Medicaid Specialty Drug List · Highmark Health Options Specialty Drug List CURRENT AS OF 11/1/2020. Notes. Drug Name

Highmark Health Options

Specialty Drug List

CURRENT AS OF 11/1/2020

Notes

Drug Name Notes

*Adenosine Deaminase Scid Treatment - Agents***

Revcovi

*Als Agents - Miscellaneous***

Radicava

*Amino Acids***

Endari

*Aminoglycosides*

Arikayce

Bethkis

Kitabis Pak

Tobi

Tobi Podhaler

Tobramycin

Tobramycin Sulfate

*Aminolevulinate Synthase 1-Directed Sirna***

Givlaari

*Analgesics - Anti-Inflammatory*

Actemra

Actemra ACTPen

Arcalyst

Enbrel

Enbrel Mini

Enbrel SureClick

Humira

Humira Pediatric Crohns Start

Humira Pen

Humira Pen-CD/UC/HS Starter

Humira Pen-Ps/UV/Adol HS Start

Ilaris

1

Drug Name Notes

Ilaris (150mg Delivered)

Kevzara

Kineret

Olumiant

Orencia

Orencia ClickJect

Otrexup

Rasuvo

Rinvoq

Simponi

Simponi Aria

Xeljanz

Xeljanz XR

*Analgesics - Nonnarcotic*

CloNIDine HCl (Analgesia)

Duraclon

Prialt

*Androgens-Anabolic*

Aveed

Testopel

*Antiasthmatic And Bronchodilator Agents*

Xolair

*Anticonvulsants*

Fintepla

Sabril

Vigabatrin

Vigadrone

*Antidepressants*

Emsam

*Antidiabetics*

Korlym

*Antidiarrheals*

Mytesi

*Antidotes And Specific Antagonists*

Praxbind

2

Drug Name Notes

Vistogard

*Antidotes*

Deferasirox

Exjade

Ferriprox

Ferriprox Twice-A-Day

Jadenu

Jadenu Sprinkle

Praxbind

Vistogard

*Antiemetics*

Akynzeo

Cinvanti

Palonosetron HCl

Sustol

*Antifungals*

AmBisome

Cancidas

Caspofungin Acetate

Micafungin Sodium

Mycamine

*Antihemophilic Products - Monoclonal Antibodies***

Hemlibra

*Antihyperlipidemics*

Juxtapid

Kynamro

*Anti-Infective Agents - Misc.*

Colistimethate Sodium

Colistimethate Sodium (CBA)

Coly-Mycin M

Cubicin

Cubicin RF

DAPTOmycin

Ertapenem Sodium

Impavido

INVanz

3

Drug Name Notes

Sivextro

Tigecycline

Tygacil

*Antimalarials*

Daraprim

Pyrimethamine

*Antimyasthenic Agents*

Firdapse

Ruzurgi

*Antimyasthenic/Cholinergic Agents*

Firdapse

Ruzurgi

*Antimycobacterial Agents*

Pretomanid

Sirturo

*Antineoplastic - Bcl-2 Inhibitors***

Venclexta

*Antineoplastic - Fgfr Kinase Inhibitors***

Balversa

Pemazyre

*Antineoplastic - Methyltransferase Inhibitors***

Tazverik

*Antineoplastic - Tropomyosin Receptor Kinase Inhibitors***

Rozlytrek

Vitrakvi

*Antineoplastic - Xpo1 Inhibitors***

Xpovio (100 MG Once Weekly)


Xpovio (40 MG Twice Weekly)





4

Drug Name Notes

*Antineoplastics And Adjunctive Therapies*

Abiraterone Acetate

Abraxane

Actimmune

Adcetris

Adriamycin Intravenous Solution

Adriamycin Intravenous Solution Reconstituted 10 MG

Adriamycin Intravenous Solution Reconstituted 50 MG

Adrucil

Afinitor

Alecensa

Alferon N

Alimta

Alkeran

Alunbrig

Arranon

Arsenic Trioxide

Arzerra

Asparlas

Avastin

Ayvakit

AzaCITIDine

Azedra Dosimetric

Azedra Therapeutic

Bavencio

Beleodaq

Belrapzo

Bendamustine HCl

Bendeka

Besponsa

Bexarotene

BiCNU

Blenrep

Bleomycin Sulfate

Bortezomib

Bosulif

5

Drug Name Notes

Braftovi

Brukinsa

Busulfan

Busulfex

Cabometyx

Calquence

Camptosar

Capecitabine

Caprelsa

CARBOplatin

Carmustine

CISplatin

Cladribine

Clofarabine

Clolar

Cometriq (100 mg Daily Dose)



