Self-injectable specialty drugs - Aetna

1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Self-injectable specialty drugs 2017 Aetna specialty CareRx SM. Benefits Plan drug List (9/16). What you should know to get started What is Aetna specialty CareRx? What is a specialty drug ? Aetna specialty CareRx is a pharmacy benefits/insurance specialty drugs treat complex, chronic diseases. A nurse or plan that covers certain specialty drugs .** You may get your pharmacist will often support their use during treatment. first fill of these drugs at an in-network retail pharmacy. These drugs may be injected, infused or taken by mouth. You For best coverage, all refills must come from an in-network may need to refrigerate them. They are often expensive and specialty pharmacy, like Aetna specialty Pharmacy medicine may not be available at retail pharmacies.

2 And support services. Look up your plan documents for specialty drug coverage details. You'll also learn more about the requirements and limitations of your pharmacy benefits and insurance plan. ** specialty medicine through Aetna specialty Pharmacy and the specialty pharmacy network may not be available to California health maintenance organization (HMO) members. Talk to your doctor about the appropriate way to get the specialty medicine you need. Doctors may have agreed to dispense and administer these drugs to you themselves. Or they may write a prescription so you can fill them at any participating retail or mail-order pharmacy you choose. Key NPL Most plans require national precertification. * drug may not be available through Aetna specialty Pharmacy. PR Most plans require precertification.

3 ** specialty drugs are also available through a retail pharmacy or through Aetna specialty Pharmacy. QL Most plans have a quantity limit. + If your doctor supplies and administers these drugs , he or she may continue to do so. Your medical plan may continue to cover your drug . ST Most plans have step therapy. Category Generic medicine Brand-name medicine Antineoplastic agents Antineoplastics leuprolide PR ELIGARD PR. hormonal agents FIRMAGON PR +. LUPRON PR. LUPRON DEPOT PR +. Antineoplastics none ACTIMMUNE NPL PR. miscellaneous INTRON-A NPL PR. SYLATRON PR QL. Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company ( Aetna ).

4 In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. Category Generic medicine Brand-name medicine Blood products modifiers volume expanders Anti-inhibitor coagulant none FEIBA NF PR FEIBA VH PR. complex Blood-clotting factor VIIa none NOVOSEVEN NPL PR NOVOSEVEN RT NPL PR. (recombinant). Blood-clotting factor VIII none ALPHANATE NPL PR KOATE-DVI NPL PR. (human) CORIFACT NPL PR MONOCLATE-P NPL PR. HEMOFIL M NPL PR WILATE NPL PR. HUMATE-P NPL PR. Blood-clotting factor VIII none ADVATE NPL PR KOVALTRY NPL PR.

5 (recombinant) ADYNOVATE NPL PR NOVOEIGHT NPL PR. AFSTYLA KIT NPL PR NUWIQ NPL PR. ELOCTATE NPL PR RECOMBINATE NPL PR. HELIXATE FS NPL PR XYNTHA NPL PR. KOGENATE FS NPL PR. Blood-clotting factor IX none ALPHANINE SD NPL PR PROFILNINE NPL PR. (nonrecombinant) MONONINE NPL PR. Blood-clotting factor IX none ALPROLIX NPL PR IDELVION NPL PR. (recombinant) BEBULIN VH NPL PR IXINITY NPL PR. BENEFIX NPL PR. Blood-clotting factor X (human) none COAGADEX NPL PR. Blood-clotting factor XIII none TRETTEN NPL PR. (recombinant). Blood-clotting complex none KCENTRA NPL PR. Fibrinogen concentrate none RIASTAP NPL + RIXUBIS NPL PR. (human). Hematopoietic growth factors none ARANESP NPL PR + NEUMEGA PR +. EPOGEN NPL PR + NEUPOGEN NPL PR +. GRANIX NPL PR + PROCRIT NPL PR +. MIRCERA NPL PR + ZARXIO NPL PR +.

