2017 drug list

This formulary is up-to-date through its publication date, January 1, 2018

Blue Cross Community CentennialSM

2018 Drug List This document contains information about the drugs we cover in this planNTENNIALCARE

Blue Cross Community Centennial

i

What is the Blue Cross Community Centennial drug list?The drug list (sometimes called a “formulary”) is a list showing the drugs that can be covered by your Blue Cross Community Centennial health plan. The drugs listed will be covered as long as you: • Have a medical need for them

• Fill the medication orders at an in-network pharmacy

• Follow the other rules of your Blue Cross Community Centennial health plan

For more information on how to fill your medication orders, please review your Member Handbook. You may also contact Blue Cross and Blue Shield of New Mexico (BCBSNM) Member Services at 1-866-689-1523 (TTY/TDD 711).

What will I pay?In most cases you do not pay for covered drugs. Some members will have prescription copays depending on their category of eligibility.

Can the drug list change?Yes, it can change for various reasons such as a new, less expensive generic drug becomes available.

You will be told in writing when changes are made to the drug list.

How do I use the drug list?There are two ways to find your drug in the list beginning on page 1.

1. Category• The list of covered drugs that begins on page 1 gives you

information about the drugs covered by Blue Cross Community Centennial. If you have trouble finding your drug in the list, turn to the Index that begins at the back of this book.

– The first column of the chart has the name of the drug. Brand name drugs are capitalized (e.g., CIPRO) and generic drugs are listed in lower-case italics (e.g., ciprofloxacin).

– The information in the “Necessary actions, restrictions, or limits on use” column tells you if Blue Cross Community Centennial has any rules for covering your drug.

• The drugs are listed in categories, or groups, based on the type of medical conditions they treat. (For example, drugs used to treat a heart condition are listed under Heart and Circulatory Drugs).

• If you know what your drug is used for, look for the group in the drug list. Then, look under that group for your drug.

2. Alphabetical Listing• Look for your drug in the index at the back of this book.

• Next to your drug, you will see the page number where you can find coverage information.

What are generic drugs?A generic drug is approved by the Food and Drug Administration (FDA) as having the same active ingredient as the brand name drug, but often costs less.

Drug List

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Are there any limits on my coverage?Added conditions or limits on some covered drugs may include:• Prior Authorization: You or your provider may need to get

approval from Blue Cross and Blue Shield of New Mexico (BCBSNM) before you fill some of your medication orders. Medications that require prior authorization are identified in the drug list by a “PA” in the “Necessary actions, restrictions, or limits on use” column. If you do not get approval, Blue Cross Community Centennial may not cover (pay for) the drug.

– What if my drug requires a prior authorization?

ú Contact BCBSNM Member Services at 1-866-689-1523 (TTY/TDD 711) and ask how you or your provider can submit a prior authorization (exception) request.

ú You can also talk to your provider to decide if you should first try a different drug on our list before you request an exception.

• Quantity Limits: For certain drugs, Blue Cross Community Centennial limits the amount of a drug that will be covered for a period of time (e.g., no more than 60 tablets for 30 days). Medications that have quantity limits are identified in the drug list by a “QL” in the “Necessary actions, restrictions, or limits on use” column.

– What if my drug is not covered because it exceeds the quantity limit?

ú Contact BCBSNM Member Services at 1-866-689-1523 (TTY/TDD 711) and ask how you or your provider can submit a quantity limit exception request.

ú You can also talk to your provider to decide if you should first try a different drug on our list or different dose of your medication before you request an exception.

• Step Therapy: In some cases, Blue Cross Community Centennial requires you to first try certain drugs before another drug can be covered. For example if Drug A and Drug B both treat your medical condition, the plan may not cover Drug B unless you try Drug A first. If Drug A does not work for you, the plan will then cover Drug B. Medications that are subject to step therapy are identified in the drug list by an “ST” in the “Necessary actions, restrictions, or limits on use” column.

– What if my drug is not covered because I have not met the step therapy?

ú Contact BCBSNM Member Services at 1-866-689-1523 (TTY/TDD 711) and ask how you or your provider can submit a step therapy exception request.

ú You can also talk to your provider to decide if you should first try a different drug on our list that does not require step therapy.

You can find out if your drug has any other conditions or limits by looking at the drug list that begins on page 1.

Does the plan cover over-the-counter (OTC) drugs?Yes, Blue Cross Community Centennial covers certain OTC drugs with a valid medication order from your health care provider, and you may get those at no cost. Generic OTC drugs are to be prescribed and filled by your pharmacy when available. These OTC drugs must be filled at a pharmacy that participates in the Blue Cross Community Centennial network and for quantities up to a 30-day supply. Many of the OTC drugs found on the drug list have an age restriction depending on what type of coverage you have.


iii

What if my drug is not on the drug list?Contact BCBSNM Member Services at 1-866-689-1523 (TTY/TDD 711) and ask if your drug is covered. If you learn that Blue Cross Community Centennial does not cover your drug, you have two options:• Talk to your provider to decide if you should first try a

different drug on our list before you request an exception.

• Ask Member Services about making an exception to cover your drug. Member Services will tell you how you or your provider can ask for an exception to the drug list.

The date we last updated the list is shown on the front cover page.

Specialty Pharmacy (SP) DrugsSpecialty drugs are certain prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis and multiple sclerosis. Specialty drugs often require special handling (like refrigeration during shipping) and administration (such as injection or infusion). Specialty pharmacy drugs require prior authorization before a prescription may be filled. They can be filled for up to a 30-day supply. They must be filled by a specialty drug supplier that participates in the network for Blue Cross Community Centennial. AllianceRx Walgreens Prime is the preferred BCBSNM supplier of specialty drugs. Most specialty drugs fall under the pharmacy benefit and can be filled by AllianceRx Walgreens Prime. Specialty drugs under the pharmacy benefit that are unavailable from AllianceRx Walgreens Prime can be obtained from a limited distribution pharmacy provider. Limited distribution pharmacy providers are identified by pharmaceutical manufacturers as having the highest standards for clinical expertise, patient education, service, treatment monitoring and support. For more information about specialty drugs, contact Member Services at 1-866-689-1523 (TTY/TDD 711).

Which drug categories are not covered by the Plan drug list?The following drug categories are not covered by your Blue Cross Community Centennial health plan:• Anorexia, weight loss, or weight gain drugs

• Bulk chemicals

• Cosmetic enhancing drugs

• Diagnostic agents

• Drug Efficacy Study Implementation (DESI). These are drugs that are not shown to be safe and effective.

• Experimental and investigational drugs

• Erectile dysfunction drugs prescribed to treat impotence

• Fertility drugs

• General anesthetic drugs

• Over-the-counter products not otherwise included on the plan’s drug list

• Surgical supply/medical devices

Blue Cross Community Centennial members who have dual coverage under both Medicare and Medicaid will find that most of their medications will be covered by Medicare. However, a limited number of drugs will be covered under Blue Cross Community Centennial.

For Medicare Part B-covered drugs, Blue Cross Community Centennial members who are enrolled in both Medicare and Medicaid may be able to have their coinsurance/copay covered under their Medicaid benefit. However, some drugs are only covered under Medicare Part B if a member has a specific medical condition or received a specific medical treatment. For these drugs, medical history information will need to be reviewed first in order to cover a member’s coinsurance/copay. Members should call Member Services at 1-866-689-1523 (TTY/TDD 711) to have this coverage determination completed.

Drug List

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For more Information For more details about drug coverage from your Blue Cross Community Centennial health plan, please review your Member Handbook and other plan materials.

If you have any questions, please call BCBSNM Member Services at: 1-866-689-1523 (TTY/TDD 711). We are open 8:00 a.m. until 5:00 p.m. Mountain time, Monday through Friday.

Drug List Language AssistanceInterpreter ServicesWe can arrange for someone to help you speak with us in any language. There is no charge for these services. If your health care provider does not speak your language, we can arrange for a translator to help you. Please call Member Services at 1-866-689-1523 (TTY/TDD 711).

Hearing and Vision ProblemsFor our members with hearing problems, we offer TTY/TDD service at no charge. The line is open 24 hours a day/seven day a week at 711.

Other Languages and FormatsYou can get this document in Spanish, or speak with someone about this information in other languages at no charge. Call 1-866-689-1523 (TTY/TDD: 711). The call is toll-free. You can also call Member Services, toll-free, to request this information in other alternative formats such as Braille, large print and other forms. Call toll-free: 1-866-689-1523 (TTY/TDD: 711). We are open 8:00 a.m. until 5:00 p.m. Mountain time, Monday through Friday.


v

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-855-710-6984 (TTY: 711).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-710-6984 (TTY: 711).

Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dę́ę́’, t’áá jiik’eh, éí ná hólǫ́, kojį’ hódíílnih 1-855-710-6984 (TTY: 711).

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-855-710-6984 (TTY: 711).

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-855-710-6984 (TTY: 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 1-855-710-6984 (TTY: 711)。

6984-710-855-1ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم ).711(رقم ھاتف الصم والبكم:

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.

1-855-710-6984 (TTY: 711) 번으로 전화해 주십시오.

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-855-710-6984 (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。1-855-710-6984 （TTY: 711）まで、お電話にてご連絡ください。

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-855-710-6984 (ATS: 711).

ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-855-710-6984 (TTY: 711).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-855-710-6984 (телетайп: 711).

!यान द': य)द आप ,हदी बोलते ह4 तो आपके िलए मु:त म' भाषा सहायता सेवाएं उपलAध ह4। 1-855-710-6984 (TTY: 711) पर कॉल कर'।

ھجوت: رگا ھب نابز یسراف وگتفگ یم دینک، تالیھست ینابز ھب تروص ناگیار یارب امش مھارف یم دشاب. اب 1-855-710-6984 (TTY: 711) سامت دیریگب.

เรียน: ถLาคุณพูดภาษาไทยคุณสามารถใชLบริการช_วยเหลือทางภาษาไดLฟรี โทร 1-855-710-6984 (TTY: 711).

Blue Cross and Blue Shield of New Mexico complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross and Blue Shield of New Mexico does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Blue Cross and Blue Shield of New Mexico:

Provides free aids and services to people with disabilities to communicate effectively with us,such as:o Qualified sign language interpreterso Written information in other formats (large print, audio, accessible electronic formats, other

formats) Provides free language services to people whose primary language is not English, such as:

o Qualified interpreterso Information written in other languages

If you need these services, contact Civil Rights Coordinator.

If you believe that Blue Cross and Blue Shield of New Mexico 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, Office of Civil Rights Coordinator, 300 E. Randolph St., 35th floor, Chicago, Illinois 60601, 1-855-664-7270, TTY/TDD: 1-855-661-6965, Fax: 1-855-661-6960, [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, 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 Avenue, 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.

To ask for auxiliary aids and services or materials in other formats and languages at no cost,

please call 1-866-689-1523 (TTY/TDD: 711).

Drug List

vi

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-855-710-6984 (TTY: 711).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-710-6984 (TTY: 711).

Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dę́ę́’, t’áá jiik’eh, éí ná hólǫ́, kojį’ hódíílnih 1-855-710-6984 (TTY: 711).

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-855-710-6984 (TTY: 711).

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-855-710-6984 (TTY: 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 1-855-710-6984 (TTY: 711)。

6984-710-855-1ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم ).711(رقم ھاتف الصم والبكم:

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.

1-855-710-6984 (TTY: 711) 번으로 전화해 주십시오.

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-855-710-6984 (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。1-855-710-6984 （TTY: 711）まで、お電話にてご連絡ください。

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-855-710-6984 (ATS: 711).

ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-855-710-6984 (TTY: 711).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-855-710-6984 (телетайп: 711).

!यान द': य)द आप ,हदी बोलते ह4 तो आपके िलए मु:त म' भाषा सहायता सेवाएं उपलAध ह4। 1-855-710-6984 (TTY: 711) पर कॉल कर'।

ھجوت: رگا ھب نابز یسراف وگتفگ یم دینک، تالیھست ینابز ھب تروص ناگیار یارب امش مھارف یم دشاب. اب 1-855-710-6984 (TTY: 711) سامت دیریگب.

เรียน: ถLาคุณพูดภาษาไทยคุณสามารถใชLบริการช_วยเหลือทางภาษาไดLฟรี โทร 1-855-710-6984 (TTY: 711).

2017

AL = Age Limit ME = Morphine Equivalent PA = Prior AuthorizationQL = Quantity Limits SP = Specialty ST = Step Therapy 90 = 90 days at mail order

1

Name of Drug

Necessaryactions,restrictions,or limits onuse

ANTI-INFECTIVE AGENTSPENICILLINSAMOXICILLIN - amoxicillin (trihydrate)

chew tab 125 mg

AMOXICILLIN - amoxicillin (trihydrate)chew tab 250 mg

amoxicillin (trihydrate) cap 250 mg

amoxicillin (trihydrate) cap 500 mg

amoxicillin (trihydrate) for susp 125 mg/5ml




amoxicillin (trihydrate) tab 875 mg

amoxicillin & k clavulanate for susp200-28.5 mg/5ml

amoxicillin & k clavulanate for susp250-62.5 mg/5ml (Augmentin)

amoxicillin & k clavulanate for susp400-57 mg/5ml

amoxicillin & k clavulanate for susp600-42.9 mg/5ml (Augmentin es-600)

amoxicillin & k clavulanate tab 250-125 mg

amoxicillin & k clavulanate tab 500-125 mg(Augmentin)

amoxicillin & k clavulanate tab 875-125 mg(Augmentin)

AMOXICILLIN/CLAVULANATE P -amoxicillin & k clavulanate chew tab200-28.5 mg

AMOXICILLIN/CLAVULANATE P -amoxicillin & k clavulanate chew tab400-57 mg

ampicillin cap 250 mg

ampicillin cap 500 mg

dicloxacillin sodium cap 250 mg

dicloxacillin sodium cap 500 mg

penicillin v potassium for soln 125 mg/5ml

penicillin v potassium for soln 250 mg/5ml

Name of Drug


penicillin v potassium tab 250 mg

penicillin v potassium tab 500 mg

CEPHALOSPORINScefaclor cap 250 mg

cefaclor cap 500 mg

cefadroxil cap 500 mg

cefadroxil for susp 250 mg/5ml

cefadroxil for susp 500 mg/5ml

cefadroxil tab 1 gm

cefdinir cap 300 mg

cefdinir for susp 125 mg/5ml

cefdinir for susp 250 mg/5ml

cefixime for susp 100 mg/5ml (Suprax)

cefixime for susp 200 mg/5ml (Suprax)

cefprozil for susp 125 mg/5ml

cefprozil for susp 250 mg/5ml

cefprozil tab 250 mg

cefprozil tab 500 mg

cefuroxime axetil tab 250 mg

cefuroxime axetil tab 500 mg (Ceftin)

cephalexin cap 250 mg (Keflex)

cephalexin cap 500 mg (Keflex)

cephalexin for susp 125 mg/5ml

cephalexin for susp 250 mg/5ml

MACROLIDESAZITHROMYCIN - azithromycin powd pack

for susp 1 gm

azithromycin for susp 100 mg/5ml(Zithromax)

azithromycin for susp 200 mg/5ml(Zithromax)

azithromycin tab 250 mg (Zithromax) QL

azithromycin tab 500 mg (Zithromax) QL

clarithromycin for susp 125 mg/5ml

clarithromycin for susp 250 mg/5ml (Biaxin)

2017


2

Name of Drug


clarithromycin tab 250 mg (Biaxin)

clarithromycin tab 500 mg (Biaxin)

TETRACYCLINESdemeclocycline hcl tab 150 mg

demeclocycline hcl tab 300 mg

doxycycline hyclate cap 50 mg

doxycycline hyclate cap 100 mg(Vibramycin)

doxycycline hyclate tab delayed release50 mg (Doryx)

PA

doxycycline hyclate tab 20 mg

doxycycline hyclate tab 100 mg

doxycycline monohydrate cap 50 mg

doxycycline monohydrate cap 100 mg(Monodox)

doxycycline monohydrate for susp25 mg/5ml (Vibramycin)

doxycycline monohydrate tab 50 mg(Adoxa)

doxycycline monohydrate tab 75 mg(Adoxa)

doxycycline monohydrate tab 100 mg(Adoxa pak 1/100)

minocycline hcl cap 50 mg (Minocin)



FLUOROQUINOLONESciprofloxacin for oral susp 250 mg/5ml (5%)

(5 gm/100ml) (Cipro)

ciprofloxacin for oral susp 500 mg/5ml(10%) (10 gm/100ml) (Cipro)

ciprofloxacin hcl tab 250 mg (base equiv)(Cipro)

ciprofloxacin hcl tab 500 mg (base equiv)(Cipro)

ciprofloxacin hcl tab 750 mg (base equiv)

levofloxacin oral soln 25 mg/ml

Name of Drug


levofloxacin tab 250 mg (Levaquin)



AMINOGLYCOSIDESneomycin sulfate tab 500 mg

paromomycin sulfate cap 250 mg

TOBRAMYCIN - tobramycin nebu soln300 mg/5ml

SP

tobramycin nebu soln 300 mg/5ml (Tobi) SP

TUBERCULOSISethambutol hcl tab 100 mg (Myambutol)

ethambutol hcl tab 400 mg (Myambutol)

isoniazid tab 100 mg 90

isoniazid tab 300 mg 90

PRIFTIN - rifapentine tab 150 mg

pyrazinamide tab 500 mg

rifabutin cap 150 mg (Mycobutin)

rifampin cap 150 mg (Rifadin)

rifampin cap 300 mg (Rifadin)

FUNGAL INFECTIONSfluconazole for susp 10 mg/ml (Diflucan)

fluconazole for susp 40 mg/ml (Diflucan)

fluconazole tab 50 mg (Diflucan)




flucytosine cap 250 mg (Ancobon)

flucytosine cap 500 mg (Ancobon)

griseofulvin microsize susp 125 mg/5ml

griseofulvin microsize tab 500 mg

griseofulvin ultramicrosize tab 125 mg(Gris-peg)

griseofulvin ultramicrosize tab 250 mg(Gris-peg)

ketoconazole tab 200 mg

2017


3

Name of Drug


NOXAFIL - posaconazole tab delayedrelease 100 mg

PA, 90

NOXAFIL - posaconazole susp 40 mg/ml PA, 90

nystatin oral powder

nystatin tab 500000 unit

terbinafine hcl tab 250 mg (Lamisil)

voriconazole for susp 40 mg/ml (Vfend) PA

voriconazole tab 50 mg (Vfend) PA

voriconazole tab 200 mg (Vfend) PA

VIRAL INFECTIONSCytomegalovirusvalganciclovir hcl for soln 50 mg/ml (base

equiv) (Valcyte)90

valganciclovir hcl tab 450 mg (baseequivalent) (Valcyte)

90

Hepatitisadefovir dipivoxil tab 10 mg (Hepsera) 90

BARACLUDE - entecavir oral soln0.05 mg/ml

90

entecavir tab 0.5 mg (Baraclude) 90

entecavir tab 1 mg (Baraclude) 90

lamivudine tab 100 mg (hbv) (Epivir hbv) 90

ribavirin cap 200 mg (Rebetol) PA, SP

ribavirin tab 200 mg (Copegus) PA, SP

Herpesacyclovir cap 200 mg (Zovirax)

acyclovir susp 200 mg/5ml (Zovirax)

acyclovir tab 400 mg (Zovirax)

acyclovir tab 800 mg (Zovirax)

famciclovir tab 125 mg (Famvir)

valacyclovir hcl tab 500 mg (Valtrex)

valacyclovir hcl tab 1 gm (Valtrex)

HIV/AIDSabacavir sulfate soln 20 mg/ml (base

equiv) (Ziagen)QL, 90

Name of Drug


abacavir sulfate tab 300 mg (base equiv)(Ziagen)

QL, 90

abacavir sulfate-lamivudine tab600-300 mg (Epzicom)

QL, 90

abacavir sulfate-lamivudine-zidovudine tab300-150-300 mg (Trizivir)

QL, 90

APTIVUS - tipranavir cap 250 mg QL, 90

APTIVUS - tipranavir oral soln 100 mg/ml QL, 90

ATRIPLA - efavirenz-emtricitabine-tenofovirdf tab 600-200-300 mg

QL, 90

COMPLERA - emtricitabine-rilpivirine-tenofovir df tab 200-25-300 mg

QL, 90

CRIXIVAN - indinavir sulfate cap 200 mg QL, 90

CRIXIVAN - indinavir sulfate cap 400 mg QL, 90

DESCOVY - emtricitabine-tenofoviralafenamide fumarate tab 200-25 mg

QL, 90

didanosine delayed release capsule125 mg (Videx ec)

QL, 90


QL, 90


QL, 90


QL, 90

EDURANT - rilpivirine hcl tab 25 mg (baseequivalent)

QL, 90

EMTRIVA - emtricitabine caps 200 mg QL, 90

EMTRIVA - emtricitabine soln 10 mg/ml QL, 90

EVOTAZ - atazanavir sulfate-cobicistat tab300-150 mg (base equiv)

QL, 90

fosamprenavir calcium tab 700 mg (baseequiv) (Lexiva)

QL, 90

FUZEON - enfuvirtide for inj 90 mg QL, SP, 90

GENVOYA - elvitegrav-cobic-emtricitab-tenofov af tab 150-150-200-10 mg

QL, 90

INTELENCE - etravirine tab 25 mg QL, 90



2017


4

Name of Drug


INVIRASE - saquinavir mesylate cap200 mg

QL, 90

INVIRASE - saquinavir mesylate tab500 mg

QL, 90

ISENTRESS - raltegravir potassium packetfor susp 100 mg (base equiv)

QL, 90

ISENTRESS - raltegravir potassium tab400 mg (base equiv)

QL, 90

ISENTRESS - raltegravir potassium chewtab 25 mg (base equiv)

QL, 90

ISENTRESS - raltegravir potassium chewtab 100 mg (base equiv)

QL, 90

ISENTRESS HD - raltegravir potassium tab600 mg (base equiv)

QL, 90

KALETRA - lopinavir-ritonavir tab100-25 mg

QL, 90

KALETRA - lopinavir-ritonavir tab200-50 mg

QL, 90

lamivudine oral soln 10 mg/ml (Epivir) QL, 90

lamivudine tab 150 mg (Epivir) QL, 90

lamivudine tab 300 mg (Epivir) QL, 90

lamivudine-zidovudine tab 150-300 mg(Combivir)

QL, 90

LEXIVA - fosamprenavir calcium susp50 mg/ml (base equiv)

QL

lopinavir-ritonavir soln 400-100 mg/5ml(80-20 mg/ml) (Kaletra)

QL, 90

NEVIRAPINE - nevirapine susp 50 mg/5ml QL, 90

nevirapine tab er 24hr 100 mg (Viramunexr)

QL, 90

nevirapine tab er 24hr 400 mg (Viramunexr)

QL, 90

nevirapine tab 200 mg (Viramune) QL, 90

NORVIR - ritonavir cap 100 mg QL, 90

NORVIR - ritonavir tab 100 mg QL, 90

NORVIR - ritonavir oral soln 80 mg/ml QL, 90

ODEFSEY - emtricitabine-rilpivirine-tenofovir af tab 200-25-25 mg

QL, 90

Name of Drug


PREZCOBIX - darunavir-cobicistat tab800-150 mg

QL, 90

PREZISTA - darunavir ethanolate susp100 mg/ml (base equiv)

QL, 90

PREZISTA - darunavir ethanolate tab75 mg (base equiv)

QL, 90


QL, 90


QL, 90


QL, 90

RESCRIPTOR - delavirdine mesylate tab100 mg

QL, 90

RESCRIPTOR - delavirdine mesylate tab200 mg

QL, 90

REYATAZ - atazanavir sulfate oral powderpacket 50 mg (base equiv)

QL, 90

REYATAZ - atazanavir sulfate cap 150 mg(base equiv)

QL, 90


QL, 90


QL, 90

SELZENTRY - maraviroc tab 150 mg QL, 90

SELZENTRY - maraviroc tab 300 mg QL, 90

stavudine cap 15 mg (Zerit) QL, 90




stavudine for oral soln 1 mg/ml (Zerit) QL, 90

STRIBILD - elvitegrav-cobic-emtricitab-tenofovdf tab 150-150-200-300 mg

QL, 90

SUSTIVA - efavirenz tab 600 mg QL, 90

SUSTIVA - efavirenz cap 50 mg QL, 90

SUSTIVA - efavirenz cap 200 mg QL, 90

TIVICAY - dolutegravir sodium tab 50 mg(base equiv)

QL, 90

2017


5

Name of Drug


TRIUMEQ - abacavir-dolutegravir-lamivudine tab 600-50-300 mg

QL, 90

TRUVADA - emtricitabine-tenofovirdisoproxil fumarate tab 100-150 mg

QL, 90


QL, 90


QL, 90


QL, 90

TYBOST - cobicistat tab 150 mg QL, 90

VIDEX - didanosine for soln 2 gm QL, 90

VIDEX - didanosine for soln 4 gm QL, 90

VIRACEPT - nelfinavir mesylate tab250 mg

QL, 90

VIRACEPT - nelfinavir mesylate tab625 mg

QL, 90

VIRAMUNE - nevirapine susp 50 mg/5ml QL, 90

VIREAD - tenofovir disoproxil fumarate oralpowder 40 mg/gm

QL, 90

VIREAD - tenofovir disoproxil fumarate tab150 mg

QL, 90


QL, 90


QL, 90


QL, 90

VITEKTA - elvitegravir tab 85 mg QL, 90

VITEKTA - elvitegravir tab 150 mg QL, 90

zidovudine cap 100 mg (Retrovir) QL, 90

zidovudine syrup 10 mg/ml (Retrovir) QL, 90

zidovudine tab 300 mg QL, 90

Influenzaoseltamivir phosphate cap 30 mg (base

equiv) (Tamiflu)QL

oseltamivir phosphate cap 45 mg (baseequiv) (Tamiflu)

QL

Name of Drug


oseltamivir phosphate cap 75 mg (baseequiv) (Tamiflu)

QL

oseltamivir phosphate for susp 6 mg/ml(base equiv) (Tamiflu)

QL

RELENZA DISKHALER - zanamivir aeropowder breath activated 5 mg/blister

QL

MALARIAatovaquone-proguanil hcl tab 62.5-25 mg

(Malarone)QL

atovaquone-proguanil hcl tab 250-100 mg(Malarone)

QL

chloroquine phosphate tab 250 mg 90

chloroquine phosphate tab 500 mg (Aralen) 90

DARAPRIM - pyrimethamine tab 25 mg PA, SP

hydroxychloroquine sulfate tab 200 mg(Plaquenil)

90

MEFLOQUINE HCL - mefloquine hcl tab250 mg

90

mefloquine hcl tab 250 mg 90

PRIMAQUINE PHOSPHATE - primaquinephosphate tab 26.3 mg (15 mg base)

WORM INFECTIONSALBENZA - albendazole tab 200 mg

BILTRICIDE - praziquantel tab 600 mg

ivermectin tab 3 mg (Stromectol)

OTHER ANTI-INFECTIVESCAYSTON - aztreonam lysine for inhal soln

75 mg (base equivalent)PA, SP

clindamycin hcl cap 75 mg (Cleocin)



clindamycin palmitate hcl for soln75 mg/5ml (base equiv) (Cleocinpediatric gr)

dapsone tab 25 mg 90

dapsone tab 100 mg 90

ENGERIX-B - hepatitis b vaccine(recombinant) susp 10 mcg/0.5ml

2017


6

Name of Drug


ENGERIX-B - hepatitis b vaccine(recombinant) susp 20 mcg/ml

ENGERIX-B - hepatitis b vaccine(recombinant) 10 mcg/0.5ml

ENGERIX-B - hepatitis b vaccine(recombinant) 20 mcg/ml

IMOVAX RABIES (H.D.C.V.) - rabies virusvaccine, hdc inj

linezolid for susp 100 mg/5ml (Zyvox) PA, QL

linezolid tab 600 mg (Zyvox) PA, QL

metronidazole cap 375 mg (Flagyl)

metronidazole tab 250 mg (Flagyl)

metronidazole tab 500 mg (Flagyl)

RABAVERT - rabies vaccine, pcec for inj

RECOMBIVAX HB - hepatitis b vaccine(recombinant) susp 5 mcg/0.5ml

RECOMBIVAX HB - hepatitis b vaccine(recombinant) susp 10 mcg/ml

RECOMBIVAX HB - hepatitis b vaccine(recombinant) susp 40 mcg/ml

sulfamethoxazole-trimethoprim susp200-40 mg/5ml

sulfamethoxazole-trimethoprim tab400-80 mg (Bactrim)

sulfamethoxazole-trimethoprim tab800-160 mg (Bactrim ds)

trimethoprim tab 100 mg

vancomycin hcl cap 125 mg (Vancocin hcl)

vancomycin hcl cap 250 mg (Vancocin hcl)

XIFAXAN - rifaximin tab 550 mg PA, QL, 90

ZYVOX - linezolid for susp 100 mg/5ml PA, QL

AFLURIA PF 2017-2018 - influenza virusvaccine split pf susp pref syringe 0.5 ml

AFLURIA QUADRIVALENT 2017 -influenza virus vac split quadrivalentsusp pref syr 0.5ml

AFLURIA QUADRIVALENT 2017 -influenza virus vaccine split quadrivalentim inj

Name of Drug


AFLURIA 2017-2018 - influenza virusvaccine split im susp

FLUARIX QUADRIVALENT 2017 -influenza virus vac split quadrivalentsusp pref syr 0.5ml

FLUCELVAX QUADRIVALENT 20 -influenza vac tissue-cultured subunitquadrivalent im susp

FLULAVAL QUADRIVALENT 201 -influenza virus vac split quadrivalentsusp pref syr 0.5ml

FLUVIRIN 2017-2018 - influenza vac typea&b surface antigen susp pref syr 0.5 ml

FLUVIRIN 2017-2018 - influenza virusvaccine types a & b surface antigen imsusp

FLUZONE HIGH-DOSE PF 2017 -influenza virus vac split high-dose pfsusp pref syr 0.5ml

FLUZONE QUADRIVALENT 2015 -influenza virus vac split quadrivalentsusp pref syr 0.5ml

FLUZONE QUADRIVALENT 2017 -influenza virus vac split quadrivalentsusp pref syr 0.5ml

FLUZONE QUADRIVALENT 2017 -influenza virus vaccine split quadrivalentim inj

CANCER DRUGSACTIMMUNE - interferon gamma-1b inj

100 mcg/0.5ml (2000000 unit/0.5ml)PA, QL,

SP, 90

AFINITOR - everolimus tab 2.5 mg PA, QL, SP

AFINITOR - everolimus tab 5 mg PA, QL, SP

AFINITOR - everolimus tab 7.5 mg PA, QL, SP

AFINITOR - everolimus tab 10 mg PA, QL, SP

AFINITOR DISPERZ - everolimus tab fororal susp 2 mg

PA, QL, SP


PA, QL, SP


PA, QL, SP

2017


7

Name of Drug


ALECENSA - alectinib hcl cap 150 mg(base equivalent)

PA, QL, SP

ALKERAN - melphalan tab 2 mg

anastrozole tab 1 mg (Arimidex) 90

bexarotene cap 75 mg (Targretin) PA, SP

bicalutamide tab 50 mg (Casodex)

BOSULIF - bosutinib tab 100 mg PA, QL, SP

BOSULIF - bosutinib tab 500 mg PA, QL, SP

CABOMETYX - cabozantinib s-malate tab20 mg (base equivalent)

PA, QL, SP


PA, QL, SP


PA, QL, SP

capecitabine tab 150 mg (Xeloda) PA, SP

capecitabine tab 500 mg (Xeloda) PA, SP

CAPRELSA - vandetanib tab 100 mg PA, QL, SP

CAPRELSA - vandetanib tab 300 mg PA, QL, SP

COMETRIQ - cabozantinib s-malate cap 3x 20 mg (60 mg dose) kit

PA, QL, SP

COMETRIQ - cabozantinib s-mal cap 1 x80 mg & 1 x 20 mg (100 dose) kit

PA, QL, SP

COMETRIQ - cabozantinib s-mal cap 1 x80 mg & 3 x 20 mg (140 dose) kit

PA, QL, SP

COTELLIC - cobimetinib fumarate tab20 mg (base equivalent)

PA, QL, SP

ELIGARD - leuprolide acetate forsubcutaneous inj kit 7.5 mg

SP

ELIGARD - leuprolide acetate (3 month) forsubcutaneous inj kit 22.5mg

SP

ELIGARD - leuprolide acetate (4 month) forsubcutaneous inj kit 30 mg

SP

ELIGARD - leuprolide acetate (6 month) forsubcutaneous inj kit 45 mg

SP

ERIVEDGE - vismodegib cap 150 mg PA, QL, SP

exemestane tab 25 mg (Aromasin) 90

flutamide cap 125 mg

Name of Drug


GILOTRIF - afatinib dimaleate tab 20 mg(base equivalent)

PA, QL, SP


PA, QL, SP


PA, QL, SP

HEXALEN - altretamine cap 50 mg PA, SP

HYCAMTIN - topotecan hcl cap 0.25 mg(base equiv)

PA, SP

HYCAMTIN - topotecan hcl cap 1 mg (baseequiv)

PA, SP

hydroxyurea cap 500 mg (Hydrea)

IBRANCE - palbociclib cap 75 mg PA, QL, SP



ICLUSIG - ponatinib hcl tab 15 mg (baseequiv)

PA, QL, SP

ICLUSIG - ponatinib hcl tab 45 mg (baseequiv)

PA, QL, SP

imatinib mesylate tab 100 mg (baseequivalent) (Gleevec)

PA, QL, SP

imatinib mesylate tab 400 mg (baseequivalent) (Gleevec)

PA, QL, SP

INLYTA - axitinib tab 1 mg PA, QL, SP

INLYTA - axitinib tab 5 mg PA, QL, SP

JAKAFI - ruxolitinib phosphate tab 5 mg(base equivalent)

PA, QL, SP


PA, QL, SP


PA, QL, SP


PA, QL, SP


PA, QL, SP

KISQALI FEMARA 600 DOSE - ribociclibtab 200 mg & letrozole tab 2.5 mgtherapy pack

PA, QL

2017


8

Name of Drug


LENVIMA 10 MG DAILY DOSE - lenvatinibcap therapy pack 10 mg (10 mg dailydose)

PA, QL, SP

LENVIMA 14 MG DAILY DOSE - lenvatinibcap therapy pack 10 & 4 mg (14 mg dailydose)

PA, QL, SP

LENVIMA 18 MG DAILY DOSE - lenvatinibcap therapy pack 10 & 4 (2) mg (18 mgdaily dose)

PA, QL, SP

LENVIMA 20 MG DAILY DOSE - lenvatinibcap therapy pack 10 (2) mg (20 mg dailydose)

PA, QL, SP

LENVIMA 24 MG DAILY DOSE - lenvatinibcap therapy pack 10 (2) & 4 mg (24 mgdaily dose)

PA, QL, SP

LENVIMA 8 MG DAILY DOSE - lenvatinibcap therapy pack 4 (2) mg (8 mg dailydose)

PA, QL, SP

letrozole tab 2.5 mg (Femara) 90

LEUCOVORIN CALCIUM - leucovorincalcium tab 10 mg

LEUCOVORIN CALCIUM - leucovorincalcium tab 15 mg

leucovorin calcium tab 5 mg

leucovorin calcium tab 25 mg

LEUKERAN - chlorambucil tab 2 mg

LOMUSTINE - lomustine cap 10 mg



LONSURF - trifluridine-tipiracil tab15-6.14 mg

PA, QL, SP

LONSURF - trifluridine-tipiracil tab20-8.19 mg

PA, QL, SP

LYNPARZA - olaparib cap 50 mg PA, QL, SP

LYNPARZA - olaparib tab 100 mg PA, QL

LYNPARZA - olaparib tab 150 mg PA, QL

LYSODREN - mitotane tab 500 mg PA, SP

MATULANE - procarbazine hcl cap 50 mg PA, SP

Name of Drug


megestrol acetate susp 40 mg/ml (Megaceoral)

megestrol acetate tab 20 mg

megestrol acetate tab 40 mg

MEKINIST - trametinib dimethyl sulfoxidetab 0.5 mg (base equivalent)

PA, QL, SP

MEKINIST - trametinib dimethyl sulfoxidetab 2 mg (base equivalent)

PA, QL, SP

mercaptopurine tab 50 mg

methotrexate sodium tab 2.5 mg (baseequiv)

MYLERAN - busulfan tab 2 mg

NEXAVAR - sorafenib tosylate tab 200 mg(base equivalent)

PA, QL, SP

NINLARO - ixazomib citrate cap 2.3 mg(base equivalent)

PA, QL, SP

NINLARO - ixazomib citrate cap 3 mg(base equivalent)

PA, QL, SP

NINLARO - ixazomib citrate cap 4 mg(base equivalent)

PA, QL, SP

POMALYST - pomalidomide cap 1 mg PA, QL, SP




PURIXAN - mercaptopurine susp2000 mg/100ml (20 mg/ml)

PA, SP

RUBRACA - rucaparib camsylate tab200 mg (base equivalent)

PA, QL


PA, QL


PA, QL

SPRYCEL - dasatinib tab 20 mg PA, QL, SP






2017


9

Name of Drug


STIVARGA - regorafenib tab 40 mg PA, QL, SP

SUTENT - sunitinib malate cap 12.5 mg(base equivalent)

PA, QL, SP

SUTENT - sunitinib malate cap 25 mg(base equivalent)

PA, QL, SP

SUTENT - sunitinib malate cap 37.5 mg(base equivalent)

PA, QL, SP

SUTENT - sunitinib malate cap 50 mg(base equivalent)

PA, QL, SP

SYLATRON - peginterferon alfa-2b for injkit 200 mcg

PA, SP


PA, SP


PA, SP

TAFINLAR - dabrafenib mesylate cap50 mg (base equivalent)

PA, QL, SP

TAFINLAR - dabrafenib mesylate cap75 mg (base equivalent)

PA, QL, SP

tamoxifen citrate tab 10 mg (baseequivalent)

90

tamoxifen citrate tab 20 mg (baseequivalent)

90

TARCEVA - erlotinib hcl tab 25 mg (baseequivalent)

PA, QL, SP


PA, QL, SP


PA, QL, SP

TARGRETIN - bexarotene cap 75 mg PA, SP

TASIGNA - nilotinib hcl cap 150 mg (baseequivalent)

PA, QL, SP

TASIGNA - nilotinib hcl cap 200 mg (baseequivalent)

PA, QL, SP

temozolomide cap 5 mg (Temodar) PA, SP





Name of Drug



tretinoin cap 10 mg PA, SP

TYKERB - lapatinib ditosylate tab 250 mg(base equiv)

PA, QL, SP

VENCLEXTA - venetoclax tab 10 mg PA, QL, SP



VENCLEXTA STARTING PACK -venetoclax tab therapy starter pack 10 &50 & 100 mg

PA, QL, SP

VOTRIENT - pazopanib hcl tab 200 mg(base equiv)

PA, QL, SP

XALKORI - crizotinib cap 200 mg PA, QL, SP

XALKORI - crizotinib cap 250 mg PA, QL, SP

XTANDI - enzalutamide cap 40 mg PA, QL, SP

ZELBORAF - vemurafenib tab 240 mg PA, QL, SP

ZOLINZA - vorinostat cap 100 mg PA, QL, SP

ZYKADIA - ceritinib cap 150 mg PA, QL, SP

ZYTIGA - abiraterone acetate tab 250 mg PA, QL, SP

ZYTIGA - abiraterone acetate tab 500 mg PA, QL

HORMONES, DIABETES AND RELATED DRUGSCORTICOSTEROIDSbudesonide delayed release particles cap

3 mg (Entocort ec)

CORTISONE ACETATE - cortisone acetatetab 25 mg

DEXAMETHASONE - dexamethasone soln0.5 mg/5ml

dexamethasone elixir 0.5 mg/5ml

dexamethasone tab 0.5 mg



dexamethasone tab 4 mg

dexamethasone tab 6 mg

fludrocortisone acetate tab 0.1 mg 90

hydrocortisone tab 5 mg (Cortef)

