIT KIT N

KOVALTRY 250 UNIT VIAL N



KOVALTRY 500 UNIT KIT N

KOVALTRY 500 UNIT VIAL N

KRYSTEXXA 8 MG/ML VIAL N

KUVAN 100 MG POWDER PACKET

N

KUVAN 100 MG TABLET N

KUVAN 500 MG POWDER PACKET

N

KYPROLIS 30 MG VIAL N

KYPROLIS 60 MG VIAL N

LEUKINE 250 MCG VIAL Y

LOVENOX 100 MG/ML SYRINGE

Y

LOVENOX 120 MG/0.8 ML SYRINGE

Y

LOVENOX 150 MG/ML SYRINGE

Y


N

LOVENOX 300 MG/3 ML VIAL N


N


N


Y

LUMIZYME 50 MG VIAL Y

LUPANETA PK 11.25-5 MG 3MO KIT

N

LUPANETA PK 3.75-5 MG 1MO KIT

N

LUPRON DEPOT 11.25 MG 3MO KIT

Y

LUPRON DEPOT 22.5 MG 3MO KIT

Y

LUPRON DEPOT 3.75 MG KIT Y

LUPRON DEPOT 45 MG 6MO KIT

Y

LUPRON DEPOT 7.5 MG KIT Y

LUPRON DEPOT-4 MONTH KIT Y

LUPRON DEPOT-PED 11.25 MG 3MO

N

LUPRON DEPOT-PED 11.25 MG KIT

Y

LUPRON DEPOT-PED 15 MG KIT

Y

LUPRON DEPOT-PED 30 MG 3MO KIT

N

LUPRON DEPOT-PED 7.5 MG KIT

Y

LYNPARZA 100 MG TABLET Y

LYNPARZA 150 MG TABLET Y

LYNPARZA 50 MG CAPSULE Y

MAKENA 1,250 MG/5 ML VIAL Y

MAKENA 250 MG/ML VIAL Y

MAVYRET 100-40 MG TABLET N

MEKINIST 0.5 MG TABLET Y

MEKINIST 2 MG TABLET Y

MENOPUR 75 UNIT VIAL N

MESNEX 1 GRAM/10 ML VIAL N

MESNEX 400 MG TABLET N

MODERIBA 200 MG TABLET N

MODERIBA 200-400 MG DOSEPACK

N


N


N


N

MONOCLATE-P 1,000 UNIT KIT N

MONOCLATE-P 1,500 UNIT KIT N

MONOCLATE-P 250 UNIT KIT N

MONOCLATE-P 500AHFU KIT N

MONONINE 1,000 UNIT VIAL N

MONOVISC 88 MG/4 ML SYRINGE

N

MOZOBIL 24 MG/1.2 ML VIAL Y

MUGARD ORAL WOUND RINSE

N

MUSTARGEN 10 MG VIAL N

MYCOPHENOLIC ACID DR 180 MG TB

Y

MYCOPHENOLIC ACID DR 360 MG TB

Y

MYFORTIC 180 MG TABLET N

MYFORTIC 360 MG TABLET N

MYOBLOC 10,000 UNITS/2 ML VIAL

N

MYOBLOC 2,500 UNIT/0.5 ML VIAL

N

MYOBLOC 5,000 UNITS/1 ML VIAL

N

MYOZYME 50 MG VIAL Y

NABI-HB VIAL N

NAGLAZYME 5 MG/5 ML VIAL N

NAVELBINE 10 MG/ML VIAL N

NAVELBINE 50 MG/5 ML VIAL N

NEBUPENT 300 MG INHAL POWDER

N

NEORAL 100 MG GELATIN CAPSULE

N

NEORAL 100 MG/ML SOLUTION

N

NEORAL 25 MG GELATIN CAPSULE

N

NEULASTA 6 MG/0.6 ML SYRINGE

Y

NEULASTA ONPRO 6 MG/0.6 ML KIT

Y

NEUMEGA 5 MG VIAL Y

