ACCREDO SPECIALTY MEDICATION LIST - Cigna

1 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. PCOMM-2022-485 2022 Cigna . Some content provided under license. ACCREDO SPECIALTY MEDICATION LIST For Cigna Medicare Advantage Providers April 2022 Use Ctrl + F on your keyboard to search for a specific MEDICATION . A ABACAVIR ABACAVIR-LAMIVUDINE ABACAVIR-LAMIVUDINE- ZIDOVUDINE ABIRATERONE ACETATE ABRAXANE ACTEMRA ACTEMRA ACTPEN ACTHAR ACTIMMUNE ADCETRIS ADCIRCA ADEMPAS ADUHELM ADVATE ADYNOVATE AFINITOR AFINITOR DISPERZ AFSTYLA ALDURAZYME ALECENSA ALPHANATE ALPHANINE SD ALPROLIX ALYQ AMBRISENTAN AMPYRA APOKYN APTIVUS ARALAST NP ARANESP ARCALYST ARESTIN ARIXTRA ARRANON ARZERRA ASCENIV ASTAGRAF XL ATAZANAVIR SULFATE ATRIPLA AUBAGIO AUSTEDO AVASTIN AVONEX AVONEX PEN AVSOLA AZACITIDINE AZASAN AZATHIOPRINE B BAFIERTAM BEBULIN BELRAPZO BENDEKA BENEFIX BENLYSTA BEOVU BERINERT BESPONSA BETASERON BETHKIS BEXAROTENE BIKTARVY BIVIGAM BONIVA BORTEZOMIB BOSENTAN BOSULIF BOTOX BRAFTOVI BRONCHITOL BYLVAY BYNFEZIA C CABENUVA CABOMETYX CAPECITABINE CARBAGLU CARGLUMIC ACID CAYSTON CELLCEPT CEPROTIN CERDELGA CEREZYME CETROTIDE CHORIONIC GONADOTROPIN CIMDUO CIMZIA CINRYZE COMBIVIR COMETRIQ COMPLERA COPAXONE CORIFACT COSENTYX PEN

2 COSENTYX SYRINGE COTELLIC CRINONE CRIXIVAN CRYSVITA CUTAQUIG CUVITRU CYCLOSPORINE CYCLOSPORINE MODIFIED CYRAMZA CYSTADANE CYTOGAM All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. PCOMM-2022-485 2022 Cigna . Some content provided under license. D DACOGEN DALFAMPRIDINE ER DARZALEX DARZALEX FASPRO DAURISMO DDAVP DECITABINE DEFERASIROX DEFERIPRONE DELSTRIGO DESCOVY DESMOPRESSIN ACETATE DIDANOSINE DIMETHYL FUMARATE DOJOLVI DOPTELET DOVATO DROXIDOPA DUOPA DUPIXENT PEN DUPIXENT SYRINGE DUROLANE DURYSTA DYSPORT E EDURANT EFAVIRENZ EFAVIRENZ-EMTRIC- TENOFOV DISOP EFAVIRENZ-LAMIVU- TENOFOV DISOP EGRIFTA EGRIFTA SV ELAPRASE ELELYSO ELIGARD ELOCTATE EMFLAZA EMPLICITI EMTRICITABINE EMTRICITABINE- TENOFOVIR DISOP EMTRIVA ENBREL ENBREL MINI ENBREL SURECLICK ENDARI ENDOMETRIN ENHERTU ENOXAPARIN SODIUM ENSPRYNG ENTYVIO ENVARSUS XR EPCLUSA EPIDIOLEX EPIVIR EPOGEN EPOPROSTENOL SODIUM EPZICOM ERBITUX ERIVEDGE ERLEADA ERLOTINIB HCL ESBRIET ESPEROCT ETRAVIRINE EUFLEXXA EVENITY EVEROLIMUS EVOTAZ EVRYSDI EXJADE EXTAVIA EYLEA F FABRAZYME FARYDAK FASENRA FASENRA PEN FEIBA NF FENSOLVI FIBRYGA FIRAZYR FIRMAGON FLOLAN FOLLISTIM AQ FOLOTYN FONDAPARINUX SODIUM FORTEO

