CHCP - Resources - Cigna Pathwell Specialty℠ Drug List

Cigna Pathwell Specialty℠ Drug List

Cigna Pathwell Specialty℠ is for patients using a specialty medication to treat a complex medical condition. As part of this program, certain medications must be administered by a provider in the Cigna Pathwell Specialty Network or ordered from an in-network specialty pharmacy to be covered.

About this drug list

This is a list of infused and injected specialty medications that must be administered by a provider in the Cigna Pathwell Specialty Network, or ordered from an in-network specialty pharmacy, for them to be covered. Medications are listed alphabetically by condition with generic medications listed in all lowercase letters and brand-name medications in all capital letters. Additionally, this list contains drugs that may be on a 180 Day Hold and/or the Drug Removal Table list. This drug list is automatically updated so it provides the latest list of medications.

Go to Cigna.com/Pathwellspecialty for additional information or to find a facility in the Cigna Pathwell Specialty Network near you.

Provider Directory

Cigna Pathwell Specialty Drug List
Drug Name/Generic Name	Brand Name/Trade Name	Purpose	HCPCS Code	Precert Required?	180 DH	DRT Drug List
abatacept/maltose	ORENCIA	RA/PSORIASIS/CROHNS	J0129	Yes	No	Yes
ado-trastuzumab emtansine	KADCYLA	CANCER	J9354	Yes	No	No
aducanumab-avwa	ADUHELM	INJECTABLES - SPECIALTY OTHER	J0172	Yes	No	No
agalsidase beta	FABRAZYME	HEREDITARY METABOLIC DISORDERS	J0180	Yes	No	No
alemtuzumab	LEMTRADA	MULTIPLE SCLEROSIS	J0202	Yes	No	Yes
alglucosidase alfa	LUMIZYME	HEREDITARY METABOLIC DISORDERS	J0221	Yes	No	No
alpha-1-proteinase inhibitor	ARALAST NP	HEREDITARY METABOLIC DISORDERS	J0256	Yes	No	No
alpha-1-proteinase inhibitor	GLASSIA	HEREDITARY METABOLIC DISORDERS	J0257	Yes	No	No
alpha-1-proteinase inhibitor	PROLASTIN C	HEREDITARY METABOLIC DISORDERS	J0256	Yes	No	No
alpha-1-proteinase inhibitor	ZEMAIRA	HEREDITARY METABOLIC DISORDERS	J0256	Yes	No	No
amivantamab-vmjw	RYBREVANT	CANCER	J9061	Yes	No	No
anifrolumab-fnia	SAPHNELO	INJECTABLES - SPECIALTY OTHER	J0491	Yes	No	Yes
antihem.fviii,sin-chn,b-dm tru	AFSTYLA	HEMOPHILIA	J7210	Yes	No	No
antihemo.fviii,full length peg	ADYNOVATE	HEMOPHILIA	J7207	Yes	No	No
antihemoph.fviii,b-domain del	XYNTHA	HEMOPHILIA	J7185	Yes	No	No
antihemoph.fviii,b-domain del	XYNTHA SOLOFUSE	HEMOPHILIA	J7185	Yes	No	No
antihemoph.fviii,b-dom truncat	NOVOEIGHT	HEMOPHILIA	J7182	Yes	No	No
