2020 essential health benefits base formulary - oral chemo parity · 2020-07-01 · formulary -...

2020 Essential Health Benefits Base Formulary - Oral Chemo ParityEffective July 1, 2020

For the most current list of covered medications or if you have questions:

Call the number on your member ID card.

Visit your plan’s website on your member ID card to:

• Find a participating retail pharmacy by ZIP code.

• Look up possible lower-cost medication alternatives.

• Compare medication pricing and options.

EHB Base - Oral Chemo Parity

2

Understanding your formulary

What is a formulary?A formulary is a list of prescribed medications or other pharmacy care products, services or supplies chosen for their safety, cost, and effectiveness. Medications are listed by categories or classes and are placed into cost levels known as tiers. It includes both brand and generic prescription medications.

To create the list, OptumRx® is guided by the Pharmacy and Therapeutics Committee. This group of doctors, nurses, and pharmacists reviews which medications will be covered, how well the drugs work, and overall value. They also make sure there are safe and covered options.

About this formulary Where differences between this formulary and your benefit plan exist, the benefit plan documents rule. This may not be a complete list of medications that are covered by your plan. Please review your benefit plan for full details.

How do I use my formulary?You and your doctor can use the formulary to help you choose the most cost-effective prescription medications. This guide tells you if a medication is generic or brand, and if special rules apply. Bring this list with you when you see your doctor. If your medication is not listed here, please visit your plan’s member website or call the number on your member ID card.

Some medications on your formulary have extra requirements before they can be covered. A few of the most common coverage programs are prior authorization (PA), step therapy (ST) and quantity limits (QL). We use programs like these to help make sure the medication you take is safe and effective. Check your plan documents for more information. Some Affordable Care Act (ACA) preventive medication may have coverage restrictions. If you want to learn more about these programs or to see if you take a medication in one of these programs, please visit your plan’s member website or call the number on your member ID card.

What are tiers?Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, set by your employer or plan sponsor. This is how much you will pay when you fill a prescription.

3

Understanding your formulary

When does the formulary change?• Medications may move to a lower tier at any time.

• Medications may be excluded from coverage as soon as a generic equal becomes available.

• Medications may move to a higher tier or be excluded from coverage on January 1 or July 1 of each year.

When a medication changes tiers, you may have to pay a different amount for that medication.

Why are some medications excluded from coverage?A medication may be excluded from coverage under your pharmacy benefit when it works the same as or similar to another prescription or over-the-counter (OTC) medication.

What if I don’t agree with a decision about an excluded medication?You or your authorized representative and your doctor can ask for a coverage request by calling the number on your member ID card.

4

Medication tips

What is the difference between brand-name and generic medications?Generic medications contain the same active ingredients (what makes the medication work) as brand-name medications, but they often cost less. Once the patent for a brand-name medication ends, the FDA can approve a generic version with the same active ingredients.

What if my doctor writes a brand-name prescription?If your doctor gives you a prescription for a brand-name medication, ask if a generic or lower-cost option could be right for you. Generic medications are usually your lowest-cost option.

Over-the-counter medicationsAn over-the-counter (OTC) medication may be the right treatment for some conditions. Talk to your doctor about available OTC options. Even though OTC medications may not be covered by your pharmacy benefit, they may cost less than a prescription medication.

What if I am taking a specialty medication?Specialty medications are for rare or complex conditions and are usually higher-cost medications. Please note, not all specialty medications are listed in the formulary. Our specialty pharmacy can provide most of your specialty medications along with helpful programs and services. Call 1-855-427-4682 and have your prescriptions delivered right to your home or doctor’s office.

5

Reading your formulary

The formulary gives you choices so you and your doctor can decide your best course of treatment. In this formulary, brand-name medications are shown in UPPERCASE (for example, CLOBEX). Generic medications are shown in lowercase (for example, clobetasol).

Tier informationUsing lower tier or preferred medications can help you pay your lowest out-of-pocket cost. Your plan may have multiple or no tiers.

Drug Tier Includes Helpful Tips

Tier CM Oral Chemotherapy Oral chemotherapy drugs may have a designated copayment or coinsurance based on state laws or client preference.

Tier 1 $ Generic Use Tier 1 generic drugs instead of brand-name drugs to help reduce your out-of-pocket costs.

Tier 2 $$ Preferred Preferred brand-name drugs will generally have lower copayments than non-preferred brand-name drugs.

Tier 3 $$$ Non-Preferred Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Tier 4 $$$$ Specialty Tier 4 is generally highest in copayment and cost. These drugs are sometimes used for complex and chronic conditions and may require special monitoring and handling.

Drug list informationIn this drug list, some medications are noted with letters next to them to help you see which ones may have coverage requirements or limits. Your benefit plan decides how these medications may be covered.

M Authorized generic or cobranded product

PA Prior Authorization – Your doctor is required to give OptumRx more information to determine coverage.

PV Preventive drugs – May have coverage and no copayments when health care reform requirements are met.

PV* Preventive drugs – Available at $0 if Health Care Reform copay waiver is approved.

QL Quantity Limit – Medication may be limited to a certain quantity.

ST Step Therapy – Must try lower-cost medication(s) before a higher-cost medication can be covered.

Table of Contents

Analgesics ....................................................................................................................................................... 11Anesthetics ...................................................................................................................................................... 13Anti-Addiction/Substance Abuse Treatment Agents ...................................................................................14Antibacterials ...................................................................................................................................................15Anticonvulsants .............................................................................................................................................. 18Antidementia Agents ...................................................................................................................................... 19Antidepressants .............................................................................................................................................. 19Antiemetics ...................................................................................................................................................... 20Antifungals .......................................................................................................................................................21Antigout Agents .............................................................................................................................................. 21Antimigraine Agents ....................................................................................................................................... 22Antimyasthenic Agents .................................................................................................................................. 22Antimycobacterials ......................................................................................................................................... 22Antineoplastics ................................................................................................................................................22Antiparasitics ...................................................................................................................................................26Antiparkinson Agents ..................................................................................................................................... 27Antipsychotics .................................................................................................................................................27Antivirals .......................................................................................................................................................... 28Anxiolytics ....................................................................................................................................................... 29Bipolar Agents .................................................................................................................................................30Blood Glucose Monitoring ............................................................................................................................. 30Blood Glucose Regulators ............................................................................................................................. 31Blood Products/Modifiers/Volume Expanders ............................................................................................. 32Cardiovascular Agents ................................................................................................................................... 34Central Nervous System Agents ....................................................................................................................38Dental and Oral Agents ...................................................................................................................................39Dermatological Agents ................................................................................................................................... 39Electrolytes/Minerals/Metals/Vitamins .......................................................................................................... 40Gastrointestinal Agents ..................................................................................................................................44Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment ............................................................ 45Genitourinary Agents ......................................................................................................................................46Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal) ................................................................47Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) ...............................................................48Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins) ................................................... 49Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) ................................... 49Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) ................................................................ 53Hormonal Agents, Suppressant (Adrenal) ....................................................................................................53Hormonal Agents, Suppressant (pituitary) ................................................................................................... 53Hormonal Agents, Suppressant (Thyroid) .................................................................................................... 53Immunological Agents ....................................................................................................................................53Inflammatory Bowel Disease Agents ............................................................................................................ 56Metabolic Bone Disease Agents .................................................................................................................... 56Miscellaneous Therapeutic Agents ............................................................................................................... 56Ophthalmic Agents ......................................................................................................................................... 59Otic Agents ...................................................................................................................................................... 61Respiratory Tract/Pulmonary Agents ............................................................................................................61Skeletal Muscle Relaxants ..............................................................................................................................64Sleep Disorder Agents ....................................................................................................................................64

9

Drug Name Drug Tier Notes

Analgesics

butalbital-acetaminophen oral capsule

1

butalbital-acetaminophen oral tablet 50-300 mg, 50-325 mg

1

butalbital-apap-caffeine 1

butalbital-aspirin-caffeine

1

duraxin 1

tencon 1

Nonsteroidal Anti-inflammatory Drugs

adult aspirin regimen 1 PV

aspirin adult 1 PV

aspirin adult low strength oral tablet delayed release

1 PV

aspirin childrens 1 PV

aspirin ec 1 PV

aspirin ec low dose 1 PV

aspirin ec low strength 1 PV

aspirin low dose 1 PV

aspirin oral tablet 1 PV

aspirin oral tablet delayed release 325 mg

1 PV

BAYER ASPIRIN 3 PV

BAYER ASPIRIN EC LOW DOSE

3 PV

celecoxib oral 1 QL

diclofenac potassium 1

diclofenac sodium er 1

diclofenac sodium oral 1

diclofenac sodium transdermal gel 1 %

1 QL


diclofenac sodium transdermal solution

1 PA

diclofenac-misoprostol 1

diclofex dc 1

diflunisal oral 1

ec-naproxen 1

etodolac 1

etodolac er 1

fenoprofen calcium oral 3

fenortho 3

flurbiprofen oral 1

goodsense aspirin low dose

1 PV

ibu 1

ibuprofen lysine 1

ibuprofen oral suspension

1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

1

indomethacin er 1

indomethacin oral capsule 25 mg, 50 mg

1

indomethacin sodium 1

ketoprofen er 1

ketoprofen oral capsule 25 mg

1

ketorolac tromethamine injection

1

ketorolac tromethamine intramuscular

1

ketorolac tromethamine oral

1 QL

meclofenamate sodium oral

1

medique aspirin 1 PV

meloxicam oral 1

nabumetone oral 1

For more information regarding the tiers and designations in this drug list, please see the Reading your formulary section of this booklet.

11


naproxen dr 1

naproxen oral tablet 1

naproxen sodium oral tablet 275 mg, 550 mg

1

oxaprozin 1

piroxicam oral 1

qc aspirin low dose oral tablet delayed release

1 PV

ST JOSEPH LOW DOSE ORAL TABLET DELAYED RELEASE

3 PV

sulindac oral 1

tolmetin sodium 1

Opioid Analgesics, Long-acting

buprenorphine transdermal patch weekly 10 mcg/hr, 15 mcg/hr, 20 mcg/hr, 5 mcg/hr

1 PA; QL

BUPRENORPHINE TRANSDERMAL PATCH WEEKLY 7.5 MCG/HR

3 PA; QL

BUTRANS TRANSDERMAL PATCH WEEKLY 7.5 MCG/HR

3 PA; QL

fentanyl 1 PA; QL

hydrocodone bitartrate er

1 PA; QL

hydromorphone hcl er 1 PA; QL

HYSINGLA ER 2 PA; QL

levorphanol tartrate oral tablet 2 mg

3 QL

methadone hcl injection 1

methadone hcl intensol 1

methadone hcl oral concentrate

1


methadone hcl oral solution

1

methadone hcl oral tablet

1 PA

methadone hcl oral tablet soluble

1

methadose oral concentrate 10 mg/ml

1

methadose oral tablet soluble

1

methadose sugar-free 1

mitigo 1

morphine sulfate er 1 PA; QL

morphine sulfate er beads

1 PA; QL

morphine sulfate intramuscular

1

OXYCODONE HCL ER 3 PA; M; QL

OXYCONTIN 2 PA; QL

oxymorphone hcl er 1 PA; QL

tramadol hcl er (biphasic)

1 QL

tramadol hcl er oral capsule extended release 24 hour 150 mg

1 PA; QL

tramadol hcl er oral tablet extended release 24 hour

1 QL

Opioid Analgesics, Short-acting

acetaminophen-codeine

1 QL

acetaminophen-codeine #2

1 QL


1 QL


1 QL

alfentanil hcl 1


12


apap-caff-dihydrocodeine oral capsule

1 PA; QL

ascomp-codeine 1

butalbital-apap-caff-cod 1

butalbital-asa-caff-codeine

1

butorphanol tartrate injection

1

butorphanol tartrate nasal

1 QL

codeine sulfate oral tablet 30 mg, 60 mg

1 QL

duramorph 1

endocet 1 QL

fentanyl citrate buccal lozenge on a handle

1 PA; QL

hydrocodone-acetaminophen

1 QL

hydrocodone-ibuprofen 1 QL

hydromorphone hcl injection solution 1 mg/ml, 2 mg/ml, 4 mg/ml

1

hydromorphone hcl oral 1 QL

hydromorphone hcl pf 1

lorcet 1 QL

lorcet hd 1 QL

lorcet plus 1 QL

meperidine hcl injection 1

meperidine hcl oral 1 QL

morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml

1 QL

morphine sulfate (pf) 1

morphine sulfate intravenous solution 1 mg/ml

1


morphine sulfate oral 1 QL

nalbuphine hcl injection 1

oxycodone hcl oral capsule

1 QL

oxycodone hcl oral concentrate 100 mg/5ml

1 QL

oxycodone hcl oral solution

1 QL

oxycodone hcl oral tablet

1 QL

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1 QL

oxycodone-aspirin 1 QL

oxycodone-ibuprofen 1 QL

oxymorphone hcl 1 QL

pentazocine-naloxone hcl

1 QL

remifentanil hcl 1

tramadol hcl ir 1 QL

tramadol-acetaminophen

1 QL

vicodin hp 1 QL

Anesthetics

Local Anesthetics

bupivacaine fisiopharma

1

bupivacaine hcl (pf) 1

bupivacaine hcl injection solution 0.25 %, 0.5 %

1

bupivacaine in dextrose intrathecal

1

bupivacaine spinal 1

bupivacaine-epinephrine

1


13


bupivacaine-epinephrine (pf)

1

chloroprocaine hcl (pf) 1

ethyl chloride 1

glydo 1

lidocaine external ointment

1

lidocaine external patch 5 %

1

lidocaine hcl (pf) 1

lidocaine hcl external solution

1

lidocaine hcl injection solution

1

lidocaine hcl mouth/throat

1

lidocaine hcl urethral/mucosal

1

lidocaine viscous hcl 1

lidocaine-epinephrine injection

1

lidocaine-prilocaine external cream

1

polocaine 1

polocaine-mpf 1

ropivacaine hcl injection solution 10 mg/ml, 2 mg/ml, 5 mg/ml, 7.5 mg/ml

1

sensorcaine 1

sensorcaine/epinephrine

1

sensorcaine-mpf 1

sensorcaine-mpf/epinephrine injection solution 0.25% -1:200000, 0.5% -1:200000

1

xylocaine dental 1


Anti-Addiction/Substance Abuse Treatment Agents

Alcohol Deterrents/Anti-craving

acamprosate calcium 1

disulfiram oral 1

naltrexone hcl oral 1

VIVITROL 4

Opioid Dependence Treatments

buprenorphine hcl injection

1

buprenorphine hcl sublingual

1 QL

buprenorphine hcl-naloxone hcl

1 QL

Opioid Reversal Agents

naloxone hcl injection solution

1

naloxone hcl injection solution cartridge

1

naloxone hcl injection solution prefilled syringe

1

NARCAN 2

Smoking Cessation Agents

bupropion hcl er (smoking det)

1 PV; QL

CHANTIX 3 ST; PV; QL

CHANTIX CONTINUING MONTH PAK

3 ST; PV; QL

CHANTIX STARTING MONTH PAK

3 ST; PV; QL


14


NICORETTE MOUTH/THROAT GUM 2 MG

3 PV; QL

nicotine polacrilex mouth/throat

1 PV; QL

nicotine step 1 1 PV; QL



NICOTROL 3 ST; PV; QL

NICOTROL NS 3 ST; PV; QL

Antibacterials

Aminoglycosides

amikacin sulfate injection

1

gentamicin in saline 1

gentamicin sulfate external

1

gentamicin sulfate injection

1

neomycin sulfate oral 1

paromomycin sulfate oral

1

streptomycin sulfate intramuscular

1

tobramycin sulfate injection

1

Antibacterials, Other

ALTABAX 3

baciim 1

bacitracin intramuscular 1

chloramphenicol sod succinate

1

clindamycin hcl oral 1

clindamycin palmitate hcl

1

clindamycin phosphate in d5w

1


clindamycin phosphate injection

1

clindamycin phosphate vaginal

1

colistimethate sodium (cba)

1

CORTISPORIN 3

daptomycin 1

iodine tincture external tincture 2 %

1

lincomycin hcl injection 1

linezolid in sodium chloride

1

linezolid intravenous 1

linezolid oral 1 QL

mafenide acetate external

1

methenamine hippurate 1

metronidazole in nacl 1

metronidazole oral 1

metronidazole vaginal 1

mupirocin external 1

NEO-SYNALAR EXTERNAL CREAM

3

nitrofurantoin 1

nitrofurantoin macrocrystal oral

1

nitrofurantoin monohydrate macrocrystals

1

polymyxin b sulfate injection

1

PRIMSOL 3

silver sulfadiazine external

1

ssd 1

SULFAMYLON EXTERNAL CREAM

3


15


tinidazole oral 1

trimethoprim oral 1

vancomycin hcl in dextrose intravenous solution 1-5 gm/200ml-%, 500-5 mg/100ml-%, 750-5 mg/150ml-%

1

vancomycin hcl in nacl intravenous solution 1-0.9 gm/200ml-%, 500-0.9 mg/100ml-%

1

VANCOMYCIN HCL IN NACL SOLUTION 750-0.9 MG/150ML-% INTRAVENOUS

3

vancomycin hcl in nacl solution 750-0.9 mg/150ml-% intravenous

1

vancomycin hcl intravenous solution 1000 mg/200ml, 1500 mg/300ml, 2000 mg/400ml, 500 mg/100ml

1

vancomycin hcl intravenous solution reconstituted

1

vancomycin hcl oral 1

vandazole 1

XIFAXAN 3 PA

ZYVOX INTRAVENOUS SOLUTION 200 MG/100ML

3

Beta-lactam, Cephalosporins

cefaclor 1

cefaclor er 1

cefadroxil 1


cefazolin sodium injection

1

cefazolin sodium intravenous solution reconstituted

1

cefazolin sodium-dextrose

1

cefdinir 1

cefditoren pivoxil 1

cefepime hcl 1

cefepime-dextrose 1

cefixime 1

cefotaxime sodium 1

cefotetan disodium 1

cefotetan disodium-dextrose

1

cefoxitin sodium 1

cefpodoxime proxetil 1

cefprozil 1

ceftazidime and dextrose

1

ceftazidime injection 1

ceftriaxone sodium in dextrose

1

ceftriaxone sodium injection

1

ceftriaxone sodium intravenous

1

ceftriaxone sodium-dextrose

1

cefuroxime axetil 1

cefuroxime sodium 1

cephalexin 1

tazicef injection 1

tazicef intravenous solution reconstituted

1

Beta-lactam, Other

aztreonam 1


16


ertapenem sodium 1

imipenem-cilastatin 1

meropenem 1

Beta-lactam, Penicillins

amoxicillin 1

amoxicillin-potassium clavulanate er

1

amoxicillin-potassium clavulanate oral

1

ampicillin 1

ampicillin sodium 1

ampicillin-sulbactam sodium

1

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

3

BICILLIN L-A 3

dicloxacillin sodium 1

nafcillin sodium injection solution reconstituted 1 gm, 2 gm

1

nafcillin sodium intravenous

1

oxacillin sodium 1

penicillin g potassium 1

penicillin g procaine 1

penicillin g sodium 1

penicillin v potassium 1

piperacillin sod-tazobactam so

1

Macrolides

azithromycin intravenous

1

azithromycin oral 1

clarithromycin er 1


clarithromycin oral 1

DIFICID 3

erythromycin base 1

erythromycin ethylsuccinate oral

1

erythromycin oral 1

ZITHROMAX ORAL PACKET

3

Quinolones

AVELOX 3

BAXDELA ORAL 3

CIPRO ORAL SUSPENSION RECONSTITUTED 250 MG/5ML (5%)