2017


10

Name of Drug




methylprednisolone tab therapy pack 4 mg(21) (Medrol dosepak)

methylprednisolone tab 4 mg (Medrol)




prednisolone sod phosph oral soln6.7 mg/5ml (5 mg/5ml base) (Pediapred)

prednisolone sod phosphate oral soln15 mg/5ml (base equiv)

prednisolone syrup 15 mg/5ml (uspsolution equivalent)

PREDNISONE - prednisone tab 50 mg

PREDNISONE - prednisone oral soln5 mg/5ml

PREDNISONE - prednisone tab therapypack 5 mg (21)




prednisone tab 1 mg

prednisone tab 2.5 mg

prednisone tab 5 mg

prednisone tab 10 mg

prednisone tab 20 mg

SOLU-CORTEF - hydrocortisone sodiumsuccinate pf for inj 100 mg




Name of Drug


MALE HORMONESdanazol cap 50 mg

danazol cap 100 mg

danazol cap 200 mg

testosterone td gel 25 mg/2.5gm (1%)(Androgel)

PA, QL, 90

testosterone td gel 50 mg/5gm (1%)(Androgel)

PA, QL, 90

testosterone td gel 12.5 mg/act (1%)(Androgel pump)

PA, QL, 90

ESTROGENSCOMBIPATCH - estradiol-norethindrone

ace td pttw 0.05-0.14 mg/day90

COMBIPATCH - estradiol-norethindroneace td pttw 0.05-0.25 mg/day

90

ENJUVIA - estrogens, conjugated syntheticb tab 0.3 mg

90


90


90


90

estradiol & norethindrone acetate tab0.5-0.1 mg (Activella)

90

estradiol & norethindrone acetate tab1-0.5 mg (Activella)

90

estradiol tab 0.5 mg (Estrace) 90

estradiol tab 1 mg (Estrace) 90

estradiol tab 2 mg (Estrace) 90

estradiol td patch twice weekly0.025 mg/24hr (Vivelle-dot)

QL, 90


QL, 90


QL, 90


QL, 90

2017


11

Name of Drug


estradiol td patch twice weekly 0.1 mg/24hr(Vivelle-dot)

QL, 90

estradiol td patch weekly 0.025 mg/24hr(Climara)

QL, 90

estradiol td patch weekly 0.0375 mg/24hr(37.5 mcg/24hr) (Climara)

QL, 90


QL, 90


QL, 90


QL


QL, 90

ESTROPIPATE - estropipate tab 3 mg 90

norethindrone acetate-ethinyl estradiol tab0.5 mg-2.5 mcg (Femhrt low dose)

90

norethindrone acetate-ethinyl estradiol tab1 mg-5 mcg

90

PROGESTINSmedroxyprogesterone acetate tab 2.5 mg

(Provera)90

medroxyprogesterone acetate tab 5 mg(Provera)

90

medroxyprogesterone acetate tab 10 mg(Provera)

90

megestrol acetate susp 625 mg/5ml(Megace es)

90

norethindrone acetate tab 5 mg (Aygestin) 90

progesterone micronized cap 100 mg(Prometrium)

90

progesterone micronized cap 200 mg(Prometrium)

90

BIRTH CONTROLELLA - ulipristal acetate tab 30 mg QL

KYLEENA - levonorgestrel releasing iud17.5 mcg/day (19.5 mg total)

levonorgestrel tab 1.5 mg QL

Name of Drug


LILETTA - levonorgestrel releasing iud18.6 mcg/day (52 mg total)

MIRENA - levonorgestrel releasing iud20 mcg/day (52 mg total)

90

NEXPLANON - etonogestrel subdermalimplant 68 mg

90

NUVARING - etonogestrel-ethinyl estradiolva ring 0.120-0.015 mg/24hr

QL, 90

PARAGARD INTRAUTERINE COP -copper iud

90

XULANE - norelgestromin-ethinyl estradioltd ptwk 150-35 mcg/24hr

QL, 90

ENDOMETRIOSISLUPANETA PACK - leuprolide (1 mon) inj

3.75 mg & norethindrone tab 5 mg kitPA, SP

LUPANETA PACK - leuprolide (3 mon) inj11.25 mg & norethindrone tab 5 mg kit

PA, SP

SYNAREL - nafarelin acetate nasal soln2 mg/ml (200 mcg/act) (base eq)

SP

DIABETESacarbose tab 25 mg (Precose) QL, 90

acarbose tab 50 mg (Precose) QL, 90

acarbose tab 100 mg (Precose) QL, 90

ALOGLIPTIN - alogliptin benzoate tab6.25 mg (base equiv)

QL, ST, 90

ALOGLIPTIN - alogliptin benzoate tab12.5 mg (base equiv)

QL, ST, 90

ALOGLIPTIN - alogliptin benzoate tab25 mg (base equiv)

QL, ST, 90

ALOGLIPTIN/METFORMIN HCL -alogliptin-metformin hcl tab 12.5-500 mg

QL, ST, 90

ALOGLIPTIN/METFORMIN HCL- alogliptin-metformin hcl tab12.5-1000 mg

QL, ST, 90

ALOGLIPTIN/PIOGLITAZONE - alogliptin-pioglitazone tab 12.5-15 mg

QL, ST, 90


QL, ST, 90

2017


12

Name of Drug



QL, ST, 90

ALOGLIPTIN/PIOGLITAZONE - alogliptin-pioglitazone tab 25-15 mg

QL, ST, 90


QL, ST, 90


QL, ST, 90

glimepiride tab 1 mg (Amaryl) QL, 90



glipizide tab er 24hr 2.5 mg (Glucotrol xl) QL, 90

glipizide tab er 24hr 5 mg (Glucotrol xl) QL, 90

glipizide tab er 24hr 10 mg (Glucotrol xl) QL, 90

glipizide tab 5 mg (Glucotrol) QL, 90

glipizide tab 10 mg (Glucotrol) QL, 90

glipizide-metformin hcl tab 2.5-250 mg QL, 90

glipizide-metformin hcl tab 2.5-500 mg QL, 90

glipizide-metformin hcl tab 5-500 mg QL, 90

GLUCAGON EMERGENCY KIT - glucagon(rdna) for inj kit 1 mg

QL

glyburide micronized tab 1.5 mg (Glynase) QL, 90

glyburide micronized tab 3 mg (Glynase) QL, 90

glyburide micronized tab 6 mg (Glynase) QL, 90

glyburide tab 1.25 mg QL, 90

glyburide tab 2.5 mg QL, 90

glyburide tab 5 mg QL, 90

glyburide-metformin tab 1.25-250 mg(Glucovance)

QL, 90

glyburide-metformin tab 2.5-500 mg(Glucovance)

QL, 90

glyburide-metformin tab 5-500 mg(Glucovance)

QL, 90

KORLYM - mifepristone tab 300 mg PA, QL,SP, 90

metformin hcl tab er 24hr 500 mg(Glucophage xr)

QL, 90

Name of Drug


metformin hcl tab er 24hr 750 mg(Glucophage xr)

QL, 90

metformin hcl tab 500 mg (Glucophage) QL, 90



miglitol tab 25 mg (Glyset) QL, 90



nateglinide tab 60 mg (Starlix) QL, 90

nateglinide tab 120 mg (Starlix) QL, 90

pioglitazone hcl tab 15 mg (base equiv)(Actos)

QL, 90


QL, 90


QL, 90

VICTOZA - liraglutide soln pen-injector18 mg/3ml (6 mg/ml)

PA, QL, 90

DIABETES - INSULINSRapid-Acting InsulinsHUMALOG - insulin lispro soln cartridge

100 unit/mlQL, 90

HUMALOG - insulin lispro inj 100 unit/ml QL, 90

HUMALOG JUNIOR KWIKPEN - insulinlispro soln pen-injector 100 unit/ml

QL, 90

HUMALOG KWIKPEN - insulin lispro solnpen-injector 100 unit/ml

QL, 90

HUMALOG KWIKPEN - insulin lispro solnpen-injector 200 unit/ml

QL, 90

NOVOLOG - insulin aspart inj 100 unit/ml QL, 90

NOVOLOG FLEXPEN - insulin aspart solnpen-injector 100 unit/ml

QL, 90

NOVOLOG PENFILL - insulin aspart solncartridge 100 unit/ml

QL, 90

Short-Acting InsulinsHUMULIN R - insulin regular (human) inj

100 unit/mlQL, 90

2017


13

Name of Drug


NOVOLIN R - insulin regular (human) inj100 unit/ml

QL, 90

NOVOLIN R RELION - insulin regular(human) inj 100 unit/ml

QL, 90

RELION R - insulin regular (human) inj 100unit/ml

QL, 90

Intermediate-Acting InsulinsHUMALOG MIX 50/50 - insulin lispro

protamine & lispro inj 100 unit/ml (50-50)QL, 90

HUMALOG MIX 50/50 KWIKPEN - insulinlispro prot & lispro sus pen-inj 100 unit/ml(50-50)

QL, 90

HUMALOG MIX 75/25 - insulin lispro prot &lispro inj 100 unit/ml (75-25)

QL, 90

HUMALOG MIX 75/25 KWIKPEN - insulinlispro prot & lispro sus pen-inj 100 unit/ml(75-25)

QL, 90

HUMULIN N - insulin nph (human)(isophane) inj 100 unit/ml

QL, 90

HUMULIN N KWIKPEN - insulin nph(human) (isophane) susp pen-injector100 unit/ml

QL, 90

HUMULIN 70/30 - insulin nph isophane &regular human inj 100 unit/ml (70-30)

QL, 90

HUMULIN 70/30 KWIKPEN - insulin nph &regular susp pen-inj 100 unit/ml (70-30)

QL, 90

NOVOLIN N - insulin nph (human)(isophane) inj 100 unit/ml

QL, 90

NOVOLIN N RELION - insulin nph (human)(isophane) inj 100 unit/ml

QL, 90

NOVOLIN 70/30 - insulin nph isophane &regular human inj 100 unit/ml (70-30)

QL, 90

NOVOLIN 70/30 RELION - insulin nphisophane & regular human inj 100 unit/ml(70-30)

QL, 90

NOVOLOG MIX 70/30 - insulin aspart prot& aspart (human) inj 100 unit/ml (70-30)

QL, 90

NOVOLOG MIX 70/30 PREFILL - insulinaspart prot & aspart sus pen-inj 100 unit/ml (70-30)

QL, 90

Basal Insulins

Name of Drug


BASAGLAR KWIKPEN - insulin glarginesoln pen-injector 100 unit/ml

QL, 90

THYROID REGULATIONlevothyroxine sodium tab 25 mcg

(Synthroid)90

levothyroxine sodium tab 50 mcg(Synthroid)

90


90


90


90


90


90


90


90


90


90


90

liothyronine sodium tab 5 mcg (Cytomel) 90



methimazole tab 5 mg (Tapazole) 90

methimazole tab 10 mg (Tapazole) 90

propylthiouracil tab 50 mg 90

thyroid tab 30 mg (1/2 grain) (Armourthyroid)

90

thyroid tab 60 mg (1 grain) (Armour thyroid) 90

thyroid tab 90 mg (1 1/2 grain) (Armourthyroid)

90

GROWTH HORMONE

2017


14

Name of Drug


INCRELEX - mecasermin inj 40 mg/4ml(10 mg/ml)

PA, SP, 90

OMNITROPE - somatropin for inj 5.8 mg PA, SP, 90

SEROSTIM - somatropin (non-refrigerated)for subcutaneous inj 4 mg

PA, SP, 90


PA, SP, 90


PA, SP, 90

ZORBTIVE - somatropin (non-refrigerated)for subcutaneous inj 8.8 mg

PA, SP, 90

OTHER HORMONES AND RELATED DRUGSALENDRONATE SODIUM - alendronate

sodium tab 40 mgQL

alendronate sodium tab 5 mg QL, 90



alendronate sodium tab 70 mg (Fosamax) QL, 90

BUPHENYL - sodium phenylbutyrate tab500 mg

PA, SP, 90

cabergoline tab 0.5 mg

calcitonin (salmon) nasal soln 200 unit/act(Miacalcin)

90

calcitriol cap 0.25 mcg (Rocaltrol) 90

calcitriol cap 0.5 mcg (Rocaltrol) 90

calcitriol oral soln 1 mcg/ml (Rocaltrol) 90

CARBAGLU - carglumic acid tab 200 mg PA, SP, 90

desmopressin acetate nasal soln 0.01%(refrigerated) (Ddavp)

90

desmopressin acetate nasal spray soln0.01% (Ddavp)

90

desmopressin acetate nasal spray soln0.01% (refrigerated)

90

desmopressin acetate tab 0.1 mg (Ddavp) 90

desmopressin acetate tab 0.2 mg (Ddavp) 90

ETIDRONATE DISODIUM - etidronatedisodium tab 200 mg

Name of Drug


H.P. ACTHAR - corticotropin inj gel 80 unit/ml

PA, SP

ibandronate sodium tab 150 mg (baseequivalent) (Boniva)

QL, 90

KUVAN - sapropterin dihydrochloridesoluble tab 100 mg

PA, SP, 90

KUVAN - sapropterin dihydrochloridepowder packet 100 mg

PA, SP, 90

KUVAN - sapropterin dihydrochloridepowder packet 500 mg

PA, SP, 90

levocarnitine oral soln 1 gm/10ml (10%)(Carnitor)

90

levocarnitine tab 330 mg (Carnitor) 90

methylergonovine maleate tab 0.2 mg

NITYR - nitisinone tab 2 mg PA, 90



raloxifene hcl tab 60 mg (Evista) MM

RAVICTI - glycerol phenylbutyrate liquid1.1 gm/ml

PA, SP, 90

risedronate sodium tab delayed release35 mg (Atelvia)

QL, 90

SAMSCA - tolvaptan tab 15 mg PA, QL, SP

SAMSCA - tolvaptan tab 30 mg PA, QL, SP

SIGNIFOR - pasireotide diaspartate inj0.3 mg/ml (base equiv)

PA, QL,SP, 90


PA, QL,SP, 90


PA, QL,SP, 90

SOMAVERT - pegvisomant for inj 10 mg(as protein)

PA, QL,SP, 90


PA, QL,SP, 90


PA, QL,SP, 90


PA, QL,SP, 90

2017


15

Name of Drug



PA, QL,SP, 90

STIMATE - desmopressin acetate nasalsoln 1.5 mg/ml

90

XURIDEN - uridine triacetate oral granulespacket 2 gm

SP, 90

HEART AND CIRCULATORY DRUGSANGIOTENSIN CONVERTING ENZYME (ACE)INHIBITORS AND COMBINATIbenazepril & hydrochlorothiazide tab

5-6.25 mg90

benazepril & hydrochlorothiazide tab10-12.5 mg (Lotensin hct)

90

benazepril & hydrochlorothiazide tab20-12.5 mg (Lotensin hct)

90

benazepril & hydrochlorothiazide tab20-25 mg (Lotensin hct)

90

benazepril hcl tab 5 mg 90

benazepril hcl tab 10 mg (Lotensin) 90



captopril tab 12.5 mg 90

captopril tab 25 mg 90



CAPTOPRIL/HYDROCHLOROTHIA -captopril & hydrochlorothiazide tab25-15 mg

90


90


90


90

enalapril maleate & hydrochlorothiazide tab5-12.5 mg

90

Name of Drug


enalapril maleate & hydrochlorothiazide tab10-25 mg (Vaseretic)

90

enalapril maleate tab 2.5 mg (Vasotec) 90

enalapril maleate tab 5 mg (Vasotec) 90



fosinopril sodium & hydrochlorothiazide tab10-12.5 mg

90

fosinopril sodium & hydrochlorothiazide tab20-12.5 mg

90

fosinopril sodium tab 10 mg 90



lisinopril & hydrochlorothiazide tab10-12.5 mg (Zestoretic)

90

lisinopril & hydrochlorothiazide tab20-12.5 mg (Zestoretic)

90

lisinopril & hydrochlorothiazide tab20-25 mg (Zestoretic)

90

lisinopril tab 2.5 mg (Zestril) 90

lisinopril tab 5 mg (Prinivil) 90



lisinopril tab 30 mg (Zestril) 90

lisinopril tab 40 mg (Zestril) 90

moexipril hcl tab 7.5 mg 90

moexipril hcl tab 15 mg 90

moexipril-hydrochlorothiazide tab7.5-12.5 mg

90

moexipril-hydrochlorothiazide tab15-12.5 mg

90

moexipril-hydrochlorothiazide tab 15-25 mg 90

perindopril erbumine tab 2 mg 90

perindopril erbumine tab 4 mg (Aceon) 90

perindopril erbumine tab 8 mg (Aceon) 90

quinapril hcl tab 5 mg (Accupril) 90


2017


16

Name of Drug




quinapril-hydrochlorothiazide tab10-12.5 mg (Accuretic)

90

quinapril-hydrochlorothiazide tab20-12.5 mg (Accuretic)

90

quinapril-hydrochlorothiazide tab 20-25 mg(Accuretic)

90

ramipril cap 1.25 mg (Altace) 90

ramipril cap 2.5 mg (Altace) 90

ramipril cap 5 mg (Altace) 90

ramipril cap 10 mg (Altace) 90

trandolapril tab 1 mg (Mavik) 90

trandolapril tab 2 mg (Mavik) 90

trandolapril tab 4 mg 90

ANGIOTENSIN II RECEPTOR ANTAGONISTS(ARBS) AND COMBINATIONSirbesartan tab 75 mg (Avapro) QL, 90

irbesartan tab 150 mg (Avapro) QL, 90

irbesartan tab 300 mg (Avapro) QL, 90

irbesartan-hydrochlorothiazide tab150-12.5 mg (Avalide)

QL, 90

irbesartan-hydrochlorothiazide tab300-12.5 mg (Avalide)

QL, 90

losartan potassium & hydrochlorothiazidetab 50-12.5 mg (Hyzaar)

QL, 90

losartan potassium & hydrochlorothiazidetab 100-12.5 mg (Hyzaar)

QL, 90

losartan potassium & hydrochlorothiazidetab 100-25 mg (Hyzaar)

QL, 90

losartan potassium tab 25 mg (Cozaar) QL, 90



olmesartan medoxomil tab 5 mg (Benicar) QL, 90



Name of Drug


olmesartan medoxomil-hydrochlorothiazidetab 20-12.5 mg (Benicar hct)

QL, 90

olmesartan medoxomil-hydrochlorothiazidetab 40-12.5 mg (Benicar hct)

QL, 90

olmesartan medoxomil-hydrochlorothiazidetab 40-25 mg (Benicar hct)

QL, 90

valsartan tab 40 mg (Diovan) QL, 90




valsartan-hydrochlorothiazide tab80-12.5 mg (Diovan hct)

QL, 90


QL, 90

valsartan-hydrochlorothiazide tab160-25 mg (Diovan hct)

QL, 90


QL, 90

valsartan-hydrochlorothiazide tab320-25 mg (Diovan hct)

QL, 90

BETA BLOCKERS AND COMBINATIONSacebutolol hcl cap 200 mg (Sectral) 90

acebutolol hcl cap 400 mg (Sectral) 90

atenolol & chlorthalidone tab 50-25 mg(Tenoretic 50)

90

atenolol & chlorthalidone tab 100-25 mg(Tenoretic 100)

90

atenolol tab 25 mg (Tenormin) 90



betaxolol hcl tab 10 mg (Kerlone) 90

betaxolol hcl tab 20 mg (Kerlone) 90

bisoprolol & hydrochlorothiazide tab2.5-6.25 mg (Ziac)

90

bisoprolol & hydrochlorothiazide tab5-6.25 mg (Ziac)

90

bisoprolol & hydrochlorothiazide tab10-6.25 mg (Ziac)

90

2017


17

Name of Drug


bisoprolol fumarate tab 5 mg (Zebeta) 90

bisoprolol fumarate tab 10 mg (Zebeta) 90

carvedilol tab 3.125 mg (Coreg) 90



carvedilol tab 25 mg (Coreg) 90

labetalol hcl tab 100 mg 90



metoprolol & hydrochlorothiazide tab50-25 mg (Lopressor hct)

90

metoprolol & hydrochlorothiazide tab100-25 mg (Lopressor hct)

90

metoprolol & hydrochlorothiazide tab100-50 mg

90

metoprolol succinate tab er 24hr 25 mg(tartrate equiv) (Toprol xl)

90


90


90


90

metoprolol tartrate tab 25 mg 90

metoprolol tartrate tab 50 mg (Lopressor) 90

metoprolol tartrate tab 100 mg (Lopressor) 90

METOPROLOL/HYDROCHLOROTHI -metoprolol & hydrochlorothiazide tab100-50 mg

90

nadolol tab 20 mg (Corgard) 90



pindolol tab 5 mg 90

propranolol hcl cap er 24hr 60 mg (Inderalla)

90


90

Name of Drug



90


90

propranolol hcl tab 10 mg 90





PROPRANOLOL/HYDROCHLOROTH -propranolol & hydrochlorothiazide tab40-25 mg

90

PROPRANOLOL/HYDROCHLOROTH -propranolol & hydrochlorothiazide tab80-25 mg

90

CALCIUM CHANNEL BLOCKERS ANDCOMBINATIONSamlodipine besylate tab 2.5 mg (Norvasc) 90

amlodipine besylate tab 5 mg (Norvasc) 90

amlodipine besylate tab 10 mg (Norvasc) 90

amlodipine besylate-benazepril hcl cap2.5-10 mg

90

amlodipine besylate-benazepril hcl cap5-10 mg (Lotrel)

90


90

amlodipine besylate-benazepril hcl cap5-40 mg

90


90


90

diltiazem hcl cap er 12hr 60 mg 90






2017


18

Name of Drug


diltiazem hcl coated beads cap er 24hr120 mg (Cardizem cd)

90


90


90

diltiazem hcl coated beads cap er 24hr300 mg

90

diltiazem hcl extended release beads caper 24hr 120 mg (Tiazac)

90


90


90


90


90


90

diltiazem hcl tab 30 mg (Cardizem) 90


diltiazem hcl tab 90 mg 90


ENTRESTO - sacubitril-valsartan tab24-26 mg

PA, QL, 90


PA, QL, 90


PA, QL, 90

felodipine tab er 24hr 2.5 mg 90

felodipine tab er 24hr 5 mg 90

felodipine tab er 24hr 10 mg 90

isradipine cap 2.5 mg 90

isradipine cap 5 mg 90

nicardipine hcl cap 20 mg 90

nifedipine cap 10 mg (Procardia) 90

nifedipine cap 20 mg 90

Name of Drug


nifedipine tab er 24hr 30 mg (Adalat cc) 90



nifedipine tab er 24hr osmotic release30 mg (Procardia xl)

90


90


90

nimodipine cap 30 mg 90

trandolapril-verapamil hcl tab er 1-240 mg(Tarka)

90


90


90


90

verapamil hcl cap er 24hr 100 mg (Verelanpm)

90

verapamil hcl cap er 24hr 120 mg (Verelan) 90



90



90


verapamil hcl tab er 120 mg (Calan sr) 90



verapamil hcl tab 40 mg 90

verapamil hcl tab 80 mg (Calan) 90

verapamil hcl tab 120 mg (Calan) 90

CHEST PAINisosorbide mononitrate tab er 24hr 30 mg 90

isosorbide mononitrate tab er 24hr 60 mg 90

2017


19

Name of Drug


isosorbide mononitrate tab er 24hr 120 mg 90

isosorbide mononitrate tab 10 mg 90

isosorbide mononitrate tab 20 mg 90

nitroglycerin cap er 2.5 mg 90

nitroglycerin cap er 6.5 mg 90

nitroglycerin cap er 9 mg 90

nitroglycerin sl tab 0.3 mg (Nitrostat) 90



nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur)

90


90


90


90

CHOLESTEROL LOWERINGatorvastatin calcium tab 10 mg (base

equivalent) (Lipitor)QL, 90

atorvastatin calcium tab 20 mg (baseequivalent) (Lipitor)

QL, 90


QL, 90


QL, 90

cholestyramine light powder packets 4 gm 90

cholestyramine light powder 4 gm/dose(Questran light)

90

cholestyramine powder packets 4 gm(Questran)

90

cholestyramine powder 4 gm/dose(Questran)

90

choline fenofibrate cap dr 45 mg (fenofibricacid equiv) (Trilipix)

QL, 90

colestipol hcl granule packets 5 gm(Colestid flavored)

90

Name of Drug


colestipol hcl granules 5 gm (Colestidflavored)

90

colestipol hcl tab 1 gm (Colestid) 90

fenofibrate micronized cap 43 mg QL, 90

fenofibrate micronized cap 67 mg (Lofibra) QL, 90

fenofibrate micronized cap 134 mg(Lofibra)

QL, 90

fenofibrate micronized cap 200 mg(Lofibra)

QL, 90

fenofibrate tab 48 mg (Tricor) QL, 90

fenofibrate tab 54 mg (Lofibra) QL, 90

fenofibrate tab 145 mg (Tricor) QL, 90

fenofibrate tab 160 mg (Lofibra) QL, 90

fluvastatin sodium tab er 24 hr 80 mg(Lescol xl)

QL, 90

gemfibrozil tab 600 mg (Lopid) QL, 90

JUXTAPID - lomitapide mesylate cap 5 mg(base equiv)

PA, QL,SP, 90

JUXTAPID - lomitapide mesylate cap10 mg (base equiv)

PA, QL,SP, 90


PA, QL,SP, 90


PA, QL,SP, 90


PA, QL,SP, 90


PA, QL,SP, 90

lovastatin tab 10 mg QL, 90

lovastatin tab 20 mg QL, 90

lovastatin tab 40 mg (Mevacor) QL, 90

PRALUENT - alirocumab subcutaneoussoln pen-injector 75 mg/ml

PA, QL,SP, 90

PRALUENT - alirocumab subcutaneoussoln pen-injector 150 mg/ml

PA, QL,SP, 90

PRALUENT - alirocumab subcutaneoussoln prefilled syringe 75 mg/ml

PA, QL,SP, 90

2017


20

Name of Drug


PRALUENT - alirocumab subcutaneoussoln prefilled syringe 150 mg/ml

PA, QL,SP, 90

pravastatin sodium tab 10 mg QL, 90

pravastatin sodium tab 20 mg (Pravachol) QL, 90



REPATHA - evolocumab subcutaneoussoln prefilled syringe 140 mg/ml

PA, QL,SP, 90

REPATHA PUSHTRONEX SYSTEM- evolocumab subcutaneous solncartridge/infusor 420 mg/3.5ml

PA, QL,SP, 90

REPATHA SURECLICK - evolocumabsubcutaneous soln auto-injector 140 mg/ml

PA, QL,SP, 90

rosuvastatin calcium tab 5 mg (Crestor) QL, 90




simvastatin tab 5 mg (Zocor) QL, 90





FLUID RETENTIONacetazolamide cap er 12hr 500 mg

(Diamox)90

acetazolamide tab 250 mg 90

amiloride & hydrochlorothiazide tab5-50 mg

90

amiloride hcl tab 5 mg 90

bumetanide tab 0.5 mg (Bumex) 90

bumetanide tab 1 mg (Bumex) 90

bumetanide tab 2 mg (Bumex) 90

CHLOROTHIAZIDE - chlorothiazide tab250 mg

90

chlorothiazide tab 500 mg 90

chlorthalidone tab 25 mg 90

Name of Drug


furosemide oral soln 10 mg/ml 90

furosemide tab 20 mg (Lasix) 90



hydrochlorothiazide cap 12.5 mg(Microzide)

90

hydrochlorothiazide tab 12.5 mg 90

hydrochlorothiazide tab 25 mg 90

hydrochlorothiazide tab 50 mg 90

indapamide tab 1.25 mg 90

indapamide tab 2.5 mg 90

metolazone tab 2.5 mg 90

metolazone tab 5 mg 90

metolazone tab 10 mg 90

spironolactone & hydrochlorothiazide tab25-25 mg (Aldactazide)

90

spironolactone tab 25 mg (Aldactone) 90



torsemide tab 5 mg 90

torsemide tab 10 mg (Demadex) 90

torsemide tab 20 mg (Demadex) 90

torsemide tab 100 mg 90

triamterene & hydrochlorothiazide cap37.5-25 mg (Dyazide)

90

triamterene & hydrochlorothiazide tab37.5-25 mg (Maxzide-25)

90

triamterene & hydrochlorothiazide tab75-50 mg (Maxzide)

90

HEART RHYTHMamiodarone hcl tab 200 mg (Cordarone) 90

disopyramide phosphate cap 100 mg(Norpace)

90

disopyramide phosphate cap 150 mg(Norpace)

90

dofetilide cap 125 mcg (0.125 mg)(Tikosyn)

90

2017


21

Name of Drug


dofetilide cap 250 mcg (0.25 mg) (Tikosyn) 90

dofetilide cap 500 mcg (0.5 mg) (Tikosyn) 90

flecainide acetate tab 50 mg 90



propafenone hcl tab 150 mg 90

propafenone hcl tab 225 mg (Rythmol) 90

propafenone hcl tab 300 mg 90

quinidine gluconate tab er 324 mg 90

QUINIDINE SULFATE - quinidine sulfatetab 200 mg

90

QUINIDINE SULFATE - quinidine sulfatetab 300 mg

90

sotalol hcl (afib/afl) tab 80 mg (Betapaceaf)

90


90


90

sotalol hcl tab 80 mg (Betapace) 90



sotalol hcl tab 240 mg 90

OTHER HEART RELATED DRUGSADCIRCA - tadalafil tab 20 mg (pah) PA, QL,

SP, 90

ADEMPAS - riociguat tab 0.5 mg PA, QL,SP, 90

ADEMPAS - riociguat tab 1 mg PA, QL,SP, 90


ADEMPAS - riociguat tab 2 mg PA, QL,SP, 90


clonidine hcl tab 0.1 mg (Catapres) 90

Name of Drug




clonidine hcl td patch weekly 0.1 mg/24hr(Catapres-tts-1)

90


90


90

DIGOXIN - digoxin oral soln 0.05 mg/ml 90

digoxin tab 125 mcg (0.125 mg) (Lanoxin) 90

digoxin tab 250 mcg (0.25 mg) (Lanoxin) 90

doxazosin mesylate tab 1 mg (Cardura) QL, 90




guanfacine hcl tab 1 mg (Tenex) 90

guanfacine hcl tab 2 mg (Tenex) 90

hydralazine hcl tab 10 mg 90




LETAIRIS - ambrisentan tab 5 mg PA, QL,SP, 90

LETAIRIS - ambrisentan tab 10 mg PA, QL,SP, 90

methyldopa tab 250 mg 90

methyldopa tab 500 mg 90

midodrine hcl tab 2.5 mg

midodrine hcl tab 5 mg

midodrine hcl tab 10 mg

minoxidil tab 2.5 mg 90

minoxidil tab 10 mg 90

phenoxybenzamine hcl cap 10 mg(Dibenzyline)

prazosin hcl cap 1 mg (Minipress) 90


2017


22

Name of Drug



REVATIO - sildenafil citrate for suspension10 mg/ml

PA, QL,SP, 90

terazosin hcl cap 1 mg QL, 90




TRACLEER - bosentan tab 62.5 mg PA, QL,SP, 90

TRACLEER - bosentan tab 125 mg PA, QL,SP, 90

TYVASO - treprostinil inhalation solution0.6 mg/ml

PA, QL,SP, 90

TYVASO REFILL - treprostinil inhalationsolution 0.6 mg/ml

PA, QL,SP, 90

TYVASO STARTER - treprostinil inhalationsolution 0.6 mg/ml

PA, QL,SP, 90

UPTRAVI - selexipag tab therapy pack200 mcg (140) & 800 mcg (60)

PA, QL, SP

UPTRAVI - selexipag tab 200 mcg PA, QL,SP, 90








VENTAVIS - iloprost inhalation solution10 mcg/ml

SP, 90

VENTAVIS - iloprost inhalation solution20 mcg/ml

SP, 90

Name of Drug


ANAPHYLAXISEPINEPHRINE - epinephrine solution auto-

injector 0.15 mg/0.3ml (1:2000)QL

EPINEPHRINE - epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000)

QL

RESPIRATORY AGENTSANTIHISTAMINEScarbinoxamine maleate soln 4 mg/5ml

carbinoxamine maleate tab 4 mg

cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)

cetirizine hcl tab 10 mg

clemastine fumarate tab 1.34 mg (1 mgbase equiv)

cyproheptadine hcl syrup 2 mg/5ml

cyproheptadine hcl tab 4 mg

desloratadine tab 5 mg (Clarinex)

diphenhydramine hcl cap 25 mg

diphenhydramine hcl cap 50 mg

diphenhydramine hcl liquid 12.5 mg/5ml

diphenhydramine hcl tab 25 mg

fexofenadine hcl tab 60 mg

fexofenadine hcl tab 180 mg

levocetirizine dihydrochloride tab 5 mg(Xyzal)

loratadine syrup 5 mg/5ml

loratadine tab 10 mg

promethazine hcl suppos 12.5 mg

promethazine hcl suppos 25 mg

promethazine hcl syrup 6.25 mg/5ml

promethazine hcl tab 12.5 mg

promethazine hcl tab 25 mg

promethazine hcl tab 50 mg

NASAL PRODUCTSazelastine hcl nasal spray 0.1% (137 mcg/

spray)QL

2017


23

Name of Drug


FLUNISOLIDE - flunisolide nasal soln25 mcg/act (0.025%)

QL

fluticasone propionate nasal susp 50 mcg/act

QL

ipratropium bromide nasal soln 0.03%(21 mcg/spray)

QL, 90

ipratropium bromide nasal soln 0.06%(42 mcg/spray)

QL, 90

saline nasal spray 0.65%

triamcinolone acetonide nasal aerosolsuspension 55 mcg/act

QL

COUGH/COLD/ALLERGYacetylcysteine inhal soln 10%

acetylcysteine inhal soln 20%

dextromethorphan-guaifenesin liquid10-100 mg/5ml

guaifenesin liquid 100 mg/5ml

loratadine & pseudoephedrine tab er 12hr5-120 mg

loratadine & pseudoephedrine tab er 24hr10-240 mg

phenylephrine w/ dm-gg liqd10-15-300 mg/5ml

phenylephrine w/ dm-gg liqd 2.5-5-50 mg/ml

phenylephrine w/ dm-gg liqd2.5-7.5-88 mg/ml

promethazine w/ codeine syrup6.25-10 mg/5ml

ME

pseudoeph-chlorphen w/ hydrocodone soln60-4-5 mg/5ml (Zutripro)

ME

sodium chloride soln nebu 0.9%

sodium chloride soln nebu 3%

sodium chloride soln nebu 7% (Hyper-sal)

sodium chloride soln nebu 10%

ASTHMA/COPDALBUTEROL SULFATE ER - albuterol

sulfate tab er 12hr 4 mgQL, 90

Name of Drug


ALBUTEROL SULFATE ER - albuterolsulfate tab er 12hr 8 mg

QL, 90

albuterol sulfate soln nebu 0.083%(2.5 mg/3ml)

QL, 90

albuterol sulfate soln nebu 0.5% (5 mg/ml) QL, 90

albuterol sulfate soln nebu 0.63 mg/3ml(base equiv)

QL, 90

albuterol sulfate soln nebu 1.25 mg/3ml(base equiv)

QL, 90

albuterol sulfate syrup 2 mg/5ml 90

albuterol sulfate tab er 12hr 4 mg (Vospireer)

90

albuterol sulfate tab er 12hr 8 mg (Vospireer)

90

albuterol sulfate tab 2 mg 90

albuterol sulfate tab 4 mg 90

ARNUITY ELLIPTA - fluticasone furoateaerosol powder breath activ 100 mcg/act

QL, 90

ARNUITY ELLIPTA - fluticasone furoateaerosol powder breath activ 200 mcg/act

QL, 90

ATROVENT HFA - ipratropium bromide hfainhal aerosol 17 mcg/act

QL, 90

budesonide inhalation susp 0.25 mg/2ml(Pulmicort)

QL, 90

budesonide inhalation susp 0.5 mg/2ml(Pulmicort)

QL, 90

budesonide inhalation susp 1 mg/2ml(Pulmicort)

QL, 90

COMBIVENT RESPIMAT - ipratropium-albuterol inhal aerosol soln 20-100 mcg/act

QL, 90

dyphylline-guaifenesin liqd 100-100 mg/5ml

FLOVENT DISKUS - fluticasonepropionate aer pow ba 50 mcg/blister

AL, QL, 90


AL, QL, 90


AL, QL, 90

FLOVENT HFA - fluticasone propionate hfainhal aero 44 mcg/act (50/valve)

AL, QL, 90

2017


24

Name of Drug


FLOVENT HFA - fluticasone propionate hfainhal aer 110 mcg/act (125/valve)

AL, QL, 90

FLOVENT HFA - fluticasone propionate hfainhal aer 220 mcg/act (250/valve)

AL, QL, 90

FLUTICASONE PROPIONATE/SA -fluticasone-salmeterol aer powder ba55-14 mcg/act

QL, 90


QL, 90


QL, 90

FORADIL AEROLIZER - formoterolfumarate inhal cap 12 mcg

QL, 90

INCRUSE ELLIPTA - umeclidinium br aeropowd breath act 62.5 mcg/inh (base eq)

QL, 90

ipratropium bromide inhal soln 0.02% QL, 90

ipratropium-albuterol nebu soln0.5-2.5(3) mg/3ml

QL, 90

montelukast sodium chew tab 4 mg (baseequiv) (Singulair)

QL, 90

montelukast sodium chew tab 5 mg (baseequiv) (Singulair)

QL, 90

montelukast sodium oral granules packet4 mg (base equiv) (Singulair)

QL, 90

montelukast sodium tab 10 mg (baseequiv) (Singulair)

QL, 90

NUCALA - mepolizumab for inj 100 mg SP, 90

QVAR - beclomethasone diprop inhal aerosoln 40 mcg/act (50/valve)

AL, QL, 90

QVAR - beclomethasone diprop inhal aerosoln 80 mcg/act (100/valve)

AL, QL, 90

SEREVENT DISKUS - salmeterol xinafoateaer pow ba 50 mcg/dose (base equiv)

QL, 90

SPIRIVA HANDIHALER - tiotropiumbromide monohydrate inhal cap 18 mcg(base equiv)

QL, 90

SPIRIVA RESPIMAT - tiotropium bromidemonohydrate inhal aerosol 1.25 mcg/act

QL, 90

Name of Drug


SPIRIVA RESPIMAT - tiotropium bromidemonohydrate inhal aerosol 2.5 mcg/act

QL, 90

SYMBICORT - budesonide-formoterolfumarate dihyd aerosol 80-4.5 mcg/act

AL, QL, 90

SYMBICORT - budesonide-formoterolfumarate dihyd aerosol 160-4.5 mcg/act

AL, QL, 90

terbutaline sulfate tab 2.5 mg 90

terbutaline sulfate tab 5 mg 90

theophylline soln 80 mg/15ml 90

theophylline tab er 12hr 100 mg 90






VENTOLIN HFA - albuterol sulfate inhalaero 108 mcg/act (90mcg base equiv)

QL, 90

OTHER RESPIRATORY DRUGSESBRIET - pirfenidone cap 267 mg PA, QL,

SP, 90

KALYDECO - ivacaftor tab 150 mg PA, QL,SP, 90

KALYDECO - ivacaftor packet 50 mg PA, QL,SP, 90

KALYDECO - ivacaftor packet 75 mg PA, QL,SP, 90

OFEV - nintedanib esylate cap 100 mg(base equivalent)

PA, QL,SP, 90

OFEV - nintedanib esylate cap 150 mg(base equivalent)