antihemoph.fviii,hek b-delete	NUWIQ	HEMOPHILIA	J7209	Yes	No	No
antihemoph.fviii rec,fc fusion	ELOCTATE	HEMOPHILIA	J7205	Yes	No	No
antihemophil.fviii,full length	ADVATE	HEMOPHILIA	J7192	Yes	No	No
antihemophil.fviii,full length	KOGENATE FS	HEMOPHILIA	J7192	Yes	No	No
antihemophil.fviii,full length	KOVALTRY	HEMOPHILIA	J7211	Yes	No	No
antihemophilic factor, human	HEMOFIL M	HEMOPHILIA	J7190	Yes	No	No
antihemophilic factor, human	KOATE	HEMOPHILIA	J7190	Yes	No	No
antihemophilic factor, hum rec	RECOMBINATE	HEMOPHILIA	J7192	Yes	No	No
antihemophilic factor/vwf	ALPHANATE	HEMOPHILIA	J7186	Yes	No	No
antihemophilic factor/vwf	HUMATE-P	HEMOPHILIA	J7187	Yes	No	No
antihemophilic factor/vwf	WILATE	HEMOPHILIA	J7183	Yes	No	No
antihemophilic fviii,rec porc	OBIZUR	HEMOPHILIA	J7188	Yes	No	No
anti-inhibitor coagulant comp.	FEIBA	HEMOPHILIA	J7198	Yes	No	No
antithrombin iii (plasma der)	THROMBATE III	OTHER BLOOD DISORDERS	J7197	Yes	No	No
atezolizumab	TECENTRIQ	CANCER	J9022	Yes	No	No
atezolizumab-hyaluronidas-tqjs	TECENTRIQ HYBREZA	CANCER	J9024	Yes	No	No
atezolizumab-hyaluronidas-tqjs	TECENTRIQ HYBREZA	CANCER	J9999	Yes	No	No
avalglucosidase alfa-ngpt	NEXVIAZYME	HEREDITARY METABOLIC DISORDERS	J0219	Yes	No	No
axatilimab-csfr	NIKTIMVO	INJECTABLES - SPECIALTY OTHER	J3590	Yes	Yes	No
axatilimab-csfr	NIKTIMVO	INJECTABLES - SPECIALTY OTHER	J9038	Yes	Yes	No
belatacept	NULOJIX	INJECTABLES - SPECIALTY OTHER	J0485	Yes	No	No
belimumab	BENLYSTA	AUTOIMMUNE/OTHER INFLAMMATORY	J0490	Yes	No	No
bendamustine hcl	BELRAPZO	CANCER	J9036	Yes	No	No
bendamustine hcl	BENDAMUSTINE HCL	CANCER	J9033	Yes	No	No
bendamustine hcl	BENDAMUSTINE HCL	CANCER	J9036	Yes	No	No
bendamustine hcl	BENDAMUSTINE HCL	CANCER	J9058	Yes	No	No
bendamustine hcl	BENDAMUSTINE HCL	CANCER	J9059	Yes	No	No
bendamustine hcl	BENDEKA	CANCER	J9034	Yes	No	No
bendamustine hcl	TREANDA	CANCER	J9033	Yes	No	No
bendamustine hcl	VIVIMUSTA	CANCER	J9056	Yes	No	No
benralizumab	FASENRA	ASTHMA/ALLERGY	J0517	Yes	No	No
bevacizumab	AVASTIN	CANCER	J9035	Yes	No	Yes
bevacizumab-adcd	VEGZELMA	CANCER	Q5129	Yes	No	Yes
bevacizumab-awwb	MVASI	CANCER	Q5107	Yes	No	No
bevacizumab-bvzr	ZIRABEV	CANCER	Q5118	Yes	No	No
bevacizumab-maly	ALYMSYS	CANCER	Q5126	Yes	No	Yes
blinatumomab	BLINCYTO	CANCER	J9039	Yes	No	No
brentuximab vedotin	ADCETRIS	CANCER	J9042	Yes	No	No
burosumab-twza	CRYSVITA	BONE	J0584	Yes	No	No
c1 esterase inhibitor	BERINERT	ASTHMA/ALLERGY	J0597	Yes	No	Yes
c1 esterase inhibitor	CINRYZE	ASTHMA/ALLERGY	J0598	Yes	No	No
c1 esterase inhibitor, recomb	RUCONEST	ASTHMA/ALLERGY	J0596	Yes	No	Yes
