Prime Therapeutics Specialty Pharmacy Drug Management List
Reminder About Coverage for Self-Administered Specialty Medications Specialty medications are generally prescribed to treat chronic, complex medical conditions, such as multiple sclerosis, hepatitis C and rheumatoid arthritis. These medications are often received by injection or infusion, require careful adherence to a treatment plan and/or have special handling or storage requirements. Specialty medications that require professional services for administration are usually covered under the medical benefit. Coverage for self-administered specialty medications is provided through the pharmacy benefit. The physician should write or call in a prescription for self-administered specialty medications for receipt from a specialty pharmacy provider. Below is a current list of specialty medications. Medications with an (M) placed after their names may be eligible for coverage under the medical benefit. The rest of the medications are FDA-approved for self-administration and are covered under the pharmacy benefit in most circumstances. Autoimmune Degeneration Hormones Fibrosis
CIMZIA PREFILLED SYRINGE NEXAVAR KALYDECO INCRELEX* Multiple PULMOZYME Sclerosis REVLIMID* OMNITROPE BETASERON Deficiencies COPAXONE (Continued on Page 2) Hepatitis C THALOMID tretinoin Modifiers VOTRIENT* INTRON-A XALKORI* NEULASTA ZELBORAF* NEUPOGEN ORFADIN* ribavirin VICTRELIS Clotting Disorders (M) ♦♦♦ Cancer – Injectable Fertility & SYLATRON Pregnancy ♦ Drugs in BOLD are preferred Disorders products Cancer – FOLLISTIM AQ AFINITOR This list is subject to change without notice.
Prime Therapeutics LLC is the independent company chosen by the Blue Cross and Blue Shield of Oklahoma to manage your prescription drug benefit. Blue Cross and Blue Shield of Oklahoma is a
Division of Health Care Service Corporation, A Mutual Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
4220 OK Prime Therapeutics LLC 5/1/13 Prime Therapeutics Specialty Pharmacy LLC is a wholly owned subsidiary of Prime Therapeutics LLC. Product names are the property of their respec
Prime Therapeutics Specialty Pharmacy Drug Management List
Multiple Sclerosis (continued) GILENYA
Pulmonary Hypertension ADCIRCA epoprostenol sodium* (M) FLOLAN* (M) TRACLEER* CHENODAL*
administration: IA, IL, IM, IO, IT, ITV & IV. Check your
leuprolide acetate Drugs in BOLD are preferred products octreotide acetate
Brand-name products are capitalized (e.g. FLOLAN)
This list is subject to change without notice.
Prime Therapeutics LLC is the independent company chosen by the Blue Cross and Blue Shield of Oklahoma to manage your prescription drug benefit. Blue Cross and Blue Shield of Oklahoma is a Division of Health Care Service Corporation, A Mutual Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
4220 OK Prime Therapeutics LLC 5/1/13 Prime Therapeutics Specialty Pharmacy LLC is a wholly owned subsidiary of Prime Therapeutics LLC. Product names are the property of their respective owners.
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