Cosmegen

Cotellic

Cyclophosphamide

Cytarabine

Cytarabine (PF)

Dacarbazine

Dacogen

DACTINomycin

Darzalex

Darzalex Faspro

DAUNOrubicin HCl

DaunoXome

Daurismo

Decitabine

DepoCyt

Dexrazoxane

Dexrazoxane HCl

Docefrez

6

Drug Name Notes

DOCEtaxel

DOCEtaxel (Non-Alcohol)

Doxil

DOXOrubicin HCl

DOXOrubicin HCl Liposomal

Eligard

Ellence

Elzonris

Empliciti

Enhertu

EpiRUBicin HCl

Erbitux

Erivedge

Erleada

Erlotinib HCl

Erwinaze

Ethyol

Etoposide

Everolimus

Evomela

Fareston

Farydak

Faslodex

Firmagon

Firmagon (240 MG Dose)

Floxuridine

Fludarabine Phosphate

Fluorouracil

Folotyn

Fulvestrant

Fusilev

Gavreto

Gazyva

Gemcitabine HCl

Gemzar

Gilotrif

7

Drug Name Notes

Gleevec

Gleostine

Halaven

Herceptin

Herceptin Hylecta

Herzuma

Hycamtin

Iclusig

Idamycin PFS

IDArubicin HCl

Ifex

Ifosfamide

Imatinib Mesylate

Imbruvica

Imfinzi

Infugem

Inlyta

Inqovi

Inrebic

Intron A

Irinotecan HCl

Istodax (Overfill)

Ixempra Kit

Jakafi

Jelmyto

Jevtana

Kadcyla

Kanjinti

Kepivance

Keytruda

Khapzory

Kisqali Femara (400 MG Dose)

Kisqali Femara (600 MG Dose)

Kisqali Femara(200 MG Dose)

Koselugo

Kymriah

8

Drug Name Notes

Kyprolis

Lartruvo

Lenvima (12 MG Daily Dose)

Lenvima (4 MG Daily Dose)

Leucovorin Calcium

Leuprolide Acetate

LEVOleucovorin Calcium

LEVOleucovorin Calcium PF

Libtayo

Lipodox 50

Lonsurf

Lorbrena

Lumoxiti

Lupron Depot (1-Month)




