Specialty Referral Forms
Pick the letter that your drug begins with:
| Drug Name | Click for Specialty Form(s) | |
| Abilify Maintena® | Opiod or Alcohol Dependence | |
| Actemra® | Rheumatology/Osteoporosis | |
| Afinitor® | Oral Oncology | |
| Alecensa® | Oral Oncology | |
| Alunbrig® | Oral Oncology | |
| Aubagio® | Neurology | |
| Avonex® | Neurology | |
| Avsola® (infliximab-axxq) | Gastroenterology | |
| Ayvakit™ (avapritinib) | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Bafiertam® | Neurology | |
| Baraclude® | Hepatology | |
| Balversa® | Oral Oncology | |
| Benlysta® | Rheumatology | |
| Betaseron® | Neurology | |
| Bethkis® | Cystic Fibrosis | |
| Boniva® | Osteoporosis | |
| Bosulif® | Oral Oncology | |
| Braftovi® | Oral Oncology | |
| Brukinsa™ | Oral Oncology | |
| Brynfezia Pen™ | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Cabometyx® | Oral Oncology | |
| Calquence® (acalabrutinib) | Oral Oncology | |
| Camzyos™ | Cardiology-Cardiac Amyloidosis | |
| Capecitabine® | Oral Oncology | |
| Cibinqo™ | Dermatology | |
| Cimzia® | Gastroenterology | |
| Cometriq® | Oral Oncology | |
| Copaxone® | Neurology | |
| Copiktra® | Oral Oncology | |
| Cosentyx® | Dermatology, Rheumatology/Osteoporosis | |
| Cotellic® | Oral Oncology | |
| Cuvitru® | Immune Globulin | |
| Drug Name | Click for Specialty Form(s) | |
| Daklinza® (daclatasvir) | Hepatology | |
| Dalfampridine | Neurology | |
| Daurismo™ | Oral Oncology | |
| Dimethyl Fumarate | Neurology | |
| Doptelet® | Oral Oncology | |
| Dupixent® (dupilumab) | Dermatology | |
| Durolane® | Orthopaedics | |
| Drug Name | Click for Specialty Form(s) | |
| Enbrel® | Dermatology | |
| Entecavir® | Hepatology | |
| Entyvio® | Gastroenterology | |
| Epclusa® (velpatasvir-100 mg sofosbuvir-400mg) | Hepatology | |
| Erivedge® | Oral Oncology | |
| Erleada® (apalutamide) | Oral Oncology | |
| Euflexxa® | Orthopaedics | |
| Evenity® | Rheumatology | |
| Evkeeza™ | Cardiology | |
| Exkivity™ | Oral Oncology | |
| Extavia® | Neurology | |
| Drug Name | Click for Specialty Form(s) | |
| Farydak® | Oral Oncology | |
| Forteo® | Osteoporosis | |
| Fotivda® (Tivozanib) | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Gablofen® (baclofen) Intrathecal | Neurology | |
| Gammagard Liquid 10% | Immune Globulin | |
| Gammagard S/D | Immune Globulin | |
| Gammunex-C 10% | Immune Globulin | |
| Gavreto™ (Pralsetinib) | Oral Oncology | |
| Gel-One® | Orthopaedics | |
| Gelsyn-3™ | Orthopaedics | |
| Gilenya® | Neurology | |
| Glatiramer Acetate (Copaxone®) | Neurology | |
| Glatopa (Copaxone®) | Neurology | |
| Gleevac® | Oral Oncology | |
| Gleostine® | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Harvoni® (ledipasvir-90mg sofosbuvir-400mg) | Hepatology C | |
| Hizentra 20% | Immune Globulin | |
| Humira® | Dermatology, Gastroenterology, Rheumatology/Osteoporosis | |
| Hyalgan® | Orthopaedics | |
| Hycamtin® (topotecan) | Oral Oncology | |
| Hydroxyprogesterone Caporate Injection | OB/GYN | |
| HyQvia 10% | Immune Globulin | |
| Drug Name | Click for Specialty Form(s) | |
| Ibrance® | Oral Oncology | |
| Iclusig® | Oral Oncology | |
| Idhifa® | Oral Oncology | |
| Ilaris® | Rheumatology | |
| Ilumya™ | Dermatology | |
