January 2023 
                                                                                                                                                                                                     Updated Quarterly 
                       
                               CVS Specialty® Pharmacy Distribution Drug List 
                          Providing one of the broadest offerings of specialty pharmaceuticals in the industry 
                      The CVS Specialty Pharmacy Distribution Drug List is a guide of medications available and distributed through CVS 
                      Specialty. Our goal is to help make your life better. With more than 40 years of experience, CVS Specialty provides quality 
                      care and service. Our network of pharmacies includes certifications and accreditations from the Joint Commission, 
                      Utilization Review Accreditation Commission (URAC), the National Association of Boards of Pharmacy (NABP) and the 
                      Accreditation Commission for Health Care (ACHC). These nationally recognized symbols reflect an organization’s 
                      commitment to meet highest standards of quality, compliance and safety. This list is updated quarterly. Below brand-name 
                      products are in CAPS, and generic products are shown in lowercase italics. 
                       
                      Prospective Patients: Ready to get started? Enroll to get your medications from CVS Specialty. 
                      Health Care Providers: Visit the CVS Specialty website to download enrollment forms or call 1-800-237-2767 (TTY: 711). 
                       
                                             Therapy Class                                                     Brand Name                                                      Generic Name 
                         Acromegaly                                                              BYNFEZIA PEN                                              octreotide acetate (SANDOSTATIN) 
                                                                                                 LANREOTIDE 
                                                                                                 SANDOSTATIN 
                                                                                                 SANDOSTATIN LAR 
                                                                                                 SOMATULINE DEPOT 
                                                                                                 SOMAVERT 
                         Alcohol/Opioid Dependency                                               SUBLOCADE                                                  
                                                                                                 VIVITROL 
                         Allergen Immunotherapy                                                  ORALAIR                                                    
                                                                                                 PALFORZIA 
                         Alopecia Areata                                                         OLUMIANT                                                   
                         Alpha-1 Antitrypsin Deficiency                                          ARALAST NP 
                                                                                                 GLASSIA                                                    
                                                                                                 ZEMAIRA 
                         Amyloidosis                                                             AMVUTTRA 
                                                                                                 ONPATTRO                                                   
                                                                                                 VYNDAMAX 
                                                                                                 VYNDAQEL 
                         Anemia                                                                  ARANESP 
                                                                                                 ENJAYMO 
                                                                                                 EPOGEN 
                                                                                                 PROCRIT                                                    
                                                                                                 REBLOZYL 
                                                                                                 RETACRIT 
                                                                                                 ZYNTEGLO 
                         Asthma                                                                  CINQAIR 
                                                                                                 DUPIXENT 
                                                                                                 FASENRA                                                    
                                                                                                 NUCALA 
                                                                                                 TEZSPIRE 
                                                                                                 XOLAIR 
                         Atopic Dermatitis                                                       ADBRY                                                      
                                                                                                 CIBINQO 
                       
                      Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may 
                      change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their 
                      appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject 
                      to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical 
                      manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.  
                      ©2023 CVS Specialty. All rights reserved. 75-CTC14953E January 2023 v01012023 CVS Specialty Pharmacy Distribution Drug List               Page 1 of 18 
                       
                                                                                                       January 2023 
                                                                                                            Updated Quarterly 
             