3

CIPRO ORAL SUSPENSION RECONSTITUTED 500 MG/5ML (10%)

2

ciprofloxacin hcl oral 1

ciprofloxacin in d5w 1

levofloxacin in d5w 1

levofloxacin intravenous

1

levofloxacin oral 1

moxifloxacin hcl in nacl 1

moxifloxacin hcl oral 1

ofloxacin oral 1

Sulfonamides

sulfadiazine oral 1

sulfamethoxazole-trimethoprim

1

sulfatrim pediatric 1

Tetracyclines

avidoxy 1

coremino 1

demeclocycline hcl 1


17


doxy 100 1

doxycycline hyclate intravenous

1

doxycycline hyclate oral capsule

1

doxycycline hyclate oral tablet 100 mg, 20 mg

1

doxycycline monohydrate oral

1

MINOCIN INTRAVENOUS

3

minocycline hcl er oral tablet extended release 24 hour

1

minocycline hcl oral 1

mondoxyne nl 1

morgidox oral 1

okebo 1

tetracycline hcl oral 1

tigecycline 1

Anticonvulsants

Anticonvulsants, Other

BRIVIACT ORAL 3 ST

levetiracetam er 1

levetiracetam in nacl 1

levetiracetam intravenous

1

levetiracetam oral 1

roweepra 1

roweepra xr 1

Calcium Channel Modifying Agents

CELONTIN 3

ethosuximide oral 1

zonisamide oral 1


Gamma-aminobutyric Acid (GABA) Augmenting Agents

clobazam 1 PA

diazepam rectal 1 QL

divalproex sodium er 1

divalproex sodium oral 1

gabapentin oral 1

pentobarbital sodium injection

1

phenobarbital oral 1

phenobarbital sodium injection

1

primidone oral 1

tiagabine hcl 1

valproate sodium intravenous

1

valproic acid oral 1

vigabatrin 4 PA

vigadrone 4 PA

Glutamate Reducing Agents

felbamate 1

FYCOMPA 3

lamotrigine er 1

lamotrigine oral 1

lamotrigine starter kit-blue

1

lamotrigine starter kit-green

1

lamotrigine starter kit-orange

1

subvenite 1

subvenite starter kit-blue

1

subvenite starter kit-green

1


18


subvenite starter kit-orange

1

topiramate er 1

topiramate oral 1

Sodium Channel Agents

BANZEL 3 PA

carbamazepine er 1

carbamazepine oral 1

DILANTIN ORAL CAPSULE 30 MG

3

epitol 1

fosphenytoin sodium 1

oxcarbazepine 1

PEGANONE 3

phenytoin infatabs 1

phenytoin oral 1

phenytoin sodium extended

1

phenytoin sodium injection

1

VIMPAT ORAL 3

Antidementia Agents

Cholinesterase Inhibitors

donepezil hcl 1

galantamine hydrobromide

1

galantamine hydrobromide er

1

rivastigmine 1

rivastigmine tartrate 1

N-methyl-D-aspartate (NMDA) Receptor Antagonist

memantine hcl er 1 QL

memantine hcl oral 1


NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR

2 QL

Antidepressants

Antidepressants, Other

APLENZIN 3 ST; QL

bupropion hcl er (sr) 1 QL

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg

1 QL

bupropion hcl oral 1

chlordiazepoxide-amitriptyline

1

mirtazapine oral 1

olanzapine-fluoxetine hcl

1 QL

perphenazine-amitriptyline

1

Monoamine Oxidase Inhibitors

EMSAM 3 QL

MARPLAN 3

phenelzine sulfate oral 1

tranylcypromine sulfate 1

SSRI/SNRI (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors)

citalopram hydrobromide

1

desvenlafaxine succinate er

1 QL

escitalopram oxalate 1

FETZIMA 3 ST; QL

FETZIMA TITRATION 3 ST; QL

fluoxetine hcl (pmdd) 1


19


fluoxetine hcl oral capsule

1

fluoxetine hcl oral capsule delayed release

1 QL

fluoxetine hcl oral solution

1

fluoxetine hcl oral tablet 1

fluvoxamine maleate 1

fluvoxamine maleate er 1 QL

maprotiline hcl 1

nefazodone hcl 1

paroxetine hcl 1

paroxetine hcl er 1

paroxetine mesylate 1 QL

PAXIL ORAL SUSPENSION

2 ST

sertraline hcl oral 1

trazodone hcl oral 1

TRINTELLIX 3 ST; QL

venlafaxine hcl 1

venlafaxine hcl er oral capsule extended release 24 hour

1

venlafaxine hcl er oral tablet extended release 24 hour 225 mg

1

VIIBRYD 3 QL

VIIBRYD STARTER PACK

3 QL

Tricyclics

amitriptyline hcl oral 1

amoxapine 1

clomipramine hcl oral 1

desipramine hcl oral 1

doxepin hcl oral capsule

1


doxepin hcl oral concentrate

1

imipramine hcl oral 1

imipramine pamoate 1

nortriptyline hcl oral 1

protriptyline hcl 1

trimipramine maleate oral

1

Antiemetics

Antiemetics, Other

compro 1

dimenhydrinate injection

1

doxylamine-pyridoxine 1 PA; QL

droperidol injection 1

meclizine hcl oral tablet 1

metoclopramide hcl injection

1

metoclopramide hcl oral

1

perphenazine oral 1

prochlorperazine 1

prochlorperazine edisylate injection

1

prochlorperazine maleate oral

1

scopolamine 1

trimethobenzamide hcl oral

1

Emetogenic Therapy Adjuncts

AKYNZEO ORAL 3 QL

ANZEMET 3 QL

aprepitant 1 QL

dronabinol 1 PA; QL

fosaprepitant dimeglumine

1


20


granisetron hcl intravenous

1

granisetron hcl oral 1 QL

ondansetron hcl injection

1

ondansetron hcl oral solution

1 QL

ondansetron hcl oral tablet 24 mg

1 QL

ondansetron hcl oral tablet 4 mg, 8 mg

1

ondansetron odt 1

palonosetron hcl 1

Antifungals

ABELCET 3

AMBISOME 3

amphotericin b intravenous

1

caspofungin acetate 1

ciclodan 1

ciclopirox 1

ciclopirox olamine external

1

clotrimazole external 1

clotrimazole mouth/throat

1

clotrimazole-betamethasone

1

CRESEMBA 3

econazole nitrate external

1

exoderm external lotion 1

fluconazole in sodium chloride

1

fluconazole oral 1

flucytosine oral 1

griseofulvin microsize oral

1


griseofulvin ultramicrosize

1

GYNAZOLE-1 3

itraconazole oral 1 PA

KERYDIN 3 PA

ketoconazole external cream

1

ketoconazole external shampoo

1

ketoconazole oral 1

miconazole 3 vaginal suppository

1

naftifine hcl 1

nyamyc 1

nystatin external 1

nystatin mouth/throat 1

nystatin oral 1

nystatin-triamcinolone 1

nystop 1

OXISTAT EXTERNAL LOTION

3

posaconazole 1

terbinafine hcl oral 1 QL

terconazole 1

voriconazole intravenous

1

voriconazole oral 1

Antigout Agents

allopurinol oral 1

allopurinol sodium 1

colchicine tablet 0.6 mg oral

1

COLCHICINE TABLET 0.6 MG ORAL

3ST; Made by Par

COLCHICINE TABLET 0.6 MG ORAL

3ST; Made by Prasco

colchicine-probenecid 1


21


COLCRYS 2

febuxostat 1 ST

probenecid 1

Antimigraine Agents

Ergot Alkaloids

dihydroergotamine mesylate injection

1

dihydroergotamine mesylate nasal

1 QL

ergotamine-caffeine 1

Serotonin (5-HT) 1b/1d Receptor Agonists

almotriptan malate 1 QL

eletriptan hydrobromide 1 QL

frovatriptan succinate 3 QL

naratriptan hcl 1 QL

rizatriptan benzoate 1 QL

sumatriptan nasal 1 QL

sumatriptan succinate oral

1 QL

sumatriptan succinate refill

1 QL

sumatriptan succinate subcutaneous

1 QL

zolmitriptan oral 1 QL

ZOMIG NASAL 3 ST; QL

Antimyasthenic Agents

Parasympathomimetics

GUANIDINE HCL 3

neostigmine methylsulfate intravenous solution 10 mg/10ml, 5 mg/10ml

1

pyridostigmine bromide er

1


pyridostigmine bromide oral

1

Antimycobacterials

Antimycobacterials, Other

dapsone oral 1

rifabutin 1

Antituberculars

CAPASTAT SULFATE 3

cycloserine oral 1

ethambutol hcl oral 1

isoniazid injection 1

isoniazid oral 1

PASER 3

PRIFTIN 3

pyrazinamide oral 1

rifampin intravenous 1

rifampin oral 1

RIFATER 3

SIRTURO 3

TRECATOR 3

Antineoplastics

Alkylating Agents

BENDEKA 4 PA

busulfan 4

carboplatin 4

carmustine 4

cisplatin intravenous solution

4

cyclophosphamide injection

4

cyclophosphamide oral CM

dacarbazine 4

GLEOSTINE CM

ifosfamide 4

LEUKERAN CM


22


MATULANE CM

melphalan CM

melphalan hcl 4

MYLERAN CM

oxaliplatin 4

paraplatin 4

TEMODAR INTRAVENOUS

4

temozolomide CM PA

thiotepa injection 4

TREANDA 4

ZANOSAR 4

Antiandrogens

abiraterone acetate CM PA

bicalutamide CM

flutamide CM

nilutamide CM

XTANDI CM PA

ZYTIGA ORAL TABLET 500 MG

CM PA

Antiangiogenic Agents

POMALYST CM PA

REVLIMID CM PA

THALOMID CM PA

Antiestrogens/Modifiers

EMCYT CM

fulvestrant 4

SOLTAMOX CM PV*

tamoxifen citrate oral tablet 10 mg

CM

tamoxifen citrate oral tablet 20 mg

CM PV*

toremifene citrate CM


Antimetabolites

adrucil 4

ALIMTA 4

capecitabine CM PA

cladribine 4

clofarabine 4

cytarabine 4

cytarabine (pf) 4

decitabine 4 PA

DROXIA 3

floxuridine injection 4

fludarabine phosphate 4

fluorouracil intravenous 4

FOLOTYN 4 PA

gemcitabine hcl 4

hydroxyurea oral CM

mercaptopurine oral CM

NIPENT 4

TABLOID CM

Antineoplastics, Other

ABRAXANE 4

adriamycin 4

ARRANON 4

arsenic trioxide intravenous

4

azacitidine 4

bleomycin sulfate 4

CAMPTOSAR INTRAVENOUS SOLUTION 300 MG/15ML

4

dactinomycin 4

daunorubicin hcl 4

dexrazoxane hcl 4


23


diclofenac sodium transdermal gel 3 %

1 ST; QL

docetaxel 4

doxorubicin hcl 4

doxorubicin hcl liposomal

4

epirubicin hcl 4

ERWINAZE 4

ETHYOL 4

FLUOROPLEX 3

FLUOROURACIL EXTERNAL CREAM 0.5 %

2

fluorouracil external cream 5 %

1

fluorouracil external solution

4

HALAVEN 4 PA

HERCEPTIN HYLECTA

4 PA

idarubicin hcl 4

irinotecan hcl 4

ISTODAX (OVERFILL) 4 PA

IXEMPRA KIT 4

leucovorin calcium injection

1

leucovorin calcium oral CM

levoleucovorin calcium 4

levoleucovorin calcium pf

4

LONSURF CM PA

MARQIBO 4

mitomycin intravenous 4

mitoxantrone hcl 4 PA

mutamycin 4

NINLARO CM PA

ONCASPAR 4


ONIVYDE 4

paclitaxel 4

PICATO 3 ST

PIQRAY (200 MG DAILY DOSE)

CM PA


CM PA


CM PA

PROLEUKIN 4

ROMIDEPSIN 4 PA

ROZLYTREK CM PA

SYNRIBO 4 PA

teniposide 4

TOTECT 4

VELCADE 4 PA

vinblastine sulfate 4

vincristine sulfate 4

vinorelbine tartrate 4

VYXEOS 4 PA

ZALTRAP 4 PA

ZOLINZA CM PA

Aromatase Inhibitors, 3rd Generation

anastrozole oral CM

exemestane CM

letrozole oral CM

Enzyme Inhibitors

etoposide intravenous 4

etoposide oral CM

HYCAMTIN ORAL CM

KYPROLIS 4 PA

RUBRACA CM PA

toposar 4

topotecan hcl 4


24


Molecular Target Inhibitors

AFINITOR DISPERZ CM PA

AFINITOR ORAL TABLET 10 MG

CM PA; QL

BELEODAQ 4 PA

BOSULIF CM PA

CABOMETYX CM PA

CAPRELSA ORAL TABLET 100 MG

CM PA; QL

CAPRELSA ORAL TABLET 300 MG

CM PA

COMETRIQ (100 MG DAILY DOSE)

CM PA


CM PA


CM PA

COTELLIC CM PA

ERIVEDGE CM PA

erlotinib hcl oral tablet 100 mg, 150 mg

CM PA

erlotinib hcl oral tablet 25 mg

CM PA; QL

everolimus oral tablet 2.5 mg, 5 mg, 7.5 mg

CM PA; QL

FARYDAK CM PA

GILOTRIF CM PA; QL

IBRANCE ORAL CAPSULE

CM PA

ICLUSIG ORAL TABLET 15 MG

CM PA; QL

ICLUSIG ORAL TABLET 45 MG

CM PA

imatinib mesylate CM PA

IMBRUVICA CM PA

INLYTA CM PA


JAKAFI ORAL TABLET 10 MG

CM PA; QL

JAKAFI ORAL TABLET 15 MG, 20 MG, 25 MG, 5 MG

CM PA

JEVTANA 4 PA

LENVIMA (10 MG DAILY DOSE)

CM PA


CM PA


CM PA


CM PA


CM PA


CM PA


CM PA


CM PA

LYNPARZA CM PA

MEKINIST CM PA

NEXAVAR CM PA

RYDAPT CM PA

SPRYCEL CM PA

STIVARGA CM PA

SUTENT CM PA

TAFINLAR CM PA

TAGRISSO ORAL TABLET 40 MG

CM PA; QL

TAGRISSO ORAL TABLET 80 MG

CM PA

TASIGNA CM PA

TURALIO CM PA

TYKERB CM PA

VENCLEXTA CM PA


25


VENCLEXTA STARTING PACK

CM PA

VOTRIENT CM PA

XALKORI CM PA

ZELBORAF CM PA

ZYDELIG CM PA

ZYKADIA CM PA

Monoclonal Antibody/Antibody-Drug Conjugate

ADCETRIS 4 PA

ARZERRA 4 PA

AVASTIN 4 PA

BAVENCIO 4 PA

BLINCYTO 4 PA

CYRAMZA 4 PA

DARZALEX 4 PA

EMPLICITI 4 PA

ERBITUX 4 PA

GAZYVA 4 PA

HERCEPTIN 4 PA

KADCYLA 4 PA

KANJINTI 4 PA

MVASI 4 PA

OPDIVO 4 PA

PERJETA 4 PA

POLIVY 4 PA

RITUXAN 4 PA

RITUXAN HYCELA 4 PA

RUXIENCE 4 PA

TECENTRIQ 4 PA

TRAZIMERA 4 PA

UNITUXIN 4 PA

YERVOY 4 PA

ZIRABEV 4 PA


Retinoids

bexarotene CM PA

PANRETIN 3

TARGRETIN EXTERNAL

4 PA

tretinoin oral CM

Treatment Adjuncts

ELITEK 4

mesna 4

MESNEX ORAL CM

Antiparasitics

Anthelmintics

albendazole oral 1 PA

EMVERM 2

ivermectin oral 1

praziquantel oral 1

SKLICE 3

Antiprotozoals

ALINIA 2

atovaquone oral 1

atovaquone-proguanil hcl

1

BENZNIDAZOLE 3

chloroquine phosphate oral

1

COARTEM 3

DARAPRIM 4 PA

hydroxychloroquine sulfate oral

1

IMPAVIDO 3

mefloquine hcl 1

pentamidine isethionate 1

primaquine phosphate 1

quinine sulfate oral 1 PA


26


Pediculicides/Scabicides

crotan 1

lindane 1

malathion 1

permethrin external 1

spinosad 1

sulfurated lime 1

ULESFIA 3

Antiparkinson Agents

Anticholinergics

benztropine mesylate 1

trihexyphenidyl hcl 1

Antiparkinson Agents, Other

amantadine hcl oral 1

entacapone 1

tolcapone 1

Dopamine Agonists

APOKYN 4 PA; QL

bromocriptine mesylate oral

1

NEUPRO 3 ST

pramipexole dihydrochloride

1

pramipexole dihydrochloride er

1

ropinirole hcl 1

ropinirole hcl er 1

Dopamine Precursors/L-Amino Acid Decarboxylase Inhibitors

carbidopa oral 1

carbidopa-levodopa 1

carbidopa-levodopa er 1


carbidopa-levodopa-entacapone

1

Monoamine Oxidase B (MAO-B) Inhibitors

rasagiline mesylate oral 1

selegiline hcl oral 1

Antipsychotics

1st Generation/Typical

chlorpromazine hcl injection

1

chlorpromazine hcl oral 1

fluphenazine decanoate injection

1

fluphenazine hcl 1

haloperidol decanoate intramuscular

1

haloperidol lactate 1

haloperidol oral 1

loxapine succinate 1

molindone hcl 1

pimozide 1

thioridazine hcl oral 1

thiothixene 1

trifluoperazine hcl 1

2nd Generation/Atypical

ABILIFY MAINTENA 3

aripiprazole 1 QL

FANAPT 3 ST; QL

FANAPT TITRATION PACK

3 ST; QL

GEODON INTRAMUSCULAR

3

INVEGA SUSTENNA 3

INVEGA TRINZA 3

LATUDA 3 QL


27


olanzapine intramuscular

1

olanzapine oral 1 QL

paliperidone er 1 QL

quetiapine fumarate 1 QL

quetiapine fumarate er 1 QL

REXULTI 3 QL

RISPERDAL CONSTA 3

risperidone 1 QL

SAPHRIS 2 QL

ziprasidone hcl 1 QL

ZYPREXA RELPREVV 3

Treatment-Resistant

clozapine 1 QL

Antivirals

Anti-cytomegalovirus (CMV) Agents

cidofovir intravenous 1

ganciclovir sodium 1

valganciclovir hcl 1

Anti-hepatitis B (HBV) Agents

adefovir dipivoxil 4

BARACLUDE ORAL SOLUTION

4 QL

entecavir 4 QL

EPIVIR HBV ORAL SOLUTION

4

lamivudine oral tablet 100 mg

4

VEMLIDY 4

Anti-hepatitis C (HBV) Agents

EPCLUSA 4 PA; QL

HARVONI 4 PA; QL

MAVYRET 4 PA; QL

PEGASYS 4 PA


PEGASYS PROCLICK 4 PA

ribavirin oral 4

ZEPATIER 4 PA; QL

Anti-hepatitis C (HCV) Agents, Other

INTRON A 4 PA

SYLATRON 4 PA

Antiherpetic Agents

acyclovir external 1

acyclovir oral 1

acyclovir sodium 1

DENAVIR 3

famciclovir 1

valacyclovir hcl oral 1 QL

Anti-HIV Agents, Integrase Inhibitors (INSTI)

