ghp family specialty network | geisinger health plan
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Geisinger Health Plan
GHP Family-PerformRx Specialty Network
GHP Family uses PerformRx’s Specialty Pharmacy Network to ensure GHP Family members have access to Specialty Medications. PerformRx Specialty allows members to use any contracted specialty pharmacy to obtain any specialty medication the pharmacy stocks. The list of specialty medications is available below.
PerformRx will allow members to receive medications from out-of-network pharmacies when the drug(s) are not available at a network pharmacy (“limited distribution” or when the drug maker limits what pharmacy can dispense their medication) or if the network pharmacy cannot serve the GHP Family member in time to prevent harm to the member.
Below is a list of PerformRx specialty providers as of October 1, 2021:
Pharmacy Name National Provider ID (NPI)
Phone Fax Physical Location City
Physical Location State
Physical Location Zip Code
Banks Apothecary 1881680718 2154949403 2153572129 Trevose PA 19053 CVS Pharmacy #02980
1730298217 7043337435 4017707108 Charlotte NC 28204
CVS/Specialty 1043382302 8002387828 4128258686 Monroeville PA 15146 CVS/Specialty – Caremark CA
1013998921 9097967171 9097996462 Redlands CA 92374
CVS/Specialty -Caremark FL
1417938820 8138810949 8138848782 Tampa FL 33614
CVS/Specialty -Caremark IL
1134100134 8476347400 8774089743 Mt. Prospect IL 60056
CVS/Specialty – Caremark KS
1902887805 9137483200 8005713995 Lenexa KS 66219
CVS/Specialty – Caremark MA
1013998913 8009502688 5086347739 Milford MA 01757
CVS/Specialty – Caremark MI
1184605099 2489686000 2489688000 Troy MI 48083
CVS/Specialty – Caremark NC
1124009121 9194746421 8005713991 Raleigh NC 27617
CVS/Specialty – Caremark NJ
1518948413 9734611550 8002661644 Fairfield NJ 07004
CVS/Specialty – Caremark PR
1053585257 7877582700 7877582737 Rio Pedras PR 00927
CVS/Specialty - NV 1417596511 8668333752 8668333752 Las Vegas NV 89119
Geisinger Medical Center
1801831326 5702716451 5702717065 Danville PA 17822
Geisinger Pharmacy 1487683348 5708087969 5708086157 Wilkes Barre PA 18711 Geisinger Pharmacy 1346366879 5702084721 5702084726 Wilkes Barre PA 19765 Kroger Specialty 1598765570 8557333126 8883153270 Lake Mary FL 32746 Kroger Specialty 1508146010 8552741694 8558196922 Orlando FL 32822 Kroger Specialty 1174708127 8883554191 8883554192 Harvey LA 70058 OCRX Pharmacy Solutions (Oncology Consultants)
1568944122 8323331425 7134009118 Katy TX 77494
DRUG NAME
Geisinger Health Plan
Onco360 1790013530 8776626633 8776626355 Waltham MA 02451 Onco360 1871885798 8776626633 8776626355 Buffalo NY 14209 PerformRx Specialty 1437562642 8552877888 8444899565 Orlando FL 32837 Rochester Health Mart
1699164863 7249876085 7249876084 Rochester PA 15074
NOTES: • Use of the Specialty Pharmacy Drug Program is mandatory only when medication will be
self-administered by the member at home. Use of the Specialty Pharmacy Drug Program is not mandatory if the physician elects to buy the medication and bill GHP Family for the cost.
• If GHP Family is the secondary insurance specialty pharmacy does not apply • Specialty medications may require prior authorization. Information is available at
www.geisinger.org/health-plan/plans/ghp-family/pharmacy-coverage or by calling 855-552-6028.
