Mercy Health Plans - Specialty Pharmaceuticals

Specialty Drug List (highest formulary tier) Specialty pharmaceuticals are high-cost (greater than $600 per month), injectable, oral or inhaled drugs that require close supervision and monitoring, are used to treat chronic conditions such as hepatitis, rheumatoid arthritis, psoriasis, and multiple sclerosis, and require special handling. Specialty pharmaceuticals will process at the highest tier of the pharmacy benefit and are limited to a thirty (30)-day supply.
Actimmune (PA) Apokyn Aranesp Arcalyst (PA) Atripla Avonex (ST) Betaseron (ST) Buphenyl Copaxone Copegus (PA) Enbrel (PA) Epogen Exjade (PA) Forteo (PA) Fuzeon (PA) Gleevec (PA) Growth Hormone (PA) Hexalen Humira (PA) Hycamtin (PA) Increlex (PA) Infergen (PA) Intelence (ST) Intron-A (PA) Iressa (PA)	Isentress Kineret (PA) Kuvan (oral) (PA) Letairis (PA) Leukine Lupron Lupron Depot Neulasta Neumega Neupogen Nexavar (PA) Octreotide Orfadin Pegasys (PA) Peg-Intron (PA) Procrit Pulmozyme Raptiva (PA) Rebetol (PA) Rebif Revatio (PA) Revlimid (PA) Ribapak (PA) Ribasphere (PA) Ribatab (PA)	Ribavirin (PA) Rilutek Roferon A (PA) Sandostatin Sandostatin LAR Selzentry (PA) Somatuline Somavert Sprycel (PA) Sutent (PA) Targretin Tasigna (PA) Temodar Thalomid (PA) Tobi Tracleer (PA) tretinoin 10mg cap Truvada Tykerb (PA) Ventavis (PA) Vesanoid Vidaza Xeloda (PA) Zavesca (PA) Zolinza Zorbtive
(PA) = Prior authorization required (ST) = Step-therapy required NOTE: This list may not be all-inclusive and is subject to change.