GENVOYA 3

ISENTRESS 2

ISENTRESS HD 2

STRIBILD 3

TIVICAY 2

TRIUMEQ 2

TYBOST 2

Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)

ATRIPLA 3 ST

COMPLERA 2

EDURANT 2

efavirenz 1

INTELENCE 2

JULUCA 2

nevirapine 1

nevirapine er 1


28


ODEFSEY 3

RESCRIPTOR ORAL TABLET 200 MG

2

SYMFI 2

SYMFI LO 2

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)

abacavir sulfate 1

abacavir sulfate-lamivudine

1

abacavir-lamivudine-zidovudine

1

BIKTARVY 3

CIMDUO 2

DESCOVY 3 PV*

didanosine 1

EMTRIVA 2

lamivudine oral solution 1

lamivudine oral tablet 150 mg, 300 mg

1

lamivudine-zidovudine 1

RETROVIR INTRAVENOUS

2

stavudine 1

tenofovir disoproxil fumarate

1 PV*

TRUVADA 2 PV*

VIDEX 2

VIDEX EC ORAL CAPSULE DELAYED RELEASE 125 MG

3

VIREAD ORAL POWDER

2

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG

2


zidovudine 1

Anti-HIV Agents, Other

FUZEON 2

SELZENTRY 2 PA

Anti-HIV Agents, Protease Inhibitors

APTIVUS 2

atazanavir sulfate 1

CRIXIVAN 2

EVOTAZ 2

fosamprenavir calcium 1

INVIRASE 2

KALETRA ORAL TABLET

2

LEXIVA ORAL SUSPENSION

2

lopinavir-ritonavir 1

NORVIR ORAL PACKET

2

NORVIR ORAL SOLUTION

2

PREZCOBIX 2

PREZISTA 2

REYATAZ ORAL PACKET

2

ritonavir 1

VIRACEPT 2

Anti-influenza Agents

oseltamivir phosphate oral

1 QL

RELENZA DISKHALER 3 QL

rimantadine hcl 1

Anxiolytics

Anxiolytics, Other

buspirone hcl oral 1


29


hydroxyzine hcl intramuscular

1

hydroxyzine hcl oral 1

hydroxyzine pamoate oral

1

meprobamate 1

Benzodiazepines

alprazolam er 1 QL

alprazolam intensol 1 QL

alprazolam oral 1 QL

alprazolam xr 1 QL

chlordiazepoxide hcl 1 QL

clonazepam oral 1 QL

clorazepate dipotassium

1 QL

diazepam injection 1

diazepam intensol 1

diazepam intramuscular

1

diazepam oral 1

estazolam 1 QL

lorazepam injection 1

lorazepam intensol 1 QL

lorazepam oral concentrate 2 mg/ml

1 QL

lorazepam oral tablet 1 QL

oxazepam 1 QL

quazepam 1 QL

triazolam 1 QL

Bipolar Agents

Mood Stabilizers

lithium 1

lithium carbonate er 1

lithium carbonate oral 1


Blood Glucose Monitoring

ACCU-CHEK FASTCLIX LANCET KIT

2

ACCU-CHEK MULTICLIX LANCET DEVICE KIT

2

ACCU-CHEK SOFTCLIX LANCET DEVICE KIT

2

CEQUR SIMPLICITY 2U

3

CHEMSTRIP UGK 3

INPEN 100-BLUE-LILLY

3

INPEN 100-BLUE-NOVO

3

INPEN 100-GRAY-LILLY

3

INPEN 100-GREY-NOVO

3

INPEN 100-PINK-LILLY

3

INPEN 100-PINK-NOVO

3

KETONE TEST 3

KETOSTIX 3

LANCETS 2

NOVOPEN ECHO 3

ONETOUCH DELICA LANCING DEV

3

ONETOUCH DELICA PLUS LANCING

3

ONETOUCH ULTRA 2 2

ONETOUCH ULTRA BLUE TEST STRIPS

2 QL

ONETOUCH ULTRA MINI KIT W/DEVICE

2


30


ONETOUCH VERIO KIT W/DEVICE

2

ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE

2

ONETOUCH VERIO IN VITRO SOLUTION HIGH

3

ONETOUCH VERIO TEST STRIPS

2 QL

ONETOUCH VERIO IQ SYSTEM

2

ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE

2

SURESTEP PRO HIGH GLUCOSE

3

SURESTEP PRO LOW GLUCOSE

3

SURESTEP PRO NORMAL GLUCOSE

3

Blood Glucose Regulators

Antidiabetic Agents

acarbose oral 1

BYDUREON 2 ST; QL

BYDUREON BCISE AUTOINJECTOR

2 ST; QL

BYETTA 10 MCG PEN 2 ST; QL

BYETTA 5 MCG PEN 2 ST; QL

CYCLOSET 3 ST

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1

glipizide-metformin hcl 1

glyburide micronized 1

glyburide oral 1


glyburide-metformin 1

GLYXAMBI 2 ST

INVOKAMET 2 ST

INVOKAMET XR 2 ST

INVOKANA 2 ST

JANUMET 2 ST

JANUMET XR 2 ST

JANUVIA 2 ST

JARDIANCE 2 ST

JENTADUETO 2 ST

JENTADUETO XR 2 ST

metformin hcl er 1

metformin hcl oral tablet

1

miglitol 1

nateglinide 1

OZEMPIC 2 ST; QL

pioglitazone hcl 1

pioglitazone hcl-glimepiride

1

pioglitazone hcl-metformin hcl

1

repaglinide 1

SYNJARDY 2 ST

SYNJARDY XR 2 ST

tolbutamide 1

TRADJENTA 2 ST

TRULICITY 2 ST; QL

VICTOZA 2 ST; QL

Glycemic Agents

GLUCAGEN HYPOKIT 2

GLUCAGON EMERGENCY KIT

2 Made by Lilly

GLUCAGON EMERGENCY KIT

2Made by Fresenius

PROGLYCEM 2


31


Insulins

HUMALOG 2

HUMALOG KWIKPEN 2

HUMALOG MIX 50/50 KWIKPEN

2

HUMALOG MIX 50/50 VIAL

2

HUMALOG MIX 75/25 KWIKPEN

2

HUMALOG MIX 75/25 VIAL

2

HUMALOG U-100 JUNIOR KWIKPEN

2

HUMULIN 70/30 KWIKPEN

2

HUMULIN 70/30 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2

HUMULIN R U-500 KWIKPEN

2

HUMULIN R U-500 VIAL (CONCENTRATED)

2

HUMULIN R VIAL 2

LANTUS SOLOSTAR 2

LANTUS U-100 VIAL 2

LEVEMIR U-100 FLEXTOUCH

2

LEVEMIR U-100 VIAL 2

NOVOLIN 70/30 FLEXPEN

3

NOVOLIN 70/30 FLEXPEN RELION

3

NOVOLIN 70/30 RELION

3

NOVOLIN 70/30 VIAL 3

NOVOLIN N FLEXPEN 3


NOVOLIN N FLEXPEN RELION

3

NOVOLIN N RELION 3

NOVOLIN N VIAL 3

NOVOLIN R FLEXPEN 3

NOVOLIN R FLEXPEN RELION

3

NOVOLIN R RELION 3

NOVOLIN R VIAL 3

NOVOLOG FLEXPEN 3

NOVOLOG MIX 70/30 FLEXPEN

3

NOVOLOG MIX 70/30 VIAL

3

NOVOLOG PENFILL 3

NOVOLOG U-100 VIAL 3

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

TRESIBA 3

TRESIBA FLEXTOUCH

3

Blood Products/Modifiers/Volume Expanders

CEPROTIN 4

SOLIRIS 4 PA

Anticoagulants

acd formula a 1

acd-a noclot-50 1

anticoagulant cit dext soln a

1

anticoagulant sodium citrate

1

argatroban 1

BEVYXXA 3 QL

bivalirudin trifluoroacetate

1


32


ELIQUIS 2 QL

ELIQUIS DVT/PE STARTER PACK

2 QL

enoxaparin sodium 1 QL

fondaparinux sodium 1 QL

heparin (porcine) in nacl intravenous solution

1

heparin sod (porcine) in d5w

1

heparin sodium (porcine)

1

heparin sodium (porcine) pf

1

jantoven 1

PRADAXA 2 QL

SAVAYSA 3 QL

THROMBATE III 4

warfarin sodium oral 1

XARELTO 2 QL

XARELTO STARTER PACK

2 QL

ZONTIVITY 3

Blood Formation Modifiers

anagrelide hcl 1

ARANESP (ALBUMIN FREE)

4 PA

MOZOBIL 4 PA; QL

NEULASTA 4 PA

NEULASTA ONPRO 4 PA

NIVESTYM 4 PA

NPLATE 4 PA

PROMACTA 4 PA

REBLOZYL 4 PA

RETACRIT 4 PA


Hemostasis Agents

ADVATE 4

aminocaproic acid intravenous

1

aminocaproic acid oral 1

BENEFIX 4

COAGADEX 4

CORIFACT 4

ELOCTATE 4

FEIBA 4

FIBRYGA 4

HEMLIBRA 4

HEMOFIL M 4

HUMATE-P 4

KOATE 4

KOATE-DVI 4

KOGENATE FS 4

NOVOSEVEN RT 4

OBIZUR 4

PROFILNINE 4

PROFILNINE SD 4

protamine sulfate intravenous

1

RECOMBINATE 4

RIASTAP 4

RIXUBIS 4

tranexamic acid intravenous

1

tranexamic acid oral 1

VONVENDI 4

XYNTHA 4

XYNTHA SOLOFUSE 4

Platelet Modifying Agents

aspirin-dipyridamole er 1

BRILINTA 2


33


CABLIVI 4 PA; QL

cilostazol 1

clopidogrel bisulfate oral

1

dipyridamole oral 1

eptifibatide 1

prasugrel hcl 1

Cardiovascular Agents

Alpha-adrenergic Agonists

clonidine 1

clonidine hcl oral 1

guanfacine hcl 1

methyldopa 1

methyldopa-hydrochlorothiazide

1

midodrine hcl 1

Alpha-adrenergic Blocking Agents

doxazosin mesylate oral

1

phenoxybenzamine hcl oral

1

phentolamine mesylate injection

1

prazosin hcl oral 1

Angiotensin II Receptor Antagonists

amlodipine besylate-valsartan

1

amlodipine-olmesartan 1

amlodipine-valsartan-hctz

1

candesartan cilexetil 1

candesartan cilexetil-hctz

1

eprosartan mesylate 1


irbesartan 1

irbesartan-hydrochlorothiazide

1

losartan potassium 1

losartan potassium-hctz 1

olmesartan medoxomil oral

1

olmesartan medoxomil-hctz

1

olmesartan-amlodipine-hctz

1

telmisartan 1

telmisartan-amlodipine 1

telmisartan-hctz 1

valsartan 1

valsartan-hydrochlorothiazide

1

Angiotensin-converting Enzyme (ACE) Inhibitors

amlodipine besylate-benazepril hcl

1

benazepril hcl oral 1

benazepril-hydrochlorothiazide

1

captopril oral 1

captopril-hydrochlorothiazide

1

enalapril maleate oral 1

enalaprilat 1

enalapril-hydrochlorothiazide

1

fosinopril sodium 1

fosinopril sodium-hctz 1

lisinopril oral 1

lisinopril-hydrochlorothiazide

1

moexipril hcl 1


34


perindopril erbumine 1

quinapril hcl 1

quinapril-hydrochlorothiazide

1

ramipril 1

trandolapril 1

trandolapril-verapamil hcl er

1

Antiarrhythmics

adenosine intravenous solution 12 mg/4ml, 6 mg/2ml

1

amiodarone hcl 1

disopyramide phosphate

1

dofetilide 1

flecainide acetate 1

ibutilide fumarate 1

lidocaine hcl (cardiac) 1

lidocaine hcl (cardiac) pf

1

lidocaine in d5w intravenous solution 4-5 mg/ml-%, 8-5 mg/ml-%

1

mexiletine hcl oral 1

pacerone oral tablet 200 mg

1

procainamide hcl injection

1

propafenone hcl 1

propafenone hcl er 1

quinidine gluconate er 1

quinidine sulfate 1

sorine 1

sotalol hcl (af) 1

sotalol hcl oral 1

sotalol hydrochloride 1


Beta-adrenergic Blocking Agents

acebutolol hcl oral 1

atenolol oral 1

atenolol-chlorthalidone 1

betaxolol hcl oral 1

bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide

1

BYSTOLIC 2

carvedilol 1

carvedilol phosphate er 1

esmolol hcl intravenous solution 100 mg/10ml

1

esmolol hcl-sodium chloride

1

labetalol hcl intravenous solution

1

labetalol hcl oral 1

metoprolol succinate er 1

metoprolol tartrate intravenous

1

metoprolol tartrate oral 1

metoprolol-hydrochlorothiazide

1

pindolol 1

propranolol hcl er 1

propranolol hcl intravenous

1

propranolol hcl oral 1

propranolol-hctz 1

timolol maleate oral 1

Calcium Channel Blocking Agents

amlodipine besylate oral

1


35


CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG

3

cartia xt 1

diltiazem hcl er beads 1

diltiazem hcl er coated beads

1

diltiazem hcl er oral capsule extended release 12 hour

1

diltiazem hcl intravenous

1

diltiazem hcl oral 1

dilt-xr 1

felodipine er 1

isradipine 1

matzim la 1

nicardipine hcl 1

nifedipine er 1

nifedipine er osmotic release

1

nifedipine oral 1

nimodipine oral 1

nisoldipine er 1

taztia xt 1

tiadylt er 1

verapamil hcl er 1

verapamil hcl intravenous

1

verapamil hcl oral 1

Cardiovascular Agents, Other

aliskiren fumarate 1

alprostadil injection 1

amiloride-hydrochlorothiazide

1

amlodipine-atorvastatin 1


DEMSER 3

digitek 1

digox 1

digoxin injection 1

digoxin oral 1

dobutamine hcl 1

dobutamine in d5w 1

dopamine hcl intravenous

1

dopamine in d5w 1

ENTRESTO 2 QL

ephedrine sulfate intravenous solution

1

epinephrine pf 1

GIAPREZA 3

mannitol intravenous 1

milrinone lactate 1

milrinone lactate in dextrose

1

norepinephrine bitartrate intravenous

1

osmitrol 1

pentoxifylline er 1

phenylephrine hcl intravenous solution

1

ranolazine er 1

spironolactone-hctz 1

triamterene-hctz 1

VECAMYL 3

VYNDAMAX 4 PA; QL

Diuretics, Carbonic Anhydrase Inhibitors

acetazolamide er 1

acetazolamide oral 1

acetazolamide sodium 1

KEVEYIS 4 PA; QL


36


methazolamide oral 1

Diuretics, Loop

bumetanide 1

ethacrynate sodium 1

ethacrynic acid 1

furosemide injection 1

furosemide oral 1

torsemide 1

Diuretics, Potassium-sparing

amiloride hcl oral 1

eplerenone 1

spironolactone oral 1

triamterene oral 1

Diuretics, Thiazide

chlorothiazide oral 1

chlorothiazide sodium 1

chlorthalidone 1

hydrochlorothiazide oral

1

indapamide 1

metolazone 1

Dyslipidemics, Fibric Acid Derivatives

fenofibrate micronized 1

fenofibrate oral capsule 1

fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg

1

fenofibric acid oral capsule delayed release

1

gemfibrozil oral 1


Dyslipidemics, HMG CoA Reductase Inhibitors

atorvastatin calcium oral tablet 10 mg, 20 mg

1 PV*

atorvastatin calcium oral tablet 40 mg, 80 mg

1

fluvastatin sodium 3

fluvastatin sodium er 3

LIVALO 3 ST

lovastatin 1 PV

pravastatin sodium 1

rosuvastatin calcium 1

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg

1 PV*

simvastatin oral tablet 80 mg

1

Dyslipidemics, Other

cholestyramine light 1

cholestyramine oral 1

colesevelam hcl 1

colestipol hcl 1

ezetimibe 1

ezetimibe-simvastatin 1

niacin (antihyperlipidemic)

1

niacin er (antihyperlipidemic)

1

niacor 1

omega-3-acid ethyl esters

1

PRALUENT 2 PA; QL

prevalite 1

REPATHA 2 PA; QL


37


REPATHA PUSHTRONEX SYSTEM

2 PA; QL

REPATHA SURECLICK

2 PA; QL

Vasodilators, Direct-acting Arterial

hydralazine hcl injection

1

hydralazine hcl oral 1

minoxidil oral 1

Vasodilators, Direct-acting Arterial/Venous

DILATRATE-SR 3

isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg

1

isosorbide mononitrate 1

isosorbide mononitrate er

1

minitran 1

NITRO-BID 3

nitroglycerin 1

nitroglycerin in d5w 1

NITROMIST 3

nitroprusside sodium 1

RECTIV 3

Central Nervous System Agents

Attention Deficit Hyperactivity Disorder Agents, Amphetamines

amphetamine sulfate 1 PA; QL

amphetamine-dextroamphetamine

1 PA; QL

amphetamine-dextroamphetamine er

1 PA; QL


dextroamphetamine sulfate

1 PA; QL

dextroamphetamine sulfate er

1 PA; QL

methamphetamine hcl 3 PA; QL

VYVANSE 2 PA; QL

Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines

atomoxetine hcl 1 QL

clonidine hcl er 1

DAYTRANA 3 ST; PA; QL

dexmethylphenidate hcl 1 PA; QL

dexmethylphenidate hcl er

1 PA; QL

guanfacine hcl er 1

metadate er 1 PA; QL

methylphenidate hcl er 1 PA; QL

methylphenidate hcl er (cd)

1 PA; QL

methylphenidate hcl er (la)