3 FOSAMPRENAVIR CALCIUM FRAGMIN FULPHILA FUZEON G GALAFOLD GAMASTAN GAMASTAN S-D GAMMAGARD LIQUID GAMMAGARD S-D GAMMAKED GAMMAPLEX GAMUNEX-C GANIRELIX ACETATE GATTEX GAVRETO GAZYVA GEL-ONE GELSYN-3 GENGRAF GENOTROPIN GENVISC 850 GENVOYA GILENYA GILOTRIF GIVLAARI GLASSIA GLATIRAMER ACETATE GLATOPA GLEEVEC GONAL-F GONAL-F RFF GONAL-F RFF REDI-JECT GRANIX H HAEGARDA HALAVEN HARVONI HEMLIBRA HEMOFIL M HERCEPTIN HERCEPTIN HYLECTA HERZUMA HETLIOZ HETLIOZ LQ HIZENTRA HUMATE-P HUMATROPE HUMIRA HUMIRA PEN HYALGAN HYCAMTIN HYDROXYPROGESTERONE CAPROATE HYMOVIS HYQVIA All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

4 PCOMM-2022-485 2022 Cigna . Some content provided under license. I IBANDRONATE SODIUM IBRANCE ICATIBANT IDELVION IDHIFA ILARIS ILUMYA ILUVIEN IMATINIB MESYLATE IMFINZI IMURAN INBRIJA INCRELEX INFLECTRA INFLIXIMAB INLYTA INQOVI INREBIC INTELENCE INTRON A INVIRASE IPRIVASK IRESSA ISENTRESS ISENTRESS HD ISTODAX IXEMPRA IXINITY J JADENU JADENU SPRINKLE JAKAFI JEMPERLI JEVTANA JIVI JULUCA JUXTAPID JYNARQUE K KADCYLA KALBITOR KALETRA KALYDECO KANJINTI KANUMA KEPIVANCE KESIMPTA PEN KEVZARA KISQALI KISQALI FEMARA CO-PACK KITABIS PAK KOATE KOGENATE FS KOVALTRY KRYSTEXXA KUVAN L LAMIVUDINE LAMIVUDINE HBV LAMIVUDINE-ZIDOVUDINE LAPATINIB LARTRUVO LEDIPASVIR-SOFOSBUVIR LEMTRADA LENVIMA LETAIRIS LEUKINE LEUPROLIDE ACETATE LEXIVA LILETTA LONSURF LOPINAVIR-RITONAVIR LORBRENA LOVENOX LUCENTIS LUMAKRAS LUMIZYME LUPRON DEPOT LUXTURNA LYNPARZA M MACRILEN MACUGEN MAKENA MAVENCLAD MAVYRET MAYZENT MEKINIST MEKTOVI MENOPUR MEPSEVII MIGLUSTAT MITOXANTRONE HCL MODERIBA MONONINE MONOVISC

5 MOZOBIL MULPLETA MVASI MYALEPT MYCAPSSA MYCOPHENOLATE MOFETIL MYCOPHENOLIC ACID MYFORTIC MYLOTARG MYOBLOC MYTESI N NAGLAZYME NATPARA NEORAL NERLYNX NEULASTA NEULASTA ONPRO NEUPOGEN NEVIRAPINE NEVIRAPINE ER NEXAVAR NEXPLANON NEXVIAZYME NINLARO NITISINONE NITYR NIVESTYM NORDITROPIN FLEXPRO NORTHERA NORVIR NOURIANZ NOVAREL NOVOEIGHT NOVOSEVEN RT NPLATE NUBEQA NUCALA NULOJIX NUPLAZID NUTROPIN AQ NUSPIN NUWIQ NYVEPRIA All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. PCOMM-2022-485 2022 Cigna . Some content provided under license.

