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.