HealthPartners.com - Specialty Drugs

Specialty Drugs

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
Ribavirin
Infergen (NF)

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

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

Oncology (starting 9/1/2009)
Afinitor
Gleevec
Nexavar
Revlimid
Sprycel
Sutent
Tarceva
Tasigna
Temodar
Thalomid
Tykerb
Xeloda
Zolinza (PA)
tretinoin oral (Vesanoid) (NF)

Others
Acthar HP (2) (PA)
Banzel (PA)
Forteo (PA)
Fuzeon (MD)
Kuvan (PA)
Letairis (2) (PA)
Promacta (PA)
Raptiva (PA)
Revatio (PA)
Somavert (2) (PA)
Sucraid (PA)
Tracleer (2) (PA)
Ventavis (2) (PA)
Xenazine (3) (PA)
Serostim (NF)
Xolair (2) (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 indicated in the Preferred Drug List (formulary) at healthpartners.com

Specialty Medications must be obtained through SpecialtyScripts^TM Pharmacy.

Contact SpecialtyScripts^TM by telephone at 1-866-294-1760 to fill your specialty medications.

You may use other choice vendors for 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) These medications must be obtained from Caremark Rx Specialty Pharmacy. Please call Caremark toll-free at 1-800-237-2767 or email customerservicefax@caremark.com.

(3) This medication has limited distribution through only a few specialty pharmacies nationwide, including Caremark Rx Specialty Pharmacy. Please call toll-free at 1-800-237-2767 or email customerservicefax@caremark.com.

GROWTH HORMONE LIST

Covered
Norditropin
Omnitrope

Not Covered
Genotropin
Humatrope
Nutropin
Nutropin AQ
Saizen
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 only available 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 receive your prescriptions 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 SpecialtyScripts^TM Pharmacy. These products are also available through Freedom Pharmacy, a subsidiary of CuraScript Pharmacy. Freedom Pharmacy can be reached toll free at 1-800-660-4283. These products are also available at any retail pharmacy when same-day service is needed. Please call SpecialtyScripts^TM Pharmacy toll-free at 1-866-294-1760.