NEUPOGEN 300 MCG/0.5 ML SYR

Y

NEUPOGEN 300 MCG/ML VIAL Y

NEUPOGEN 480 MCG/0.8 ML SYR

Y

NEUPOGEN 480 MCG/1.6 ML VIAL

Y

NEXPLANON 68 MG IMPLANT N

NINLARO 2.3 MG CAPSULE Y

NINLARO 3 MG CAPSULE Y

NINLARO 4 MG CAPSULE Y

NIPENT 10 MG VIAL N

NORDITROPIN FLEXPRO 10 MG/1.5

Y


Y

NORDITROPIN FLEXPRO 30 MG/3 ML

Y


Y

NORDITROPIN NORDIFLEX 30 MG/3

Y

NOVOSEVEN RT 1 MG VIAL N




NPLATE 250 MCG VIAL N

NPLATE 500 MCG VIAL N

NULOJIX 250 MG VIAL Y

NUTROPIN AQ 20 MG/2ML PEN CART

Y

NUTROPIN AQ NUSPIN 10 INJECTOR

Y


Y


Y

NUTROPIN AQ PEN CARTRIDGE

Y

NUWIQ 1,000 UNIT VIAL N

NUWIQ 1,000 UNIT VIAL PACK N





NUWIQ 250 UNIT VIAL N

NUWIQ 250 UNIT VIAL PACK N





NUWIQ 500 UNIT VIAL N

NUWIQ 500 UNIT VIAL PACK N

OCTAGAM 10% VIAL N

OCTAGAM 5% VIAL N

OCTREOTIDE 1,000 MCG/5 ML VIAL

Y

OCTREOTIDE 1,000 MCG/ML VIAL

Y

OCTREOTIDE 5,000 MCG/5 ML VIAL

Y

OCTREOTIDE ACET 0.05 MG/ML VL

Y

OCTREOTIDE ACET 100 MCG/ML AMP

Y

OCTREOTIDE ACET 100 MCG/ML SYR

Y

OCTREOTIDE ACET 100 MCG/ML VL

Y


Y


Y


Y

OCTREOTIDE ACET 50 MCG/ML VIAL

Y


Y


Y


Y

ODOMZO 200 MG CAPSULE N

OLYSIO 150 MG CAPSULE N

OMNITROPE 10 MG/1.5 ML CRTG

Y

OMNITROPE 5 MG/1.5 ML CRTG

Y

OMNITROPE 5.8 MG VIAL Y

ONCASPAR 3,750 UNIT/5 ML VIAL

N

ONCASPAR 750 UNIT/ML VIAL N

ORAFATE 1 GM/10 ML PASTE N

ORENCIA 125 MG/ML SYRINGE

Y

ORENCIA 250 MG VIAL Y

ORENCIA 50 MG/0.4 ML SYRINGE

Y

ORENCIA 87.5 MG/0.7 ML SYRINGE

Y

ORENCIA CLICKJECT 125 MG/ML

Y

ORKAMBI 100 MG-125 MG TABLET

Y

ORKAMBI 200 MG-125 MG TABLET

Y

ORTHOVISC 15 MG/ML SYRINGE

N

OTEZLA 28 DAY STARTER PACK

Y

OTEZLA 30 MG TABLET Y

OTEZLA STARTER PACK Y

OVIDREL 250 MCG/0.5 ML SYRG

N

PEGASYS 180 MCG/0.5 ML SYRINGE

Y

PEGASYS 180 MCG/ML VIAL Y

PEGASYS PROCLICK 135 MCG/0.5

Y

PEGASYS PROCLICK 180 MCG/0.5

N

PEGINTRON 120 MCG KIT N


PEGINTRON 50 MCG KIT Y


PEGINTRON REDIPEN 120 MCG

Y

PEGINTRON REDIPEN 120 MCG 4PK

Y

PEGINTRON REDIPEN 150 MCG

Y


Y

PEGINTRON REDIPEN 50 MCG Y


Y

PEGINTRON REDIPEN 80 MCG Y


Y

PERJETA 420 MG/14 ML VIAL N

PHOTOFRIN 75 MG VIAL N

