Self‐Administered Drug List BRAND NAME GENERIC DRUG NME ABIRATERONE ACETATE ABIRATERONE ACETATE ACTEMRA TOCILIZUMAB ACTEMRA ACTPEN TOCILIZUMAB ACTHAR CORTICOTROPIN ACTIMMUNE INTERFERON GAMMA‐1B,RECOMB ADCIRCA TADALAFIL ADEMPAS RIOCIGUAT AFINITOR EVEROLIMUS AFINITOR DISPERZ EVEROLIMUS ALECENSA ALECTINIB HCL ALUNBRIG BRIGATINIB ALYQ TADALAFIL AMBRISENTAN AMBRISENTAN AMPYRA DALFAMPRIDINE APOKYN APOMORPHINE HCL ARANESP DARBEPOETIN ALFA IN POLYSORBAT ARCALYST RILONACEPT ARIKAYCE AMIKACIN LIPOSOMAL/NEB.ACCESSR ARIXTRA FONDAPARINUX SODIUM AUBAGIO TERIFLUNOMIDE AUSTEDO DEUTETRABENAZINE AVEED TESTOSTERONE UNDECANOATE AVONEX INTERFERON BETA‐1A AVONEX INTERFERON BETA‐1A/ALBUMIN AVONEX PEN INTERFERON BETA‐1A AYVAKIT AVAPRITINIB BAFIERTAM MONOMETHYL FUMARATE BALVERSA ERDAFITINIB BENLYSTA BELIMUMAB BETASERON INTERFERON BETA‐1B BETHKIS TOBRAMYCIN BOSENTAN BOSENTAN BOSULIF BOSUTINIB BRAFTOVI ENCORAFENIB BRONCHITOL MANNITOL BRUKINSA ZANUBRUTINIB BYNFEZIA OCTREOTIDE ACETATE CABENUVA CABOTEGRAVIR/RILPIVIRINE CABLIVI CAPLACIZUMAB‐YHDP CABOMETYX CABOZANTINIB S‐MALATE CALQUENCE ACALABRUTINIB CAPECITABINE CAPECITABINE CAPRELSA VANDETANIB CARBAGLU CARGLUMIC ACID CAYSTON AZTREONAM LYSINE CERDELGA ELIGLUSTAT TARTRATE CETROTIDE CETRORELIX ACETATE CHENODAL CHENODIOL CHOLBAM CHOLIC ACID CHORIONIC GONADOTROPIN CHORIONIC GONADOTROPIN, HUMAN CIMZIA CERTOLIZUMAB PEGOL COPAXONE GLATIRAMER ACETATE COPIKTRA DUVELISIB COSENTYX (2 SYRINGES) SECUKINUMAB COSENTYX PEN SECUKINUMAB COSENTYX PEN (2 PENS) SECUKINUMAB COSENTYX SYRINGE SECUKINUMAB COTELLIC COBIMETINIB FUMARATE CYSTADANE BETAINE CYSTADROPS CYSTEAMINE HCL Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association 015158 (04.21.2021)
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Self‐Administered Drug List BRAND NAME GENERIC DRUG NMEABIRATERONE ACETATE ABIRATERONE ACETATEACTEMRA TOCILIZUMABACTEMRA ACTPEN TOCILIZUMABACTHAR CORTICOTROPINACTIMMUNE INTERFERON GAMMA‐1B,RECOMBADCIRCA TADALAFILADEMPAS RIOCIGUATAFINITOR EVEROLIMUSAFINITOR DISPERZ EVEROLIMUSALECENSA ALECTINIB HCLALUNBRIG BRIGATINIBALYQ TADALAFILAMBRISENTAN AMBRISENTANAMPYRA DALFAMPRIDINEAPOKYN APOMORPHINE HCLARANESP DARBEPOETIN ALFA IN POLYSORBATARCALYST RILONACEPTARIKAYCE AMIKACIN LIPOSOMAL/NEB.ACCESSRARIXTRA FONDAPARINUX SODIUMAUBAGIO TERIFLUNOMIDEAUSTEDO DEUTETRABENAZINEAVEED TESTOSTERONE UNDECANOATEAVONEX INTERFERON BETA‐1AAVONEX INTERFERON BETA‐1A/ALBUMINAVONEX PEN INTERFERON BETA‐1AAYVAKIT AVAPRITINIBBAFIERTAM MONOMETHYL FUMARATEBALVERSA ERDAFITINIBBENLYSTA BELIMUMABBETASERON INTERFERON BETA‐1BBETHKIS TOBRAMYCINBOSENTAN BOSENTANBOSULIF BOSUTINIBBRAFTOVI ENCORAFENIBBRONCHITOL MANNITOLBRUKINSA ZANUBRUTINIBBYNFEZIA OCTREOTIDE ACETATECABENUVA CABOTEGRAVIR/RILPIVIRINECABLIVI CAPLACIZUMAB‐YHDPCABOMETYX CABOZANTINIB S‐MALATECALQUENCE