1 PA; QL

methylphenidate hcl oral

1 PA; QL

QUILLIVANT XR 3 ST; PA; QL

relexxii 1 PA; QL

Central Nervous System, Other

caffeine citrate 1

GRALISE 3 ST; QL

GRALISE STARTER 3 ST; QL

riluzole 4 PA; QL

tetrabenazine 4 PA

Fibromyalgia Agents

duloxetine hcl oral 1 QL

pregabalin oral 1 QL


38


SAVELLA 3 ST; QL

SAVELLA TITRATION PACK

3 ST; QL

Multiple Sclerosis Agents

AVONEX PEN 4 PA; QL

AVONEX PREFILLED 4 PA; QL

BETASERON 4 PA; QL

COPAXONE 4 PA; QL

dalfampridine er 4 PA; QL

GILENYA 4 PA; QL

glatiramer acetate 4 PA; QL

glatopa 4 PA; QL

TECFIDERA 4 PA; QL

TYSABRI 4 PA; QL

Dental and Oral Agents

cavarest 1

cevimeline hcl 1

chlorhexidine gluconate mouth/throat

1

clinpro 5000 1

DEBACTEROL 3

denta 5000 plus 1

dentagel 1

easygel 1

fluoridex 1

fluoridex daily renewal 1

fluoridex enhanced whitening

1

fluoridex sensitivity relief

1

neutral sodium fluoride 1

oralone 1

paroex 1

periogard 1


pilocarpine hcl oral 1

prevident mouth/throat 1

sf 1

sf 5000 plus 1

sodium fluoride 5000 plus

1

sodium fluoride dental 1

triamcinolone acetonide mouth/throat

1

Dermatological Agents

acitretin 1

adapalene external cream

1 PA

adapalene external gel 1 PA

adapalene-benzoyl peroxide

1

ammonium lactate external

1

amnesteem 1 PA

avita 1 PA

azelaic acid external 1

AZELEX 3

benzoyl peroxide-erythromycin

1

calcipotriene external cream

1

calcipotriene external ointment

1

calcipotriene external solution

1

calcitriol external 1

claravis 1 PA

clindacin etz external swab

1

clindacin-p 1

clindamycin phosphate-benzoyl peroxide

1


39


clindamycin phosphate external

1

clindamycin-tretinoin 1

coal tar external 1

CONDYLOX 3

COSENTYX (300 MG DOSE)

4 PA

COSENTYX 150 MG/ML

4 PA

COSENTYX SENSOREADY (300 MG)

4 PA

COSENTYX SENSOREADY PEN

4 PA

dapsone external 1

doxepin hcl external 3

doxycycline 1

DUPIXENT 4 PA; QL

EPIDUO FORTE 3

ery 1

erythromycin external 1

imiquimod external 1

isotretinoin oral 1 PA

ivermectin external 1

lactic acid e 1

lactic acid external 1

methoxsalen rapid 1

metronidazole external 1

MIRVASO 2

myorisan 1 PA

neuac external gel 1

pimecrolimus 1

podofilox external 1

REGRANEX 3 PA

rosadan external cream 1

rosadan external gel 1


SANTYL 3

selenium sulfide external lotion

1

sodium sulfacetamide 1

STELARA 4 PA

sulfacetamide sodium (acne)

1

TACLONEX EXTERNAL SUSPENSION

3 QL

tacrolimus external ointment

1

tazarotene external 1

TAZORAC EXTERNAL CREAM 0.05 %

3

TAZORAC EXTERNAL GEL

3

TREMFYA 4 PA

tretinoin external 1 PA

tretinoin microsphere 1 PA

tretinoin microsphere pump

1 PA

zenatane 1 PA

Electrolytes/Minerals/Metals/Vitamins

Electrolyte/Mineral Replacement

calcium chloride 1

calcium gluconate intravenous solution

1

CARBAGLU 4

chromagen 1

chromic chloride intravenous

1

corvita 150 1

dehydrated alcohol 1

dextrose in lactated ringers

1


40


dextrose intravenous 1

dextrose-nacl 1

dextrose-sodium chloride

1

effer-k oral tablet effervescent 25 meq

1

ferocon 1

ferotrinsic 1

ferraplus 90 1

ferrocite plus 1

fluoritab 1 PV

foltrin 1

hematinic plus vit/minerals

1

hematinic/folic acid 1

hematogen 1

hematogen forte 1

hemocyte-f 1

hemocyte-plus 1

hepatamine 1

iferex 150 forte 1

intralipid intravenous emulsion 20 %

1

iodine strong oral 1

kcl in dextrose-nacl 1

kcl-lactated ringers-d5w 1

klor-con 1

klor-con 10 1

klor-con m10 1

KLOR-CON M15 3

klor-con m20 1

klor-con sprinkle 1

klor-con/ef 1

k-prime 1

k-tan plus 1


lactated ringers intravenous

1

levocarnitine oral solution

1

levocarnitine oral tablet 1

levocarnitine sf 1

ludent 1 PV

magnesium chloride injection

1

magnesium sulfate in d5w

1

magnesium sulfate injection

1

magnesium sulfate intravenous solution 2 gm/50ml, 20 gm/500ml, 4 gm/100ml, 4 gm/50ml, 40 gm/1000ml

1

multigen 1

multigen folic 1

multigen plus 1

na ferric gluc cplx in sucrose

1

nafrinse 1 PV

nafrinse drops 1 PV

nutrilipid 1

phosphorous 1

poly-iron 150 forte 1

polysaccharide iron forte

1

pot bicarb-pot chloride 1

potassium acetate intravenous

1

potassium chloride crys er

1

potassium chloride er 1

potassium chloride in dextrose

1


41


potassium chloride in nacl

1

potassium chloride intravenous solution

1

potassium chloride oral 1

potassium citrate er 1

purevit dualfe plus 1

ringers 1

se-tan plus 1

sod citrate-citric acid 1

sodium acetate intravenous

1

sodium bicarbonate intravenous

1

sodium chloride (pf) 1

sodium chloride injection

1

sodium chloride intravenous

1

sodium fluoride oral 1 PV

sodium phosphates intravenous solution 45 mmole/15ml

1

tl-hem 150 1

tpn electrolytes 1

tricon 1

trigels-f forte 1

virt-phos 250 neutral 1

Electrolyte/Mineral/Metal Modifiers

CHEMET 3

clovique 4 PA

deferasirox 1 PA

FERRIPROX ORAL TABLET

4 PA

JADENU ORAL TABLET 180 MG

3 PA

JADENU SPRINKLE 3 PA


kionex 1

SAMSCA 4 QL

sodium polystyrene sulfonate

1

sps 1

trientine hcl 4 PA

VELTASSA 3

Phosphate Binders

calcium acetate (phos binder)

1

calcium acetate oral tablet 667 mg

1

FOSRENOL ORAL PACKET

3

lanthanum carbonate 1

PHOSLYRA 3

sevelamer carbonate 1

sevelamer hcl 1

Vitamins

adc/f (0.5mg/ml) 1

airavite 1

ascorbic acid injection 1

b-6 folic acid 1

biocel 1

bp vit 3 1

b-plex 1

b-plex plus 1

cod liver oil oral oil 1

corvita 1

corvite free 1

cyanocobalamin injection solution 1000 mcg/ml

1

DECARA ORAL CAPSULE 1.25 MG (50000 UT)

1

dexifol 1


42


dialyvite 1

ergocalciferol oral capsule

1

fabb 1

fa-vitamin b-6-vitamin b-12

1

folbee 1

folbee plus 1

folbee plus cz 1

folic acid injection 1

folic acid oral tablet 1 mg

1

folic acid oral tablet 400 mcg, 800 mcg

1 PV

folplex 2.2 1

gnp folic acid 1 PV

hydroxocobalamin acetate

1

infuvite adult 1

infuvite pediatric 1

lysiplex plus oral tablet 1

multi prenatal 1 PV

multi-vit/iron/fluoride 1

multi-vitamin/fluoride 1

multivitamin/fluoride oral solution

1

multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg

1

multivitamin/fluoride/iron

1

multi-vitamin/fluoride/iron

1

multivitamins/fluoride 1

mvc-fluoride 1

mynephron 1

NASCOBAL 3


nephronex oral tablet 1

nufol 1

nutricap 1

nutrifac zx 1

ONE-A-DAY WOMENS PRENATAL 1

3 PV

phytonadione injection 1

phytonadione oral 1

pnv prenatal plus multivit+dha

1

prenatal multi +dha 1 PV

prenatal oral tablet 27-0.8 mg, 28-0.8 mg

1 PV

prenatal oral tablet 27-1 mg

1

prenatal plus iron 1

pyridoxine hcl injection 1

renal 1

siderol 1

thiamine hcl injection 1

trinate 1

triphrocaps 1

tri-vitamin/fluoride 1

tri-vite/fluoride 1

v-c forte 1

vic-forte 1

virt-caps 1

virt-gard 1

vita s forte 1

vitacel 1

vita-min 1

vitamin b complex 100 1

vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut)

1

vitamin k1 injection 1


43


vitamins acd-fluoride 1

vp-pnv-dha 1

vp-vite rx 1

weekly-d 1

westab one 1

Gastrointestinal Agents

Antispasmodics, Gastrointestinal

atropine sulfate injection solution 8 mg/20ml

1

atropine sulfate injection solution prefilled syringe

1

CUVPOSA 3

dicyclomine hcl intramuscular

1

dicyclomine hcl oral 1

ed-spaz 1

glycopyrrolate injection solution

1

glycopyrrolate oral tablet 1 mg, 2 mg

1

glycopyrrolate pf 1

hyoscyamine sulfate oral

1

hyoscyamine sulfate sl 1

hyoscyamine sulfate sublingual

1

methscopolamine bromide oral

1

nulev 1

oscimin 1

phenobarbital-belladonna alk

1


Gastrointestinal Agents, Other

amoxicill-clarithro-lansopraz

1

cromolyn sodium oral 1

diphenoxylate-atropine 1

GATTEX 4 PA

loperamide hcl oral capsule

1

OMECLAMOX-PAK 2

PYLERA 2

sodium bicarbonate oral powder

1

SYMPROIC 2 ST; QL

ursodiol oral 1

Histamine2 (H2) receptor Antagonists

cimetidine hcl 1

cimetidine oral 1

famotidine intravenous 1

famotidine oral suspension reconstituted

1

famotidine oral tablet 20 mg, 40 mg

1

famotidine premixed 1

nizatidine 1

ranitidine hcl injection 1

ranitidine hcl oral capsule

1

ranitidine hcl oral syrup 1

ranitidine hcl oral tablet 150 mg, 300 mg

1

Irritable Bowel Syndrome Agents

alosetron hcl 1 PA

AMITIZA 3 ST; QL

LINZESS 2 ST; QL


44


Laxatives

bisacodyl ec 1 PV; QL

cascara sagrada oral fluid extract

1

citroma 1 PV; QL

clearlax 1 PV; QL

constulose 1

enulose 1

gavilax oral powder 1 PV; QL

gavilyte-c 1 PV; QL

gavilyte-g 1 PV; QL

gavilyte-h 1

gavilyte-n with flavor pack

1 PV; QL

generlac 1

gentle laxative oral 1 PV; QL

glycolax 1 PV; QL

lactulose 1

lactulose encephalopathy

1

magnesium citrate oral solution

1 PV; QL

mineral oil heavy oral 1

MOVIPREP 3

peg 3350-kcl-na bicarb-nacl

1 PV; QL

peg-3350/electrolytes 1 PV; QL

peg-prep 1

PREPOPIK 3

qc magnesium citrate 1 PV; QL

SUPREP BOWEL PREP KIT

3

trilyte 1 PV; QL

Protectants

misoprostol oral 1

sucralfate oral 1


Proton Pump Inhibitors

DEXILANT 2 QL

esomeprazole sodium 1

lansoprazole oral capsule delayed release

1 QL

lansoprazole oral tablet delayed release dispersible 15 mg

1 QL

omeprazole oral capsule delayed release

1 QL

pantoprazole sodium intravenous

1 QL

pantoprazole sodium oral

1 QL

rabeprazole sodium oral tablet delayed release

1 QL

Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment

ALDURAZYME 4 PA

ARALAST NP 4 PA

CERDELGA 4 PA

CEREZYME 4 PA

CHOLBAM 4 PA

CREON 2

CYSTADANE 4

CYSTAGON 4

ELAPRASE 4 PA

FABRAZYME 4 PA

GLASSIA 4 PA

KANUMA 4 PA

KUVAN 4 PA

LUMIZYME 4 PA


45


MEPSEVII 4 PA

miglustat 4 PA

MYALEPT 4 PA

NAGLAZYME 4 PA

nitisinone 4 PA

ORFADIN ORAL CAPSULE 20 MG

4 PA

ORFADIN ORAL SUSPENSION

4 PA

PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED

4 PA

RAVICTI 4 PA

REVCOVI 4 PA

sod benz-sod phenylacet

1

sodium phenylbutyrate oral

4

STRENSIQ 4 PA

SUCRAID 4

TEGSEDI 4 PA

VIMIZIM 4 PA

ZEMAIRA 4 PA

ZENPEP 2

Genitourinary Agents

Antispasmodics, Urinary

darifenacin hydrobromide er

1

flavoxate hcl 1

GELNIQUE 3 ST

MYRBETRIQ 2

oxybutynin chloride er 1

oxybutynin chloride oral 1

solifenacin succinate 1

tolterodine tartrate 1


tolterodine tartrate er 1

TOVIAZ 3

trospium chloride 1

trospium chloride er 1

Benign Prostatic Hypertrophy Agents

alfuzosin hcl er 1

dutasteride oral 1

dutasteride-tamsulosin hcl

1

finasteride oral tablet 5 mg

1

silodosin 1

tadalafil oral tablet 2.5 mg, 5 mg

1 PA; QL

tamsulosin hcl 1

terazosin hcl 1

Genitourinary Agents, Other

acetic acid irrigation 1

aminoacetic acid 1

argyle sterile saline 1

bethanechol chloride oral

1

curity sterile saline 1

ELMIRON 2

glycine irrigation 1

glycine urologic 1

neomycin-polymyxin b gu

1

OPTIONS CONCEPTROL

3 PV; QL

penicillamine oral capsule

4 PA

penicillamine oral tablet 1

pentosan polysulfate sodium oral

1


46


phenazo oral tablet 200 mg

1

phenazopyridine hcl oral tablet 100 mg, 200 mg

1

RENACIDIN 3

sodium chloride irrigation

1

sorbitol irrigation solution 3.3 %

1

sorbitol-mannitol 1

vcf vaginal contraceptive vaginal gel

1 PV; QL

Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal)

ala-cort 1

alclometasone dipropionate

1

amcinonide 1

beser external lotion 1

betamethasone dipropionate aug

1

betamethasone dipropionate external

1

betamethasone sod phos & acet injection suspension 6 (3-3) mg/ml

1

betamethasone valerate external

1

clobetasol prop emollient base

1

clobetasol propionate e 1

clobetasol propionate emulsion

1

clobetasol propionate external

1


clocortolone pivalate 1

clodan external shampoo

1

CORDRAN EXTERNAL TAPE

3

cortisone acetate oral 1

DEPO-MEDROL INJECTION SUSPENSION 20 MG/ML

3

desonide external 1

desoximetasone external

1

dexamethasone intensol

1

dexamethasone oral 1

dexamethasone sod phosphate pf

1

dexamethasone sodium phosphate injection

1

fludrocortisone acetate oral

1

fluocinolone acetonide body

1

fluocinolone acetonide external

1

fluocinolone acetonide scalp

1

fluocinonide emulsified base

1

fluocinonide external cream 0.05 %

1

fluocinonide external gel

1

fluocinonide external ointment

1

fluocinonide external solution

1


47


fluticasone propionate external

1

halcinonide 1

halobetasol propionate external cream

1

halobetasol propionate external ointment

1

hydrocortisone butyr lipo base

1

hydrocortisone butyrate external cream

1

hydrocortisone butyrate external ointment

1

hydrocortisone butyrate external solution

1

hydrocortisone external cream 1 %, 2.5 %

1

hydrocortisone external lotion 2.5 %

1

hydrocortisone external ointment 1 %, 2.5 %

1

hydrocortisone oral 1

hydrocortisone valerate 1

methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml

1

methylprednisolone oral

1

methylprednisolone sodium succ

1

mometasone furoate external

1

prednicarbate 1

prednisolone oral solution

1

prednisolone sodium phosphate oral

1

prednisone intensol 1


prednisone oral 1

SOLU-CORTEF INJECTION SOLUTION RECONSTITUTED 1000 MG

3

TEXACORT 3

tovet external foam 1

triamcinolone acetonide external

1

triamcinolone acetonide injection suspension 40 mg/ml

1

trianex 1

triderm 1

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary)

ACTHAR 4 PA

cabergoline 1

chorionic gonadotropin intramuscular

4 PA

desmopressin ace spray refrig

1

desmopressin acetate injection

1

desmopressin acetate oral

1

desmopressin acetate spray

1

INCRELEX 4 PA

NORDITROPIN FLEXPRO

4 PA

novarel intramuscular solution reconstituted 10000 unit

4 PA

NUTROPIN AQ NUSPIN 10

4 PA


48



4 PA


4 PA

oxytocin injection 1

pregnyl 4 PA

Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins)

carboprost tromethamine

1

KORLYM 4 PA; QL

mifepristone 1

Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers)

Androgens

ANADROL-50 3 PA

danazol oral 1

INTRAROSA 3

METHITEST 3 PA

methyltestosterone oral 1 PA

oxandrolone oral 1 PA; QL

STRIANT 3 PA

testosterone cypionate intramuscular

1 PA

testosterone enanthate intramuscular

1 PA

testosterone transdermal gel 1.62 %, 12.5 mg/act (1%), 20.25 mg/1.25gm (1.62%), 20.25 mg/act (1.62%), 25 mg/2.5gm (1%), 40.5 mg/2.5gm (1.62%), 50 mg/5gm (1%)