PLEGRIDY 125 MCG/0.5 ML PEN

Y

PLEGRIDY 125 MCG/0.5 ML SYRING

Y

PLEGRIDY PEN INJ STARTER PACK

Y

PLEGRIDY SYRINGE STARTER PACK

Y

PRALUENT 150 MG/ML PEN Y

PRALUENT 75 MG/ML PEN Y

PREGNYL 10,000 UNITS VIAL N

PRIALT 100 MCG/ML VIAL N

PRIALT 25 MCG/ML VIAL N

PRIVIGEN 10% VIAL Y

PROCRIT 10,000 UNITS/ML VIAL

Y

PROCRIT 2,000 UNITS/ML VIAL Y


Y




Y

PROFILNINE 1,000 UNITS VIAL N

PROFILNINE 1,500 UNITS VIAL N

PROFILNINE 500 UNITS VIAL N

PROGRAF 0.5 MG CAPSULE N

PROGRAF 1 MG CAPSULE N

PROGRAF 5 MG CAPSULE N

PROGRAF 5 MG/ML AMPULE N

PROLEUKIN 22 MILLION UNIT VIAL

Y

PROLIA 60 MG/ML SYRINGE N

PROMACTA 12.5 MG TABLET Y

PROMACTA 25 MG TABLET Y



PROTHELIAL 1 GM/10 ML PASTE

N

PROVISC 10 MG/ML DISP SYRNG

N

PULMOZYME 1 MG/ML AMPUL

Y

RAPAMUNE 0.5 MG TABLET N

RAPAMUNE 1 MG TABLET N

RAPAMUNE 1 MG/ML ORAL SOLN

Y

RAPAMUNE 2 MG TABLET N

RAVICTI 1.1 GRAM/ML LIQUID N

REBETOL 200 MG CAPSULE N

REBETOL 40 MG/ML SOLUTION

N

REBIF 22 MCG/0.5 ML SYRINGE

Y

REBIF 44 MCG/0.5 ML SYRINGE

Y

REBIF REBIDOSE 22 MCG/0.5 ML

Y

REBIF REBIDOSE 44 MCG/0.5 ML

Y

REBIF REBIDOSE TITRATION PACK

Y

REBIF TITRATION PACK Y

RECLAST 5 MG/100 ML SOLUTION

N

RECOMBINATE 1,241-1,800 UNIT V

N

RECOMBINATE 1,801-2,400 UNIT V

N

RECOMBINATE 220-400 UNIT VIAL

N

RECOMBINATE 401-800 UNIT VIAL

N

RECOMBINATE 801-1,240 UNIT VL

N

REMICADE 100 MG VIAL Y

REPATHA 140 MG/ML SURECLICK

Y

REVATIO 10 MG/12.5 ML VIAL Y

REVATIO 10 MG/ML ORAL SUSP

N

REVATIO 20 MG TABLET Y

RHOGAM ULTRA-FILTERED PLUS SYR

N

RHOPHYLAC 300 MCG/2 ML SYRINGE

N

RIBASPHERE 200 MG CAPSULE

Y

RIBASPHERE 200 MG TABLET N



RIBASPHERE RIBAPAK 200-400 MG

N


N


N


N

RIBATAB 400-400 MG DOSEPACK

N


N


N

RIBAVIRIN 200 MG CAPSULE Y

RIBAVIRIN 200 MG TABLET Y

RIBAVIRIN 6 GM INHALATION VIAL

N

RILUTEK 50 MG TABLET N

RITUXAN 10 MG/ML VIAL Y

RIXUBIS 1,000 UNIT NOMINAL N


RIXUBIS 250 UNIT NOMINAL N


RIXUBIS 500 UNIT NOMINAL N

RYDAPT 25 MG CAPSULE Y

SAIZEN 5 MG VIAL Y

SAIZEN 8.8 MG CLICK.EASY CARTG

Y

SAIZEN 8.8 MG VIAL N