6 O OCALIVA OCREVUS OCTAGAM OCTREOTIDE ACETATE ODEFSEY ODOMZO OFEV OGIVRI OLUMIANT OMNITROPE ONUREG OPDIVO OPSUMIT ORALAIR ORENCIA ORENCIA CLICKJECT ORENITRAM ER ORKAMBI ORTHOVISC OTEZLA OVIDREL OXBRYTA OXERVATE OZURDEX P PADCEV PALYNZIQ PANZYGA PEGASYS PEGASYS PROCLICK PEGINTRON PERJETA PHESGO PIFELTRO PIQRAY PLEGRIDY PLEGRIDY PEN POLIVY POMALYST PONVORY PORTRAZZA PREGNYL PREZCOBIX PREZISTA PRIVIGEN PROCRIT PROCYSBI PROFILNINE PROGESTERONE PROGRAF PROLEUKIN PROLIA PROMACTA PROVENGE PULMOZYME PYRIMETHAMINE R RAPAMUNE RAVICTI REBETOL REBIF REBIF REBIDOSE REBINYN RECLAST RECOMBINATE REMICADE REMODULIN RENFLEXIS RESCRIPTOR RETACRIT RETEVMO RETISERT RETROVIR REVATIO REVLIMID REYATAZ RIABNI RIASTAP RIBASPHERE RIBASPHERE RIBAPAK RIBAVIRIN RINVOQ RITONAVIR RITUXAN RITUXAN HYCELA RIXUBIS ROMIDEPSIN ROZLYTREK RUBRACA RUCONEST RUKOBIA RUXIENCE RYBREVANT RYDAPT S SABRIL SAIZEN SAIZEN-SAIZENPREP SAJAZIR SAMSCA SANDIMMUNE SANDOSTATIN SANDOSTATIN LAR DEPOT SAPROPTERIN DIHYDROCHLORIDE SCEMBLIX SELZENTRY SEROSTIM SEVENFACT SIGNIFOR SIGNIFOR LAR SILDENAFIL CITRATE SILIQ SIMPONI SIMPONI ARIA SIMULECT SIROLIMUS SKYRIZI SKYRIZI PEN SODIUM HYALURONATE SOFOSBUVIR- VELPATASVIR SOLESTA SOLIRIS SOMATULINE DEPOT SOMAVERT SOVALDI SPINRAZA SPRYCEL STAVUDINE STELARA STIMATE STIVARGA STRIBILD SUBLOCADE SUNITINIB MALATE SUPARTZ FX SUPPRELIN LA SUSTIVA SUTENT SYLATRON SYLVANT SYMDEKO SYMFI SYMFI LO SYMTUZA SYNAGIS SYNVISC SYNVISC-ONE All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Care Solutions, Inc.

7 , Evernorth Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. PCOMM-2022-485 2022 Cigna . Some content provided under license. T TABRECTA TACROLIMUS TADALAFIL TAFINLAR TAGRISSO TAKHZYRO TALTZ AUTOINJECTOR TALTZ SYRINGE TALZENNA TARCEVA TARGRETIN TASIGNA TECENTRIQ TECFIDERA TEGSEDI TEMIXYS TEMODAR TEMOZOLOMIDE TEMSIROLIMUS TENOFOVIR DISOPROXIL FUMARATE TEPEZZA TERIPARATIDE TETRABENAZINE THALOMID THYMOGLOBULIN THYROGEN TIOPRONIN TIVDAK TIVICAY TIVICAY PD TOBI TOBI PODHALER TOBRAMYCIN TOLVAPTAN TOPOTECAN HCL TORISEL TRACLEER TRAZIMERA TREANDA TREMFYA TREPROSTINIL TRETTEN TRIKAFTA TRILURON TRIUMEQ TRIVISC TRIZIVIR TROGARZO TRUVADA TRUXIMA TYBOST TYKERB TYMLOS TYSABRI TYVASO U UDENYCA ULTOMIRIS UPLIZNA UPTRAVI V VALCHLOR VALRUBICIN VALSTAR VECTIBIX VELCADE VELETRI VENTAVIS VERZENIO VIDAZA VIDEX VIDEX EC VIEKIRA PAK VIGABATRIN VIGADRONE VIMIZIM VIRACEPT VIRAMUNE VIRAMUNE XR VIREAD VISCO-3 VISUDYNE VITRAKVI VIVITROL VIZIMPRO VONVENDI VOSEVI VOTRIENT VOXZOGO VPRIV VUMERITY VYNDAMAX VYNDAQEL W WAKIX WILATE X XALKORI XELJANZ XELJANZ

8 XR XELODA XEMBIFY XENAZINE XEOMIN XGEVA XIAFLEX XOLAIR XTANDI XYNTHA XYNTHA SOLOFUSE XYREM XYW AV Y YERVOY YONSA YUTIQ Z ZALTRAP ZARXIO ZAVESCA ZELBORAF ZEMAIRA ZEPATIER ZEPOSIA ZERIT ZIAGEN ZIDOVUDINE ZIEXTENZO ZIRABEV ZOLADEX ZOLEDRONIC ACID ZOLGENSMA ZOLINZA ZOMACTON ZOMETA ZORBTIVE ZORTRESS ZYDELIG ZYKADIA ZYTIGA