1 PA


testosterone transdermal solution

1 PA

Estrogens

afirmelle 1 PV

altavera 1 PV

alyacen 1/35 1 PV

alyacen 7/7/7 1 PV

amabelz 1

amethia 1 PV; QL

amethia lo 1 PV; QL

amethyst 1 PV

ANNOVERA 3 PV

apri 1 PV

aranelle 1 PV

ashlyna 1 PV; QL

aubra 1 PV

aubra eq 1 PV

aurovela 1.5/30 1 PV

aurovela 1/20 1 PV

aurovela 24 fe 1 PV

aurovela fe 1.5/30 1 PV

aurovela fe 1/20 1 PV

aviane 1 PV

ayuna 1 PV

azurette 1 PV

balziva 1 PV

bekyree 1 PV

blisovi 24 fe 1 PV

blisovi fe 1.5/30 1 PV

blisovi fe 1/20 1 PV

briellyn 1 PV

camrese 1 PV; QL

camrese lo 1 PV; QL

caziant 1 PV

chateal 1 PV


49


chateal eq 1 PV

COMBIPATCH 3

cryselle-28 1 PV

cyclafem 1/35 1 PV

cyclafem 7/7/7 1 PV

cyred 1 PV

cyred eq 1 PV

dasetta 1/35 1 PV

dasetta 7/7/7 1 PV

daysee 1 PV; QL

delyla 1 PV

desogestrel-ethinyl estradiol

1 PV

DIVIGEL 3

dotti 1

drospiren-eth estrad-levomefol

1 PV

drospirenone-ethinyl estradiol

1 PV

DUAVEE 2

elinest 1 PV

eluryng 1 PV

emoquette 1 PV

enpresse-28 1 PV

enskyce 1 PV

estarylla 1 PV

estradiol oral 1

estradiol transdermal 1

estradiol vaginal 1

estradiol valerate intramuscular

1

estradiol-norethindrone acet

1

ethynodiol diac-eth estradiol

1 PV

etonogestrel-ethinyl estradiol

1 PV


EVAMIST 3

falmina 1 PV

fayosim 1 PV; QL

femynor 1 PV

fyavolv 1

gianvi 1 PV

hailey 1.5/30 1 PV

hailey 24 fe 1 PV

introvale 1 PV; QL

isibloom 1 PV

jaimiess 1 PV; QL

jasmiel 1 PV

jinteli 1

jolessa 1 PV; QL

juleber 1 PV

junel 1.5/30 1 PV

junel 1/20 1 PV

junel fe 1.5/30 1 PV

junel fe 1/20 1 PV

junel fe 24 1 PV

kaitlib fe 1 PV

kalliga 1 PV

kariva 1 PV

kelnor 1/35 1 PV

kelnor 1/50 1 PV

kurvelo 1 PV

larin 1.5/30 1 PV

larin 1/20 1 PV

larin 24 fe 1 PV

larin fe 1.5/30 1 PV

larin fe 1/20 1 PV

larissia 1 PV

layolis fe 1 PV

leena 1 PV

lessina 1 PV


50


levonest 1 PV

levonorgest-eth est & eth est

1 PV; QL

levonorgest-eth estrad 91-day

1 PV; QL

levonorgestrel-ethinyl estrad

1 PV

levonorg-eth estrad triphasic

1 PV

levora 0.15/30 (28) 1 PV

lillow 1 PV

LO LOESTRIN FE 3

lojaimiess 1 PV; QL

lopreeza 1

loryna 1 PV

low-ogestrel 1 PV

lo-zumandimine 1 PV

lutera 1 PV

marlissa 1 PV

melodetta 24 fe 1 PV

MENEST 2

mibelas 24 fe 1 PV

microgestin 1.5/30 1 PV

microgestin 1/20 1 PV

microgestin fe 1.5/30 1 PV

microgestin fe 1/20 1 PV

mili 1 PV

mimvey 1

mono-linyah 1 PV

NATAZIA 2 PV

necon 0.5/35 (28) 1 PV

nikki 1 PV

norethin ace-eth estrad-fe

1 PV

norethindrone acet-ethinyl est

1 PV


norethindrone-eth estradiol

1

norethin-eth estradiol-fe 1 PV

norgestimate-eth estradiol

1 PV

norgestimate-ethinyl estradiol triphasic

1 PV

nortrel 0.5/35 (28) 1 PV

nortrel 1/35 (21) 1 PV

nortrel 1/35 (28) 1 PV

nortrel 7/7/7 1 PV

ocella 1 PV

ogestrel 1 PV

orsythia 1 PV

philith 1 PV

pimtrea 1 PV

pirmella 1/35 1 PV

pirmella 7/7/7 1 PV

portia-28 1 PV

PREMARIN ORAL 2

PREMPHASE 2

PREMPRO 2

previfem 1 PV

reclipsen 1 PV

rivelsa 1 PV; QL

setlakin 1 PV; QL

simliya 1 PV

simpesse 1 PV; QL

sprintec 28 1 PV

sronyx 1 PV

syeda 1 PV

tarina 24 fe 1 PV

tarina fe 1/20 1 PV

tarina fe 1/20 eq 1 PV

tilia fe 1 PV

tri femynor 1 PV


51


tri-estarylla 1 PV

tri-legest fe 1 PV

tri-linyah 1 PV

tri-lo-estarylla 1 PV

tri-lo-marzia 1 PV

tri-lo-mili 1 PV

tri-lo-sprintec 1 PV

tri-mili 1 PV

tri-previfem 1 PV

tri-sprintec 1 PV

trivora (28) 1 PV

tri-vylibra 1 PV

tri-vylibra lo 1 PV

tydemy 1 PV

velivet 1 PV

vienva 1 PV

viorele 1 PV

volnea 1 PV

vyfemla 1 PV

vylibra 1 PV

wera 1 PV

wymzya fe 1 PV

xulane 1 PV

yuvafem 1

zarah 1 PV

zovia 1/35e (28) 1 PV

zumandimine 1 PV

Progestins

camila 1 PV

deblitane 1 PV

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

3

DEPO-SUBQ PROVERA 104

3 QL


ELLA 3 PV

errin 1 PV

heather 1 PV

hydroxyprogesterone caproate intramuscular oil

4 PA

incassia 1 PV

jencycla 1 PV

KYLEENA 4 PV

levonorgestrel 1 PV

LILETTA (52 MG) 4 PV

lyza 1 PV

MAKENA SUBCUTANEOUS

4 PA

medroxyprogesterone acetate intramuscular

1 PV; QL

medroxyprogesterone acetate oral

1

megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml

CM

megestrol acetate oral suspension 625 mg/5ml

1

megestrol acetate oral tablet

CM

MIRENA (52 MG) 4 PV

NEXPLANON 3 PV

nora-be 1 PV

norethindrone acetate oral

1

norethindrone oral 1 PV

norlyda 1 PV

norlyroc 1 PV

preventeza 1 PV

progesterone intramuscular

1

progesterone micronized oral

1


52


sharobel 1 PV

SKYLA 4 PV

SLYND 3 PV

tulana 1 PV

Selective Estrogen Receptor Modifying Agents

OSPHENA 3

raloxifene hcl 1 PV*

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid)

ARMOUR THYROID 3 ST

euthyrox 1

levo-t 1

levothyroxine sodium intravenous

1

levothyroxine sodium oral

1

levoxyl 1

liothyronine sodium intravenous

1

liothyronine sodium oral 1

np thyroid 1

thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg

1

unithroid 1

WP THYROID 3 ST

Hormonal Agents, Suppressant (Adrenal)

LYSODREN CM

Hormonal Agents, Suppressant (pituitary)

leuprolide acetate injection

4 PA


LUPANETA PACK 4 PA; QL

LUPRON DEPOT (1-MONTH)

4 PA

LUPRON DEPOT (3-MONTH)

4 PA

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG

4 PA

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG

4 PA

LUPRON DEPOT-PED (1-MONTH)

4 PA

LUPRON DEPOT-PED (3-MONTH)

4 PA

octreotide acetate 4 PA

SIGNIFOR 4 PA; QL

SOMATULINE DEPOT 4 PA

SOMAVERT 4 PA

SUPPRELIN LA 4 PA; QL

SYNAREL 2

ZOLADEX SUBCUTANEOUS IMPLANT 3.6 MG

4 QL

Hormonal Agents, Suppressant (Thyroid)

Antithyroid Agents

methimazole oral 1

propylthiouracil oral 1

Immunological Agents

Angioedema Agents

BERINERT 4 PA

CINRYZE 4 PA

icatibant acetate 4 PA


53


Immune Suppressants

AZASAN 3

azathioprine oral 1

azathioprine sodium 1

CIMZIA 4 PA

CIMZIA PREFILLED KIT

4 PA

CIMZIA STARTER KIT 4 PA

cyclosporine intravenous

1

cyclosporine modified 1

cyclosporine oral 1

ENBREL 4 PA

ENBREL MINI 4 PA

ENBREL SURECLICK 4 PA

gengraf 1

HUMIRA 4 PA

HUMIRA PEDIATRIC CROHNS START

4 PA

HUMIRA PEN 4 PA

HUMIRA PEN-CD/UC/HS STARTER

4 PA

HUMIRA PEN-PS/UV/ADOL HS START

4 PA

INFLECTRA 4 PA

KINERET 4 PA

methotrexate oral CM

methotrexate sodium (pf)

1

methotrexate sodium injection

1

methotrexate sodium oral

CM

mycophenolate mofetil 1

mycophenolate mofetil hcl

1


mycophenolate sodium 1

ORENCIA 4 PA

ORENCIA CLICKJECT 4 PA

PROGRAF INTRAVENOUS

3

RENFLEXIS 4 PA

SANDIMMUNE ORAL SOLUTION

2

SIMPONI 4 PA

SIMPONI ARIA 4 PA

sirolimus oral 1

tacrolimus oral 1

temsirolimus 4

TREXALL CM

XELJANZ 4 PA

XELJANZ XR 4 PA

ZORTRESS 3 PA

Immunizing Agents, Passive

BIVIGAM 4 PA

CARIMUNE NF 4 PA

CUVITRU 4 PA

CYTOGAM 4 PA

FLEBOGAMMA DIF 4 PA

GAMASTAN 4 PA

GAMASTAN S/D 4 PA

GAMMAGARD 4 PA

GAMMAGARD S/D LESS IGA

4 PA

GAMMAKED 4 PA

GAMMAPLEX 4 PA

GAMUNEX-C 4 PA

HEPAGAM B 4

HIZENTRA 4 PA

HYPERHEP B S/D 4

HYPERRHO S/D 4


54


MICRHOGAM ULTRA-FILTERED PLUS

4

NABI-HB 4

OCTAGAM 4 PA

PRIVIGEN 4 PA

RHOGAM ULTRA-FILTERED PLUS

4

RHOPHYLAC 4

THYMOGLOBULIN 3

WINRHO SDF 4

Immunomodulators

ACTEMRA 4 PA

ACTEMRA ACTPEN 4 PA

ACTIMMUNE 4 PA

ALFERON N 4

GAMIFANT 4 PA

HYQVIA 4 PA

ILARIS 4 PA; QL

leflunomide oral 1

OTEZLA 4 PA

RINVOQ 4 PA

SYNAGIS 4 PA

ULTOMIRIS 4 PA

XOLAIR 4 PA

Vaccines

ACTHIB 2 PV

ADACEL 2 PV

AFLURIA QUADRIVALENT

2 PV

BEXSERO 2 PV

BOOSTRIX 2 PV

DAPTACEL 2 PV

DIPHTHERIA-TETANUS TOXOIDS DT

2 PV

ENGERIX-B 2 PV


FLUAD 2 PV

FLUARIX QUADRIVALENT

2 PV

FLUBLOK QUADRIVALENT

2 PV

FLUCELVAX QUADRIVALENT

2 PV

FLULAVAL QUADRIVALENT

2 PV

FLUMIST QUADRIVALENT NASAL SUSPENSION

2 PV

FLUZONE HIGH-DOSE

2 PV

FLUZONE QUADRIVALENT

2 PV

GARDASIL 9 2 PV

HAVRIX 2 PV

HEPLISAV-B 2 PV

HIBERIX 2 PV

INFANRIX 2 PV

IPOL 2 PV

KINRIX 2 PV

MENACTRA 2 PV

MENVEO 2 PV

M-M-R II 2 PV

PEDIARIX 2 PV

PEDVAX HIB 2 PV

PENTACEL 2 PV

PNEUMOVAX 23 2 PV

PREVNAR 13 2 PV

PROQUAD 2 PV

QUADRACEL 2 PV

RECOMBIVAX HB 2 PV

ROTARIX 2 PV

ROTATEQ 2 PV

SHINGRIX 2 PV


55


TDVAX 2 PV

TENIVAC 2 PV

TRUMENBA 2 PV

TWINRIX 2 PV

VAQTA 2 PV

VARIVAX 2 PV

ZOSTAVAX 2 PV

Inflammatory Bowel Disease Agents

Aminosalicylates

balsalazide disodium 1

DIPENTUM 3

mesalamine er 1

mesalamine oral capsule delayed release

1

mesalamine oral tablet delayed release 1.2 gm

1

mesalamine rectal 1

mesalamine-cleanser 1

PENTASA 3

Glucocorticoids

budesonide er 1

budesonide oral 1

colocort 1

CORTIFOAM 3

hydrocortisone ace-pramoxine rectal cream 1-1 %

1

hydrocortisone rectal 1

procto-med hc 1

procto-pak 1

proctosol hc 1

proctozone-hc 1

Sulfonamides

sulfasalazine oral 1


Metabolic Bone Disease Agents

alendronate sodium oral solution

1

alendronate sodium oral tablet 10 mg, 5 mg

1

alendronate sodium oral tablet 35 mg, 70 mg

1 QL

calcitonin (salmon) 1 QL

calcitriol intravenous 1

calcitriol oral 1

cinacalcet hcl 1 PA

doxercalciferol intravenous

1

FORTEO 4 PA

FOSAMAX PLUS D 3 QL

ibandronate sodium 1 QL

MIACALCIN INJECTION

3

pamidronate disodium 4

paricalcitol 1

PROLIA 4 PA; QL

RAYALDEE 3

risedronate sodium oral tablet 150 mg, 35 mg

1 QL

risedronate sodium oral tablet 30 mg, 5 mg

1

risedronate sodium oral tablet delayed release

1 QL

XGEVA 4 PA

zoledronic acid 4

Miscellaneous Therapeutic Agents

albumin human 1

albumin-zlb 1

alburx 1


56


ALCOHOL PREP PADS PAD , 70 %

3

argyle sterile water 1

bal in oil 1

BD AUTOSHIELD DUO PEN NEEDLES

2

BD ULTRA-FINE INSULIN SYRINGES

2

BD ULTRA-FINE PEN NEEDLES

2

benzalkonium chloride external solution

1

BOTOX INJECTION SOLUTION RECONSTITUTED 200 UNIT

4PA; Non-Cosmetic

BOTOX SOLUTION RECONSTITUTED 100 UNIT INJECTION

4 PA

BOTOX SOLUTION RECONSTITUTED 100 UNIT INJECTION

4PA; Non-Cosmetic

BREATHE EASE LARGE

2

BREATHE EASE MEDIUM

2

BREATHE EASE SMALL

2

BREATHERITE 2

CAYA 3 PV; QL

CEQUR SIMPLICITY STARTER

3

COMPACT SPACE CHAMBER/LG MASK

2

COMPACT SPACE CHAMBER/MED MASK

2

COMPACT SPACE CHAMBER/SM MASK

2

deferoxamine mesylate 1


dexmedetomidine hcl in nacl

1

dexmedetomidine hcl intravenous solution 200 mcg/2ml

1

DROPLET MICRON 2

EASIVENT 2

ergoloid mesylates oral 1

FEMCAP 3 PV; QL

FLEXICHAMBER ADULT MASK/SMALL

2

FLEXICHAMBER CHILD MASK/LARGE

2

FLEXICHAMBER CHILD MASK/SMALL

2

flumazenil intravenous 1

fomepizole 1

heparin lock flush 1

heparin sodium lock flush

1

hetastarch-nacl 1

INSPIREASE RESERVOIR BAGS

2

INSULIN PEN NEEDLES

2


57


INSULIN SYRINGES 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G 0.3 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 15/64" 0.3 ML, 31G X 15/64" 0.5 ML, 31G X 15/64" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML, 32G X 5/16" 0.5 ML, 32G X 5/16" 1 ML

2

J-TIP KIT W/VIAL ADAPTERS

3

kedbumin 1

lactated ringers irrigation

1

lmd in d5w 1

MASK VORTEX 2

MAXICOMFORT SYR 27G X 1/2"

2

methergine 1

methylergonovine maleate

1

MICRODOT PEN NEEDLE 31G X 6 MM , 33G X 4 MM

2

monoject flush syringe 1

monoject sodium chloride flush

1

n-acetyl-l-cysteine oral 1

normal saline flush 1

NOVOFINE AUTOCOVER PEN NEEDLE

2


NOVOFINE PEN NEEDLE

2

NOVOFINE PLUS PEN NEEDLE

2

NOVOTWIST PEN NEEDLE

2

PANDA MASK LARGE 2

PANDA MASK MEDIUM

2

PANDA MASK SMALL 2

PARAGARD INTRAUTERINE COPPER

3 PV

PEDIATRIC PANDA MASK

2

pocket spacer 1

pralidoxime chloride intramuscular

1

PRO COMFORT SPACER ADULT

2

PRO COMFORT SPACER CHILD

2

PROCARE SPACER/ADULT MASK

2

PROCARE SPACER/CHILD MASK

2

PURE COMFORT ALCOHOL PREP

3

PURE COMFORT PEN NEEDLE

2

ringers irrigation 1

saline flush 1

saline flush zr 1

sodium chloride flush 1

sodium nitrite intravenous

1

sodium thiosulfate intravenous

1


58


sterile water for irrigation

1

swabflush saline flush 1

tis-u-sol 1

ULTIGUARD SAFEPACK PEN NEEDLE

2

VISTOGARD 3

water for irrigation, sterile

1

WIDE-SEAL DIAPHRAGM 60

3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL


3 PV; QL

XIAFLEX 4 PA

Ophthalmic Agents

Aminoglycosides

gentak 1

gentamicin sulfate ophthalmic

1

neomycin-polymyxin-gramicidin

1

TOBRADEX OPHTHALMIC OINTMENT

3

TOBRADEX ST 3

tobramycin ophthalmic 1


tobramycin-dexamethasone

1

TOBREX OPHTHALMIC OINTMENT

3

Antibacterials, Other

ak-poly-bac 1

bacitracin ophthalmic 1

bacitracin-polymyxin b ophthalmic

1

bacitra-neomycin-polymyxin-hc

1

neomycin-bacitracin zn-polymyx

1

neomycin-polymyxin-dexameth ophthalmic ointment

1

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

1

neomycin-polymyxin-hc ophthalmic

1

neo-polycin 1

neo-polycin hc 1

polycin 1

polymyxin b-trimethoprim

1

Anti-cytomegalovirus (CMV) Agents

ZIRGAN 3

Antifungals

NATACYN 2

Antiherpetic Agents

trifluridine 1

Macrolides

AZASITE 3

erythromycin ophthalmic

1


59


Ophthalmic Agents, Other

atropine sulfate ophthalmic ointment

1

atropine sulfate ophthalmic solution

1

cyclopentolate hcl ophthalmic

1

CYSTARAN 4 PA; QL

homatropaire 1

homatropine hbr 1

OMIDRIA 3

proparacaine hcl ophthalmic

1

RESTASIS 2 PA

RESTASIS MULTIDOSE

2 PA

sulfacetamide-prednisolone ophthalmic solution

1

tetcaine 1

tetracaine hcl ophthalmic

1

tropicamide ophthalmic solution 0.5 %

1

XIIDRA 2 PA

Ophthalmic Anti-allergy Agents

ALOCRIL 3

ALOMIDE 3

altafrin 1

azelastine hcl ophthalmic

1

BEPREVE 3 ST

cromolyn sodium ophthalmic

1

epinastine hcl 1

LASTACAFT 3 ST


olopatadine hcl ophthalmic

1

PAZEO 2

phenylephrine hcl ophthalmic

1

Ophthalmic Antiglaucoma Agents

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 %

2

apraclonidine hcl 1

AZOPT 2

betaxolol hcl ophthalmic

1

BETIMOL 3

brimonidine tartrate ophthalmic

1

carteolol hcl 1

COMBIGAN 2

dorzolamide hcl ophthalmic

1

dorzolamide hcl-timolol mal

1

dorzolamide hcl-timolol mal pf

1

IOPIDINE 3

levobunolol hcl 1

PHOSPHOLINE IODIDE

2

pilocarpine hcl ophthalmic

1

RHOPRESSA 2

SIMBRINZA 2

timolol maleate ophthalmic

1

Ophthalmic Anti-inflammatories

bromfenac sodium (once-daily)

