Medical Specialty Pharmacy Drug List (preferred vs non-preferred products)
A formulary/preferred product list for specialty and pharmacy drugs used by Blue Cross Blue Shield - Wisconsin/Anthem; indicates preferred and non-preferred biologics and specialty agents and notes limited distribution and manufacturer HUB requirements. Intended for providers, pharmacists, and utilization management staff to guide product selection and prior authorization decisions.
No material clinical or coverage changes in this revision.
Preferred vs Non-Preferred Product Guidance
Use / Coverage Guidance
Preferred products should be utilized when clinically appropriate; for Commercial members preferred products must be used first unless clinical exception criteria are met.
- Preferred products should be used when they meet medical necessity criteria.
- For Commercial members, preferred products need to be used first unless clinical circumstances meet exception requirements.
- Some products are designated Limited Distribution Drug (LDD) and/or have mandatory manufacturer HUB requirements which must be followed.
Providers must follow manufacturer HUB enrollment and distribution processes for products so designated; failure to comply may affect access/coverage.
Listed Products by Therapeutic Category
| Category | Preferred products | Non-preferred products |
|---|---|---|
| Autoimmune - Infliximab | Avsola, Remicade Infliximab, Unbranded | Inflectra, Renflexis |
| Bevacizumab (non-ophthalmological) | Avastin, Mvasi | Alymsys, Avzivi, Jobevne, Vegzelma, Zirabev |
| Crohn's Disease | Avsola, Remicade Infliximab Unbranded, Entyvio, Selarsdi IV, Skyrizi IV, Stelara IV, Tremfya IV | Cimzia, Imuldosa, Omvoh, Otulfi, Pyzchvia, Steqeyma, Wezlana, Yesintek |
| Denosumab - Osteoporosis | Prolia | Conexxence, Jubbonti, Ospomyv, Stoboclo |
| Denosumab - Oncology | Xgeva | Bomyntra, Osenvelt, Wyost, Xbryk |
| Hereditary Angioedema | Haegarda, Takhzyro | Cinryze |
| Hyperlipidemia Agents | Praluent (pharmacy), Repatha (pharmacy) | Leqvio |
| Immunoglobulins (IVIG/SCIG) | IVIG: Gamunex-C (IV and SC), Octagam; SCIG: Cutaquig, Hizentra | Alyglo, Asceniv, Bivigam, Carimune NF, Flebogamma DIF, Gammagard, Gammagard S/D, Gammaked, Gammaplex, Panzyga, Privigen, Yimmugo, Cuvitru, HyQvia |
| Injectable Iron Agents | Venofer, Feraheme, Ferrlecit, Infed | Injectafer, Monoferric |
| Migraines | Aimovig (pharmacy), Emgality (pharmacy) | Vyepti |
| Multiple Sclerosis | Ocrevus (trial of generic Tecfidera required), Briumvi (trial of generic Tecfidera required), Tysabri (trial of generic Tecfidera required) | Kesimpta, Tyruko |
| Neutropenia Colony Stimulating Factors - Long Acting | Neulasta, Neulasta OnPro, Udenyca, Udenyca Onbody | Fulphila, Fylnetra, Nyvepria, Rolvedon, Ryzneuta, Stimufend, Ziextenzo |
| Neutropenia Colony Stimulating Factors - Short Acting | Zarxio | Granix, Neupogen, Nivestym, Nypozi, Releuko |
| Ophthalmic Disorders | Bevacizumab (Avastin, Mvasi, Zirabev), Byooviz, Cimerli, Eylea, Eylea HD, Lucentis, Pavblu, Vabysmo | Ahzantive, Beovu, Enzeevu, Macugen, Opuviz, Yesafili |
| Plaque Psoriasis | Avsola, Remicade Infliximab Unbranded | Cimzia, Cosentyx IV |
| Rituximab | Riabni, Rituxan | Ruxience, Truxima |
| Rheumatoid Arthritis and Psoriatic Arthritis | Avsola, Remicade Infliximab Unbranded, Simponi Aria | Cimzia, Cosentyx IV |
| Trastuzumab | Herceptin, Kanjinti | Hercessi, Herzuma, Ogivri, Ontruzant, Trazimera |
| Ulcerative Colitis | Avsola, Remicade Infliximab Unbranded, Entyvio, Selarsdi IV, Skyrizi IV, Stelara IV, Trenfya IV, Ustekinumab Unbranded IV | Imuldosa, Omvoh, Otulfi, Pyzchvia, Steqeyma, Wezlana, Yesintek |
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