HealthPartners.com - Specialty Drug List

Specialty Drug List

SPECIALTY MEDICATIONS LIST

Anemia/Blood Modifiers
Aranesp (PA)
Leukine
Neulasta
Neupogen
Procrit
Epogen (NF)
Neumega (NF)

Hemophilia (1)
All blood factor products

Hepatitis
Peg-Intron
Pegasys (PA)
Ribavirin
Infergen (NF)

Multiple Sclerosis
Avonex (ST)
Betaseron (ST)
Copaxone
Rebif

Rheumatoid Arthritis
Enbrel (PA)
Humira (PA)
Kineret (PA)

Others
Acthar HP(PA)
Forteo (PA)
Fuzeon (MD)
Letairis (PA)
Raptiva (PA)
Revatio (PA)
Tracleer (2) (PA)
Ventavis (PA)
Serostim (NF)
Xolair (NF)
Zorbtive (NF)

MD = physician-edit, PA = prior approval, ST = step-therapy, NF = non-formulary (not covered)
This list is subject to change and is not all-inclusive.
Some medications have limits (such as prior approval, physician-edit or step-therapy)
as listed in the Preferred Drug List (formulary) at www.healthpartners.com

Specialty Medications must be obtained through CuraScript Pharmacy.

Contact CuraScript by telephone at 1-877-696-5247 to enroll in the specialty drug program.

HealthPartners also makes available other choice vendors on select products, see footnotes below.

(1) Blood factor products are also available through Children's/Caremark Hemophilia Treatment Center Pharmacy (651-846-3262 or toll free at 1-800-873-1850 x3262) and through Fairview Specialty Pharmacy (612-626-8484 or toll free at 1-866-419-7859).

(2) Tracleer is also available through Caremark Specialty Pharmacy. Please call toll free at 1-800-238-7828.

GROWTH HORMONE LIST
Covered Norditropin Omnitrope	Not Covered Genotropin Humatrope Nutropin Nutropin AQ Tev-tropin
This list is subject to change. Growth hormone requires prior approval.

Growth Hormone products are covered under your medical growth hormone benefit and require prior approval. Growth Hormone is available only through HealthPartners Riverside Pharmacy. Please look under medical policy criteria to verify your coverage for growth hormone. Call HealthPartners Riverside Pharmacy at 612-371-1726 or toll free at 1-866-554-6570 to enroll in the specialty drug program for growth hormone.

INFERTILITY PRODUCT LIST
Covered Cetrotide chorionic gonadotropin Follistim AQ ganirelix leuprolide (Lupron) Luveris Menopur Ovidrel Repronex	Not Covered Bravelle Gonal-F
This list is subject to change.

Infertility products are covered under your infertility benefit. Please verify your coverage for infertility. Infertility products are available through Freedom Pharmacy, a subsidiary of CuraScript. These infertility products are also available at any retail pharmacy when same-day service is needed. Please call Freedom Pharmacy toll free at 1-800-660-4283.