SANDIMMUNE 100 MG CAPSULE

N

SANDIMMUNE 100 MG/ML SOLN

N

SANDIMMUNE 25 MG CAPSULE

N

SANDIMMUNE 50 MG/ML AMPUL

N

SANDOSTATIN 0.05 MG/ML AMPUL

N


Y

SANDOSTATIN 0.2 MG/ML VIAL

Y


Y

SANDOSTATIN 1 MG/ML VIAL Y

SANDOSTATIN LAR 10 MG KIT Y



SANDOSTATIN LAR DEPOT 10 MG KT

N

SANDOSTATIN LAR DEPOT 10 MG VL

N


N


N


N


N

SENSIPAR 30 MG TABLET Y



SILDENAFIL 10 MG/12.5 ML VIAL

Y

SILDENAFIL 20 MG TABLET Y

SILDENAFIL CITRATE POWDER

N

SILIQ 210 MG/1.5 ML SYRINGE N

SIMPONI 100 MG/ML PEN INJECTOR

Y

SIMPONI 100 MG/ML SYRINGE Y

SIMPONI 50 MG/0.5 ML PEN INJEC

Y

SIMPONI 50 MG/0.5 ML SYRINGE

Y

SIMPONI ARIA 50 MG/4 ML VIAL

Y

SIMULECT 10 MG VIAL N

SIMULECT 20 MG VIAL N

SOLIRIS 300 MG/30 ML VIAL N

SOMATULINE DEPOT 120 MG/0.5 ML

Y


Y


Y

SOVALDI 400 MG TABLET N

SPRYCEL 100 MG TABLET Y






STELARA 130 MG/26 ML VIAL N

STELARA 45 MG/0.5 ML SYRINGE

Y

STELARA 45 MG/0.5 ML VIAL Y

STELARA 90 MG/ML SYRINGE Y

SUPPRELIN LA 50 MG KIT N

SYLATRON 200 MCG 4-PACK Y

SYLATRON 200 MCG KIT Y

SYLATRON 300 MCG 4-PACK Y



SYLVANT 100 MG VIAL N

SYLVANT 400 MG VIAL N

SYNRIBO 3.5 MG/ML VIAL Y

SYNVISC SYRINGE N

SYNVISC-ONE SYRINGE N

TAFINLAR 50 MG CAPSULE Y

TAFINLAR 75 MG CAPSULE Y

TARCEVA 100 MG TABLET Y



TASIGNA 150 MG CAPSULE Y

TASIGNA 200 MG CAPSULE Y

TAXOTERE 20 MG/ML VIAL N

TAXOTERE 80 MG/4 ML VIAL N

TECENTRIQ 1,200 MG/20 ML VIAL

Y

TECFIDERA DR 120 MG CAPSULE

Y

TECFIDERA DR 240 MG CAPSULE

Y

TECFIDERA STARTER PACK Y

TECHNIVIE DOSE PACK N

TEMODAR 100 MG CAPSULE N

TEMODAR 100 MG VIAL N






TEMOZOLOMIDE 100 MG CAPSULE

N


N


N


N


N


N

TENIPOSIDE 50 MG/5 ML AMPULE

N

TETRABENAZINE 12.5 MG TABLET

Y

TETRABENAZINE 25 MG TABLET

Y

THERACYS 81 MG VIAL N

THYMOGLOBULIN 25 MG VIAL

Y

THYROGEN 1.1 MG VIAL N

THYROGEN 1.1 MG VIAL W-DILUENT

N

TOBI 300 MG/5 ML SOLUTION N

TOBI PODHALER 28 MG INHALE CAP

N

TOBRAMYCIN 300 MG/5 ML AMPULE

Y

TOBRAMYCIN PAK 300 MG/5 ML

N

TORISEL 25 MG KIT N

TOTECT 500 MG VIAL N

TREANDA 100 MG VIAL N

TREANDA 180 MG/2 ML VIAL N

TREANDA 25 MG VIAL N

