7 PREFERRED OPTIONS FOR EXCLUDED SPECIALTY MEDICATIONS The preferred options listed below are a broad representation of available treatment options and do not necessarily represent clinical equivalency. DRUG NAME(S) PREFERRED OPTION(S) ACTEMRA INTRAVENOUS AVSOLA, REMICADE, SIMPONI ARIA ADCIRCA sildenafil, tadalafil, TADLIQ AFINITOR, AFINITOR DISPERZ everolimus ALPROLIX BENEFIX, REBINYN APOKYN INBRIJA APTIVUS Talk to your doctor ARCALYST Talk to your doctor AUBAGIO dimethyl fumarate delayed-rel, fingolimod, glatiramer, teriflunomide, AVONEX, BAFIERTAM, BETASERON, COPAXONE 40 MG/ML, KESIMPTA, MAYZENT, OCREVUS, REBIF, TYSABRI, VUMERITY, ZEPOSIA AUSTEDO XR tetrabenazine, AUSTEDO, INGREZZA AVASTIN ZIRABEV BARACLUDE TABLET entecavir, lamivudine, tenofovir disoproxil fumarate BERINERT icatibant, RUCONEST BETHKIS tobramycin inhalation solution BORTEZOMIB bortezomib, NINLARO BOTOX AJOVY, DAXXIFY, DYSPORT, EMGALITY, QULIPTA, XEOMIN BUPHENYL sodium phenylbutyrate, PHEBURANE CARBAGLU carglumic acid CAYSTON tobramycin inhalation solution CETROTIDE cetrorelix acetate, GANIRELIX ACETATE CHORIONIC GONADOTROPIN PREGNYL CIMZIA LYOPHILIZED POWDER AVSOLA, ILUMYA, PYZCHIVA INTRAVENOUS, REMICADE, SIMPONI ARIA, SKYRIZI INTRAVENOUS, STELARA INTRAVENOUS, TREMFYA INTRAVENOUS, YESINTEK INTRAVENOUS CINRYZE ORLADEYO, TAKHZYRO DRUG NAME(S) PREFERRED OPTION(S) COMPLERA efavirenz-emtricitabine-tenofovir disoproxil fumarate, efavirenz-lamivudine- tenofovir disoproxil fumarate, emtricitabine-rilpivirine-tenofovir disoproxil fumarate, BIKTARVY, CABENUVA, DOVATO, GENVOYA, ODEFSEY, SYMTUZA, TRIUMEQ COPAXONE 20 MG/ML dimethyl fumarate delayed-rel, fingolimod, glatiramer, teriflunomide, AVONEX, BAFIERTAM, BETASERON, COPAXONE 40 MG/ML, KESIMPTA, MAYZENT, OCREVUS, REBIF, TYSABRI, VUMERITY, ZEPOSIA COPIKTRA BRUKINSA, CALQUENCE COTELLIC MEKINIST, MEKTOVI CUPRIMINE penicillamine CYSTADANE betaine DESFERAL deferasirox, deferiprone, deferoxamine DIACOMIT Talk to your doctor EDURANT efavirenz ELELYSO CERDELGA, CEREZYME EPOGEN ARANESP, PROCRIT, RETACRIT ESBRIET pirfenidone, OFEV EXJADE deferasirox, deferiprone, deferoxamine EXTAVIA dimethyl fumarate delayed-rel, fingolimod, glatiramer, teriflunomide, AVONEX, BAFIERTAM, BETASERON, COPAXONE 40 MG/ML, KESIMPTA, MAYZENT, OCREVUS, REBIF, TYSABRI, VUMERITY, ZEPOSIA EYLEA BYOOVIZ FEIBA NOVOSEVEN RT, SEVENFACT FERRIPROX deferasirox, deferiprone, deferoxamine FINTEPLA clobazam, clonazepam, lamotrigine, rufinamide, topiramate, topiramate ext-rel FIRAZYR icatibant, RUCONEST FIRMAGON ELIGARD