| Imbruvica® | Oral Oncology | |
| Inflectra® (infliximab-dyyb) | Dermatology, Gastroenterology, Rheumatology | |
| Infliximab (unbranded) | Gastroenterology | |
| Inlyta® | Oral Oncology | |
| Inqovi® | Oral Oncology | |
| Inrebic® | Oral Oncology | |
| Invega Sustenna® | Opiod or Alcohol Dependence | |
| Iressa® | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Jadenu® | Oral Oncology | |
| Jakafi® | Oral Oncology | |
| Jaypirca™ (Pirtobrutinib) | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Kalydeco® | Cystic Fibrosis | |
| Kevzara® | Rheumatology | |
| Kineret® | Rheumatology | |
| Kisqali® (ribociclib) | Oral Oncology | |
| Kitabis Pak® | Cystic Fibrosis | |
| Koselugo™ | Oral Oncology | |
| Krazati™ (Adagrasib) | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Lenvima® | Oral Oncology | |
| Leqvio® | Cardiology | |
| Lioresal® | Neurology | |
| Litfulo™ | Dermatology | |
| Lonsurf® | Oral Oncology | |
| Lorbrena® | Oral Oncology | |
| Lumakras™ | Oral Oncology | |
| Lupeneta Pack™ | OB/GYN | |
| Lupron Depot® | OB/GYN | |
| Lupron Depot-Pediatric® | Endocrinology | |
| Lynparza® | Oral Oncology | |
| Lytgobi® | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Makena® | OB/GYN | |
| Mavyret® | Hepatology | |
| Mayzent® | Neurology | |
| Mekinist® | Oral Oncology | |
| Mektovi® | Oral Oncology | |
| Myfembree® | OB/GYN | |
| Monovisic® | Orthopaedics | |
| Drug Name | Click for Specialty Form(s) | |
| Nerlynx® | Oral Oncology | |
| Nexavar® | Oral Oncology | |
| Nilandron® | Oral Oncology | |
| Ninlaro® | Oral Oncology | |
| Nubeqa™ | Oral Oncology | |
| Nucala® | Asthma | |
| Drug Name | Click for Specialty Form(s) | |
| Ocaliva™ | Gastroenterology, Hepatology | |
| Ocrevus® | Neurology | |
| Odomzo® | Oral Oncology | |
| Ojjaara™ (momelotinib) | Oral Oncology | |
| Olysio® (simeprevir) | Hepatology | |
| Olumiant® | Rheumatology | |
| Onureg™ | Oral Oncology | |
| Opzelura™ | Dermatology | |
| Orencia® | Rheumatology/Osteoporosis | |
| Orgovyx® (Relugolix) | Oral Oncology | |
| Orilissa® | OB/GYN | |
| Orkambi® | Cystic Fibrosis | |
| Orthovisc® | Orthopaedics | |
| Otezla® | Dermatology | |
| Drug Name | Click for Specialty Form(s) | |
| Pegasys® | Hepatology | |
| Peg-Intron® | Hepatology | |
| Pemazyre™ | Oral Oncology | |
| Piqray® | Oral Oncology | |
| Plegridy® | Neurology | |
| Ponvory™ | Neurology | |
| Praluent® (alirocumab) | Cardiology | |
| Privigen 10% | Immune Globulin | |
| Prolia® | Osteoporosis | |
| Pulmozyme® | Cystic Fibrosis | |
| No medications are available that begin with a "Q". |
| Drug Name | Click for Specialty Form(s) | |
| Rebif® | Neurology | |
| Reclast® | Osteoporosis | |
| Remicade® (infliximab) | Dermatology, Gastroenterology, Rheumatology/Osteoporosis | |
| Renflexis® (infliximab-abda) | Gastroenterology | |
| Repatha® (evolocumab) | Cardiology | |
| Retevmo™ | Oral Oncology | |
| Rezlidhia™ (Olutasidenib) | Oral Oncology | |
| Rezurock™ | Oral Oncology | |
| Ribasphere Ribapak® | Hepatology | |
| Ribavirin® | Hepatology | |
| Rinvoq™ | Rheumatology, Gastroenterology | |
| Risperdal® | Opiod or Alcohol Dependence | |
| Risperdal Consta® | Opiod or Alcohol Dependence | |
| Rituxan® | Rheumatology/Osteoporosis | |