1 QL


60


dexamethasone sodium phosphate ophthalmic

1

diclofenac sodium ophthalmic

1

DUREZOL 3

FLAREX 3

fluorometholone 1

flurbiprofen sodium 1

FML 2

ketorolac tromethamine ophthalmic

1

LOTEMAX SM 3

loteprednol etabonate 1

NEVANAC 3 ST; QL

PRED MILD 2

prednisolone acetate ophthalmic

1

prednisolone sodium phosphate ophthalmic

1

PROLENSA 2 QL

Ophthalmic Prostaglandin and Prostamide Analogs

bimatoprost ophthalmic 1 QL

latanoprost ophthalmic 1 QL

LUMIGAN 2 QL

travoprost (bak free) 1 QL

Quinolones

BESIVANCE 3

ciprofloxacin hcl ophthalmic

1

gatifloxacin ophthalmic 1

levofloxacin ophthalmic 1

moxifloxacin hcl (2x day)

1

moxifloxacin hcl ophthalmic

1


ofloxacin ophthalmic 1

Sulfonamides

sulfacetamide sodium ophthalmic

1

Otic Agents

acetic acid otic 1

CIPRO HC 3

CIPRODEX 2

ciprofloxacin hcl otic 1

COLY-MYCIN S 3

flac 1

fluocinolone acetonide otic

1

hydrocortisone-acetic acid

1

neomycin-polymyxin-hc otic

1

ofloxacin otic 1

Respiratory Tract/Pulmonary Agents

Antihistamines

azelastine hcl nasal 1 QL

brompheniramine tannate

1

carbinoxamine maleate oral solution

1

carbinoxamine maleate oral tablet 4 mg

1

cetirizine hcl oral solution

1

clemastine fumarate oral tablet 2.68 mg

3

cyproheptadine hcl oral 1

desloratadine 1

dexchlorpheniramine maleate oral

3


61


diphenhydramine hcl injection

1

diphenhydramine hcl oral elixir

1

levocetirizine dihydrochloride oral

1

olopatadine hcl nasal 1 QL

phenadoz 1

promethazine hcl injection

1

promethazine hcl oral 1

promethazine hcl rectal 1

promethegan 1

ryvent 1

Anti-inflammatories, Inhaled Corticosteroids

ADVAIR HFA 2 QL

ARNUITY ELLIPTA 2 QL

BECONASE AQ 3 QL

BREO ELLIPTA 2 QL

budesonide inhalation 1 QL

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL

flunisolide nasal 1 QL

fluticasone propionate nasal

1

fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

1 QL


FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT

1 QL

mometasone furoate nasal

1 QL

OMNARIS 3 QL

PULMICORT FLEXHALER

2 QL

SYMBICORT 2 QL

wixela inhub 1 QL

Antileukotrienes

montelukast sodium oral

1

zafirlukast 1

zileuton er 3 ST

Bronchodilators, Anticholinergic

ANORO ELLIPTA 2 QL

ATROVENT HFA 3 QL

INCRUSE ELLIPTA 2 QL

ipratropium bromide inhalation

1 QL

ipratropium bromide nasal

1

SPIRIVA HANDIHALER

2 QL

SPIRIVA RESPIMAT 2 QL

STIOLTO RESPIMAT 2 QL

Bronchodilators, Sympathomimetic

albuterol sulfate er 1


62


albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation

1Made by Perrigo; M; QL

albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation

1Made by Teva; M; QL

albuterol sulfate inhalation

1 QL

albuterol sulfate oral 1

AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 0.1 MG/0.1ML

3 QL

BROVANA 3 QL

epinephrine injection solution auto-injector

1

isoproterenol hcl injection

1

levalbuterol hcl inhalation

1 QL

metaproterenol sulfate oral

1

PERFOROMIST 3 QL

PROAIR HFA 2 M; QL

PROAIR RESPICLICK 2 QL

SEREVENT DISKUS 2 QL

terbutaline sulfate injection

1

terbutaline sulfate oral 1

VENTOLIN HFA 2 M; QL

Cystic Fibrosis Agents

BETHKIS 4

CAYSTON 4 PA

KALYDECO 4 PA

ORKAMBI 4 PA; QL

PULMOZYME 4 PA


tobramycin inhalation 4

Mast Cell Stabilizers

cromolyn sodium inhalation

1

Phosphodiesterase Inhibitors, Airways Disease

aminophylline intravenous

1

DALIRESP ORAL TABLET 500 MCG

3 PA

difil-g forte 1

ELIXOPHYLLIN 2

THEO-24 3

theophylline 1

theophylline er 1

theophylline in d5w 1

Pulmonary Antihypertensives

ADEMPAS 4 PA; QL

alyq 4 PA; QL

ambrisentan 4 PA; QL

bosentan 4 PA; QL

epoprostenol sodium 4 PA

OPSUMIT 4 PA; QL

ORENITRAM 4 PA

sildenafil citrate intravenous

4 PA

sildenafil citrate oral suspension reconstituted

4 PA; QL

sildenafil citrate oral tablet 20 mg

4 PA; QL

tadalafil (pah) 4 PA; QL

TRACLEER 32 MG 4 PA; QL

treprostinil 4 PA

TYVASO 4 PA; QL


63


TYVASO REFILL 4 PA; QL

TYVASO STARTER 4 PA; QL

UPTRAVI 4 PA; QL

VELETRI 4 PA

VENTAVIS 4 PA; QL

Pulmonary Fibrosis Agents

ESBRIET 4 PA

OFEV 4 PA

Respiratory Tract Agents, Other

acetylcysteine inhalation

1

acetylcysteine intravenous

1

benzonatate 1

COMBIVENT RESPIMAT

2 QL

DYMISTA 2 QL

hydrocodone-homatropine

1 PA; QL

hydromet 1 PA; QL

ipratropium-albuterol 1 QL

nebusal inhalation nebulization solution 3 %

1

NUCALA 4 PA; QL

pulmosal 1

sodium chloride inhalation

1

TUZISTRA XR 3 PA; QL

Skeletal Muscle Relaxants

atracurium besylate 1

baclofen intrathecal 1

baclofen oral 1

carisoprodol oral 1


chlorzoxazone oral tablet 375 mg, 500 mg, 750 mg

1

cisatracurium besylate (pf)

1

cisatracurium besylate intravenous solution 10 mg/ml, 2 mg/ml, 20 mg/10ml

1

cyclobenzaprine hcl er 1

cyclobenzaprine hcl oral

1

dantrolene sodium intravenous

1

dantrolene sodium oral 1

metaxalone 1

methocarbamol injection

1

methocarbamol oral 1

orphenadrine citrate er 1

orphenadrine citrate injection

1

pancuronium bromide 1

revonto 1

rocuronium bromide intravenous solution

1

succinylcholine chloride injection solution

1

tizanidine hcl oral 1

vecuronium bromide intravenous solution reconstituted

1

Sleep Disorder Agents

GABA Receptor Modulators

eszopiclone 1 QL

flurazepam hcl 1 PA; QL

temazepam 1 QL


64


zaleplon 1 QL

zolpidem tartrate 1 QL

zolpidem tartrate er 1 QL

Sleep Disorders, Other

armodafinil 1 PA; QL

BELSOMRA 3 ST; QL

doxepin hcl oral tablet 1 QL

HETLIOZ 4 PA; QL

modafinil 1 PA; QL

ramelteon 1 QL


65


66

Index of Drugs

abacavir sulfate.........................29abacavir sulfate-lamivudine...... 29abacavir-lamivudine-zidovudine.................................29ABELCET..................................21ABILIFY MAINTENA................. 27abiraterone acetate................... 23ABRAXANE.............................. 23acamprosate calcium................ 14acarbose................................... 31ACCU-CHEK FASTCLIX LANCET KIT............................. 30ACCU-CHEK MULTICLIX LANCET DEVICE KIT...............30ACCU-CHEK SOFTCLIX LANCET DEVICE KIT...............30acd formula a............................ 32acd-a noclot-50......................... 32acebutolol hcl............................ 35acetaminophen-codeine............12acetaminophen-codeine #2.......12acetaminophen-codeine #3.......12acetaminophen-codeine #4.......12acetazolamide...........................36acetazolamide er.......................36acetazolamide sodium.............. 36acetic acid........................... 46, 61acetylcysteine........................... 64acitretin..................................... 39ACTEMRA................................ 55ACTEMRA ACTPEN.................55ACTHAR................................... 48ACTHIB.....................................55ACTIMMUNE............................ 55acyclovir.................................... 28acyclovir sodium....................... 28ADACEL....................................55adapalene................................. 39adapalene-benzoyl peroxide.....39adc/f (0.5mg/ml)........................ 42ADCETRIS................................26adefovir dipivoxil ....................... 28ADEMPAS................................ 63adenosine................................. 35adriamycin.................................23adrucil ....................................... 23adult aspirin regimen.................11ADVAIR HFA............................ 62ADVATE....................................33AFINITOR................................. 25AFINITOR DISPERZ.................25afirmelle.................................... 49AFLURIA QUADRIVALENT......55

airavite...................................... 42ak-poly-bac............................... 59AKYNZEO.................................20ala-cort...................................... 47albendazole...............................26albumin human......................... 56albumin-zlb................................56alburx........................................ 56albuterol sulfate.........................63albuterol sulfate er.................... 62albuterol sulfate hfa...................63alclometasone dipropionate...... 47ALCOHOL PREP PADS........... 57ALDURAZYME......................... 45alendronate sodium.................. 56alfentanil hcl.............................. 12ALFERON N............................. 55alfuzosin hcl er.......................... 46ALIMTA..................................... 23ALINIA.......................................26aliskiren fumarate......................36allopurinol..................................21allopurinol sodium..................... 21almotriptan malate.................... 22ALOCRIL...................................60ALOMIDE..................................60alosetron hcl..............................44ALPHAGAN P........................... 60alprazolam................................ 30alprazolam er............................ 30alprazolam intensol................... 30alprazolam xr............................ 30alprostadil ..................................36ALTABAX..................................15altafrin....................................... 60altavera..................................... 49alyacen 1/35..............................49alyacen 7/7/7.............................49alyq........................................... 63amabelz.................................... 49amantadine hcl..........................27AMBISOME...............................21ambrisentan.............................. 63amcinonide................................47amethia..................................... 49amethia lo................................. 49amethyst................................... 49amikacin sulfate........................ 15amiloride hcl..............................37amiloride-hydrochlorothiazide... 36aminoacetic acid....................... 46aminocaproic acid..................... 33aminophylline............................ 63

amiodarone hcl......................... 35AMITIZA....................................44amitriptyline hcl......................... 20amlodipine besylate.................. 35amlodipine besylate-benazepril hcl............................................. 34amlodipine besylate-valsartan.. 34amlodipine-atorvastatin.............36amlodipine-olmesartan..............34amlodipine-valsartan-hctz......... 34ammonium lactate.....................39amnesteem............................... 39amoxapine................................ 20amoxicill-clarithro-lansopraz..... 44amoxicillin................................. 17amoxicillin-potassium clavulanate................................17amoxicillin-potassium clavulanate er............................17amphetamine sulfate.................38amphetamine-dextroamphetamine.................. 38amphetamine-dextroamphetamine er.............. 38amphotericin b.......................... 21ampicillin................................... 17ampicillin sodium.......................17ampicillin-sulbactam sodium..... 17ANADROL-50........................... 49anagrelide hcl............................33anastrozole............................... 24ANNOVERA..............................49ANORO ELLIPTA..................... 62anticoagulant cit dext soln a......32anticoagulant sodium citrate..... 32ANZEMET.................................20apap-caff-dihydrocodeine......... 13APLENZIN................................ 19APOKYN................................... 27apraclonidine hcl....................... 60aprepitant.................................. 20apri............................................ 49APTIVUS...................................29ARALAST NP............................45aranelle..................................... 49ARANESP (ALBUMIN FREE)...33argatroban.................................32argyle sterile saline................... 46argyle sterile water....................57aripiprazole............................... 27armodafinil ................................ 65ARMOUR THYROID.................53ARNUITY ELLIPTA...................62

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ARRANON................................ 23arsenic trioxide..........................23ARZERRA.................................26ascomp-codeine........................13ascorbic acid............................. 42ashlyna......................................49aspirin....................................... 11aspirin adult...............................11aspirin adult low strength.......... 11aspirin childrens........................ 11aspirin ec...................................11aspirin ec low dose................... 11aspirin ec low strength.............. 11aspirin low dose........................ 11aspirin-dipyridamole er..............33atazanavir sulfate......................29atenolol..................................... 35atenolol-chlorthalidone..............35atomoxetine hcl.........................38atorvastatin calcium.................. 37atovaquone............................... 26atovaquone-proguanil hcl..........26atracurium besylate...................64ATRIPLA................................... 28atropine sulfate................... 44, 60ATROVENT HFA...................... 62aubra.........................................49aubra eq....................................49AUGMENTIN............................ 17aurovela 1.5/30......................... 49aurovela 1/20............................ 49aurovela 24 fe........................... 49aurovela fe 1.5/30..................... 49aurovela fe 1/20........................ 49AUVI-Q......................................63AVASTIN...................................26AVELOX....................................17aviane....................................... 49avidoxy......................................17avita.......................................... 39AVONEX PEN...........................39AVONEX PREFILLED.............. 39ayuna........................................ 49azacitidine................................. 23AZASAN....................................54AZASITE................................... 59azathioprine.............................. 54azathioprine sodium..................54azelaic acid............................... 39azelastine hcl...................... 60, 61AZELEX.................................... 39azithromycin..............................17AZOPT...................................... 60

aztreonam................................. 16azurette..................................... 49b-6 folic acid..............................42baciim........................................15bacitracin.............................15, 59bacitracin-polymyxin b.............. 59bacitra-neomycin-polymyxin-hc 59baclofen.................................... 64bal in oil .....................................57balsalazide disodium.................56balziva.......................................49BANZEL.................................... 19BARACLUDE............................ 28BAVENCIO............................... 26BAXDELA................................. 17BAYER ASPIRIN...................... 11BAYER ASPIRIN EC LOW DOSE........................................11BD AUTOSHIELD DUO PEN NEEDLES................................. 57BD ULTRA-FINE INSULIN SYRINGES............................... 57BD ULTRA-FINE PEN NEEDLES................................. 57BECONASE AQ........................62bekyree..................................... 49BELEODAQ.............................. 25BELSOMRA.............................. 65benazepril hcl............................34benazepril-hydrochlorothiazide. 34BENDEKA.................................22BENEFIX...................................33benzalkonium chloride.............. 57BENZNIDAZOLE...................... 26benzonatate.............................. 64benzoyl peroxide-erythromycin. 39benztropine mesylate................27BEPREVE................................. 60BERINERT................................53beser......................................... 47BESIVANCE............................. 61betamethasone dipropionate.... 47betamethasone dipropionate aug............................................ 47betamethasone sod phos & acet........................................... 47betamethasone valerate........... 47BETASERON............................39betaxolol hcl........................ 35, 60bethanechol chloride.................46BETHKIS...................................63BETIMOL.................................. 60BEVYXXA................................. 32

bexarotene................................ 26BEXSERO.................................55bicalutamide..............................23BICILLIN L-A.............................17BIKTARVY................................ 29bimatoprost............................... 61biocel.........................................42bisacodyl ec.............................. 45bisoprolol fumarate................... 35bisoprolol-hydrochlorothiazide.. 35bivalirudin trifluoroacetate......... 32BIVIGAM................................... 54bleomycin sulfate...................... 23BLINCYTO................................ 26blisovi 24 fe............................... 49blisovi fe 1.5/30......................... 49blisovi fe 1/20............................ 49BOOSTRIX............................... 55bosentan................................... 63BOSULIF...................................25BOTOX..................................... 57bp vit 3...................................... 42b-plex........................................ 42b-plex plus.................................42BREATHE EASE LARGE......... 57BREATHE EASE MEDIUM.......57BREATHE EASE SMALL..........57BREATHERITE.........................57BREO ELLIPTA........................ 62briellyn.......................................49BRILINTA..................................33brimonidine tartrate................... 60BRIVIACT................................. 18bromfenac sodium (once-daily).60bromocriptine mesylate.............27brompheniramine tannate......... 61BROVANA................................ 63budesonide......................... 56, 62budesonide er........................... 56bumetanide............................... 37bupivacaine fisiopharma........... 13bupivacaine hcl......................... 13bupivacaine hcl (pf)...................13bupivacaine in dextrose............ 13bupivacaine spinal.................... 13bupivacaine-epinephrine...........13bupivacaine-epinephrine (pf).... 14buprenorphine...........................12BUPRENORPHINE...................12buprenorphine hcl..................... 14buprenorphine hcl-naloxone hcl............................................. 14bupropion hcl............................ 19

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bupropion hcl er (smoking det). 14bupropion hcl er (sr)..................19bupropion hcl er (xl).................. 19buspirone hcl.............................29busulfan.................................... 22butalbital-acetaminophen..........11butalbital-apap-caff-cod............ 13butalbital-apap-caffeine.............11butalbital-asa-caff-codeine........13butalbital-aspirin-caffeine.......... 11butorphanol tartrate...................13BUTRANS.................................12BYDUREON..............................31BYDUREON BCISE AUTOINJECTOR...................... 31BYETTA 10 MCG PEN............. 31BYETTA 5 MCG PEN............... 31BYSTOLIC................................ 35cabergoline............................... 48CABLIVI.................................... 34CABOMETYX........................... 25caffeine citrate...........................38calcipotriene..............................39calcitonin (salmon).................... 56calcitriol............................... 39, 56calcium acetate......................... 42calcium acetate (phos binder)...42calcium chloride........................ 40calcium gluconate..................... 40camila........................................52CAMPTOSAR........................... 23camrese.................................... 49camrese lo................................ 49candesartan cilexetil ................. 34candesartan cilexetil-hctz..........34CAPASTAT SULFATE..............22capecitabine..............................23CAPRELSA...............................25captopril .................................... 34captopril-hydrochlorothiazide.... 34CARBAGLU.............................. 40carbamazepine......................... 19carbamazepine er..................... 19carbidopa.................................. 27carbidopa-levodopa.................. 27carbidopa-levodopa er.............. 27carbidopa-levodopa-entacapone............................... 27carbinoxamine maleate.............61carboplatin................................ 22carboprost tromethamine.......... 49CARDIZEM LA..........................36CARIMUNE NF......................... 54

carisoprodol.............................. 64carmustine................................ 22carteolol hcl...............................60cartia xt..................................... 36carvedilol...................................35carvedilol phosphate er.............35cascara sagrada....................... 45caspofungin acetate..................21cavarest.................................... 39CAYA........................................ 57CAYSTON.................................63caziant.......................................49cefaclor..................................... 16cefaclor er................................. 16cefadroxil ...................................16cefazolin sodium....................... 16cefazolin sodium-dextrose........ 16cefdinir...................................... 16cefditoren pivoxil ....................... 16cefepime hcl..............................16cefepime-dextrose.................... 16cefixime.....................................16cefotaxime sodium.................... 16cefotetan disodium....................16cefotetan disodium-dextrose.....16cefoxitin sodium........................ 16cefpodoxime proxetil ................. 16cefprozil .....................................16ceftazidime................................16ceftazidime and dextrose.......... 16ceftriaxone sodium....................16ceftriaxone sodium in dextrose. 16ceftriaxone sodium-dextrose.....16cefuroxime axetil ....................... 16cefuroxime sodium....................16celecoxib................................... 11CELONTIN................................18cephalexin.................................16CEPROTIN............................... 32CEQUR SIMPLICITY 2U.......... 30CEQUR SIMPLICITY STARTER................................. 57CERDELGA.............................. 45CEREZYME.............................. 45cetirizine hcl.............................. 61cevimeline hcl........................... 39CHANTIX.................................. 14CHANTIX CONTINUING MONTH PAK.............................14CHANTIX STARTING MONTH PAK...........................................14chateal...................................... 49chateal eq................................. 50