Lutathera

Lysodren

Marqibo

Matulane

Mekinist

Mektovi

Melphalan

Melphalan HCl

Mesna

Mesnex

MitoMYcin

Mitoxantrone HCl

Monjuvi

Mustargen

Mutamycin

Mvasi

Mylotarg

Navelbine

Nerlynx

9

Drug Name Notes

NexAVAR

Ninlaro

Nipent

Nubeqa

Odomzo

Ogivri

Oncaspar

Onivyde

Ontruzant

Onureg

Opdivo

Oxaliplatin

PACLitaxel

Padcev

Paraplatin

Perjeta

Phesgo

Photofrin

Polivy

Pomalyst

Portrazza

Poteligeo

Proleukin

Provenge

Purixan

Qinlock

Retevmo

Rituxan

Rituxan Hycela

romiDEPsin

Ruxience

Rydapt

Sarclisa

Sprycel

Stivarga

Sutent

10

Drug Name Notes

Sylatron

Synribo

Tabrecta

Tafinlar

Tagrisso

Tarceva

Targretin

Tasigna

Taxotere

Tecartus

Tecentriq

Temodar

Temozolomide

Temsirolimus

Teniposide

Tepadina

TheraCys

Thiotepa

Tice BCG

Toposar

Topotecan HCl

Toremifene Citrate

Torisel

Totect

Trazimera

Treanda

Trelstar Mixject

Tretinoin

Trisenox

Trodelvy

Truxima

Tukysa

Turalio

Tykerb

Uvadex

Valrubicin

11

Drug Name Notes

Valstar

Vantas

Vectibix

Velcade

Vidaza

VinBLAStine Sulfate

Vincasar PFS

vinCRIStine Sulfate

Vinorelbine Tartrate

Vizimpro

Voraxaze

Votrient

Vyxeos

Xalkori

Xatmep

Xeloda

Xofigo

Xospata

Xtandi

Yervoy

Yescarta

Yonsa

Zaltrap

Zanosar

Zelboraf

Zepzelca

Zinecard

Zirabev

Zoladex

Zolinza

Zykadia

Zytiga

*Antiparkinson Agents*

Apokyn

Inbrija

Kynmobi

12

Drug Name Notes

*Antipsychotics/Antimanic Agents*

Abilify Maintena

Aristada

Aristada Initio

FluPHENAZine Decanoate

Haldol Decanoate

Haloperidol Decanoate

Invega Sustenna

Invega Trinza

Nuplazid

Perseris

RisperDAL Consta

ZyPREXA Relprevv

*Antiretrovirals - Cd4-Directed Post-Attachment Inhibitor***

Trogarzo

*Antiretrovirals - Gp120-Directed Attachment Inhibitor***

Rukobia

*Antiretrovirals Adjuvants***

Tybost

*Antisense Oligonucleotide (Aso) Inhibitor Agents***

Tegsedi

*Antivirals*

Abacavir Sulfate

Abacavir Sulfate-lamiVUDine

Abacavir-Lamivudine-Zidovudine

Adefovir Dipivoxil

Aptivus

Atazanavir Sulfate

Atripla

Baraclude

Biktarvy

Cimduo

Combivir

Complera

Crixivan

13

Drug Name Notes

Cytovene

Daklinza

Delstrigo

Descovy

Didanosine

Dovato

Edurant

Efavirenz

Emtriva

Entecavir

Epivir

Epivir HBV

Epzicom

Evotaz

Fosamprenavir Calcium

Fuzeon

Ganciclovir Sodium

Genvoya

Hepsera

Intelence

Invirase

Isentress

Isentress HD

Juluca

Kaletra

LamiVUDine

lamiVUDine-Zidovudine

Lexiva

Lopinavir-Ritonavir

Moderiba

Moderiba (1200 MG Pack)



Nevirapine

Nevirapine ER

Norvir

14

Drug Name Notes

Odefsey

Olysio

Pegasys

Pegasys ProClick

PegIntron

Peg-Intron

Peg-Intron Redipen

Peg-Intron Redipen Pak 4

Pifeltro

Prevymis

Prezcobix

Prezista

Rebetol

Rescriptor

Retrovir

Reyataz

RibaPak

Ribasphere

Ribasphere RibaPak

Ribasphere RibaPak (1000 Pack)

Ribasphere Ribapak (1200 Pack)



RibaTab

Ribavirin

Ritonavir

Selzentry

Sovaldi

Stavudine

Stribild

Sustiva

Symfi

Symfi Lo

Symtuza

Temixys

Tenofovir Disoproxil Fumarate

15

Drug Name Notes

Tivicay

Tivicay PD

Triumeq

Trizivir

Truvada

Tyzeka

Vemlidy

Victrelis

Videx

Videx EC

Viracept

Viramune

Viramune XR

Virazole

Viread

Vitekta

Zerit

Ziagen

Zidovudine

*Anti-Von Willebrand Factor Agents***

Cablivi

*Assorted Classes*

Astagraf XL

Atgam

Azasan

azaTHIOprine

AzaTHIOprine Sodium

Benlysta

CellCept

CellCept Intravenous

Clovique

Cuprimine

CycloSPORINE

CycloSPORINE Modified

Depen Titratabs

D-Penamine

16

Drug Name Notes

Enspryng

Envarsus XR

Everolimus

Gamifant

Gengraf

Imuran

Mycophenolate Mofetil

Mycophenolate Mofetil HCl

Mycophenolate Sodium

Myfortic

Neoral

Nulojix

penicillAMINE

Prograf

Rapamune

Revlimid

SandIMMUNE

Sirolimus

Solesta

Syprine

Tacrolimus

Thalomid

Thymoglobulin

Trientine HCl

Uplizna

Varithena

Veltassa

Xiaflex

Zortress

*Atopic Dermatitis - Monoclonal Antibodies***

Dupixent

*Beta Blockers*

Hemangeol

*Bile Acid Synthesis Disorder Agents***

Cholbam

17

Drug Name Notes

*Biologicals Misc*

Adagen

*Cardiovascular Agents - Misc.*

Adcirca

Adempas

Alyq

Ambrisentan

Bosentan

Epoprostenol Sodium

Flolan

Letairis

Opsumit

Orenitram

Revatio

Sildenafil Citrate

Tadalafil (PAH)

