Unclassified Drugs in excess of $10,000 Unclassified Biologics in excess of $10,000 Revenue Codes in excess of $10,000 J3490 J3590 R250 - R259 ABRAXANE J9264 & J9267 ACTEMRA J3262 ACTHAR J0800 ACTIMMUNE J9216 ADAGEN J2504 ADCETRIS J9042 ADCIRCA ADEMPAS ADVATE (All Forms) AFINITOR J7527 AFINITOR DISPERZ J7527 ALECENSA ALPHANINE SD J7193, J7194, J7200, J7201, 77202 AMPYRA APOKYN J0364 ARCALYST J2793 ATRIPLA AUBAGIO AVASTIN J9035 AVONEX J1826 & Q3027 AVONEX PEN KIT J1826 & Q3027 BENEFIX J7195 BENLYSTA J0490 BERINERT BETASERON J1830 BETHKIS J7682 & J7685 BICNU J9050 BLINCYTO J9039 BOSULIF BRAVELLE J3355 CARIMUNE NF
CAYSTON CEREZYME CETROTIDE CIMZIA CIMZIA PREFL KIT CINQAIR CINRYZE COMETRIQ COMPLERA COPAXONE* Corlanor COSENTYX COSENTYX PEN INJ COTELLIC DAKLINZA ELAPRASE ELOCTATE ENBREL SRCLK* ENBREL* Enoxaparin (generic Lovenox) Enstilar ENTYVIO EPCLUSA EPOGEN ERIVEDGE ESBRIET Evzio EXJADE EXTAVIA EYLEA FABRAZYME FARYDAK Femara (brand only) FIRAZYR FORTEO FUZEON GAMMAGARD J0717 & J0718 J1595 J1743 J1438 J1438 J1650 J3380 J0885 & J0886 J2310 J1830 J0178 J0180 J1744 J3110 J1324
GAMMAGARD SD GAMUNEX GAMUNEX C GAZYVA GENVOYA GILENYA GLATOPA GLEEVEC HARVONI HELIXATE FS HERCEPTIN HIZENTRA* HUMATE-P HUMATROPE HUMIRA HUMIRA PEN HYCAMTIN HYQVIA IBRANCE ILARIS ILUVIEN Imatinib (generic Gleevec) IMBRUVICA IMLYGIC INCIVEK INLYTA INTELENCE ISENTRESS Jadenu JAKAFI KADCYLA KALETRA KALYDECO KYPROLIS LEMTRADA LETAIRIS LOVENOX LUCENTIS J9301 J1595 & J7199 S0088 J9355 J0135 J0135 J8705 & J9351 & J3470 J0638 J7313 S0088 J9325 J9354 J9047 J0202 & J9010 J1650 J2778
LYNPARZA MAKENA J1725 MATULANE S0182 MEKINIST NEORAL J7502 & J7515 NEULASTA J2505 NEUPOGEN J1440, J1441, J1442, J1446, J1447 NEXAVAR NINLARO NORDITROPIN (ALL FORMS)* NORTHERA NPLATE J2796 NUCALA J2182 NUTROPIN (ALL FORMS)* Nutropin Nuspin AQ* ODEFSEY ODOMZO OFEV OLYSIO OPDIVO J9299 OPSUMIT ORENCIA J0129 ORENCIA-C J0129 ORENITRAM J3285 & J7686 ORKAMBI OTEZLA PEG-INTRON S0148 PERJETA J9306 PLEGRIDY POMALYST PREZCOBIX PREZISTA PRIVIGEN PROLIA J0897 PROMACTA PULMOZYME J7639 RAVICTI
Rayos REBIF REBIF REBIDO REBIF TITRTN INJ PACK RELISTOR REMICADE (Inflectra is biosimilar to Remicade) REMODULIN REPATHA (all 3 versions) REVATIO REVLIMID REYATAZ RIBAVIRIN RITUXAN SABRIL SANDIMMUNE SANDOSTATIN SENSIPAR SIMPONI SOMAVERT SOVALDI SPINRAZA SPRYCEL STELARA STIVARGA STRIBILD SUCRAID SUTENT Syprine TAFINLAR TALTZ TARCEVA TASIGNA TECFIDERA* THALOMID THYROGEN TIVICAY TOBI J7506 & J7512 J1826 & Q3026 & Q3028 J1826 & Q3026 & Q3028 J1826 & Q3026 & Q3028 J2212 J1745 J3285 & J7686 J9310 J7502 & J7515 J2353 & J2354 J1602 J3357 J3240 J7682
TOBI PODHALR Tobramycin inhaled (generic Tobi) Topotecan (generic Hycamtin) TRIUMEQ TYKERB TYSABRI TYVASO VECTIBIX VELCADE VENCLEXTA Viberzi VIEKIRA VIREAD Vivaglobin VIVITROL VOTRIENT VPRIV VRAYLAR XALKORI XELJANZ XENAZINE XGEVA XIAFLEX Xifaxan* XOLAIR XTANDI XYREM ZELBORAF ZEMAIRA ZEPATIER ZOLADEX ZORTRESS ZYDELIG ZYKADIA ZYTIGA J7682 J7682 J8705 & J9351 J2323 J3285 & J7686 J9303 J9041 J2315 J3385 J0897 J0775 J2357 J0256 J9202 J7527