cabazitaxel	JEVTANA	CANCER	J9043	Yes	No	No
cabotegravir/rilpivirine	CABENUVA	INFECTIOUS DISEASE	J0741	Yes	No	No
canakinumab/pf	ILARIS	AUTOIMMUNE/OTHER INFLAMMATORY	J0638	Yes	No	No
caplacizumab-yhdp	CABLIVI	OTHER BLOOD DISORDERS	C9047	Yes	No	No
carfilzomib	KYPROLIS	CANCER	J9047	Yes	No	No
casimersen	AMONDYS-45	GENETIC NEUROMUSCLAR DISORDERS	J1426	Yes	No	No
cemiplimab-rwlc	LIBTAYO	CANCER	J9119	Yes	No	No
cerliponase alfa	BRINEURA	HEREDITARY METABOLIC DISORDERS	J0567	Yes	No	No
certolizumab pegol	CIMZIA (2 PACK)	RA/PSORIASIS/CROHNS	J0717	Yes	No	No
cetuximab	ERBITUX	CANCER	J9055	Yes	No	No
cipaglucosidase alfa-atga	POMBILITI	HEREDITARY METABOLIC DISORDERS	J1203	Yes	No	No
coagulation factor viia,recomb	NOVOSEVEN RT	HEMOPHILIA	J7189	Yes	No	No
coagulation factor x	COAGADEX	HEMOPHILIA	J7175	Yes	No	No
coagulation viia,recomb-jncw	SEVENFACT	HEMOPHILIA	J7189	Yes	No	No
coagulation viia,recomb-jncw	SEVENFACT	HEMOPHILIA	J7212	Yes	No	No
crizanlizumab-tmca	ADAKVEO	OTHER BLOOD DISORDERS	J0791	Yes	No	No
crovalimab-akkz	PIASKY	OTHER BLOOD DISORDERS	J1307	Yes	No	Yes
daratumumab	DARZALEX	CANCER	J9145	Yes	No	No
daratumumab-hyaluronidase-fihj	DARZALEX FASPRO	CANCER	J9144	Yes	No	No
darbepoetin alfa in polysorbat	ARANESP	ANEMIA	J0881	Yes	No	No
datopotamab deruxtecan-dlnk	DATROWAY	CANCER	J9999	Yes	Yes	No
decitabine	DACOGEN	CANCER	J0894	Yes	No	No
decitabine	DECITABINE	CANCER	J0893	Yes	No	No
decitabine	DECITABINE	CANCER	J0894	Yes	No	No
denosumab	PROLIA	BONE	J0897	Yes	No	No
denosumab	XGEVA	BONE	J0897	Yes	No	No
dostarlimab-gxly	JEMPERLI	CANCER	J9272	Yes	No	No
doxorubicin hcl peg-liposomal	DOXIL	CANCER	Q2050	Yes	No	No
doxorubicin hcl peg-liposomal	DOXORUBICIN HCL LIPOSOME	CANCER	Q2050	Yes	No	No
durvalumab	IMFINZI	CANCER	J9173	Yes	No	No
ecallantide	KALBITOR	ASTHMA/ALLERGY	J1290	Yes	No	Yes
eculizumab	SOLIRIS	OTHER BLOOD DISORDERS	J1299	Yes	No	No
eculizumab	SOLIRIS	OTHER BLOOD DISORDERS	J1300	Yes	No	No
edaravone	EDARAVONE	GENETIC NEUROMUSCLAR DISORDERS	J1301	Yes	No	No
edaravone	RADICAVA	GENETIC NEUROMUSCLAR DISORDERS	J1301	Yes	No	No
efgartigimod alfa-fcab	VYVGART	INJECTABLES - SPECIALTY OTHER	J9332	Yes	No	No
efgartigimod-hyaluronidas-qvfc	VYVGART HYTRULO	INJECTABLES - SPECIALTY OTHER	J9334	Yes	No	No
eflapegrastim-xnst	ROLVEDON	NEUTROPENIA	J1449	Yes	No	No
elapegademase-lvlr	REVCOVI	INJECTABLES - SPECIALTY OTHER	J3590	Yes	No	No
elosulfase alfa	VIMIZIM	HEREDITARY METABOLIC DISORDERS	J1322	Yes	No	No
elotuzumab	EMPLICITI	CANCER	J9176	Yes	No	No
elranatamab-bcmm	ELREXFIO	CANCER	J1323	Yes	No	No