Tracleer

Tyvaso

Tyvaso Refill

Tyvaso Starter

Veletri

*Cephalosporin Combinations***

Avycaz

Zerbaxa

*Cephalosporins*

Teflaro

*Chemicals*

5-Fluorouracil

Cyclophosphamide

CycloSPORINE

CycloSPORINE A

Etoposide

Floxuridine

Fluorouracil

FluPHENAZine Decanoate

Haloperidol Decanoate

18

Drug Name Notes

Leuprolide Acetate

Mitomycin

Sirolimus

Tacrolimus

Thiotepa

Tobramycin

*Corticosteroids*

Emflaza

Zilretta

*Cyclin-Dependent Kinases (Cdk) Inhibitors***

Ibrance

Kisqali (200 MG Dose)



Kisqali 200 Dose

Kisqali 400 Dose

Kisqali 600 Dose

Verzenio

*Cystic Fibrosis Agent - Combinations***

Orkambi

Symdeko

Trikafta

*Dermatologicals*

8-Mop

Acitretin

Botox Cosmetic

Cosentyx

Cosentyx (300 MG Dose)

Cosentyx Sensoready (300 MG)

Cosentyx Sensoready Pen

Durolane

Ilumya

Methoxsalen

Methoxsalen Rapid

Oxsoralen Ultra

Perlane

19

Drug Name Notes

Qutenza

Qutenza (2 Patch)

Refissa

Restylane

Siliq

Skyrizi (150 MG Dose)

Soriatane

Stelara

Taltz

Targretin

Tremfya

Tretinoin (Emollient)

Valchlor

*Diagnostic Products*

Acthrel

Macrilen

Thyrogen

*Digestive Aids*

Sucraid

*Diuretics*

Keveyis

*Endocrine And Metabolic Agents - Misc.*

Acthar

Aldurazyme

Buphenyl

Bynfezia Pen

Calcitonin (Salmon)

Cinacalcet HCl

Cystadane

DDAVP

DDAVP Rhinal Tube

Desmopressin Acetate Spray

Egrifta

Egrifta SV

Elaprase

Fabrazyme

20

Drug Name Notes

Fensolvi (6 Month)

Forteo

Galafold

Genotropin

Genotropin MiniQuick

Humatrope

Increlex

Ipamorelin Acetate

Jynarque

Kuvan

Lumizyme

Lupron Depot-Ped (1-Month)

Lupron Depot-Ped (3-Month)

Miacalcin

Mycapssa

Naglazyme

Natpara

Nitisinone

Nityr

Nocdurna

Norditropin FlexPro

Nutropin AQ NuSpin 10



Octreotide Acetate

Omnitrope

Orfadin

Palynziq

Pamidronate Disodium

Paricalcitol

Prolia

Ravicti

Rayaldee

Reclast

Saizen

Saizen Click.Easy

21

Drug Name Notes

Saizenprep

Samsca

SandoSTATIN

SandoSTATIN LAR Depot

Sensipar

Serostim

Signifor

Signifor LAR

Sodium Phenylbutyrate

Somatuline Depot

Somavert

Supprelin LA

Synarel

Teriparatide (Recombinant)