TREANDA 45 MG/0.5 ML VIAL N

TRELSTAR 11.25 MG SYRINGE Y

TRELSTAR 11.25 MG VIAL Y





TREMFYA 100 MG/ML SYRINGE

N

TRETTEN 2,500 UNIT VIAL N

TRISENOX 10 MG/10 ML AMPULE

N

TYKERB 250 MG TABLET Y

TYMLOS 80 MCG DOSE PEN INJECTR

N

TYZEKA 600 MG TABLET Y

VALSTAR 40 MG/ML VIAL N

VANTAS 50 MG KIT N

VECTIBIX 100 MG/5 ML VIAL Y

VECTIBIX 400 MG/20 ML VIAL Y

VELCADE 3.5 MG VIAL Y

VELTASSA 16.8 GM POWDER PACKET

Y


Y


Y

VEMLIDY 25 MG TABLET Y

VERZENIO 100 MG TABLET N




VIDAZA 100 MG VIAL Y

VIEKIRA PAK N

VIMIZIM 5 MG/5 ML VIAL Y

VIREAD 150 MG TABLET Y




VIREAD POWDER Y

VIVITROL 380 MG VIAL + DILUENT

N

VOSEVI 400-100-100 MG TABLET

N

VOTRIENT 200 MG TABLET Y

VPRIV 400 UNITS VIAL Y

WILATE 1,000-1,000 UNIT VIAL N

WILATE 450-450 UNIT VIAL N



WINRHO SDF 1,500 UNIT VIAL N

WINRHO SDF 15,000 UNIT VIAL

N



XELJANZ 5 MG TABLET Y

XELJANZ XR 11 MG TABLET Y

XELODA 150 MG TABLET N

XELODA 500 MG TABLET N

XEOMIN 100 UNIT VIAL Y



XGEVA 120 MG/1.7 ML VIAL Y

XOLAIR 150 MG VIAL Y

XYNTHA 1,000 UNIT KIT N

XYNTHA 2,000 UNIT KIT N

XYNTHA 250 UNIT KIT N

XYNTHA 500 UNIT KIT N

XYNTHA SOLOFUSE 1,000 UNIT KIT

N


N

XYNTHA SOLOFUSE 250 UNIT KIT

N


N

XYNTHA SOLOFUSE 500 UNIT KIT

N

ZALTRAP 100 MG/4 ML VIAL Y

ZALTRAP 200 MG/8 ML VIAL Y

ZANOSAR 1 GM POWDER VIAL

N

ZARXIO 300 MCG/0.5 ML SYRINGE

Y

ZARXIO 480 MCG/0.8 ML SYRINGE

Y

ZELBORAF 240 MG TABLET Y

ZEPATIER 50-100 MG TABLET Y

ZINECARD 250 MG VIAL N

ZINECARD 500 MG VIAL N

ZOLADEX 10.8 MG IMPLANT SYRN

N

ZOLADEX 3.6 MG IMPLANT SYRN

N

ZOLEDRONIC ACID 4 MG VIAL Y

ZOLEDRONIC ACID 4 MG/100 ML

Y

ZOLEDRONIC ACID 4 MG/5 ML VIAL

Y

ZOLEDRONIC ACID 5 MG/100 ML

Y

ZOLINZA 100 MG CAPSULE Y

ZOMACTON 10 MG VIAL N

ZOMACTON 5 MG VIAL N

ZOMETA 4 MG/100 ML INJECTION

N

ZOMETA 4 MG/5 ML VIAL N

ZORBTIVE 8.8 MG VIAL Y

ZORTRESS 0.25 MG TABLET Y



ZYKADIA 150 MG CAPSULE Y

ZYTIGA 250 MG TABLET Y

ZYTIGA 500 MG TABLET Y

specialty pharmacy drug list - amazon web services · 2018-01-09 · uc fvc_010518_1 ia (01052018)...

Documents