6 NEULASTA NPL PR +. Hereditary angioedema none RUCONEST * NPL PR +. Cardiovascular system Inherited homozygous familial none KYNAMRO PR QL ST REPATHA NPL PR QL ST. hypercholesterolemia Inherited heterozygous familial none PRALUENT NPL PR QL ST REPATHA NPL PR QL ST. hypercholesterolemia Pulmonary hypertension agents none REVATIO IV * NPL PR. Category Generic medicine Brand-name medicine Central nervous system Multiple sclerosis agents glatopa NPL PR AVONEX NPL PR ST EXTAVIA NPL PR ST. BETASERON NPL PR ST PLEGRIDY NPL PR QL ST. COPAXONE NPL PR REBIF NPL PR. Dermatological agents Antipsoriatics none COSENTYX NPL PR ST OTREXUP ST. ENBREL NPL PR SIMPONI NPL PR ST +. HUMIRA NPL PR TALTZ NPL PR ST. KINERET NPL PR ST. Endocrine system Acromegaly octreotide PR + SANDOSTATIN PR + SOMATULINE NPL PR +.

7 SANDOSTATIN LAR PR +. SOMAVERT PR. Cushing's disease none SIGNIFOR PR QL. Fertility agents chorionic BRAVELLE NPL PR LUPRON PR. gonadotropin PR CETROTIDE NPL PR MENOPUR NPL PR. leuprolide PR FOLLISTIM AQ NPL PR OVIDREL NPL PR. novarel PR GANIRELIX NPL PR REPRONEX NPL PR. pregnyl PR GONAL-F NPL PR. GONAL-F RFF NPL PR. Gaucher disease none VPRIV NPL PR +. Growth factors insulin-like none INCRELEX NPL PR. Growth hormone agents none GENOTROPIN NPL PR ST OMNITROPE NPL PR. HUMATROPE NPL PR ST SAIZEN NPL PR ST. NORDITROPIN NPL PR ST SEROSTIM NPL PR ST. NUTROPIN NPL PR ST ZOMACTON NPL PR ST. NUTROPIN AQ NPL PR ST ZORBTIVE NPL PR. NUTROPIN AQ. NUSPIN NPL PR ST. Hormone replacement none MAKENA PR QL. progestins Hyperparathyroidism doxercalciferol HECTOROL. Hypoparathyroidism none NATPARA * NPL PR QL.

8 Hypophosphatasia none STRENSIQ * NPL PR. Leptin deficiency none MYALEPT NPL PR QL. Category Generic medicine Brand-name medicine Gastrointestinal system Crohn's disease none HUMIRA NPL PR. Short bowel syndrome none GATTEX * NPL PR QL. Infections and infestations Antiretrovirals fusion none FUZEON PR. inhibitors Antivirals hepatitis agents none INFERGEN NPL PR + PEGINTRON NPL PR. PEGASYS NPL PR. Musculoskeletal system Bone-modifying agents none FORTEO NPL PR + XGEVA NPL PR +. PROLIA NPL PR +. Enzymes none XIAFLEX +. Gout none KRYSTEXXA NPL PR +. Interleukin-1beta blockers none ILARIS * NPL PR +. Rheumatoid arthritis none ACTEMRA SC NPL PR ST OTREXUP ST. ENBREL NPL PR RASUVO ST. HUMIRA NPL PR SIMPONI NPL PR ST. KINERET NPL PR ST SIMPONI ARIA NPL PR. Respiratory tract agents Antiasthmatic monoclonal none XOLAIR NPL PR +.

9 Antibodies Cystic fibrosis none CAYSTON *. Vaccines, toxoids and biologics Immune globulin none GAMMAGARD NPL PR + GAMUNEX-C NPL PR +. immune disorders GAMMAGARD HIZENTRA NPL PR +. S/D NPL PR + HYQVIA NPL PR +. GAMMAKED NPL PR. For more information on Aetna specialty Pharmacy, call 1-866-782-ASRX (1-866-782-2779) or TDD: 1-877-833-ASRX (1-877-833-2779). Or visit Commercial fully insured members in Louisiana and Texas (except Federal Employee Health Benefit Plan members) who have coverage for medications that are added to or removed from the Aetna specialty CareRx list, national precertification list, precertification safety edit list, precertification list, step-therapy list or quantity limit list, or have quantity limits modified during the plan year will continue to have those medications covered at the same benefits level under their plan prior to the addition, removal or change, until their plan's renewal date.

10 The term precertification means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. In accordance with state law, fully insured commercial California HMO members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the precertification or step-therapy lists will continue to have those medications covered, for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee's medical condition.