Table Of Content

Product Label Generic Name AHFS Therapeutic Class Description ABIRATERONE TAB 250MG ABIRATERONE ACETATE TAB 250 MG ANTINEOPLASTIC AGENTS ABIRATERONE TAB 500MG ABIRATERONE ACETATE TAB 500 MG ANTINEOPLASTIC AGENTS ACTEMRA INJ 162/0.9 TOCILIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 162 MG/0.9ML DISEASE-MODIFYING ANTIRHEUMATIC AGENTS ACTEMRA INJ ACTPEN TOCILIZUMAB SUBCUTANEOUS SOLN AUTO-INJECTOR 162 MG/0.9ML DISEASE-MODIFYING ANTIRHEUMATIC AGENTS ACTHAR INJ 80UNIT CORTICOTROPIN INJ GEL 80 UNIT/ML PITUITARY ACTIMMUNE INJ 2MU/0.5 INTERFERON GAMMA-1B INJ 100 MCG/0.5ML (2000000 UNIT/0.5ML) IMMUNOMODULATORY AGENTS ADBRY INJ 150MG/ML TRALOKINUMAB-LDRM SUBCUTANEOUS SOLN PREFILLED SYR 150 MG/ML SKIN AND MUCOUS MEMBRANE AGENTS, MISC. ADEFOV DIPIV TAB 10MG ADEFOVIR DIPIVOXIL TAB 10 MG NUCLEOSIDE AND NUCLEOTIDE ANTIVIRALS ADEMPAS TAB 0.5MG RIOCIGUAT TAB 0.5 MG VASODILATING AGENTS (RESPIRATORY TRACT) ADEMPAS TAB 1.5MG RIOCIGUAT TAB 1.5 MG VASODILATING AGENTS (RESPIRATORY TRACT) ADEMPAS TAB 1MG RIOCIGUAT TAB 1 MG VASODILATING AGENTS (RESPIRATORY TRACT) ADEMPAS TAB 2.5MG RIOCIGUAT TAB 2.5 MG VASODILATING AGENTS (RESPIRATORY TRACT) ADEMPAS TAB 2MG RIOCIGUAT TAB 2 MG VASODILATING AGENTS (RESPIRATORY TRACT) ADVATE INJ 1000UNIT ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 1000 UNIT HEMOSTATICS ADVATE INJ 1500UNIT ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 1500 UNIT HEMOSTATICS ADVATE INJ 2000UNIT ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 2000 UNIT HEMOSTATICS ADVATE INJ 250UNIT ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 250 UNIT HEMOSTATICS ADVATE INJ 3000UNIT ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 3000 UNIT HEMOSTATICS ADVATE INJ 4000UNIT ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 4000 UNIT HEMOSTATICS ADVATE INJ 500UNIT ANTIHEMOPHILIC FACTOR RECOMB (RAHF-PFM) FOR INJ 500 UNIT HEMOSTATICS ADYNOVATE INJ 1000UNIT ANTIHEMOPHILIC FACTOR RECOMB PEGYLATED FOR INJ 1000 UNIT HEMOSTATICS ADYNOVATE INJ 1500UNIT ANTIHEMOPHILIC FACTOR RECOMB PEGYLATED FOR INJ 1500 UNIT HEMOSTATICS ADYNOVATE INJ 2000UNIT ANTIHEMOPHILIC FACTOR RECOMB PEGYLATED FOR INJ 2000 UNIT HEMOSTATICS ADYNOVATE INJ 250UNIT ANTIHEMOPHILIC FACTOR RECOMB PEGYLATED FOR INJ 250 UNIT HEMOSTATICS ADYNOVATE INJ 3000UNIT ANTIHEMOPHILIC FACTOR RECOMB PEGYLATED FOR INJ 3000 UNIT HEMOSTATICS ADYNOVATE INJ 500UNIT ANTIHEMOPHILIC FACTOR RECOMB PEGYLATED FOR INJ 500 UNIT HEMOSTATICS ADYNOVATE INJ 750UNIT ANTIHEMOPHILIC FACTOR RECOMB PEGYLATED FOR INJ 750 UNIT HEMOSTATICS AFSTYLA KIT 1000UNIT ANTIHEMOPHILIC FACT RCMB SINGLE CHAIN FOR INJ KIT 1000 UNIT HEMOSTATICS AFSTYLA KIT 1500UNIT ANTIHEMOPHILIC FACT RCMB SINGLE CHAIN FOR INJ KIT 1500 UNIT HEMOSTATICS AFSTYLA KIT 2000UNIT ANTIHEMOPHILIC FACT RCMB SINGLE CHAIN FOR INJ KIT 2000 UNIT HEMOSTATICS AFSTYLA KIT 2500UNIT ANTIHEMOPHILIC FACT RCMB SINGLE CHAIN FOR INJ KIT 2500 UNIT HEMOSTATICS AFSTYLA KIT 250UNIT ANTIHEMOPHILIC FACT RCMB SINGLE CHAIN FOR INJ KIT 250 UNIT HEMOSTATICS AFSTYLA KIT 3000UNIT ANTIHEMOPHILIC FACT RCMB SINGLE CHAIN FOR INJ KIT 3000 UNIT HEMOSTATICS AFSTYLA KIT 500UNIT ANTIHEMOPHILIC FACT RCMB SINGLE CHAIN FOR INJ KIT 500 UNIT HEMOSTATICS AIMOVIG INJ 140MG/ML ERENUMAB-AOOE SUBCUTANEOUS SOLN AUTO-INJECTOR 140 MG/ML CALCITONIN GENE-RELATED PEPTIDE ANTAG. AIMOVIG INJ 70MG/ML ERENUMAB-AOOE SUBCUTANEOUS SOLN AUTO-INJECTOR 70 MG/ML CALCITONIN GENE-RELATED PEPTIDE ANTAG. ALECENSA CAP 150MG ALECTINIB HCL CAP 150 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS ALFERON N INJ 5MU/ML INTERFERON ALFA-N3 INJ 5000000 UNIT/ML ANTINEOPLASTIC AGENTS Atrium Health Specialty Drug List - February 2023 Product Label Generic Name AHFS Therapeutic Class Description ALKERAN TAB 2MG MELPHALAN TAB 2 MG ANTINEOPLASTIC AGENTS ALPHANATE INJ 1000UNIT ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1000 UNIT HEMOSTATICS ALPHANATE INJ 1500UNIT ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 1500 UNIT HEMOSTATICS ALPHANATE INJ 2000UNIT ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 2000 UNIT HEMOSTATICS ALPHANATE INJ 250 UNIT ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 250 UNIT HEMOSTATICS ALPHANATE INJ 500 UNIT ANTIHEMOPHILIC FACTOR/VWF (HUMAN) FOR INJ 500 UNIT HEMOSTATICS ALPHANINE SD INJ 1000UNIT COAGULATION FACTOR IX FOR INJ 1000 UNIT HEMOSTATICS ALPHANINE SD