ACALABRUTINIBCAPECITABINE CAPECITABINECAPRELSA VANDETANIBCARBAGLU CARGLUMIC ACIDCAYSTON AZTREONAM LYSINECERDELGA ELIGLUSTAT TARTRATECETROTIDE CETRORELIX ACETATECHENODAL CHENODIOLCHOLBAM CHOLIC ACIDCHORIONIC GONADOTROPIN CHORIONIC GONADOTROPIN, HUMANCIMZIA CERTOLIZUMAB PEGOLCOPAXONE GLATIRAMER ACETATECOPIKTRA DUVELISIBCOSENTYX (2 SYRINGES) SECUKINUMABCOSENTYX PEN SECUKINUMABCOSENTYX PEN (2 PENS) SECUKINUMABCOSENTYX SYRINGE SECUKINUMABCOTELLIC COBIMETINIB FUMARATECYSTADANE BETAINECYSTADROPS CYSTEAMINE HCL
Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association 015158 (04.21.2021)
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Self‐Administered Drug List BRAND NAME GENERIC DRUG NMECYSTAGON CYSTEAMINE BITARTRATECYSTARAN CYSTEAMINE HCLDALFAMPRIDINE ER DALFAMPRIDINEDARAPRIM PYRIMETHAMINEDAURISMO GLASDEGIB MALEATEDEFERASIROX DEFERASIROXDIACOMIT STIRIPENTOLDIMETHYL FUMARATE DIMETHYL FUMARATEDOJOLVI TRIHEPTANOINDOPTELET AVATROMBOPAG MALEATEDROXIDOPA DROXIDOPADUOPA CARBIDOPA/LEVODOPADUPIXENT PEN DUPILUMABDUPIXENT SYRINGE DUPILUMABEMFLAZA DEFLAZACORTENBREL ETANERCEPTENBREL MINI ETANERCEPTENBREL SURECLICK ETANERCEPTENDARI GLUTAMINEENOXAPARIN SODIUM ENOXAPARIN SODIUMENSPRYNG SATRALIZUMAB‐MWGEEPCLUSA SOFOSBUVIR/VELPATASVIREPIDIOLEX CANNABIDIOL (CBD)EPOGEN EPOETIN ALFAERIVEDGE VISMODEGIBERLEADA APALUTAMIDEERLOTINIB HCL ERLOTINIB HCLESBRIET PIRFENIDONEEVEROLIMUS EVEROLIMUSEVRYSDI RISDIPLAMEXJADE DEFERASIROXEXTAVIA INTERFERON BETA‐1BFARYDAK PANOBINOSTAT LACTATEFASENRA BENRALIZUMABFASENRA PEN BENRALIZUMABFINTEPLA FENFLURAMINE HCLFIRAZYR ICATIBANT ACETATEFIRDAPSE AMIFAMPRIDINE PHOSPHATEFOLLISTIM AQ FOLLITROPIN BETA,RECOMBFONDAPARINUX SODIUM FONDAPARINUX SODIUMFORTEO TERIPARATIDEFRAGMIN DALTEPARIN SODIUM,PORCINEFULPHILA PEGFILGRASTIM‐JMDBFUZEON ENFUVIRTIDEGALAFOLD MIGALASTAT HCLGANIRELIX ACETATE GANIRELIX ACETATEGATTEX TEDUGLUTIDEGAVRETO PRALSETINIBGENOTROPIN SOMATROPINGILENYA FINGOLIMOD HCLGILOTRIF AFATINIB DIMALEATEGIMOTI METOCLOPRAMIDE HCLGLATIRAMER ACETATE GLATIRAMER ACETATEGLATOPA GLATIRAMER ACETATEGLEEVEC IMATINIB MESYLATEGOCOVRI AMANTADINE HCLGONAL‐F FOLLITROPIN ALFA, RECOMBINANTGONAL‐F RFF FOLLITROPIN ALFA, RECOMBINANTGONAL‐F RFF REDI‐JECT FOLLITROPIN ALFA, RECOMBINANTGRANIX TBO‐FILGRASTIM
Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association 015158 (04.21.2021)
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Self‐Administered Drug List BRAND NAME GENERIC DRUG NMEHAEGARDA C1 ESTERASE INHIBITORHARVONI LEDIPASVIR/SOFOSBUVIRHEMANGEOL PROPRANOLOL HCLHEMLIBRA EMICIZUMAB‐KXWHHETLIOZ TASIMELTEONHETLIOZ LQ TASIMELTEONHUMATROPE SOMATROPINHUMIRA ADALIMUMABHUMIRA PEDIATRIC CROHN'S ADALIMUMABHUMIRA PEN ADALIMUMABHUMIRA PEN CROHN'S‐UC‐HS ADALIMUMABHUMIRA PEN PSOR‐UVEITS‐ADOL HS