SPECIALTY MEDICATIONS

Coverage under your plan requires that the following medications be ordered from Accredo.

To order, call toll-free 1-877-7NYSHIP (1-877-769-7447) between 8:00 a.m. and 8:00 p.m., Eastern Time, Monday through Friday – or just have your doctor contact Accredo at 1-800-987-4904.

Abraxane® (paclitaxel protein-bound particles)
Actemra® (tocilizumab) (effective 1/27/2010)
Actimmune® (interferon gamma-1b)
Adagen® (pegademase bovine)
Adcirca™ (tadalafil)
Advate® (antihemophilic factor [recombinant])
Afinitor® (everolimus)
Aldurazyme® (laronidase)
Alphanate® (antihemophilic factor [human])
AlphaNine® SD (coagulation factor IX [human])
Amevive® (alefacept)
Ampyra® (dalfampradine ext release tabs) (effective 1/7/2011)
Apokyn® (apomorphine hydrochloride)
Aralast® (alpha[1]-proteinase inhibitor [human])
Aranesp® (darbepoetin alfa)
Arcalyst® (rilonacept)
Arixtra® (fondaparinux sodium)
Arranon® (nelarabine)
Arzerra™ (ofatumumab)
ATryn® (antithrombin alfa)
Avastin® (bevacizumab)
Avonex® (interferon beta-1a)
Bebulin® VH (factor IX complex)
BeneFIXstrong® (coagulation factor IX [recombinant])
Benlysta® (belimumab) (effective 4/12/2011)
Berinert® (C1 esterase inhibitor [human])
Betaseron® (interferon beta-1b)
Bravelle® (urofollitropin)
Carbaglu® (carglumic acid) (effective 1/7/2011)
Carimune® NF (immune globulin intravenous [human])
Cerezyme® (imiglucerase)
Cetrotide® (cetrorelix acetate)
Chorionic Gonadotropin
Cimzia® (certolizumab pegol)
Copaxone® (glatiramer acetate)
Copegus® (ribivirin)
Corifact® (Factor XIII Concentrate [Human]) (effective 6/23/2011)
Cystadane® (betaine anhydrous for oral solution)
CytoGam® (cytomegalovirus immune globulin intravenous [human])
Cytovene®-IV (ganciclovir sodium)
Dacogen® (decitabine)
Dysport® (abobotulinumtoxin A) (effective 1/27/2010)
Egrifta™ (tesamorelin) (effective 2/10/2011)
Elaprase® (idursulfase)
Eligard® (leuprolide acetate)
Enbrel® (etanercept)
Epogen® (epoetin alfa)
Epoprostenol sodium (generic)
Erbitux® (cetuximab)
Erivedge™ (vismodegib) (effective 4/11/12)
Exjade® (deferasirox)
Extavia® (interferon beta-1b)
Eylea (effective 12/28/2011)
Fabrazyme® (agalsidase beta)
FEIBA® VH (anti-inhibitor coagulant complex)
Firazyr (effective 11/13/2011)
Firmagon® (degarelix)
Flebogamma® (immune globulin intravenous [human])
Flolan® (epoprostenol sodium)
Follistim® (follitropin beta)
Folotyn™ (pralatrexate)
Forteo® (teriparatide [rDNA origin])
Fragmin® (dalteparin sodium)
Fuzeon® (enfuvirtide)
GamaSTAN® S/D (immune globulin [human])
Gammagard® Liquid (immune globulin intravenous [human])
Gammagard® S/D (immune globulin intravenous [human])
Gammaked (effective 12/7/2011)
Gammaplex® (Immune globulin intravenous [human] 5%) (effective 2/10/2011)
Gamunex® (immune globulin intravenous [human])
Gamunex-C® (immune globulin intravenous/subcutaneous [human]) (effective 12/16/2010)
Ganirelix acetate (formerly Antagon™)
Genotropin® (somatropin [rDNA origin])
Gilenya™ (fingolimod)
Glassia® (alpha1 - proteinase inhibitor [human]) (effective 11/15/2010)
Gleevec® (imatinib mesylate)
Gonal-f® (follitropin alfa)
Gonal-f® RFF (follitropin beta)
Halaven™ (eribulin mesylate) (effective 1/7/2011)
Helixate® FS (antihemophilic factor [recombinant])
Hemofil® M (antihemophilic factor [human])
Herceptin® (trastuzumab)
Hizentra® (immune globin)
H.P. Acthar® Gel (corticotropin)
Humate-P® (antihemophilic factor/von Willebrand factor complex [human])
Humatrope® (somatropin [rDNA origin])
Humira® (adalimumab)
Hycamtin® (topotecan hydrochloride)
HyperRHO® S/D (Rho[D] immune globulin [human])
Incivek™ (telaprevir) (effective 6/23/2011)
Increlex® (mecasermin [rDNA origin])
Infergen® (interferon alfacon-1)
Inlyta® (axitinib) (effective 3/12/12)
Innohep® (tinzaparin sodium)
Intron A® (interferon alfa-2b)
Iprivask® (desirudin) (effective 10/12/2010)
Istodax® (romidepsin)
Ixempra® (ixabepilone)
Jakafi (effective 1/6/2012)
Jevtana® (cabazitaxel)
Kalydeco® (ivacaftor) (effective 3/12/12)
Kineret® (anakinra)
Koate®-DVI (antihemophilic factor [human])
Kogenate® FS (antihemophilic factor [recombinant])