PA, QL,SP, 90

ORKAMBI - lumacaftor-ivacaftor tab100-125 mg

PA, QL,SP, 90

ORKAMBI - lumacaftor-ivacaftor tab200-125 mg

PA, QL,SP, 90

PULMOZYME - dornase alfa inhal soln1 mg/ml

PA, SP, 90

GASTROINTESTINAL DRUGSLAXATIVES

2017


25

Name of Drug


bisacodyl tab & peg 3350-kcl-sod bicarb-nacl for soln kit

bisacodyl tab delayed release 5 mg

docusate sodium cap 100 mg

lactulose solution 10 gm/15ml 90

magnesium citrate soln

peg 3350-kcl-sod bicarb-nacl for soln420 gm (Nulytely/flavor pack)

peg 3350-kcl-na bicarb-nacl-na sulfate forsoln 236 gm (Golytely)

peg 3350-kcl-na bicarb-nacl-na sulfate forsoln 240 gm (Colyte-flavor packs)

polyethylene glycol 3350 oral packet

polyethylene glycol 3350 oral powder

sennosides tab 8.6 mg

ANTIDIARRHEALSdiphenoxylate w/ atropine tab 2.5-0.025 mg

(Lomotil)

loperamide hcl cap 2 mg

ANTACIDSalum & mag hydroxide-simethicone susp

200-200-20 mg/5ml

alum & mag hydroxide-simethicone susp400-400-40 mg/5ml

ULCER/GERDchlordiazepoxide hcl-clidinium bromide cap

5-2.5 mg (Librax)

CIMETIDINE HCL - cimetidine hcl soln300 mg/5ml

90

cimetidine hcl soln 300 mg/5ml 90

cimetidine tab 200 mg

cimetidine tab 300 mg 90



dicyclomine hcl cap 10 mg (Bentyl)

dicyclomine hcl oral soln 10 mg/5ml

dicyclomine hcl tab 20 mg (Bentyl)

Name of Drug


famotidine for susp 40 mg/5ml (Pepcid) 90

famotidine tab 20 mg (Pepcid) 90

famotidine tab 40 mg (Pepcid) 90

glycopyrrolate tab 1 mg (Robinul)

glycopyrrolate tab 2 mg (Robinul forte)

hyoscyamine sulfate elixir 0.125 mg/5ml 90

hyoscyamine sulfate soln 0.125 mg/ml 90

hyoscyamine sulfate tab disint 0.125 mg(Anaspaz)

90

hyoscyamine sulfate tab er 12hr 0.375 mg(Levbid)

90

hyoscyamine sulfate tab sl 0.125 mg(Levsin/sl)

90

hyoscyamine sulfate tab 0.125 mg (Levsin) 90

lansoprazole cap delayed release 15 mg(Prevacid)

QL, 90

lansoprazole cap delayed release 30 mg(Prevacid)

QL, 90

methscopolamine bromide tab 2.5 mg(Pamine)

misoprostol tab 100 mcg (Cytotec) 90

misoprostol tab 200 mcg (Cytotec) 90

nizatidine cap 150 mg 90

nizatidine cap 300 mg 90

omeprazole cap delayed release 10 mg(Prilosec)

QL, 90


QL, 90


QL, 90

pantoprazole sodium ec tab 20 mg (baseequiv) (Protonix)

QL, 90

pantoprazole sodium ec tab 40 mg (baseequiv) (Protonix)

QL, 90

rabeprazole sodium ec tab 20 mg(Aciphex)

QL, 90

ranitidine hcl syrup 15 mg/ml (75 mg/5ml) 90

ranitidine hcl tab 150 mg (Zantac) 90

2017


26

Name of Drug


ranitidine hcl tab 300 mg (Zantac) 90

sucralfate tab 1 gm (Carafate) 90

NAUSEA AND VOMITINGmeclizine hcl tab 12.5 mg

meclizine hcl tab 25 mg

ondansetron hcl oral soln 4 mg/5ml(Zofran)

QL

ondansetron hcl tab 4 mg (Zofran) QL

ondansetron hcl tab 8 mg (Zofran) QL

ondansetron hcl tab 24 mg QL

ondansetron orally disintegrating tab 4 mg(Zofran odt)

QL

ondansetron orally disintegrating tab 8 mg(Zofran odt)

QL

trimethobenzamide hcl cap 300 mg (Tigan)

DIGESTIVE ENZYMESCREON - pancrelipase (lip-prot-amyl) dr

cap 3000-9500-15000 unit90

CREON - pancrelipase (lip-prot-amyl) drcap 6000-19000-30000 unit

90


90


90


90

SUCRAID - sacrosidase soln 8500 unit/ml PA, SP, 90

ZENPEP - pancrelipase (lip-prot-amyl) drcap 3000-10000-16000 unit

90


90


90


90


90

Name of Drug



90


90

OTHER GASTROINTESTINAL DRUGSalosetron hcl tab 0.5 mg (base equiv)

(Lotronex)PA, QL, 90

alosetron hcl tab 1 mg (base equiv)(Lotronex)

PA, QL, 90

balsalazide disodium cap 750 mg (Colazal)

calcium acetate (phosphate binder) cap667 mg (169 mg ca) (Phoslo)

90

calcium acetate (phosphate binder) tab667 mg (Eliphos)

CANASA - mesalamine suppos 1000 mg

CHENODAL - chenodiol tab 250 mg PA, SP

CHOLBAM - cholic acid cap 50 mg 90

CHOLBAM - cholic acid cap 250 mg 90

CIMZIA - certolizumab pegol for inj kit 2 x200 mg

PA, QL, SP

CIMZIA - certolizumab pegol inj kit 2 x200 mg/ml

PA, QL,SP, 90

CIMZIA STARTER KIT - certolizumabpegol inj kit 6 x 200 mg/ml

PA, QL,SP, 90

GATTEX - teduglutide (rdna) for inj kit 5 mg PA, SP, 90

lactulose (encephalopathy) solution10 gm/15ml

90

MESALAMINE DR - mesalamine tabdelayed release 800 mg

mesalamine enema 4 gm

mesalamine rectal enema 4 gm & cleanserwipe kit (Rowasa)

metoclopramide hcl soln 5 mg/5ml(10 mg/10ml)

metoclopramide hcl tab 5 mg (Reglan)

metoclopramide hcl tab 10 mg (Reglan) 90

PENTASA - mesalamine cap er 250 mg 90

PENTASA - mesalamine cap er 500 mg 90

2017


27

Name of Drug


simethicone chew tab 125 mg

simethicone susp 40 mg/0.6ml

sulfasalazine tab delayed release 500 mg(Azulfidine en-tabs)

90

sulfasalazine tab 500 mg (Azulfidine) 90

ursodiol cap 300 mg (Actigall) 90

ursodiol tab 250 mg (Urso 250) 90

ursodiol tab 500 mg (Urso forte) 90

GENITOURINARY DRUGSURINARY TRACT INFECTIONSnitrofurantoin macrocrystalline cap 25 mg

(Macrodantin)

nitrofurantoin macrocrystalline cap 50 mg(Macrodantin)

nitrofurantoin macrocrystalline cap 100 mg(Macrodantin)

nitrofurantoin monohydratemacrocrystalline cap 100 mg (Macrobid)

URINARY TRACT SPASMSbethanechol chloride tab 5 mg (Urecholine)

bethanechol chloride tab 10 mg(Urecholine)



darifenacin hydrobromide tab er 24hr7.5 mg (base equiv) (Enablex)

QL, 90

darifenacin hydrobromide tab er 24hr15 mg (base equiv) (Enablex)

QL, 90

flavoxate hcl tab 100 mg 90

oxybutynin chloride syrup 5 mg/5ml QL, 90

oxybutynin chloride tab er 24hr 5 mg(Ditropan xl)

QL, 90


QL, 90


QL, 90

Name of Drug


oxybutynin chloride tab 5 mg QL, 90

tolterodine tartrate tab 2 mg (Detrol) QL, 90

trospium chloride cap er 24hr 60 mg QL, 90

trospium chloride tab 20 mg QL, 90

VAGINAL PRODUCTSclindamycin phosphate vaginal cream 2%

(Cleocin)

estradiol vaginal tab 10 mcg (Vagifem) 90

metronidazole vaginal gel 0.75%(Metrogel-vaginal)

terconazole vaginal cream 0.4% (Terazol 7)

terconazole vaginal cream 0.8% (Terazol 3)

terconazole vaginal suppos 80 mg

OTHER GENITOURINARY DRUGSacetic acid irrigation soln 0.25%

alfuzosin hcl tab er 24hr 10 mg (Uroxatral) QL, 90

CYSTAGON - cysteamine bitartrate cap50 mg

PA, SP, 90

CYSTAGON - cysteamine bitartrate cap150 mg

PA, SP, 90

dutasteride cap 0.5 mg (Avodart) QL, 90

dutasteride-tamsulosin hcl cap 0.5-0.4 mg(Jalyn)

QL, 90

finasteride tab 5 mg (Proscar) QL, 90

glycine irrigation soln 1.5%

neomycin-polymyxin b gu irrigation soln(Neosporin gu irrigan)

phenazopyridine hcl tab 100 mg (Pyridium)

phenazopyridine hcl tab 200 mg (Pyridium)

pot & sod citrates w/ cit ac soln550-500-334 mg/5ml

potassium citrate & citric acid powder pack3300-1002 mg

potassium citrate & citric acid soln1100-334 mg/5ml

potassium citrate tab er 5 meq (540 mg)(Urocit-k 5)

2017


28

Name of Drug




PROCYSBI - cysteamine bitartrate capdelayed release 25 mg (base equiv)

PA, SP, 90

PROCYSBI - cysteamine bitartrate capdelayed release 75 mg (base equiv)

PA, SP, 90

sodium chloride irrigation soln 0.9%

sodium citrate & citric acid soln500-334 mg/5ml (Shohls solution modi)

tamsulosin hcl cap 0.4 mg (Flomax) QL, 90

CENTRAL NERVOUS SYSTEM DRUGSANXIETYALPRAZOLAM INTENSOL - alprazolam

conc 1 mg/mlQL

alprazolam tab er 24hr 0.5 mg (Xanax xr) QL

alprazolam tab er 24hr 1 mg (Xanax xr) QL



alprazolam tab 0.25 mg (Xanax) QL

alprazolam tab 0.5 mg (Xanax) QL

alprazolam tab 1 mg (Xanax) QL

alprazolam tab 2 mg (Xanax) QL

buspirone hcl tab 5 mg




chlordiazepoxide hcl cap 5 mg QL



clorazepate dipotassium tab 3.75 mg QL

clorazepate dipotassium tab 7.5 mg(Tranxene t)

QL

clorazepate dipotassium tab 15 mg QL

DIAZEPAM - diazepam im solution auto-inj10 mg/2ml

PA

Name of Drug


DIAZEPAM - diazepam oral soln 1 mg/ml QL

diazepam conc 5 mg/ml QL

diazepam tab 2 mg (Valium) QL



hydroxyzine hcl syrup 10 mg/5ml

hydroxyzine hcl tab 10 mg



hydroxyzine pamoate cap 25 mg (Vistaril)

hydroxyzine pamoate cap 50 mg (Vistaril)

lorazepam conc 2 mg/ml QL

lorazepam tab 0.5 mg (Ativan) QL

lorazepam tab 1 mg (Ativan) QL

lorazepam tab 2 mg (Ativan) QL

DEPRESSIONamitriptyline hcl tab 10 mg 90

amitriptyline hcl tab 25 mg (Elavil) 90

amitriptyline hcl tab 50 mg 90




AMOXAPINE - amoxapine tab 25 mg PA, 90




APLENZIN - bupropion hbr tab er 24hr174 mg

PA, QL, 90


PA, QL, 90


PA, QL, 90

BRINTELLIX - vortioxetine hbr tab 5 mg(base equiv)

QL, 90


QL, 90

2017


29

Name of Drug



QL, 90

bupropion hcl tab er 12hr 100 mg(Wellbutrin sr)

QL, 90


QL, 90


QL, 90

bupropion hcl tab er 24hr 150 mg(Wellbutrin xl)

QL, 90

bupropion hcl tab er 24hr 300 mg(Wellbutrin xl)

QL, 90

bupropion hcl tab 75 mg QL, 90

bupropion hcl tab 100 mg QL, 90

citalopram hydrobromide oral soln10 mg/5ml

QL, 90

citalopram hydrobromide tab 10 mg (baseequiv) (Celexa)

QL, 90


QL, 90


QL, 90

desipramine hcl tab 10 mg (Norpramin) 90

desipramine hcl tab 25 mg (Norpramin) 90

desipramine hcl tab 50 mg 90




doxepin hcl cap 10 mg 90






doxepin hcl conc 10 mg/ml 90

duloxetine hcl enteric coated pellets cap20 mg (base eq) (Cymbalta)

QL, 90

Name of Drug



QL, 90


QL, 90

EMSAM - selegiline td patch 24hr6 mg/24hr

PA, 90


PA, 90


PA, 90

escitalopram oxalate soln 5 mg/5ml (baseequiv) (Lexapro)

QL, 90

escitalopram oxalate tab 5 mg (base equiv)(Lexapro)

QL, 90

escitalopram oxalate tab 10 mg (baseequiv) (Lexapro)

QL, 90

escitalopram oxalate tab 20 mg (baseequiv) (Lexapro)

QL, 90

FETZIMA - levomilnacipran hcl cap er 24hr20 mg (base equivalent)

PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90

FETZIMA TITRATION PACK -levomilnacipran hcl cap er 24hr 20 &40 mg therapy pack

PA, QL, 90

fluoxetine hcl cap 10 mg (Prozac) QL, 90



fluoxetine hcl solution 20 mg/5ml QL, 90

fluoxetine hcl tab 10 mg QL, 90

fluoxetine hcl tab 20 mg QL, 90

fluvoxamine maleate tab 25 mg QL, 90



2017


30

Name of Drug


FORFIVO XL - bupropion hcl tab er 24hr450 mg

PA, QL, 90

imipramine hcl tab 10 mg (Tofranil) 90



MAPROTILINE HCL - maprotiline hcl tab25 mg

PA, QL, 90


PA, QL, 90


PA, QL, 90

MARPLAN - isocarboxazid tab 10 mg PA, 90

mirtazapine tab 15 mg (Remeron) QL, 90



NEFAZODONE HCL - nefazodone hcl tab100 mg

PA, 90


PA, 90


PA, 90

nortriptyline hcl cap 10 mg (Pamelor) 90




paroxetine hcl tab 10 mg (Paxil) QL, 90




PAXIL - paroxetine hcl oral susp 10 mg/5ml(base equiv)

PA, QL, 90

PEXEVA - paroxetine mesylate tab 10 mg(base equiv)

PA, QL, 90


PA, QL, 90


PA, QL, 90

Name of Drug



PA, QL, 90

sertraline hcl oral conc 20 mg/ml (Zoloft) QL, 90

sertraline hcl tab 25 mg (Zoloft) QL, 90



trazodone hcl tab 50 mg 90



venlafaxine hcl cap er 24hr 37.5 mg (baseequivalent) (Effexor xr)

QL, 90

venlafaxine hcl cap er 24hr 75 mg (baseequivalent) (Effexor xr)

QL, 90

venlafaxine hcl cap er 24hr 150 mg (baseequivalent) (Effexor xr)

QL, 90

venlafaxine hcl tab 25 mg QL, 90

venlafaxine hcl tab 37.5 mg QL, 90




VIIBRYD - vilazodone hcl tab 10 mg PA, QL, 90



VIIBRYD STARTER PACK - vilazodone hcltab starter kit 10 (7) & 20 (23) mg

PA, QL, 90

PSYCHOTIC AND BIPOLAR DISORDERSABILIFY MAINTENA - aripiprazole im for er

susp prefilled syringe 300 mgPA, QL

ABILIFY MAINTENA - aripiprazole im for ersusp prefilled syringe 400 mg

PA, QL

ABILIFY MAINTENA - aripiprazole im forextended release susp 300 mg

PA, QL

ABILIFY MAINTENA - aripiprazole im forextended release susp 400 mg

PA, QL

ADASUVE - loxapine aerosol powderbreath activated 10 mg

PA, QL

aripiprazole oral solution 1 mg/ml PA, QL, 90

2017


31

Name of Drug


aripiprazole orally disintegrating tab 15 mg AL, PA,QL, 90

aripiprazole tab 2 mg (Abilify) AL, PA,QL, 90






ARISTADA - aripiprazole lauroxil im ersusp prefilled syr 441 mg/1.6ml

PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90

CHLORPROMAZINE HCL -chlorpromazine hcl inj 50 mg/2ml

PA

CLOZAPINE ODT - clozapine orallydisintegrating tab 12.5 mg

PA, QL

clozapine orally disintegrating tab 25 mg(Fazaclo)

PA, QL

clozapine orally disintegrating tab 100 mg(Fazaclo)

PA, QL

clozapine tab 25 mg (Clozaril) AL, PA, QL

clozapine tab 50 mg AL, PA, QL

clozapine tab 100 mg (Clozaril) AL, PA, QL

clozapine tab 200 mg AL, PA, QL

EQUETRO - carbamazepine(antipsychotic) cap er 12hr 100 mg

PA, 90


PA, 90

Name of Drug



PA, 90

FANAPT - iloperidone tab 1 mg PA, QL, 90







FANAPT TITRATION PACK - iloperidonetab 1 mg & 2 mg & 4 mg & 6 mg titrationpak

PA, QL

FAZACLO - clozapine orally disintegratingtab 12.5 mg

PA, QL

FAZACLO - clozapine orally disintegratingtab 150 mg

PA, QL

FAZACLO - clozapine orally disintegratingtab 200 mg

PA, QL

FLUPHENAZINE HCL - fluphenazine hclelixir 2.5 mg/5ml

PA, 90

FLUPHENAZINE HCL - fluphenazine hcloral conc 5 mg/ml

PA, 90

FLUPHENAZINE HCL - fluphenazine hclinj 2.5 mg/ml

PA

fluphenazine hcl tab 1 mg 90

fluphenazine hcl tab 2.5 mg 90



GEODON - ziprasidone mesylate for inj20 mg (base equivalent)

PA, QL

haloperidol lactate oral conc 2 mg/ml AL, PA, 90

haloperidol tab 0.5 mg AL, PA, 90

haloperidol tab 1 mg AL, PA, 90





2017


32

Name of Drug


INVEGA - paliperidone tab er 24hr 1.5 mg PA, QL, 90

INVEGA - paliperidone tab er 24hr 3 mg PA, QL, 90



INVEGA SUSTENNA - paliperidonepalmitate im extended-release susp39 mg/0.25ml

PA, QL


PA, QL

INVEGA SUSTENNA - paliperidonepalmitate im extend-release susp117 mg/0.75ml

PA, QL

INVEGA SUSTENNA - paliperidonepalmitate im extended-release susp156 mg/ml

PA, QL


PA, QL

INVEGA TRINZA - paliperidone palmitateim extend-release susp 273 mg/0.875ml

PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90

LATUDA - lurasidone hcl tab 20 mg PA, QL, 90





LITHIUM - lithium oral solution 8 meq/5ml PA, 90

lithium carbonate cap 150 mg (Lithiumcarbonate)

90

lithium carbonate cap 300 mg 90

lithium carbonate cap 600 mg (Lithiumcarbonate)

90

lithium carbonate tab er 300 mg (Lithobid) 90

Name of Drug


lithium carbonate tab er 450 mg 90

lithium carbonate tab 300 mg 90

loxapine succinate cap 5 mg AL, PA, 90




MOLINDONE HYDROCHLORIDE -molindone hcl tab 5 mg

90


90


90

olanzapine orally disintegrating tab 5 mg(Zyprexa zydis)

AL, PA,QL, 90


AL, PA,QL, 90


AL, PA,QL, 90


AL, PA,QL, 90

olanzapine tab 2.5 mg (Zyprexa) AL, PA,QL, 90

olanzapine tab 5 mg (Zyprexa) AL, PA,QL, 90

olanzapine tab 7.5 mg (Zyprexa) AL, PA,QL, 90




paliperidone tab er 24hr 1.5 mg (Invega) PA, QL, 90

paliperidone tab er 24hr 3 mg (Invega) PA, QL, 90



perphenazine tab 2 mg AL, PA, 90


2017


33

Name of Drug




quetiapine fumarate tab er 24hr 400 mg(Seroquel xr)

PA, QL, 90

quetiapine fumarate tab 25 mg (Seroquel) AL, PA,QL, 90






REXULTI - brexpiprazole tab 0.25 mg PA, QL, 90

REXULTI - brexpiprazole tab 0.5 mg PA, QL, 90

REXULTI - brexpiprazole tab 1 mg PA, QL, 90




RISPERDAL CONSTA - risperidonemicrospheres for inj 12.5 mg

PA

RISPERDAL CONSTA - risperidonemicrospheres for inj 25 mg

PA

RISPERDAL CONSTA - risperidonemicrospheres for inj 37.5 mg

PA

RISPERDAL CONSTA - risperidonemicrospheres for inj 50 mg

PA

RISPERIDONE ODT - risperidone orallydisintegrating tab 0.25 mg

AL, QL, 90

risperidone orally disintegrating tab0.25 mg

AL, PA,QL, 90

risperidone orally disintegrating tab 0.5 mg(Risperdal m-tab)

AL, PA,QL, 90

risperidone orally disintegrating tab 1 mg(Risperdal m-tab)

AL, PA,QL, 90

Name of Drug



AL, PA,QL, 90


AL, PA,QL, 90


AL, PA,QL, 90

risperidone soln 1 mg/ml (Risperdal) AL, PA,QL, 90

risperidone tab 0.25 mg (Risperdal) AL, PA,QL, 90

risperidone tab 0.5 mg (Risperdal) AL, PA,QL, 90

risperidone tab 1 mg (Risperdal) AL, PA,QL, 90




SAPHRIS - asenapine maleate sl tab2.5 mg (base equiv)

PA, QL, 90

SAPHRIS - asenapine maleate sl tab 5 mg(base equiv)

PA, QL, 90

SAPHRIS - asenapine maleate sl tab10 mg (base equiv)

PA, QL, 90

thioridazine hcl tab 10 mg AL, PA, 90




thiothixene cap 1 mg AL, PA, 90




trifluoperazine hcl tab 1 mg (baseequivalent)

AL, PA, 90


AL, PA, 90

2017


34

Name of Drug



AL, PA, 90


AL, PA, 90

VERSACLOZ - clozapine susp 50 mg/ml PA, QL

ziprasidone hcl cap 20 mg (Geodon) AL, PA,QL, 90




ZYPREXA RELPREVV - olanzapinepamoate for extended rel im susp210 mg (base eq)

PA, QL


PA, QL


PA, QL

SLEEP AIDSdiphenhydramine hcl (sleep) cap 50 mg QL

diphenhydramine hcl (sleep) tab 25 mg QL

estazolam tab 1 mg QL

estazolam tab 2 mg QL

eszopiclone tab 1 mg (Lunesta) QL



PHENOBARBITAL - phenobarbital tab15 mg

90


90


90


90

phenobarbital elixir 20 mg/5ml 90

Name of Drug


phenobarbital tab 16.2 mg 90




QUAZEPAM - quazepam tab 15 mg QL

temazepam cap 15 mg (Restoril) QL

temazepam cap 30 mg (Restoril) QL

zaleplon cap 5 mg (Sonata) QL

zaleplon cap 10 mg (Sonata) QL

zolpidem tartrate tab 5 mg (Ambien) QL

zolpidem tartrate tab 10 mg (Ambien) QL

HYPERACTIVITY/NARCOLEPSYamphetamine-dextroamphetamine cap er

24hr 5 mg (Adderall xr)PA, QL, 90

amphetamine-dextroamphetamine cap er24hr 10 mg (Adderall xr)

PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90

amphetamine-dextroamphetamine tab5 mg (Adderall)

PA, QL, 90

amphetamine-dextroamphetamine tab7.5 mg (Adderall)

PA, QL, 90


PA, QL, 90

amphetamine-dextroamphetamine tab12.5 mg (Adderall)

PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90

2017


35

Name of Drug


armodafinil tab 50 mg (Nuvigil) PA, QL, 90



caffeine citrate oral soln 60 mg/3ml (10 mg/ml base equiv)

clonidine hcl tab er 12hr 0.1 mg (Kapvay) QL, 90

dexmethylphenidate hcl cap er 24 hr 5 mg(Focalin xr)

PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90

dexmethylphenidate hcl tab 2.5 mg(Focalin)

PA, QL, 90

dexmethylphenidate hcl tab 5 mg (Focalin) PA, QL, 90

dexmethylphenidate hcl tab 10 mg(Focalin)

PA, QL, 90

dextroamphetamine sulfate cap er 24hr5 mg (Dexedrine)

PA, QL, 90


PA, QL, 90


PA, QL, 90

dextroamphetamine sulfate oral solution5 mg/5ml (Procentra)

PA, QL, 90

dextroamphetamine sulfate tab 5 mg PA, QL, 90

dextroamphetamine sulfate tab 10 mg PA, QL, 90

guanfacine hcl tab er 24hr 1 mg (baseequiv) (Intuniv)

QL, 90


QL, 90


QL, 90

Name of Drug



QL, 90

methylphenidate hcl cap er 10 mg (cd) PA, QL, 90






methylphenidate hcl cap er 24hr 20 mg (la)(Ritalin la)

PA, QL, 90


PA, QL, 90


PA, QL, 90

METHYLPHENIDATE HCL ER -methylphenidate hcl tab er 24hr 18 mg

PA, QL, 90


PA, QL, 90


PA, QL, 90


PA, QL, 90

methylphenidate hcl soln 5 mg/5ml(Methylin)

PA, QL, 90

methylphenidate hcl soln 10 mg/5ml(Methylin)

PA, QL, 90

methylphenidate hcl tab er 10 mg PA, QL, 90

methylphenidate hcl tab er 20 mg PA, QL, 90

methylphenidate hcl tab 5 mg (Ritalin) PA, QL, 90



modafinil tab 100 mg (Provigil) PA, QL, 90

modafinil tab 200 mg (Provigil) PA, QL, 90

MULTIPLE SCLEROSISAUBAGIO - teriflunomide tab 7 mg PA, QL,

SP, 90

AUBAGIO - teriflunomide tab 14 mg PA, QL,SP, 90

2017


36

Name of Drug


AVONEX - interferon beta-1a im prefilledsyringe kit 30 mcg/0.5ml

PA, QL,SP, 90

AVONEX - interferon beta-1a for im inj kit30mcg (33mcg(6.6 mu)/vial)

PA, QL,SP, 90

AVONEX PEN - interferon beta-1a im auto-injector kit 30 mcg/0.5ml

PA, QL,SP, 90

EXTAVIA - interferon beta-1b for inj kit0.3 mg

PA, QL,SP, 90

glatiramer acetate soln prefilled syringe20 mg/ml (Glatopa)

PA, QL,SP, 90

glatiramer acetate soln prefilled syringe40 mg/ml (Copaxone)

PA, QL,SP, 90

OTHER CENTRAL NERVOUS SYSTEM DRUGSacamprosate calcium tab delayed release

333 mg90

bupropion hcl (smoking deterrent) tab er12hr 150 mg (Zyban)

QL

CHANTIX - varenicline tartrate tab 0.5 mg(base equiv)

QL

CHANTIX - varenicline tartrate tab 1 mg(base equiv)

QL

CHANTIX CONTINUING MONTH -varenicline tartrate tab 1 mg (base equiv)

QL

CHANTIX STARTING MONTH PA -varenicline tartrate tab 0.5 mg x 11 & tab1 mg x 42 pack

QL

CHLORDIAZEPOXIDE/AMITRIPT -chlordiazepoxide-amitriptyline tab5-12.5 mg

QL, 90

CHLORDIAZEPOXIDE/AMITRIPT -chlordiazepoxide-amitriptyline tab10-25 mg

QL, 90

disulfiram tab 250 mg (Antabuse) 90

disulfiram tab 500 mg (Antabuse) 90

donepezil hydrochloride orallydisintegrating tab 5 mg

QL, 90

donepezil hydrochloride orallydisintegrating tab 10 mg

QL, 90

donepezil hydrochloride tab 5 mg (Aricept) QL, 90

Name of Drug


donepezil hydrochloride tab 10 mg(Aricept)

QL, 90

GALANTAMINE HYDROBROMIDE- galantamine hydrobromide oral soln4 mg/ml

QL, 90

galantamine hydrobromide cap er 24hr8 mg (Razadyne er)

QL, 90


QL, 90


QL, 90

galantamine hydrobromide tab 4 mg(Razadyne)

QL, 90


QL, 90


QL, 90

memantine hcl oral solution 2 mg/ml(Namenda)

QL, 90

memantine hcl tab 5 mg (Namenda) QL, 90

memantine hcl tab 10 mg (Namenda) QL, 90

memantine hcl tab 5 mg (28) & 10 mg (21)titration pak (Namenda titration pa)

QL

nicotine polacrilex gum 2 mg QL

nicotine polacrilex gum 4 mg QL

nicotine polacrilex lozenge 2 mg QL

nicotine polacrilex lozenge 4 mg QL

nicotine td patch 24hr 7 mg/24hr QL



NICOTROL INHALER - nicotine inhalersystem 10 mg (4 mg delivered)

QL

NICOTROL NS - nicotine nasal spray10 mg/ml (0.5 mg/spray)

QL

PERPHENAZINE/AMITRIPTYLIN -perphenazine-amitriptyline tab 2-10 mg

PA, 90


PA, 90

2017


37

Name of Drug



PA, 90


PA, 90


PA, 90

pimozide tab 1 mg (Orap) 90

pimozide tab 2 mg (Orap) 90

rivastigmine tartrate cap 4.5 mg (Exelon) QL, 90

PAIN RELIEF DRUGSNON-NARCOTIC DRUGSacetaminophen susp 160 mg/5ml

acetaminophen tab er 650 mg

acetaminophen tab 325 mg

acetaminophen tab 500 mg

aspirin chew tab 81 mg 90

aspirin tab delayed release 81 mg 90

aspirin-acetaminophen-caffeine tab250-250-65 mg

butalbital-acetaminophen tab 50-325 mg QL

butalbital-acetaminophen-caffeine cap50-300-40 mg (Fioricet)

QL

butalbital-acetaminophen-caffeine tab50-325-40 mg (Esgic)

QL

butalbital-aspirin-caffeine cap50-325-40 mg (Fiorinal)

QL

NARCOTIC DRUGSacetaminophen w/ codeine soln

120-12 mg/5mlME, QL

acetaminophen w/ codeine tab 300-15 mg(Tylenol/codeine)

ME, QL

acetaminophen w/ codeine tab 300-30 mg(Tylenol/codeine #3)

ME, QL

acetaminophen w/ codeine tab 300-60 mg(Tylenol/codeine #4)

ME, QL

ACETAMINOPHEN/CAFFEINE/DI -acetaminophen-caffeine-dihydrocodeinecap 320.5-30-16 mg

ME, QL

Name of Drug


buprenorphine hcl sl tab 2 mg (base equiv) QL

buprenorphine hcl sl tab 8 mg (base equiv) QL

buprenorphine hcl-naloxone hcl sl tab2-0.5 mg (base equiv)

QL

buprenorphine hcl-naloxone hcl sl tab8-2 mg (base equiv)

QL

butalbital-acetaminophen-caff w/ cod cap50-325-40-30 mg

ME, QL

butalbital-aspirin-caff w/ codeine cap50-325-40-30 mg (Fiorinal/codeine #3)

ME, QL

butorphanol tartrate nasal soln 10 mg/ml ME, QL

codeine sulfate tab 15 mg (Codeinesulfate)

ME, QL


ME, QL


ME, QL

fentanyl td patch 72hr 12 mcg/hr(Duragesic)

ME, QL


ME, QL


ME, QL


ME, QL


ME, QL

hydrocodone-acetaminophen soln7.5-325 mg/15ml (Hycet)

ME, QL

hydrocodone-acetaminophen soln10-325 mg/15ml (Zamicet)

ME, QL

hydrocodone-acetaminophen tab2.5-325 mg

ME, QL

hydrocodone-acetaminophen tab10-325 mg (Norco)

ME, QL

hydrocodone-acetaminophen tab7.5-300 mg (Xodol)

ME, QL

hydrocodone-acetaminophen tab 5-325 mg(Norco)

ME, QL

2017


38

Name of Drug


hydrocodone-acetaminophen tab7.5-325 mg (Norco)

ME, QL

hydrocodone-acetaminophen tab10-300 mg (Xodol)

ME, QL

hydrocodone-ibuprofen tab 5-200 mg(Reprexain)

ME, QL

hydrocodone-ibuprofen tab 7.5-200 mg ME, QL

hydromorphone hcl liqd 1 mg/ml (Dilaudid) ME, QL

hydromorphone hcl tab 2 mg (Dilaudid) ME, QL



methadone hcl conc 10 mg/ml (Methadose) ME, QL

methadone hcl soln 5 mg/5ml (Methadonehcl)

ME, QL

methadone hcl soln 10 mg/5ml (Methadonehcl)

ME, QL

methadone hcl tab for oral susp 40 mg ME, QL

methadone hcl tab 5 mg (Dolophine) ME, QL

methadone hcl tab 10 mg (Dolophine) ME, QL

MORPHINE SULFATE - morphine sulfatetab 15 mg

ME, QL

MORPHINE SULFATE - morphine sulfatetab 30 mg

ME, QL

MORPHINE SULFATE - morphine sulfatesuppos 5 mg

ME


ME


ME


ME

morphine sulfate cap er 24hr 100 mg(Kadian)

ME, QL

MORPHINE SULFATE ER - morphinesulfate beads cap er 24hr 60 mg

ME, QL


ME, QL


ME, QL

Name of Drug


morphine sulfate oral soln 10 mg/5ml ME, QL

morphine sulfate oral soln 20 mg/5ml ME, QL

morphine sulfate oral soln 100 mg/5ml(20 mg/ml)

ME, QL

morphine sulfate tab er 15 mg (Ms contin) ME, QL





oxycodone hcl conc 100 mg/5ml (20 mg/ml)

ME, QL

oxycodone hcl soln 5 mg/5ml ME, QL

oxycodone hcl tab 5 mg (Roxicodone) ME, QL

oxycodone hcl tab 10 mg ME, QL


oxycodone hcl tab 20 mg ME, QL


oxycodone w/ acetaminophen tab2.5-325 mg (Percocet)

ME, QL

oxycodone w/ acetaminophen tab5-325 mg (Percocet)

ME, QL

oxycodone w/ acetaminophen tab7.5-325 mg (Percocet)

ME, QL

oxycodone w/ acetaminophen tab10-325 mg (Percocet)

ME, QL

oxycodone-aspirin tab 4.8355-325 mg ME, QL

OXYCODONE/ACETAMINOPHEN -oxycodone w/ acetaminophen soln5-325 mg/5ml

ME, QL

OXYCODONE/IBUPROFEN - oxycodone-ibuprofen tab 5-400 mg

ME, QL

oxymorphone hcl tab er 12hr 5 mg ME, QL

oxymorphone hcl tab er 12hr 7.5 mg ME, QL





2017


39

Name of Drug



oxymorphone hcl tab 5 mg (Opana) ME, QL

oxymorphone hcl tab 10 mg (Opana) ME, QL

SUBOXONE - buprenorphine hcl-naloxonehcl sl film 2-0.5 mg (base equiv)

QL

SUBOXONE - buprenorphine hcl-naloxonehcl sl film 4-1 mg (base equiv)

QL


QL


QL

tramadol hcl tab 50 mg (Ultram) ME, QL

tramadol-acetaminophen tab 37.5-325 mg(Ultracet)

ME, QL

RHEUMATOID AND OSTEOARTHRITISARCALYST - rilonacept for inj 220 mg PA, QL,

SP, 90

celecoxib cap 50 mg (Celebrex) QL, ST, 90



celecoxib cap 400 mg (Celebrex) QL, ST

diclofenac potassium tab 50 mg QL, 90

diclofenac sodium tab delayed release50 mg

QL, 90

diclofenac sodium tab delayed release75 mg

QL, 90

diclofenac sodium tab er 24hr 100 mg QL, 90

ENBREL - etanercept for subcutaneous inj25 mg

PA, QL,SP, 90

ENBREL - etanercept subcutaneous solnprefilled syringe 25 mg/0.5ml

PA, QL,SP, 90

ENBREL - etanercept subcutaneous solnprefilled syringe 50 mg/ml

PA, QL,SP, 90

ENBREL SURECLICK - etanerceptsubcutaneous solution auto-injector50 mg/ml

PA, QL,SP, 90

flurbiprofen tab 50 mg QL, 90

flurbiprofen tab 100 mg QL, 90

Name of Drug


HUMIRA - adalimumab prefilled syringe kit10 mg/0.2ml

PA, QL,SP, 90


PA, QL,SP, 90


PA, QL,SP, 90

HUMIRA PEDIATRIC CROHNS D- adalimumab prefilled syringe kit40 mg/0.8ml

PA, QL,SP, 90

HUMIRA PEN - adalimumab pen-injectorkit 40 mg/0.8ml

PA, QL,SP, 90

HUMIRA PEN-CROHNS DISEASE -adalimumab pen-injector kit 40 mg/0.8ml

PA, QL,SP, 90

HUMIRA PEN-PSORIASIS STAR -adalimumab pen-injector kit 40 mg/0.8ml

PA, QL,SP, 90

ibuprofen cap 200 mg 90

ibuprofen chew tab 100 mg 90

ibuprofen susp 40 mg/ml

ibuprofen susp 100 mg/5ml QL

ibuprofen tab 200 mg 90

ibuprofen tab 400 mg QL, 90



indomethacin cap er 75 mg QL, 90

indomethacin cap 25 mg QL, 90

indomethacin cap 50 mg QL, 90

ketoprofen cap 50 mg QL, 90

ketoprofen cap 75 mg QL, 90

ketorolac tromethamine tab 10 mg QL

KINERET - anakinra subcutaneous solnprefilled syringe 100 mg/0.67ml

PA, QL,SP, 90

leflunomide tab 10 mg (Arava) 90

leflunomide tab 20 mg (Arava) 90

meloxicam tab 7.5 mg (Mobic) QL, 90

meloxicam tab 15 mg (Mobic) QL, 90

nabumetone tab 500 mg QL, 90

nabumetone tab 750 mg QL, 90

2017


40

Name of Drug


NAPROXEN - naproxen susp 125 mg/5ml QL, 90

naproxen sodium tab er 24hr 375 mg (baseequiv) (Naprelan)

QL, 90

naproxen sodium tab 220 mg 90

naproxen sodium tab 275 mg QL, 90

naproxen sodium tab 550 mg (Anaprox ds) QL, 90

naproxen susp 125 mg/5ml (Naprosyn) QL, 90

naproxen tab ec 375 mg (Ec-naprosyn) QL, 90

naproxen tab ec 500 mg (Ec-naprosyn) QL, 90

naproxen tab 250 mg QL, 90

naproxen tab 375 mg QL, 90

naproxen tab 500 mg (Naprosyn) QL, 90

ORENCIA - abatacept subcutaneous solnprefilled syringe 125 mg/ml

PA, QL,SP, 90

ORENCIA CLICKJECT - abataceptsubcutaneous soln auto-injector 125 mg/ml

PA, QL,SP, 90

piroxicam cap 10 mg (Feldene) QL, 90

piroxicam cap 20 mg (Feldene) QL, 90

SIMPONI - golimumab subcutaneous solnauto-injector 50 mg/0.5ml

PA, QL,SP, 90

SIMPONI - golimumab subcutaneous solnauto-injector 100 mg/ml

PA, QL,SP, 90

SIMPONI - golimumab subcutaneous solnprefilled syringe 50 mg/0.5ml

PA, QL,SP, 90

SIMPONI - golimumab subcutaneous solnprefilled syringe 100 mg/ml

PA, QL,SP, 90

sulindac tab 150 mg QL, 90

sulindac tab 200 mg QL, 90

XELJANZ - tofacitinib citrate tab 5 mg(base equivalent)

PA, QL,SP, 90

XELJANZ XR - tofacitinib citrate tab er24hr 11 mg (base equivalent)

PA, QL,SP, 90

MIGRAINE HEADACHESalmotriptan malate tab 6.25 mg (Axert) QL

almotriptan malate tab 12.5 mg (Axert) QL

Name of Drug


frovatriptan succinate tab 2.5 mg (baseequivalent) (Frova)

QL

IMITREX - sumatriptan nasal spray 5 mg/act

QL

IMITREX - sumatriptan nasal spray 20 mg/act

QL

rizatriptan benzoate oral disintegrating tab5 mg (base eq) (Maxalt-mlt)

QL

rizatriptan benzoate oral disintegrating tab10 mg (base eq) (Maxalt-mlt)

QL

rizatriptan benzoate tab 5 mg (baseequivalent) (Maxalt)

QL

rizatriptan benzoate tab 10 mg (baseequivalent) (Maxalt)