INJ 1500UNIT COAGULATION FACTOR IX FOR INJ 1500 UNIT HEMOSTATICS ALPHANINE SD INJ 500UNIT COAGULATION FACTOR IX FOR INJ 500 UNIT HEMOSTATICS ALPROLIX INJ 1000UNIT COAGULATION FACTOR IX (RECOMB) (RFIXFC) FOR INJ 1000 UNIT HEMOSTATICS ALPROLIX INJ 2000UNIT COAGULATION FACTOR IX (RECOMB) (RFIXFC) FOR INJ 2000 UNIT HEMOSTATICS ALPROLIX INJ 250UNIT COAGULATION FACTOR IX (RECOMB) (RFIXFC) FOR INJ 250 UNIT HEMOSTATICS ALPROLIX INJ 3000UNIT COAGULATION FACTOR IX (RECOMB) (RFIXFC) FOR INJ 3000 UNIT HEMOSTATICS ALPROLIX INJ 4000UNIT COAGULATION FACTOR IX (RECOMB) (RFIXFC) FOR INJ 4000 UNIT HEMOSTATICS ALPROLIX INJ 500UNIT COAGULATION FACTOR IX (RECOMB) (RFIXFC) FOR INJ 500 UNIT HEMOSTATICS ALUNBRIG PAK BRIGATINIB TAB INITIATION THERAPY PACK 90 MG & 180 MG ANTINEOPLASTIC AGENTS ALUNBRIG TAB 180MG BRIGATINIB TAB 180 MG ANTINEOPLASTIC AGENTS ALUNBRIG TAB 30MG BRIGATINIB TAB 30 MG ANTINEOPLASTIC AGENTS ALUNBRIG TAB 90MG BRIGATINIB TAB 90 MG ANTINEOPLASTIC AGENTS ALYQ TAB 20MG TADALAFIL TAB 20 MG (PAH) PHOSPHODIESTERASE TYPE 5 INHIBITORS AMBRISENTAN TAB 10MG AMBRISENTAN TAB 10 MG VASODILATING AGENTS (RESPIRATORY TRACT) AMBRISENTAN TAB 5MG AMBRISENTAN TAB 5 MG VASODILATING AGENTS (RESPIRATORY TRACT) AMICAR SOL 0.25/ML AMINOCAPROIC ACID ORAL SOLN 0.25 GM/ML HEMOSTATICS AMICAR TAB 1000MG AMINOCAPROIC ACID TAB 1000 MG HEMOSTATICS AMICAR TAB 500MG AMINOCAPROIC ACID TAB 500 MG HEMOSTATICS AMINOCAPR AC TAB 1000MG AMINOCAPROIC ACID TAB 1000 MG HEMOSTATICS AMINOCAPR AC TAB 500MG AMINOCAPROIC ACID TAB 500 MG HEMOSTATICS AMINOCAPROIC SOL 0.25/ML AMINOCAPROIC ACID ORAL SOLN 0.25 GM/ML HEMOSTATICS AMPYRA TAB 10MG DALFAMPRIDINE TAB ER 12HR 10 MG OTHER MISCELLANEOUS THERAPEUTIC AGENTS AMVUTTRA SOL 25/0.5ML VUTRISIRAN SODIUM SOLN PREFILLED SYRINGE 25 MG/0.5ML OTHER MISCELLANEOUS THERAPEUTIC AGENTS APOKYN INJ 10MG/ML APOMORPHINE HCL SOLN CARTRIDGE 30 MG/3ML NONERGOT-DERIV.DOPAMINE RECEPTOR AGONIST APOMORPHINE INJ 30MG/3ML APOMORPHINE HCL SOLN CARTRIDGE 30 MG/3ML NONERGOT-DERIV.DOPAMINE RECEPTOR AGONIST ARANESP INJ 100MCG DARBEPOETIN ALFA SOLN INJ 100 MCG/ML HEMATOPOIETIC AGENTS ARANESP INJ 10MCG DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 10 MCG/0.4ML HEMATOPOIETIC AGENTS ARANESP INJ 150MCG DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 150 MCG/0.3ML HEMATOPOIETIC AGENTS ARANESP INJ 200MCG DARBEPOETIN ALFA SOLN INJ 200 MCG/ML HEMATOPOIETIC AGENTS ARANESP INJ 25MCG DARBEPOETIN ALFA SOLN INJ 25 MCG/ML HEMATOPOIETIC AGENTS ARANESP INJ 300MCG DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 300 MCG/0.6ML HEMATOPOIETIC AGENTS Atrium Health Specialty Drug List - February 2023 Product Label Generic Name AHFS Therapeutic Class Description ARANESP INJ 40MCG DARBEPOETIN ALFA SOLN INJ 40 MCG/ML HEMATOPOIETIC AGENTS ARANESP INJ 500MCG DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 500 MCG/ML HEMATOPOIETIC AGENTS ARANESP INJ 60MCG DARBEPOETIN ALFA SOLN INJ 60 MCG/ML HEMATOPOIETIC AGENTS ARCALYST INJ 220MG RILONACEPT FOR INJ 220 MG OTHER MISCELLANEOUS THERAPEUTIC AGENTS ARIKAYCE SUS AMIKACIN SULFATE LIPOSOME INHAL SUSP 590 MG/8.4ML (BASE EQ) AMINOGLYCOSIDE ANTIBIOTICS ARIXTRA INJ 10/0.8ML FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML ANTICOAGULANTS, MISCELLANEOUS ARIXTRA INJ 2.5/0.5 FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML ANTICOAGULANTS, MISCELLANEOUS ARIXTRA INJ 5/0.4ML FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML ANTICOAGULANTS, MISCELLANEOUS ARIXTRA INJ 7.5/0.6 FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML ANTICOAGULANTS, MISCELLANEOUS AROMASIN TAB 25MG EXEMESTANE TAB 25 MG ANTIESTROGENS AUBAGIO TAB 14MG TERIFLUNOMIDE TAB 14 MG IMMUNOMODULATORY AGENTS AUBAGIO TAB 7MG TERIFLUNOMIDE TAB 7 MG IMMUNOMODULATORY AGENTS AUSTEDO TAB 12MG DEUTETRABENAZINE TAB 12 MG VESICULAR MONOAMINE TRANSPORT2 INHIBITOR AUSTEDO TAB 6MG DEUTETRABENAZINE TAB 6 MG VESICULAR MONOAMINE TRANSPORT2 INHIBITOR AUSTEDO TAB 9MG DEUTETRABENAZINE TAB 9 MG VESICULAR MONOAMINE TRANSPORT2 INHIBITOR AVONEX PEN KIT 30MCG INTERFERON BETA-1A IM AUTO-INJECTOR KIT 30 MCG/0.5ML IMMUNOMODULATORY AGENTS AVONEX PREFL KIT 30MCG INTERFERON BETA-1A IM PREFILLED SYRINGE KIT 30 MCG/0.5ML IMMUNOMODULATORY AGENTS AYVAKIT TAB 100MG AVAPRITINIB TAB 100 MG ANTINEOPLASTIC AGENTS AYVAKIT TAB 200MG AVAPRITINIB TAB 200 MG ANTINEOPLASTIC AGENTS AYVAKIT TAB 25MG AVAPRITINIB