ACTEMRA IV (USSC can dispense 162 mg PFS) ACTHAR HP ACTIMMUNE ADAGEN ADCETRIS CVS Specialty 1-800-237-2767 1-800-237-2767 ADEMPAS ADVATE ALDURAZYME ALECENSA ALIQOPA ALUNBRIG AMPYRA (USSC can dispense generic - dalfampridine) APOKYN ARALAST NP ARCALYST ARIKAYCE Kroger Specialty 1-855-733-3126 1-888-315-3270 IV Solutions & Maxor Pharmacies 1-806-355-5029 Orisini Pharmacy 1-800-356-5034 PANTHERx 1-855-726-8479 1-855-246-3986 ARZERRA ATRYN Limited to Hospital Pharmacies www.atryn.com/orderatryn.php AVEED BAVENCIO Biologics 1-800-850-4306 BELEODAQ BENDEKA BENLYSTA BERINERT BETHKIS WDRx 1/1/19 www.welldynerx.com 1
BIVIGAM BLINCYTO BOSULIF BRAFTOVI BRINEURA Provider must obtain 1-866-906-6100 CABOMETYX CALQUENCE CAMPATH Shipped directly from manufacturer; physician must call 1-877-422-6728 CAPRELSA CVS Specialty 1-800-237-2767 Biologics 1-800-850-4306 CARBAGLU Foundation Care 1-877-291-1122 CAYSTON IV Solutions & Maxor Pharmacies 1-806-355-5029 Mckesson Plasma and Biologics 1-877-625-2566 CEPROTIN CERDELGA CEREZYME CHENODAL CHOLBAM CINRYZE COMETRIQ COPIKTRA Avella 1-877-470-7603 Biologics 1-800-850-4306 WDRx 1/1/19 www.welldynerx.com 2
US Bioservices 1-888-518-7246 1-888-418-7246 CORIFACT COTELLIC CUVITRU Option Care 1-866-827-8203 BriovaRx 1-888-293-9309 CYRAMZA CRYSVITA CYSTADANE AnovoRx 1-844-288-5007 CYSTAGON CYSTARAN DACOGEN DARAPRIM DARZALEX DOPELET Kroger Specialty 1-855-733-3126 1-888-315-3270 PANTHERx 1-855-726-8479 1-855-246-3986 DUOPA DYSPORT Provider must obtain 1-908-275-6300 EGRIFTA ELAPRASE ELELYSO (USSC may be able to order this medication) EMFLAZA US Bioservices 1-888-518-7246 1-888-418-7246 EMPLICITI WDRx 1/1/19 www.welldynerx.com 3
ENDARI US Bioservices 1-888-518-7246 1-888-418-7246 EPOPROSTENOL SODIUM ERIVEDGE ERLEADA ERWINAZE ESBRIET (USSC will fill for all mandatory USSC plans) BriovaRx 1-855-427-4682 BriovaRx Infusion 1-877-306-4036 Option Care 1-844-672-4842 EVOMELA EXJADE Orsini Pharmacy 1-800-356-5034 EXONDYS 51 Option Care-I only have 1-855-647-2884 their fax # EYLEA FABRAZYME FASENRA Acaria Health 1-877-541-1503 BriovaRx 1-855-427-4682 Cigna Specialty 1-800-351-3606 Humana 1-800-486-2668 Special Care Pharmacy (Located in 1-888-727-7127 Puerto Rico) FERRIPROX FIRAZYR FLOLAN WDRx 1/1/19 www.welldynerx.com 4
GALAFOLD GAMMAPLEX GATTEX GAZYVA GILOTRIF GLASSIA Option Care 1-855-275-9647 HAEGARDA Orsini Pharmacy 1-800-410-8575 HEMLIBRA HETLIOZ HUMIRA PEDIATRIC CROHN'S (20 MG) BioPlus Specialty Pharmacy 1-866-514-8082 Advance Care Scripts 1-866-944-9511 Vanda-Manufacturer of product 1-844-438-5469 Call Pharmacy Solutions for Available Pharmacies 1-888-857-0668 ACS Pharmacy 1-877-985-6337 HYQVIA IBRANCE ICLUSIG IDHIFA CuraScript 1-866-474-8326 PASS program 1-855-447-7277 Biologics 1-800-850-4306 WDRx 1/1/19 www.welldynerx.com 5
ILARIS ILUVIEN IMBRUVICA IMFINZI IMPLANON INCRELEX INGREZZA PANTHERx 1-855-726-8479 1-855-246-3986 INLYTA INTRON A IRESSA ISTODAX JAKAFI JETREA Coram CVS Specialty JIVI Infusion 1-800-423-1411 JUXTAPID 1-888-608-9010 1-888-302-1028 JYNARQUE PANTHERx 1-855-726-8479 1-855-246-3986 KADCYLA KALBITOR KALYDECO BriovaRx 1-855-427-4682 Kroger Specialty 1-855-733-3126 1-888-315-3270 KANUMA KEVEYIS PANTHERx 1-855-726-8479 1-855-246-3986 KINERET RxCrossroads 1-866-547-0644 KITABIS PAK WDRx 1/1/19 www.welldynerx.com 6