                        Therapy Class                        Brand Name                        Generic Name 
              Atopic Dermatitis (cont.)              DUPIXENT                         
                                                     RINVOQ 
              Bone Disorders – Other                 VOXZOGO                          
              Botulinum Toxins                       DYSPORT 
                                                     MYOBLOC                          
                                                     XEOMIN 
              Cardiac Disorders                      ARCALYST                        dofetilide (TIKOSYN) 
                                                     CAMZYOS 
                                                     TIKOSYN 
              Coagulation Disorders                  CEPROTIN                         
              Contraceptives                         KYLEENA 
                                                     LILETTA 
                                                     MIRENA                           
                                                     NEXPLANON 
                                                     SKYLA 
              Cryopyrin-Associated Periodic          ARCALYST                         
              Syndromes                              ILARIS 
              Cystic Fibrosis                        BETHKIS                         tobramycin (BETHKIS)                                            
                                                     BRONCHITOL                      tobramycin nebulizer (TOBI) 
                                                     CAYSTON 
                                                     KITABIS PAK                      
                                                     PULMOZYME                        
                                                     TOBI                             
                                                     TOBI PODHALER 
              Dupuytren’s Contracture                XIAFLEX                          
              Endocrine Disorders – Other            ACTHAR                           
                                                     CORTROPHIN 
              Electrolyte Disorders                  SAMSCA                          tolvaptan (SAMSCA) 
              Enzyme Deficiency Disorders – Other                                    nitisinone 
              Gastrointestinal Disorders – Other     DUPIXENT 
                                                     GATTEX 
                                                     MYTESI                           
                                                     OCALIVA 
                                                     SOLESTA 
              Gout                                   KRYSTEXXA                        
              Growth Hormone & Related Disorders     EGRIFTA                          
                                                     EGRIFTA SV 
                                                     GENOTROPIN 
                                                     HUMATROPE 
                                                     INCRELEX 
                                                     MACRILEN 
                                                     NORDITROPIN 
                                                     NUTROPIN AQ 
                                                     OMNITROPE 
                                                     SAIZEN 
                                                     SEROSTIM 
                                                     SKYTROFA 
                                                     ZOMACTON 
                                                     ZORBTIVE 
              Hematopoietics                         MOZOBIL                          
             
            Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may 
            change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their 
            appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject 
            to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical 
            manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.  
            ©2023 CVS Specialty. All rights reserved. 75-CTC14953E January 2023 v01012023 CVS Specialty Pharmacy Distribution Drug List               Page 2 of 18 
             
                                                                                                        January 2023 
                                                                                                             Updated Quarterly 
             
                         Therapy Class                        Brand Name                         Generic Name 
              Hemophilia, Von Willebrand Disease      ADVATE                           
              & Related Bleeding Disorders            ADYNOVATE                        
                                                      AFSTYLA  
                                                      ALPHANATE 
                                                      ALPHANINE SD 
                                                      ALPROLIX 
                                                      BENEFIX 
                                                      COAGADEX 
                                                      CORIFACT 
                                                      ELOCTATE 
                                                      ESPEROCT 
                                                      FEIBA 
                                                      FIBRYGA 
                                                      HEMGENIX 
                                                      HEMLIBRA 
                                                      HEMOFIL M 
                                                      HUMATE-P 
                                                      IDELVION 
                                                      IXINITY 
                                                      JIVI 
                                                      KOATE 
                                                      KOATE-DVI 
                                                      KOGENATE FS 
                                                      KOVALTRY 
                                                      MONONINE 
                                                      NOVOEIGHT 
                                                      NOVOSEVEN RT 
                                                      NUWIQ 
                                                      OBIZUR 
                                                      PROFILNINE 
                                                      PROFILNINE SD 
                                                      REBINYN 
                                                      RECOMBINATE 
                                                      RIASTAP 
                                                      RIXUBIS 
                                                      SEVENFACT 
                                                      STIMATE 
                                                      TRETTEN 
                                                      VONVENDI 
                                                      WILATE 
                                                      XYNTHA 
              Hepatitis                               BARACLUDE                       adefovir dipivoxil 
                                                      EPCLUSA                         entecavir (BARACLUDE) 
                                                      EPIVIR HBV                      lamivudine hbv (EPIVIR HBV) 
                                                      HARVONI                         ribavirin caps   
                                                      INTRON A                        ribavirin tabs 
                                                      LEDIPASVIR-SOFOSBUVIR           tenofovir disoproxil fumarate (VIREAD) 
                                                      MAVYRET                          
                                                      PEGASYS 
                                                      PEGINTRON 
                                                      SOFOSBUVIR/VELPATASVIR 
             
            Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may 
            change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their 
            appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject 
            to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical 
            manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.  
            ©2023 CVS Specialty. All rights reserved. 75-CTC14953E January 2023 v01012023 CVS Specialty Pharmacy Distribution Drug List               Page 3 of 18 
             
                                                                                                        January 2023 
                                                                                                             Updated Quarterly 
             
                         Therapy Class                        Brand Name                         Generic Name 
              Hepatitis (cont.)                       SOVALDI                          
                                                      VEMLIDY 
                                                      VIEKIRA PAK  
                                                      VIREAD 
                                                      VOSEVI 
                                                      ZEPATIER 
              Hereditary Angioedema                   BERINERT                        icatibant acetate (FIRAZYR) 
                                                      CINRYZE                          
                                                      FIRAZYR 
                                                      HAEGARDA 
                                                      KALBITOR 
                                                      RUCONEST 
                                                      TAKHZYRO 
              Hormonal Therapies                      AVEED                           leuprolide acetate (LUPRON) 
                                                      ELIGARD 
                                                      FENSOLVI 
                                                      FIRMAGON 
                                                      LUPRON 
                                                      LUPRON DEPOT 
                                                      NATPARA 
                                                      SUPPRELIN LA 
                                                      TRELSTAR 
                                                      ZOLADEX 
              Human Immunodeficiency Virus            APRETUDE                        abacavir tab (ZIAGEN) 
                                                      APTIVUS                         abacavir-lamivudine (EPZICOM) 
                                                      BIKTARVY                        abacavir sulfate-lamivudine-zidovudine  
                                                      CABENUVA                              (TRIZIVIR) 
                                                      CIMDUO                          atazanavir sulfate (REYATAZ) 
                                                      COMBIVIR                        didanosine (VIDEX, VIDEX EC) 
                                                      COMPLERA                        efavirenz (SUSTIVA) 
                                                      CRIXIVAN                        efavirenz-emtricitabine-tenofovir df  
                                                      DELSTRIGO                       efavirenz-lamivudine-tenofovir df 
                                                      DESCOVY                              (SYMFI, SYMFI LO) 
                                                      DOVATO                          emtricitabine (EMTRIVA) 
                                                      EDURANT                         emtricitabine-tenofovir df  
                                                      EMTRIVA                              (TRUVADA) 
                                                      EPIVIR                          etravirine (INTELENCE) 
                                                      EPZICOM                         fosamprenavir (LEXIVA) 
                                                      EVOTAZ                          lamivudine (EPIVIR) 
                                                      FUZEON                          lamivudine-zidovudine (COMBIVIR) 
                                                      GENVOYA                         lopinavir-ritonavir (KALETRA) 
                                                      INTELENCE                       maraviroc (SELZENTRY) 
                                                      INVIRASE                        nevirapine (VIRAMUNE, VIRAMUNE XR) 
                                                      ISENTRESS                       ritonavir (NORVIR) 
                                                      JULUCA                          stavudine 
                                                      KALETRA                         tenofovir disoproxil fumarate (VIREAD) 
                                                      LEXIVA                          zidovudine (RETROVIR) 
                                                      NORVIR                           
                                                      ODEFSEY 
                                                      PIFELTRO 
                                                      PREZCOBIX 
             
            Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may 
            change from time to time. In addition, a member’s specific benefit plan design may not cover certain products or categories, regardless of their 
            appearance on this document. Call CVS Specialty at 1-800-237-2767 (TTY: 711) for specific medications available through CVS Specialty. Listing is subject 
            to change. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical 
            manufacturers not affiliated with CVS Specialty. Fax: 1-800-323-2445; e-Prescribe: CVS Specialty Pharmacy.  
            ©2023 CVS Specialty. All rights reserved. 75-CTC14953E January 2023 v01012023 CVS Specialty Pharmacy Distribution Drug List               Page 4 of 18