TAB 25 MG ANTINEOPLASTIC AGENTS AYVAKIT TAB 300MG AVAPRITINIB TAB 300 MG ANTINEOPLASTIC AGENTS AYVAKIT TAB 50MG AVAPRITINIB TAB 50 MG ANTINEOPLASTIC AGENTS AZACITIDINE INJ 100MG AZACITIDINE FOR INJ 100 MG ANTINEOPLASTIC AGENTS BAFIERTAM CAP 95MG MONOMETHYL FUMARATE CAPSULE DELAYED RELEASE 95 MG IMMUNOMODULATORY AGENTS BALVERSA TAB 3MG ERDAFITINIB TAB 3 MG ANTINEOPLASTIC AGENTS BALVERSA TAB 4MG ERDAFITINIB TAB 4 MG ANTINEOPLASTIC AGENTS BALVERSA TAB 5MG ERDAFITINIB TAB 5 MG ANTINEOPLASTIC AGENTS BARACLUDE SOL ENTECAVIR ORAL SOLN 0.05 MG/ML NUCLEOSIDE AND NUCLEOTIDE ANTIVIRALS BENEFIX INJ 1000UNIT COAGULATION FACTOR IX (RECOMBINANT) FOR INJ KIT 1000 UNIT HEMOSTATICS BENEFIX INJ 2000UNIT COAGULATION FACTOR IX (RECOMBINANT) FOR INJ KIT 2000 UNIT HEMOSTATICS BENEFIX INJ 250UNIT COAGULATION FACTOR IX (RECOMBINANT) FOR INJ KIT 250 UNIT HEMOSTATICS BENEFIX INJ 3000UNIT COAGULATION FACTOR IX (RECOMBINANT) FOR INJ KIT 3000 UNIT HEMOSTATICS BENEFIX INJ 500UNIT COAGULATION FACTOR IX (RECOMBINANT) FOR INJ KIT 500 UNIT HEMOSTATICS BENLYSTA INJ 200MG/ML BELIMUMAB SUBCUTANEOUS SOLUTION AUTO-INJECTOR 200 MG/ML IMMUNOSUPPRESSIVE AGENTS BETAINE ANHY POW *BETAINE POWDER FOR ORAL SOLUTION*** OTHER MISCELLANEOUS THERAPEUTIC AGENTS BETASERON INJ 0.3MG INTERFERON BETA-1B FOR INJ KIT 0.3 MG IMMUNOMODULATORY AGENTS BEVACIZUMAB INJ 1.25MG BEVACIZUMAB INTRAVIT PREF SYR 3 MG/0.12ML (1.25 MG/0.05ML) ANTINEOPLASTIC AGENTS BEVACIZUMAB INJ 2.5/.1ML BEVACIZUMAB INTRAVITREAL SOLN PREF SYR 2.5 MG/0.1ML ANTINEOPLASTIC AGENTS Atrium Health Specialty Drug List - February 2023 Product Label Generic Name AHFS Therapeutic Class Description BEVACIZUMAB INJ 3.25/.13 BEVACIZUMAB INTRAVITREAL SOLN PREF SYR 3.25 MG/0.13ML ANTINEOPLASTIC AGENTS BEVACIZUMAB INJ 3.75/.15 BEVACIZUMAB INTRAVITREAL SOLN PREF SYR 3.75 MG/0.15ML ANTINEOPLASTIC AGENTS BEXAROTENE CAP 75MG BEXAROTENE CAP 75 MG ANTINEOPLASTIC AGENTS BEXAROTENE GEL 1% BEXAROTENE GEL 1% SKIN AND MUCOUS MEMBRANE AGENTS, MISC. BLEOMYCIN INJ 15UNIT BLEOMYCIN SULFATE FOR INJ 15 UNIT ANTINEOPLASTIC AGENTS BLEOMYCIN INJ 30UNIT BLEOMYCIN SULFATE FOR INJ 30 UNIT ANTINEOPLASTIC AGENTS BORTEZOMIB INJ 1MG BORTEZOMIB FOR INJ 1 MG ANTINEOPLASTIC AGENTS BORTEZOMIB INJ 2.5MG BORTEZOMIB FOR INJ 2.5 MG ANTINEOPLASTIC AGENTS BORTEZOMIB INJ 3.5/1.4 BORTEZOMIB INJ 3.5 MG/1.4ML ANTINEOPLASTIC AGENTS BORTEZOMIB INJ 3.5MG BORTEZOMIB FOR INJ 3.5 MG ANTINEOPLASTIC AGENTS BOSENTAN TAB 125MG BOSENTAN TAB 125 MG VASODILATING AGENTS (RESPIRATORY TRACT) BOSENTAN TAB 62.5MG BOSENTAN TAB 62.5 MG VASODILATING AGENTS (RESPIRATORY TRACT) BOSULIF TAB 100MG BOSUTINIB TAB 100 MG ANTINEOPLASTIC AGENTS BOSULIF TAB 400MG BOSUTINIB TAB 400 MG ANTINEOPLASTIC AGENTS BOSULIF TAB 500MG BOSUTINIB TAB 500 MG ANTINEOPLASTIC AGENTS BRAFTOVI CAP 75MG ENCORAFENIB CAP 75 MG ANTINEOPLASTIC AGENTS BRUKINSA CAP 80MG ZANUBRUTINIB CAP 80 MG ANTINEOPLASTIC AGENTS BYLVAY CAP 1200MCG ODEVIXIBAT CAP 1200 MCG GI DRUGS, MISCELLANEOUS BYLVAY CAP 200MCG ODEVIXIBAT PELLETS CAP SPRINKLE 200 MCG GI DRUGS, MISCELLANEOUS BYLVAY CAP 400MCG ODEVIXIBAT CAP 400 MCG GI DRUGS, MISCELLANEOUS BYLVAY CAP 600MCG ODEVIXIBAT PELLETS CAP SPRINKLE 600 MCG GI DRUGS, MISCELLANEOUS CABLIVI KIT 11MG CAPLACIZUMAB-YHDP FOR INJ KIT 11 MG ANTITHROMBOTIC AGENTS, MISCELLANEOUS CABOMETYX TAB 20MG CABOZANTINIB S-MALATE TAB 20 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS CABOMETYX TAB 40MG CABOZANTINIB S-MALATE TAB 40 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS CABOMETYX TAB 60MG CABOZANTINIB S-MALATE TAB 60 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS CALQUENCE CAP 100MG ACALABRUTINIB CAP 100 MG ANTINEOPLASTIC AGENTS CALQUENCE TAB 100MG ACALABRUTINIB MALEATE TAB 100 MG ANTINEOPLASTIC AGENTS CAPECITABINE TAB 150MG CAPECITABINE TAB 150 MG ANTINEOPLASTIC AGENTS CAPECITABINE TAB 500MG CAPECITABINE TAB 500 MG ANTINEOPLASTIC AGENTS CAPRELSA TAB 100MG VANDETANIB TAB 100 MG ANTINEOPLASTIC AGENTS CAPRELSA TAB 300MG VANDETANIB TAB 300 MG ANTINEOPLASTIC AGENTS CARBAGLU TAB 200MG CARGLUMIC ACID SOLUBLE TAB 200 MG AMMONIA DETOXICANTS CARGLUMIC TAB 200MG CARGLUMIC ACID SOLUBLE TAB 200 MG AMMONIA DETOXICANTS CELLCEPT CAP 250MG MYCOPHENOLATE MOFETIL CAP 250 MG IMMUNOSUPPRESSIVE AGENTS CELLCEPT SUS 200MG/ML MYCOPHENOLATE MOFETIL FOR ORAL SUSP 200 MG/ML IMMUNOSUPPRESSIVE AGENTS CELLCEPT TAB 500MG MYCOPHENOLATE MOFETIL TAB 