ADALIMUMABHUMIRA(CF) ADALIMUMABHUMIRA(CF) PEDIATRIC CROHN'S ADALIMUMABHUMIRA(CF) PEN ADALIMUMABHUMIRA(CF) PEN CROHN'S‐UC‐HS ADALIMUMABHUMIRA(CF) PEN PEDIATRIC UC ADALIMUMABHUMIRA(CF) PEN PSOR‐UV‐ADOL HS ADALIMUMABHYCAMTIN TOPOTECAN HCLHYDROXYPROGESTERONE CAPROATE HYDROXYPROGESTERONE CAPROAT/PFHYDROXYPROGESTERONE CAPROATE HYDROXYPROGESTERONE CAPROATEIBRANCE PALBOCICLIBICATIBANT ICATIBANT ACETATEICLUSIG PONATINIB HCLIDHIFA ENASIDENIB MESYLATEIMATINIB MESYLATE IMATINIB MESYLATEIMBRUVICA IBRUTINIBINBRIJA LEVODOPAINCRELEX MECASERMININGREZZA VALBENAZINE TOSYLATEINGREZZA INITIATION PACK VALBENAZINE TOSYLATEINLYTA AXITINIBINQOVI DECITABINE/CEDAZURIDINEINREBIC FEDRATINIB DIHYDROCHLORIDEINTRON A INTERFERON ALFA‐2B,RECOMBIRESSA GEFITINIBISTURISA OSILODROSTAT PHOSPHATEJADENU DEFERASIROXJADENU SPRINKLE DEFERASIROXJAKAFI RUXOLITINIB PHOSPHATEJELMYTO MITOMYCINJUXTAPID LOMITAPIDE MESYLATEJYNARQUE TOLVAPTANKALYDECO IVACAFTORKESIMPTA PEN OFATUMUMABKEVEYIS DICHLORPHENAMIDEKEVZARA SARILUMABKINERET ANAKINRAKISQALI RIBOCICLIB SUCCINATEKISQALI FEMARA CO‐PACK RIBOCICLIB SUCCINATE/LETROZOLEKITABIS PAK TOBRAMYCIN/NEBULIZERKORLYM MIFEPRISTONEKOSELUGO SELUMETINIB/VITAMIN E TPGSKUVAN SAPROPTERIN DIHYDROCHLORIDELAPATINIB LAPATINIB DITOSYLATELEDIPASVIR‐SOFOSBUVIR LEDIPASVIR/SOFOSBUVIRLENVIMA LENVATINIB MESYLATELETAIRIS AMBRISENTANLEUKINE SARGRAMOSTIMLEUPROLIDE ACETATE LEUPROLIDE ACETATE
Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association 015158 (04.21.2021)
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Self‐Administered Drug List BRAND NAME GENERIC DRUG NMELONSURF TRIFLURIDINE/TIPIRACIL HCLLORBRENA LORLATINIBLOVENOX ENOXAPARIN SODIUMLUPANETA PACK LEUPROLIDE/NORETHINDRONE ACETLUPKYNIS VOCLOSPORINLYNPARZA OLAPARIBLYSODREN MITOTANEMACRILEN MACIMORELIN ACETATEMAKENA HYDROXYPROGESTERONE CAPROAT/PFMAKENA HYDROXYPROGESTERONE CAPROAT/PFMAKENA HYDROXYPROGESTERONE CAPROATEMAVENCLAD CLADRIBINEMAVYRET GLECAPREVIR/PIBRENTASVIRMAYZENT SIPONIMODMEKINIST TRAMETINIB DIMETHYL SULFOXIDEMEKTOVI BINIMETINIBMENOPUR MENOTROPINSMIGLUSTAT MIGLUSTATMIRCERA METHOXY PEG‐EPOETIN BETAMODERIBA RIBAVIRINMULPLETA LUSUTROMBOPAGMYALEPT METRELEPTINMYCAPSSA OCTREOTIDE ACETATENATPARA PARATHYROID HORMONENERLYNX NERATINIB MALEATENEULASTA PEGFILGRASTIMNEULASTA ONPRO PEGFILGRASTIMNEUPOGEN FILGRASTIMNEXAVAR SORAFENIB TOSYLATENINLARO IXAZOMIB CITRATENITISINONE NITISINONENITYR NITISINONENIVESTYM FILGRASTIM‐AAFINIVESTYM FILGRASTIM‐AAFINORDITROPIN FLEXPRO SOMATROPINNORTHERA DROXIDOPANOURIANZ ISTRADEFYLLINENOVAREL CHORIONIC GONADOTROPIN, HUMANNUBEQA DAROLUTAMIDENUCALA MEPOLIZUMABNUPLAZID PIMAVANSERIN TARTRATENUTROPIN AQ NUSPIN SOMATROPINNYVEPRIA PEGFILGRASTIM‐APGFOCALIVA OBETICHOLIC ACIDOCTREOTIDE ACETATE OCTREOTIDE ACETATEODOMZO SONIDEGIB PHOSPHATEOFEV NINTEDANIB ESYLATEOLUMIANT BARICITINIBOMNITROPE SOMATROPINONUREG AZACITIDINEOPSUMIT MACITENTANORALAIR GR POL‐ORC/SW VER/RYE/KENT/TIMORENCIA ABATACEPTORENCIA CLICKJECT ABATACEPTORENITRAM ER TREPROSTINIL DIOLAMINEORFADIN NITISINONEORGOVYX RELUGOLIXORKAMBI LUMACAFTOR/IVACAFTORORLADEYO BEROTRALSTAT HYDROCHLORIDEOSMOLEX ER AMANTADINE HCL
Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association 015158 (04.21.2021)
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Self‐Administered Drug List BRAND NAME GENERIC DRUG NMEOTEZLA APREMILASTOVIDREL CHORIOGONADOTROPIN ALFAOXBRYTA VOXELOTOROXERVATE CENEGERMIN‐BKBJPALFORZIA PEANUT ALLERGEN POWDER‐DNFPPALYNZIQ PEGVALIASE‐PQPZPEGASYS PEGINTERFERON ALFA‐2APEGASYS PROCLICK PEGINTERFERON ALFA‐2APEGINTRON PEGINTERFERON ALFA‐2BPEMAZYRE PEMIGATINIBPIQRAY ALPELISIBPLEGRIDY PEGINTERFERON BETA‐1APLEGRIDY PEN PEGINTERFERON BETA‐1APOMALYST POMALIDOMIDEPONVORY PONESIMODPREGNYL CHORIONIC GONADOTROPIN, HUMANPROCRIT EPOETIN ALFAPROCYSBI CYSTEAMINE BITARTRATEPROLIA DENOSUMABPROMACTA ELTROMBOPAG OLAMINEPROTHELIAL SUCRALFATE MALATE, POLYMERIZEDPULMOZYME DORNASE ALFAPURIXAN MERCAPTOPURINEPYRIMETHAMINE PYRIMETHAMINEQINLOCK RIPRETINIBQUTENZA CAPSAICIN/SKIN CLEANSERRAVICTI GLYCEROL PHENYLBUTYRATEREBETOL RIBAVIRINREBIF INTERFERON BETA‐1A/ALBUMINREBIF REBIDOSE INTERFERON BETA‐1A/ALBUMINRETACRIT EPOETIN ALFA‐EPBXRETEVMO SELPERCATINIBREVATIO SILDENAFIL CITRATEREVLIMID LENALIDOMIDERIBASPHERE RIBAVIRINRIBASPHERE RIBAPAK RIBAVIRINRIBAVIRIN RIBAVIRINRINVOQ UPADACITINIBROZLYTREK ENTRECTINIBRUBRACA RUCAPARIB CAMSYLATERUZURGI AMIFAMPRIDINERYDAPT MIDOSTAURINSABRIL VIGABATRINSAIZEN SOMATROPINSAIZEN‐SAIZENPREP SOMATROPINSAMSCA TOLVAPTANSANDOSTATIN OCTREOTIDE ACETATESAPROPTERIN DIHYDROCHLORIDE SAPROPTERIN DIHYDROCHLORIDESENSIPAR CINACALCET HCLSEROSTIM SOMATROPINSIGNIFOR PASIREOTIDE DIASPARTATESILDENAFIL CITRATE SILDENAFIL CITRATESILIQ BRODALUMABSIMPONI GOLIMUMABSINUVA MOMETASONE FUROATESKYRIZI (2 SYRINGES) KIT RISANKIZUMAB‐RZAASOFOSBUVIR‐VELPATASVIR SOFOSBUVIR/VELPATASVIRSOMAVERT PEGVISOMANTSOVALDI SOFOSBUVIRSPRAVATO ESKETAMINE HCL
Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association 015158 (04.21.2021)
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Self‐Administered Drug List BRAND NAME GENERIC DRUG NMESPRIX KETOROLAC TROMETHAMINESPRYCEL DASATINIBSTELARA USTEKINUMABSTIMATE DESMOPRESSIN ACETATESTIVARGA REGORAFENIBSTRENSIQ ASFOTASE ALFASUTENT SUNITINIB MALATESYLATRON PEGINTERFERON ALFA‐2BSYMDEKO TEZACAFTOR/IVACAFTORSYNRIBO OMACETAXINE MEPESUCCINATETABRECTA CAPMATINIB HYDROCHLORIDETADALAFIL TADALAFILTAFINLAR DABRAFENIB MESYLATETAGRISSO OSIMERTINIB MESYLATETAKHZYRO LANADELUMAB‐FLYOTALTZ AUTOINJECTOR IXEKIZUMABTALTZ AUTOINJECTOR (2 PACK) IXEKIZUMABTALTZ AUTOINJECTOR (3 PACK) IXEKIZUMABTALTZ SYRINGE IXEKIZUMABTALTZ SYRINGE (2 