emapalumab-lzsg	GAMIFANT	OTHER BLOOD DISORDERS	J9210	Yes	No	No
enfortumab vedotin-ejfv	PADCEV	CANCER	J9177	Yes	No	No
epcoritamab-bysp	EPKINLY	CANCER	J9321	Yes	No	No
epoetin alfa	EPOGEN	ANEMIA	J0885	Yes	No	No
epoetin alfa	PROCRIT	ANEMIA	J0885	Yes	No	No
epoetin alfa-epbx	RETACRIT	ANEMIA	Q5106	Yes	No	No
eptinezumab-jjmr	VYEPTI	INJECTABLES - SPECIALTY OTHER	J3032	Yes	No	Yes
eribulin mesylate	ERIBULIN MESYLATE	CANCER	J9179	Yes	No	No
eribulin mesylate	HALAVEN	CANCER	J9179	Yes	No	No
eteplirsen	EXONDYS-51	GENETIC NEUROMUSCLAR DISORDERS	J1428	Yes	No	No
evinacumab-dgnb	EVKEEZA	INJECTABLES - SPECIALTY OTHER	J1305	Yes	No	No
factor ix	ALPHANINE SD	HEMOPHILIA	J7193	Yes	No	No
factor ix cplx(pcc)no4,3factor	PROFILNINE	HEMOPHILIA	J7194	Yes	No	No
factor ix human recombinant	BENEFIX	HEMOPHILIA	J7195	Yes	No	No
factor ix human recombinant	RIXUBIS	HEMOPHILIA	J7200	Yes	No	No
factor ix human recomb,thr 148	IXINITY	HEMOPHILIA	J7195	Yes	No	No
factor ix human recomb,thr 148	IXINITY	HEMOPHILIA	J7213	No	No	No
factor ix human rec,pegylated	REBINYN	HEMOPHILIA	J7203	Yes	No	No
factor ix rec, fc fusion protn	ALPROLIX	HEMOPHILIA	J7201	Yes	No	No
factor ix recom,albumin fusion	IDELVION	HEMOPHILIA	J7202	Yes	No	No
factor xiii	CORIFACT	HEMOPHILIA	J7180	Yes	No	No
factor xiii a-subunit,recomb	TRETTEN	HEMOPHILIA	J7181	Yes	No	No
fam-trastuzumab deruxtecn-nxki	ENHERTU	CANCER	J9358	Yes	No	No
fibrinogen	RIASTAP	OTHER BLOOD DISORDERS	J7178	Yes	No	No
fosdenopterin hydrobromide	NULIBRY	HEREDITARY METABOLIC DISORDERS	J3490	Yes	No	No
fulvestrant	FASLODEX	CANCER	J9395	Yes	No	No
fulvestrant	FULVESTRANT	CANCER	J9393	Yes	No	No
fulvestrant	FULVESTRANT	CANCER	J9394	Yes	No	No
fulvestrant	FULVESTRANT	CANCER	J9395	Yes	No	No
fviii rec,b-dom delet peg-aucl	JIVI	HEMOPHILIA	J7208	Yes	No	No
fviii rec,b-dom trunc peg-exei	ESPEROCT	HEMOPHILIA	J7204	Yes	No	No
fviii rec,fc-vwf-xten,bdd-ehtl	ALTUVIIIO	HEMOPHILIA	J7214	Yes	No	No
galsulfase	NAGLAZYME	HEREDITARY METABOLIC DISORDERS	J1458	Yes	No	No
givosiran sodium	GIVLAARI	HEREDITARY METABOLIC DISORDERS	J0223	Yes	No	No
glofitamab-gxbm	COLUMVI	CANCER	J9286	Yes	No	No
golimumab	SIMPONI ARIA	RA/PSORIASIS/CROHNS	J1602	Yes	No	No
golodirsen	VYONDYS-53	GENETIC NEUROMUSCLAR DISORDERS	J1429	Yes	No	No
goserelin acetate	ZOLADEX	CANCER	J9202	Yes	No	No
guselkumab	TREMFYA	RA/PSORIASIS/CROHNS	J1628	Yes	No	No
ibalizumab-uiyk	TROGARZO	INJECTABLES - SPECIALTY OTHER	J1746	Yes	No	No
idursulfase	ELAPRASE	HEREDITARY METABOLIC DISORDERS	J1743	Yes	No	No