500 MG IMMUNOSUPPRESSIVE AGENTS CERDELGA CAP 84MG ELIGLUSTAT TARTRATE CAP 84 MG (BASE EQUIVALENT) OTHER MISCELLANEOUS THERAPEUTIC AGENTS CETRORELIX INJ 0.25MG CETRORELIX ACETATE FOR INJ KIT 0.25 MG ANTIGONADTROPINS Atrium Health Specialty Drug List - February 2023 Product Label Generic Name AHFS Therapeutic Class Description CHENODAL TAB 250MG CHENODIOL TAB 250 MG CHOLELITHOLYTIC AGENTS CHOLBAM CAP 250MG CHOLIC ACID CAP 250 MG GI DRUGS, MISCELLANEOUS CHOLBAM CAP 50MG CHOLIC ACID CAP 50 MG GI DRUGS, MISCELLANEOUS CHOR GONADOT INJ 10000UNT CHORIONIC GONADOTROPIN FOR IM INJ 10000 UNIT GONADOTROPINS CIBINQO TAB 100MG ABROCITINIB TAB 100 MG SKIN AND MUCOUS MEMBRANE AGENTS, MISC. CIBINQO TAB 200MG ABROCITINIB TAB 200 MG SKIN AND MUCOUS MEMBRANE AGENTS, MISC. CIBINQO TAB 50MG ABROCITINIB TAB 50 MG SKIN AND MUCOUS MEMBRANE AGENTS, MISC. CIMZIA KIT 200MG CERTOLIZUMAB PEGOL FOR INJ KIT 2 X 200 MG DISEASE-MODIFYING ANTIRHEUMATIC AGENTS CIMZIA PREFL KIT 200MG/ML CERTOLIZUMAB PEGOL PREFILLED SYRINGE KIT 2 X 200 MG/ML DISEASE-MODIFYING ANTIRHEUMATIC AGENTS CIMZIA START KIT 200MG/ML CERTOLIZUMAB PEGOL PREFILLED SYRINGE KIT 6 X 200 MG/ML DISEASE-MODIFYING ANTIRHEUMATIC AGENTS CINACALCET TAB 30MG CINACALCET HCL TAB 30 MG (BASE EQUIV) ANTIPARATHYROID AGENTS CINACALCET TAB 60MG CINACALCET HCL TAB 60 MG (BASE EQUIV) ANTIPARATHYROID AGENTS CINACALCET TAB 90MG CINACALCET HCL TAB 90 MG (BASE EQUIV) ANTIPARATHYROID AGENTS CLOVIQUE CAP 250MG TRIENTINE HCL CAP 250 MG HEAVY METAL ANTAGONISTS COAGADEX INJ 250UNIT COAGULATION FACTOR X (HUMAN) FOR INJ 250 UNIT HEMOSTATICS COAGADEX INJ 500UNIT COAGULATION FACTOR X (HUMAN) FOR INJ 500 UNIT HEMOSTATICS COMETRIQ KIT 100MG CABOZANTINIB S-MAL CAP 1 X 80 MG & 1 X 20 MG (100 DOSE) KIT ANTINEOPLASTIC AGENTS COMETRIQ KIT 140MG CABOZANTINIB S-MAL CAP 1 X 80 MG & 3 X 20 MG (140 DOSE) KIT ANTINEOPLASTIC AGENTS COMETRIQ KIT 60MG CABOZANTINIB S-MALATE CAP 3 X 20 MG (60 MG DOSE) KIT ANTINEOPLASTIC AGENTS COPAXONE INJ 20MG/ML GLATIRAMER ACETATE SOLN PREFILLED SYRINGE 20 MG/ML IMMUNOMODULATORY AGENTS COPAXONE INJ 40MG/ML GLATIRAMER ACETATE SOLN PREFILLED SYRINGE 40 MG/ML IMMUNOMODULATORY AGENTS COPIKTRA CAP 15MG DUVELISIB CAP 15 MG ANTINEOPLASTIC AGENTS COPIKTRA CAP 25MG DUVELISIB CAP 25 MG ANTINEOPLASTIC AGENTS CORIFACT KIT FACTOR XIII CONCENTRATE (HUMAN) FOR INJ KIT 1000-1600 UNIT HEMOSTATICS CORTROPHIN GEL 80UNIT CORTICOTROPIN INJ GEL 80 UNIT/ML PITUITARY COTELLIC TAB 20MG COBIMETINIB FUMARATE TAB 20 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS CRESEMBA CAP 186 MG ISAVUCONAZONIUM SULFATE CAP 186 MG (ISAVUCONAZOLE 100 MG) AZOLE ANTIFUNGALS CRYSVITA INJ 10MG/ML BUROSUMAB-TWZA INJ 10 MG/ML ELECTROLYTIC,CALORIC,WATER BALANCE MISC, CRYSVITA INJ 20MG/ML BUROSUMAB-TWZA INJ 20 MG/ML ELECTROLYTIC,CALORIC,WATER BALANCE MISC, CRYSVITA INJ 30MG/ML BUROSUMAB-TWZA INJ 30 MG/ML ELECTROLYTIC,CALORIC,WATER BALANCE MISC, CUVITRU INJ 2GM/10ML IMMUNE GLOBULIN (HUMAN) SUBCUTANEOUS INJ 2 GM/10ML ANTITOXINS AND IMMUNE GLOBULINS CUVITRU INJ 4GM/20ML IMMUNE GLOBULIN (HUMAN) SUBCUTANEOUS INJ 4 GM/20ML ANTITOXINS AND IMMUNE GLOBULINS CUVITRU INJ 8GM/40ML IMMUNE GLOBULIN (HUMAN) SUBCUTANEOUS INJ 8 GM/40ML ANTITOXINS AND IMMUNE GLOBULINS CUVITRU SOL 10GM/50M IMMUNE GLOBULIN (HUMAN) SUBCUTANEOUS INJ 10 GM/50ML ANTITOXINS AND IMMUNE GLOBULINS CUVITRU SOL 1GM/5ML IMMUNE GLOBULIN (HUMAN) SUBCUTANEOUS INJ 1 GM/5ML ANTITOXINS AND IMMUNE GLOBULINS CYCLOPHOSPH CAP 25MG CYCLOPHOSPHAMIDE CAP 25 MG ANTINEOPLASTIC AGENTS CYCLOPHOSPH CAP 50MG CYCLOPHOSPHAMIDE CAP 50 MG ANTINEOPLASTIC AGENTS CYCLOPHOSPH INJ 1GM CYCLOPHOSPHAMIDE FOR INJ 1 GM ANTINEOPLASTIC AGENTS Atrium Health Specialty Drug List - February 2023 Product Label Generic Name AHFS Therapeutic Class Description CYCLOPHOSPH INJ 2GM CYCLOPHOSPHAMIDE FOR INJ 2 GM ANTINEOPLASTIC AGENTS CYCLOPHOSPH INJ 500MG CYCLOPHOSPHAMIDE FOR INJ 500 MG ANTINEOPLASTIC AGENTS CYCLOPHOSPH TAB 25MG CYCLOPHOSPHAMIDE TAB 25 MG ANTINEOPLASTIC AGENTS CYCLOPHOSPH TAB 50MG CYCLOPHOSPHAMIDE TAB 50 MG ANTINEOPLASTIC AGENTS CYSTADANE POW *BETAINE POWDER FOR ORAL SOLUTION*** OTHER MISCELLANEOUS THERAPEUTIC AGENTS CYSTADROPS SOL 0.37% CYSTEAMINE HCL OPHTH SOLN 0.37% (BASE EQUIVALENT) EENT DRUGS, MISCELLANEOUS CYSTAGON CAP 150MG CYSTEAMINE BITARTRATE CAP 150 MG OTHER MISCELLANEOUS THERAPEUTIC AGENTS CYSTAGON CAP 50MG CYSTEAMINE BITARTRATE CAP 50 MG