Krystexxa™ (pegloticase) (effective 2/10/2011)
Kuvan® (sapropterin dihydrochloride)
Letairis® (ambrisentan)
Leukine® (sargramostim)
Leuprolide
Lovenox® (enoxaparin sodium)
Lucentis® (ranibizumab)
Lumizyme® (alglucosidase alfa) (effective 10/20/2010)
Lupron Depot® (leuprolide acetate)
Lupron Depot-PED® (leuprolide acetate)
Luveris® (lutropin alfa)
Macugen® (pegaptanib sodium injection)
Makena® (hydroxyprogesterone caproate injection) (effective 3/22/2011)
Menopur® (menotropins)
MICRhoGAM® (Rho[D] immune globulin [human])
Mitoxantrone HCl (generic)
Monoclate-P® (antihemophilic factor [human])
Mononine® (coagulation factor IX [human])
Mozobil® (plerixafor)
Myozyme® (alglucosidase alfa)
Naglazyme® (galsulfase)
Neulasta® (pegfilgrastim)
Neumega® (oprelvekin)
Neupogen® (filgrastim)
Nexavar® (sorafenib)
Norditropin® (somatropin [rDNA origin])
Norditropin/NordiFlex® (somatropin [rDNA origin])
Novantrone® (mitoxantrone)
Novarel® (chorionic gonadotropin)
NovoSeven® RT (coagulation factor VIIa [recombinant])
Nplate® (romiplostim)
Nulojix (effective 11/20/2011)
Nutropin® (somatropin [rDNA origin])
Nutropin AQ® (somatropin [rDNA origin])
Octagam® (immune globulin intravenous [human])
Octreotide acetate (generic)
Oforta® (fludarabine)
Omnitrope® (somatropin [rDNA origin])
Orencia® (abatacept)
Orfadin® (nitisinone)
Ovidrel® (choriogonadotropin alfa)
Ozurdex™ (dexamethasone intravitreal implant)
Pegasys® (peginterferon alfa-2a)
PEG-Intron® (peginterferon alfa-2b)
PEG-Intron® Redipen® (peginterferon alfa-2b)
Pregnyl® (human chorionic gonadotropin)
Prialt® (ziconotide)
Privigen® (immune globulin intravenous [human])
Procrit® (epoetin alfa)
Profilnine® SD (factor IX complex [human])
Proleukin® (aldesleukin)
Prolia™ (denosumab)
Promacta® (eltrombopag)
Pulmozyme® (dornase alfa)
Qutenza® (capsaicin) (effective 1/27/2010)
Rebetol® (ribavirin)
Rebif® (interferon beta-1a)
Recombinate™ (antihemophilic factor [recombinant])
ReFacto® (antihemophilic factor [recombinant])
Remicade® (infliximab)
Remodulin® (treprostinil sodium)
Repronex® (menotropins)
Retisert® (fluocinolone acetonide)
Revatio® (sildenafil citrate)
Revlimid® (lenalidomide)
RhoGAM® (Rho[D] immune globulin [human])
Rhophylac® (Rho[D]
RiaSTAP® (fibrinogen concentrate [human])
RibaPak® (ribavirin)
Ribasphere® (ribavirin)
Ribavirin (generic)
Rituxan® (rituximab)
Sabril® (vigabatrin)
Saizen® (somatropin [rDNA origin])
Samsca™ (tolvaptan)
Sandostatin® (octreotide acetate)
Sandostatin LAR® (octreotide/IM)
Sensipar® (cinacalcet hydrochloride)
Serostim® (somatropin [rDNA origin])
Simponi™ (golimumab)
Soliris® (eculizumab)
Somatuline Depot® (lanreotide)
Somavert® (pegvisomant)
Sprycel® (dasatinib)
Stelara™ (ustekinumab)
Stimate® (desmopressin acetate)
Supprelin® LA (histrelin acetate)
Sutent® capsules (sunitinib malate)
Sylatron™ (peginterferon alfa-2b) (effective 6/23/2011)
Synagis® (palivizumab)
Tarceva® (erlotinib)
Tasigna® (nilotinib)
Temodar® (temozolomide)
Tev-Tropin® (somatropin [rDNA origin])
Thalomid® (thalidomide)
Tobi® (tobramycin)
Torisel® (temsirolimus)
Tracleer® (bosentan)
Treanda® (bendamustine hydrochloride)
Tykerb® (lapatinib)
Tysabri® (natalizumab)
Tyvaso™ (treprostinil)
Vantas® (histrelin implant)
Vectibix® (panitumumab)
Velcade® (bortezomib)
Veletri® (epoprostenol sodium) (effective 2/11/2011)
Ventavis® (iloprost)
Victrelis™ (boceprevir) (effective 6/20/2011)
Vidaza® (azacitidine)
Vivaglobin® (immune globulin subcutaneous [human])
Vivitrol® (naltrexone)
Votrient® (pazopanib)
Vpriv® (velaglucerase alfa) (effective 1/27/2010)
WinRho® SDF (Rho [D]immune globulin intravenous [human])
Xeloda® (capecitabine)
Xenazine® (tetrabenazine)
Xiaflex® (collagenase clostridium histolyticum injection)
Xeomin® (incobotulinumtoxin A) (effective 2/18/2011)
Xgeva™ (denosumab) (effective 2/10/2011)
Xolair® (omalizumab)
Xyntha® (antihemophilic factor [recombinant])
Yervoy™ (ipilimumab) (effective 6/23/2011)
Zemaira® (alpha [1]-proteinase inhibitor [human])
Zoladex® (goserelin acetate)
Zolinza® (vorinostat)
Zorbtive® (somatropin [rDNA origin])
Zytiga™ (abiraterone) (effective 6/23/2011)