QL

sumatriptan nasal spray 5 mg/act (Imitrex) QL

sumatriptan nasal spray 20 mg/act (Imitrex) QL

SUMATRIPTAN SUCCINATE - sumatriptansuccinate solution prefilled syringe6 mg/0.5ml

QL

sumatriptan succinate inj 6 mg/0.5ml(Imitrex)

QL

sumatriptan succinate solution auto-injector4 mg/0.5ml (Imitrex statdose sys)

QL

sumatriptan succinate solution auto-injector6 mg/0.5ml (Imitrex statdose sys)

QL

sumatriptan succinate solution cartridge4 mg/0.5ml (Imitrex statdose ref)

QL

sumatriptan succinate solution cartridge6 mg/0.5ml (Imitrex statdose ref)

QL

sumatriptan succinate tab 25 mg (Imitrex) QL



GOUTallopurinol tab 100 mg (Zyloprim) 90

allopurinol tab 300 mg (Zyloprim) 90

colchicine w/ probenecid tab 0.5-500 mg 90

COLCRYS - colchicine tab 0.6 mg

probenecid tab 500 mg 90

2017


41

Name of Drug


NEUROMUSCULAR DRUGSSEIZURESAPTIOM - eslicarbazepine acetate tab

200 mg90

APTIOM - eslicarbazepine acetate tab400 mg

90


90


90

carbamazepine cap er 12hr 100 mg(Carbatrol)

90


90


90

carbamazepine chew tab 100 mg 90

carbamazepine susp 100 mg/5ml(Tegretol)

90

carbamazepine tab er 12hr 100 mg(Tegretol-xr)

90


90


90

carbamazepine tab 200 mg (Tegretol) 90

clonazepam orally disintegrating tab0.125 mg

QL, 90


QL, 90


QL, 90

clonazepam orally disintegrating tab 1 mg QL, 90

clonazepam orally disintegrating tab 2 mg QL, 90

clonazepam tab 0.5 mg (Klonopin) QL, 90

clonazepam tab 1 mg (Klonopin) QL, 90

clonazepam tab 2 mg (Klonopin) QL, 90

DIAZEPAM - diazepam rectal gel deliverysystem 2.5 mg

QL

Name of Drug


DIAZEPAM - diazepam rectal gel deliverysystem 10 mg

QL

DIAZEPAM - diazepam rectal gel deliverysystem 20 mg

QL

DILANTIN - phenytoin sodium extendedcap 30 mg

90

divalproex sodium cap delayed releasesprinkle 125 mg (Depakote sprinkles)

90

divalproex sodium tab delayed release125 mg (Depakote)

90


90


90

divalproex sodium tab er 24 hr 250 mg(Depakote er)

90

divalproex sodium tab er 24 hr 500 mg(Depakote er)

90

ethosuximide cap 250 mg (Zarontin) 90

ethosuximide soln 250 mg/5ml (Zarontin) 90

felbamate susp 600 mg/5ml (Felbatol) 90

felbamate tab 400 mg (Felbatol) 90

felbamate tab 600 mg (Felbatol) 90

gabapentin cap 100 mg (Neurontin) QL, 90



gabapentin oral soln 250 mg/5ml(Neurontin)

QL, 90

gabapentin tab 600 mg (Neurontin) QL, 90

gabapentin tab 800 mg (Neurontin) QL, 90

LAMICTAL STARTER/NOT TAKI -lamotrigine tab 25 mg (42) & 100 mg (7)starter kit

PA

LAMICTAL STARTER/TAKING C -lamotrigine tab 25 mg (84) & 100 mg (14)starter kit

PA

LAMICTAL STARTER/TAKING V -lamotrigine tab 25 mg (35) starter kit

PA

2017


42

Name of Drug


LAMICTAL XR - lamotrigine tab er 24hr25 mg (21) & 50 mg (7) titration kit

PA

LAMICTAL XR - lamotrigine tab er 24hr 25(14) & 50 mg (14) & 100 mg(7) kit

PA

LAMICTAL XR - lamotrigine tab er 24hr 50(14) & 100 mg(14) & 200 mg(7) kit

PA

lamotrigine tab chewable dispersible 5 mg(Lamictal chewable di)

90

lamotrigine tab chewable dispersible 25 mg(Lamictal chewable di)

90

lamotrigine tab disint 25 mg (21) & 50 mg(7) titration kit (Lamictal odt)

PA

lamotrigine tab disint 50 mg (42)-100 mg(14) titration kit (Lamictal odt)

PA

lamotrigine tab disint 25 (14) & 50 mg (14)& 100 mg (7) kit (Lamictal odt)

PA

lamotrigine tab er 24hr 25 mg (Lamictal xr) 90

lamotrigine tab er 24hr 50 mg (Lamictal xr) 90

lamotrigine tab er 24hr 100 mg (Lamictalxr)

90


90


90


90

lamotrigine tab 25 mg (Lamictal) 90




levetiracetam oral soln 100 mg/ml (Keppra) 90

levetiracetam tab er 24hr 500 mg (Keppraxr)

90

levetiracetam tab er 24hr 750 mg (Keppraxr)

90

levetiracetam tab 250 mg (Keppra) 90



Name of Drug



oxcarbazepine susp 300 mg/5ml (60 mg/ml) (Trileptal)

90

oxcarbazepine tab 150 mg (Trileptal) 90



OXTELLAR XR - oxcarbazepine tab er24hr 150 mg

PA, 90


PA, 90


PA, 90

phenytoin chew tab 50 mg (Dilantininfatabs)

90

phenytoin sodium extended cap 100 mg(Dilantin)

90

phenytoin sodium extended cap 200 mg(Phenytek)

90

phenytoin sodium extended cap 300 mg(Phenytek)

90

phenytoin susp 125 mg/5ml (Dilantin-125) 90

primidone tab 50 mg (Mysoline) 90

primidone tab 250 mg (Mysoline) 90

SABRIL - vigabatrin tab 500 mg SP, 90

tiagabine hcl tab 2 mg (Gabitril) 90

tiagabine hcl tab 4 mg (Gabitril) 90

topiramate sprinkle cap 15 mg (Topamaxsprinkle)

90

topiramate sprinkle cap 25 mg (Topamaxsprinkle)

90

topiramate tab 25 mg (Topamax) 90




valproic acid cap 250 mg (Depakene) 90

vigabatrin powd pack 500 mg (Sabril) SP, 90

zonisamide cap 25 mg (Zonegran) 90

2017


43

Name of Drug


zonisamide cap 50 mg 90

zonisamide cap 100 mg (Zonegran) 90

PARKINSON'S DISEASEamantadine hcl cap 100 mg 90

amantadine hcl syrup 50 mg/5ml 90

benztropine mesylate tab 0.5 mg 90

benztropine mesylate tab 1 mg 90

benztropine mesylate tab 2 mg 90

bromocriptine mesylate cap 5 mg (baseequivalent)

90

bromocriptine mesylate tab 2.5 mg (baseequivalent) (Parlodel)

90

carbidopa & levodopa orally disintegratingtab 10-100 mg

90


90


90

carbidopa & levodopa tab er 25-100 mg(Sinemet cr)

90

carbidopa & levodopa tab er 50-200 mg(Sinemet cr)

90

carbidopa & levodopa tab 10-100 mg(Sinemet)

90


90


90

carbidopa tab 25 mg (Lodosyn) 90

entacapone tab 200 mg (Comtan) 90

pramipexole dihydrochloride tab er 24hr2.25 mg (Mirapex er)

90

pramipexole dihydrochloride tab 0.125 mg(Mirapex)

90


90


90

Name of Drug



90

pramipexole dihydrochloride tab 1 mg(Mirapex)

90


90

ropinirole hydrochloride tab 0.25 mg(Requip)

90

ropinirole hydrochloride tab 0.5 mg(Requip)

90

ropinirole hydrochloride tab 1 mg (Requip) 90





selegiline hcl cap 5 mg (Eldepryl) 90

selegiline hcl tab 5 mg 90

tolcapone tab 100 mg (Tasmar) 90

trihexyphenidyl hcl elixir 0.4 mg/ml 90

trihexyphenidyl hcl tab 2 mg 90

trihexyphenidyl hcl tab 5 mg 90

MUSCLE RELAXANTSbaclofen tab 10 mg 90

baclofen tab 20 mg 90

carisoprodol tab 250 mg (Soma)

CHLORZOXAZONE - chlorzoxazone tab500 mg

cyclobenzaprine hcl tab 5 mg

cyclobenzaprine hcl tab 10 mg

dantrolene sodium cap 25 mg (Dantrium)

dantrolene sodium cap 50 mg (Dantrium)

dantrolene sodium cap 100 mg

methocarbamol tab 500 mg (Robaxin)

methocarbamol tab 750 mg (Robaxin-750)

orphenadrine citrate tab er 12hr 100 mg

tizanidine hcl tab 2 mg (base equivalent) QL, 90

2017


44

Name of Drug


tizanidine hcl tab 4 mg (base equivalent)(Zanaflex)

QL, 90

OTHER NEUROMUSCULAR DRUGSpyridostigmine bromide tab 60 mg

(Mestinon)

riluzole tab 50 mg (Rilutek) 90

SUPPLEMENTSVITAMINScholecalciferol tab 400 unit

cholecalciferol tab 1000 unit

ergocalciferol cap 50000 unit 90

MEPHYTON - phytonadione tab 5 mg

niacin tab 500 mg

MULTIVITAMINSb-complex w/ c & folic acid cap 1 mg

(Nephrocaps)

b-complex w/ c & folic acid tab

b-complex w/ c & folic acid tab 1 mg(Nephro-vite rx)

b-complex w/ c & folic acid tab 5 mg

CLASSIC PRENATAL - prenatal vit w/ fefumarate-fa tab 28-0.8 mg

EQL PRENATAL FORMULA - prenatal vitw/ fe fumarate-fa tab 28-0.8 mg

FOLBEE PLUS CZ - b-complex w/ c-biotin-minerals & folic acid tab 5 mg

GNP PRENATAL - prenatal vit w/ fefumarate-fa tab 28-0.8 mg

GOODSENSE PRENATAL VITAMI- prenatal vit w/ fe fumarate-fa tab28-0.8 mg

HM PRENATAL - prenatal vit w/ fefumarate-fa tab 28-0.8 mg

IMMUNE SUPPORT - multiple vitamins w/minerals chew tab

KP PRENATAL MULTIVITAMINS - prenatalvit w/ fe fumarate-fa tab 28-0.8 mg

Name of Drug


M-VIT - prenatal vit w/ fe fumarate-fa tab27-1 mg

MULTI PRENATAL - prenatal vit w/ fefumarate-fa tab 27-0.8 mg

multiple vitamins w/ minerals & fa tab1.25 mg (Corvite)

multiple vitamins w/ minerals cap

multiple vitamins w/ minerals chew tab

multiple vitamins w/ minerals tab (Stroviteforte)

NAT-RUL PRENATAL VITAMINS - prenatalvit w/ fe fumarate-fa tab 28-0.8 mg

NIVA-PLUS - prenatal vit w/ fe fumarate-fatab 27-1 mg

O-CAL FA - prenatal vit w/ fe fumarate-fatab 27-1 mg

pediatric multiple vitamin w/ minerals & cdrops 45 mg/ml

pediatric vitamins acd w/ fluoride soln0.25 mg/ml

PNV FOLIC ACID + IRON MUL - prenatalvit w/ fe fumarate-fa tab 27-1 mg

PNV PRENATAL PLUS MULTIVI - prenatalvit w/ fe fumarate-fa tab 27-1 mg

POLY-VI-FLOR - ped multiple vit w/fluoride biphasic chew tab 0.25 mg

POLY-VI-FLOR - ped multiple vit w/fluoride biphasic chew tab 0.5 mg

POLY-VI-FLOR - ped multiple vit w/fluoride biphasic chew tab 1 mg

PRE-NATAL FORMULA - prenatalmultivitamins & minerals w/iron & fa tab0.8 mg

PRENATAL - prenatal multivitamins &minerals w/iron & fa tab 0.8 mg

PRENATAL - prenatal vit w/ fe fumarate-fatab 27-0.8 mg

PRENATAL - prenatal vit w/ fe fumarate-fatab 27-1 mg

2017


45

Name of Drug


PRENATAL - prenatal vit w/ fe fumarate-fatab 28-0.8 mg

PRENATAL AND IRON - prenatalmultivitamins & minerals w/iron & fa tab0.8 mg

PRENATAL FORMULA - prenatal vit w/ fefumarate-fa tab 28-0.8 mg

PRENATAL FORTE - prenatalmultivitamins & minerals w/iron & fa tab0.8 mg

PRENATAL LOW IRON - prenatal vit w/ fefumarate-fa tab 27-0.8 mg

PRENATAL MULTI +DHA - prenatal vit w/fe fum-fa-omega 3 cap 27-0.8-228 mg

PRENATAL ONE DAILY - prenatal vit w/ fefumarate-fa tab 27-0.8 mg

PRENATAL PLUS - prenatal vit w/ fefumarate-fa tab 27-1 mg

PRENATAL PLUS DHA - prenatalmv & min w/fe carbonyl-fa-dha tab7-0.4-100 mg

prenatal vit w/ fe fumarate-fa tab 28-0.8 mg

PRENATAL VITAMIN - prenatal vit w/ fefumarate-fa tab 27-0.8 mg

PRENATAL VITAMINS - prenatalmultivitamins & minerals w/iron & fa tab0.8 mg

PRENATAL VITAMINS - prenatal vit w/ fefumarate-fa tab 28-0.8 mg

PRENATAL 19 - prenatal vit w/ fe fumarate-fa chew tab 29-1 mg

PRENATAL 19 - prenatal vit w/ dss-fefumarate-fa tab 29-1 mg

PREPLUS - prenatal vit w/ fe fumarate-fatab 27-1 mg

PX PRENATAL MULTIVITAMINS - prenatalvit w/ fe fumarate-fa tab 28-0.8 mg

QC PRENATAL - prenatal vit w/ fefumarate-fa tab 28-0.8 mg

RA PRENATAL - prenatal vit w/ fefumarate-fa tab 28-0.8 mg

Name of Drug


RA PRENATAL FORMULA/FOLIC -prenatal vit w/ fe fumarate-fa tab28-0.8 mg

RIGHT STEP PRENATAL - prenatal vit w/fe fumarate-fa tab 27-0.8 mg

SE-NATAL 19 - prenatal vit w/ fe fumarate-fa chew tab 29-1 mg

SE-NATAL 19 - prenatal vit w/ dss-fefumarate-fa tab 29-1 mg

SM PRENATAL VITAMINS - prenatal vit w/fe fumarate-fa tab 28-0.8 mg

speciality vitamin product tab

TRI-VIT/FLUORIDE/IRON - pediatricvitamins acd fluoride & fe drops0.25-10 mg/ml

TRICARE - prenatal vit w/ fe fumarate-fatab 27-1 mg

TRINATAL RX 1 - prenatal vit w/ fefumarate-fa tab 60-1 mg

VINATE M - prenatal vit w/ sel-fe fumarate-fa tab 27-1 mg

VINATE ONE - prenatal vit w/ fe fumarate-fa tab 60-1 mg

VOL-PLUS - prenatal vit w/ fe fumarate-fatab 27-1 mg

MINERALS AND ELECTROLYTEScalcium carbonate-cholecalciferol tab

500 mg-200 unit

calcium carbonate-cholecalciferol tab500 mg-400 unit

calcium carbonate-cholecalciferol tab600 mg-400 unit

ENFAMIL ENFALYTE - oral electrolytesolution

K-PHOS - potassium phosphatemonobasic tab 500 mg

90

oral electrolyte solution

pot bicarbonate & chloride effer tab 25 meq 90

2017


46

Name of Drug


pot phos monobasic w/sod phos di &monobas tab 155-852-130mg (K-phosneutral)

90

potassium bicarbonate effer tab 25 meq 90

potassium chloride cap er 8 meq (Micro-k) 90

potassium chloride cap er 10 meq (Micro-k) 90

POTASSIUM CHLORIDE ER - potassiumchloride tab er 8 meq (600 mg)

90

potassium chloride microencapsulated cryser tab 10 meq

90

potassium chloride microencapsulated cryser tab 20 meq

90

potassium chloride oral soln 10% (20meq/15ml)

90

potassium chloride oral soln 20% (40meq/15ml)

90

potassium chloride tab er 8 meq (600 mg) 90

potassium chloride tab er 10 meq (K-tab) 90

SODIUM FLUORIDE - sodium fluoride tab0.5 mg f (from 1.1 mg naf)

90

SODIUM FLUORIDE - sodium fluoride tab1 mg f (from 2.2 mg naf)

90

sodium fluoride chew tab 0.25 mg f (from0.55 mg naf) (Luride)

90

sodium fluoride chew tab 0.5 mg f (from1.1 mg naf) (Luride)

90

sodium fluoride chew tab 1 mg f (from2.2 mg naf) (Luride)

90

sodium fluoride soln 0.125 mg/drop f(0.275 mg/drop naf)

90

sodium fluoride soln 0.5 mg/ml f (from1.1 mg/ml naf) (Luride)

90

OTHER SUPPLEMENTSacetylcysteine cap 600 mg

amino acids cap

folic acid-pyridoxine-cyanocobalamin tab2.5-25-2 mg

2-fucosyllactose & lacto-n-neotetraosepacket 2000-1000 mg (Ollizac)

Name of Drug


BLOOD MODIFYING DRUGSBLOOD MODIFYING DRUGSanagrelide hcl cap 0.5 mg (Agrylin) 90

anagrelide hcl cap 1 mg 90

ARANESP ALBUMIN FREE - darbepoetinalfa soln prefilled syringe 10 mcg/0.4ml

PA, SP


PA, SP


PA, SP


PA, SP


PA, SP


PA, SP


PA, SP


PA, SP

ARANESP ALBUMIN FREE - darbepoetinalfa soln prefilled syringe 500 mcg/ml

PA, SP

ARANESP ALBUMIN FREE - darbepoetinalfa soln inj 25 mcg/ml

PA, SP


PA, SP


PA, SP


PA, SP


PA, SP


PA, SP

BRILINTA - ticagrelor tab 60 mg PA, QL, 90

BRILINTA - ticagrelor tab 90 mg PA, QL, 90

cilostazol tab 50 mg 90

cilostazol tab 100 mg 90

2017


47

Name of Drug


clopidogrel bisulfate tab 75 mg (baseequiv) (Plavix)

90

clopidogrel bisulfate tab 300 mg (baseequiv) (Plavix)

cyanocobalamin inj 1000 mcg/ml

dipyridamole tab 25 mg 90



ELIQUIS - apixaban tab 2.5 mg PA, QL, 90

ELIQUIS - apixaban tab 5 mg PA, QL, 90

enoxaparin sodium inj 30 mg/0.3ml(Lovenox)

QL


QL


QL


QL

enoxaparin sodium inj 100 mg/ml(Lovenox)

QL


QL

enoxaparin sodium inj 150 mg/ml(Lovenox)

QL

EPOGEN - epoetin alfa inj 2000 unit/ml PA, SP





fe fum-iron polysacch complex-fa-b cmplx-c-zn-mn-cu cap (Tandem plus)

fe fumarate w/ b12-vit c-fa-ifc cap110-0.015-75-0.5-240 mg

fe fumarate-vit c-vit b12-fa cap 460 (151fe)-60-0.01-1 mg

ferrous fumarate-fa-b complex-c-zn-mg-mn-cu tab 106-1 mg

ferrous fumarate-folic acid tab 324-1 mg

Name of Drug


ferrous gluconate tab 324 mg (37.5 mgelemental iron)

ferrous sulfate tab 325 mg (65 mgelemental fe)

FIRAZYR - icatibant acetate inj 30 mg/3ml(base equivalent)

PA, QL, SP

folic acid tab 800 mcg 90

folic acid tab 1 mg 90

folic acid-vitamin b6-vitamin b12 tab2.2-25-0.5 mg

folic acid-vitamin b6-vitamin b12 tab2.2-25-1 mg (Folgard rx)

folic acid-vitamin b6-vitamin b12 tab2.5-25-1 mg

INFED - iron dextran inj 50 mg/ml(elemental iron)

IPRIVASK - desirudin for inj 15 mg SP

iron combination cap

iron polysacch complex-vit b12-fa cap150-0.025-1 mg

iron-docusate-b12-folic acid-c-e-cu-biotintab 150-1 mg (Hematron-af)

iron-folic acid-vit c-vit b6-vit b12-zinc tab150-1.25 mg (Corvite 150)

NEULASTA - pegfilgrastim soln prefilledsyringe 6 mg/0.6ml

SP

NEULASTA ONPRO KIT - pegfilgrastimsoln prefilled syringe kit 6 mg/0.6ml

SP

pentoxifylline tab er 400 mg 90

PROCRIT - epoetin alfa inj 2000 unit/ml PA, SP






PROMACTA - eltrombopag olamine tab12.5 mg (base equiv)

PA, QL,SP, 90

2017


48

Name of Drug


PROMACTA - eltrombopag olamine tab25 mg (base equiv)

PA, QL,SP, 90


PA, QL,SP, 90


PA, QL,SP, 90

tranexamic acid tab 650 mg (Lysteda)

warfarin sodium tab 1 mg (Coumadin) 90


warfarin sodium tab 2.5 mg (Coumadin) 90





warfarin sodium tab 7.5 mg (Coumadin) 90


XARELTO - rivaroxaban tab 10 mg QL, 90

XARELTO - rivaroxaban tab 15 mg PA, QL, 90

XARELTO - rivaroxaban tab 20 mg PA, QL, 90

XARELTO STARTER PACK - rivaroxabantab starter therapy pack 15 mg & 20 mg

PA, QL

ZAVESCA - miglustat cap 100 mg PA, QL,SP, 90

TOPICAL PRODUCTSEYEAnti-infectivesBACITRACIN - bacitracin ophth oint 500

unit/gm

bacitracin-polymyxin b ophth oint

ciprofloxacin hcl ophth soln 0.3% (Ciloxan)

erythromycin ophth oint 5 mg/gm

gentamicin sulfate ophth oint 0.3%

gentamicin sulfate ophth soln 0.3%

NATACYN - natamycin ophth susp 5%

neomycin-bacitrac zn-polymyx5(3.5)mg-400unt-10000unt op oin

Name of Drug


neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml(Neosporin)

ofloxacin ophth soln 0.3% (Ocuflox)

polymyxin b-trimethoprim ophth soln 10000unit/ml-0.1% (Polytrim)

sulfacetamide sodium ophth soln 10%(Bleph-10)

tobramycin ophth soln 0.3% (Tobrex)

trifluridine ophth soln 1% (Viroptic)

Steroids and Combination Productsbacitracin-polymyxin-neomycin-hc ophth

oint 1%

DEXAMETHASONE SODIUM PHOS -dexamethasone sodium phosphate ophthsoln 0.1%

fluorometholone ophth susp 0.1% (Fmlliquifilm)

neomycin-polymyxin-dexamethasoneophth oint 0.1% (Maxitrol)

neomycin-polymyxin-dexamethasoneophth susp 0.1% (Maxitrol)

prednisolone acetate ophth susp 1% (Predforte)

PREDNISOLONE SODIUM PHOSP -prednisolone sodium phosphate ophthsoln 1%

sulfacetamide sodium-prednisolone ophthsoln 10-0.23(0.25)%

Glaucomaapraclonidine hcl ophth soln 0.5% (base

equivalent) (Iopidine)

betaxolol hcl ophth soln 0.5% 90

brimonidine tartrate ophth soln 0.2% 90

carteolol hcl ophth soln 1% 90

dorzolamide hcl ophth soln 2% (Trusopt) 90

dorzolamide hcl-timolol maleate ophth soln22.3-6.8 mg/ml (Cosopt)

90

latanoprost ophth soln 0.005% (Xalatan) QL, 90

2017


49

Name of Drug


levobunolol hcl ophth soln 0.5% (Betagan) 90

METIPRANOLOL - metipranolol ophth soln0.3%

90

pilocarpine hcl ophth soln 1% (Isoptocarpine)

90


90


90

timolol maleate ophth soln 0.25%(Timoptic)

90

timolol maleate ophth soln 0.5% (Timoptic) 90

Other Eye ProductsATROPINE SULFATE - atropine sulfate

ophth soln 1%90

ATROPINE SULFATE - atropine sulfateophth oint 1%

90

azelastine hcl ophth soln 0.05%

cromolyn sodium ophth soln 4%

cyclopentolate hcl ophth soln 0.5%(Cyclogyl)

90

cyclopentolate hcl ophth soln 1%(Cyclogyl)

90

cyclopentolate hcl ophth soln 2%(Cyclogyl)

90

diclofenac sodium ophth soln 0.1%

epinastine hcl ophth soln 0.05% (Elestat)

flurbiprofen sodium ophth soln 0.03%(Ocufen)

homatropine hbr ophth soln 5% 90

ketorolac tromethamine ophth soln 0.4%(Acular ls)

ketorolac tromethamine ophth soln 0.5%(Acular)

NAPHAZOLINE HCL - naphazoline hclophth soln 0.1%

olopatadine hcl ophth soln 0.1% (baseequivalent) (Patanol)

phenylephrine hcl ophth soln 2.5%

Name of Drug


proparacaine hcl ophth soln 0.5% (Alcaine)

tetracaine hcl ophth soln 0.5%

EARacetic acid otic soln 2%

carbamide peroxide 6.5% otic soln

hydrocortisone w/ acetic acid otic soln1-2%

neomycin-polymyxin-hc otic soln 1%

neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1%

ofloxacin otic soln 0.3% (Floxin otic)

MOUTH AND THROAT (LOCAL)chlorhexidine gluconate soln 0.12%

(Peridex)

clotrimazole troche 10 mg

lidocaine hcl viscous soln 2%

LISTERINE NATURALS WITH F - sodiumfluoride rinse 0.02%

nystatin susp 100000 unit/ml

pilocarpine hcl tab 5 mg (Salagen) 90

pilocarpine hcl tab 7.5 mg (Salagen) 90

PREVIDENT FLUORIDE - sodiumfluoride gel 1.1% (0.5% f)

90

PREVIDENT 5000 DRY MOUTH - sodiumfluoride gel 1.1% (0.5% f)

90

sodium fluoride cream 1.1% (Prevident5000 plus)

90

sodium fluoride gel 1.1% (0.5% f)(Prevident fluoride)

90

sodium fluoride paste 1.1% (Prevident5000 boost)

90

sodium fluoride rinse 0.2% 90

sodium fluoride-potassium nitrate paste1.1-5% (Prevident 5000 sensi)

stannous fluoride gel 0.4%

THERA-FLUR-N - sodium fluoride gel 1.1%(0.5% f)

90

2017


50

Name of Drug


triamcinolone acetonide dental paste 0.1%

ANORECTAL AGENTShydrocortisone enema 100 mg/60ml

(Cortenema)

hydrocortisone rectal cream 1%(Proctocort)

hydrocortisone rectal cream 2.5% (Anusol-hc)

SKIN CONDITIONS/PRODUCTSAcneadapalene cream 0.1% (Differin) PA

benzoyl peroxide cloth 6% PA

benzoyl peroxide cream 10%

benzoyl peroxide gel 10% PA

benzoyl peroxide lotion 6% PA

benzoyl peroxide-erythromycin gel 5-3%(Benzamycin)

PA

clindamycin phosph-benzoyl peroxide(refrig) gel 1.2 (1)-5% (Duac)

PA

clindamycin phosphate gel 1% (Cleocin-t) PA

clindamycin phosphate lotion 1% (Cleocin-t)

PA

clindamycin phosphate soln 1% (Cleocin-t) PA

clindamycin phosphate swab 1% (Cleocin-t)

PA

DIFFERIN - adapalene gel 0.1% PA

erythromycin pads 2% PA

erythromycin soln 2% PA

FINACEA - azelaic acid gel 15% PA

isotretinoin cap 10 mg PA




metronidazole cream 0.75% (Metrocream) PA

metronidazole gel 0.75% PA

sulfacetamide sodium lotion 10% (acne)(Klaron)

PA

Name of Drug


tazarotene cream 0.1% (Tazorac) PA

TAZORAC - tazarotene cream 0.05% PA

TAZORAC - tazarotene gel 0.05% PA

TAZORAC - tazarotene gel 0.1% PA

tretinoin cream 0.025% (Retin-a) PA



tretinoin gel 0.01% (Retin-a) PA

tretinoin gel 0.025% (Retin-a) PA

tretinoin gel 0.05% (Atralin) PA

Anti-infectivesacyclovir oint 5% (Zovirax)

bacitracin oint 500 unit/gm

bacitracin-polymyxin b oint

ciclopirox olamine cream 0.77% (baseequiv) (Loprox)

ciclopirox olamine susp 0.77% (base equiv)

ciclopirox solution 8% (Penlac NailLacquer)

PA, QL

clotrimazole cream 1%

clotrimazole soln 1%

clotrimazole w/ betamethasone cream1-0.05% (Lotrisone)

diclofenac sodium gel 1% (Voltaren) QL

GENTAMICIN SULFATE - gentamicinsulfate oint 0.1%

ketoconazole cream 2%

ketoconazole shampoo 2% (Nizoral)

miconazole nitrate cream 2%

mupirocin oint 2%

naftifine hcl cream 2% (Naftin)

neomycin-bacitracin-polymyxin oint

nystatin cream 100000 unit/gm

nystatin oint 100000 unit/gm

oxiconazole nitrate cream 1% (Oxistat)

salicylic acid cream 6%

2017


51

Name of Drug


salicylic acid cream 6% & cleanser liqd kit(Salex cream)

salicylic acid film forming liquid 27.5%(Virasal)

salicylic acid foam 6% (Salvax)

salicylic acid gel 6% (Keralyt)

salicylic acid lotion 6%

salicylic acid lotion 6% & cleanser liqd kit(Salex lotion)

salicylic acid shampoo 6% (Salex)

silver sulfadiazine cream 1% (Silvadene)

terbinafine hcl cream 1%

tolnaftate cream 1%

Corticosteroidsalclometasone dipropionate cream 0.05%

(Aclovate)

alclometasone dipropionate oint 0.05%

AUGMENTED BETAMETHASONED - betamethasone dipropionateaugmented gel 0.05%

betamethasone dipropionate augmentedcream 0.05% (Diprolene af)

betamethasone dipropionateaugmented gel 0.05%

betamethasone dipropionate augmentedlotion 0.05% (Diprolene)

betamethasone dipropionate augmentedoint 0.05% (Diprolene)

betamethasone dipropionate cream 0.05%

betamethasone dipropionate lotion 0.05%

betamethasone dipropionate oint 0.05%

betamethasone valerate cream 0.1% (baseequivalent)

betamethasone valerate lotion 0.1% (baseequivalent)

betamethasone valerate oint 0.1% (baseequivalent)

Name of Drug


clobetasol propionate emollient basecream 0.05% (Temovate e)

clobetasol propionate soln 0.05%(Temovate)

desonide cream 0.05% (Desowen)

desonide oint 0.05%

desoximetasone cream 0.25% (Topicort)

desoximetasone gel 0.05% (Topicort)

fluocinolone acetonide cream 0.01%

fluocinolone acetonide cream 0.025%(Synalar)

fluocinolone acetonide oil 0.01% (scalp oil)(Derma-smoothe/fs sca)

fluocinolone acetonide oint 0.025%(Synalar)

fluocinolone acetonide soln 0.01%(Synalar)

fluocinonide cream 0.05%

fluocinonide emulsified base cream 0.05%

fluocinonide gel 0.05%

fluocinonide oint 0.05%

fluocinonide soln 0.05%

flurandrenolide cream 0.05% (Cordran)

fluticasone propionate cream 0.05%(Cutivate)

fluticasone propionate oint 0.005%

halobetasol propionate cream 0.05%(Ultravate)

halobetasol propionate oint 0.05%(Ultravate)

hydrocortisone butyrate oint 0.1% (Locoid)

hydrocortisone butyrate soln 0.1% (Locoid)

hydrocortisone cream 1%

hydrocortisone cream 2.5%

hydrocortisone lotion 2% (Ala scalp)

hydrocortisone lotion 2.5%

hydrocortisone oint 1%

2017


52

Name of Drug


hydrocortisone oint 2.5%

hydrocortisone valerate cream 0.2%

hydrocortisone valerate oint 0.2%(Westcort)

mometasone furoate cream 0.1% (Elocon)

mometasone furoate oint 0.1% (Elocon)

mometasone furoate solution 0.1% (lotion)(Elocon)

PREDNICARBATE - prednicarbate cream0.1%

PREDNICARBATE - prednicarbate oint0.1%

prednicarbate cream 0.1% (Dermatop)

triamcinolone acetonide aerosol soln0.147 mg/gm (Kenalog)

triamcinolone acetonide cream 0.025%



triamcinolone acetonide lotion 0.025%

triamcinolone acetonide lotion 0.1%

triamcinolone acetonide oint 0.025%

triamcinolone acetonide oint 0.1%

Other Skin Productsacitretin cap 10 mg (Soriatane)

acitretin cap 17.5 mg (Soriatane)

acitretin cap 25 mg (Soriatane)

calcipotriene cream 0.005% (Dovonex)

calcipotriene oint 0.005%

calcipotriene soln 0.005% (50 mcg/ml)

capsaicin-menthol disk 0.0375-5%

CEM-UREA - urea soln 45%

COSENTYX - secukinumab subcutaneoussoln prefilled syringe 150 mg/ml

PA, QL,SP, 90

COSENTYX SENSOREADY PEN -secukinumab subcutaneous soln auto-injector 150 mg/ml

PA, QL,SP, 90

Name of Drug


CUTTER BACKWOODS - diethyltoluamide(deet) aerosol

CUTTER SKINSATIONS - diethyltoluamide(deet) liquid

ELIDEL - pimecrolimus cream 1% ST

fluorouracil cream 5% (Efudex) QL

fluorouracil soln 2%

fluorouracil soln 5%

imiquimod cream 5% (Aldara) QL

lidocaine hcl gel 2% QL

lidocaine hcl soln 4% (Xylocaine) QL

lidocaine patch 5% (Lidoderm) PA, QL

lidocaine-prilocaine cream 2.5-2.5% QL

methoxsalen rapid cap 10 mg (Oxsoralenultra)

NATRAPEL 12-HOUR TICK & I - picaridinaerosol

OFF ACTIVE - diethyltoluamide (deet)aerosol

OFF DEEP WOODS - diethyltoluamide(deet) aerosol

OFF DEEP WOODS DRY -diethyltoluamide (deet) aerosol

OFF SMOOTH & DRY - diethyltoluamide(deet) aerosol

permethrin cream 5% (Elimite)

permethrin creme rinse 1%

podofilox soln 0.5% (Condylox)

REPEL SPORTSMEN - diethyltoluamide(deet) aerosol

REPEL SPORTSMEN MAX -diethyltoluamide (deet) aerosol

SAWYER PREMIUM INSECT REP -picaridin liquid

selenium sulfide lotion 2.5%

selenium sulfide-pyrithione zinc in ureashampoo 2.25%

skin protectants misc - cream

2017


53

Name of Drug


STELARA - ustekinumab soln prefilledsyringe 45 mg/0.5ml

PA, QL,SP, 90

STELARA - ustekinumab soln prefilledsyringe 90 mg/ml

PA, QL,SP, 90

tacrolimus oint 0.03% (Protopic) ST

tacrolimus oint 0.1% (Protopic) ST

MISCELLANEOUS CATEGORIESDIABETIC SUPPLIESBAYER Blood Glucose Monitoring

System - BREEZE 2, CONTOUR,CONTOURNEXT/EZ/LINK/USB

CALIBRATION LIQUID - BAYERBREEZE2, CONTOUR, CONTOUR NEXT

KETOSTIX - acetone (urine) test strip QL

TEST STRIPS – BAYER ASCENCIA QL, ST, 90

INSULIN SYRINGES - TECHLITE ANDTRUEPLUS

QL, 90

INUSLIN PEN NEEDLES - TECHLITEAND TRUEPLUS

QL, 90

LANCETS - BAYER ASCENCIA QL, 90

RESPIRATORY INHALER-ASSIST DEVICESAEROCHAMBER

BREATHERITE

MISCELLANEOUS DRUGSazathioprine tab 50 mg (Imuran) 90

CHEMET - succimer cap 100 mg

CUPRIMINE - penicillamine cap 250 mg PA, SP

cyclosporine cap 25 mg (Sandimmune) 90

cyclosporine cap 100 mg (Sandimmune) 90

CYCLOSPORINE MODIFIED -cyclosporine modified cap 50 mg

90

cyclosporine modified cap 25 mg (Neoral) 90

cyclosporine modified cap 50 mg(Cyclosporine modifie)

90

cyclosporine modified cap 100 mg (Neoral) 90

cyclosporine modified oral soln 100 mg/ml(Neoral)

90

Name of Drug


DEPEN TITRATABS - penicillamine tab250 mg

PA, SP

EXJADE - deferasirox tab for oral susp125 mg

PA, QL,SP, 90


PA, QL,SP, 90


PA, QL,SP, 90

FERRIPROX - deferiprone tab 500 mg PA, QL,SP, 90

FERRIPROX - deferiprone oral soln100 mg/ml

PA, QL,SP, 90

irrigation solution, physiological

lactated ringer's for irrigation

METHYLENE BLUE - methylene blue inj1%

mycophenolate mofetil cap 250 mg(Cellcept)

90

mycophenolate mofetil for oral susp200 mg/ml (Cellcept)

90

mycophenolate mofetil tab 500 mg(Cellcept)

90

mycophenolate sodium tab dr 180 mg(mycophenolic acid equiv) (Myfortic)

90

mycophenolate sodium tab dr 360 mg(mycophenolic acid equiv) (Myfortic)

90

naltrexone hcl tab 50 mg

NARCAN - naloxone hcl nasal spray4 mg/0.1ml

NEXAVIR - liver derivative complex inj25.5 mg/ml

REVLIMID - lenalidomide caps 2.5 mg PA, QL, SP

REVLIMID - lenalidomide cap 5 mg PA, QL, SP





ringer's solution for irrigation

2017


54

Name of Drug


sirolimus tab 0.5 mg (Rapamune) 90

sirolimus tab 1 mg (Rapamune) 90

sirolimus tab 2 mg (Rapamune) 90

sodium polystyrene sulfonate oral susp15 gm/60ml

sodium polystyrene sulfonate powder(Kayexalate)

sodium polystyrene sulfonate rectal susp30 gm/120ml

tacrolimus cap 0.5 mg (Prograf) 90

tacrolimus cap 1 mg (Prograf) 90

tacrolimus cap 5 mg (Prograf) 90

THALOMID - thalidomide cap 50 mg PA, QL,SP, 90




water for irrigation, sterile irrigation soln

ZORTRESS - everolimus tab 0.25 mg 90



2017

55

INDEX

Aabacavir sulfate-lamivudine tab 600-300 mg...................... 3abacavir sulfate-lamivudine-zidovudine tab 300-150-300mg........................................................................................3

abacavir sulfate soln 20 mg/ml (base equiv).......................3abacavir sulfate tab 300 mg (base equiv)........................... 3ABILIFY MAINTENA - aripiprazole im for er susp prefilledsyringe 300 mg.................................................................30

ABILIFY MAINTENA - aripiprazole im for er susp prefilledsyringe 400 mg.................................................................30

ABILIFY MAINTENA - aripiprazole im for extendedrelease susp 300 mg........................................................30