OTHER MISCELLANEOUS THERAPEUTIC AGENTS CYSTARAN SOL 0.44% CYSTEAMINE HCL OPHTH SOLN 0.44% (BASE EQUIVALENT) EENT DRUGS, MISCELLANEOUS CYTARABINE INJ 100MG/ML CYTARABINE INJ PF 100 MG/ML ANTINEOPLASTIC AGENTS CYTARABINE INJ 20MG/ML CYTARABINE INJ PF 20 MG/ML ANTINEOPLASTIC AGENTS DALFAMPRIDIN TAB 10MG ER DALFAMPRIDINE TAB ER 12HR 10 MG OTHER MISCELLANEOUS THERAPEUTIC AGENTS DARAPRIM TAB 25MG PYRIMETHAMINE TAB 25 MG ANTIMALARIALS DAURISMO TAB 100MG GLASDEGIB MALEATE TAB 100 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS DAURISMO TAB 25MG GLASDEGIB MALEATE TAB 25 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS DEFERASIROX GRA 180MG DEFERASIROX GRANULES PACKET 180 MG HEAVY METAL ANTAGONISTS DEFERASIROX GRA 360MG DEFERASIROX GRANULES PACKET 360 MG HEAVY METAL ANTAGONISTS DEFERASIROX GRA 90MG DEFERASIROX GRANULES PACKET 90 MG HEAVY METAL ANTAGONISTS DEFERASIROX TAB 125MG DEFERASIROX TAB FOR ORAL SUSP 125 MG HEAVY METAL ANTAGONISTS DEFERASIROX TAB 180MG DEFERASIROX TAB 180 MG HEAVY METAL ANTAGONISTS DEFERASIROX TAB 250MG DEFERASIROX TAB FOR ORAL SUSP 250 MG HEAVY METAL ANTAGONISTS DEFERASIROX TAB 360MG DEFERASIROX TAB 360 MG HEAVY METAL ANTAGONISTS DEFERASIROX TAB 500MG DEFERASIROX TAB FOR ORAL SUSP 500 MG HEAVY METAL ANTAGONISTS DEFERASIROX TAB 90MG DEFERASIROX TAB 90 MG HEAVY METAL ANTAGONISTS DEFERIPRONE TAB 1000MG DEFERIPRONE TAB 1000 MG HEAVY METAL ANTAGONISTS DEPEN TITRA TAB 250MG PENICILLAMINE TAB 250 MG HEAVY METAL ANTAGONISTS DIACOMIT CAP 250MG STIRIPENTOL CAP 250 MG ANTICONVULSANTS, MISCELLANEOUS DIACOMIT CAP 500MG STIRIPENTOL CAP 500 MG ANTICONVULSANTS, MISCELLANEOUS DIACOMIT PAK 250MG STIRIPENTOL PACKET 250 MG ANTICONVULSANTS, MISCELLANEOUS DIACOMIT PAK 500MG STIRIPENTOL PACKET 500 MG ANTICONVULSANTS, MISCELLANEOUS DICHLORPHENA TAB 50MG DICHLORPHENAMIDE TAB 50 MG CARBONIC ANHYDRASE INHIBITORS (MISC.) DIMETHYL FUM CAP 120MG DR DIMETHYL FUMARATE CAPSULE DELAYED RELEASE 120 MG IMMUNOMODULATORY AGENTS DIMETHYL FUM CAP 240MG DR DIMETHYL FUMARATE CAPSULE DELAYED RELEASE 240 MG IMMUNOMODULATORY AGENTS DIMETHYL FUM MIS STARTER DIMETHYL FUMARATE CAPSULE DR STARTER PACK 120 MG & 240 MG IMMUNOMODULATORY AGENTS DOPTELET TAB 20MG AVATROMBOPAG MALEATE TAB 20 MG (BASE EQUIV) HEMATOPOIETIC AGENTS DUPIXENT INJ 100/0.67 DUPILUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 100 MG/0.67ML INTERLEUKIN ANTAGONISTS DUPIXENT INJ 200/1.14 DUPILUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 200 MG/1.14ML INTERLEUKIN ANTAGONISTS DUPIXENT INJ 200MG DUPILUMAB SUBCUTANEOUS SOLN PEN-INJECTOR 200 MG/1.14ML SKIN AND MUCOUS MEMBRANE AGENTS, MISC. Atrium Health Specialty Drug List - February 2023 Product Label Generic Name AHFS Therapeutic Class Description DUPIXENT INJ 300/2ML DUPILUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 300 MG/2ML SKIN AND MUCOUS MEMBRANE AGENTS, MISC. DYSPORT INJ 300UNIT ABOBOTULINUMTOXINA FOR IM INJ 300 UNIT OTHER MISCELLANEOUS THERAPEUTIC AGENTS DYSPORT INJ 500UNIT ABOBOTULINUMTOXINA FOR IM INJ 500 UNIT OTHER MISCELLANEOUS THERAPEUTIC AGENTS EGRIFTA SV INJ 2MG TESAMORELIN ACETATE FOR INJ 2 MG (BASE EQUIV) SOMATOTROPIN AGONISTS ELIGARD INJ 22.5MG LEUPROLIDE ACETATE (3 MONTH) FOR SUBCUTANEOUS INJ KIT 22.5MG GONADOTROPINS ELIGARD INJ 30MG LEUPROLIDE ACETATE (4 MONTH) FOR SUBCUTANEOUS INJ KIT 30 MG GONADOTROPINS ELIGARD INJ 45MG LEUPROLIDE ACETATE (6 MONTH) FOR SUBCUTANEOUS INJ KIT 45 MG GONADOTROPINS ELIGARD INJ 7.5MG LEUPROLIDE ACETATE FOR SUBCUTANEOUS INJ KIT 7.5 MG GONADOTROPINS ELOCTATE INJ 1000UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 1000 UNIT HEMOSTATICS ELOCTATE INJ 1500UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 1500 UNIT HEMOSTATICS ELOCTATE INJ 2000UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 2000 UNIT HEMOSTATICS ELOCTATE INJ 250UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 250 UNIT HEMOSTATICS ELOCTATE INJ 3000UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 3000 UNIT HEMOSTATICS ELOCTATE INJ 4000UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 4000 UNIT HEMOSTATICS ELOCTATE INJ 5000UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 5000 UNIT HEMOSTATICS ELOCTATE INJ 500UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 500 UNIT HEMOSTATICS ELOCTATE INJ 6000UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 6000 UNIT HEMOSTATICS ELOCTATE INJ 