PACK) IXEKIZUMABTALTZ SYRINGE (3 PACK) IXEKIZUMABTALZENNA TALAZOPARIB TOSYLATETARCEVA ERLOTINIB HCLTASIGNA NILOTINIB HCLTAVALISSE FOSTAMATINIB DISODIUMTAZVERIK TAZEMETOSTAT HYDROBROMIDETECFIDERA DIMETHYL FUMARATETEGSEDI INOTERSEN SODIUMTEMODAR TEMOZOLOMIDETEMOZOLOMIDE TEMOZOLOMIDETEPMETKO TEPOTINIB HCLTERIPARATIDE TERIPARATIDETETRABENAZINE TETRABENAZINETHALOMID THALIDOMIDETHIOLA TIOPRONINTHIOLA EC TIOPRONINTIBSOVO IVOSIDENIBTOBI TOBRAMYCIN IN 0.225% SOD CHLORTOBI PODHALER TOBRAMYCINTOBRAMYCIN TOBRAMYCINTOBRAMYCIN TOBRAMYCIN IN 0.225% SOD CHLORTOBRAMYCIN TOBRAMYCIN/NEBULIZERTOLVAPTAN TOLVAPTANTRACLEER BOSENTANTREMFYA GUSELKUMABTREPROSTINIL TREPROSTINIL SODIUMTRIKAFTA ELEXACAFTOR/TEZACAFTOR/IVACAFTTUKYSA TUCATINIBTURALIO PEXIDARTINIB HYDROCHLORIDETYKERB LAPATINIB DITOSYLATETYMLOS ABALOPARATIDETYVASO TREPROSTINILTYVASO INSTITUTIONAL START KIT TREPROSTINIL/NEBULIZER/ACCESORTYVASO REFILL KIT TREPROSTINIL/NEB ACCESSORIESTYVASO STARTER KIT TREPROSTINIL/NEBULIZER/ACCESORUDENYCA PEGFILGRASTIM‐CBQVUPTRAVI SELEXIPAGVALCHLOR MECHLORETHAMINE HCLVARITHENA ADMINISTRATION PACK TRANSFER SET/SYRINGE/BAND/TUBEVELTASSA PATIROMER CALCIUM SORBITEX
Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association 015158 (04.21.2021)
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Self‐Administered Drug List BRAND NAME GENERIC DRUG NMEVENCLEXTA VENETOCLAXVENCLEXTA STARTING PACK VENETOCLAXVENTAVIS ILOPROST TROMETHAMINEVERZENIO ABEMACICLIBVIEKIRA PAK OMBITA/PARITAP/RITON/DASABUVIRVIGABATRIN VIGABATRINVIGADRONE VIGABATRINVISTOGARD URIDINE TRIACETATEVITRAKVI LAROTRECTINIB SULFATEVIVITROL NALTREXONE MICROSPHERESVIZIMPRO DACOMITINIBVOSEVI SOFOSBUVIR/VELPATAS/VOXILAPREVVOTRIENT PAZOPANIB HCLVUMERITY DIROXIMEL FUMARATEVYLEESI BREMELANOTIDE ACETATEVYNDAMAX TAFAMIDISVYNDAQEL TAFAMIDIS MEGLUMINEWAKIX PITOLISANT HCLXALKORI CRIZOTINIBXELJANZ TOFACITINIB CITRATEXELJANZ XR TOFACITINIB CITRATEXELODA CAPECITABINEXENAZINE TETRABENAZINEXERMELO TELOTRISTAT ETIPRATEXOLAIR OMALIZUMABXOSPATA GILTERITINIB FUMARATEXPOVIO SELINEXORXTANDI ENZALUTAMIDEXURIDEN URIDINE TRIACETATEXYWAV SODIUM,CALCIUM,MAG,POT OXYBATEYONSA ABIRATERONE ACET,SUBMICRONIZEDZARXIO FILGRASTIM‐SNDZZAVESCA MIGLUSTATZEJULA NIRAPARIB TOSYLATEZELBORAF VEMURAFENIBZEPATIER ELBASVIR/GRAZOPREVIRZEPOSIA OZANIMOD HYDROCHLORIDEZIEXTENZO PEGFILGRASTIM‐BMEZZOKINVY LONAFARNIBZOLINZA VORINOSTATZOMACTON SOMATROPINZORBTIVE SOMATROPINZYDELIG IDELALISIBZYKADIA CERITINIBZYTIGA ABIRATERONE ACETATE
Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association 015158 (04.21.2021)
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An independent licensee of the Blue Cross Blue Shield Association 037398 (11-06-2019)
Discrimination is Against the Law