Tolvaptan

Triptodur

Tymlos

Xgeva

Zemplar

Zoledronic Acid

Zomacton

Zometa

Zorbtive

*Erythroid Maturation Agents***

Reblozyl

*Farnesoid X Receptor (Fxr) Agonists***

Ocaliva

*Gastrointestinal Agents - Misc.*

Avsola

Chenodal

Cimzia

Cimzia Prefilled

Cimzia Starter Kit

Entereg

Gattex

Inflectra

22

Drug Name Notes

Relistor

Remicade

Renflexis

*Genitourinary Agents - Miscellaneous*

Procysbi

Thiola

Thiola EC

*Gout Agents*

Krystexxa

*Growth Hormone Releasing Hormones (Ghrh) Combinations***

GHRP2-GHRP6-Sermorelin

GHRP2-Sermorelin

*Hematological Agents - Misc.*

Advate

Adynovate

Afstyla

Alphanate/VWF Complex/Human

AlphaNine SD

Alprolix

Bebulin

BeneFIX

Berinert

Cathflo Activase

Cinryze

Coagadex

Corifact

Eloctate

Esperoct

Feiba

Feiba NF

Feiba VH Immuno

Fibryga

Firazyr

Haegarda

Helixate FS

23

Drug Name Notes

Hemofil M

Humate-P

Icatibant Acetate

Idelvion

Ixinity

Jivi

Kalbitor

Kcentra

Koate

Koate-DVI

Kogenate FS

Kogenate FS Bio-Set

Kovaltry

Monoclate-P

Mononine

Novoeight

NovoSeven RT

Nuwiq

Obizur

Panhematin

Profilnine

Profilnine SD

Rebinyn

Recombinate

Retavase

Retavase Half-Kit

RiaSTAP

Rixubis

Ruconest

Sevenfact

Soliris

Tretten

Ultomiris

Vonvendi

Wilate

Xyntha

24

Drug Name Notes

Xyntha Solofuse

*Hematopoietic Agents*

Aranesp (Albumin Free)

Cerdelga

Cerezyme

Doptelet

Elelyso

Epogen

Fulphila

Granix

Injectafer

Leukine

Miglustat

Mircera

Mozobil

Mulpleta

Neulasta

Neulasta Onpro

Neumega

Neupogen

Nivestym

Nplate

Procrit

Promacta

Retacrit

Siklos

Udenyca

Vpriv

Zarxio

Zavesca

Ziextenzo

*Hemoglobin S (Hbs) Polymerization Inhibitors***

Oxbryta

*Hemostatics*

Cyklokapron

Tranexamic Acid

25

Drug Name Notes

*Hepatitis C Agent - Combinations***

Epclusa

Harvoni

Ledipasvir-Sofosbuvir

Mavyret

Sofosbuvir-Velpatasvir

Technivie

Viekira Pak

Viekira XR

Vosevi

Zepatier

*Hereditary Orotic Aciduria Treatment - Agents**

Xuriden

*Hypnotics*

Hetlioz

*Hypophosphatasia (Hpp) Agents***

Strensiq

*Insulin-Like Growth Factor-1 Receptor Inhibitors(Igf-1R)***

Tepezza

*Integrin Receptor Antagonists***

Entyvio

*Interleukin Antagonists***

Stelara

*Interleukin-5 Antagonists (Igg1 Kappa)***

Fasenra

Fasenra Pen

Nucala

*Interleukin-5 Antagonists (Igg4 Kappa)***

Cinqair

*Interleukin-6 (Il-6) Antagonists***

Sylvant

*Isocitrate Dehydrogenase-1 (Idh1) Inhibitors***

Tibsovo

26

Drug Name Notes

*Isocitrate Dehydrogenase-2 (Idh2) Inhibitors***

IDHIFA

*Leptin Analogues***

Myalept

*Lhrh/Gnrh Agonist Analog Combinations***

Lupaneta Pack

*Lysosomal Acid Lipase (Lal) Deficiency - Agents***

Kanuma

*Macrolides*

Dificid

*Migraine Products*

Zecuity

*Mixed Allergenic Extracts***

Oralair

*Monobactams***

Azactam

Aztreonam

Cayston

*Mouth/Throat/Dental Agents*

MuGard

*Mucopolysaccharidosis Iv (Mps Iv) - Agents***

Vimizim

*Mucopolysaccharidosis Vii (Mps Vii) - Agents***

Mepsevii

*Multiple Sclerosis Agents - Antimetabolites***

Mavenclad (10 Tabs)

Mavenclad (4 Tabs)

Mavenclad (5 Tabs)

Mavenclad (6 Tabs)

Mavenclad (7 Tabs)

Mavenclad (8 Tabs)

Mavenclad (9 Tabs)