igg/hyaluronidase,recombinant	HYQVIA	IVIG/IMMUNE RELATED	J1575	Yes	No	Yes
imetelstat sodium	RYTELO	CANCER	J0870	Yes	No	Yes
imiglucerase	CEREZYME	HEREDITARY METABOLIC DISORDERS	J1786	Yes	No	No
imm glob g (igg)/sorb/iga 0-50	FLEBOGAMMA DIF	IVIG/IMMUNE RELATED	J1572	Yes	No	No
immune globul g/gly/iga avg 46	GAMMAKED	IVIG/IMMUNE RELATED	J1561	Yes	No	No
immune globul g/gly/iga avg 46	GAMUNEX-C	IVIG/IMMUNE RELATED	J1561	Yes	No	No
immune globul g (igg)/glycine	GAMASTAN	IVIG/IMMUNE RELATED	90281	Yes	No	No
immune globul g (igg)/glycine	GAMASTAN S-D	IVIG/IMMUNE RELATED	90281	Yes	No	No
immune globulin,gamma(igg)klhw	XEMBIFY	IVIG/IMMUNE RELATED	J1558	Yes	No	No
immune globulin,gamma(igg)slra	ASCENIV	IVIG/IMMUNE RELATED	J1554	Yes	No	Yes
immune globulin,gamma(igg)stwk	ALYGLO	IVIG/IMMUNE RELATED	J1552	Yes	No	Yes
immun glob g/gly/gluc/iga 0-50	GAMMAGARD S-D	IVIG/IMMUNE RELATED	J1566	Yes	No	Yes
immun glob g(igg)/gly/iga 0-50	GAMMAPLEX	IVIG/IMMUNE RELATED	J1557	Yes	No	No
immun glob g(igg)/gly/iga ov50	BIVIGAM	IVIG/IMMUNE RELATED	J1556	Yes	No	No
immun glob g(igg)/gly/iga ov50	CUVITRU	IVIG/IMMUNE RELATED	J1555	Yes	No	No
immun glob g(igg)/gly/iga ov50	GAMMAGARD LIQUID	IVIG/IMMUNE RELATED	J1569	Yes	No	Yes
immun glob g(igg)-hipp/maltose	CUTAQUIG	IVIG/IMMUNE RELATED	J1551	Yes	No	No
immun glob g(igg)-ifas/glycine	PANZYGA	IVIG/IMMUNE RELATED	J1576	Yes	No	No
immun globg(igg)/malt/iga ov50	OCTAGAM	IVIG/IMMUNE RELATED	J1568	Yes	No	No
immun glob g(igg)/pro/iga 0-50	HIZENTRA	IVIG/IMMUNE RELATED	J1559	Yes	No	No
immun glob g(igg)/pro/iga 0-50	PRIVIGEN	IVIG/IMMUNE RELATED	J1459	Yes	No	No
immun glob g/sorb/gly/iga 0-50	GAMMAPLEX	IVIG/IMMUNE RELATED	J1557	Yes	No	No
inclisiran sodium	LEQVIO	INJECTABLES - SPECIALTY OTHER	J1306	Yes	No	Yes
inebilizumab-cdon	UPLIZNA	MULTIPLE SCLEROSIS	J1823	Yes	No	No
infliximab	INFLIXIMAB	RA/PSORIASIS/CROHNS	J1745	Yes	No	Yes
infliximab	REMICADE	RA/PSORIASIS/CROHNS	J1745	Yes	No	Yes
infliximab-abda	RENFLEXIS	RA/PSORIASIS/CROHNS	Q5104	Yes	No	Yes
infliximab-axxq	AVSOLA	RA/PSORIASIS/CROHNS	Q5121	Yes	No	No
infliximab-dyyb	INFLECTRA	RA/PSORIASIS/CROHNS	Q5103	Yes	No	No
infliximab-dyyb	ZYMFENTRA	RA/PSORIASIS/CROHNS	J1748	Yes	No	No
ipilimumab	YERVOY	CANCER	J9228	Yes	No	No
ixabepilone	IXEMPRA	CANCER	J9207	Yes	No	No
lanreotide acetate	LANREOTIDE ACETATE	HORMONE RELATED	J1930	Yes	No	No
lanreotide acetate	LANREOTIDE ACETATE	INJECTABLES - SPECIALTY OTHER	J1932	Yes	No	No
lanreotide acetate	SOMATULINE DEPOT	HORMONE RELATED	J1930	Yes	No	No
laronidase	ALDURAZYME	HEREDITARY METABOLIC DISORDERS	J1931	Yes	No	No
