Current Specialty Medication List (as of 7/1/2019)

1 Current Specialty Medication List (as of 1/1/2021). New Drug Additions in Red 8-Mop Aristada Initio Cablivi Cytogam Abraxane Arranon Calcijex Cytovene Abilify Maintena Arzerra Calquence CYTOXAN. Abrilada Asceniv Campath Dacogen Accrufer Asparlas Camptosar Daklinza Actemra SOC Astagraf XL capecitabine Darzalex ACTHAR Atgam Caprelsa Darzalex Faspro Actimmune Atripla Carbaglu Daurismo Adagen Aubagio Carbometyx Delstrigo Adakveo Austedo Carimune NF SOC Depen Adcirca Avastin CAYSTON Depo Provera Adecetris Avonex Ceenu Depocyt Adefovir Avsola Cellcept Descovy Adempas Ayvakit Ceprotin Desferal Adriamycin Bafiertam Cerdelga Dexferrum Adrucil Balversa Cerezyme Diacomit Advate Baraclude Cerubidine Dojolvi Advate H Bavencio Chirhostim Dolutegravir/.

2 Advate L BCG Vaccine Cimduo lamivudine/tenofovir disoproxil fumarate Advate M (Tice Strain) Cimzia Advate SH Bebulin VH Immuno Cinqair SOC Doptelet Advate UH Beleodaq Cinryze SOC Dovato Adynovate Belrapzo Clolar Doxil Afinitor Bendeka Clovique Doxorubicin Afinitor Disperz Benefix Coagadex Doxorubicin Liposomal Afstyla Benlysta Combivir Droxia Aldurazyme Beovu Cometriq Dupixent Alecensa Berinert SOC Complera Durolane Alferon N Besponsa Copaxone Durysta Alimta Betaseron Copegus Dysport Efavirenz/lamivudine/. Aliqopa Bethkis Copiktra tenofovir disoproxil ALKERAN Biktarvy Cortifact fumarate Alphanate Bicnu Cosentyx EGIRIFTA. Alphanine SD Bivigam SOC Cosmegen Elaprase Alprolix Blenoxane Cotellic Elelyso Alunbrig Blenrep Crysvita ELIGARD.

3 Ampyra Blincyto Crixivan Elitek Andexxa Bosulif Cuprimine Ellence Anjeso Botox Cutaquig Eloctate Apokyn Braftovi Cuvitru Eloxatin Aralast Brineura Cyklokapron Elzonris ARANESP / SURECLICK Bronchitol Cyramza Emcyt ARCALYST Brukinsa Cystadane Emflaza Aredia Buphenyl Cystadrops Empliciti Arikayce Kit Busulfex Cystaran Emtriva Aristada Bynfezia Pen Cytarabine Enbrel *The list of drugs contained on this Specialty list, or subject to Site of Care requirements is subject to change. **If you have questions about which Medication your specific plan covers please refer to your benefits book or check BCBSNC formulary webpage at If you need to speak with someone please call the customer service number on the back of your card.

4 Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Current Specialty Medication List (as of 1/1/2021). New Drug Additions in Red Endari Flolan Herceptin Istodax Enhertu Fludara Herceptin Hylectra Isturisa Enspryng Folotyn Hexalen Ixempra Entecarvir Forteo Hizentra SOC Ixinity Entyvio SOC Foscavir Hulio Jadenu Envarsus XR Fudr Humate-P Jakafi Epclusa fulphila Humatrope Jelmyto Epidiolex Fusilev Humira Jetrea Epivir Fuzeon Hyalgan Jeuveau EPOGEN Galafold HYCAMTIN Jevtana Epzicom Gamifant Hydrea Jivi Erbitux Gammagard SOC Hylenex Juluca Erivedge Gammagard S/D SOC Hymovis Juxtapid Erleada Gammaked SOC Hyperrho S-D Jynarque Erwinaze Gammaplex SOC Hyqvia SOC Kadcyla Esbriet Gamunex SOC Hyrimoz Kalbitor SOC.

5 Esperoct Gamunex-C SOC Ibalizumab Kaletra Ethyol Gastrocrom Ibrance Kalydeco Eticovo Gattex Iclusig Kanjinti ETOPOPHOS Gavreto Idamycin PFS Kanuma Euflexxa Gazyva Idelvion Kepivance Eulexin Gel-One Idhifa Kesimpta Evenity Gelsyn 3 Ifex Kevzara Exjade Gemzar Ilaris Keytruda Exondys 51 Gengraf ILUMYA Kineret Exservan Genotropin Imatinib Kisqali Extavia Genotropin Miniquick Imbruvica Kisqali-Femara Evomela GenVisc 850 Imfinzi KITABIS PAK. Evotaz Genvoya Imlygic Koate-DVI. Evrysdi GILENYA Implanon Kogenate FS /. Eylea Gilotrif INCIVEK Kogenate-FS Bio-Set Fabrazyme Givlaari Increlex Korlym Farydak Glassia SOC Infed Koselugo Fasenra Glatopa Infergen Kovaltry FASLODEX Gleevec Inflectra SOC KRYSTEXXA.