750UNIT ANTIHEMOPHILIC FACTOR RCMB (BDD-RFVIIIFC) FOR INJ 750 UNIT HEMOSTATICS EMCYT CAP 140MG ESTRAMUSTINE PHOSPHATE SODIUM CAP 140 MG ANTINEOPLASTIC AGENTS EMGALITY INJ 100MG/ML GALCANEZUMAB-GNLM SUBCUTANEOUS SOLN PREFILLED SYR 100 MG/ML CALCITONIN GENE-RELATED PEPTIDE ANTAG. EMPAVELI INJ 1080MG PEGCETACOPLAN SUBCUTANEOUS SOLN 1080 MG/20ML (54 MG/ML) COMPLEMENT INHIBITORS ENBREL INJ 25/0.5ML ETANERCEPT SUBCUTANEOUS SOLN PREFILLED SYRINGE 25 MG/0.5ML DISEASE-MODIFYING ANTIRHEUMATIC AGENTS ENBREL INJ 25MG ETANERCEPT SUBCUTANEOUS INJ 25 MG/0.5ML DISEASE-MODIFYING ANTIRHEUMATIC AGENTS ENBREL INJ 50MG/ML ETANERCEPT SUBCUTANEOUS SOLN PREFILLED SYRINGE 50 MG/ML DISEASE-MODIFYING ANTIRHEUMATIC AGENTS ENBREL MINI INJ 50MG/ML ETANERCEPT SUBCUTANEOUS SOLUTION CARTRIDGE 50 MG/ML DISEASE-MODIFYING ANTIRHEUMATIC AGENTS ENDARI POW 5GM GLUTAMINE (SICKLE CELL) POWD PACK 5 GM OTHER MISCELLANEOUS THERAPEUTIC AGENTS ENOXAPARIN INJ 100MG/ML ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML HEPARINS ENOXAPARIN INJ 120/0.8 ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML HEPARINS ENOXAPARIN INJ 150MG/ML ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML HEPARINS ENOXAPARIN INJ 30/0.3ML ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML HEPARINS ENOXAPARIN INJ 300/3ML ENOXAPARIN SODIUM INJ 300 MG/3ML HEPARINS ENOXAPARIN INJ 40/0.4ML ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML HEPARINS ENOXAPARIN INJ 60/0.6ML ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML HEPARINS ENOXAPARIN INJ 80/0.8ML ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML HEPARINS ENSPRYNG INJ SATRALIZUMAB-MWGE SUBCUTANEOUS SOLN PREF SYRINGE 120 MG/ML IMMUNOMODULATORY AGENTS ENTECAVIR TAB 0.5MG ENTECAVIR TAB 0.5 MG NUCLEOSIDE AND NUCLEOTIDE ANTIVIRALS ENTECAVIR TAB 1MG ENTECAVIR TAB 1 MG NUCLEOSIDE AND NUCLEOTIDE ANTIVIRALS EPCLUSA PAK 150-37.5 SOFOSBUVIR-VELPATASVIR PELLET PACK 150-37.5 MG HCV POLYMERASE INHIBITOR ANTIVIRALS Atrium Health Specialty Drug List - February 2023 Product Label Generic Name AHFS Therapeutic Class Description EPCLUSA PAK 200-50MG SOFOSBUVIR-VELPATASVIR PELLET PACK 200-50 MG HCV POLYMERASE INHIBITOR ANTIVIRALS EPCLUSA TAB 200-50MG SOFOSBUVIR-VELPATASVIR TAB 200-50 MG HCV POLYMERASE INHIBITOR ANTIVIRALS EPCLUSA TAB 400-100 SOFOSBUVIR-VELPATASVIR TAB 400-100 MG HCV POLYMERASE INHIBITOR ANTIVIRALS EPIDIOLEX SOL 100MG/ML CANNABIDIOL SOLN 100 MG/ML ANTICONVULSANTS, MISCELLANEOUS EPIVIR HBV SOL 5MG/ML LAMIVUDINE ORAL SOLN 5 MG/ML (HBV) HIV NUCLEOSIDE, NUCLEOTIDE RT INHIBITORS EPIVIR HBV TAB 100MG LAMIVUDINE TAB 100 MG (HBV) HIV NUCLEOSIDE, NUCLEOTIDE RT INHIBITORS ERIVEDGE CAP 150MG VISMODEGIB CAP 150 MG ANTINEOPLASTIC AGENTS ERLEADA TAB 60MG APALUTAMIDE TAB 60 MG ANTINEOPLASTIC AGENTS ERLOTINIB TAB 100MG ERLOTINIB HCL TAB 100 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS ERLOTINIB TAB 150MG ERLOTINIB HCL TAB 150 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS ERLOTINIB TAB 25MG ERLOTINIB HCL TAB 25 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS ERWINASE INJ 10000UNT ASPARAGINASE ERWINIA CHRYSANTHEMI FOR INJ 10000 UNIT ANTINEOPLASTIC AGENTS ERWINAZE INJ 10000UNT ASPARAGINASE ERWINIA CHRYSANTHEMI FOR INJ 10000 UNIT ANTINEOPLASTIC AGENTS ESBRIET CAP 267MG PIRFENIDONE CAP 267 MG ANTIFIBROTIC AGENTS ETOPOSIDE CAP 50MG ETOPOSIDE CAP 50 MG ANTINEOPLASTIC AGENTS EVENITY INJ 105MG ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML BONE ANABOLIC AGENTS EVEROLIMUS TAB 0.25MG EVEROLIMUS TAB 0.25 MG IMMUNOSUPPRESSIVE AGENTS EVEROLIMUS TAB 0.5 MG EVEROLIMUS TAB 0.5 MG IMMUNOSUPPRESSIVE AGENTS EVEROLIMUS TAB 0.75MG EVEROLIMUS TAB 0.75 MG IMMUNOSUPPRESSIVE AGENTS EVEROLIMUS TAB 10MG EVEROLIMUS TAB 10 MG ANTINEOPLASTIC AGENTS EVEROLIMUS TAB 1MG EVEROLIMUS TAB 1 MG IMMUNOSUPPRESSIVE AGENTS EVEROLIMUS TAB 2.5MG EVEROLIMUS TAB 2.5 MG ANTINEOPLASTIC AGENTS EVEROLIMUS TAB 2MG EVEROLIMUS TAB FOR ORAL SUSP 2 MG ANTINEOPLASTIC AGENTS EVEROLIMUS TAB 3MG EVEROLIMUS TAB FOR ORAL SUSP 3 MG ANTINEOPLASTIC AGENTS EVEROLIMUS TAB 5MG EVEROLIMUS TAB 5 MG ANTINEOPLASTIC AGENTS EVEROLIMUS TAB 7.5MG EVEROLIMUS TAB 7.5 MG ANTINEOPLASTIC AGENTS EVRYSDI SOL RISDIPLAM FOR SOLN 0.75 MG/ML OTHER MISCELLANEOUS THERAPEUTIC AGENTS EXEMESTANE TAB 25MG EXEMESTANE TAB 25 MG ANTIESTROGENS EXKIVITY CAP 40MG MOBOCERTINIB SUCCINATE CAP 40 MG ANTINEOPLASTIC