| Document Date: 2014-07-03 13:32:20
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City Dysport / / Company CVS Caremark / Indicates Limited / / Facility CVS Caremark Specialty Pharmacy / / IndustryTerm injectable devices / pharmaceuticals / generic products / / MedicalCondition HIV / IMMUNE (IDIOPATHIC) THROMBOCYTOPENIC PURPURA / ACROMEGALY / *† Exjade LIPID DISORDERS / VPRIV MOVEMENT DISORDERS / Tysabri* IRON OVERLOAD / Myobloc *† Xeomin COAGULATION DISORDERS / Deficiency *† Increlex HEMATOPOIETICS *† Mozobil Neumega HEMOPHILIA / Synagis RETINAL DISORDERS / Zemaira* ANEMIA / Sovaldi Victrelis HEREDITARY / *† Mirena *† Skyla CRYOPYRINASSOCIATED PERIODIC SYNDROMES *† Arcalyst *† Ilaris GOUT / RELATED DISORDERS Growth Hormone Disorders / PAROXYSMAL NOCTURNAL HEMOGLOBINURIA *† Soliris PHENYLKETONURIA *† Kuvan PRE-TERM BIRTH *† Makena PSORIASIS / Sandostatin LAR *† Somatuline Depot *† Somavert CYSTIC FIBROSIS / Stelara PULMONARY ARTERIAL / Remicade Simponi *† Simponi Aria Xeljanz SEIZURE DISORDERS *† H.P. Acthar Gel *† Sabril SLEEP DISORDERS *† Hetlioz SYSTEMIC LUPUS ERYTHEMATOSUS / Vivitrol DUPUYTREN’S CONTRACTURE *† Xiaflex ALLERGIC ASTHMA / Retisert *† Visudyne RHEUMATOID ARTHRITIS / ANGIOEDEMA / VON WILLEBRAND DISEASE / Benlysta UREA CYCLE DISORDERS / Thalomid *† Tykerb *† Votrient *† Xalkori *† Xtandi *† Zelboraf Zolinza Zytiga OSTEOARTHRITIS / Tracleer* Tyvaso* Veletri* Ventavis* RENAL DISEASE Sensipar RESPIRATORY SYNCYTIAL VIRUS / ANTITRYPSIN DEFICIENCY / DISORDERS / / MedicalTreatment Botox / / Organization Joint Commission / URAC / / Person Aria Xeljanz / / / Position MICRhoGAM Nabi-HB / / Product Humira / Hycamtin / Synagis / Remodulin / Exjade / Serostim / Humatrope / Apokyn / Gleevec / Infergen / Amevive / Cerezyme / Aranesp / Neupogen / Lupron Depot / Temodar / Zorbtive / Leukine / FS / Soliris / Macugen / Zolinza / Ribasphere / XELODA / octreotide acetate / DESFERAL / Neulasta / Remicade / Implanon / PegIntron / ZOMETA / Mirena / LUPRON / Tracleer / Viadur / Lucentis / Rebif / Betaseron / Avonex / Letairis / Neumega / Tykerb / Pulmozyme / Norditropin / Revatio / Aldurazyme / Increlex / tobramycin / Thyrogen / Orencia / Kineret / Fuzeon / Targretin / Somavert / Reclast / leuprolide acetate / TOBI / Sandostatin LAR / Sprycel / Enbrel / Copaxone / Cystagon / BUPHENYL / Sensipar / Visudyne / Nutropin / COPEGUS / Kuvan / Tev-Tropin / Supprelin LA / Nexavar / Somatuline Depot / ribavirin / Saizen / Zoladex / Tasigna / Forteo / Pegasys / Myozyme / Vivitrol / Eligard / SANDOSTATIN / Naglazyme / Retisert / Trelstar / Genotropin / Rebetol / H.P. Acthar Gel / Myobloc / Ventavis / Arcalyst / Revlimid / Vantas / Xolair / Actimmune / Tysabri / Omnitrope / Fabrazyme / Sutent / Stimate / Elaprase / Thalomid / Tarceva / sildenafil citrate / / Technology ALPHA / / URL www.cvscaremarkspecialtyrx.com / /
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July[removed]State of Tennessee Specialty Pharmacy Drug List Providing one of the broadest offerings of specialty pharmaceuticals in the industry If you are a plan member or health care provider, please contact Specialty C