6 Feiba Gloestine Infugem Kuvan Fensolvi Granix Ingrezza Kynamro Feraheme Hadlima Injectafer Kyleena Ferriprox Haegarda Inlyta Kymriah Ferrlecit Halaven Inqovi Kyprolis Fibryna Harvoni Inrebic Lemtrada SOC. Fintepla Hecoria Invega Sustenna Lenvima FIRAZYR SOC Helixate FS Invega Trinza Letairis Firdapse Hemlibra Invirase Leukeran Firmagon Hemofil M Iressa LEUKINE. Flebogamma SOC Hepsera Isentress Leustatin *The list of drugs contained on this Specialty list, or subject to Site of Care requirements is subject to change. **If you have questions about which Medication your specific plan covers please refer to your benefits book or check BCBSNC formulary webpage at If you need to speak with someone please call the customer service number on the back of your card.

7 Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Current Specialty Medication List (as of 1/1/2021). New Drug Additions in Red Lexiva Naglazyme Opsumit Purixan Libtayo Natpara Orencia SOC Qutenza Liletta Navelbine Orenitram Radicava Lipodox Neoral Orfadin Rapamune Lonsurf Nerlynx Orkambi Ravicti Lorbrena NEULASTA Orthovisc Rayaldee Lucentis Neumega Otezla Rebetol Lumizyme NEUPOGEN Oxbryta Rebif Lumoxiti Nexavar Padcev Reblozyl LUPRON DEPOT Nexplanon Palforzia Reclast Lutathera Nilutamide Palynziq Recombinate Luxturna Ninlaro Panretin Remicade SOC.

8 Lynparza Nipent Panzyga Remodulin Lysodren nivestym Paraguard IUD Renflexis SOC. Macugen Norditropin Paraplatin Rescriptor Makena Norditropin Flexpro Parsabiv Resperidal Consta Marqibo Northera Pegasys RETACRIT. Matulane Norvir Peg-Intron Retisert Mavenclad Novantrone Pemazyre Retrovir Mavyret Novoeight Perjeta Revatio Mayzent Novoseven/RT Perseris Revcovi Mekinist NPLATE Phesgo Revlimid Mektovi Nubeqa Photofrin Reyataz Melphalan Nucala SOC Pifeltro Rhogam-UF Plus Mepsevii Nulojix Piqray Rhophylac Mesnex Nutropin Platinol AQ Riastap Micrhogam Nutropin AQ Plegridy Ribapak Micrhogam Plus Nuwiq Polivy Ribasphere MIRCERA Obizur Pomalyst Ribatab Mirena Ocaliva Portrazza Ribavirin Mitomycin Ocrevus SOC Poteligeo Rilutek Moderiba Octagam SOC Prevymis Rinvoq Monjuvi Odefsey Prezista Ritonavir Monoclate-P Odomzo Prezcobix Rituxan Mononine Ofev

9 Prialt Rituxan Hycela Monovisc Oforta Privigen SOC Rixubis MOZOBIL Ogivri PROCRIT Rozlytrek Mulpleta Olysio Procysbi Rubraca Mustargen Olumiant Profilnine SD Ruconest SOC. Mvasi Omnitrope Prograf Rukobia MYALEPT Oncaspar Prolastin-C SOC Ruxience Mycapssa Onivyde Proleukin Ruzurgi Myfortic Onpattro Prolia Rydapt Myleran Onureg Promacta Sabril Mylotarg Onxol Provenge Saizen Myobloc Opdivo Pulmozyme Samsca *The list of drugs contained on this Specialty list, or subject to Site of Care requirements is subject to change. **If you have questions about which Medication your specific plan covers please refer to your benefits book or check BCBSNC formulary webpage at If you need to speak with someone please call the customer service number on the back of your card.

10 Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Current Specialty Medication List (as of 1/1/2021). New Drug Additions in Red SANDIMMUNE Synagis Trazimera Viekira XR. SANDOSTATIN Synarel Treanda Viltepso SANDOSTATIN LAR Synojoynt Trelstar Depot, LA, Vimizim Sarclisa Synribo Mixject Vincasar Scenesse Synvisc TREMFYA Viracept Selzentry Synvisc One Tretten Viramune Sensipar Syprine Trikafta Viramune XR. Serostim Tabloid Triluron Virazole Sevenfact Tabrecta Triptodur Viread SIGNIFOR Tafinlar Trisenox Visco-3.