lenacapavir sodium	SUNLENCA	INJECTABLES - SPECIALTY OTHER	J1961	Yes	No	No
leuprolide acetate	ELIGARD	HORMONE RELATED	J9217	Yes	No	No
leuprolide acetate	FENSOLVI	HORMONE RELATED	J1950	Yes	No	No
leuprolide acetate	FENSOLVI	HORMONE RELATED	J1951	Yes	No	No
leuprolide acetate	LEUPROLIDE DEPOT	INJECTABLES - SPECIALTY OTHER	J1954	Yes	No	No
leuprolide acetate	LUPRON DEPOT	HORMONE RELATED	J1950	Yes	No	No
leuprolide acetate	LUPRON DEPOT	HORMONE RELATED	J9217	Yes	No	No
leuprolide acetate	LUPRON DEPOT-PED	HORMONE RELATED	J1950	Yes	No	No
loncastuximab tesirine-lpyl	ZYNLONTA	CANCER	J9359	Yes	No	No
lumasiran sodium	OXLUMO	HEREDITARY METABOLIC DISORDERS	J0224	Yes	No	No
luspatercept-aamt	REBLOZYL	INJECTABLES - SPECIALTY OTHER	J0896	Yes	No	No
mepolizumab	NUCALA	ASTHMA/ALLERGY	J2182	Yes	No	No
methoxy peg-epoetin beta	MIRCERA	ANEMIA	J0888	Yes	No	No
mirikizumab-mrkz	OMVOH	RA/PSORIASIS/CROHNS	J2267	Yes	No	No
mirvetuximab soravtansine-gynx	ELAHERE	CANCER	J9063	Yes	No	No
mosunetuzumab-axgb	LUNSUMIO	CANCER	J9350	No	No	No
natalizumab	TYSABRI	MULTIPLE SCLEROSIS	J2323	Yes	No	No
nivolumab	OPDIVO	CANCER	J9299	Yes	No	No
nivolumab-hyaluronidase-nvhy	OPDIVO QVANTIG	CANCER	J9999	Yes	Yes	No
nivolumab-relatlimab-rmbw	OPDUALAG	CANCER	J9298	Yes	No	No
nogapendekin alfa inbakic-pmln	ANKTIVA	CANCER	J9028	Yes	No	Yes
nusinersen sodium/pf	SPINRAZA	GENETIC NEUROMUSCLAR DISORDERS	J2326	Yes	No	No
obinutuzumab	GAZYVA	CANCER	J9301	Yes	No	No
ocrelizumab	OCREVUS	MULTIPLE SCLEROSIS	J2350	Yes	No	No
ocrelizumab-hyaluronidase-ocsq	OCREVUS ZUNOVO	MULTIPLE SCLEROSIS	J2351	Yes	No	No
ocrelizumab-hyaluronidase-ocsq	OCREVUS ZUNOVO	MULTIPLE SCLEROSIS	J3590	Yes	No	No
octreotide acetate,mi-spheres	OCTREOTIDE ACETATE ER	HORMONE RELATED	J2353	Yes	No	Yes
octreotide acetate,mi-spheres	SANDOSTATIN LAR DEPOT	HORMONE RELATED	J2353	Yes	No	Yes
olipudase alfa-rpcp	XENPOZYME	HEREDITARY METABOLIC DISORDERS	J0218	Yes	No	No
omalizumab	XOLAIR	ASTHMA/ALLERGY	J2357	Yes	No	No
paclitaxel protein-bound	ABRAXANE	CANCER	J9264	Yes	No	No
paclitaxel protein-bound	PACLITAXEL PROTEIN-BOUND	CANCER	J9259	Yes	No	No
paclitaxel protein-bound	PACLITAXEL PROTEIN-BOUND	CANCER	J9264	Yes	No	No
palivizumab	SYNAGIS	INFECTIOUS DISEASE	90378	Yes	No	No
panitumumab	VECTIBIX	CANCER	J9303	Yes	No	No
parathyroid hormone	NATPARA	INJECTABLES - SPECIALTY OTHER	J3590	Yes	No	No
pasireotide pamoate	SIGNIFOR LAR	INJECTABLES - SPECIALTY OTHER	J2502	Yes	No	Yes
patisiran sodium,lipid complex	ONPATTRO	GENETIC NEUROMUSCLAR DISORDERS	J0222	Yes	No	No