Specialty Drug List October 2021
Abilify Maintena Abilify MyCite Abiratone Acetate Abraxane Acitretin Actemra ACTPen Actemra Acthar Gel Acthrel Actimmune Activase Adakveo Adasuve Adcetris Adcirca Adefovir Dipivoxil Adempas Aduhelm Advate Adynovate Afinitor Dispz Afinitor Afstyla Kit Agrylin Aldurazyme Alecensa Alferon N Alimta Aliqopa Alkeran Alphanate Alphanate VWF AlphaNine SD Alprolix Alunbrig Alyq Ambrisentan Amondys Ampyra Andexxa Apokyn Cartridge
Geisinger Health Plan
Aralast NP Aranesp Arcalyst Arikayce Aristada Initio Aristada Arranon Arsenic Trioxide Artesunate Solution Arzerra Asceniv Asparlas Aubagio Austedo Avastin Aveed Avonex Avsola AyvaKit AzaCITIDine Azedra Dosimetric Azedra Thapeutic Bafiertam Balversa Baraclude Bavencio Beleodaq Bendeka BeneFIX Kit Benlysta Beovu Berinert Besponsa Betaseron Kit Bethkis Bevacizumab Bexarotene BiCNU Bivigam Blenrep Bleomycin Blincyto Bortezomib Bosentan Bosulif Botox Cosmetic Botox Braftovi Breyanzi Brineura Kit Bronchitol Brukinsa Buphenyl Powd Buphenyl Busulfan Busulfex Byfavo Bylvay Bynfezia Pen Cabenuva Suspension Cablivi Kit
Geisinger Health Plan
Cabometyx Calcitonin Calquence Camptosar Capecitabine Caprelsa Carbaglu CARBOplatin Carimune NF Carmustine Cayston Ceprotin Cerdelga Cerezyme Cerianna Chenodal Cholbam Cimzia Cinacalcet HCl Cinqair Cinryze Cinvanti CISplatin Cladribine Clofarabine Clolar Clovique Coagadex Cometriq Copaxone Copiktra Corifact Kit Cosela Cosentyx (2 Syringes) Cosentyx Pen Cosmegen Cotellic Crysvita Cuprimine Cutaquig Cuvitru Cyclophosphamide Cyramza Cystadane Powd Cystadrops Cystagon Cystaran Cytarabine (PF) Cytarabine Cytogam Dacarbazine Dacogen DACTINomycin Dalfampridine Danyelza Daraprim Darzalex Faspro Darzalex DAUNOrubicin HCl Daurismo Decitabine
Geisinger Health Plan
Defasirox Granules Packet Defasirox Defasirox Soluble Deflux Prefilled Syringe Demser Depen Titratabs Dexrazoxane HCl Diacomit Diacomit Packet Dibenzyline Dimethyl Fumarate DOCEtaxel Dojolvi Liquid Doptelet Doxil Injectable DOXOrubicin HCl Liposomal DOXOrubicin HCl D-Penamine Duopa Dupixent Pen-Injector Dupixent Prefilled Syringe Durolane Prefilled Syringe Durysta Dysport Egrifta Egrifta SV Elaprase Elelyso Eligard Kit Elitek Ellence Eloctate Elzonris Emcyt Emflaza Suspension Emflaza Empaveli Solution Empliciti Enbrel Mini Enbrel Enbrel SureClick Endari Packet Enhertu Enspryng Entecavir Entyvio Epclusa Epidiolex EpiRUBicin HCl Epogen Injection Epoprostenol Sodium Erbitux Erivedge Erleada Erlotinib HCl Erwinaze Esbriet Esperoct Ethyol Etopophos Etoposide
NAME
NAME
Geisinger Health Plan
Euflexxa Evenity Everolimus Evkeeza Evomela Evrysdi Exjade Exondys Exservan Film Extavia Kit Eylea Fabrazyme Fareston Farydak Fasenra Pen Fasenra Faslodex Feiba Fensolvi Feraheme Ferriprox Ferrlecit Ferumoxytol Fibryga Fintepla Firazyr Firdapse Firmagon Flebogamma DIF Flolan Floxuridine Fludarabine Folotyn Forteo Fotivda Fulphila Fulvestrant Fusilev Gablofen Galafold GamaSTAN Gamifant Gammagard SD Less IgA Gammagard Gammaked Gammaplex Gamunex-C Gattex Kit Gavreto Gazyva Gel-One Gelsyn GelX Gel Getabine HCl Genotropin MiniQuick Genotropin GenVisc Gilenya Gilotrif Gimoti Givlaari