CHEMET...................................42CHEMSTRIP UGK.................... 30chloramphenicol sod succinate.15chlordiazepoxide hcl................. 30chlordiazepoxide-amitriptyline...19chlorhexidine gluconate............ 39chloroprocaine hcl (pf).............. 14chloroquine phosphate..............26chlorothiazide............................37chlorothiazide sodium............... 37chlorpromazine hcl....................27chlorthalidone............................37chlorzoxazone...........................64CHOLBAM................................ 45cholestyramine..........................37cholestyramine light.................. 37chorionic gonadotropin..............48chromagen................................ 40chromic chloride........................40ciclodan.....................................21ciclopirox................................... 21ciclopirox olamine..................... 21cidofovir.....................................28cilostazol................................... 34CIMDUO................................... 29cimetidine..................................44cimetidine hcl............................ 44CIMZIA......................................54CIMZIA PREFILLED KIT...........54CIMZIA STARTER KIT............. 54cinacalcet hcl............................ 56CINRYZE.................................. 53CIPRO.......................................17CIPRO HC................................ 61CIPRODEX............................... 61ciprofloxacin hcl.................. 17, 61ciprofloxacin in d5w...................17cisatracurium besylate.............. 64cisatracurium besylate (pf)........64cisplatin..................................... 22citalopram hydrobromide.......... 19citroma...................................... 45cladribine...................................23claravis......................................39clarithromycin............................17clarithromycin er........................17clearlax......................................45clemastine fumarate..................61clindacin etz.............................. 39clindacin-p.................................39clindamycin hcl..........................15clindamycin palmitate hcl.......... 15clindamycin phosphate....... 15, 40

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clindamycin phosphate in d5w.. 15clindamycin phosphate-benzoyl peroxide.......................39clindamycin-tretinoin................. 40clinpro 5000.............................. 39clobazam...................................18clobetasol prop emollient base. 47clobetasol propionate................47clobetasol propionate e.............47clobetasol propionate emulsion 47clocortolone pivalate................. 47clodan....................................... 47clofarabine................................ 23clomipramine hcl....................... 20clonazepam...............................30clonidine....................................34clonidine hcl.............................. 34clonidine hcl er.......................... 38clopidogrel bisulfate.................. 34clorazepate dipotassium........... 30clotrimazole...............................21clotrimazole-betamethasone.....21clovique.....................................42clozapine...................................28COAGADEX..............................33coal tar...................................... 40COARTEM................................ 26cod liver oil ................................ 42codeine sulfate..........................13colchicine.................................. 21COLCHICINE............................21colchicine-probenecid............... 21COLCRYS.................................22colesevelam hcl........................ 37colestipol hcl............................. 37colistimethate sodium (cba)...... 15colocort..................................... 56COLY-MYCIN S........................ 61COMBIGAN.............................. 60COMBIPATCH.......................... 50COMBIVENT RESPIMAT......... 64COMETRIQ (100 MG DAILY DOSE).......................................25COMETRIQ (140 MG DAILY DOSE).......................................25COMETRIQ (60 MG DAILY DOSE).......................................25COMPACT SPACE CHAMBER/LG MASK............... 57COMPACT SPACE CHAMBER/MED MASK............57COMPACT SPACE CHAMBER/SM MASK.............. 57

COMPLERA..............................28compro...................................... 20CONDYLOX..............................40constulose.................................45COPAXONE..............................39CORDRAN................................47coremino................................... 17CORIFACT................................33CORTIFOAM............................ 56cortisone acetate.......................47CORTISPORIN......................... 15corvita....................................... 42corvita 150................................ 40corvite free................................ 42COSENTYX (300 MG DOSE)...40COSENTYX 150 MG/ML.......... 40COSENTYX SENSOREADY (300 MG)...................................40COSENTYX SENSOREADY PEN...........................................40COTELLIC................................ 25CREON..................................... 45CRESEMBA..............................21CRIXIVAN................................. 29cromolyn sodium...........44, 60, 63crotan........................................ 27cryselle-28.................................50curity sterile saline.................... 46CUVITRU.................................. 54CUVPOSA................................ 44cyanocobalamin........................ 42cyclafem 1/35............................50cyclafem 7/7/7...........................50cyclobenzaprine hcl.................. 64cyclobenzaprine hcl er.............. 64cyclopentolate hcl..................... 60cyclophosphamide.................... 22cycloserine................................ 22CYCLOSET...............................31cyclosporine.............................. 54cyclosporine modified............... 54cyproheptadine hcl....................61CYRAMZA................................ 26cyred......................................... 50cyred eq.................................... 50CYSTADANE............................ 45CYSTAGON..............................45CYSTARAN.............................. 60cytarabine................................. 23cytarabine (pf)........................... 23CYTOGAM................................54dacarbazine.............................. 22dactinomycin............................. 23

dalfampridine er........................ 39DALIRESP................................ 63danazol..................................... 49dantrolene sodium.................... 64dapsone.............................. 22, 40DAPTACEL............................... 55daptomycin................................15DARAPRIM............................... 26darifenacin hydrobromide er..... 46DARZALEX............................... 26dasetta 1/35.............................. 50dasetta 7/7/7............................. 50daunorubicin hcl........................23daysee...................................... 50DAYTRANA.............................. 38DEBACTEROL..........................39deblitane................................... 52DECARA................................... 42decitabine..................................23deferasirox................................ 42deferoxamine mesylate.............57dehydrated alcohol....................40delyla.........................................50demeclocycline hcl....................17DEMSER...................................36DENAVIR.................................. 28denta 5000 plus........................ 39dentagel.................................... 39DEPO-MEDROL....................... 47DEPO-PROVERA..................... 52DEPO-SUBQ PROVERA 104...52DESCOVY................................ 29desipramine hcl.........................20desloratadine............................ 61desmopressin ace spray refrig..48desmopressin acetate...............48desmopressin acetate spray..... 48desogestrel-ethinyl estradiol..... 50desonide................................... 47desoximetasone........................47desvenlafaxine succinate er......19dexamethasone........................ 47dexamethasone intensol........... 47dexamethasone sod phosphate pf............................. 47dexamethasone sodium phosphate........................... 47, 61dexchlorpheniramine maleate...61dexifol........................................42DEXILANT................................ 45dexmedetomidine hcl................ 57dexmedetomidine hcl in nacl.....57dexmethylphenidate hcl............ 38

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dexmethylphenidate hcl er........ 38dexrazoxane hcl........................23dextroamphetamine sulfate.......38dextroamphetamine sulfate er.. 38dextrose.................................... 41dextrose in lactated ringers.......40dextrose-nacl............................ 41dextrose-sodium chloride..........41dialyvite..................................... 43diazepam............................ 18, 30diazepam intensol..................... 30diclofenac potassium................ 11diclofenac sodium......... 11, 24, 61diclofenac sodium er................. 11diclofenac-misoprostol.............. 11diclofex dc................................. 11dicloxacillin sodium................... 17dicyclomine hcl..........................44didanosine.................................29DIFICID..................................... 17difil-g forte................................. 63diflunisal.................................... 11digitek........................................36digox......................................... 36digoxin.......................................36dihydroergotamine mesylate.....22DILANTIN..................................19DILATRATE-SR........................ 38diltiazem hcl.............................. 36diltiazem hcl er.......................... 36diltiazem hcl er beads............... 36diltiazem hcl er coated beads... 36dilt-xr......................................... 36dimenhydrinate......................... 20DIPENTUM............................... 56diphenhydramine hcl.................62diphenoxylate-atropine..............44DIPHTHERIA-TETANUS TOXOIDS DT............................ 55dipyridamole..............................34disopyramide phosphate...........35disulfiram...................................14divalproex sodium..................... 18divalproex sodium er.................18DIVIGEL....................................50dobutamine hcl..........................36dobutamine in d5w....................36docetaxel...................................24dofetilide....................................35donepezil hcl............................. 19dopamine hcl.............................36dopamine in d5w.......................36dorzolamide hcl.........................60

dorzolamide hcl-timolol mal...... 60dorzolamide hcl-timolol mal pf.. 60dotti ........................................... 50doxazosin mesylate.................. 34doxepin hcl....................20, 40, 65doxercalciferol...........................56doxorubicin hcl.......................... 24doxorubicin hcl liposomal..........24doxy 100................................... 18doxycycline............................... 40doxycycline hyclate................... 18doxycycline monohydrate......... 18doxylamine-pyridoxine.............. 20dronabinol................................. 20droperidol.................................. 20DROPLET MICRON................. 57drospiren-eth estrad-levomefol. 50drospirenone-ethinyl estradiol...50DROXIA.................................... 23DUAVEE................................... 50duloxetine hcl............................ 38DUPIXENT................................40duramorph.................................13duraxin...................................... 11DUREZOL.................................61dutasteride................................ 46dutasteride-tamsulosin hcl........ 46DYMISTA.................................. 64EASIVENT................................ 57easygel......................................39ec-naproxen.............................. 11econazole nitrate.......................21ed-spaz..................................... 44EDURANT.................................28efavirenz................................... 28effer-k........................................41ELAPRASE............................... 45eletriptan hydrobromide............ 22elinest........................................50ELIQUIS....................................33ELIQUIS DVT/PE STARTER PACK........................................ 33ELITEK......................................26ELIXOPHYLLIN........................ 63ELLA......................................... 52ELMIRON..................................46ELOCTATE............................... 33eluryng...................................... 50EMCYT..................................... 23emoquette................................. 50EMPLICITI................................ 26EMSAM.....................................19EMTRIVA.................................. 29

EMVERM.................................. 26enalapril maleate.......................34enalaprilat................................. 34enalapril-hydrochlorothiazide.... 34ENBREL....................................54ENBREL MINI........................... 54ENBREL SURECLICK.............. 54endocet..................................... 13ENGERIX-B.............................. 55enoxaparin sodium....................33enpresse-28.............................. 50enskyce.....................................50entacapone............................... 27entecavir................................... 28ENTRESTO.............................. 36enulose..................................... 45EPCLUSA................................. 28ephedrine sulfate...................... 36EPIDUO FORTE....................... 40epinastine hcl............................ 60epinephrine............................... 63epinephrine pf........................... 36epirubicin hcl............................. 24epitol......................................... 19EPIVIR HBV..............................28eplerenone................................ 37epoprostenol sodium.................63eprosartan mesylate................. 34eptifibatide.................................34ERBITUX.................................. 26ergocalciferol.............................43ergoloid mesylates.................... 57ergotamine-caffeine.................. 22ERIVEDGE............................... 25erlotinib hcl................................25errin...........................................52ertapenem sodium.................... 17ERWINAZE............................... 24ery............................................. 40erythromycin................. 17, 40, 59erythromycin base.....................17erythromycin ethylsuccinate......17ESBRIET...................................64escitalopram oxalate................. 19esmolol hcl................................ 35esmolol hcl-sodium chloride......35esomeprazole sodium...............45estarylla.....................................50estazolam..................................30estradiol.................................... 50estradiol valerate.......................50estradiol-norethindrone acet..... 50eszopiclone............................... 64

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ethacrynate sodium...................37ethacrynic acid.......................... 37ethambutol hcl...........................22ethosuximide.............................18ethyl chloride.............................14ethynodiol diac-eth estradiol..... 50ETHYOL....................................24etodolac.................................... 11etodolac er................................ 11etonogestrel-ethinyl estradiol.... 50etoposide.................................. 24euthyrox.................................... 53EVAMIST.................................. 50everolimus.................................25EVOTAZ....................................29exemestane.............................. 24exoderm.................................... 21ezetimibe...................................37ezetimibe-simvastatin............... 37fabb........................................... 43FABRAZYME............................ 45falmina...................................... 50famciclovir................................. 28famotidine................................. 44famotidine premixed..................44FANAPT....................................27FANAPT TITRATION PACK..... 27FARYDAK................................. 25fa-vitamin b-6-vitamin b-12....... 43fayosim......................................50febuxostat................................. 22FEIBA........................................33felbamate.................................. 18felodipine er.............................. 36FEMCAP................................... 57femynor..................................... 50fenofibrate................................. 37fenofibrate micronized...............37fenofibric acid............................37fenoprofen calcium....................11fenortho.....................................11fentanyl..................................... 12fentanyl citrate...........................13ferocon...................................... 41ferotrinsic.................................. 41ferraplus 90............................... 41FERRIPROX............................. 42ferrocite plus............................. 41FETZIMA...................................19FETZIMA TITRATION...............19FIBRYGA.................................. 33finasteride................................. 46flac............................................ 61

FLAREX.................................... 61flavoxate hcl.............................. 46FLEBOGAMMA DIF..................54flecainide acetate...................... 35FLEXICHAMBER ADULT MASK/SMALL........................... 57FLEXICHAMBER CHILD MASK/LARGE...........................57FLEXICHAMBER CHILD MASK/SMALL........................... 57FLOVENT DISKUS................... 62FLOVENT HFA......................... 62floxuridine..................................23FLUAD...................................... 55FLUARIX QUADRIVALENT......55FLUBLOK QUADRIVALENT.....55FLUCELVAX QUADRIVALENT...................... 55fluconazole................................21fluconazole in sodium chloride..21flucytosine................................. 21fludarabine phosphate.............. 23fludrocortisone acetate..............47FLULAVAL QUADRIVALENT... 55flumazenil ..................................57FLUMIST QUADRIVALENT......55flunisolide.................................. 62fluocinolone acetonide........ 47, 61fluocinolone acetonide body..... 47fluocinolone acetonide scalp.....47fluocinonide...............................47fluocinonide emulsified base.....47fluoridex.................................... 39fluoridex daily renewal.............. 39fluoridex enhanced whitening... 39fluoridex sensitivity relief........... 39fluoritab..................................... 41fluorometholone........................ 61FLUOROPLEX..........................24fluorouracil .......................... 23, 24FLUOROURACIL......................24fluoxetine hcl............................. 20fluoxetine hcl (pmdd).................19fluphenazine decanoate............27fluphenazine hcl........................ 27flurazepam hcl...........................64flurbiprofen................................ 11flurbiprofen sodium................... 61flutamide................................... 23fluticasone propionate.........48, 62fluticasone-salmeterol............... 62FLUTICASONE-SALMETEROL..........................62

fluvastatin sodium..................... 37fluvastatin sodium er................. 37fluvoxamine maleate................. 20fluvoxamine maleate er.............20FLUZONE HIGH-DOSE............55FLUZONE QUADRIVALENT.... 55FML...........................................61folbee........................................ 43folbee plus.................................43folbee plus cz............................ 43folic acid.................................... 43FOLOTYN................................. 23folplex 2.2..................................43foltrin......................................... 41fomepizole.................................57fondaparinux sodium.................33FORTEO................................... 56FOSAMAX PLUS D.................. 56fosamprenavir calcium.............. 29fosaprepitant dimeglumine........20fosinopril sodium....................... 34fosinopril sodium-hctz............... 34fosphenytoin sodium................. 19FOSRENOL.............................. 42frovatriptan succinate................22fulvestrant................................. 23furosemide................................ 37FUZEON................................... 29fyavolv.......................................50FYCOMPA................................ 18gabapentin................................ 18galantamine hydrobromide....... 19galantamine hydrobromide er... 19GAMASTAN..............................54GAMASTAN S/D.......................54GAMIFANT............................... 55GAMMAGARD.......................... 54GAMMAGARD S/D LESS IGA..54GAMMAKED............................. 54GAMMAPLEX........................... 54GAMUNEX-C............................ 54ganciclovir sodium.................... 28GARDASIL 9.............................55gatifloxacin................................ 61GATTEX....................................44gavilax.......................................45gavilyte-c...................................45gavilyte-g...................................45gavilyte-h...................................45gavilyte-n with flavor pack.........45GAZYVA................................... 26GELNIQUE............................... 46gemcitabine hcl......................... 23

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gemfibrozil .................................37generlac.................................... 45gengraf......................................54gentak....................................... 59gentamicin in saline.................. 15gentamicin sulfate............... 15, 59gentle laxative........................... 45GENVOYA................................ 28GEODON.................................. 27gianvi.........................................50GIAPREZA................................36GILENYA.................................. 39GILOTRIF................................. 25GLASSIA...................................45glatiramer acetate..................... 39glatopa...................................... 39GLEOSTINE............................. 22glimepiride.................................31glipizide er.................................31glipizide ir.................................. 31glipizide xl................................. 31glipizide-metformin hcl.............. 31GLUCAGEN HYPOKIT............. 31GLUCAGON EMERGENCY KIT............................................ 31glyburide................................... 31glyburide micronized................. 31glyburide-metformin.................. 31glycine.......................................46glycine urologic......................... 46glycolax..................................... 45glycopyrrolate............................44glycopyrrolate pf........................44glydo......................................... 14GLYXAMBI................................31gnp folic acid............................. 43goodsense aspirin low dose......11GRALISE.................................. 38GRALISE STARTER.................38granisetron hcl.......................... 21griseofulvin microsize................21griseofulvin ultramicrosize.........21guanfacine hcl...........................34guanfacine hcl er.......................38GUANIDINE HCL......................22GYNAZOLE-1........................... 21hailey 1.5/30..............................50hailey 24 fe................................50HALAVEN................................. 24halcinonide................................48halobetasol propionate..............48haloperidol................................ 27haloperidol decanoate...............27

haloperidol lactate.....................27HARVONI..................................28HAVRIX.....................................55heather......................................52hematinic plus vit/minerals........41hematinic/folic acid....................41hematogen................................ 41hematogen forte........................41HEMLIBRA................................33hemocyte-f................................ 41hemocyte-plus...........................41HEMOFIL M.............................. 33HEPAGAM B.............................54heparin (porcine) in nacl........... 33heparin lock flush...................... 57heparin sod (porcine) in d5w.....33heparin sodium (porcine).......... 33heparin sodium (porcine) pf...... 33heparin sodium lock flush......... 57hepatamine............................... 41HEPLISAV-B.............................55HERCEPTIN............................. 26HERCEPTIN HYLECTA............24hetastarch-nacl......................... 57HETLIOZ...................................65HIBERIX....................................55HIZENTRA................................ 54homatropaire.............................60homatropine hbr........................60HUMALOG................................32HUMALOG KWIKPEN.............. 32HUMALOG MIX 50/50 KWIKPEN................................. 32HUMALOG MIX 50/50 VIAL......32HUMALOG MIX 75/25 KWIKPEN................................. 32HUMALOG MIX 75/25 VIAL......32HUMALOG U-100 JUNIOR KWIKPEN................................. 32HUMATE-P............................... 33HUMIRA....................................54HUMIRA PEDIATRIC CROHNS START......................54HUMIRA PEN........................... 54HUMIRA PEN-CD/UC/HS STARTER................................. 54HUMIRA PEN-PS/UV/ADOL HS START................................ 54HUMULIN 70/30 KWIKPEN...... 32HUMULIN 70/30 VIAL...............32HUMULIN N KWIKPEN............ 32HUMULIN N VIAL..................... 32HUMULIN R U-500 KWIKPEN..32