ABILIFY MAINTENA - aripiprazole im for extendedrelease susp 400 mg........................................................30

acamprosate calcium tab delayed release 333 mg...........36acarbose tab 25 mg...........................................................11acarbose tab 50 mg...........................................................11acarbose tab 100 mg.........................................................11acebutolol hcl cap 200 mg.................................................16acebutolol hcl cap 400 mg.................................................16ACETAMINOPHEN/CAFFEINE/DI - acetaminophen-caffeine-dihydrocodeine cap 320.5-30-16 mg................. 37

acetaminophen susp 160 mg/5ml......................................37acetaminophen tab er 650 mg...........................................37acetaminophen tab 325 mg............................................... 37acetaminophen tab 500 mg............................................... 37acetaminophen w/ codeine soln 120-12 mg/5ml...............37acetaminophen w/ codeine tab 300-15 mg....................... 37acetaminophen w/ codeine tab 300-30 mg....................... 37acetaminophen w/ codeine tab 300-60 mg....................... 37acetazolamide cap er 12hr 500 mg...................................20acetazolamide tab 250 mg................................................ 20acetic acid irrigation soln 0.25%........................................27acetic acid otic soln 2%..................................................... 49acetylcysteine cap 600 mg................................................ 46acetylcysteine inhal soln 10%............................................23acetylcysteine inhal soln 20%............................................23acitretin cap 10 mg............................................................ 52acitretin cap 17.5 mg......................................................... 52acitretin cap 25 mg............................................................ 52ACTIMMUNE - interferon gamma-1b inj 100 mcg/0.5ml(2000000 unit/0.5ml)...........................................................6

acyclovir cap 200 mg...........................................................3acyclovir oint 5%................................................................ 50acyclovir susp 200 mg/5ml.................................................. 3acyclovir tab 400 mg............................................................3acyclovir tab 800 mg............................................................3adapalene cream 0.1%......................................................50ADASUVE - loxapine aerosol powder breath activated 10mg......................................................................................30

ADCIRCA - tadalafil tab 20 mg (pah)................................21adefovir dipivoxil tab 10 mg.................................................3ADEMPAS - riociguat tab 0.5 mg...................................... 21

ADEMPAS - riociguat tab 1 mg......................................... 21ADEMPAS - riociguat tab 1.5 mg...................................... 21ADEMPAS - riociguat tab 2 mg......................................... 21ADEMPAS - riociguat tab 2.5 mg...................................... 21AEROCHAMBER................................................................53AFINITOR DISPERZ - everolimus tab for oral susp 2mg........................................................................................6

AFINITOR DISPERZ - everolimus tab for oral susp 3mg........................................................................................6

AFINITOR DISPERZ - everolimus tab for oral susp 5mg........................................................................................6

AFINITOR - everolimus tab 2.5 mg.....................................6AFINITOR - everolimus tab 5 mg........................................6AFINITOR - everolimus tab 7.5 mg.....................................6AFINITOR - everolimus tab 10 mg......................................6AFLURIA 2017-2018 - influenza virus vaccine split imsusp..................................................................................... 6

AFLURIA PF 2017-2018 - influenza virus vaccine split pfsusp pref syringe 0.5 ml.................................................... 6

AFLURIA QUADRIVALENT 2017 - influenza virus vaccinesplit quadrivalent im inj.......................................................6

AFLURIA QUADRIVALENT 2017 - influenza virus vacsplit quadrivalent susp pref syr 0.5ml................................ 6

ALBENZA - albendazole tab 200 mg.................................. 5ALBUTEROL SULFATE ER - albuterol sulfate tab er 12hr4 mg.................................................................................. 23

ALBUTEROL SULFATE ER - albuterol sulfate tab er 12hr8 mg.................................................................................. 23

albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)..............23albuterol sulfate soln nebu 0.5% (5 mg/ml).......................23albuterol sulfate soln nebu 0.63 mg/3ml (base equiv).......23albuterol sulfate soln nebu 1.25 mg/3ml (base equiv).......23albuterol sulfate syrup 2 mg/5ml....................................... 23albuterol sulfate tab er 12hr 4 mg..................................... 23albuterol sulfate tab er 12hr 8 mg..................................... 23albuterol sulfate tab 2 mg..................................................23albuterol sulfate tab 4 mg..................................................23alclometasone dipropionate cream 0.05%........................ 51alclometasone dipropionate oint 0.05%............................ 51ALECENSA - alectinib hcl cap 150 mg (baseequivalent)...........................................................................7

ALENDRONATE SODIUM - alendronate sodium tab 40mg......................................................................................14

alendronate sodium tab 5 mg............................................14alendronate sodium tab 10 mg..........................................14alendronate sodium tab 35 mg..........................................14alendronate sodium tab 70 mg..........................................14alfuzosin hcl tab er 24hr 10 mg.........................................27ALKERAN - melphalan tab 2 mg.........................................7allopurinol tab 100 mg....................................................... 40allopurinol tab 300 mg....................................................... 40almotriptan malate tab 6.25 mg.........................................40almotriptan malate tab 12.5 mg.........................................40ALOGLIPTIN/METFORMIN HCL - alogliptin-metformin hcltab 12.5-500 mg............................................................... 11

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56

ALOGLIPTIN/METFORMIN HCL - alogliptin-metformin hcltab 12.5-1000 mg............................................................. 11

ALOGLIPTIN/PIOGLITAZONE - alogliptin-pioglitazone tab12.5-15 mg........................................................................11



ALOGLIPTIN/PIOGLITAZONE - alogliptin-pioglitazone tab25-15 mg...........................................................................12



ALOGLIPTIN - alogliptin benzoate tab 6.25 mg (baseequiv).................................................................................11

ALOGLIPTIN - alogliptin benzoate tab 12.5 mg (baseequiv).................................................................................11

ALOGLIPTIN - alogliptin benzoate tab 25 mg (baseequiv).................................................................................11

alosetron hcl tab 0.5 mg (base equiv)...............................26alosetron hcl tab 1 mg (base equiv)..................................26ALPRAZOLAM INTENSOL - alprazolam conc 1 mg/ml.......................................................................................28

alprazolam tab er 24hr 0.5 mg.......................................... 28alprazolam tab er 24hr 1 mg............................................. 28alprazolam tab er 24hr 2 mg............................................. 28alprazolam tab er 24hr 3 mg............................................. 28alprazolam tab 0.25 mg..................................................... 28alprazolam tab 0.5 mg....................................................... 28alprazolam tab 1 mg.......................................................... 28alprazolam tab 2 mg.......................................................... 28alum & mag hydroxide-simethicone susp 200-200-20mg/5ml...............................................................................25

alum & mag hydroxide-simethicone susp 400-400-40mg/5ml...............................................................................25

amantadine hcl cap 100 mg.............................................. 43amantadine hcl syrup 50 mg/5ml...................................... 43amiloride & hydrochlorothiazide tab 5-50 mg....................20amiloride hcl tab 5 mg....................................................... 20amino acids cap................................................................. 46amiodarone hcl tab 200 mg...............................................20amitriptyline hcl tab 10 mg.................................................28amitriptyline hcl tab 25 mg.................................................28amitriptyline hcl tab 50 mg.................................................28amitriptyline hcl tab 75 mg.................................................28amitriptyline hcl tab 100 mg...............................................28amitriptyline hcl tab 150 mg...............................................28amlodipine besylate-benazepril hcl cap 2.5-10 mg...........17amlodipine besylate-benazepril hcl cap 5-10 mg..............17amlodipine besylate-benazepril hcl cap 5-20 mg..............17amlodipine besylate-benazepril hcl cap 5-40 mg..............17amlodipine besylate-benazepril hcl cap 10-20 mg............17amlodipine besylate-benazepril hcl cap 10-40 mg............17amlodipine besylate tab 2.5 mg.........................................17amlodipine besylate tab 5 mg............................................17

amlodipine besylate tab 10 mg..........................................17AMOXAPINE - amoxapine tab 25 mg...............................28AMOXAPINE - amoxapine tab 50 mg...............................28AMOXAPINE - amoxapine tab 100 mg.............................28AMOXAPINE - amoxapine tab 150 mg.............................28AMOXICILLIN/CLAVULANATE P - amoxicillin & kclavulanate chew tab 200-28.5 mg....................................1

AMOXICILLIN/CLAVULANATE P - amoxicillin & kclavulanate chew tab 400-57 mg.......................................1

amoxicillin & k clavulanate for susp 200-28.5 mg/5ml........ 1amoxicillin & k clavulanate for susp 250-62.5 mg/5ml........ 1amoxicillin & k clavulanate for susp 400-57 mg/5ml........... 1amoxicillin & k clavulanate for susp 600-42.9 mg/5ml........ 1amoxicillin & k clavulanate tab 250-125 mg........................1amoxicillin & k clavulanate tab 500-125 mg........................1amoxicillin & k clavulanate tab 875-125 mg........................1AMOXICILLIN - amoxicillin (trihydrate) chew tab 125mg........................................................................................1

AMOXICILLIN - amoxicillin (trihydrate) chew tab 250mg........................................................................................1

amoxicillin (trihydrate) cap 250 mg......................................1amoxicillin (trihydrate) cap 500 mg......................................1amoxicillin (trihydrate) for susp 125 mg/5ml........................1amoxicillin (trihydrate) for susp 200 mg/5ml........................1amoxicillin (trihydrate) for susp 250 mg/5ml........................1amoxicillin (trihydrate) for susp 400 mg/5ml........................1amoxicillin (trihydrate) tab 875 mg...................................... 1amphetamine-dextroamphetamine cap er 24hr 5 mg....... 34amphetamine-dextroamphetamine cap er 24hr 10 mg..... 34amphetamine-dextroamphetamine cap er 24hr 15 mg..... 34amphetamine-dextroamphetamine cap er 24hr 20 mg..... 34amphetamine-dextroamphetamine cap er 24hr 25 mg..... 34amphetamine-dextroamphetamine cap er 24hr 30 mg..... 34amphetamine-dextroamphetamine tab 5 mg.....................34amphetamine-dextroamphetamine tab 7.5 mg..................34amphetamine-dextroamphetamine tab 10 mg...................34amphetamine-dextroamphetamine tab 12.5 mg............... 34amphetamine-dextroamphetamine tab 15 mg...................34amphetamine-dextroamphetamine tab 20 mg...................34amphetamine-dextroamphetamine tab 30 mg...................34ampicillin cap 250 mg.......................................................... 1ampicillin cap 500 mg.......................................................... 1anagrelide hcl cap 0.5 mg................................................. 46anagrelide hcl cap 1 mg.................................................... 46anastrozole tab 1 mg........................................................... 7APLENZIN - bupropion hbr tab er 24hr 174 mg................28APLENZIN - bupropion hbr tab er 24hr 348 mg................28APLENZIN - bupropion hbr tab er 24hr 522 mg................28apraclonidine hcl ophth soln 0.5% (base equivalent)........48APTIOM - eslicarbazepine acetate tab 200 mg................ 41APTIOM - eslicarbazepine acetate tab 400 mg................ 41APTIOM - eslicarbazepine acetate tab 600 mg................ 41APTIOM - eslicarbazepine acetate tab 800 mg................ 41APTIVUS - tipranavir cap 250 mg.......................................3APTIVUS - tipranavir oral soln 100 mg/ml.......................... 3

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57

ARANESP ALBUMIN FREE - darbepoetin alfa soln inj 25mcg/ml...............................................................................46



ARANESP ALBUMIN FREE - darbepoetin alfa soln inj100 mcg/ml....................................................................... 46



ARANESP ALBUMIN FREE - darbepoetin alfa solnprefilled syringe 10 mcg/0.4ml......................................... 46

ARANESP ALBUMIN FREE - darbepoetin alfa solnprefilled syringe 25 mcg/0.42ml.......................................46







ARANESP ALBUMIN FREE - darbepoetin alfa solnprefilled syringe 500 mcg/ml............................................ 46

ARCALYST - rilonacept for inj 220 mg..............................39aripiprazole orally disintegrating tab 15 mg.......................31aripiprazole oral solution 1 mg/ml......................................30aripiprazole tab 2 mg......................................................... 31aripiprazole tab 5 mg......................................................... 31aripiprazole tab 10 mg....................................................... 31aripiprazole tab 15 mg....................................................... 31aripiprazole tab 20 mg....................................................... 31aripiprazole tab 30 mg....................................................... 31ARISTADA - aripiprazole lauroxil im er susp prefilled syr441 mg/1.6ml....................................................................31

ARISTADA - aripiprazole lauroxil im er susp prefilled syr662 mg/2.4ml....................................................................31

ARISTADA - aripiprazole lauroxil im er susp prefilled syr882 mg/3.2ml....................................................................31

ARISTADA - aripiprazole lauroxil im er susp prefilled syr1064 mg/3.9ml..................................................................31

armodafinil tab 50 mg........................................................ 35armodafinil tab 150 mg...................................................... 35armodafinil tab 250 mg...................................................... 35ARNUITY ELLIPTA - fluticasone furoate aerosol powderbreath activ 100 mcg/act..................................................23

ARNUITY ELLIPTA - fluticasone furoate aerosol powderbreath activ 200 mcg/act..................................................23

aspirin-acetaminophen-caffeine tab 250-250-65 mg.........37aspirin chew tab 81 mg..................................................... 37

aspirin tab delayed release 81 mg.................................... 37atenolol & chlorthalidone tab 50-25 mg.............................16atenolol & chlorthalidone tab 100-25 mg...........................16atenolol tab 25 mg............................................................. 16atenolol tab 50 mg............................................................. 16atenolol tab 100 mg........................................................... 16atorvastatin calcium tab 10 mg (base equivalent).............19atorvastatin calcium tab 20 mg (base equivalent).............19atorvastatin calcium tab 40 mg (base equivalent).............19atorvastatin calcium tab 80 mg (base equivalent).............19atovaquone-proguanil hcl tab 62.5-25 mg...........................5atovaquone-proguanil hcl tab 250-100 mg..........................5ATRIPLA - efavirenz-emtricitabine-tenofovir df tab600-200-300 mg................................................................. 3

ATROPINE SULFATE - atropine sulfate ophth oint1%..................................................................................... 49

ATROPINE SULFATE - atropine sulfate ophth soln1%..................................................................................... 49

ATROVENT HFA - ipratropium bromide hfa inhal aerosol17 mcg/act........................................................................ 23

AUBAGIO - teriflunomide tab 7 mg...................................35AUBAGIO - teriflunomide tab 14 mg.................................35AUGMENTED BETAMETHASONE D - betamethasonedipropionate augmented gel 0.05%.................................51

AVONEX - interferon beta-1a for im inj kit 30mcg(33mcg(6.6 mu)/vial).........................................................36

AVONEX - interferon beta-1a im prefilled syringe kit 30mcg/0.5ml..........................................................................36

AVONEX PEN - interferon beta-1a im auto-injector kit 30mcg/0.5ml..........................................................................36

azathioprine tab 50 mg...................................................... 53azelastine hcl nasal spray 0.1% (137 mcg/spray).............22azelastine hcl ophth soln 0.05%........................................49AZITHROMYCIN - azithromycin powd pack for susp 1gm........................................................................................1

azithromycin for susp 100 mg/5ml.......................................1azithromycin for susp 200 mg/5ml.......................................1azithromycin tab 250 mg..................................................... 1azithromycin tab 500 mg..................................................... 1

BBACITRACIN - bacitracin ophth oint 500 unit/gm............. 48bacitracin oint 500 unit/gm.................................................50bacitracin-polymyxin b oint................................................ 50bacitracin-polymyxin b ophth oint...................................... 48bacitracin-polymyxin-neomycin-hc ophth oint 1%............. 48baclofen tab 10 mg............................................................ 43baclofen tab 20 mg............................................................ 43balsalazide disodium cap 750 mg..................................... 26BARACLUDE - entecavir oral soln 0.05 mg/ml...................3BASAGLAR KWIKPEN - insulin glargine soln pen-injector100 unit/ml........................................................................ 13

BAYER Blood Glucose Monitoring System - BREEZE 2,CONTOUR,CONTOUR NEXT/EZ/LINK/USB..................53

b-complex w/ c & folic acid cap 1 mg................................44b-complex w/ c & folic acid tab..........................................44

2017

58

b-complex w/ c & folic acid tab 1 mg................................ 44b-complex w/ c & folic acid tab 5 mg................................ 44benazepril & hydrochlorothiazide tab 5-6.25 mg...............15benazepril & hydrochlorothiazide tab 10-12.5 mg.............15benazepril & hydrochlorothiazide tab 20-12.5 mg.............15benazepril & hydrochlorothiazide tab 20-25 mg................15benazepril hcl tab 5 mg..................................................... 15benazepril hcl tab 10 mg................................................... 15benazepril hcl tab 20 mg................................................... 15benazepril hcl tab 40 mg................................................... 15benzoyl peroxide cloth 6%.................................................50benzoyl peroxide cream 10%............................................ 50benzoyl peroxide-erythromycin gel 5-3%.......................... 50benzoyl peroxide gel 10%................................................. 50benzoyl peroxide lotion 6%................................................50benztropine mesylate tab 0.5 mg...................................... 43benztropine mesylate tab 1 mg......................................... 43benztropine mesylate tab 2 mg......................................... 43betamethasone dipropionate augmented cream0.05%................................................................................ 51

betamethasone dipropionate augmented gel 0.05%.........51betamethasone dipropionate augmented lotion 0.05%.....51betamethasone dipropionate augmented oint 0.05%........51betamethasone dipropionate cream 0.05%.......................51betamethasone dipropionate lotion 0.05%........................51betamethasone dipropionate oint 0.05%...........................51betamethasone valerate cream 0.1% (baseequivalent).........................................................................51

betamethasone valerate lotion 0.1% (baseequivalent).........................................................................51

betamethasone valerate oint 0.1% (base equivalent).......51betaxolol hcl ophth soln 0.5%............................................48betaxolol hcl tab 10 mg..................................................... 16betaxolol hcl tab 20 mg..................................................... 16bethanechol chloride tab 5 mg.......................................... 27bethanechol chloride tab 10 mg........................................ 27bethanechol chloride tab 25 mg........................................ 27bethanechol chloride tab 50 mg........................................ 27bexarotene cap 75 mg.........................................................7bicalutamide tab 50 mg........................................................7BILTRICIDE - praziquantel tab 600 mg...............................5bisacodyl tab & peg 3350-kcl-sod bicarb-nacl for solnkit....................................................................................... 25

bisacodyl tab delayed release 5 mg..................................25bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg.............16bisoprolol & hydrochlorothiazide tab 5-6.25 mg................16bisoprolol & hydrochlorothiazide tab 10-6.25 mg..............16bisoprolol fumarate tab 5 mg.............................................17bisoprolol fumarate tab 10 mg...........................................17BOSULIF - bosutinib tab 100 mg........................................ 7BOSULIF - bosutinib tab 500 mg........................................ 7BREATHERITE...................................................................53BRILINTA - ticagrelor tab 60 mg....................................... 46BRILINTA - ticagrelor tab 90 mg....................................... 46brimonidine tartrate ophth soln 0.2%.................................48BRINTELLIX - vortioxetine hbr tab 5 mg (base equiv)......28

BRINTELLIX - vortioxetine hbr tab 10 mg (baseequiv).................................................................................28

BRINTELLIX - vortioxetine hbr tab 20 mg (baseequiv).................................................................................29

bromocriptine mesylate cap 5 mg (base equivalent).........43bromocriptine mesylate tab 2.5 mg (base equivalent)...... 43budesonide delayed release particles cap 3 mg.................9budesonide inhalation susp 0.25 mg/2ml..........................23budesonide inhalation susp 0.5 mg/2ml............................23budesonide inhalation susp 1 mg/2ml...............................23bumetanide tab 0.5 mg......................................................20bumetanide tab 1 mg.........................................................20bumetanide tab 2 mg.........................................................20BUPHENYL - sodium phenylbutyrate tab 500 mg............ 14buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (baseequiv).................................................................................37

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (baseequiv).................................................................................37

buprenorphine hcl sl tab 2 mg (base equiv)......................37buprenorphine hcl sl tab 8 mg (base equiv)......................37bupropion hcl (smoking deterrent) tab er 12hr 150 mg.....36bupropion hcl tab er 12hr 100 mg.....................................29bupropion hcl tab er 12hr 150 mg.....................................29bupropion hcl tab er 12hr 200 mg.....................................29bupropion hcl tab er 24hr 150 mg.....................................29bupropion hcl tab er 24hr 300 mg.....................................29bupropion hcl tab 75 mg....................................................29bupropion hcl tab 100 mg..................................................29buspirone hcl tab 5 mg...................................................... 28buspirone hcl tab 10 mg....................................................28buspirone hcl tab 15 mg....................................................28buspirone hcl tab 30 mg....................................................28butalbital-acetaminophen-caffeine cap 50-300-40 mg......37butalbital-acetaminophen-caffeine tab 50-325-40 mg.......37butalbital-acetaminophen-caff w/ cod cap 50-325-40-30mg......................................................................................37

butalbital-acetaminophen tab 50-325 mg..........................37butalbital-aspirin-caffeine cap 50-325-40 mg.................... 37butalbital-aspirin-caff w/ codeine cap 50-325-40-30mg......................................................................................37

butorphanol tartrate nasal soln 10 mg/ml..........................37

Ccabergoline tab 0.5 mg...................................................... 14CABOMETYX - cabozantinib s-malate tab 20 mg (baseequivalent)...........................................................................7

CABOMETYX - cabozantinib s-malate tab 40 mg (baseequivalent)...........................................................................7

CABOMETYX - cabozantinib s-malate tab 60 mg (baseequivalent)...........................................................................7

caffeine citrate oral soln 60 mg/3ml (10 mg/ml baseequiv).................................................................................35

calcipotriene cream 0.005%.............................................. 52calcipotriene oint 0.005%...................................................52calcipotriene soln 0.005% (50 mcg/ml)............................. 52calcitonin (salmon) nasal soln 200 unit/act....................... 14

2017

59

calcitriol cap 0.25 mcg....................................................... 14calcitriol cap 0.5 mcg......................................................... 14calcitriol oral soln 1 mcg/ml............................................... 14calcium acetate (phosphate binder) cap 667 mg (169 mgca)......................................................................................26

calcium acetate (phosphate binder) tab 667 mg...............26calcium carbonate-cholecalciferol tab 500 mg-200unit.....................................................................................45

calcium carbonate-cholecalciferol tab 500 mg-400unit.....................................................................................45

calcium carbonate-cholecalciferol tab 600 mg-400unit.....................................................................................45

CALIBRATION LIQUID - BAYERBREEZE 2, CONTOUR,CONTOUR NEXT.............................................................53

CANASA - mesalamine suppos 1000 mg......................... 26capecitabine tab 150 mg..................................................... 7capecitabine tab 500 mg..................................................... 7CAPRELSA - vandetanib tab 100 mg................................. 7CAPRELSA - vandetanib tab 300 mg................................. 7capsaicin-menthol disk 0.0375-5%....................................52CAPTOPRIL/HYDROCHLOROTHIA - captopril &hydrochlorothiazide tab 25-15 mg................................... 15

CAPTOPRIL/HYDROCHLOROTHIA - captopril &hydrochlorothiazide tab 25-25 mg................................... 15



captopril tab 12.5 mg......................................................... 15captopril tab 25 mg............................................................ 15captopril tab 50 mg............................................................ 15captopril tab 100 mg.......................................................... 15CARBAGLU - carglumic acid tab 200 mg......................... 14carbamazepine cap er 12hr 100 mg................................. 41carbamazepine cap er 12hr 200 mg................................. 41carbamazepine cap er 12hr 300 mg................................. 41carbamazepine chew tab 100 mg..................................... 41carbamazepine susp 100 mg/5ml......................................41carbamazepine tab er 12hr 100 mg.................................. 41carbamazepine tab er 12hr 200 mg.................................. 41carbamazepine tab er 12hr 400 mg.................................. 41carbamazepine tab 200 mg............................................... 41carbamide peroxide 6.5% otic soln................................... 49carbidopa & levodopa orally disintegrating tab 10-100mg......................................................................................43

carbidopa & levodopa orally disintegrating tab 25-100mg......................................................................................43

carbidopa & levodopa orally disintegrating tab 25-250mg......................................................................................43

carbidopa & levodopa tab er 25-100 mg...........................43carbidopa & levodopa tab er 50-200 mg...........................43carbidopa & levodopa tab 10-100 mg............................... 43carbidopa & levodopa tab 25-100 mg............................... 43carbidopa & levodopa tab 25-250 mg............................... 43carbidopa tab 25 mg..........................................................43carbinoxamine maleate soln 4 mg/5ml..............................22

carbinoxamine maleate tab 4 mg...................................... 22carisoprodol tab 250 mg.................................................... 43carteolol hcl ophth soln 1%............................................... 48carvedilol tab 3.125 mg..................................................... 17carvedilol tab 6.25 mg........................................................17carvedilol tab 12.5 mg........................................................17carvedilol tab 25 mg...........................................................17CAYSTON - aztreonam lysine for inhal soln 75 mg (baseequivalent)...........................................................................5

cefaclor cap 250 mg............................................................ 1cefaclor cap 500 mg............................................................ 1cefadroxil cap 500 mg..........................................................1cefadroxil for susp 250 mg/5ml........................................... 1cefadroxil for susp 500 mg/5ml........................................... 1cefadroxil tab 1 gm.............................................................. 1cefdinir cap 300 mg............................................................. 1cefdinir for susp 125 mg/5ml............................................... 1cefdinir for susp 250 mg/5ml............................................... 1cefixime for susp 100 mg/5ml..............................................1cefixime for susp 200 mg/5ml..............................................1cefprozil for susp 125 mg/5ml............................................. 1cefprozil for susp 250 mg/5ml............................................. 1cefprozil tab 250 mg............................................................ 1cefprozil tab 500 mg............................................................ 1cefuroxime axetil tab 250 mg.............................................. 1cefuroxime axetil tab 500 mg.............................................. 1celecoxib cap 50 mg..........................................................39celecoxib cap 100 mg........................................................39celecoxib cap 200 mg........................................................39celecoxib cap 400 mg........................................................39CEM-UREA - urea soln 45%.............................................52cephalexin cap 250 mg........................................................1cephalexin cap 500 mg........................................................1cephalexin for susp 125 mg/5ml..........................................1cephalexin for susp 250 mg/5ml..........................................1cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)........................22cetirizine hcl tab 10 mg......................................................22CHANTIX CONTINUING MONTH - varenicline tartrate tab1 mg (base equiv)............................................................ 36

CHANTIX STARTING MONTH PA - varenicline tartratetab 0.5 mg x 11 & tab 1 mg x 42 pack............................ 36

CHANTIX - varenicline tartrate tab 0.5 mg (baseequiv).................................................................................36

CHANTIX - varenicline tartrate tab 1 mg (base equiv)......36CHEMET - succimer cap 100 mg......................................53CHENODAL - chenodiol tab 250 mg.................................26CHLORDIAZEPOXIDE/AMITRIPT - chlordiazepoxide-amitriptyline tab 5-12.5 mg.............................................. 36

CHLORDIAZEPOXIDE/AMITRIPT - chlordiazepoxide-amitriptyline tab 10-25 mg............................................... 36

chlordiazepoxide hcl cap 5 mg..........................................28chlordiazepoxide hcl cap 10 mg........................................28chlordiazepoxide hcl cap 25 mg........................................28chlordiazepoxide hcl-clidinium bromide cap 5-2.5 mg...... 25chlorhexidine gluconate soln 0.12%..................................49chloroquine phosphate tab 250 mg.....................................5

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chloroquine phosphate tab 500 mg.....................................5CHLOROTHIAZIDE - chlorothiazide tab 250 mg.............. 20chlorothiazide tab 500 mg................................................. 20CHLORPROMAZINE HCL - chlorpromazine hcl inj 50mg/2ml...............................................................................31

chlorthalidone tab 25 mg................................................... 20CHLORZOXAZONE - chlorzoxazone tab 500 mg............ 43CHOLBAM - cholic acid cap 50 mg.................................. 26CHOLBAM - cholic acid cap 250 mg................................ 26cholecalciferol tab 400 unit................................................ 44cholecalciferol tab 1000 unit.............................................. 44cholestyramine light powder 4 gm/dose............................19cholestyramine light powder packets 4 gm....................... 19cholestyramine powder 4 gm/dose....................................19cholestyramine powder packets 4 gm...............................19choline fenofibrate cap dr 45 mg (fenofibric acidequiv).................................................................................19

ciclopirox olamine cream 0.77% (base equiv)...................50ciclopirox olamine susp 0.77% (base equiv).....................50ciclopirox solution 8%........................................................ 50cilostazol tab 50 mg...........................................................46cilostazol tab 100 mg.........................................................46CIMETIDINE HCL - cimetidine hcl soln 300 mg/5ml.........25cimetidine hcl soln 300 mg/5ml......................................... 25cimetidine tab 200 mg........................................................25cimetidine tab 300 mg........................................................25cimetidine tab 400 mg........................................................25cimetidine tab 800 mg........................................................25CIMZIA - certolizumab pegol for inj kit 2 x 200 mg........... 26CIMZIA - certolizumab pegol inj kit 2 x 200 mg/ml............26CIMZIA STARTER KIT - certolizumab pegol inj kit 6 x 200mg/ml.................................................................................26

ciprofloxacin for oral susp 250 mg/5ml (5%) (5gm/100ml)........................................................................... 2

ciprofloxacin for oral susp 500 mg/5ml (10%) (10gm/100ml)........................................................................... 2

ciprofloxacin hcl ophth soln 0.3%......................................48ciprofloxacin hcl tab 250 mg (base equiv)...........................2ciprofloxacin hcl tab 500 mg (base equiv)...........................2ciprofloxacin hcl tab 750 mg (base equiv)...........................2citalopram hydrobromide oral soln 10 mg/5ml.................. 29citalopram hydrobromide tab 10 mg (base equiv).............29citalopram hydrobromide tab 20 mg (base equiv).............29citalopram hydrobromide tab 40 mg (base equiv).............29clarithromycin for susp 125 mg/5ml.....................................1clarithromycin for susp 250 mg/5ml.....................................1clarithromycin tab 250 mg................................................... 2clarithromycin tab 500 mg................................................... 2CLASSIC PRENATAL - prenatal vit w/ fe fumarate-fa tab28-0.8 mg..........................................................................44

clemastine fumarate tab 1.34 mg (1 mg base equiv)........22clindamycin hcl cap 75 mg.................................................. 5clindamycin hcl cap 150 mg................................................ 5clindamycin hcl cap 300 mg................................................ 5clindamycin palmitate hcl for soln 75 mg/5ml (baseequiv)...................................................................................5

clindamycin phosphate gel 1%..........................................50clindamycin phosphate lotion 1%...................................... 50clindamycin phosphate soln 1%........................................ 50clindamycin phosphate swab 1%...................................... 50clindamycin phosphate vaginal cream 2%........................ 27clindamycin phosph-benzoyl peroxide (refrig) gel 1.2(1)-5%................................................................................50

clobetasol propionate emollient base cream 0.05%..........51clobetasol propionate soln 0.05%......................................51clonazepam orally disintegrating tab 0.125 mg.................41clonazepam orally disintegrating tab 0.25 mg...................41clonazepam orally disintegrating tab 0.5 mg.....................41clonazepam orally disintegrating tab 1 mg........................41clonazepam orally disintegrating tab 2 mg........................41clonazepam tab 0.5 mg..................................................... 41clonazepam tab 1 mg........................................................ 41clonazepam tab 2 mg........................................................ 41clonidine hcl tab er 12hr 0.1 mg........................................35clonidine hcl tab 0.1 mg.....................................................21clonidine hcl tab 0.2 mg.....................................................21clonidine hcl tab 0.3 mg.....................................................21clonidine hcl td patch weekly 0.1 mg/24hr........................ 21clonidine hcl td patch weekly 0.2 mg/24hr........................ 21clonidine hcl td patch weekly 0.3 mg/24hr........................ 21clopidogrel bisulfate tab 75 mg (base equiv).................... 47clopidogrel bisulfate tab 300 mg (base equiv).................. 47clorazepate dipotassium tab 3.75 mg................................28clorazepate dipotassium tab 7.5 mg..................................28clorazepate dipotassium tab 15 mg...................................28clotrimazole cream 1%.......................................................50clotrimazole soln 1%.......................................................... 50clotrimazole troche 10 mg................................................. 49clotrimazole w/ betamethasone cream 1-0.05%............... 50CLOZAPINE ODT - clozapine orally disintegrating tab12.5 mg.............................................................................31

clozapine orally disintegrating tab 25 mg..........................31clozapine orally disintegrating tab 100 mg........................31clozapine tab 25 mg...........................................................31clozapine tab 50 mg...........................................................31clozapine tab 100 mg.........................................................31clozapine tab 200 mg.........................................................31codeine sulfate tab 15 mg................................................. 37codeine sulfate tab 30 mg................................................. 37codeine sulfate tab 60 mg................................................. 37colchicine w/ probenecid tab 0.5-500 mg..........................40COLCRYS - colchicine tab 0.6 mg....................................40colestipol hcl granule packets 5 gm.................................. 19colestipol hcl granules 5 gm..............................................19colestipol hcl tab 1 gm.......................................................19COMBIPATCH - estradiol-norethindrone ace td pttw0.05-0.14 mg/day..............................................................10

COMBIPATCH - estradiol-norethindrone ace td pttw0.05-0.25 mg/day..............................................................10

COMBIVENT RESPIMAT - ipratropium-albuterol inhalaerosol soln 20-100 mcg/act............................................23

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COMETRIQ - cabozantinib s-malate cap 3 x 20 mg (60mg dose) kit........................................................................7

COMETRIQ - cabozantinib s-mal cap 1 x 80 mg & 1 x 20mg (100 dose) kit............................................................... 7

COMETRIQ - cabozantinib s-mal cap 1 x 80 mg & 3 x 20mg (140 dose) kit............................................................... 7

COMPLERA - emtricitabine-rilpivirine-tenofovir df tab200-25-300 mg................................................................... 3

CORTISONE ACETATE - cortisone acetate tab 25 mg...... 9COSENTYX - secukinumab subcutaneous soln prefilledsyringe 150 mg/ml............................................................52

COSENTYX SENSOREADY PEN - secukinumabsubcutaneous soln auto-injector 150 mg/ml....................52

COTELLIC - cobimetinib fumarate tab 20 mg (baseequivalent)...........................................................................7

CREON - pancrelipase (lip-prot-amyl) dr cap3000-9500-15000 unit...................................................... 26

CREON - pancrelipase (lip-prot-amyl) dr cap6000-19000-30000 unit.................................................... 26

CREON - pancrelipase (lip-prot-amyl) dr cap12000-38000-60000 unit.................................................. 26

CREON - pancrelipase (lip-prot-amyl) dr cap24000-76000-120000 unit................................................ 26

CREON - pancrelipase (lip-prot-amyl) dr cap36000-114000-180000 unit.............................................. 26

CRIXIVAN - indinavir sulfate cap 200 mg........................... 3CRIXIVAN - indinavir sulfate cap 400 mg........................... 3cromolyn sodium ophth soln 4%....................................... 49CUPRIMINE - penicillamine cap 250 mg.......................... 53CUTTER BACKWOODS - diethyltoluamide (deet)aerosol...............................................................................52

CUTTER SKINSATIONS - diethyltoluamide (deet)liquid.................................................................................. 52

cyanocobalamin inj 1000 mcg/ml...................................... 47cyclobenzaprine hcl tab 5 mg............................................43cyclobenzaprine hcl tab 10 mg..........................................43cyclopentolate hcl ophth soln 0.5%...................................49cyclopentolate hcl ophth soln 1%......................................49cyclopentolate hcl ophth soln 2%......................................49cyclosporine cap 25 mg.....................................................53cyclosporine cap 100 mg...................................................53cyclosporine modified cap 25 mg......................................53cyclosporine modified cap 50 mg......................................53cyclosporine modified cap 100 mg....................................53CYCLOSPORINE MODIFIED - cyclosporine modified cap50 mg................................................................................ 53

cyclosporine modified oral soln 100 mg/ml....................... 53cyproheptadine hcl syrup 2 mg/5ml...................................22cyproheptadine hcl tab 4 mg............................................. 22CYSTAGON - cysteamine bitartrate cap 50 mg................27CYSTAGON - cysteamine bitartrate cap 150 mg..............27

Ddanazol cap 50 mg............................................................ 10danazol cap 100 mg.......................................................... 10danazol cap 200 mg.......................................................... 10

dantrolene sodium cap 25 mg...........................................43dantrolene sodium cap 50 mg...........................................43dantrolene sodium cap 100 mg.........................................43dapsone tab 25 mg..............................................................5dapsone tab 100 mg............................................................5DARAPRIM - pyrimethamine tab 25 mg............................. 5darifenacin hydrobromide tab er 24hr 7.5 mg (baseequiv).................................................................................27

darifenacin hydrobromide tab er 24hr 15 mg (baseequiv).................................................................................27

demeclocycline hcl tab 150 mg........................................... 2demeclocycline hcl tab 300 mg........................................... 2DEPEN TITRATABS - penicillamine tab 250 mg.............. 53DESCOVY - emtricitabine-tenofovir alafenamide fumaratetab 200-25 mg.................................................................... 3

desipramine hcl tab 10 mg................................................ 29desipramine hcl tab 25 mg................................................ 29desipramine hcl tab 50 mg................................................ 29desipramine hcl tab 75 mg................................................ 29desipramine hcl tab 100 mg.............................................. 29desipramine hcl tab 150 mg.............................................. 29desloratadine tab 5 mg...................................................... 22desmopressin acetate nasal soln 0.01% (refrigerated).....14desmopressin acetate nasal spray soln 0.01%.................14desmopressin acetate nasal spray soln 0.01%(refrigerated)..................................................................... 14

desmopressin acetate tab 0.1 mg..................................... 14desmopressin acetate tab 0.2 mg..................................... 14desonide cream 0.05%...................................................... 51desonide oint 0.05%.......................................................... 51desoximetasone cream 0.25%.......................................... 51desoximetasone gel 0.05%................................................51DEXAMETHASONE - dexamethasone soln 0.5mg/5ml.................................................................................9

dexamethasone elixir 0.5 mg/5ml........................................9DEXAMETHASONE SODIUM PHOS - dexamethasonesodium phosphate ophth soln 0.1%................................ 48

dexamethasone tab 0.5 mg................................................. 9dexamethasone tab 0.75 mg............................................... 9dexamethasone tab 1.5 mg................................................. 9dexamethasone tab 4 mg.................................................... 9dexamethasone tab 6 mg.................................................... 9dexmethylphenidate hcl cap er 24 hr 5 mg.......................35dexmethylphenidate hcl cap er 24 hr 10 mg.....................35dexmethylphenidate hcl cap er 24 hr 15 mg.....................35dexmethylphenidate hcl cap er 24 hr 20 mg.....................35dexmethylphenidate hcl cap er 24 hr 30 mg.....................35dexmethylphenidate hcl cap er 24 hr 40 mg.....................35dexmethylphenidate hcl tab 2.5 mg...................................35dexmethylphenidate hcl tab 5 mg......................................35dexmethylphenidate hcl tab 10 mg....................................35dextroamphetamine sulfate cap er 24hr 5 mg.................. 35dextroamphetamine sulfate cap er 24hr 10 mg.................35dextroamphetamine sulfate cap er 24hr 15 mg.................35dextroamphetamine sulfate oral solution 5 mg/5ml...........35dextroamphetamine sulfate tab 5 mg................................35

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dextroamphetamine sulfate tab 10 mg..............................35dextromethorphan-guaifenesin liquid 10-100 mg/5ml.......23diazepam conc 5 mg/ml.....................................................28DIAZEPAM - diazepam im solution auto-inj 10mg/2ml...............................................................................28

DIAZEPAM - diazepam oral soln 1 mg/ml.........................28DIAZEPAM - diazepam rectal gel delivery system 2.5mg......................................................................................41

DIAZEPAM - diazepam rectal gel delivery system 10mg......................................................................................41