Geisinger Health Plan
Glassia Glatiramer Glatopa Gleevec Gleostine Gliadel Wafer Gocovri Granix Haegarda Halaven Harvoni Packet Harvoni Hemlibra Hemofil M HepaGam B Hepsera Herceptin Hylecta Herceptin Herzuma Hetlioz Hizentra Humate-P Humatrope Humira Humira Pen Humira Pen-Ps-UV-Adol HS Start Humira Pen Crohns-UC-HS Start Humira Pediatric Crohns Start Kit Hyalgan Hycamtin HYDROXYprogestone Caproate Oil Hydroxyprogestone Caproate Hymovis Prefilled Syringe HypHEP B SD Hyqvia Kit Ibrance Icatibant Acetate Iclusig Idamycin PFS IDArubicin HCl Idelvion IDHIFA Ifex Ifosfamide Ilaris Ilumya Prefilled Syringe Iluvien Implant Imatinib Mesylate Imbruvica Imcivree Imfinzi ImIygic Suspension Intralesional Inbrija Inhalation Increlex Infed Injection Inflectra Infugem Ingrezza Injectafer Inlyta Inqovi
NAME
Geisinger Health Plan
Inrebic Intron A Invega Sustenna Invega Trinza Iressa Irinotecan HCl Istodax Isturisa Ixempra Kit Ixinity Jadenu Sprinkle Jadenu Jakafi Jelmyto Jemperli Solution Jevtana Jivi Juxtapid Jynarque Kadcyla Kalbitor Kalydeco Packet Kalydeco Kanjinti Kanuma Kcentra Kit Kepivance Kesimpta Keveyis Kevzara Keytruda Khapzory Kineret Kisqali Kisqali Femara Kitabis Pak Koate Koate-DVI Kogenate FS Korlym Koselugo Kovaltry Krystexxa Kuvan Packet Kuvan Soluble Kymriah Kyprolis Lartruvo Ledipasvir-Sofosbuvir Lemtrada Lenvima Letairis Leukeran Leukine Leuprolide Acetate LEVOleucovorin Calcium PF LEVOleucovorin Calcium Libtayo Lioresal Lonsurf Lorbrena
Geisinger Health Plan
Lucentis Lumakras Lumizyme Lumoxiti Lupaneta Lupkynis Lupron Depot Lupron Depot-Ped Lutatha Luxturna Suspension VG Lynparza Lysodren Macrilen Macugen Makena Oil Makena Marqibo Margenza Solution Matulane Mavenclad Mavyret Mayzent Mekinist Mektovi Melphalan HCl Mepsevii Metopirone Miacalcin Miglustat Mircera MitoMYcin Mitoxantrone HCl Monjuvi Mononine Monovisc Mozobil Mulpleta Mutamycin Mvasi Myalept Mycapssa Myleran Mylotarg Myobloc Nabi-HB Naglazyme Natpara Navelbine Nlynx Neulasta Onpro Neulasta Neupogen NeuraCeq Solution NexAVAR Nexviazyme Nilandron Nilutamide Ninlaro Nipent Nitisinone Nityr
Geisinger Health Plan
Nivestym Norditropin FlexPro Northera Nourianz Novoeight NovoSeven RT Nplate Nubeqa Nucala Nulibry Solution Nuplazid Nutropin AQ NuSpin Nuwiq Nymalize Nyvepria Obizur Ocaliva Ocrevus Octagam Octreotide Acetate Odomzo Ofev Ogivri Olinvyk Olumiant Omnitrope Oncaspar Onivyde Onpattro Ontruzant Onureg Opdivo Opsumit Orencia ClickJect Orencia Orenitram Orfadin Orfadin Suspension Orgovyx Orkambi Packet Orkambi Orladeyo OrthoVisc Otezla Oxaliplatin Oxbryta Oxervate Oxlumo Ozurdex PACLitaxel Padcev Palforzia Palynziq Panhematin Panretin Gel Panzyga Paraplatin Parsabiv Pegasys ProClick Pegasys PegIntro
Geisinger Health Plan
