Example: confidence

Self-Administered Specialty Drugs - Florida Blue

Self-Administered Specialty Drugs *. current 4/1/19. Newly marketed prescription medications may not be covered until the Pharmacy & Therapeutics Committee has had an opportunity to review the medication to determine if the medication will be covered and if so, which tier will apply based on safety, efficacy, and the availability of other products within that class of medications. The current list of newly marketed Drugs can be found on our New to Market Drug list. Important: Prior Authorization requirements may vary. Certain Drugs may not be covered by certain member plans.

The current list of newly marketed drugs can be found on our . New to Market Drug list. Important: • Prior Authorization (PA) requirements may vary. Certain specialty drugs may not be covered by certain plans. • Refer to the member contract benefit for inclusion in the PA program and medication guide for determination of coverage (Prior

Tags:

  Lists, Current, Medication, Florida, Specialty, Blue, Self, Administered, Florida blue, Self administered specialty, Current list

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of Self-Administered Specialty Drugs - Florida Blue

1 Self-Administered Specialty Drugs *. current 4/1/19. Newly marketed prescription medications may not be covered until the Pharmacy & Therapeutics Committee has had an opportunity to review the medication to determine if the medication will be covered and if so, which tier will apply based on safety, efficacy, and the availability of other products within that class of medications. The current list of newly marketed Drugs can be found on our New to Market Drug list. Important: Prior Authorization requirements may vary. Certain Drugs may not be covered by certain member plans.

2 Refer to the member's individual policy for inclusion in the PA program and medication guide for determination of coverage. Member cost share may be higher for Self-Administered Specialty Drugs not obtained at an in-network Specialty pharmacy. If you have questions or need further assistance after consulting this table, call our Provider Contact Center or the number on the back of your insurance card. Actemra SQ PA, QL Braftovi20 PA Daurismo PA Forteo PA, QL. Actimmune PA Bravelle PA Depen PA Fulphila1 PA. Adcirca PA, QL Buphenyl17 PA, QL Doptelet PA Fuzeon PA, QL.

3 Adempas17 PA, QL Cabometyx5,7 PA, QL Dupixent PA, QL Galafold5 PA. Advate8 PA Calquence13 PA,QL Egrifta PA Gammagard1 PA. Adynovate8 PA capecitabine PA, QL Eloctate8 PA Gammaked1 PA. Afinitor PA,QL Caprelsa3 PA, QL Emflaza16 PA, QL Gamunex C1 PA. Afstyla8 PA Carbaglu2 Enbrel PA, QL Ganirelix PA. Alecensa PA, QL Cerdelga PA, QL Enbrel Mini PA, QL Gattex2,15,17 PA, QL. Alphanate VWF8 PA Cetrotide PA Endari PA Genotropin PA. Alphanine SD8 PA Chemet PA Epclusa PA, QL Gilenya PA, QL. Alprolix8 PA Cholbam4 PA Epidiolex17 PA Gilotrif2 PA, QL.

4 Alunbrig PA,QL chorionic gonadotropins PA Epogen1 PA glatiramer PA, QL. Amjevita PA, QL Cimzia Pen PA, QL Erelzi PA, QL Glatopa PA, QL. Apokyn1 PA Cinryze PA, QL Ergomar5 PA Gleevec PA, QL. Aranesp1 PA Coagadex8 PA Erivedge PA, QL Gleostine Arcalyst PA, QL Cometriq7 PA Erleada PA, QL Gonal-F PA. Arikayce14 Copaxone PA, QL Esbriet PA, QL Granix1 PA, QL. Aubagio PA, QL Copegus PA Evzio20 PA, QL Haegarda PA, QL. Austedo12,17 PA, QL Copiktra3,7 PA Exjade Harvoni PA, QL. Avonex PA, QL Corifact8 PA Extavia PA, QL Helixate FS8 PA.

5 Bebulin8 PA Cosentyx PA, QL Farydak PA, QL Hemlibra8 PA. Benefix8 PA Cotellic PA, QL Feiba VH Immuno8 PA Hemofil M8 PA. Benlysta SC PA Cuprimine PA Feiba NF8 PA Hetlioz5 PA, QL. Berinert1 PA, QL Cuvitru15,17 PA Ferriprox4 Hexalen Betaseron PA, QL Cystadane5 PA Fibryga1 PA Hizentra PA. Bethkis Cystaran5 QL Firazyr PA, QL HP Acthar Gel1 PA, QL. Bexarotene PA, QL Daklinza PA, QL Firdapse PA Humate-P8 PA. Bosulif PA,QL Daraprim5 PA, QL Follistim AQ PA Humatrope PA. 1. Covered as Self-Administered or Provider- administered Specialty Pharmacy Drugs .

