Aetna Specialty Pharmacy Most Frequently Prescribed Medications

Aetna Specialty Pharmacy®
Most Frequently
Prescribed
Medications‡
PRODUCT NAME
GENERIC NAME
naltrexone
ALPHA-1 ANTITRYPSIN (AAT) DEFICIENCY
Aralast
Prolastin
alpha 1-proteinase inhibitor
alpha 1-proteinase inhibitor
ASTHMA
Xolair
Brethine
omalizumab
terbutaline sulfate
CHRONIC RENAL
Aranesp
Epogen
Ferrlecit
Procrit*
darbepoetin alfa
epoetin alfa
sodium ferric gluconate complex
epoetin alfa
CROHN’S DISEASE
Remicade
infliximab
ENDOCRINOLOGY
Cortrosyn
Dostinex
Forteo SI
Miacalcin
cosyntropin
cabergoline
teriparatide
calcitonin-salmon-synthetic
ENZYME REPLACEMENT
Aldurazyme
laronidase
FABRY DISEASE
Fabrazyme
agalsidase beta
imiglucerase
POMPE DISEASE
Myozyme
alglucosidase alfa
‡ This
document is a sample list of medications that are available
through Aetna Specialty Pharmacy. This list is subject to change.
*Indicates medications that can be filled through our
Ready-To-Inject, pre-filled syringe dosing program.
If you have questions or need more information, please call
1-866-782-ASRX.
05.03.350.1 (11/06)
Genotropin PR SI
Humatrope* PR SI
Norditropin PR SI
Nutropin PR SI
Nutropin AQ PR SI
Saizen PR SI
Serostim PR SI
Tev-Tropin PR SI
somatropin
somatropin
somatropin
somatropin
somatropin
somatropin
somatropin
somatropin
HEMATOLOGY / CARDIOLOGY
Activase
Arixtra SI
Desferral
Fragmin SI
Heparin
Innohep* SI
Lovenox* SI
Phentolamine
alteplase recombinant
fondaparinux
deferrioxamine mesylate
dalteparin sodium
heparin sodium
tinzaparin sodium
enoxaparin sodium
phentolamine mesylate
SI
HEMOPHILIA
Advate
PR SI
Alphanate PR SI
AlphaNine SD PR SI
Amicar
Autoplex T PR SI
Bebulin VH PR SI
BeneFIX PR SI
Bioclate PR SI
DDAVP
FEIBA VH IMMUNO
Helixate FS PR SI
Hemofil M PR SI
Humate P PR SI
Hyate: C PR SI
Koate DVI PR SI
GAUCHER DISEASE
Cerezyme
GENERIC NAME
GROWTH HORMONE
ALCOHOLISM
Vivatrol
PRODUCT NAME
PR
antihemophilic factor VIII (recombinant)
plasma/albumin free
antihemophilic factor VIII (human)
coagulation factor IX
aminocaproic acid
anti-inhibitor coagulant complex
factor IX complex
coagulation factor IX (recombinant)
antihemophilic factor VIII (recombinant)
desmopressin acetate
anti-inhibitor coagulant complex
antihemophilic factor VIII (recombinate)
antihemophilic factor VIII (human)
antihemophilic factor/von Willebrand
Factor complex (human)
antihemophilic factor VIII (porcine)
antihemophilic factor VIII (human)
PRODUCT NAME
GENERIC NAME
PRODUCT NAME
Kogenate FS PR SI
Monarc M PR SI
Monoclate P PR SI
Mononine PR
NovoSeven PR
Profilnine SD PR
Proplex T PR
Recombinate PR
Refacto PR
Stimate
antihemophilic factor VIII (recombinate)
antihemophilic factor VIII (human)
antihemophilic factor VIII (human)
coagulation Factor IX
coagulation Factor VIIa (recombinant)
factor IX complex
factor IX complex
antihemophilic factor VIII (recombinate)
antihemophilic factor VIII (recombinate)
desmopressin acetate
MACULAR DEGENERATION
HEPATITIS
BayHep B
Copegus
Engerix-B
Havrix
Hepsera
Infergen PR SI
Nabi-HB
Peg-Intron* PR SI
Pegasys* PR SI
Rebetol
Twinrix
hepatitis B immune globulin
ribavirin tablets
hepatitis B vaccine recombinant
hepatitis A vaccine inactivated
adefovir dipivoxil
interferon alfacon-1
hepatitis B immune globulin
peginterferon alfa 2b
peginterferon alfa 2a
ribavirin capsules
hepatitis A (inactive)/hepatitis B
(recombinate) Hepatitis B Vaccine
Recombinant
HIV & AIDS
Fuzeon
SI
enfuvirtide
IMMUNE SYSTEM / IVIG
BayRho-D
Carimune NF PR
CellCept
CytoGam
Depo-Medrol
Flebogamma
