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State Health Plan Traditional Pharmacy Benefit Specialty Drug List The State Health Plan designates between self-administered specialty medications and provider-administered specialty medications for benefit coverage. Fo
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Document Date: 2014-07-02 12:29:39
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File Size: 109,04 KB
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Company
Express Scripts Holding Company /
Express Scripts /
/
Facility
Sildenafil*† SimponiTM*† NP Somatuline Depot /
Lupron Depot /
/
/
Position
RT /
/
Product
Sandostatin LAR /
Chorionic gonadotropin /
Octreotide acetate /
Lupron Depot /
Nutropin AQ /
Ganciclovir sodium /
Gonal-f /
Tev-Tropin /
Nutropin Depot /
Somatuline Depot /
Leuprolide acetate /
/
SocialTag
Dosage forms
Routes of administration
Medicinal chemistry
Pharmacy
Medical prescription
Injection
Pharmaceutical drug
Intravenous therapy
Pharmaceutical sciences
Pharmacology
State Health Plan Traditional Pharmacy Benefit Specialty Drug List The State Health Plan designates between self-administered specialty medications and provider-administered specialty medications for benefit coverage. Fo