DIAZEPAM - diazepam rectal gel delivery system 20mg......................................................................................41

diazepam tab 2 mg............................................................ 28diazepam tab 5 mg............................................................ 28diazepam tab 10 mg.......................................................... 28diclofenac potassium tab 50 mg........................................39diclofenac sodium gel 1%..................................................50diclofenac sodium ophth soln 0.1%...................................49diclofenac sodium tab delayed release 50 mg..................39diclofenac sodium tab delayed release 75 mg..................39diclofenac sodium tab er 24hr 100 mg..............................39dicloxacillin sodium cap 250 mg..........................................1dicloxacillin sodium cap 500 mg..........................................1dicyclomine hcl cap 10 mg................................................ 25dicyclomine hcl oral soln 10 mg/5ml................................. 25dicyclomine hcl tab 20 mg.................................................25didanosine delayed release capsule 125 mg......................3didanosine delayed release capsule 200 mg......................3didanosine delayed release capsule 250 mg......................3didanosine delayed release capsule 400 mg......................3DIFFERIN - adapalene gel 0.1%.......................................50DIGOXIN - digoxin oral soln 0.05 mg/ml...........................21digoxin tab 125 mcg (0.125 mg)........................................21digoxin tab 250 mcg (0.25 mg)..........................................21DILANTIN - phenytoin sodium extended cap 30 mg.........41diltiazem hcl cap er 12hr 60 mg........................................17diltiazem hcl cap er 12hr 90 mg........................................17diltiazem hcl cap er 12hr 120 mg......................................17diltiazem hcl cap er 24hr 120 mg......................................17diltiazem hcl cap er 24hr 180 mg......................................17diltiazem hcl cap er 24hr 240 mg......................................17diltiazem hcl coated beads cap er 24hr 120 mg............... 18diltiazem hcl coated beads cap er 24hr 180 mg............... 18diltiazem hcl coated beads cap er 24hr 240 mg............... 18diltiazem hcl coated beads cap er 24hr 300 mg............... 18diltiazem hcl extended release beads cap er 24hr 120mg......................................................................................18

diltiazem hcl extended release beads cap er 24hr 180mg......................................................................................18





diltiazem hcl tab 30 mg......................................................18diltiazem hcl tab 60 mg......................................................18diltiazem hcl tab 90 mg......................................................18diltiazem hcl tab 120 mg....................................................18diphenhydramine hcl cap 25 mg....................................... 22diphenhydramine hcl cap 50 mg....................................... 22diphenhydramine hcl liquid 12.5 mg/5ml...........................22diphenhydramine hcl (sleep) cap 50 mg........................... 34diphenhydramine hcl (sleep) tab 25 mg............................34diphenhydramine hcl tab 25 mg........................................ 22diphenoxylate w/ atropine tab 2.5-0.025 mg..................... 25dipyridamole tab 25 mg..................................................... 47dipyridamole tab 50 mg..................................................... 47dipyridamole tab 75 mg..................................................... 47disopyramide phosphate cap 100 mg............................... 20disopyramide phosphate cap 150 mg............................... 20disulfiram tab 250 mg........................................................ 36disulfiram tab 500 mg........................................................ 36divalproex sodium cap delayed release sprinkle 125mg......................................................................................41

divalproex sodium tab delayed release 125 mg................41divalproex sodium tab delayed release 250 mg................41divalproex sodium tab delayed release 500 mg................41divalproex sodium tab er 24 hr 250 mg............................ 41divalproex sodium tab er 24 hr 500 mg............................ 41docusate sodium cap 100 mg........................................... 25dofetilide cap 125 mcg (0.125 mg)....................................20dofetilide cap 250 mcg (0.25 mg)......................................21dofetilide cap 500 mcg (0.5 mg)........................................21donepezil hydrochloride orally disintegrating tab 5 mg..... 36donepezil hydrochloride orally disintegrating tab 10mg......................................................................................36

donepezil hydrochloride tab 5 mg..................................... 36donepezil hydrochloride tab 10 mg................................... 36dorzolamide hcl ophth soln 2%......................................... 48dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml.......................................................................................48

doxazosin mesylate tab 1 mg............................................21doxazosin mesylate tab 2 mg............................................21doxazosin mesylate tab 4 mg............................................21doxazosin mesylate tab 8 mg............................................21doxepin hcl cap 10 mg...................................................... 29doxepin hcl cap 25 mg...................................................... 29doxepin hcl cap 50 mg...................................................... 29doxepin hcl cap 75 mg...................................................... 29doxepin hcl cap 100 mg.................................................... 29doxepin hcl cap 150 mg.................................................... 29doxepin hcl conc 10 mg/ml................................................29doxycycline hyclate cap 50 mg............................................2doxycycline hyclate cap 100 mg..........................................2doxycycline hyclate tab delayed release 50 mg..................2doxycycline hyclate tab 20 mg............................................ 2doxycycline hyclate tab 100 mg.......................................... 2doxycycline monohydrate cap 50 mg..................................2

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doxycycline monohydrate cap 100 mg................................2doxycycline monohydrate for susp 25 mg/5ml....................2doxycycline monohydrate tab 50 mg...................................2doxycycline monohydrate tab 75 mg...................................2doxycycline monohydrate tab 100 mg.................................2duloxetine hcl enteric coated pellets cap 20 mg (baseeq)..................................................................................... 29

duloxetine hcl enteric coated pellets cap 30 mg (baseeq)..................................................................................... 29

duloxetine hcl enteric coated pellets cap 60 mg (baseeq)..................................................................................... 29

dutasteride cap 0.5 mg...................................................... 27dutasteride-tamsulosin hcl cap 0.5-0.4 mg....................... 27dyphylline-guaifenesin liqd 100-100 mg/5ml..................... 23

EEDURANT - rilpivirine hcl tab 25 mg (base equivalent)...... 3ELIDEL - pimecrolimus cream 1%.................................... 52ELIGARD - leuprolide acetate for subcutaneous inj kit 7.5mg........................................................................................7

ELIGARD - leuprolide acetate (3 month) for subcutaneousinj kit 22.5mg...................................................................... 7

ELIGARD - leuprolide acetate (4 month) for subcutaneousinj kit 30 mg........................................................................7

ELIGARD - leuprolide acetate (6 month) for subcutaneousinj kit 45 mg........................................................................7

ELIQUIS - apixaban tab 2.5 mg........................................ 47ELIQUIS - apixaban tab 5 mg........................................... 47ELLA - ulipristal acetate tab 30 mg...................................11EMSAM - selegiline td patch 24hr 6 mg/24hr................... 29EMSAM - selegiline td patch 24hr 9 mg/24hr................... 29EMSAM - selegiline td patch 24hr 12 mg/24hr................. 29EMTRIVA - emtricitabine caps 200 mg............................... 3EMTRIVA - emtricitabine soln 10 mg/ml............................. 3enalapril maleate & hydrochlorothiazide tab 5-12.5mg......................................................................................15

enalapril maleate & hydrochlorothiazide tab 10-25 mg.....15enalapril maleate tab 2.5 mg.............................................15enalapril maleate tab 5 mg................................................15enalapril maleate tab 10 mg..............................................15enalapril maleate tab 20 mg..............................................15ENBREL - etanercept for subcutaneous inj 25 mg........... 39ENBREL - etanercept subcutaneous soln prefilled syringe25 mg/0.5ml...................................................................... 39

ENBREL - etanercept subcutaneous soln prefilled syringe50 mg/ml........................................................................... 39

ENBREL SURECLICK - etanercept subcutaneoussolution auto-injector 50 mg/ml........................................39

ENFAMIL ENFALYTE - oral electrolyte solution................45ENGERIX-B - hepatitis b vaccine (recombinant) 10mcg/0.5ml............................................................................6

ENGERIX-B - hepatitis b vaccine (recombinant) 20 mcg/ml.........................................................................................6

ENGERIX-B - hepatitis b vaccine (recombinant) susp 10mcg/0.5ml............................................................................5

ENGERIX-B - hepatitis b vaccine (recombinant) susp 20mcg/ml.................................................................................6

ENJUVIA - estrogens, conjugated synthetic b tab 0.3mg......................................................................................10




enoxaparin sodium inj 30 mg/0.3ml...................................47enoxaparin sodium inj 40 mg/0.4ml...................................47enoxaparin sodium inj 60 mg/0.6ml...................................47enoxaparin sodium inj 80 mg/0.8ml...................................47enoxaparin sodium inj 100 mg/ml......................................47enoxaparin sodium inj 120 mg/0.8ml.................................47enoxaparin sodium inj 150 mg/ml......................................47entacapone tab 200 mg.....................................................43entecavir tab 0.5 mg............................................................ 3entecavir tab 1 mg............................................................... 3ENTRESTO - sacubitril-valsartan tab 24-26 mg............... 18ENTRESTO - sacubitril-valsartan tab 49-51 mg............... 18ENTRESTO - sacubitril-valsartan tab 97-103 mg............. 18epinastine hcl ophth soln 0.05%........................................49EPINEPHRINE - epinephrine solution auto-injector 0.15mg/0.3ml (1:2000)............................................................ 22

EPINEPHRINE - epinephrine solution auto-injector 0.3mg/0.3ml (1:1000)............................................................ 22

EPOGEN - epoetin alfa inj 2000 unit/ml............................47EPOGEN - epoetin alfa inj 3000 unit/ml............................47EPOGEN - epoetin alfa inj 4000 unit/ml............................47EPOGEN - epoetin alfa inj 10000 unit/ml..........................47EPOGEN - epoetin alfa inj 20000 unit/ml..........................47EQL PRENATAL FORMULA - prenatal vit w/ fe fumarate-fa tab 28-0.8 mg...............................................................44

EQUETRO - carbamazepine (antipsychotic) cap er 12hr100 mg..............................................................................31



ergocalciferol cap 50000 unit.............................................44ERIVEDGE - vismodegib cap 150 mg................................ 7erythromycin ophth oint 5 mg/gm......................................48erythromycin pads 2%....................................................... 50erythromycin soln 2%.........................................................50ESBRIET - pirfenidone cap 267 mg..................................24escitalopram oxalate soln 5 mg/5ml (base equiv).............29escitalopram oxalate tab 5 mg (base equiv)..................... 29escitalopram oxalate tab 10 mg (base equiv)................... 29escitalopram oxalate tab 20 mg (base equiv)................... 29estazolam tab 1 mg........................................................... 34estazolam tab 2 mg........................................................... 34estradiol & norethindrone acetate tab 0.5-0.1 mg.............10estradiol & norethindrone acetate tab 1-0.5 mg................10estradiol tab 0.5 mg........................................................... 10

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estradiol tab 1 mg.............................................................. 10estradiol tab 2 mg.............................................................. 10estradiol td patch twice weekly 0.025 mg/24hr................. 10estradiol td patch twice weekly 0.0375 mg/24hr............... 10estradiol td patch twice weekly 0.05 mg/24hr................... 10estradiol td patch twice weekly 0.075 mg/24hr................. 10estradiol td patch twice weekly 0.1 mg/24hr..................... 11estradiol td patch weekly 0.025 mg/24hr...........................11estradiol td patch weekly 0.05 mg/24hr.............................11estradiol td patch weekly 0.06 mg/24hr.............................11estradiol td patch weekly 0.075 mg/24hr...........................11estradiol td patch weekly 0.1 mg/24hr...............................11estradiol td patch weekly 0.0375 mg/24hr (37.5mcg/24hr).......................................................................... 11

estradiol vaginal tab 10 mcg..............................................27ESTROPIPATE - estropipate tab 3 mg..............................11eszopiclone tab 1 mg.........................................................34eszopiclone tab 2 mg.........................................................34eszopiclone tab 3 mg.........................................................34ethambutol hcl tab 100 mg..................................................2ethambutol hcl tab 400 mg..................................................2ethosuximide cap 250 mg..................................................41ethosuximide soln 250 mg/5ml..........................................41ETIDRONATE DISODIUM - etidronate disodium tab 200mg......................................................................................14

EVOTAZ - atazanavir sulfate-cobicistat tab 300-150 mg(base equiv)........................................................................ 3

exemestane tab 25 mg........................................................ 7EXJADE - deferasirox tab for oral susp 125 mg............... 53EXJADE - deferasirox tab for oral susp 250 mg............... 53EXJADE - deferasirox tab for oral susp 500 mg............... 53EXTAVIA - interferon beta-1b for inj kit 0.3 mg................. 36

Ffamciclovir tab 125 mg.........................................................3famotidine for susp 40 mg/5ml.......................................... 25famotidine tab 20 mg......................................................... 25famotidine tab 40 mg......................................................... 25FANAPT - iloperidone tab 1 mg........................................ 31FANAPT - iloperidone tab 2 mg........................................ 31FANAPT - iloperidone tab 4 mg........................................ 31FANAPT - iloperidone tab 6 mg........................................ 31FANAPT - iloperidone tab 8 mg........................................ 31FANAPT - iloperidone tab 10 mg...................................... 31FANAPT - iloperidone tab 12 mg...................................... 31FANAPT TITRATION PACK - iloperidone tab 1 mg & 2 mg& 4 mg & 6 mg titration pak.............................................31

FAZACLO - clozapine orally disintegrating tab 12.5mg......................................................................................31

FAZACLO - clozapine orally disintegrating tab 150mg......................................................................................31

FAZACLO - clozapine orally disintegrating tab 200mg......................................................................................31

fe fumarate-vit c-vit b12-fa cap 460 (151 fe)-60-0.01-1mg......................................................................................47

fe fumarate w/ b12-vit c-fa-ifc cap 110-0.015-75-0.5-240mg......................................................................................47

fe fum-iron polysacch complex-fa-b cmplx-c-zn-mn-cucap.....................................................................................47

felbamate susp 600 mg/5ml.............................................. 41felbamate tab 400 mg........................................................41felbamate tab 600 mg........................................................41felodipine tab er 24hr 2.5 mg............................................ 18felodipine tab er 24hr 5 mg............................................... 18felodipine tab er 24hr 10 mg............................................. 18fenofibrate micronized cap 43 mg..................................... 19fenofibrate micronized cap 67 mg..................................... 19fenofibrate micronized cap 134 mg................................... 19fenofibrate micronized cap 200 mg................................... 19fenofibrate tab 48 mg.........................................................19fenofibrate tab 54 mg.........................................................19fenofibrate tab 145 mg.......................................................19fenofibrate tab 160 mg.......................................................19fentanyl td patch 72hr 12 mcg/hr.......................................37fentanyl td patch 72hr 25 mcg/hr.......................................37fentanyl td patch 72hr 50 mcg/hr.......................................37fentanyl td patch 72hr 75 mcg/hr.......................................37fentanyl td patch 72hr 100 mcg/hr.....................................37FERRIPROX - deferiprone oral soln 100 mg/ml............... 53FERRIPROX - deferiprone tab 500 mg.............................53ferrous fumarate-fa-b complex-c-zn-mg-mn-cu tab 106-1mg......................................................................................47

ferrous fumarate-folic acid tab 324-1 mg.......................... 47ferrous gluconate tab 324 mg (37.5 mg elementaliron)................................................................................... 47

ferrous sulfate tab 325 mg (65 mg elemental fe).............. 47FETZIMA - levomilnacipran hcl cap er 24hr 20 mg (baseequivalent).........................................................................29

FETZIMA - levomilnacipran hcl cap er 24hr 40 mg (baseequivalent).........................................................................29



FETZIMA TITRATION PACK - levomilnacipran hcl cap er24hr 20 & 40 mg therapy pack........................................29

fexofenadine hcl tab 60 mg............................................... 22fexofenadine hcl tab 180 mg............................................. 22FINACEA - azelaic acid gel 15%.......................................50finasteride tab 5 mg........................................................... 27FIRAZYR - icatibant acetate inj 30 mg/3ml (baseequivalent).........................................................................47

flavoxate hcl tab 100 mg................................................... 27flecainide acetate tab 50 mg............................................. 21flecainide acetate tab 100 mg........................................... 21flecainide acetate tab 150 mg........................................... 21FLOVENT DISKUS - fluticasone propionate aer pow ba50 mcg/blister................................................................... 23

FLOVENT DISKUS - fluticasone propionate aer pow ba100 mcg/blister................................................................. 23

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FLOVENT DISKUS - fluticasone propionate aer pow ba250 mcg/blister................................................................. 23

FLOVENT HFA - fluticasone propionate hfa inhal aer 110mcg/act (125/valve).......................................................... 24

FLOVENT HFA - fluticasone propionate hfa inhal aer 220mcg/act (250/valve).......................................................... 24

FLOVENT HFA - fluticasone propionate hfa inhal aero 44mcg/act (50/valve)............................................................ 23

FLUARIX QUADRIVALENT 2017 - influenza virus vacsplit quadrivalent susp pref syr 0.5ml................................ 6

FLUCELVAX QUADRIVALENT 20 - influenza vac tissue-cultured subunit quadrivalent im susp............................... 6

fluconazole for susp 10 mg/ml.............................................2fluconazole for susp 40 mg/ml.............................................2fluconazole tab 50 mg..........................................................2fluconazole tab 100 mg........................................................2fluconazole tab 150 mg........................................................2fluconazole tab 200 mg........................................................2flucytosine cap 250 mg........................................................2flucytosine cap 500 mg........................................................2fludrocortisone acetate tab 0.1 mg......................................9FLULAVAL QUADRIVALENT 201 - influenza virus vacsplit quadrivalent susp pref syr 0.5ml................................ 6

FLUNISOLIDE - flunisolide nasal soln 25 mcg/act(0.025%)............................................................................23

fluocinolone acetonide cream 0.01%................................ 51fluocinolone acetonide cream 0.025%.............................. 51fluocinolone acetonide oil 0.01% (scalp oil)...................... 51fluocinolone acetonide oint 0.025%...................................51fluocinolone acetonide soln 0.01%....................................51fluocinonide cream 0.05%................................................. 51fluocinonide emulsified base cream 0.05%.......................51fluocinonide gel 0.05%.......................................................51fluocinonide oint 0.05%......................................................51fluocinonide soln 0.05%.....................................................51fluorometholone ophth susp 0.1%.....................................48fluorouracil cream 5%........................................................ 52fluorouracil soln 2%............................................................52fluorouracil soln 5%............................................................52fluoxetine hcl cap 10 mg....................................................29fluoxetine hcl cap 20 mg....................................................29fluoxetine hcl cap 40 mg....................................................29fluoxetine hcl solution 20 mg/5ml...................................... 29fluoxetine hcl tab 10 mg.................................................... 29fluoxetine hcl tab 20 mg.................................................... 29FLUPHENAZINE HCL - fluphenazine hcl elixir 2.5mg/5ml...............................................................................31

FLUPHENAZINE HCL - fluphenazine hcl inj 2.5 mg/ml.......................................................................................31

FLUPHENAZINE HCL - fluphenazine hcl oral conc 5 mg/ml.......................................................................................31

fluphenazine hcl tab 1 mg................................................. 31fluphenazine hcl tab 2.5 mg.............................................. 31fluphenazine hcl tab 5 mg................................................. 31fluphenazine hcl tab 10 mg............................................... 31flurandrenolide cream 0.05%.............................................51

flurbiprofen sodium ophth soln 0.03%...............................49flurbiprofen tab 50 mg........................................................39flurbiprofen tab 100 mg......................................................39flutamide cap 125 mg.......................................................... 7FLUTICASONE PROPIONATE/SA - fluticasone-salmeterol aer powder ba 55-14 mcg/act........................ 24

FLUTICASONE PROPIONATE/SA - fluticasone-salmeterol aer powder ba 113-14 mcg/act...................... 24

FLUTICASONE PROPIONATE/SA - fluticasone-salmeterol aer powder ba 232-14 mcg/act...................... 24

fluticasone propionate cream 0.05%................................. 51fluticasone propionate nasal susp 50 mcg/act.................. 23fluticasone propionate oint 0.005%................................... 51fluvastatin sodium tab er 24 hr 80 mg...............................19FLUVIRIN 2017-2018 - influenza vac type a&b surfaceantigen susp pref syr 0.5 ml.............................................. 6

FLUVIRIN 2017-2018 - influenza virus vaccine types a &b surface antigen im susp..................................................6

fluvoxamine maleate tab 25 mg........................................ 29fluvoxamine maleate tab 50 mg........................................ 29fluvoxamine maleate tab 100 mg...................................... 29FLUZONE HIGH-DOSE PF 2017 - influenza virus vacsplit high-dose pf susp pref syr 0.5ml................................6

FLUZONE QUADRIVALENT 2017 - influenza virusvaccine split quadrivalent im inj.........................................6

FLUZONE QUADRIVALENT 2015 - influenza virus vacsplit quadrivalent susp pref syr 0.5ml................................ 6

FLUZONE QUADRIVALENT 2017 - influenza virus vacsplit quadrivalent susp pref syr 0.5ml................................ 6

FOLBEE PLUS CZ - b-complex w/ c-biotin-minerals &folic acid tab 5 mg............................................................44

folic acid-pyridoxine-cyanocobalamin tab 2.5-25-2 mg.....46folic acid tab 800 mcg........................................................47folic acid tab 1 mg............................................................. 47folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5 mg..........47folic acid-vitamin b6-vitamin b12 tab 2.2-25-1 mg.............47folic acid-vitamin b6-vitamin b12 tab 2.5-25-1 mg.............47FORADIL AEROLIZER - formoterol fumarate inhal cap 12mcg....................................................................................24

FORFIVO XL - bupropion hcl tab er 24hr 450 mg............ 30fosamprenavir calcium tab 700 mg (base equiv)................ 3fosinopril sodium & hydrochlorothiazide tab 10-12.5mg......................................................................................15

fosinopril sodium & hydrochlorothiazide tab 20-12.5mg......................................................................................15

fosinopril sodium tab 10 mg.............................................. 15fosinopril sodium tab 20 mg.............................................. 15fosinopril sodium tab 40 mg.............................................. 15frovatriptan succinate tab 2.5 mg (base equivalent)......... 402-fucosyllactose & lacto-n-neotetraose packet 2000-1000mg......................................................................................46

furosemide oral soln 10 mg/ml.......................................... 20furosemide tab 20 mg........................................................20furosemide tab 40 mg........................................................20furosemide tab 80 mg........................................................20FUZEON - enfuvirtide for inj 90 mg.....................................3

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Ggabapentin cap 100 mg..................................................... 41gabapentin cap 300 mg..................................................... 41gabapentin cap 400 mg..................................................... 41gabapentin oral soln 250 mg/5ml...................................... 41gabapentin tab 600 mg......................................................41gabapentin tab 800 mg......................................................41galantamine hydrobromide cap er 24hr 8 mg................... 36galantamine hydrobromide cap er 24hr 16 mg................. 36galantamine hydrobromide cap er 24hr 24 mg................. 36GALANTAMINE HYDROBROMIDE - galantaminehydrobromide oral soln 4 mg/ml...................................... 36

galantamine hydrobromide tab 4 mg.................................36galantamine hydrobromide tab 8 mg.................................36galantamine hydrobromide tab 12 mg...............................36GATTEX - teduglutide (rdna) for inj kit 5 mg.....................26gemfibrozil tab 600 mg...................................................... 19GENTAMICIN SULFATE - gentamicin sulfate oint0.1%.................................................................................. 50

gentamicin sulfate ophth oint 0.3%................................... 48gentamicin sulfate ophth soln 0.3%...................................48GENVOYA - elvitegrav-cobic-emtricitab-tenofov af tab150-150-200-10 mg............................................................ 3

GEODON - ziprasidone mesylate for inj 20 mg (baseequivalent).........................................................................31

GILOTRIF - afatinib dimaleate tab 20 mg (baseequivalent)...........................................................................7



glatiramer acetate soln prefilled syringe 20 mg/ml............36glatiramer acetate soln prefilled syringe 40 mg/ml............36glimepiride tab 1 mg.......................................................... 12glimepiride tab 2 mg.......................................................... 12glimepiride tab 4 mg.......................................................... 12glipizide-metformin hcl tab 2.5-250 mg............................. 12glipizide-metformin hcl tab 2.5-500 mg............................. 12glipizide-metformin hcl tab 5-500 mg................................ 12glipizide tab er 24hr 2.5 mg...............................................12glipizide tab er 24hr 5 mg..................................................12glipizide tab er 24hr 10 mg................................................12glipizide tab 5 mg...............................................................12glipizide tab 10 mg.............................................................12GLUCAGON EMERGENCY KIT - glucagon (rdna) for injkit 1 mg.............................................................................12

glyburide-metformin tab 1.25-250 mg............................... 12glyburide-metformin tab 2.5-500 mg................................. 12glyburide-metformin tab 5-500 mg.....................................12glyburide micronized tab 1.5 mg....................................... 12glyburide micronized tab 3 mg.......................................... 12glyburide micronized tab 6 mg.......................................... 12glyburide tab 1.25 mg........................................................ 12glyburide tab 2.5 mg.......................................................... 12glyburide tab 5 mg............................................................. 12

glycine irrigation soln 1.5%................................................27glycopyrrolate tab 1 mg..................................................... 25glycopyrrolate tab 2 mg..................................................... 25GNP PRENATAL - prenatal vit w/ fe fumarate-fa tab28-0.8 mg..........................................................................44

GOODSENSE PRENATAL VITAMI - prenatal vit w/ fefumarate-fa tab 28-0.8 mg............................................... 44

griseofulvin microsize susp 125 mg/5ml..............................2griseofulvin microsize tab 500 mg.......................................2griseofulvin ultramicrosize tab 125 mg................................2griseofulvin ultramicrosize tab 250 mg................................2guaifenesin liquid 100 mg/5ml...........................................23guanfacine hcl tab er 24hr 1 mg (base equiv)...................35guanfacine hcl tab er 24hr 2 mg (base equiv)...................35guanfacine hcl tab er 24hr 3 mg (base equiv)...................35guanfacine hcl tab er 24hr 4 mg (base equiv)...................35guanfacine hcl tab 1 mg.................................................... 21guanfacine hcl tab 2 mg.................................................... 21

Hhalobetasol propionate cream 0.05%................................51halobetasol propionate oint 0.05%.................................... 51haloperidol lactate oral conc 2 mg/ml................................31haloperidol tab 0.5 mg....................................................... 31haloperidol tab 1 mg.......................................................... 31haloperidol tab 2 mg.......................................................... 31haloperidol tab 5 mg.......................................................... 31haloperidol tab 10 mg........................................................ 31haloperidol tab 20 mg........................................................ 31HEXALEN - altretamine cap 50 mg.....................................7HM PRENATAL - prenatal vit w/ fe fumarate-fa tab 28-0.8mg......................................................................................44

homatropine hbr ophth soln 5%........................................ 49H.P. ACTHAR - corticotropin inj gel 80 unit/ml..................14HUMALOG - insulin lispro inj 100 unit/ml..........................12HUMALOG - insulin lispro soln cartridge 100 unit/ml........12HUMALOG JUNIOR KWIKPEN - insulin lispro soln pen-injector 100 unit/ml........................................................... 12

HUMALOG KWIKPEN - insulin lispro soln pen-injector100 unit/ml........................................................................ 12

HUMALOG KWIKPEN - insulin lispro soln pen-injector200 unit/ml........................................................................ 12

HUMALOG MIX 75/25 - insulin lispro prot & lispro inj 100unit/ml (75-25)...................................................................13

HUMALOG MIX 50/50 - insulin lispro protamine & lisproinj 100 unit/ml (50-50)...................................................... 13

HUMALOG MIX 50/50 KWIKPEN - insulin lispro prot &lispro sus pen-inj 100 unit/ml (50-50).............................. 13

HUMALOG MIX 75/25 KWIKPEN - insulin lispro prot &lispro sus pen-inj 100 unit/ml (75-25).............................. 13

HUMIRA - adalimumab prefilled syringe kit 10mg/0.2ml............................................................................39



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HUMIRA PEDIATRIC CROHNS D - adalimumab prefilledsyringe kit 40 mg/0.8ml....................................................39

HUMIRA PEN - adalimumab pen-injector kit 40mg/0.8ml............................................................................39

HUMIRA PEN-CROHNS DISEASE - adalimumab pen-injector kit 40 mg/0.8ml....................................................39

HUMIRA PEN-PSORIASIS STAR - adalimumab pen-injector kit 40 mg/0.8ml....................................................39

HUMULIN 70/30 - insulin nph isophane & regular humaninj 100 unit/ml (70-30)...................................................... 13

HUMULIN 70/30 KWIKPEN - insulin nph & regular susppen-inj 100 unit/ml (70-30)...............................................13

HUMULIN N - insulin nph (human) (isophane) inj 100 unit/ml.......................................................................................13

HUMULIN N KWIKPEN - insulin nph (human) (isophane)susp pen-injector 100 unit/ml...........................................13

HUMULIN R - insulin regular (human) inj 100 unit/ml.......12HYCAMTIN - topotecan hcl cap 0.25 mg (base equiv)....... 7HYCAMTIN - topotecan hcl cap 1 mg (base equiv)............ 7hydralazine hcl tab 10 mg................................................. 21hydralazine hcl tab 25 mg................................................. 21hydralazine hcl tab 50 mg................................................. 21hydralazine hcl tab 100 mg............................................... 21hydrochlorothiazide cap 12.5 mg.......................................20hydrochlorothiazide tab 12.5 mg....................................... 20hydrochlorothiazide tab 25 mg.......................................... 20hydrochlorothiazide tab 50 mg.......................................... 20hydrocodone-acetaminophen soln 7.5-325 mg/15ml........37hydrocodone-acetaminophen soln 10-325 mg/15ml......... 37hydrocodone-acetaminophen tab 2.5-325 mg...................37hydrocodone-acetaminophen tab 7.5-300 mg...................37hydrocodone-acetaminophen tab 7.5-325 mg...................38hydrocodone-acetaminophen tab 5-325 mg......................37hydrocodone-acetaminophen tab 10-300 mg....................38hydrocodone-acetaminophen tab 10-325 mg....................37hydrocodone-ibuprofen tab 7.5-200 mg............................ 38hydrocodone-ibuprofen tab 5-200 mg............................... 38hydrocortisone butyrate oint 0.1%.....................................51hydrocortisone butyrate soln 0.1%.................................... 51hydrocortisone cream 1%.................................................. 51hydrocortisone cream 2.5%............................................... 51hydrocortisone enema 100 mg/60ml................................. 50hydrocortisone lotion 2%....................................................51hydrocortisone lotion 2.5%................................................ 51hydrocortisone oint 1%...................................................... 51hydrocortisone oint 2.5%................................................... 52hydrocortisone rectal cream 1%........................................50hydrocortisone rectal cream 2.5%.....................................50hydrocortisone tab 5 mg...................................................... 9hydrocortisone tab 10 mg.................................................. 10hydrocortisone tab 20 mg.................................................. 10hydrocortisone valerate cream 0.2%.................................52hydrocortisone valerate oint 0.2%..................................... 52hydrocortisone w/ acetic acid otic soln 1-2%.................... 49hydromorphone hcl liqd 1 mg/ml....................................... 38hydromorphone hcl tab 2 mg.............................................38

hydromorphone hcl tab 4 mg.............................................38hydromorphone hcl tab 8 mg.............................................38hydroxychloroquine sulfate tab 200 mg...............................5hydroxyurea cap 500 mg..................................................... 7hydroxyzine hcl syrup 10 mg/5ml......................................28hydroxyzine hcl tab 10 mg.................................................28hydroxyzine hcl tab 25 mg.................................................28hydroxyzine hcl tab 50 mg.................................................28hydroxyzine pamoate cap 25 mg...................................... 28hydroxyzine pamoate cap 50 mg...................................... 28hyoscyamine sulfate elixir 0.125 mg/5ml.......................... 25hyoscyamine sulfate soln 0.125 mg/ml............................. 25hyoscyamine sulfate tab disint 0.125 mg.......................... 25hyoscyamine sulfate tab er 12hr 0.375 mg....................... 25hyoscyamine sulfate tab 0.125 mg....................................25hyoscyamine sulfate tab sl 0.125 mg................................25

Iibandronate sodium tab 150 mg (base equivalent)...........14IBRANCE - palbociclib cap 75 mg...................................... 7IBRANCE - palbociclib cap 100 mg.................................... 7IBRANCE - palbociclib cap 125 mg.................................... 7ibuprofen cap 200 mg........................................................39ibuprofen chew tab 100 mg...............................................39ibuprofen susp 40 mg/ml................................................... 39ibuprofen susp 100 mg/5ml............................................... 39ibuprofen tab 200 mg.........................................................39ibuprofen tab 400 mg.........................................................39ibuprofen tab 600 mg.........................................................39ibuprofen tab 800 mg.........................................................39ICLUSIG - ponatinib hcl tab 15 mg (base equiv)................ 7ICLUSIG - ponatinib hcl tab 45 mg (base equiv)................ 7imatinib mesylate tab 100 mg (base equivalent).................7imatinib mesylate tab 400 mg (base equivalent).................7imipramine hcl tab 10 mg.................................................. 30imipramine hcl tab 25 mg.................................................. 30imipramine hcl tab 50 mg.................................................. 30imiquimod cream 5%......................................................... 52IMITREX - sumatriptan nasal spray 5 mg/act................... 40IMITREX - sumatriptan nasal spray 20 mg/act................. 40IMMUNE SUPPORT - multiple vitamins w/ minerals chewtab......................................................................................44

IMOVAX RABIES (H.D.C.V.) - rabies virus vaccine, hdcinj......................................................................................... 6

INCRELEX - mecasermin inj 40 mg/4ml (10 mg/ml).........14INCRUSE ELLIPTA - umeclidinium br aero powd breathact 62.5 mcg/inh (base eq).............................................. 24

indapamide tab 1.25 mg.................................................... 20indapamide tab 2.5 mg...................................................... 20indomethacin cap er 75 mg...............................................39indomethacin cap 25 mg................................................... 39indomethacin cap 50 mg................................................... 39INFED - iron dextran inj 50 mg/ml (elemental iron)...........47INLYTA - axitinib tab 1 mg...................................................7INLYTA - axitinib tab 5 mg...................................................7INTELENCE - etravirine tab 25 mg.....................................3

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INTELENCE - etravirine tab 100 mg...................................3INTELENCE - etravirine tab 200 mg...................................3INVEGA - paliperidone tab er 24hr 1.5 mg....................... 32INVEGA - paliperidone tab er 24hr 3 mg.......................... 32INVEGA - paliperidone tab er 24hr 6 mg.......................... 32INVEGA - paliperidone tab er 24hr 9 mg.......................... 32INVEGA SUSTENNA - paliperidone palmitate imextended-release susp 39 mg/0.25ml............................. 32

INVEGA SUSTENNA - paliperidone palmitate imextended-release susp 78 mg/0.5ml............................... 32

INVEGA SUSTENNA - paliperidone palmitate imextended-release susp 156 mg/ml...................................32

INVEGA SUSTENNA - paliperidone palmitate imextended-release susp 234 mg/1.5ml............................. 32

INVEGA SUSTENNA - paliperidone palmitate im extend-release susp 117 mg/0.75ml............................................32

INVEGA TRINZA - paliperidone palmitate im extend-release susp 273 mg/0.875ml..........................................32


INVEGA TRINZA - paliperidone palmitate im extend-release susp 546 mg/1.75ml............................................32


INVIRASE - saquinavir mesylate cap 200 mg.....................4INVIRASE - saquinavir mesylate tab 500 mg..................... 4ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml........... 24ipratropium bromide inhal soln 0.02%...............................24ipratropium bromide nasal soln 0.03% (21 mcg/spray).....23ipratropium bromide nasal soln 0.06% (42 mcg/spray).....23IPRIVASK - desirudin for inj 15 mg................................... 47irbesartan-hydrochlorothiazide tab 150-12.5 mg...............16irbesartan-hydrochlorothiazide tab 300-12.5 mg...............16irbesartan tab 75 mg..........................................................16irbesartan tab 150 mg........................................................16irbesartan tab 300 mg........................................................16iron combination cap..........................................................47iron-docusate-b12-folic acid-c-e-cu-biotin tab 150-1mg......................................................................................47

iron-folic acid-vit c-vit b6-vit b12-zinc tab 150-1.25 mg.....47iron polysacch complex-vit b12-fa cap 150-0.025-1mg......................................................................................47

irrigation solution, physiological.........................................53ISENTRESS HD - raltegravir potassium tab 600 mg (baseequiv)...................................................................................4

ISENTRESS - raltegravir potassium chew tab 25 mg(base equiv)........................................................................ 4

ISENTRESS - raltegravir potassium chew tab 100 mg(base equiv)........................................................................ 4

ISENTRESS - raltegravir potassium packet for susp 100mg (base equiv)..................................................................4

ISENTRESS - raltegravir potassium tab 400 mg (baseequiv)...................................................................................4

isoniazid tab 100 mg............................................................2isoniazid tab 300 mg............................................................2isosorbide mononitrate tab er 24hr 30 mg........................ 18

isosorbide mononitrate tab er 24hr 60 mg........................ 18isosorbide mononitrate tab er 24hr 120 mg...................... 19isosorbide mononitrate tab 10 mg.....................................19isosorbide mononitrate tab 20 mg.....................................19isotretinoin cap 10 mg........................................................50isotretinoin cap 20 mg........................................................50isotretinoin cap 30 mg........................................................50isotretinoin cap 40 mg........................................................50isradipine cap 2.5 mg.........................................................18isradipine cap 5 mg............................................................18ivermectin tab 3 mg............................................................. 5

JJAKAFI - ruxolitinib phosphate tab 5 mg (baseequivalent)...........................................................................7

JAKAFI - ruxolitinib phosphate tab 10 mg (baseequivalent)...........................................................................7




JUXTAPID - lomitapide mesylate cap 5 mg (baseequiv).................................................................................19






KKALETRA - lopinavir-ritonavir tab 100-25 mg.....................4KALETRA - lopinavir-ritonavir tab 200-50 mg.....................4KALYDECO - ivacaftor packet 50 mg............................... 24KALYDECO - ivacaftor packet 75 mg............................... 24KALYDECO - ivacaftor tab 150 mg................................... 24ketoconazole cream 2%.....................................................50ketoconazole shampoo 2%................................................50ketoconazole tab 200 mg.................................................... 2ketoprofen cap 50 mg........................................................39ketoprofen cap 75 mg........................................................39ketorolac tromethamine ophth soln 0.4%..........................49ketorolac tromethamine ophth soln 0.5%..........................49ketorolac tromethamine tab 10 mg....................................39KETOSTIX - acetone (urine) test strip.............................. 53KINERET - anakinra subcutaneous soln prefilled syringe100 mg/0.67ml..................................................................39

KISQALI FEMARA 600 DOSE - ribociclib tab 200 mg &letrozole tab 2.5 mg therapy pack..................................... 7

KORLYM - mifepristone tab 300 mg................................. 12

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69

K-PHOS - potassium phosphate monobasic tab 500mg......................................................................................45

KP PRENATAL MULTIVITAMINS - prenatal vit w/ fefumarate-fa tab 28-0.8 mg............................................... 44

KUVAN - sapropterin dihydrochloride powder packet 100mg......................................................................................14

KUVAN - sapropterin dihydrochloride powder packet 500mg......................................................................................14

KUVAN - sapropterin dihydrochloride soluble tab 100mg......................................................................................14

KYLEENA - levonorgestrel releasing iud 17.5 mcg/day(19.5 mg total).................................................................. 11

Llabetalol hcl tab 100 mg.................................................... 17labetalol hcl tab 200 mg.................................................... 17labetalol hcl tab 300 mg.................................................... 17lactated ringer's for irrigation............................................. 53lactulose (encephalopathy) solution 10 gm/15ml.............. 26lactulose solution 10 gm/15ml........................................... 25LAMICTAL STARTER/NOT TAKI - lamotrigine tab 25 mg(42) & 100 mg (7) starter kit............................................ 41

LAMICTAL STARTER/TAKING C - lamotrigine tab 25 mg(84) & 100 mg (14) starter kit.......................................... 41

LAMICTAL STARTER/TAKING V - lamotrigine tab 25 mg(35) starter kit................................................................... 41

LAMICTAL XR - lamotrigine tab er 24hr 25 (14) & 50 mg(14) & 100 mg(7) kit.........................................................42

LAMICTAL XR - lamotrigine tab er 24hr 50 (14) & 100mg(14) & 200 mg(7) kit....................................................42