pegfilgrastim	NEULASTA	NEUTROPENIA	J2506	Yes	No	No
pegfilgrastim	NEULASTA ONPRO	NEUTROPENIA	J2506	Yes	No	Yes
pegfilgrastim-apgf	NYVEPRIA	NEUTROPENIA	Q5122	Yes	No	No
pegfilgrastim-bmez	ZIEXTENZO	NEUTROPENIA	Q5120	Yes	No	Yes
pegfilgrastim-cbqv	UDENYCA	NEUTROPENIA	Q5111	Yes	No	No
pegfilgrastim-cbqv	UDENYCA AUTOINJECTOR	NEUTROPENIA	Q5111	Yes	No	No
pegfilgrastim-cbqv	UDENYCA ONBODY	NEUTROPENIA	Q5111	Yes	No	No
pegfilgrastim-fpgk	STIMUFEND	NEUTROPENIA	Q5127	Yes	No	Yes
pegfilgrastim-jmdb	FULPHILA	NEUTROPENIA	Q5108	Yes	No	Yes
pegfilgrastim-pbbk	FYLNETRA	NEUTROPENIA	Q5130	Yes	No	Yes
pegloticase	KRYSTEXXA	AUTOIMMUNE/OTHER INFLAMMATORY	J2507	Yes	No	No
pegunigalsidase alfa-iwxj	ELFABRIO	HEREDITARY METABOLIC DISORDERS	J2508	Yes	No	No
pembrolizumab	KEYTRUDA	CANCER	J9271	Yes	No	No
pemetrexed	PEMETREXED	CANCER	J9305	Yes	No	No
pemetrexed disodium	ALIMTA	CANCER	J9305	Yes	No	No
pemetrexed disodium	PEMETREXED DISODIUM	CANCER	J9305	Yes	No	No
pertuzumab	PERJETA	CANCER	J9306	Yes	No	No
pertuzumab-trastuzumab-hy-zzxf	PHESGO	CANCER	J9316	Yes	No	No
plasminogen, human-tvmh	RYPLAZIM	OTHER BLOOD DISORDERS	J2998	Yes	No	No
pozelimab-bbfg	VEOPOZ	OTHER BLOOD DISORDERS	J9376	Yes	No	No
pralatrexate	FOLOTYN	CANCER	J9307	Yes	No	No
pralatrexate	PRALATREXATE	CANCER	J9307	Yes	No	No
protein c, human	CEPROTIN	OTHER BLOOD DISORDERS	J2724	Yes	No	No
ramucirumab	CYRAMZA	CANCER	J9308	Yes	No	No
ravulizumab-cwvz	ULTOMIRIS	OTHER BLOOD DISORDERS	J1303	Yes	No	No
reslizumab	CINQAIR	ASTHMA/ALLERGY	J2786	Yes	No	Yes
risankizumab-rzaa	SKYRIZI	INJECTABLES - SPECIALTY OTHER	J2327	Yes	No	No
rituximab	RITUXAN	CANCER	J9312	Yes	No	Yes
rituximab-abbs	TRUXIMA	CANCER	Q5115	Yes	No	No
rituximab-arrx	RIABNI	CANCER	Q5123	Yes	No	No
rituximab/hyaluronidase,human	RITUXAN HYCELA	CANCER	J9311	Yes	No	Yes
rituximab-pvvr	RUXIENCE	CANCER	Q5119	Yes	No	No
romiplostim	NPLATE	OTHER BLOOD DISORDERS	J2802	Yes	No	No
romosozumab-aqqg	EVENITY	BONE	J3111	Yes	No	No
romosozumab-aqqg	EVENITY (2 SYRINGES)	BONE	J3111	Yes	No	No
rozanolixizumab-noli	RYSTIGGO	INJECTABLES - SPECIALTY OTHER	J9333	Yes	No	No
sacituzumab govitecan-hziy	TRODELVY	CANCER	J9317	Yes	No	No
sebelipase alfa	KANUMA	HEREDITARY METABOLIC DISORDERS	J2840	Yes	No	No
secukinumab	COSENTYX	RA/PSORIASIS/CROHNS	J3247	Yes	No	No
siltuximab	SYLVANT	CANCER	J2860	Yes	No	No
sirolimus protein-bound	FYARRO	CANCER	J9331	Yes	No	No
spesolimab-sbzo	SPEVIGO	RA/PSORIASIS/CROHNS	J1747	Yes	No	No
sutimlimab-jome	ENJAYMO	OTHER BLOOD DISORDERS	J1302	Yes	No	No
taliglucerase alfa	ELELYSO	HEREDITARY METABOLIC DISORDERS	J3060	Yes	No	No