Gamastan
Gammagard S/D PR
Gamunex PR
Iveegam PR
Medrol
Octagam
Panglobulin NF PR
Pentamidine
Polygam SD PR
Prograf
RhoGam
Sandimmune
Solu-Cortef
Venoglobulin-S PR SI
Rho (D) immune globulin
immune globulin intraveous
mycophenolate mofetil
cytomegalovirus immune globulin
methylprednisolone
immune globulin intraveous
immune globulin-intramuscular
immune globulin intraveous
immune globulin intraveous
immune globulin intraveous
methylprednisolone tablets
immune globulin intraveous
immune globulin intraveous
pentamidine isethionate
immune globulin intraveous
tacrolimus
Rho (D) immune globulin
cyclosporine
hydrocortisone sodium sccinate
immune globulin intraveous
INFERTILITY
Bravelle PR SI
Cetrotide PR
Chorionic
Gonadotropin PR SI
Clomid
Factrel PR
Fertinex PR SI
Follistim PR SI
Follistim AQ PR SI
Ganirelix PR SI
Gonal-F PR
HCG PR SI
Humegon PR SI
Lupron Depot SI
Novarel PR SI
Ovidrel PR SI
Pergonal PR SI
Pregnyl PR SI
Profasi HP
Progesterone
Repronex PR SI
urofollitropin
cetrorelix
chorionic gonadotropin
clomiphene citrate
gonadorelin
urofollitropin
follitropin beta
follitropin beta
ganirelix acetate
follitropin alfa
human chorionic gonadotropin
menotropins
leuprolide acetate
chorionic gonadotropin
choriogonadotropin alfa
menotropins
human chorionic gonadotropin
human chorionic gonadotropin
progesterone
menotropins
Macugen
Visudyne
GENERIC NAME
pegaptanib sodium
verteporfin
NEUROLOGY / MULTIPLE SCLEROSIS
Avonex* SI
Betaseron SI
Botox
Copaxone SI
Myobloc
Rebif SI
Tysabri
interferon beta-1a
interferon beta-1b
botulinum toxin type A
glatiramer acetate
botulinum toxin type B
interferon beta-1a
natalizumab
ONCOLOGY
Adriamycin
Alferon N SI
Alkeran
Aredia
Arimidex
Aromasin
BCG Live
BiCNU
Blenoxane
Bleomycin
CamPath
Camptosar
Casodex
CeeNU
Cerubidine
Cisplatin
Cosmegen
Cytadren
Cytarabine
Cytoxan
Dacarbazine
Daunorubicin
DaunoXome
Delestrogen
Depo-Estradiol
Depo-Testosterone
Doxil
Doxorubicin
Eligard
Ellence
Eloxatin
Elspar
Emcyt
Ethyol
Etopophos
Etoposide
Eulexin
Fareston
Faslodex
Femara
Fludara
Fluorouracil
Gemzar
Gleevec PR
Herceptin
Hexalen
Hycamtin
Idamycin
Idarubicin
Ifex/Mesnex
Intron A PR SI
Iressa PR
Leukeran
Leukine*
Leuprolide
Leustatin
Lupron
Lysodren
Matulane
Mesnex
Methotrexate
Mitomycin
doxorubicin HCL
interferon alpha-N3
melphalan
pamidronate disodium
anastrozole
exemestane
bacillus calmette guerin
carmustine
bleomycin sulfate
bleomycin sulfate
alemtuzumab
irinotecan
bicalutamide
lomustine
daunorubicin HCL
cisplatin
dactinomycin
aminoglutethimide
cytarabine
cyclophosphamide
dacarbazine
daunorubicin
daunorubicin citrate liposomal
hormones endocrinology
hormones endocrinology
hormones endocrinology
doxorubicin liposomal
doxorubicin
leuprolide acetate
epirubicin
oxaliplatin
asparaginase
estramustine phosphate sodium
amifostine
etoposide
etoposide
flutamide
toremifene citrate
fulvestrant
letrozole
fludarabine phosphate
fluorouracil
gemcitabine HCL
imatinib mesylate
trastuzumab
altretamine
topotecan
idarubicin
idarubicin
ifosfamide/mesna
interferon alfa 2b
gefitinib
chlorambucil
sargramostim
leuprolide acetate
cladribine
leuprolide acetate
mitotane
procarbazine
mesna
methotrexate
mitomycin
PRODUCT NAME
GENERIC NAME
PRODUCT NAME
Mustargen
Mutamycin
Myleran
Mylotarg
Navelbine
Neosar
NeuTrexin
Nexavar
Nipent
Nolvadex
Novantrone
Ontak
Onxol
Paclitaxel
Panretin
Paraplatin
Photofrin
Platinol-AQ
Plenaxis
Proleukin*
Purinethol
Revlimed
Rituxan
Roferon-A* PR SI
Sutent
Tamoxifen
Tarceva
Targretin
Taxol
Taxotere
Temodar
Thalomid