LAMICTAL XR - lamotrigine tab er 24hr 25 mg (21) & 50mg (7) titration kit............................................................. 42

lamivudine oral soln 10 mg/ml.............................................4lamivudine tab 150 mg.........................................................4lamivudine tab 300 mg.........................................................4lamivudine tab 100 mg (hbv)...............................................3lamivudine-zidovudine tab 150-300 mg...............................4lamotrigine tab chewable dispersible 5 mg....................... 42lamotrigine tab chewable dispersible 25 mg..................... 42lamotrigine tab disint 25 (14) & 50 mg (14) & 100 mg (7)kit....................................................................................... 42

lamotrigine tab disint 25 mg (21) & 50 mg (7) titrationkit....................................................................................... 42

lamotrigine tab disint 50 mg (42)- 100 mg(14) titrationkit....................................................................................... 42

lamotrigine tab er 24hr 25 mg........................................... 42lamotrigine tab er 24hr 50 mg........................................... 42lamotrigine tab er 24hr 100 mg......................................... 42lamotrigine tab er 24hr 200 mg......................................... 42lamotrigine tab er 24hr 250 mg......................................... 42lamotrigine tab er 24hr 300 mg......................................... 42lamotrigine tab 25 mg........................................................ 42lamotrigine tab 100 mg...................................................... 42lamotrigine tab 150 mg...................................................... 42lamotrigine tab 200 mg...................................................... 42LANCETS - BAYER ASCENCIA....................................... 53

lansoprazole cap delayed release 15 mg..........................25lansoprazole cap delayed release 30 mg..........................25latanoprost ophth soln 0.005%..........................................48LATUDA - lurasidone hcl tab 20 mg..................................32LATUDA - lurasidone hcl tab 40 mg..................................32LATUDA - lurasidone hcl tab 60 mg..................................32LATUDA - lurasidone hcl tab 80 mg..................................32LATUDA - lurasidone hcl tab 120 mg................................32leflunomide tab 10 mg....................................................... 39leflunomide tab 20 mg....................................................... 39LENVIMA 14 MG DAILY DOSE - lenvatinib cap therapypack 10 & 4 mg (14 mg daily dose).................................. 8

LENVIMA 18 MG DAILY DOSE - lenvatinib cap therapypack 10 & 4 (2) mg (18 mg daily dose).............................8

LENVIMA 24 MG DAILY DOSE - lenvatinib cap therapypack 10 (2) & 4 mg (24 mg daily dose).............................8

LENVIMA 10 MG DAILY DOSE - lenvatinib cap therapypack 10 mg (10 mg daily dose).........................................8

LENVIMA 20 MG DAILY DOSE - lenvatinib cap therapypack 10 (2) mg (20 mg daily dose)................................... 8

LENVIMA 8 MG DAILY DOSE - lenvatinib cap therapypack 4 (2) mg (8 mg daily dose)....................................... 8

LETAIRIS - ambrisentan tab 5 mg.................................... 21LETAIRIS - ambrisentan tab 10 mg.................................. 21letrozole tab 2.5 mg............................................................. 8LEUCOVORIN CALCIUM - leucovorin calcium tab 10mg........................................................................................8

LEUCOVORIN CALCIUM - leucovorin calcium tab 15mg........................................................................................8

leucovorin calcium tab 5 mg................................................8leucovorin calcium tab 25 mg..............................................8LEUKERAN - chlorambucil tab 2 mg.................................. 8levetiracetam oral soln 100 mg/ml.....................................42levetiracetam tab er 24hr 500 mg..................................... 42levetiracetam tab er 24hr 750 mg..................................... 42levetiracetam tab 250 mg.................................................. 42levetiracetam tab 500 mg.................................................. 42levetiracetam tab 750 mg.................................................. 42levetiracetam tab 1000 mg................................................ 42levobunolol hcl ophth soln 0.5%........................................49levocarnitine oral soln 1 gm/10ml (10%)...........................14levocarnitine tab 330 mg................................................... 14levocetirizine dihydrochloride tab 5 mg............................. 22levofloxacin oral soln 25 mg/ml........................................... 2levofloxacin tab 250 mg.......................................................2levofloxacin tab 500 mg.......................................................2levofloxacin tab 750 mg.......................................................2levonorgestrel tab 1.5 mg.................................................. 11levothyroxine sodium tab 25 mcg......................................13levothyroxine sodium tab 50 mcg......................................13levothyroxine sodium tab 75 mcg......................................13levothyroxine sodium tab 88 mcg......................................13levothyroxine sodium tab 100 mcg....................................13levothyroxine sodium tab 112 mcg....................................13levothyroxine sodium tab 125 mcg....................................13levothyroxine sodium tab 137 mcg....................................13

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levothyroxine sodium tab 150 mcg....................................13levothyroxine sodium tab 175 mcg....................................13levothyroxine sodium tab 200 mcg....................................13levothyroxine sodium tab 300 mcg....................................13LEXIVA - fosamprenavir calcium susp 50 mg/ml (baseequiv)...................................................................................4

lidocaine hcl gel 2%...........................................................52lidocaine hcl soln 4%......................................................... 52lidocaine hcl viscous soln 2%............................................49lidocaine patch 5%.............................................................52lidocaine-prilocaine cream 2.5-2.5%................................. 52LILETTA - levonorgestrel releasing iud 18.6 mcg/day (52mg total)............................................................................11

linezolid for susp 100 mg/5ml..............................................6linezolid tab 600 mg.............................................................6liothyronine sodium tab 5 mcg...........................................13liothyronine sodium tab 25 mcg.........................................13liothyronine sodium tab 50 mcg.........................................13lisinopril & hydrochlorothiazide tab 10-12.5 mg................ 15lisinopril & hydrochlorothiazide tab 20-12.5 mg................ 15lisinopril & hydrochlorothiazide tab 20-25 mg................... 15lisinopril tab 2.5 mg............................................................15lisinopril tab 5 mg...............................................................15lisinopril tab 10 mg.............................................................15lisinopril tab 20 mg.............................................................15lisinopril tab 30 mg.............................................................15lisinopril tab 40 mg.............................................................15LISTERINE NATURALS WITH F - sodium fluoride rinse0.02%................................................................................ 49

lithium carbonate cap 150 mg........................................... 32lithium carbonate cap 300 mg........................................... 32lithium carbonate cap 600 mg........................................... 32lithium carbonate tab er 300 mg........................................32lithium carbonate tab er 450 mg........................................32lithium carbonate tab 300 mg............................................32LITHIUM - lithium oral solution 8 meq/5ml........................32LOMUSTINE - lomustine cap 10 mg...................................8LOMUSTINE - lomustine cap 40 mg...................................8LOMUSTINE - lomustine cap 100 mg.................................8LONSURF - trifluridine-tipiracil tab 15-6.14 mg...................8LONSURF - trifluridine-tipiracil tab 20-8.19 mg...................8loperamide hcl cap 2 mg................................................... 25lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml).......4loratadine & pseudoephedrine tab er 12hr 5-120 mg........23loratadine & pseudoephedrine tab er 24hr 10-240 mg......23loratadine syrup 5 mg/5ml................................................. 22loratadine tab 10 mg..........................................................22lorazepam conc 2 mg/ml................................................... 28lorazepam tab 0.5 mg........................................................28lorazepam tab 1 mg...........................................................28lorazepam tab 2 mg...........................................................28losartan potassium & hydrochlorothiazide tab 50-12.5mg......................................................................................16

losartan potassium & hydrochlorothiazide tab 100-12.5mg......................................................................................16

losartan potassium & hydrochlorothiazide tab 100-25mg......................................................................................16

losartan potassium tab 25 mg........................................... 16losartan potassium tab 50 mg........................................... 16losartan potassium tab 100 mg......................................... 16lovastatin tab 10 mg...........................................................19lovastatin tab 20 mg...........................................................19lovastatin tab 40 mg...........................................................19loxapine succinate cap 5 mg.............................................32loxapine succinate cap 10 mg...........................................32loxapine succinate cap 25 mg...........................................32loxapine succinate cap 50 mg...........................................32LUPANETA PACK - leuprolide (1 mon) inj 3.75 mg &norethindrone tab 5 mg kit...............................................11

LUPANETA PACK - leuprolide (3 mon) inj 11.25 mg &norethindrone tab 5 mg kit...............................................11

LYNPARZA - olaparib cap 50 mg........................................8LYNPARZA - olaparib tab 100 mg.......................................8LYNPARZA - olaparib tab 150 mg.......................................8LYSODREN - mitotane tab 500 mg.....................................8

Mmagnesium citrate soln......................................................25MAPROTILINE HCL - maprotiline hcl tab 25 mg.............. 30MAPROTILINE HCL - maprotiline hcl tab 50 mg.............. 30MAPROTILINE HCL - maprotiline hcl tab 75 mg.............. 30MARPLAN - isocarboxazid tab 10 mg...............................30MATULANE - procarbazine hcl cap 50 mg......................... 8meclizine hcl tab 12.5 mg..................................................26meclizine hcl tab 25 mg.....................................................26medroxyprogesterone acetate tab 2.5 mg........................ 11medroxyprogesterone acetate tab 5 mg........................... 11medroxyprogesterone acetate tab 10 mg......................... 11MEFLOQUINE HCL - mefloquine hcl tab 250 mg...............5mefloquine hcl tab 250 mg.................................................. 5megestrol acetate susp 40 mg/ml....................................... 8megestrol acetate susp 625 mg/5ml................................. 11megestrol acetate tab 20 mg...............................................8megestrol acetate tab 40 mg...............................................8MEKINIST - trametinib dimethyl sulfoxide tab 0.5 mg(base equivalent)................................................................ 8

MEKINIST - trametinib dimethyl sulfoxide tab 2 mg (baseequivalent)...........................................................................8

meloxicam tab 7.5 mg........................................................39meloxicam tab 15 mg.........................................................39memantine hcl oral solution 2 mg/ml.................................36memantine hcl tab 5 mg.................................................... 36memantine hcl tab 10 mg..................................................36memantine hcl tab 5 mg (28) & 10 mg (21) titrationpak.....................................................................................36

MEPHYTON - phytonadione tab 5 mg.............................. 44mercaptopurine tab 50 mg...................................................8MESALAMINE DR - mesalamine tab delayed release 800mg......................................................................................26

mesalamine enema 4 gm.................................................. 26mesalamine rectal enema 4 gm & cleanser wipe kit.........26

2017

71

metformin hcl tab er 24hr 500 mg.....................................12metformin hcl tab er 24hr 750 mg.....................................12metformin hcl tab 500 mg..................................................12metformin hcl tab 850 mg..................................................12metformin hcl tab 1000 mg................................................12methadone hcl conc 10 mg/ml.......................................... 38methadone hcl soln 5 mg/5ml........................................... 38methadone hcl soln 10 mg/5ml......................................... 38methadone hcl tab for oral susp 40 mg............................ 38methadone hcl tab 5 mg....................................................38methadone hcl tab 10 mg..................................................38methimazole tab 5 mg....................................................... 13methimazole tab 10 mg..................................................... 13methocarbamol tab 500 mg...............................................43methocarbamol tab 750 mg...............................................43methotrexate sodium tab 2.5 mg (base equiv)....................8methoxsalen rapid cap 10 mg........................................... 52methscopolamine bromide tab 2.5 mg.............................. 25methyldopa tab 250 mg..................................................... 21methyldopa tab 500 mg..................................................... 21METHYLENE BLUE - methylene blue inj 1%................... 53methylergonovine maleate tab 0.2 mg.............................. 14methylphenidate hcl cap er 24hr 20 mg (la)......................35methylphenidate hcl cap er 24hr 30 mg (la)......................35methylphenidate hcl cap er 24hr 40 mg (la)......................35methylphenidate hcl cap er 10 mg (cd).............................35methylphenidate hcl cap er 20 mg (cd).............................35methylphenidate hcl cap er 30 mg (cd).............................35methylphenidate hcl cap er 40 mg (cd).............................35methylphenidate hcl cap er 50 mg (cd).............................35methylphenidate hcl cap er 60 mg (cd).............................35METHYLPHENIDATE HCL ER - methylphenidate hcl taber 24hr 18 mg...................................................................35

METHYLPHENIDATE HCL ER - methylphenidate hcl taber 24hr 27 mg...................................................................35



methylphenidate hcl soln 5 mg/5ml...................................35methylphenidate hcl soln 10 mg/5ml.................................35methylphenidate hcl tab er 10 mg.....................................35methylphenidate hcl tab er 20 mg.....................................35methylphenidate hcl tab 5 mg........................................... 35methylphenidate hcl tab 10 mg......................................... 35methylphenidate hcl tab 20 mg......................................... 35methylprednisolone tab 4 mg............................................ 10methylprednisolone tab 8 mg............................................ 10methylprednisolone tab 16 mg.......................................... 10methylprednisolone tab 32 mg.......................................... 10methylprednisolone tab therapy pack 4 mg (21)...............10METIPRANOLOL - metipranolol ophth soln 0.3%............ 49metoclopramide hcl soln 5 mg/5ml (10 mg/10ml)............. 26metoclopramide hcl tab 5 mg............................................ 26metoclopramide hcl tab 10 mg.......................................... 26metolazone tab 2.5 mg...................................................... 20

metolazone tab 5 mg......................................................... 20metolazone tab 10 mg....................................................... 20METOPROLOL/HYDROCHLOROTHI - metoprolol &hydrochlorothiazide tab 100-50 mg................................. 17

metoprolol & hydrochlorothiazide tab 50-25 mg................17metoprolol & hydrochlorothiazide tab 100-25 mg..............17metoprolol & hydrochlorothiazide tab 100-50 mg..............17metoprolol succinate tab er 24hr 25 mg (tartrateequiv).................................................................................17

metoprolol succinate tab er 24hr 50 mg (tartrateequiv).................................................................................17



metoprolol tartrate tab 25 mg............................................ 17metoprolol tartrate tab 50 mg............................................ 17metoprolol tartrate tab 100 mg.......................................... 17metronidazole cap 375 mg.................................................. 6metronidazole cream 0.75%.............................................. 50metronidazole gel 0.75%................................................... 50metronidazole tab 250 mg................................................... 6metronidazole tab 500 mg................................................... 6metronidazole vaginal gel 0.75%.......................................27miconazole nitrate cream 2%............................................ 50midodrine hcl tab 2.5 mg...................................................21midodrine hcl tab 5 mg...................................................... 21midodrine hcl tab 10 mg....................................................21miglitol tab 25 mg...............................................................12miglitol tab 50 mg...............................................................12miglitol tab 100 mg.............................................................12minocycline hcl cap 50 mg.................................................. 2minocycline hcl cap 75 mg.................................................. 2minocycline hcl cap 100 mg................................................ 2minoxidil tab 2.5 mg...........................................................21minoxidil tab 10 mg............................................................21MIRENA - levonorgestrel releasing iud 20 mcg/day (52mg total)............................................................................11

mirtazapine tab 15 mg....................................................... 30mirtazapine tab 30 mg....................................................... 30mirtazapine tab 45 mg....................................................... 30misoprostol tab 100 mcg................................................... 25misoprostol tab 200 mcg................................................... 25modafinil tab 100 mg......................................................... 35modafinil tab 200 mg......................................................... 35moexipril hcl tab 7.5 mg.................................................... 15moexipril hcl tab 15 mg..................................................... 15moexipril-hydrochlorothiazide tab 7.5-12.5 mg................. 15moexipril-hydrochlorothiazide tab 15-12.5 mg.................. 15moexipril-hydrochlorothiazide tab 15-25 mg..................... 15MOLINDONE HYDROCHLORIDE - molindone hcl tab 5mg......................................................................................32

MOLINDONE HYDROCHLORIDE - molindone hcl tab 10mg......................................................................................32

MOLINDONE HYDROCHLORIDE - molindone hcl tab 25mg......................................................................................32

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72

mometasone furoate cream 0.1%..................................... 52mometasone furoate oint 0.1%..........................................52mometasone furoate solution 0.1% (lotion).......................52montelukast sodium chew tab 4 mg (base equiv).............24montelukast sodium chew tab 5 mg (base equiv).............24montelukast sodium oral granules packet 4 mg (baseequiv).................................................................................24

montelukast sodium tab 10 mg (base equiv).................... 24morphine sulfate cap er 24hr 100 mg............................... 38MORPHINE SULFATE ER - morphine sulfate beads caper 24hr 60 mg...................................................................38

MORPHINE SULFATE ER - morphine sulfate beads caper 24hr 75 mg...................................................................38

MORPHINE SULFATE ER - morphine sulfate beads caper 24hr 120 mg.................................................................38

MORPHINE SULFATE - morphine sulfate suppos 5mg......................................................................................38




MORPHINE SULFATE - morphine sulfate tab 15 mg....... 38MORPHINE SULFATE - morphine sulfate tab 30 mg....... 38morphine sulfate oral soln 10 mg/5ml............................... 38morphine sulfate oral soln 20 mg/5ml............................... 38morphine sulfate oral soln 100 mg/5ml (20 mg/ml)...........38morphine sulfate tab er 15 mg.......................................... 38morphine sulfate tab er 30 mg.......................................... 38morphine sulfate tab er 60 mg.......................................... 38morphine sulfate tab er 100 mg........................................ 38morphine sulfate tab er 200 mg........................................ 38multiple vitamins w/ minerals & fa tab 1.25 mg.................44multiple vitamins w/ minerals cap......................................44multiple vitamins w/ minerals chew tab.............................44multiple vitamins w/ minerals tab.......................................44MULTI PRENATAL - prenatal vit w/ fe fumarate-fa tab27-0.8 mg..........................................................................44

mupirocin oint 2%...............................................................50M-VIT - prenatal vit w/ fe fumarate-fa tab 27-1 mg........... 44mycophenolate mofetil cap 250 mg...................................53mycophenolate mofetil for oral susp 200 mg/ml................53mycophenolate mofetil tab 500 mg................................... 53mycophenolate sodium tab dr 180 mg (mycophenolic acidequiv).................................................................................53

mycophenolate sodium tab dr 360 mg (mycophenolic acidequiv).................................................................................53

MYLERAN - busulfan tab 2 mg...........................................8

Nnabumetone tab 500 mg....................................................39nabumetone tab 750 mg....................................................39nadolol tab 20 mg.............................................................. 17nadolol tab 40 mg.............................................................. 17nadolol tab 80 mg.............................................................. 17

naftifine hcl cream 2%....................................................... 50naltrexone hcl tab 50 mg...................................................53NAPHAZOLINE HCL - naphazoline hcl ophth soln0.1%.................................................................................. 49

NAPROXEN - naproxen susp 125 mg/5ml....................... 40naproxen sodium tab er 24hr 375 mg (base equiv).......... 40naproxen sodium tab 220 mg............................................40naproxen sodium tab 275 mg............................................40naproxen sodium tab 550 mg............................................40naproxen susp 125 mg/5ml............................................... 40naproxen tab ec 375 mg....................................................40naproxen tab ec 500 mg....................................................40naproxen tab 250 mg.........................................................40naproxen tab 375 mg.........................................................40naproxen tab 500 mg.........................................................40NARCAN - naloxone hcl nasal spray 4 mg/0.1ml............. 53NATACYN - natamycin ophth susp 5%............................. 48nateglinide tab 60 mg........................................................ 12nateglinide tab 120 mg...................................................... 12NATRAPEL 12-HOUR TICK & I - picaridin aerosol...........52NAT-RUL PRENATAL VITAMINS - prenatal vit w/ fefumarate-fa tab 28-0.8 mg............................................... 44

NEFAZODONE HCL - nefazodone hcl tab 100 mg...........30NEFAZODONE HCL - nefazodone hcl tab 150 mg...........30NEFAZODONE HCL - nefazodone hcl tab 200 mg...........30neomycin-bacitracin-polymyxin oint...................................50neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000untop oin................................................................................ 48

neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml.......................................................................... 48

neomycin-polymyxin b gu irrigation soln........................... 27neomycin-polymyxin-dexamethasone ophth oint 0.1%.....48neomycin-polymyxin-dexamethasone ophth susp0.1%.................................................................................. 48

neomycin-polymyxin-hc otic soln 1%................................ 49neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1%................................................................................ 49

neomycin sulfate tab 500 mg.............................................. 2NEULASTA ONPRO KIT - pegfilgrastim soln prefilledsyringe kit 6 mg/0.6ml......................................................47

NEULASTA - pegfilgrastim soln prefilled syringe 6mg/0.6ml............................................................................47

NEVIRAPINE - nevirapine susp 50 mg/5ml........................ 4nevirapine tab er 24hr 100 mg............................................ 4nevirapine tab er 24hr 400 mg............................................ 4nevirapine tab 200 mg......................................................... 4NEXAVAR - sorafenib tosylate tab 200 mg (baseequivalent)...........................................................................8

NEXAVIR - liver derivative complex inj 25.5 mg/ml...........53NEXPLANON - etonogestrel subdermal implant 68mg......................................................................................11

niacin tab 500 mg.............................................................. 44nicardipine hcl cap 20 mg..................................................18nicotine polacrilex gum 2 mg.............................................36nicotine polacrilex gum 4 mg.............................................36nicotine polacrilex lozenge 2 mg....................................... 36

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nicotine polacrilex lozenge 4 mg....................................... 36nicotine td patch 24hr 7 mg/24hr.......................................36nicotine td patch 24hr 14 mg/24hr.....................................36nicotine td patch 24hr 21 mg/24hr.....................................36NICOTROL INHALER - nicotine inhaler system 10 mg (4mg delivered)....................................................................36

NICOTROL NS - nicotine nasal spray 10 mg/ml (0.5 mg/spray)................................................................................ 36

nifedipine cap 10 mg..........................................................18nifedipine cap 20 mg..........................................................18nifedipine tab er 24hr 30 mg............................................. 18nifedipine tab er 24hr 60 mg............................................. 18nifedipine tab er 24hr 90 mg............................................. 18nifedipine tab er 24hr osmotic release 30 mg................... 18nifedipine tab er 24hr osmotic release 60 mg................... 18nifedipine tab er 24hr osmotic release 90 mg................... 18nimodipine cap 30 mg........................................................18NINLARO - ixazomib citrate cap 2.3 mg (baseequivalent)...........................................................................8

NINLARO - ixazomib citrate cap 3 mg (baseequivalent)...........................................................................8

NINLARO - ixazomib citrate cap 4 mg (baseequivalent)...........................................................................8

nitrofurantoin macrocrystalline cap 25 mg........................ 27nitrofurantoin macrocrystalline cap 50 mg........................ 27nitrofurantoin macrocrystalline cap 100 mg...................... 27nitrofurantoin monohydrate macrocrystalline cap 100mg......................................................................................27

nitroglycerin cap er 2.5 mg................................................19nitroglycerin cap er 6.5 mg................................................19nitroglycerin cap er 9 mg...................................................19nitroglycerin sl tab 0.3 mg................................................. 19nitroglycerin sl tab 0.4 mg................................................. 19nitroglycerin sl tab 0.6 mg................................................. 19nitroglycerin td patch 24hr 0.1 mg/hr.................................19nitroglycerin td patch 24hr 0.2 mg/hr.................................19nitroglycerin td patch 24hr 0.4 mg/hr.................................19nitroglycerin td patch 24hr 0.6 mg/hr.................................19NITYR - nitisinone tab 2 mg..............................................14NITYR - nitisinone tab 5 mg..............................................14NITYR - nitisinone tab 10 mg............................................14NIVA-PLUS - prenatal vit w/ fe fumarate-fa tab 27-1mg......................................................................................44

nizatidine cap 150 mg........................................................25nizatidine cap 300 mg........................................................25norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5mcg....................................................................................11

norethindrone acetate-ethinyl estradiol tab 1 mg-5mcg....................................................................................11

norethindrone acetate tab 5 mg........................................ 11nortriptyline hcl cap 10 mg................................................ 30nortriptyline hcl cap 25 mg................................................ 30nortriptyline hcl cap 50 mg................................................ 30nortriptyline hcl cap 75 mg................................................ 30NORVIR - ritonavir cap 100 mg.......................................... 4NORVIR - ritonavir oral soln 80 mg/ml................................4

NORVIR - ritonavir tab 100 mg........................................... 4NOVOLIN 70/30 - insulin nph isophane & regular humaninj 100 unit/ml (70-30)...................................................... 13

NOVOLIN 70/30 RELION - insulin nph isophane & regularhuman inj 100 unit/ml (70-30)..........................................13

NOVOLIN N - insulin nph (human) (isophane) inj 100 unit/ml.......................................................................................13

NOVOLIN N RELION - insulin nph (human) (isophane) inj100 unit/ml........................................................................ 13

NOVOLIN R - insulin regular (human) inj 100 unit/ml....... 13NOVOLIN R RELION - insulin regular (human) inj 100unit/ml................................................................................13

NOVOLOG FLEXPEN - insulin aspart soln pen-injector100 unit/ml........................................................................ 12

NOVOLOG - insulin aspart inj 100 unit/ml........................ 12NOVOLOG MIX 70/30 - insulin aspart prot & aspart(human) inj 100 unit/ml (70-30)....................................... 13

NOVOLOG MIX 70/30 PREFILL - insulin aspart prot &aspart sus pen-inj 100 unit/ml (70-30).............................13

NOVOLOG PENFILL - insulin aspart soln cartridge 100unit/ml................................................................................12

NOXAFIL - posaconazole susp 40 mg/ml...........................3NOXAFIL - posaconazole tab delayed release 100 mg......3NUCALA - mepolizumab for inj 100 mg............................ 24NUVARING - etonogestrel-ethinyl estradiol va ring0.120-0.015 mg/24hr........................................................ 11

nystatin cream 100000 unit/gm......................................... 50nystatin oint 100000 unit/gm..............................................50nystatin oral powder.............................................................3nystatin susp 100000 unit/ml.............................................49nystatin tab 500000 unit...................................................... 3

OO-CAL FA - prenatal vit w/ fe fumarate-fa tab 27-1 mg.....44ODEFSEY - emtricitabine-rilpivirine-tenofovir af tab200-25-25 mg..................................................................... 4

OFEV - nintedanib esylate cap 100 mg (baseequivalent).........................................................................24

OFEV - nintedanib esylate cap 150 mg (baseequivalent).........................................................................24

OFF ACTIVE - diethyltoluamide (deet) aerosol.................52OFF DEEP WOODS - diethyltoluamide (deet) aerosol.....52OFF DEEP WOODS DRY - diethyltoluamide (deet)aerosol...............................................................................52

OFF SMOOTH & DRY - diethyltoluamide (deet)aerosol...............................................................................52

ofloxacin ophth soln 0.3%..................................................48ofloxacin otic soln 0.3%..................................................... 49olanzapine orally disintegrating tab 5 mg..........................32olanzapine orally disintegrating tab 10 mg........................32olanzapine orally disintegrating tab 15 mg........................32olanzapine orally disintegrating tab 20 mg........................32olanzapine tab 2.5 mg....................................................... 32olanzapine tab 5 mg.......................................................... 32olanzapine tab 7.5 mg....................................................... 32olanzapine tab 10 mg........................................................ 32

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olanzapine tab 15 mg........................................................ 32olanzapine tab 20 mg........................................................ 32olmesartan medoxomil-hydrochlorothiazide tab 20-12.5mg......................................................................................16

olmesartan medoxomil-hydrochlorothiazide tab 40-12.5mg......................................................................................16

olmesartan medoxomil-hydrochlorothiazide tab 40-25mg......................................................................................16

olmesartan medoxomil tab 5 mg....................................... 16olmesartan medoxomil tab 20 mg..................................... 16olmesartan medoxomil tab 40 mg..................................... 16olopatadine hcl ophth soln 0.1% (base equivalent)...........49omeprazole cap delayed release 10 mg........................... 25omeprazole cap delayed release 20 mg........................... 25omeprazole cap delayed release 40 mg........................... 25OMNITROPE - somatropin for inj 5.8 mg......................... 14ondansetron hcl oral soln 4 mg/5ml.................................. 26ondansetron hcl tab 4 mg..................................................26ondansetron hcl tab 8 mg..................................................26ondansetron hcl tab 24 mg................................................26ondansetron orally disintegrating tab 4 mg....................... 26ondansetron orally disintegrating tab 8 mg....................... 26oral electrolyte solution...................................................... 45ORENCIA - abatacept subcutaneous soln prefilled syringe125 mg/ml......................................................................... 40

ORENCIA CLICKJECT - abatacept subcutaneous solnauto-injector 125 mg/ml....................................................40

ORKAMBI - lumacaftor-ivacaftor tab 100-125 mg.............24ORKAMBI - lumacaftor-ivacaftor tab 200-125 mg.............24orphenadrine citrate tab er 12hr 100 mg...........................43oseltamivir phosphate cap 30 mg (base equiv).................. 5oseltamivir phosphate cap 45 mg (base equiv).................. 5oseltamivir phosphate cap 75 mg (base equiv).................. 5oseltamivir phosphate for susp 6 mg/ml (base equiv).........5oxcarbazepine susp 300 mg/5ml (60 mg/ml).................... 42oxcarbazepine tab 150 mg................................................ 42oxcarbazepine tab 300 mg................................................ 42oxcarbazepine tab 600 mg................................................ 42oxiconazole nitrate cream 1%........................................... 50OXTELLAR XR - oxcarbazepine tab er 24hr 150 mg....... 42OXTELLAR XR - oxcarbazepine tab er 24hr 300 mg....... 42OXTELLAR XR - oxcarbazepine tab er 24hr 600 mg....... 42oxybutynin chloride syrup 5 mg/5ml..................................27oxybutynin chloride tab er 24hr 5 mg................................27oxybutynin chloride tab er 24hr 10 mg..............................27oxybutynin chloride tab er 24hr 15 mg..............................27oxybutynin chloride tab 5 mg.............................................27OXYCODONE/ACETAMINOPHEN - oxycodone w/acetaminophen soln 5-325 mg/5ml..................................38

OXYCODONE/IBUPROFEN - oxycodone-ibuprofen tab5-400 mg...........................................................................38

oxycodone-aspirin tab 4.8355-325 mg.............................. 38oxycodone hcl conc 100 mg/5ml (20 mg/ml).................... 38oxycodone hcl soln 5 mg/5ml............................................38oxycodone hcl tab 5 mg.................................................... 38oxycodone hcl tab 10 mg.................................................. 38

oxycodone hcl tab 15 mg.................................................. 38oxycodone hcl tab 20 mg.................................................. 38oxycodone hcl tab 30 mg.................................................. 38oxycodone w/ acetaminophen tab 2.5-325 mg................. 38oxycodone w/ acetaminophen tab 5-325 mg.................... 38oxycodone w/ acetaminophen tab 7.5-325 mg................. 38oxycodone w/ acetaminophen tab 10-325 mg.................. 38oxymorphone hcl tab er 12hr 5 mg................................... 38oxymorphone hcl tab er 12hr 7.5 mg................................ 38oxymorphone hcl tab er 12hr 10 mg................................. 38oxymorphone hcl tab er 12hr 15 mg................................. 38oxymorphone hcl tab er 12hr 20 mg................................. 38oxymorphone hcl tab er 12hr 30 mg................................. 38oxymorphone hcl tab er 12hr 40 mg................................. 39oxymorphone hcl tab 5 mg................................................39oxymorphone hcl tab 10 mg..............................................39

Ppaliperidone tab er 24hr 1.5 mg........................................ 32paliperidone tab er 24hr 3 mg........................................... 32paliperidone tab er 24hr 6 mg........................................... 32paliperidone tab er 24hr 9 mg........................................... 32pantoprazole sodium ec tab 20 mg (base equiv).............. 25pantoprazole sodium ec tab 40 mg (base equiv).............. 25PARAGARD INTRAUTERINE COP - copper iud..............11paromomycin sulfate cap 250 mg....................................... 2paroxetine hcl tab 10 mg...................................................30paroxetine hcl tab 20 mg...................................................30paroxetine hcl tab 30 mg...................................................30paroxetine hcl tab 40 mg...................................................30PAXIL - paroxetine hcl oral susp 10 mg/5ml (baseequiv).................................................................................30

pediatric multiple vitamin w/ minerals & c drops 45 mg/ml.......................................................................................44

pediatric vitamins acd w/ fluoride soln 0.25 mg/ml............44peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236gm......................................................................................25

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240gm......................................................................................25

peg 3350-kcl-sod bicarb-nacl for soln 420 gm.................. 25penicillin v potassium for soln 125 mg/5ml......................... 1penicillin v potassium for soln 250 mg/5ml......................... 1penicillin v potassium tab 250 mg....................................... 1penicillin v potassium tab 500 mg....................................... 1PENTASA - mesalamine cap er 250 mg...........................26PENTASA - mesalamine cap er 500 mg...........................26pentoxifylline tab er 400 mg.............................................. 47perindopril erbumine tab 2 mg...........................................15perindopril erbumine tab 4 mg...........................................15perindopril erbumine tab 8 mg...........................................15permethrin cream 5%.........................................................52permethrin creme rinse 1%............................................... 52PERPHENAZINE/AMITRIPTYLIN - perphenazine-amitriptyline tab 2-10 mg................................................. 36

PERPHENAZINE/AMITRIPTYLIN - perphenazine-amitriptyline tab 2-25 mg................................................. 36

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perphenazine tab 2 mg......................................................32perphenazine tab 4 mg......................................................32perphenazine tab 8 mg......................................................33perphenazine tab 16 mg....................................................33PEXEVA - paroxetine mesylate tab 10 mg (baseequiv).................................................................................30

PEXEVA - paroxetine mesylate tab 20 mg (baseequiv).................................................................................30



phenazopyridine hcl tab 100 mg....................................... 27phenazopyridine hcl tab 200 mg....................................... 27phenobarbital elixir 20 mg/5ml...........................................34PHENOBARBITAL - phenobarbital tab 15 mg.................. 34PHENOBARBITAL - phenobarbital tab 30 mg.................. 34PHENOBARBITAL - phenobarbital tab 60 mg.................. 34PHENOBARBITAL - phenobarbital tab 100 mg................ 34phenobarbital tab 16.2 mg.................................................34phenobarbital tab 32.4 mg.................................................34phenobarbital tab 64.8 mg.................................................34phenobarbital tab 97.2 mg.................................................34phenoxybenzamine hcl cap 10 mg....................................21phenylephrine hcl ophth soln 2.5%................................... 49phenylephrine w/ dm-gg liqd 10-15-300 mg/5ml...............23phenylephrine w/ dm-gg liqd 2.5-5-50 mg/ml....................23phenylephrine w/ dm-gg liqd 2.5-7.5-88 mg/ml.................23phenytoin chew tab 50 mg................................................ 42phenytoin sodium extended cap 100 mg.......................... 42phenytoin sodium extended cap 200 mg.......................... 42phenytoin sodium extended cap 300 mg.......................... 42phenytoin susp 125 mg/5ml...............................................42pilocarpine hcl ophth soln 1%............................................49pilocarpine hcl ophth soln 2%............................................49pilocarpine hcl ophth soln 4%............................................49pilocarpine hcl tab 5 mg.................................................... 49pilocarpine hcl tab 7.5 mg................................................. 49pimozide tab 1 mg............................................................. 37pimozide tab 2 mg............................................................. 37pindolol tab 5 mg............................................................... 17pioglitazone hcl tab 15 mg (base equiv)........................... 12pioglitazone hcl tab 30 mg (base equiv)........................... 12pioglitazone hcl tab 45 mg (base equiv)........................... 12piroxicam cap 10 mg..........................................................40piroxicam cap 20 mg..........................................................40PNV FOLIC ACID + IRON MUL - prenatal vit w/ fefumarate-fa tab 27-1 mg.................................................. 44

PNV PRENATAL PLUS MULTIVI - prenatal vit w/ fefumarate-fa tab 27-1 mg.................................................. 44

podofilox soln 0.5%............................................................52polyethylene glycol 3350 oral packet................................ 25polyethylene glycol 3350 oral powder............................... 25polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1%............................................................................. 48

POLY-VI-FLOR - ped multiple vit w/ fluoride biphasicchew tab 0.25 mg.............................................................44

POLY-VI-FLOR - ped multiple vit w/ fluoride biphasicchew tab 0.5 mg...............................................................44

POLY-VI-FLOR - ped multiple vit w/ fluoride biphasicchew tab 1 mg..................................................................44

POMALYST - pomalidomide cap 1 mg............................... 8POMALYST - pomalidomide cap 2 mg............................... 8POMALYST - pomalidomide cap 3 mg............................... 8POMALYST - pomalidomide cap 4 mg............................... 8pot & sod citrates w/ cit ac soln 550-500-334 mg/5ml.......27potassium bicarbonate effer tab 25 meq...........................46potassium chloride cap er 8 meq...................................... 46potassium chloride cap er 10 meq.................................... 46POTASSIUM CHLORIDE ER - potassium chloride tab er8 meq (600 mg)................................................................46

potassium chloride microencapsulated crys er tab 10meq....................................................................................46

potassium chloride microencapsulated crys er tab 20meq....................................................................................46

potassium chloride oral soln 10% (20 meq/15ml)............. 46potassium chloride oral soln 20% (40 meq/15ml)............. 46potassium chloride tab er 10 meq.....................................46potassium chloride tab er 8 meq (600 mg)....................... 46potassium citrate & citric acid powder pack 3300-1002mg......................................................................................27

potassium citrate & citric acid soln 1100-334 mg/5ml....... 27potassium citrate tab er 5 meq (540 mg).......................... 27potassium citrate tab er 10 meq (1080 mg)...................... 28potassium citrate tab er 15 meq (1620 mg)...................... 28pot bicarbonate & chloride effer tab 25 meq.....................45pot phos monobasic w/sod phos di & monobas tab155-852-130mg.................................................................46

PRALUENT - alirocumab subcutaneous soln pen-injector75 mg/ml........................................................................... 19

PRALUENT - alirocumab subcutaneous soln pen-injector150 mg/ml......................................................................... 19

PRALUENT - alirocumab subcutaneous soln prefilledsyringe 75 mg/ml..............................................................19

PRALUENT - alirocumab subcutaneous soln prefilledsyringe 150 mg/ml............................................................20

pramipexole dihydrochloride tab er 24hr 2.25 mg.............43pramipexole dihydrochloride tab 0.125 mg....................... 43pramipexole dihydrochloride tab 0.25 mg......................... 43pramipexole dihydrochloride tab 0.5 mg........................... 43pramipexole dihydrochloride tab 0.75 mg......................... 43pramipexole dihydrochloride tab 1 mg.............................. 43pramipexole dihydrochloride tab 1.5 mg........................... 43pravastatin sodium tab 10 mg........................................... 20pravastatin sodium tab 20 mg........................................... 20pravastatin sodium tab 40 mg........................................... 20

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pravastatin sodium tab 80 mg........................................... 20prazosin hcl cap 1 mg....................................................... 21prazosin hcl cap 2 mg....................................................... 21prazosin hcl cap 5 mg....................................................... 22prednicarbate cream 0.1%.................................................52PREDNICARBATE - prednicarbate cream 0.1%...............52PREDNICARBATE - prednicarbate oint 0.1%...................52prednisolone acetate ophth susp 1%................................ 48PREDNISOLONE SODIUM PHOSP - prednisolonesodium phosphate ophth soln 1%................................... 48

prednisolone sod phosphate oral soln 15 mg/5ml (baseequiv).................................................................................10

prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5mlbase)..................................................................................10

prednisolone syrup 15 mg/5ml (usp solutionequivalent).........................................................................10

PREDNISONE - prednisone oral soln 5 mg/5ml...............10PREDNISONE - prednisone tab 50 mg............................ 10PREDNISONE - prednisone tab therapy pack 5 mg(21).................................................................................... 10

PREDNISONE - prednisone tab therapy pack 5 mg(48).................................................................................... 10



prednisone tab 1 mg..........................................................10prednisone tab 2.5 mg.......................................................10prednisone tab 5 mg..........................................................10prednisone tab 10 mg........................................................10prednisone tab 20 mg........................................................10PRENATAL AND IRON - prenatal multivitamins &minerals w/iron & fa tab 0.8 mg.......................................45

PRE-NATAL FORMULA - prenatal multivitamins &minerals w/iron & fa tab 0.8 mg.......................................44

PRENATAL FORMULA - prenatal vit w/ fe fumarate-fa tab28-0.8 mg..........................................................................45

PRENATAL FORTE - prenatal multivitamins & minerals w/iron & fa tab 0.8 mg.........................................................45

PRENATAL LOW IRON - prenatal vit w/ fe fumarate-fa tab27-0.8 mg..........................................................................45

PRENATAL MULTI +DHA - prenatal vit w/ fe fum-fa-omega 3 cap 27-0.8-228 mg........................................... 45

PRENATAL ONE DAILY - prenatal vit w/ fe fumarate-fatab 27-0.8 mg................................................................... 45

PRENATAL PLUS DHA - prenatal mv & min w/fecarbonyl-fa-dha tab 7-0.4-100 mg................................... 45

PRENATAL PLUS - prenatal vit w/ fe fumarate-fa tab 27-1mg......................................................................................45

PRENATAL - prenatal multivitamins & minerals w/iron & fatab 0.8 mg.........................................................................44