6 2. Dispensed by Accredo 877-ACCREDO. 3. Dispensed by Biologics. 4. Dispensed by Dohmen Life Science. 5. Dispensed by AllianceRx Walgreens Prime. 6. Dispensed by Centric Health Resources. 7. Dispensed by Diplomat Pharmacy. 8. Caremark is our preferred in-network pharmacy for hemophilia products. 9. Dispensed by Express Scripts. 10. Dispensed by AnovoRx. 11. Dispensed by RxCrossroads. 12. Dispensed by Cardinal Health Specialty . 13. Dispensed by Onco360 14. Dispensed by PantheRx 15. Dispensed by Option Care. 16. Dispensed by US Bioservices.

7 17. Dispensed by Caremark Specialty . 18. Dispensed by CuraScript. 19. Dispensed by Optime Care. 20. Dispensed by Avella. 21. Dispensed by Foundation Care. 22. Dispensed by MMS Solutions. * Important information on page 1. Page 1 of 3. Florida blue is an Independent Licensee of the blue Cross and blue Shield Association Self-Administered Specialty Drugs *. current 4/1/19. Humira PA, QL Letairis PA, QL Ocaliva PA, QL Revlimid PA, QL. Hycamtin PA Leukine1 PA, Octanate8 PA Riastap1 PA. Hyqvia5 PA leuprolide PA, QL octreotide Rixubis8 PA.

8 Ibrance PA, QL lomustine Odomzo17 PA, QL Rubraca PA, QL. Iclusig3 PA, QL Lonsurf PA, QL Ofev PA, QL Ruconest PA, QL. Idelvion8 PA Lorbrena PA Olumiant PA Rydapt PA. Idhifa PA, QL Luveris PA Olysio PA, QL Saizen PA. imatinib PA, QL Lynparza3 PA, QL Omnitrope PA Samsca QL. Imbruvica3,13,20 PA, QL Lysodren Opsumit PA, QL Sandostatin Impavido PA Matulane5 Orencia SQ PA, QL Serostim PA. Increlex17 PA Mavyret PA, QL Orenitram PA Signifor2 PA, QL. Infergen Mekinist PA, QL Orfadin5 PA sildenafil PA, QL. Ingrezza14 PA, QL Mektovi20 PA Orkambi5 PA, QL Siliq PA, QL.

9 Inlyta PA, QL Menopur PA Otezla PA, QL Simponi PA, QL. Intron A1 PA Mircera PA, QL Ovidrel PA sodium phenylbuterate PA, QL. Iressa7,17,20 PA, QL Moderiba PA Oxervate PA Somavert Ixinity8 PA Monoclate-P8 PA Palynziq PA Sovaldi PA, QL. Jadenu Mononine8 PA Pegasys PA Sprycel PA, QL. Jadenu Sprinkle Mulpleta PA Pegasys ProClick PA Stelara1 PA, QL. Jakafi PA, QL Myalept5 PA, QL Peg-Intron PA Stivarga PA, QL. Jivi8 PA Natpara PA Plegridy PA, QL Strensiq14 PA. Juxtapid2 PA, QL Nerlynx PA Pomalyst PA, QL Sucraid16 PA. Jynarque PA Neulasta1 PA, QL Praluent PA, QL Sutent PA, QL.

10 Kalbitor1 PA Neumega PA, QL Procrit1 PA Sylatron Kalydeco2,5 PA, QL Neupogen1 PA Procysbi2 PA Symdeko2,5 PA. Keveyis7,14 PA, QL Nexavar PA, QL Profilnine SD8 PA Synarel Kevzara PA, QL Ninlaro PA, QL Promacta PA, QL Synribo1,7 PA. Kineret3,11 PA, QL Nityr PA, QL Pulmozyme Syprine PA. Kisqali PA, QL Nivestym1 PA Purixan Tafinlar PA, QL. Kisqali-Femara PA, QL Norditropin PA Ravicti PA, QL Tagrisso3,17,20 PA, QL. Kitabis Novoeight PA Rebif PA, QL Takhzyro PA. Koate DVI8 PA NovoSeven8 PA Rebinyn8 PA Taltz1 PA, QL. Kogenate FS8 PA NovoSeven RT8 PA Recombinate8 PA Talzenna PA.


Related search queries