Thioguanine
Thioplex
Trisenox
Velcade
VePesid
Vesanoid
Vinblastine
Vincristine
Vumon
Xeloda
Zanosar
Zinecard
Zoladex
mechlorethamine HCL
mitomycin
busulfan tablets
gemtuzumab ozogamicin
vinorelbine
cyclophosphamide
trimetrexate glucuronate
sorafenib
pentostatin
tamoxifen citrate tablets
mitoxantrone
denileukin diftitox
paclitaxel
paclitaxel
alitretinoin
carboplatin
porfimer sodium
cisplatin
abarelix
aldesleukin
mercaptopurine
lenalidomid
rituximab
interferon alfa-2a
sunitinib malate
tamoxifen citrate tablets
erlotinib
bexarotene
paclitaxel
docetaxel
temozolomide
thalidomide
thioguanine
thiotepa
arsenic trioxide
bortezomib
etoposide
tretinoin
vinblastine sulfate
vincristine sulfate
teniposide
capecitabine
streptozocin
dexrazoxane
goserelin acetate
PAIN MANAGEMENT
Buprenex
Imitrex PR QL SI
Ketorolac
Lioresal
Marcaine
Nalbuphine
Nubain
GENERIC NAME
buprenorphine
sumatriptan succinate
ketorlac tromethamine
baclofen
bupivacaine
nalbuphine
nalbuphine
PARKINSON’S DISEASE
Apokyn
apomorphine
PSORIASIS
Amevive
Enbrel SI
Raptiva SI
alefacept
etanercept
efalizumab
PULMONARY
Coly-Mycin M
Pulmozyme
Tobi
colistimethate sodium
dornase alfa
tobramycin
RESPIRATORY SYNCYTIAL VIRUS (RSV)
Synagis
PR
palivizumab
TRANSPLANT
CellCept
Deltasone
Gengraf
Imuran
Neoral
Prograf
Rapamune
Sandimmune
Prednisone
mycophenolate
prednisone
cyclosporine
azathioprine
cyclosporine
tacrolimus
sirolimus
cyclosporine
prednisone
ONCOLOGY ADJUNCT
Anzemet QL
Aloxi
Compazine
Droperidol
Emend
Epogen
Kytril QL
Leucovorin
Neulasta
Neumega
Neupogen*
Procrit*
Sandostatin*
Zofran QL
Zometa
dolasetron mesylate
palonosetron
prochlorperazine
droperidol
aprepitant
epoetin alfa
granisetron HCL
leucovorin calcium
pegfilgrastim
oprelvekin
filgrastim
epoetin alfa
octreotide acetate
ondansetron HCL
zoledronic acid
OSTEOARTHRITIS & RHEUMATOID ARTHRITIS
Hyalgan
Supartz
Synvisc
Acthar
Enbrel SI
Humira SI
Kineret SI
Methotrexate
Myochrysine
Remicade
sodium hyaluronate
sodium hyaluronate
hylan G-F 20
corticotropin
etanercept
adalimumab
anakinra
methotrexate
gold sodium thiomalate
infliximab recombinant
*Indicates medications that can be filled through our
Ready-To-Inject, pre-filled syringe dosing program.
This document is a sample list of medications that are
available through Aetna Specialty Pharmacy. This list is
subject to change.
If you have questions or need more information,
please call 1-866-782-ASRX.
Key
PR = Precertification required under most plans
QL = Quantity Limits applies under most plans
SI = Self-injectable drug (some plans may cover injectable
medications through the medical benefit)
Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which
is a licensed pharmacy that operates through mail order. The charges Aetna negotiates with Aetna
Specialty Pharmacy may be higher than the cost it pays for the drugs and the costs of its specialty
pharmacy services. For these purposes, Aetna Specialty Pharmacy’s cost of purchasing drugs takes
into account discounts, credits and other amounts it may receive from wholesalers, manufacturers,
suppliers and distributors.
Aetna is the brand name used for products and services provided by one or more of the
Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or
administer benefits coverage include: Aetna Health Inc., Aetna Health of California Inc.,
Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance
Company of New York, Corporate Health Insurance Company and/or Aetna Life Insurance
Company.
05.03.350.1 (11/06)
©2006 Aetna Inc.