PRENATAL 19 - prenatal vit w/ dss-fe fumarate-fa tab29-1 mg.............................................................................45

PRENATAL 19 - prenatal vit w/ fe fumarate-fa chew tab29-1 mg.............................................................................45

PRENATAL - prenatal vit w/ fe fumarate-fa tab 27-0.8mg......................................................................................44

PRENATAL - prenatal vit w/ fe fumarate-fa tab 27-1mg......................................................................................44

PRENATAL - prenatal vit w/ fe fumarate-fa tab 28-0.8mg......................................................................................45

PRENATAL VITAMIN - prenatal vit w/ fe fumarate-fa tab27-0.8 mg..........................................................................45

PRENATAL VITAMINS - prenatal multivitamins & mineralsw/iron & fa tab 0.8 mg..................................................... 45

PRENATAL VITAMINS - prenatal vit w/ fe fumarate-fa tab28-0.8 mg..........................................................................45

prenatal vit w/ fe fumarate-fa tab 28-0.8 mg..................... 45PREPLUS - prenatal vit w/ fe fumarate-fa tab 27-1mg......................................................................................45

PREVIDENT 5000 DRY MOUTH - sodium fluoride gel1.1% (0.5% f)....................................................................49

PREVIDENT FLUORIDE - sodium fluoride gel 1.1% (0.5%f).........................................................................................49

PREZCOBIX - darunavir-cobicistat tab 800-150 mg...........4PREZISTA - darunavir ethanolate susp 100 mg/ml (baseequiv)...................................................................................4

PREZISTA - darunavir ethanolate tab 75 mg (baseequiv)...................................................................................4




PRIFTIN - rifapentine tab 150 mg....................................... 2PRIMAQUINE PHOSPHATE - primaquine phosphate tab26.3 mg (15 mg base)....................................................... 5

primidone tab 50 mg..........................................................42primidone tab 250 mg........................................................42probenecid tab 500 mg......................................................40PROCRIT - epoetin alfa inj 2000 unit/ml...........................47PROCRIT - epoetin alfa inj 3000 unit/ml...........................47PROCRIT - epoetin alfa inj 4000 unit/ml...........................47PROCRIT - epoetin alfa inj 10000 unit/ml.........................47PROCRIT - epoetin alfa inj 20000 unit/ml.........................47PROCRIT - epoetin alfa inj 40000 unit/ml.........................47PROCYSBI - cysteamine bitartrate cap delayed release25 mg (base equiv).......................................................... 28

PROCYSBI - cysteamine bitartrate cap delayed release75 mg (base equiv).......................................................... 28

progesterone micronized cap 100 mg...............................11progesterone micronized cap 200 mg...............................11PROMACTA - eltrombopag olamine tab 12.5 mg (baseequiv).................................................................................47

PROMACTA - eltrombopag olamine tab 25 mg (baseequiv).................................................................................48



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promethazine hcl suppos 12.5 mg.................................... 22promethazine hcl suppos 25 mg....................................... 22promethazine hcl syrup 6.25 mg/5ml................................ 22promethazine hcl tab 12.5 mg...........................................22promethazine hcl tab 25 mg..............................................22promethazine hcl tab 50 mg..............................................22promethazine w/ codeine syrup 6.25-10 mg/5ml.............. 23propafenone hcl tab 150 mg..............................................21propafenone hcl tab 225 mg..............................................21propafenone hcl tab 300 mg..............................................21proparacaine hcl ophth soln 0.5%.....................................49PROPRANOLOL/HYDROCHLOROTH - propranolol &hydrochlorothiazide tab 40-25 mg................................... 17

PROPRANOLOL/HYDROCHLOROTH - propranolol &hydrochlorothiazide tab 80-25 mg................................... 17

propranolol hcl cap er 24hr 60 mg.................................... 17propranolol hcl cap er 24hr 80 mg.................................... 17propranolol hcl cap er 24hr 120 mg.................................. 17propranolol hcl cap er 24hr 160 mg.................................. 17propranolol hcl tab 10 mg..................................................17propranolol hcl tab 20 mg..................................................17propranolol hcl tab 40 mg..................................................17propranolol hcl tab 60 mg..................................................17propranolol hcl tab 80 mg..................................................17propylthiouracil tab 50 mg................................................. 13pseudoeph-chlorphen w/ hydrocodone soln 60-4-5mg/5ml...............................................................................23

PULMOZYME - dornase alfa inhal soln 1 mg/ml.............. 24PURIXAN - mercaptopurine susp 2000 mg/100ml (20 mg/ml)........................................................................................8

PX PRENATAL MULTIVITAMINS - prenatal vit w/ fefumarate-fa tab 28-0.8 mg............................................... 45

pyrazinamide tab 500 mg.................................................... 2pyridostigmine bromide tab 60 mg.................................... 44

QQC PRENATAL - prenatal vit w/ fe fumarate-fa tab 28-0.8mg......................................................................................45

QUAZEPAM - quazepam tab 15 mg................................. 34quetiapine fumarate tab er 24hr 400 mg...........................33quetiapine fumarate tab 25 mg..........................................33quetiapine fumarate tab 50 mg..........................................33quetiapine fumarate tab 100 mg........................................33quetiapine fumarate tab 200 mg........................................33quetiapine fumarate tab 300 mg........................................33quetiapine fumarate tab 400 mg........................................33quinapril hcl tab 5 mg........................................................ 15quinapril hcl tab 10 mg...................................................... 15quinapril hcl tab 20 mg...................................................... 16quinapril hcl tab 40 mg...................................................... 16quinapril-hydrochlorothiazide tab 10-12.5 mg................... 16quinapril-hydrochlorothiazide tab 20-12.5 mg................... 16quinapril-hydrochlorothiazide tab 20-25 mg...................... 16quinidine gluconate tab er 324 mg....................................21QUINIDINE SULFATE - quinidine sulfate tab 200 mg.......21QUINIDINE SULFATE - quinidine sulfate tab 300 mg.......21

QVAR - beclomethasone diprop inhal aero soln 40 mcg/act (50/valve).................................................................... 24

QVAR - beclomethasone diprop inhal aero soln 80 mcg/act (100/valve).................................................................. 24

RRABAVERT - rabies vaccine, pcec for inj........................... 6rabeprazole sodium ec tab 20 mg.....................................25raloxifene hcl tab 60 mg.................................................... 14ramipril cap 1.25 mg.......................................................... 16ramipril cap 2.5 mg............................................................ 16ramipril cap 5 mg............................................................... 16ramipril cap 10 mg............................................................. 16ranitidine hcl syrup 15 mg/ml (75 mg/5ml)........................ 25ranitidine hcl tab 150 mg................................................... 25ranitidine hcl tab 300 mg................................................... 26RA PRENATAL FORMULA/FOLIC - prenatal vit w/ fefumarate-fa tab 28-0.8 mg............................................... 45

RA PRENATAL - prenatal vit w/ fe fumarate-fa tab 28-0.8mg......................................................................................45

RAVICTI - glycerol phenylbutyrate liquid 1.1 gm/ml..........14RECOMBIVAX HB - hepatitis b vaccine (recombinant)susp 5 mcg/0.5ml............................................................... 6

RECOMBIVAX HB - hepatitis b vaccine (recombinant)susp 10 mcg/ml.................................................................. 6

RECOMBIVAX HB - hepatitis b vaccine (recombinant)susp 40 mcg/ml.................................................................. 6

RELENZA DISKHALER - zanamivir aero powder breathactivated 5 mg/blister......................................................... 5

RELION R - insulin regular (human) inj 100 unit/ml..........13REPATHA - evolocumab subcutaneous soln prefilledsyringe 140 mg/ml............................................................20

REPATHA PUSHTRONEX SYSTEM - evolocumabsubcutaneous soln cartridge/infusor 420 mg/3.5ml.........20

REPATHA SURECLICK - evolocumab subcutaneous solnauto-injector 140 mg/ml....................................................20

REPEL SPORTSMEN - diethyltoluamide (deet)aerosol...............................................................................52

REPEL SPORTSMEN MAX - diethyltoluamide (deet)aerosol...............................................................................52

RESCRIPTOR - delavirdine mesylate tab 100 mg..............4RESCRIPTOR - delavirdine mesylate tab 200 mg..............4REVATIO - sildenafil citrate for suspension 10 mg/ml.......22REVLIMID - lenalidomide cap 5 mg..................................53REVLIMID - lenalidomide cap 10 mg................................53REVLIMID - lenalidomide cap 15 mg................................53REVLIMID - lenalidomide cap 20 mg................................53REVLIMID - lenalidomide cap 25 mg................................53REVLIMID - lenalidomide caps 2.5 mg............................. 53REXULTI - brexpiprazole tab 0.25 mg.............................. 33REXULTI - brexpiprazole tab 0.5 mg................................ 33REXULTI - brexpiprazole tab 1 mg................................... 33REXULTI - brexpiprazole tab 2 mg................................... 33REXULTI - brexpiprazole tab 3 mg................................... 33REXULTI - brexpiprazole tab 4 mg................................... 33

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REYATAZ - atazanavir sulfate cap 150 mg (baseequiv)...................................................................................4



REYATAZ - atazanavir sulfate oral powder packet 50 mg(base equiv)........................................................................ 4

ribavirin cap 200 mg............................................................ 3ribavirin tab 200 mg............................................................. 3rifabutin cap 150 mg............................................................ 2rifampin cap 150 mg............................................................ 2rifampin cap 300 mg............................................................ 2RIGHT STEP PRENATAL - prenatal vit w/ fe fumarate-fatab 27-0.8 mg................................................................... 45

riluzole tab 50 mg.............................................................. 44ringer's solution for irrigation..............................................53risedronate sodium tab delayed release 35 mg................ 14RISPERDAL CONSTA - risperidone microspheres for inj12.5 mg.............................................................................33

RISPERDAL CONSTA - risperidone microspheres for inj25 mg................................................................................ 33

RISPERDAL CONSTA - risperidone microspheres for inj37.5 mg.............................................................................33

RISPERDAL CONSTA - risperidone microspheres for inj50 mg................................................................................ 33

RISPERIDONE ODT - risperidone orally disintegrating tab0.25 mg.............................................................................33

risperidone orally disintegrating tab 0.25 mg.................... 33risperidone orally disintegrating tab 0.5 mg...................... 33risperidone orally disintegrating tab 1 mg......................... 33risperidone orally disintegrating tab 2 mg......................... 33risperidone orally disintegrating tab 3 mg......................... 33risperidone orally disintegrating tab 4 mg......................... 33risperidone soln 1 mg/ml................................................... 33risperidone tab 0.25 mg.....................................................33risperidone tab 0.5 mg.......................................................33risperidone tab 1 mg..........................................................33risperidone tab 2 mg..........................................................33risperidone tab 3 mg..........................................................33risperidone tab 4 mg..........................................................33rivastigmine tartrate cap 4.5 mg........................................37rizatriptan benzoate oral disintegrating tab 5 mg (baseeq)..................................................................................... 40

rizatriptan benzoate oral disintegrating tab 10 mg (baseeq)..................................................................................... 40

rizatriptan benzoate tab 5 mg (base equivalent)...............40rizatriptan benzoate tab 10 mg (base equivalent).............40ropinirole hydrochloride tab 0.25 mg.................................43ropinirole hydrochloride tab 0.5 mg...................................43ropinirole hydrochloride tab 1 mg......................................43ropinirole hydrochloride tab 2 mg......................................43ropinirole hydrochloride tab 3 mg......................................43ropinirole hydrochloride tab 4 mg......................................43ropinirole hydrochloride tab 5 mg......................................43rosuvastatin calcium tab 5 mg...........................................20

rosuvastatin calcium tab 10 mg.........................................20rosuvastatin calcium tab 20 mg.........................................20rosuvastatin calcium tab 40 mg.........................................20RUBRACA - rucaparib camsylate tab 200 mg (baseequivalent)...........................................................................8

RUBRACA - rucaparib camsylate tab 250 mg (baseequivalent)...........................................................................8

RUBRACA - rucaparib camsylate tab 300 mg (baseequivalent)...........................................................................8

SSABRIL - vigabatrin tab 500 mg........................................42salicylic acid cream 6%..................................................... 50salicylic acid cream 6% & cleanser liqd kit........................51salicylic acid film forming liquid 27.5%..............................51salicylic acid foam 6%........................................................51salicylic acid gel 6%...........................................................51salicylic acid lotion 6%.......................................................51salicylic acid lotion 6% & cleanser liqd kit.........................51salicylic acid shampoo 6%.................................................51saline nasal spray 0.65%...................................................23SAMSCA - tolvaptan tab 15 mg........................................ 14SAMSCA - tolvaptan tab 30 mg........................................ 14SAPHRIS - asenapine maleate sl tab 2.5 mg (baseequiv).................................................................................33

SAPHRIS - asenapine maleate sl tab 5 mg (baseequiv).................................................................................33

SAPHRIS - asenapine maleate sl tab 10 mg (baseequiv).................................................................................33

SAWYER PREMIUM INSECT REP - picaridin liquid........ 52selegiline hcl cap 5 mg...................................................... 43selegiline hcl tab 5 mg.......................................................43selenium sulfide lotion 2.5%.............................................. 52selenium sulfide-pyrithione zinc in urea shampoo2.25%................................................................................ 52

SELZENTRY - maraviroc tab 150 mg................................. 4SELZENTRY - maraviroc tab 300 mg................................. 4SE-NATAL 19 - prenatal vit w/ dss-fe fumarate-fa tab 29-1mg......................................................................................45

SE-NATAL 19 - prenatal vit w/ fe fumarate-fa chew tab29-1 mg.............................................................................45

sennosides tab 8.6 mg...................................................... 25SEREVENT DISKUS - salmeterol xinafoate aer pow ba50 mcg/dose (base equiv)............................................... 24

SEROSTIM - somatropin (non-refrigerated) forsubcutaneous inj 4 mg.....................................................14



sertraline hcl oral conc 20 mg/ml...................................... 30sertraline hcl tab 25 mg..................................................... 30sertraline hcl tab 50 mg..................................................... 30sertraline hcl tab 100 mg...................................................30SIGNIFOR - pasireotide diaspartate inj 0.3 mg/ml (baseequiv).................................................................................14

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79

SIGNIFOR - pasireotide diaspartate inj 0.6 mg/ml (baseequiv).................................................................................14

SIGNIFOR - pasireotide diaspartate inj 0.9 mg/ml (baseequiv).................................................................................14

silver sulfadiazine cream 1%.............................................51simethicone chew tab 125 mg...........................................27simethicone susp 40 mg/0.6ml..........................................27SIMPONI - golimumab subcutaneous soln auto-injector 50mg/0.5ml............................................................................40

SIMPONI - golimumab subcutaneous soln auto-injector100 mg/ml......................................................................... 40

SIMPONI - golimumab subcutaneous soln prefilledsyringe 50 mg/0.5ml.........................................................40

SIMPONI - golimumab subcutaneous soln prefilledsyringe 100 mg/ml............................................................40

simvastatin tab 5 mg..........................................................20simvastatin tab 10 mg........................................................20simvastatin tab 20 mg........................................................20simvastatin tab 40 mg........................................................20simvastatin tab 80 mg........................................................20sirolimus tab 0.5 mg...........................................................54sirolimus tab 1 mg..............................................................54sirolimus tab 2 mg..............................................................54skin protectants misc - cream............................................52SM PRENATAL VITAMINS - prenatal vit w/ fe fumarate-fatab 28-0.8 mg................................................................... 45

sodium chloride irrigation soln 0.9%..................................28sodium chloride soln nebu 0.9%....................................... 23sodium chloride soln nebu 3%.......................................... 23sodium chloride soln nebu 7%.......................................... 23sodium chloride soln nebu 10%........................................ 23sodium citrate & citric acid soln 500-334 mg/5ml..............28sodium fluoride chew tab 0.25 mg f (from 0.55 mgnaf).................................................................................... 46

sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)........46sodium fluoride chew tab 1 mg f (from 2.2 mg naf)...........46sodium fluoride cream 1.1%.............................................. 49sodium fluoride gel 1.1% (0.5% f)..................................... 49sodium fluoride paste 1.1%............................................... 49sodium fluoride-potassium nitrate paste 1.1-5%............... 49sodium fluoride rinse 0.2%................................................ 49SODIUM FLUORIDE - sodium fluoride tab 0.5 mg f (from1.1 mg naf)....................................................................... 46

SODIUM FLUORIDE - sodium fluoride tab 1 mg f (from2.2 mg naf)....................................................................... 46

sodium fluoride soln 0.125 mg/drop f (0.275 mg/dropnaf).................................................................................... 46

sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)......46sodium polystyrene sulfonate oral susp 15 gm/60ml........ 54sodium polystyrene sulfonate powder............................... 54sodium polystyrene sulfonate rectal susp 30gm/120ml...........................................................................54

SOLU-CORTEF - hydrocortisone sodium succinate pf forinj 100 mg.........................................................................10



SOLU-CORTEF - hydrocortisone sodium succinate pf forinj 1000 mg.......................................................................10

SOMAVERT - pegvisomant for inj 10 mg (as protein).......14SOMAVERT - pegvisomant for inj 15 mg (as protein).......14SOMAVERT - pegvisomant for inj 20 mg (as protein).......14SOMAVERT - pegvisomant for inj 25 mg (as protein).......14SOMAVERT - pegvisomant for inj 30 mg (as protein).......15sotalol hcl (afib/afl) tab 80 mg........................................... 21sotalol hcl (afib/afl) tab 120 mg......................................... 21sotalol hcl (afib/afl) tab 160 mg......................................... 21sotalol hcl tab 80 mg......................................................... 21sotalol hcl tab 120 mg....................................................... 21sotalol hcl tab 160 mg....................................................... 21sotalol hcl tab 240 mg....................................................... 21speciality vitamin product tab............................................ 45SPIRIVA HANDIHALER - tiotropium bromidemonohydrate inhal cap 18 mcg (base equiv).................. 24

SPIRIVA RESPIMAT - tiotropium bromide monohydrateinhal aerosol 1.25 mcg/act...............................................24

SPIRIVA RESPIMAT - tiotropium bromide monohydrateinhal aerosol 2.5 mcg/act.................................................24

spironolactone & hydrochlorothiazide tab 25-25 mg.........20spironolactone tab 25 mg.................................................. 20spironolactone tab 50 mg.................................................. 20spironolactone tab 100 mg................................................ 20SPRYCEL - dasatinib tab 20 mg.........................................8SPRYCEL - dasatinib tab 50 mg.........................................8SPRYCEL - dasatinib tab 70 mg.........................................8SPRYCEL - dasatinib tab 80 mg.........................................8SPRYCEL - dasatinib tab 100 mg.......................................8SPRYCEL - dasatinib tab 140 mg.......................................8stannous fluoride gel 0.4%................................................ 49stavudine cap 15 mg............................................................4stavudine cap 20 mg............................................................4stavudine cap 30 mg............................................................4stavudine cap 40 mg............................................................4stavudine for oral soln 1 mg/ml........................................... 4STELARA - ustekinumab soln prefilled syringe 45mg/0.5ml............................................................................53

STELARA - ustekinumab soln prefilled syringe 90 mg/ml.......................................................................................53

STIMATE - desmopressin acetate nasal soln 1.5 mg/ml.......................................................................................15

STIVARGA - regorafenib tab 40 mg....................................9STRIBILD - elvitegrav-cobic-emtricitab-tenofovdf tab150-150-200-300 mg..........................................................4

SUBOXONE - buprenorphine hcl-naloxone hcl sl film2-0.5 mg (base equiv)......................................................39

SUBOXONE - buprenorphine hcl-naloxone hcl sl film 4-1mg (base equiv)................................................................39



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SUCRAID - sacrosidase soln 8500 unit/ml....................... 26sucralfate tab 1 gm............................................................ 26sulfacetamide sodium lotion 10% (acne).......................... 50sulfacetamide sodium ophth soln 10%..............................48sulfacetamide sodium-prednisolone ophth soln10-0.23(0.25)%................................................................. 48

sulfamethoxazole-trimethoprim susp 200-40 mg/5ml......... 6sulfamethoxazole-trimethoprim tab 400-80 mg...................6sulfamethoxazole-trimethoprim tab 800-160 mg.................6sulfasalazine tab delayed release 500 mg........................27sulfasalazine tab 500 mg...................................................27sulindac tab 150 mg...........................................................40sulindac tab 200 mg...........................................................40sumatriptan nasal spray 5 mg/act..................................... 40sumatriptan nasal spray 20 mg/act................................... 40sumatriptan succinate inj 6 mg/0.5ml................................40sumatriptan succinate solution auto-injector 4mg/0.5ml............................................................................40

sumatriptan succinate solution auto-injector 6mg/0.5ml............................................................................40

sumatriptan succinate solution cartridge 4 mg/0.5ml........40sumatriptan succinate solution cartridge 6 mg/0.5ml........40SUMATRIPTAN SUCCINATE - sumatriptan succinatesolution prefilled syringe 6 mg/0.5ml............................... 40

sumatriptan succinate tab 25 mg...................................... 40sumatriptan succinate tab 50 mg...................................... 40sumatriptan succinate tab 100 mg.................................... 40SUSTIVA - efavirenz cap 50 mg......................................... 4SUSTIVA - efavirenz cap 200 mg....................................... 4SUSTIVA - efavirenz tab 600 mg........................................ 4SUTENT - sunitinib malate cap 12.5 mg (baseequivalent)...........................................................................9

SUTENT - sunitinib malate cap 25 mg (baseequivalent)...........................................................................9

SUTENT - sunitinib malate cap 37.5 mg (baseequivalent)...........................................................................9

SUTENT - sunitinib malate cap 50 mg (baseequivalent)...........................................................................9

SYLATRON - peginterferon alfa-2b for inj kit 200 mcg....... 9SYLATRON - peginterferon alfa-2b for inj kit 300 mcg....... 9SYLATRON - peginterferon alfa-2b for inj kit 600 mcg....... 9SYMBICORT - budesonide-formoterol fumarate dihydaerosol 80-4.5 mcg/act.....................................................24

SYMBICORT - budesonide-formoterol fumarate dihydaerosol 160-4.5 mcg/act...................................................24

SYNAREL - nafarelin acetate nasal soln 2 mg/ml (200mcg/act) (base eq)........................................................... 11

Ttacrolimus cap 0.5 mg........................................................54tacrolimus cap 1 mg...........................................................54tacrolimus cap 5 mg...........................................................54tacrolimus oint 0.03%.........................................................53tacrolimus oint 0.1%...........................................................53TAFINLAR - dabrafenib mesylate cap 50 mg (baseequivalent)...........................................................................9

TAFINLAR - dabrafenib mesylate cap 75 mg (baseequivalent)...........................................................................9

tamoxifen citrate tab 10 mg (base equivalent).................... 9tamoxifen citrate tab 20 mg (base equivalent).................... 9tamsulosin hcl cap 0.4 mg.................................................28TARCEVA - erlotinib hcl tab 25 mg (base equivalent).........9TARCEVA - erlotinib hcl tab 100 mg (base equivalent).......9TARCEVA - erlotinib hcl tab 150 mg (base equivalent).......9TARGRETIN - bexarotene cap 75 mg.................................9TASIGNA - nilotinib hcl cap 150 mg (base equivalent)....... 9TASIGNA - nilotinib hcl cap 200 mg (base equivalent)....... 9tazarotene cream 0.1%......................................................50TAZORAC - tazarotene cream 0.05%...............................50TAZORAC - tazarotene gel 0.05%.................................... 50TAZORAC - tazarotene gel 0.1%...................................... 50TECHLITE PEN NEEDLES 29G....................................... 53temazepam cap 15 mg...................................................... 34temazepam cap 30 mg...................................................... 34temozolomide cap 5 mg...................................................... 9temozolomide cap 20 mg.................................................... 9temozolomide cap 100 mg.................................................. 9temozolomide cap 140 mg.................................................. 9temozolomide cap 180 mg.................................................. 9temozolomide cap 250 mg.................................................. 9terazosin hcl cap 1 mg...................................................... 22terazosin hcl cap 2 mg...................................................... 22terazosin hcl cap 5 mg...................................................... 22terazosin hcl cap 10 mg.................................................... 22terbinafine hcl cream 1%................................................... 51terbinafine hcl tab 250 mg...................................................3terbutaline sulfate tab 2.5 mg............................................24terbutaline sulfate tab 5 mg...............................................24terconazole vaginal cream 0.4%....................................... 27terconazole vaginal cream 0.8%....................................... 27terconazole vaginal suppos 80 mg....................................27testosterone td gel 12.5 mg/act (1%)................................ 10testosterone td gel 25 mg/2.5gm (1%)..............................10testosterone td gel 50 mg/5gm (1%).................................10TEST STRIPS – BAYER ASCENCIA................................53tetracaine hcl ophth soln 0.5%.......................................... 49THALOMID - thalidomide cap 50 mg................................ 54THALOMID - thalidomide cap 100 mg.............................. 54THALOMID - thalidomide cap 150 mg.............................. 54THALOMID - thalidomide cap 200 mg.............................. 54theophylline soln 80 mg/15ml............................................24theophylline tab er 12hr 100 mg........................................24theophylline tab er 12hr 200 mg........................................24theophylline tab er 12hr 300 mg........................................24theophylline tab er 12hr 450 mg........................................24theophylline tab er 24hr 400 mg........................................24theophylline tab er 24hr 600 mg........................................24THERA-FLUR-N - sodium fluoride gel 1.1% (0.5% f)....... 49thioridazine hcl tab 10 mg................................................. 33thioridazine hcl tab 25 mg................................................. 33thioridazine hcl tab 50 mg................................................. 33thioridazine hcl tab 100 mg............................................... 33

2017

81

thiothixene cap 1 mg..........................................................33thiothixene cap 2 mg..........................................................33thiothixene cap 5 mg..........................................................33thiothixene cap 10 mg........................................................33thyroid tab 30 mg (1/2 grain).............................................13thyroid tab 90 mg (1 1/2 grain)..........................................13thyroid tab 60 mg (1 grain)................................................13tiagabine hcl tab 2 mg....................................................... 42tiagabine hcl tab 4 mg....................................................... 42timolol maleate ophth soln 0.25%..................................... 49timolol maleate ophth soln 0.5%....................................... 49TIVICAY - dolutegravir sodium tab 50 mg (base equiv)...... 4tizanidine hcl tab 2 mg (base equivalent)..........................43tizanidine hcl tab 4 mg (base equivalent)..........................44tobramycin nebu soln 300 mg/5ml...................................... 2tobramycin ophth soln 0.3%.............................................. 48TOBRAMYCIN - tobramycin nebu soln 300 mg/5ml........... 2tolcapone tab 100 mg........................................................ 43tolnaftate cream 1%........................................................... 51tolterodine tartrate tab 2 mg.............................................. 27topiramate sprinkle cap 15 mg.......................................... 42topiramate sprinkle cap 25 mg.......................................... 42topiramate tab 25 mg.........................................................42topiramate tab 50 mg.........................................................42topiramate tab 100 mg.......................................................42topiramate tab 200 mg.......................................................42torsemide tab 5 mg............................................................20torsemide tab 10 mg..........................................................20torsemide tab 20 mg..........................................................20torsemide tab 100 mg........................................................20TRACLEER - bosentan tab 62.5 mg.................................22TRACLEER - bosentan tab 125 mg..................................22tramadol-acetaminophen tab 37.5-325 mg....................... 39tramadol hcl tab 50 mg......................................................39trandolapril tab 1 mg..........................................................16trandolapril tab 2 mg..........................................................16trandolapril tab 4 mg..........................................................16trandolapril-verapamil hcl tab er 1-240 mg........................18trandolapril-verapamil hcl tab er 2-180 mg........................18trandolapril-verapamil hcl tab er 2-240 mg........................18trandolapril-verapamil hcl tab er 4-240 mg........................18tranexamic acid tab 650 mg.............................................. 48trazodone hcl tab 50 mg....................................................30trazodone hcl tab 100 mg..................................................30trazodone hcl tab 150 mg..................................................30tretinoin cap 10 mg.............................................................. 9tretinoin cream 0.025%......................................................50tretinoin cream 0.05%........................................................50tretinoin cream 0.1%.......................................................... 50tretinoin gel 0.01%............................................................. 50tretinoin gel 0.025%........................................................... 50tretinoin gel 0.05%............................................................. 50triamcinolone acetonide aerosol soln 0.147 mg/gm..........52triamcinolone acetonide cream 0.025%............................ 52triamcinolone acetonide cream 0.1%................................ 52triamcinolone acetonide cream 0.5%................................ 52

triamcinolone acetonide dental paste 0.1%...................... 50triamcinolone acetonide lotion 0.025%..............................52triamcinolone acetonide lotion 0.1%..................................52triamcinolone acetonide nasal aerosol suspension 55mcg/act..............................................................................23

triamcinolone acetonide oint 0.025%................................ 52triamcinolone acetonide oint 0.1%.....................................52triamterene & hydrochlorothiazide cap 37.5-25 mg.......... 20triamterene & hydrochlorothiazide tab 37.5-25 mg........... 20triamterene & hydrochlorothiazide tab 75-50 mg.............. 20TRICARE - prenatal vit w/ fe fumarate-fa tab 27-1 mg..... 45trifluoperazine hcl tab 1 mg (base equivalent).................. 33trifluoperazine hcl tab 2 mg (base equivalent).................. 33trifluoperazine hcl tab 5 mg (base equivalent).................. 34trifluoperazine hcl tab 10 mg (base equivalent)................ 34trifluridine ophth soln 1%................................................... 48trihexyphenidyl hcl elixir 0.4 mg/ml....................................43trihexyphenidyl hcl tab 2 mg..............................................43trihexyphenidyl hcl tab 5 mg..............................................43trimethobenzamide hcl cap 300 mg.................................. 26trimethoprim tab 100 mg......................................................6TRINATAL RX 1 - prenatal vit w/ fe fumarate-fa tab 60-1mg......................................................................................45

TRIUMEQ - abacavir-dolutegravir-lamivudine tab600-50-300 mg................................................................... 5

TRI-VIT/FLUORIDE/IRON - pediatric vitamins acd fluoride& fe drops 0.25-10 mg/ml................................................ 45

trospium chloride cap er 24hr 60 mg................................ 27trospium chloride tab 20 mg..............................................27TRUEPLUS INSULIN SYRINGE/...................................... 53TRUVADA - emtricitabine-tenofovir disoproxil fumaratetab 100-150 mg.................................................................. 5

TRUVADA - emtricitabine-tenofovir disoproxil fumaratetab 133-200 mg.................................................................. 5



TYBOST - cobicistat tab 150 mg.........................................5TYKERB - lapatinib ditosylate tab 250 mg (base equiv)..... 9TYVASO REFILL - treprostinil inhalation solution 0.6 mg/ml.......................................................................................22

TYVASO STARTER - treprostinil inhalation solution 0.6mg/ml.................................................................................22

TYVASO - treprostinil inhalation solution 0.6 mg/ml......... 22

UUPTRAVI - selexipag tab 200 mcg....................................22UPTRAVI - selexipag tab 400 mcg....................................22UPTRAVI - selexipag tab 600 mcg....................................22UPTRAVI - selexipag tab 800 mcg....................................22UPTRAVI - selexipag tab 1000 mcg..................................22UPTRAVI - selexipag tab 1200 mcg..................................22UPTRAVI - selexipag tab 1400 mcg..................................22UPTRAVI - selexipag tab 1600 mcg..................................22

2017

82

UPTRAVI - selexipag tab therapy pack 200 mcg (140) &800 mcg (60).................................................................... 22

ursodiol cap 300 mg.......................................................... 27ursodiol tab 250 mg........................................................... 27ursodiol tab 500 mg........................................................... 27

Vvalacyclovir hcl tab 1 gm..................................................... 3valacyclovir hcl tab 500 mg................................................. 3valganciclovir hcl for soln 50 mg/ml (base equiv)............... 3valganciclovir hcl tab 450 mg (base equivalent)................. 3valproic acid cap 250 mg...................................................42valsartan-hydrochlorothiazide tab 80-12.5 mg.................. 16valsartan-hydrochlorothiazide tab 160-12.5 mg................ 16valsartan-hydrochlorothiazide tab 160-25 mg................... 16valsartan-hydrochlorothiazide tab 320-12.5 mg................ 16valsartan-hydrochlorothiazide tab 320-25 mg................... 16valsartan tab 40 mg........................................................... 16valsartan tab 80 mg........................................................... 16valsartan tab 160 mg......................................................... 16valsartan tab 320 mg......................................................... 16vancomycin hcl cap 125 mg................................................6vancomycin hcl cap 250 mg................................................6VENCLEXTA STARTING PACK - venetoclax tab therapystarter pack 10 & 50 & 100 mg......................................... 9

VENCLEXTA - venetoclax tab 10 mg..................................9VENCLEXTA - venetoclax tab 50 mg..................................9VENCLEXTA - venetoclax tab 100 mg................................9venlafaxine hcl cap er 24hr 37.5 mg (baseequivalent).........................................................................30

venlafaxine hcl cap er 24hr 75 mg (base equivalent)........30venlafaxine hcl cap er 24hr 150 mg (base equivalent)......30venlafaxine hcl tab 25 mg..................................................30venlafaxine hcl tab 37.5 mg...............................................30venlafaxine hcl tab 50 mg..................................................30venlafaxine hcl tab 75 mg..................................................30venlafaxine hcl tab 100 mg................................................30VENTAVIS - iloprost inhalation solution 10 mcg/ml...........22VENTAVIS - iloprost inhalation solution 20 mcg/ml...........22VENTOLIN HFA - albuterol sulfate inhal aero 108 mcg/act(90mcg base equiv)..........................................................24

verapamil hcl cap er 24hr 100 mg.....................................18verapamil hcl cap er 24hr 120 mg.....................................18verapamil hcl cap er 24hr 180 mg.....................................18verapamil hcl cap er 24hr 200 mg.....................................18verapamil hcl cap er 24hr 240 mg.....................................18verapamil hcl cap er 24hr 300 mg.....................................18verapamil hcl cap er 24hr 360 mg.....................................18verapamil hcl tab er 120 mg..............................................18verapamil hcl tab er 180 mg..............................................18verapamil hcl tab er 240 mg..............................................18verapamil hcl tab 40 mg.................................................... 18verapamil hcl tab 80 mg.................................................... 18verapamil hcl tab 120 mg.................................................. 18VERSACLOZ - clozapine susp 50 mg/ml..........................34

VICTOZA - liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)......................................................................................12

VIDEX - didanosine for soln 2 gm.......................................5VIDEX - didanosine for soln 4 gm.......................................5vigabatrin powd pack 500 mg............................................42VIIBRYD STARTER PACK - vilazodone hcl tab starter kit10 (7) & 20 (23) mg......................................................... 30

VIIBRYD - vilazodone hcl tab 10 mg.................................30VIIBRYD - vilazodone hcl tab 20 mg.................................30VIIBRYD - vilazodone hcl tab 40 mg.................................30VINATE M - prenatal vit w/ sel-fe fumarate-fa tab 27-1mg......................................................................................45

VINATE ONE - prenatal vit w/ fe fumarate-fa tab 60-1mg......................................................................................45

VIRACEPT - nelfinavir mesylate tab 250 mg...................... 5VIRACEPT - nelfinavir mesylate tab 625 mg...................... 5VIRAMUNE - nevirapine susp 50 mg/5ml...........................5VIREAD - tenofovir disoproxil fumarate oral powder 40mg/gm..................................................................................5

VIREAD - tenofovir disoproxil fumarate tab 150 mg........... 5VIREAD - tenofovir disoproxil fumarate tab 200 mg........... 5VIREAD - tenofovir disoproxil fumarate tab 250 mg........... 5VIREAD - tenofovir disoproxil fumarate tab 300 mg........... 5VITEKTA - elvitegravir tab 85 mg........................................5VITEKTA - elvitegravir tab 150 mg......................................5VOL-PLUS - prenatal vit w/ fe fumarate-fa tab 27-1mg......................................................................................45

voriconazole for susp 40 mg/ml...........................................3voriconazole tab 50 mg........................................................3voriconazole tab 200 mg..................................................... 3VOTRIENT - pazopanib hcl tab 200 mg (base equiv).........9

Wwarfarin sodium tab 1 mg..................................................48warfarin sodium tab 2 mg..................................................48warfarin sodium tab 2.5 mg...............................................48warfarin sodium tab 3 mg..................................................48warfarin sodium tab 4 mg..................................................48warfarin sodium tab 5 mg..................................................48warfarin sodium tab 6 mg..................................................48warfarin sodium tab 7.5 mg...............................................48warfarin sodium tab 10 mg................................................48water for irrigation, sterile irrigation soln........................... 54

XXALKORI - crizotinib cap 200 mg....................................... 9XALKORI - crizotinib cap 250 mg....................................... 9XARELTO - rivaroxaban tab 10 mg...................................48XARELTO - rivaroxaban tab 15 mg...................................48XARELTO - rivaroxaban tab 20 mg...................................48XARELTO STARTER PACK - rivaroxaban tab startertherapy pack 15 mg & 20 mg.......................................... 48

XELJANZ - tofacitinib citrate tab 5 mg (baseequivalent).........................................................................40

XELJANZ XR - tofacitinib citrate tab er 24hr 11 mg (baseequivalent).........................................................................40

XIFAXAN - rifaximin tab 550 mg......................................... 6

2017

83

XTANDI - enzalutamide cap 40 mg.....................................9XULANE - norelgestromin-ethinyl estradiol td ptwk 150-35mcg/24hr........................................................................... 11

XURIDEN - uridine triacetate oral granules packet 2gm......................................................................................15

Y

Zzaleplon cap 5 mg..............................................................34zaleplon cap 10 mg............................................................34ZAVESCA - miglustat cap 100 mg.................................... 48ZELBORAF - vemurafenib tab 240 mg............................... 9ZENPEP - pancrelipase (lip-prot-amyl) dr cap3000-10000-16000 unit.................................................... 26

ZENPEP - pancrelipase (lip-prot-amyl) dr cap5000-17000-27000 unit.................................................... 26

ZENPEP - pancrelipase (lip-prot-amyl) dr cap10000-34000-55000 unit.................................................. 26

ZENPEP - pancrelipase (lip-prot-amyl) dr cap15000-51000-82000 unit.................................................. 26

ZENPEP - pancrelipase (lip-prot-amyl) dr cap20000-68000-109000 unit................................................ 26

ZENPEP - pancrelipase (lip-prot-amyl) dr cap25000-85000-136000 unit................................................ 26

ZENPEP - pancrelipase (lip-prot-amyl) dr cap40000-136000-218000 unit.............................................. 26

zidovudine cap 100 mg........................................................5zidovudine syrup 10 mg/ml..................................................5zidovudine tab 300 mg.........................................................5ziprasidone hcl cap 20 mg.................................................34ziprasidone hcl cap 40 mg.................................................34ziprasidone hcl cap 60 mg.................................................34ziprasidone hcl cap 80 mg.................................................34ZOLINZA - vorinostat cap 100 mg...................................... 9zolpidem tartrate tab 5 mg.................................................34zolpidem tartrate tab 10 mg...............................................34zonisamide cap 25 mg.......................................................42zonisamide cap 50 mg.......................................................43zonisamide cap 100 mg.....................................................43ZORBTIVE - somatropin (non-refrigerated) forsubcutaneous inj 8.8 mg..................................................14

ZORTRESS - everolimus tab 0.25 mg.............................. 54ZORTRESS - everolimus tab 0.5 mg................................ 54ZORTRESS - everolimus tab 0.75 mg.............................. 54ZYKADIA - ceritinib cap 150 mg......................................... 9ZYPREXA RELPREVV - olanzapine pamoate forextended rel im susp 210 mg (base eq)..........................34

ZYPREXA RELPREVV - olanzapine pamoate forextended rel im susp 300 mg (base eq)..........................34

ZYPREXA RELPREVV - olanzapine pamoate forextended rel im susp 405 mg (base eq)..........................34

ZYTIGA - abiraterone acetate tab 250 mg..........................9ZYTIGA - abiraterone acetate tab 500 mg..........................9ZYVOX - linezolid for susp 100 mg/5ml.............................. 6

Such services are funded in part with the State of New Mexico.

Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 479328.0218

2017 drug list

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