Pemazyre penicillAMINE Pepaxto Solution Perjeta Perseris Prefilled Syringe Phenoxybenzamine HCl Phesgo Photofrin Photrexa Piqray Plegridy Polivy Pomalyst Portrazza Poteligeo Praxbind Prialt Privigen Procrit Procysbi Profilnine SD Profilnine Prolastin-C Proleukin Prolia Promacta Provenge Pulmozyme Purixan Pyrimethamine Qinlock Radicava Ravicti Liquid Rebif Rebidose Rebif Rebinyn Reblozyl Reclast Recombinate Remdesivir Remicade Remodulin Renflexis Retacrit Retevmo Retisert Revatio Revcovi Revlimid RhoGAM Ultra-Filted Plus Rhophylac Riabni RiaSTAP Ribasphere RibaPak Ribasphere Ribavirin Rinvoq RispDAL Consta Rituxan Hycela Rituxan Rixubis
Geisinger Health Plan
romiDEPsin Rozlytrek Rubraca Ruconest Ruxience Ruzurgi Rybrevant Rydapt Rylaze Sabril Saizen Saizenprep Samsca SandoSTATIN LAR Depot SandoSTATIN Saphnelo Sapropterin Dihydrochloride Sarclisa Scenesse Sensipar Serostim Sevenfact Signifor LAR Signifor Siklos Sildenafil Citrate Suspension Siliq Simponi Aria Simponi Sirturo Skyrizi Sodium Phenylbutyrate Powd Sodium Phenylbutyrate Sofosbuvir-Velpatasvir Solesta Gel Soliris Somatuline Depot Somavert Soriatane Sovaldi Spinraza Spravato Sprycel Stelara Stivarga Strensiq Sucraid Supartz FX Supprelin LA Sustol Sutent Sylatron Sylvant Symdeko Synagis Synarel Synribo Synvisc One Synvisc Syprine Tabloid
Geisinger Health Plan
Tabrecta Tadalafil (PAH) Tafinlar Tagrisso Takhzyro Taltz Talzenna Tarceva Targretin Targretin Gel Tasigna Tavalisse Taxotere Tazverik Tecartus Tecentriq Tecfidera Tegsedi Temodar Temozolomide Temsirolimus Teniposide Tepadina Tepezza Tepmetko Teriparatide (Recombinant) Tetrabenazine Thalomid Thiola EC Thiola Thiotepa Thyrogen Tibsovo Tice BCG Tiglutik Tiopronin Tobi Tobi Podhaler Tobramycin Tolvaptan Topotecan HCL Toremifene Citrate Torisel Totect Tracleer Trazimera Treanda Trelstar Mixject Tremfya Treprostinil Tretinoin Tretten Trientine HCl Trikafta Triptodur Trisenox TriVisc Trodelvy Truseltiq Truxima Tukysa
Geisinger Health Plan
Turalio Tykerb Tymlos Tysabri Tyvaso Udenyca Ukoniq Ultomiris Unituxin Uplizna Uptravi Valchlor Gel Valrubicin Valstar Vantas VariZIG Vectibix Veklury Velcade Veletri Vemlidy Venclexta Venofer Ventavis Verzenio Vidaza Viekira Pak Vigabatrin Vigadrone Viltepso Vimizim VinBLAStine Sulfate vinCRIStine Sulfate Vinorelbine Tartrate Visco-3 Vistogard Visudyne Vitrakvi Vizimpro Vonvendi Voraxaze Vosevi Votrient Vpriv Vumerity Vyepti Vyndamax Vyndaqel Vyondys Vyxeos Suspension Wakix Wilate WinRho SDF Xalkori Xaracoll Xatmep Xeljanz Xeljanz XR Xeloda Xembify Xenazine
NAME
Geisinger Health Plan
Xeomin Xermelo Xgeva Xiaflex Xofigo Xolair Xospata Xpovio Xtandi Xuriden Xyntha Xyntha Solofuse Xyrem Xywav Solution Yervoy Yescarta Yondelis Yonsa Yutiq Zaltrap Zanosar Zarxio Zavesca Zejula Zelboraf Zemaira Zepatier Zeposia Zepzelca Zevalin Y-90 Ziextenzo Zinplava Zirabev Zokinvy Zoladex Zoledronic Acid Zolgensma Zolinza Zomacton Zorbtive Zulresso Zydelig Zykadia Zynlonta Solution ZyPREXA Relprevv Zytiga
Specialty Drug List effective October 1, 2021