AGENTS EYLEA INJ 2/0.05ML AFLIBERCEPT INTRAVITREAL SOLN PREF SYR 2 MG/0.05ML VASCULAR ENDOTHELIAL GROWTH FACTOR ANTAG FARESTON TAB 60MG TOREMIFENE CITRATE TAB 60 MG (BASE EQUIVALENT) ESTROGEN AGONIST-ANTAGONISTS FARYDAK CAP 10MG PANOBINOSTAT LACTATE CAP 10 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS FARYDAK CAP 15MG PANOBINOSTAT LACTATE CAP 15 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS FARYDAK CAP 20MG PANOBINOSTAT LACTATE CAP 20 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS FASENRA INJ 30MG/ML BENRALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 30 MG/ML INTERLEUKIN ANTAGONISTS FASENRA PEN INJ 30MG/ML BENRALIZUMAB SUBCUTANEOUS SOLN AUTO-INJECTOR 30 MG/ML INTERLEUKIN ANTAGONISTS FASLODEX INJ 250/5ML FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML ANTINEOPLASTIC AGENTS FEIBA INJ ANTIINHIBITOR COAGULANT COMPLEX FOR IV SOLN 1000 UNIT HEMOSTATICS Atrium Health Specialty Drug List - February 2023 Product Label Generic Name AHFS Therapeutic Class Description FENSOLVI INJ 45MG LEUPROLIDE ACET (6 MONTH) FOR INJ PEDIATRIC KIT 45 MG GONADOTROPINS FERRIPROX SOL 100MG/ML DEFERIPRONE ORAL SOLN 100 MG/ML HEAVY METAL ANTAGONISTS FERRIPROX TAB 1000MG DEFERIPRONE TAB 1000 MG HEAVY METAL ANTAGONISTS FIBRYGA INJ 1GM FIBRINOGEN CONC (HUMAN) INJ APPROXIMATELY 1 GM (900-1300 MG) HEMOSTATICS FINGOLIMOD CAP 0.5MG FINGOLIMOD HCL CAP 0.5 MG (BASE EQUIV) IMMUNOMODULATORY AGENTS FINTEPLA SOL 2.2MG/ML FENFLURAMINE HCL ORAL SOLN 2.2 MG/ML ANTICONVULSANTS, MISCELLANEOUS FIRMAGON INJ 120MG DEGARELIX ACETATE FOR INJ 120 MG/VIAL (240 MG DOSE) ANTIGONADTROPINS FIRMAGON INJ 80MG DEGARELIX ACETATE FOR INJ 80 MG (BASE EQUIV) ANTIGONADTROPINS FLOXURIDINE INJ 0.5GM FLOXURIDINE FOR INJ 0.5 GM ANTINEOPLASTIC AGENTS FOLLISTIM AQ INJ 300UNIT FOLLITROPIN BETA INJ 300 UNIT/0.36ML GONADOTROPINS FOLLISTIM AQ INJ 600UNIT FOLLITROPIN BETA INJ 600 UNIT/0.72ML GONADOTROPINS FOLLISTIM AQ INJ 900UNIT FOLLITROPIN BETA INJ 900 UNIT/1.08ML GONADOTROPINS FONDAPARINUX INJ 10/0.8ML FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML ANTICOAGULANTS, MISCELLANEOUS FONDAPARINUX INJ 2.5/0.5 FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML ANTICOAGULANTS, MISCELLANEOUS FONDAPARINUX INJ 5/0.4ML FONDAPARINUX SODIUM SUBCUTANEOUS INJ 5 MG/0.4ML ANTICOAGULANTS, MISCELLANEOUS FONDAPARINUX INJ 7.5/0.6 FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML ANTICOAGULANTS, MISCELLANEOUS FRAGMIN INJ 10000/ML DALTEPARIN SODIUM SOLN PREFILLED SYR 10000 UNIT/ML HEPARINS FRAGMIN INJ 12500UNT DALTEPARIN SODIUM SOLN PREFILLED SYR 12500 UNIT/0.5ML HEPARINS FRAGMIN INJ 15000UNT DALTEPARIN SODIUM SOLN PREFILLED SYR 15000 UNIT/0.6ML HEPARINS FRAGMIN INJ 18000UNT DALTEPARIN SODIUM SOLN PREFILLED SYR 18000 UNIT/0.72ML HEPARINS FRAGMIN INJ 2500/0.2 DALTEPARIN SODIUM SOLN PREFILLED SYR 2500 UNIT/0.2ML HEPARINS FRAGMIN INJ 2500/ML DALTEPARIN SODIUM INJ 2500 UNIT/ML HEPARINS FRAGMIN INJ 5000/0.2 DALTEPARIN SODIUM SOLN PREFILLED SYR 5000 UNIT/0.2ML HEPARINS FRAGMIN INJ 7500/0.3 DALTEPARIN SODIUM SOLN PREFILLED SYR 7500 UNIT/0.3ML HEPARINS FRAGMIN INJ 95000UNT DALTEPARIN SODIUM INJ 95000 UNIT/3.8ML HEPARINS FULVESTRANT INJ 250/5ML FULVESTRANT INJ SOLN PREF SYR 250 MG/5ML ANTINEOPLASTIC AGENTS FUZEON INJ 90MG ENFUVIRTIDE FOR INJ 90 MG HIV ENTRY AND FUSION INHIBITORS FYREMADEL SOL 250/0.5 GANIRELIX ACETATE SOLN PREFILLED SYRINGE 250 MCG/0.5ML ANTIGONADTROPINS GALAFOLD CAP 123MG MIGALASTAT HCL CAP 123 MG (BASE EQUIVALENT) OTHER MISCELLANEOUS THERAPEUTIC AGENTS GAMASTAN INJ IMMUNE GLOBULIN (HUMAN) IM INJ ANTITOXINS AND IMMUNE GLOBULINS GAMMAGARD INJ 10GM/100 IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML ANTITOXINS AND IMMUNE GLOBULINS GAMMAGARD INJ 1GM/10ML IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 1 GM/10ML ANTITOXINS AND IMMUNE GLOBULINS GAMMAGARD INJ 2.5GM/25 IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 2.5 GM/25ML ANTITOXINS AND IMMUNE GLOBULINS GAMMAGARD INJ 20GM/200 IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML ANTITOXINS AND IMMUNE GLOBULINS GAMMAGARD INJ 30GM/300 IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 30 GM/300ML ANTITOXINS AND IMMUNE GLOBULINS GAMMAGARD INJ 5GM/50ML IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML ANTITOXINS AND IMMUNE GLOBULINS GAMMAKED INJ 10GM/100 IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML ANTITOXINS AND IMMUNE GLOBULINS GAMMAKED INJ 1GM/10ML IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 1 GM/10ML ANTITOXINS AND IMMUNE GLOBULINS Atrium Health Specialty Drug List - February 2023 Product Label Generic Name AHFS Therapeutic Class Description GAMMAKED INJ 20GM/200 IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML ANTITOXINS AND IMMUNE GLOBULINS GAMMAKED INJ 5GM/50ML IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML ANTITOXINS AND IMMUNE GLOBULINS GAMUNEX-C INJ 10GM/100 IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML ANTITOXINS AND IMMUNE GLOBULINS GAMUNEX-C INJ 1GM/10ML IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 1 GM/10ML ANTITOXINS AND IMMUNE GLOBULINS GAMUNEX-C INJ 2.5GM/25 IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 2.5 GM/25ML ANTITOXINS AND IMMUNE GLOBULINS GAMUNEX-C INJ 20GM/200 IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML ANTITOXINS AND IMMUNE GLOBULINS GAMUNEX-C INJ 40/400ML IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 40 GM/400ML ANTITOXINS AND IMMUNE GLOBULINS GAMUNEX-C INJ 5GM/50ML IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML ANTITOXINS AND IMMUNE GLOBULINS GANIRELIX AC INJ 250/0.5 GANIRELIX ACETATE SOLN PREFILLED SYRINGE 250 MCG/0.5ML ANTIGONADTROPINS GATTEX KIT 5MG TEDUGLUTIDE (RDNA) FOR INJ KIT 5 MG GI DRUGS, MISCELLANEOUS GAVRETO CAP 100MG PRALSETINIB CAP 100 MG ANTINEOPLASTIC AGENTS GILENYA CAP 0.25MG FINGOLIMOD HCL CAP 0.25 MG (BASE EQUIV) IMMUNOMODULATORY AGENTS GILENYA CAP 0.5MG FINGOLIMOD HCL CAP 0.5 MG (BASE EQUIV) IMMUNOMODULATORY AGENTS GILOTRIF TAB 20MG AFATINIB DIMALEATE TAB 20 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS GILOTRIF TAB 30MG AFATINIB DIMALEATE TAB 30 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS GILOTRIF TAB 40MG AFATINIB DIMALEATE TAB 40 MG (BASE EQUIVALENT) ANTINEOPLASTIC AGENTS GLATIRAMER INJ 20MG/ML GLATIRAMER ACETATE SOLN PREFILLED SYRINGE 20 MG/ML IMMUNOMODULATORY AGENTS GLATIRAMER INJ 40MG/ML GLATIRAMER ACETATE SOLN PREFILLED SYRINGE 40 MG/ML IMMUNOMODULATORY AGENTS GLATOPA INJ 20MG/ML GLATIRAMER ACETATE SOLN PREFILLED SYRINGE 20 MG/ML IMMUNOMODULATORY AGENTS GLATOPA INJ 40MG/ML GLATIRAMER ACETATE SOLN PREFILLED SYRINGE 40 MG/ML IMMUNOMODULATORY AGENTS GLEOSTINE CAP 100MG LOMUSTINE CAP 100 MG ANTINEOPLASTIC AGENTS GLEOSTINE CAP 10MG LOMUSTINE CAP 10 MG ANTINEOPLASTIC AGENTS GLEOSTINE CAP 40MG LOMUSTINE CAP 40 MG ANTINEOPLASTIC AGENTS GONAL-F INJ 1050UNIT FOLLITROPIN ALFA FOR INJ 1050 UNIT GONADOTROPINS GONAL-F INJ 450UNIT FOLLITROPIN ALFA FOR INJ 450 UNIT GONADOTROPINS GONAL-F RFF INJ 300/0.5 FOLLITROPIN ALFA SUBCUTANEOUS SOLN PEN-INJ 300 UNIT/0.5ML GONADOTROPINS GONAL-F RFF INJ 450/0.75 FOLLITROPIN ALFA SUBCUTANEOUS SOLN PEN-INJ 450 UNIT/0.75ML GONADOTROPINS GONAL-F RFF INJ 75UNIT FOLLITROPIN ALFA FOR SUBCUTANEOUS INJ 75 UNIT GONADOTROPINS GONAL-F RFF INJ 900/1.5 FOLLITROPIN ALFA SUBCUTANEOUS SOLN PEN-INJ 900 UNIT/1.5ML GONADOTROPINS GRASTEK SUB 2800BAU TIMOTHY GRASS POLLEN ALLERGEN EXT SL TAB 2800 BAU ALLERGENIC EXTRACTS (THERAPEUTIC) HARVONI PAK LEDIPASVIR-SOFOSBUVIR PELLET PACK 33.75-150 MG HCV REPLICATION COMPLEX INHIBITORS HARVONI PAK 45-200MG LEDIPASVIR-SOFOSBUVIR PELLET PACK 45-200 MG HCV REPLICATION COMPLEX INHIBITORS HARVONI TAB 45-200MG LEDIPASVIR-SOFOSBUVIR TAB 45-200 MG HCV REPLICATION COMPLEX INHIBITORS HARVONI TAB 90-400MG LEDIPASVIR-SOFOSBUVIR TAB 90-400 MG HCV REPLICATION COMPLEX INHIBITORS HEMLIBRA INJ 105/0.7 EMICIZUMAB-KXWH SUBCUTANEOUS SOLN 105 MG/0.7ML (150 MG/ML) HEMOSTATICS HEMLIBRA INJ 150/ML EMICIZUMAB-KXWH SUBCUTANEOUS SOLN 150 MG/ML HEMOSTATICS HEMLIBRA INJ 30MG/ML EMICIZUMAB-KXWH SUBCUTANEOUS SOLN 30 MG/ML HEMOSTATICS HEMLIBRA INJ 60/0.4 EMICIZUMAB-KXWH SUBCUTANEOUS SOLN 60 MG/0.4ML (150 MG/ML) HEMOSTATICS Atrium Health Specialty Drug List - February 2023

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Product Generic Name AHFS Therapeutic Class Description BETASERON INJ 0.3MG INTERFERON BETA‐1B FOR INJ KIT 0.3 MG IMMUNOMODULATORY AGENTS

Product Generic Name AHFS Therapeutic Class Description PDF

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Product Generic Name AHFS Therapeutic Class Description BETASERON INJ 0.3MG INTERFERON BETA‐1B FOR INJ KIT 0.3 MG IMMUNOMODULATORY AGENTS

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