KORLYM KUVAN KYLEENA KYMRIAH Available at select treatment centers KYMRIAH-hcp.com KYNAMRO KYPROLIS LARTRUVO LEMTRADA LENVIMA Biologics 1-800-850-4306 1-800-823-4506 LETAIRIS LIBTAYO LILETTA LONSURF LUCENTIS LUMIZYME LUXTURNA CuraScript 1-866-474-8326 LYNPARZA Biologics 1-800-856-1984 LYSODREN HRA Pharma 1-844-597-6373 MACRILEN MACUGEN MAKENA MATULANE MEKTOVI MEPSEVII MIRENA MYALEPT MYLOTARG Biologics Specialty Pharmacy 1-800-850-4306 NAGLAZYME NATPARA NERLYNX WDRx 1/1/19 www.welldynerx.com 7
NEXAVAR NEXPLANON NITYR NORTHERA NOVOEIGHT NPLATE NUCALA NUPLAZID OBIZUR OCALIVA OCREVUS ODOMZO OFEV ONCASPAR Provider must obtain www.oncaspar.com ONIVYDE US Bioservices 1-888-518-7246 Orsini Pharmacy 1-800-410-8575 ONPATTRO US Bioservices 1-888-518-7246 OPSUMIT ORALAIR ORENITRAM ORFADIN ORKAMBI 1-866-849-4481 1-877-473-3172 BriovaRx 1-855-427-4682 Kroger Specialty 1-855-733-3126 1-888-315-3270 WDRx 1/1/19 www.welldynerx.com 8
OZURDEX PALYNZIQ PERJETA PHOTREXA Provider must obtain www.livingwithkeratoconus.co m PLEGRIDY POMALYST PORTRAZZA PROBUPHINE IMPLANT KIT Braeburn Access Plan 1-844-859-6341 PROCYSBI PROLASTIN-C PROVENGE Available only through approved cancer treatment centers (go to website to enter zip code for to find a Provenge Treatment Center) www.provenge.com QUTENZA RADICAVA RAVICTI REBINYN REMODULIN RETISERT REVLIMID RIASTAP RUBRACA RUCONEST SABRIL (VIGABATRIN) SAMSCA SEROSTIM WDRx 1/1/19 www.welldynerx.com 9
SILIQ SIRTURO Aetna Specialty 1-866-782-2779 SKYLA SOLESTA SOLIRIS SOMAVERT SPINRAZA STIVARGA STRENSIQ PANTHERx 1-855-726-8479 1-855-246-3986 SUBLOCADE SUCRAID US Bioservices 1-888-518-7246 1-888-418-7246 SUTENT SYLVANT SYMDEKO BriovaRx 1-855-427-4682 SYNAGIS TAGRISSO TAKHZYRO BriovaRx 1-888-293-9309 Option Care 1-866-827-8203 Orsini Pharmacy 1-800-410-8575 TARCEVA TAVALISSE US Bioservices 1-888-518-7246 1-888-418-7246 TECENTRIQ TECFIDERA TESTOPEL THALOMID THIOLA WDRx 1/1/19 www.welldynerx.com 10
TIBSOVO Biologics 1-800-850-4306 1-800-823-4506 TOBI (Generic formulation is NOT LD and can be filled through USSC) TOBI PODHALER TRACLEER TRETTEN TRIPTODUR PANTHERx 1-855-726-8479 1-855-246-3986 CuraScript SD 1-877-599-7748 TROGARZO Option Care 1-866-827-8203 TYSABRI TYVASO UPTRAVI VALCHLOR VELETRI VENTAVIS VERZENIO VIGADRONE PANTHERx 1-855-726-8479 1-855-246-3986 VIMIZIM VISTOGARD Biologics 1-800-850-4306 1-800-823-4506 VISUDYNE VIVAGLOBIN BioRx 1-866-442-4679 VIZIMPRO VONVENDI VPRIV XALKORI XENAZINE (Generic WDRx 1/1/19 www.welldynerx.com 11
formulation is NOT LD and can be filled through USSC) XERMELO Biologics 1-800-856-1984 XIAFLEX US Bioservices 1-888-518-7246 1-888-418-7246 XOFIGO Provider must order through manufacturer 1-855-696-3446; XofigoAccessOnline.com XOLAIR (USSC will fill for all mandatory USSC plans) XTANDI XURIDEN Cardinal Health Specialty Pharmacy 1-888-662-6779 XYREM Xyrem Central Pharmacy 1-866-997-3688 YESCARTA Cancer Centers Mayo Clinic YONDELIS ZALTRAP ZAVESCA ZEJULA US Bioservices 1-888-518-7246 1-888-418-7246 ZELBORAF ZEMAIRA ZEVALIN Y-90 Cell Therapeutics, Inc - Limited to Radiopharmacies 1-866-298-8433 ZINBRYTA ZYDELIG WDRx 1/1/19 www.welldynerx.com 12