*Muscular Dystrophy Agents***

Exondys 51

Viltepso

27

Drug Name Notes

Vyondys 53

*Musculoskeletal Therapy Agents*

Baclofen

Durolane

Euflexxa

Gablofen

Gel-One

Gelsyn-3

GenVisc 850

Hyalgan

Hymovis

Lioresal

Monovisc

OrthoVisc

Sodium Hyaluronate

Supartz FX

Synvisc

Synvisc One

Triluron

TriVisc

Visco-3

*Neurogenic Orthostatic Hypotension (Noh) - Agents***

Northera

*Neuromuscular Agents*

Botox

Dysport

Myobloc

Rilutek

Riluzole

Tiglutik

Xeomin

*Nutrients*

Dojolvi

*Oncolytic Viral Agents - Hsv1***

Imlygic

28

Drug Name Notes

*Ophthalmic Agents*

Beovu

Bevacizumab

Cystadrops

Cystaran

Eylea

Iluvien

Jetrea

Lucentis

Macugen

Ozurdex

Retisert

Visudyne

*Ophthalmic Gene Therapy***

Luxturna

*Ophthalmic Nerve Growth Factors***

Oxervate

*Passive Immunizing Agents - Combinations***

Hyqvia

*Passive Immunizing Agents*

Asceniv

Bivigam

Carimune NF

Cutaquig

Cuvitru

Flebogamma DIF

GamaSTAN

GamaSTAN S/D

Gammagard

Gammagard S/D Less IgA

Gammaked

Gammaplex

Gamunex-C

Hizentra

HyperRHO S/D

MICRhoGAM Ultra-Filtered Plus

29

Drug Name Notes

Octagam

Panzyga

Privigen

RhoGAM Ultra-Filtered Plus

Rhophylac

Synagis

WinRho SDF

Xembify

*Pcsk9 Inhibitors***

Praluent

Repatha

Repatha Pushtronex System

Repatha SureClick

*Phosphatidylinositol 3-Kinase (Pi3k) Inhibitors***

Aliqopa

Copiktra

Piqray (200 MG Daily Dose)



Zydelig

*Phosphodiesterase 4 (Pde4) Inhibitors***

Otezla

*Plasma Kallikrein Inhibitors - Monoclonal Antibodies***

Takhzyro

*Poly (Adp-Ribose) Polymerase (Parp) Inhibitors**

Lynparza

Rubraca

Talzenna

Zejula

*Poly (Adp-Ribose) Polymerase (Parp) Inhibitors***

Lynparza

Rubraca

Talzenna

Zejula

*Potassium Removing Agents***

Veltassa

30

Drug Name Notes

*Progestins*

HYDROXYprogesterone Caproate

Makena

*Psychotherapeutic And Neurological Agents - Misc.*

Ampyra

Aubagio

Austedo

Avonex

Avonex Pen

Avonex Prefilled

Bafiertam

Betaseron

Copaxone

Dalfampridine ER

Extavia

Gilenya

Glatiramer Acetate

Glatopa

Ingrezza

Kesimpta

Lemtrada

Mayzent

Ocrevus

Plegridy

Plegridy Starter Pack

Rebif

Rebif Rebidose

Rebif Rebidose Titration Pack

Rebif Titration Pack

Tecfidera

Tetrabenazine

Tysabri

Vumerity

Vumerity (Starter)

Xenazine

Xyrem

31

Drug Name Notes

Zeposia

Zeposia 7-Day Starter Pack

Zeposia Starter Kit

Zinbryta

*Pulmonary Fibrosis Agents - Kinase Inhibitors***

Ofev

*Pulmonary Fibrosis Agents***

Esbriet

*Pulmonary Hypertension - Prostacyclin Receptor Agonist***

Uptravi

*Respiratory Agents - Misc.*

Aralast

Aralast NP

Glassia

Kalydeco

Prolastin-C

Pulmozyme

Zemaira

*Sclerostin Inhibitors***

Evenity

*Small Interfering Ribonucleic Acid (Sirna) Agents***

Onpattro

*Spinal Muscular Atrophy-Antisense Oligonucleotides***

Spinraza

*Spinal Muscular Atrophy-Gene Therapy Agents***

Zolgensma 10.1-10.5 kg









32

Drug Name Notes














*Spinal Muscular Atrophy-Smn2 Splicing Modifiers***

Evrysdi

*Spleen Tyrosine Kinase (Syk) Inhibitors***

Tavalisse

*Tetrahydroisoquinolines***

Yondelis

*Thrombolytic Agent - Misc***

Defitelio

*Transthyretin Stabilizers***

Vyndamax

Vyndaqel

*Tripeptidyl Peptidase 1 Deficiency Treatment - Agents***

Brineura

*Tryptophan Hydroxylase Inhibitors***

Xermelo

*Vaccines*

BCG Vaccine

*X-Linked Hypophosphatemia (Xlh) Treatment - Agents***

Crysvita

33

34

Documents

Medicaid Specialty Drug List · Highmark Health Options Specialty Drug List CURRENT AS OF 11/1/2020. Notes. Drug Name