talquetamab-tgvs	TALVEY	CANCER	J3055	Yes	No	No
tarlatamab-dlle	IMDELLTRA	CANCER	J9026	Yes	No	No
tebentafusp-tebn	KIMMTRAK	CANCER	J9274	Yes	No	No
teclistamab-cqyv	TECVAYLI	CANCER	J9380	No	No	No
temsirolimus	TEMSIROLIMUS	CANCER	J9330	Yes	No	No
temsirolimus	TORISEL	CANCER	J9330	Yes	No	No
teplizumab-mzwv	TZIELD	INJECTABLES - SPECIALTY OTHER	J9381	Yes	No	No
teprotumumab-trbw	TEPEZZA	AUTOIMMUNE/OTHER INFLAMMATORY	J3241	Yes	No	No
testosterone undecanoate	AVEED	HORMONE RELATED	J3145	Yes	No	No
tezepelumab-ekko	TEZSPIRE	INJECTABLES - SPECIALTY OTHER	J2356	Yes	No	No
tildrakizumab-asmn	ILUMYA	RA/PSORIASIS/CROHNS	J3245	Yes	No	No
tislelizumab-jsgr	TEVIMBRA	CANCER	J9329	Yes	No	No
tisotumab vedotin-tftv	TIVDAK	CANCER	J9273	Yes	No	No
tocilizumab	ACTEMRA	RA/PSORIASIS/CROHNS	J3262	Yes	No	No
tocilizumab-aazg	TYENNE	RA/PSORIASIS/CROHNS	Q5135	Yes	No	No
tocilizumab-bavi	TOFIDENCE	RA/PSORIASIS/CROHNS	Q5133	Yes	No	Yes
tofersen	QALSODY	GENETIC NEUROMUSCLAR DISORDERS	J1304	Yes	No	No
toripalimab-tpzi	LOQTORZI	CANCER	J3263	Yes	No	No
trastuzumab	HERCEPTIN	CANCER	J9355	Yes	No	Yes
trastuzumab-anns	KANJINTI	CANCER	Q5117	Yes	No	No
trastuzumab-dkst	OGIVRI	CANCER	Q5114	Yes	No	No
trastuzumab-dttb	ONTRUZANT	CANCER	Q5112	Yes	No	Yes
trastuzumab-hyaluronidase-oysk	HERCEPTIN HYLECTA	CANCER	J9356	Yes	No	Yes
trastuzumab-pkrb	HERZUMA	CANCER	Q5113	Yes	No	Yes
trastuzumab-qyyp	TRAZIMERA	CANCER	Q5116	Yes	No	No
trastuzumab-strf	HERCESSI	CANCER	Q5146	Yes	No	No
tremelimumab-actl	IMJUDO	CANCER	J9347	Yes	No	No
treprostinil sodium	REMODULIN	PAH/VASODILATORS	J3285	Yes	No	Yes
treprostinil sodium	TREPROSTINIL	PAH/VASODILATORS	J3285	Yes	No	No
triptorelin pamoate	TRELSTAR	CANCER	J3315	Yes	No	No
ublituximab-xiiy	BRIUMVI	MULTIPLE SCLEROSIS	J2329	Yes	No	No
vedolizumab	ENTYVIO	RA/PSORIASIS/CROHNS	J3380	Yes	No	No
vedolizumab	ENTYVIO PEN	RA/PSORIASIS/CROHNS	J3590	Yes	No	No
velaglucerase alfa	VPRIV	HEREDITARY METABOLIC DISORDERS	J3385	Yes	No	No
velmanase alfa-tycv	LAMZEDE	HEREDITARY METABOLIC DISORDERS	J0217	Yes	No	No
vestronidase alfa-vjbk	MEPSEVII	HEREDITARY METABOLIC DISORDERS	J3397	Yes	No	No
viltolarsen	VILTEPSO	GENETIC NEUROMUSCLAR DISORDERS	J1427	Yes	No	No
von willebrand factor	VONVENDI	HEMOPHILIA	J7179	Yes	No	No
vutrisiran sodium	AMVUTTRA	INJECTABLES - SPECIALTY OTHER	J0225	Yes	No	No
zenocutuzumab-zbco	BIZENGRI	CANCER	J9999	Yes	Yes	No
zero row	LUNSUMIO	CANCER	J9350	No	No	No
zolbetuximab-clzb	VYLOY	CANCER	J9999	Yes	No	No

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