Premera Blue Cross Blue Shield of Alaska (Premera) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Premera does not exclude people or treat them differently because of race, color, national origin, age, disability, sex, gender identity, or sexual orientation. Premera provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). Premera provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact the Civil Rights Coordinator. If you believe that Premera has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator ─ Complaints and Appeals, PO Box 91102, Seattle, WA 98111, Toll free: 855-332-4535, Fax: 425-918-5592, TTY: 711, Email [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Ave SW, Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Language Assistance PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.
Tumawag sa 800-508-4722 (TTY: 711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 800-508-4722 (TTY: 711). 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 800-508-4722
(TTY: 711) 번으로 전화해 주십시오. LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 800-508-4722 (TTY: 711). ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.
Звоните 800-508-4722 (телетайп: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 800-508-4722 (TTY：711）。 MO LOU SILAFIA: Afai e te tautala Gagana fa'a Sāmoa, o loo iai auaunaga fesoasoan, e fai fua e leai se totogi, mo oe,
Telefoni mai: 800-508-4722 (TTY: 711). ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 800-508-4722 (TTY: 711).
注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。800-508-4722 （TTY:711）まで、お電話にてご連絡ください。
PAKDAAR: Nu saritaem ti Ilocano, ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Awagan ti 800-508-4722 (TTY: 711).
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 800-508-4722 (TTY: 711). УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної
підтримки. Телефонуйте за номером 800-508-4722 (телетайп: 711). เรียน: ถา้คุณพดูภาษาไทยคุณสามารถใชบ้ริการช่วยเหลือทางภาษาไดฟ้รี โทร 800-508-4722 (TTY: 711). ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.
Rufnummer: 800-508-4722 (TTY: 711). UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 800-508-4722 (TTY: 711).
.(711: والبكم الصم هاتف رقم) 800-508-4722 برقم اتصل. بالمجان لك تتوافر اللغوية المساعدة خدمات فإن اللغة، اذكر تتحدث كنت إذا: ملحوظةATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 800-508-4722 (TTY: 711). ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 800-508-4722 (ATS: 711). ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 800-508-4722 (TTY: 711). ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero
800-508-4722 (TTY: 711). .ديریبگ تماس TTY: 711)-508-800) 4722 با. باشد یم فراهم شما یبرا گانيرا بصورت یزبان التیتسه د،یکن یم گفتگو فارسی زبان به اگر: توجه
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