| Rolvedon™ (Eflapegrastim-xnst) | Oral Oncology | |
| Rozlytek® | Oral Oncology | |
| Rubraca™ (rucaparib) | Oral Oncology | |
| Rydapt™ | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Saphnelo™ | Rheumatology | |
| Siliq™ | Dermatology | |
| Scemblix® | Oral Oncology | |
| Simponi® | Gastroenterology, Rheumatology/Osteoporosis | |
| Simponi Aria® | Rheumatology/Osteoporosis | |
| Skyrizi™ | Dermatology, Gastroenterology | |
| Sovaldi®(sofosbuvir) | Hepatology | |
| Sprycel® | Oral Oncology | |
| Stelara® | Dermatology, Gastroenterology | |
| Stivarga® | Oral Oncology | |
| Supartz® | Orthopaedics | |
| Supprelin® LA | Endocrinology | |
| Sutent® | Oral Oncology | |
| Symdeko® | Cystic Fibrosis | |
| Synvisc® | Orthopaedics | |
| Synvisc-One® | Orthopaedics | |
| Drug Name | Click for Specialty Form(s) | |
| Tabrecta™ | Oral Oncology | |
| Tafinlar® | Oral Oncology | |
| Tagrisso® | Oral Oncology | |
| Taltz® | Dermatology | |
| Talzenna® | Oral Oncology | |
| Tarceva® | Oral Oncology | |
| Targretin® | Oral Oncology | |
| Tasigna® | Oral Oncology | |
| Tazverik™ | Oral Oncology | |
| Tecfidera® | Neurology | |
| Technivie® | Hepatology | |
| Temodar® | Oral Oncology | |
| Temozolomide® | Oral Oncology | |
| Tepmetko® | Oral Oncology | |
| Testosterone® | Endocrinology | |
| Tezspire™ | Asthma | |
| Therasys® | Urology | |
| Tibsovo® | Oral Oncology | |
| TOBI® Podhaler® | Cystic Fibrosis | |
| Tobramycin | Cystic Fibrosis | |
| Tremfya® | Dermatology | |
| Truseltiq™ | Oral Oncology | |
| Tukysa™ | Oral Oncology | |
| Tykerb® | Oral Oncology | |
| Tymlos® | Osteoporosis | |
| Drug Name | Click for Specialty Form(s) | |
| Ukoniq™ | Oral Oncology |
| Drug Name | Click for Specialty Form(s) | |
| Vanflyta® | Oral Oncology | |
| Vantas® | Urology | |
| Vemlidy® | Hepatology | |
| Venclexta® | Oral Oncology | |
| Verzenio® | Oral Oncology | |
| VieKira PAK® | Hepatology | |
| VieKira XR™ (ombitasvir, paritaprevir, ritonavir, dasabuvir) | Hepatology | |
| Vijoice® | Oncology | |
| Visco-3™ | Orthopaedics | |
| Vivitrol® | Opiod or Alcohol Dependence | |
| Vizimpro® | Oral Oncology | |
| Vonjo (Pacritinib) | Oral Oncology | |
| Vosevi® | Hepatology | |
| Votrient® | Oral Oncology | |
| Vumerity® | Neurology | |
| Vyndamax™ | Cardiology, Cardiology: Cardiac Amyloidosis | |
| Vyndaqel® | Cardiology, Cardiology: Cardiac Amyloidosis | |
| No medications are available that begin with a "W". |
| Drug Name | Click for Specialty Form(s) | |
| Xalkori® | Oral Oncology | |
| Xeljanz® | Rheumatology/Osteoporosis, Gastroenterology | |
| Xembify 20% | Immune Globulin | |
| Xermelo® | Oral Oncology | |
| Xifaxan® | Gastroenterology | |
| Xolair® | Asthma | |
| Xospata® | Oral Oncology | |
| Xpovio® | Oral Oncology | |
| Xtandi® | Oral Oncology | |
| Drug Name | Click for Specialty Form(s) | |
| Yonsa® | Oral Oncology |
| Drug Name | Click for Specialty Form(s) | |
| Zejula® (niraparib) | Oral Oncology | |
| Zelboraf® | Oral Oncology | |
| Zepatier® (elbasvir, grazoprevir) | Hepatology | |
| Zeposia® | Gastroenterology | |
| Zoladex® | OB/GYN | |
| Zolinza® | Oral Oncology | |
| Zydelig® | Oral Oncology | |
| Zykadia® | Oral Oncology | |
| Zytiga® | Oral Oncology | |