HUMULIN R U-500 VIAL (CONCENTRATED)..................32HUMULIN R VIAL..................... 32HYCAMTIN............................... 24hydralazine hcl.......................... 38hydrochlorothiazide...................37hydrocodone bitartrate er..........12hydrocodone-acetaminophen... 13hydrocodone-homatropine........ 64hydrocodone-ibuprofen............. 13hydrocortisone.................... 48, 56hydrocortisone ace-pramoxine..56hydrocortisone butyr lipo base.. 48hydrocortisone butyrate............ 48hydrocortisone valerate.............48hydrocortisone-acetic acid........ 61hydromet................................... 64hydromorphone hcl................... 13hydromorphone hcl er............... 12hydromorphone hcl pf............... 13hydroxocobalamin acetate........ 43hydroxychloroquine sulfate....... 26hydroxyprogesterone caproate. 52hydroxyurea.............................. 23hydroxyzine hcl......................... 30hydroxyzine pamoate................30hyoscyamine sulfate................. 44hyoscyamine sulfate sl..............44HYPERHEP B S/D....................54HYPERRHO S/D.......................54HYQVIA.................................... 55HYSINGLA ER..........................12ibandronate sodium.................. 56IBRANCE.................................. 25ibu............................................. 11ibuprofen................................... 11ibuprofen lysine.........................11ibutilide fumarate.......................35icatibant acetate........................53ICLUSIG....................................25idarubicin hcl............................. 24iferex 150 forte.......................... 41ifosfamide..................................22ILARIS.......................................55imatinib mesylate...................... 25IMBRUVICA.............................. 25imipenem-cilastatin................... 17imipramine hcl...........................20imipramine pamoate................. 20imiquimod..................................40IMPAVIDO................................ 26incassia..................................... 52INCRELEX................................ 48

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INCRUSE ELLIPTA.................. 62indapamide............................... 37indomethacin.............................11indomethacin er........................ 11indomethacin sodium................ 11INFANRIX................................. 55INFLECTRA.............................. 54infuvite adult..............................43infuvite pediatric........................ 43INLYTA..................................... 25INPEN 100-BLUE-LILLY...........30INPEN 100-BLUE-NOVO..........30INPEN 100-GRAY-LILLY.......... 30INPEN 100-GREY-NOVO.........30INPEN 100-PINK-LILLY............30INPEN 100-PINK-NOVO...........30INSPIREASE RESERVOIR BAGS........................................ 57INSULIN PEN NEEDLES..........57INSULIN SYRINGES................ 58INTELENCE..............................28intralipid.....................................41INTRAROSA............................. 49INTRON A.................................28introvale.................................... 50INVEGA SUSTENNA................27INVEGA TRINZA...................... 27INVIRASE................................. 29INVOKAMET.............................31INVOKAMET XR.......................31INVOKANA............................... 31iodine strong............................. 41iodine tincture............................15IOPIDINE.................................. 60IPOL..........................................55ipratropium bromide.................. 62ipratropium-albuterol................. 64irbesartan.................................. 34irbesartan-hydrochlorothiazide..34irinotecan hcl.............................24ISENTRESS..............................28ISENTRESS HD....................... 28isibloom.....................................50isoniazid.................................... 22isoproterenol hcl........................63isosorbide dinitrate....................38isosorbide mononitrate..............38isosorbide mononitrate er......... 38isotretinoin.................................40isradipine...................................36ISTODAX (OVERFILL)............. 24itraconazole...............................21ivermectin............................26, 40

IXEMPRA KIT........................... 24JADENU....................................42JADENU SPRINKLE.................42jaimiess..................................... 50JAKAFI......................................25jantoven.................................... 33JANUMET................................. 31JANUMET XR........................... 31JANUVIA...................................31JARDIANCE..............................31jasmiel.......................................50jencycla..................................... 52JENTADUETO.......................... 31JENTADUETO XR.................... 31JEVTANA..................................25jinteli ..........................................50jolessa.......................................50J-TIP KIT W/VIAL ADAPTERS. 58juleber....................................... 50JULUCA.................................... 28junel 1.5/30............................... 50junel 1/20.................................. 50junel fe 1.5/30........................... 50junel fe 1/20.............................. 50junel fe 24................................. 50KADCYLA................................. 26kaitlib fe.....................................50KALETRA..................................29kalliga........................................50KALYDECO.............................. 63KANJINTI.................................. 26KANUMA...................................45kariva........................................ 50kcl in dextrose-nacl................... 41kcl-lactated ringers-d5w............ 41kedbumin.................................. 58kelnor 1/35................................ 50kelnor 1/50................................ 50KERYDIN.................................. 21ketoconazole.............................21KETONE TEST......................... 30ketoprofen................................. 11ketoprofen er.............................11ketorolac tromethamine...... 11, 61KETOSTIX................................ 30KEVEYIS...................................36KINERET.................................. 54KINRIX...................................... 55kionex........................................42klor-con..................................... 41klor-con 10................................ 41klor-con m10............................. 41KLOR-CON M15....................... 41

klor-con m20............................. 41klor-con sprinkle........................41klor-con/ef................................. 41KOATE......................................33KOATE-DVI...............................33KOGENATE FS........................ 33KORLYM...................................49k-prime...................................... 41k-tan plus.................................. 41kurvelo...................................... 50KUVAN......................................45KYLEENA................................. 52KYPROLIS................................ 24labetalol hcl............................... 35lactated ringers................... 41, 58lactic acid.................................. 40lactic acid e............................... 40lactulose....................................45lactulose encephalopathy......... 45lamivudine...........................28, 29lamivudine-zidovudine.............. 29lamotrigine................................ 18lamotrigine er............................ 18lamotrigine starter kit-blue.........18lamotrigine starter kit-green...... 18lamotrigine starter kit-orange.... 18LANCETS................................. 30lansoprazole..............................45lanthanum carbonate................ 42LANTUS SOLOSTAR............... 32LANTUS U-100 VIAL................ 32larin 1.5/30................................ 50larin 1/20................................... 50larin 24 fe.................................. 50larin fe 1.5/30............................ 50larin fe 1/20............................... 50larissia.......................................50LASTACAFT............................. 60latanoprost................................ 61LATUDA....................................27layolis fe.................................... 50leena......................................... 50leflunomide................................55LENVIMA (10 MG DAILY DOSE).......................................25LENVIMA (12 MG DAILY DOSE).......................................25LENVIMA (14 MG DAILY DOSE).......................................25LENVIMA (18 MG DAILY DOSE).......................................25LENVIMA (20 MG DAILY DOSE).......................................25

74

LENVIMA (24 MG DAILY DOSE).......................................25LENVIMA (4 MG DAILY DOSE).......................................25LENVIMA (8 MG DAILY DOSE).......................................25lessina.......................................50letrozole.................................... 24leucovorin calcium.................... 24LEUKERAN...............................22leuprolide acetate......................53levalbuterol hcl.......................... 63LEVEMIR U-100 FLEXTOUCH.32LEVEMIR U-100 VIAL...............32levetiracetam.............................18levetiracetam er........................ 18levetiracetam in nacl................. 18levobunolol hcl.......................... 60levocarnitine..............................41levocarnitine sf.......................... 41levocetirizine dihydrochloride....62levofloxacin......................... 17, 61levofloxacin in d5w....................17levoleucovorin calcium..............24levoleucovorin calcium pf..........24levonest.....................................51levonorgest-eth est & eth est.... 51levonorgest-eth estrad 91-day.. 51levonorgestrel........................... 52levonorgestrel-ethinyl estrad.....51levonorg-eth estrad triphasic.....51levora 0.15/30 (28)....................51levorphanol tartrate................... 12levo-t......................................... 53levothyroxine sodium................ 53levoxyl....................................... 53LEXIVA..................................... 29lidocaine....................................14lidocaine hcl.............................. 14lidocaine hcl (cardiac)............... 35lidocaine hcl (cardiac) pf........... 35lidocaine hcl (pf)........................14lidocaine hcl urethral/mucosal...14lidocaine in d5w........................ 35lidocaine viscous hcl................. 14lidocaine-epinephrine................14lidocaine-prilocaine................... 14LILETTA (52 MG)......................52lillow.......................................... 51lincomycin hcl............................15lindane...................................... 27linezolid..................................... 15linezolid in sodium chloride....... 15

LINZESS................................... 44liothyronine sodium................... 53lisinopril ..................................... 34lisinopril-hydrochlorothiazide.....34lithium........................................30lithium carbonate.......................30lithium carbonate er.................. 30LIVALO..................................... 37lmd in d5w.................................58LO LOESTRIN FE.....................51lojaimiess.................................. 51LONSURF.................................24loperamide hcl...........................44lopinavir-ritonavir.......................29lopreeza.................................... 51lorazepam................................. 30lorazepam intensol....................30lorcet......................................... 13lorcet hd.................................... 13lorcet plus..................................13loryna........................................ 51losartan potassium....................34losartan potassium-hctz............ 34LOTEMAX SM.......................... 61loteprednol etabonate............... 61lovastatin...................................37low-ogestrel...............................51loxapine succinate.................... 27lo-zumandimine.........................51ludent........................................ 41LUMIGAN..................................61LUMIZYME............................... 45LUPANETA PACK.................... 53LUPRON DEPOT (1-MONTH)..53LUPRON DEPOT (3-MONTH)..53LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG..53LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG..53LUPRON DEPOT-PED (1-MONTH)....................................53LUPRON DEPOT-PED (3-MONTH)....................................53lutera......................................... 51LYNPARZA............................... 25lysiplex plus...............................43LYSODREN.............................. 53lyza............................................52mafenide acetate...................... 15magnesium chloride..................41magnesium citrate.....................45magnesium sulfate....................41magnesium sulfate in d5w........ 41

MAKENA...................................52malathion.................................. 27mannitol.................................... 36maprotiline hcl...........................20marlissa.....................................51MARPLAN.................................19MARQIBO................................. 24MASK VORTEX........................ 58MATULANE.............................. 23matzim la...................................36MAVYRET.................................28MAXICOMFORT SYR 27G X 1/2"............................................58meclizine hcl............................. 20meclofenamate sodium.............11medique aspirin.........................11medroxyprogesterone acetate.. 52mefloquine hcl...........................26megestrol acetate..................... 52MEKINIST................................. 25melodetta 24 fe......................... 51meloxicam.................................11melphalan................................. 23melphalan hcl............................23memantine hcl...........................19memantine hcl er...................... 19MENACTRA..............................55MENEST................................... 51MENVEO.................................. 55meperidine hcl...........................13meprobamate............................30MEPSEVII................................. 46mercaptopurine......................... 23meropenem...............................17mesalamine...............................56mesalamine er.......................... 56mesalamine-cleanser................56mesna....................................... 26MESNEX...................................26metadate er...............................38metaproterenol sulfate.............. 63metaxalone............................... 64metformin hcl er........................ 31metformin hcl ir ......................... 31methadone hcl.......................... 12methadone hcl intensol............. 12methadose................................ 12methadose sugar-free...............12methamphetamine hcl...............38methazolamide..........................37methenamine hippurate............ 15methergine................................ 58methimazole..............................53

75

METHITEST..............................49methocarbamol......................... 64methotrexate............................. 54methotrexate sodium................ 54methotrexate sodium (pf).......... 54methoxsalen rapid.....................40methscopolamine bromide........44methyldopa............................... 34methyldopa-hydrochlorothiazide...................34methylergonovine maleate........58methylphenidate hcl.................. 38methylphenidate hcl er..............38methylphenidate hcl er (cd).......38methylphenidate hcl er (la)........38methylprednisolone...................48methylprednisolone acetate...... 48methylprednisolone sodium succ...........................................48methyltestosterone....................49metoclopramide hcl...................20metolazone............................... 37metoprolol succinate er.............35metoprolol tartrate.....................35metoprolol-hydrochlorothiazide.35metronidazole..................... 15, 40metronidazole in nacl................ 15mexiletine hcl............................ 35MIACALCIN.............................. 56mibelas 24 fe.............................51miconazole 3.............................21MICRHOGAM ULTRA-FILTERED PLUS...................... 55MICRODOT PEN NEEDLE.......58microgestin 1.5/30.....................51microgestin 1/20........................51microgestin fe 1.5/30.................51microgestin fe 1/20....................51midodrine hcl.............................34mifepristone.............................. 49miglitol.......................................31miglustat....................................46mili .............................................51milrinone lactate........................36milrinone lactate in dextrose..... 36mimvey......................................51mineral oil heavy....................... 45minitran..................................... 38MINOCIN.................................. 18minocycline hcl..........................18minocycline hcl er..................... 18minoxidil .................................... 38MIRENA (52 MG)......................52

mirtazapine............................... 19MIRVASO................................. 40misoprostol................................45mitigo........................................ 12mitomycin..................................24mitoxantrone hcl........................24M-M-R II.................................... 55modafinil ....................................65moexipril hcl.............................. 34molindone hcl............................27mometasone furoate........... 48, 62mondoxyne nl............................18monoject flush syringe.............. 58monoject sodium chloride flush.58mono-linyah.............................. 51montelukast sodium.................. 62morgidox................................... 18morphine sulfate................. 12, 13morphine sulfate (concentrate). 13morphine sulfate (pf)................. 13morphine sulfate er................... 12morphine sulfate er beads........ 12MOVIPREP............................... 45moxifloxacin hcl...................17, 61moxifloxacin hcl (2x day)...........61moxifloxacin hcl in nacl............. 17MOZOBIL..................................33multi prenatal............................ 43multigen.................................... 41multigen folic............................. 41multigen plus.............................41multi-vit/iron/fluoride..................43multivitamin/fluoride.................. 43multi-vitamin/fluoride................. 43multivitamin/fluoride/iron........... 43multi-vitamin/fluoride/iron.......... 43multivitamins/fluoride................ 43mupirocin.................................. 15mutamycin.................................24MVASI.......................................26mvc-fluoride.............................. 43MYALEPT................................. 46mycophenolate mofetil .............. 54mycophenolate mofetil hcl........ 54mycophenolate sodium............. 54MYLERAN.................................23mynephron................................ 43myorisan................................... 40MYRBETRIQ.............................46na ferric gluc cplx in sucrose.....41NABI-HB................................... 55nabumetone.............................. 11n-acetyl-l-cysteine..................... 58

nafcillin sodium......................... 17nafrinse..................................... 41nafrinse drops........................... 41naftifine hcl................................21NAGLAZYME............................46nalbuphine hcl...........................13naloxone hcl..............................14naltrexone hcl............................14NAMZARIC............................... 19naproxen................................... 12naproxen dr...............................12naproxen sodium...................... 12naratriptan hcl........................... 22NARCAN...................................14NASCOBAL.............................. 43NATACYN.................................59NATAZIA...................................51nateglinide.................................31nebusal..................................... 64necon 0.5/35 (28)......................51nefazodone hcl..........................20neomycin sulfate....................... 15neomycin-bacitracin zn-polymyx.....................................59neomycin-polymyxin b gu......... 46neomycin-polymyxin-dexameth 59neomycin-polymyxin-gramicidin..................................59neomycin-polymyxin-hc...... 59, 61neo-polycin................................59neo-polycin hc...........................59neostigmine methylsulfate........ 22NEO-SYNALAR........................ 15nephronex................................. 43neuac........................................ 40NEULASTA............................... 33NEULASTA ONPRO.................33NEUPRO...................................27neutral sodium fluoride..............39NEVANAC.................................61nevirapine................................. 28nevirapine er............................. 28NEXAVAR.................................25NEXPLANON............................52niacin (antihyperlipidemic)........ 37niacin er (antihyperlipidemic).... 37niacor........................................ 37nicardipine hcl........................... 36NICORETTE............................. 15nicotine polacrilex..................... 15nicotine step 1...........................15nicotine step 2...........................15nicotine step 3...........................15

76

NICOTROL............................... 15NICOTROL NS......................... 15nifedipine...................................36nifedipine er.............................. 36nifedipine er osmotic release.... 36nikki...........................................51nilutamide..................................23nimodipine.................................36NINLARO.................................. 24NIPENT.....................................23nisoldipine er.............................36nitisinone...................................46NITRO-BID................................38nitrofurantoin............................. 15nitrofurantoin macrocrystal........15nitrofurantoin monohydrate macrocrystals............................15nitroglycerin...............................38nitroglycerin in d5w................... 38NITROMIST.............................. 38nitroprusside sodium.................38NIVESTYM................................33nizatidine...................................44nora-be......................................52NORDITROPIN FLEXPRO....... 48norepinephrine bitartrate...........36norethin ace-eth estrad-fe.........51norethindrone............................52norethindrone acetate............... 52norethindrone acet-ethinyl est...51norethindrone-eth estradiol....... 51norethin-eth estradiol-fe............ 51norgestimate-eth estradiol........ 51norgestimate-ethinyl estradiol triphasic.....................................51norlyda...................................... 52norlyroc..................................... 52normal saline flush.................... 58nortrel 0.5/35 (28)..................... 51nortrel 1/35 (21)........................ 51nortrel 1/35 (28)........................ 51nortrel 7/7/7...............................51nortriptyline hcl..........................20NORVIR.................................... 29novarel...................................... 48NOVOFINE AUTOCOVER PEN NEEDLE........................... 58NOVOFINE PEN NEEDLE....... 58NOVOFINE PLUS PEN NEEDLE....................................58NOVOLIN 70/30 FLEXPEN...... 32NOVOLIN 70/30 FLEXPEN RELION.....................................32

NOVOLIN 70/30 RELION......... 32NOVOLIN 70/30 VIAL............... 32NOVOLIN N FLEXPEN.............32NOVOLIN N FLEXPEN RELION.....................................32NOVOLIN N RELION................32NOVOLIN N VIAL..................... 32NOVOLIN R FLEXPEN.............32NOVOLIN R FLEXPEN RELION.....................................32NOVOLIN R RELION................32NOVOLIN R VIAL..................... 32NOVOLOG FLEXPEN.............. 32NOVOLOG MIX 70/30 FLEXPEN..................................32NOVOLOG MIX 70/30 VIAL......32NOVOLOG PENFILL................ 32NOVOLOG U-100 VIAL............ 32NOVOPEN ECHO.....................30NOVOSEVEN RT..................... 33NOVOTWIST PEN NEEDLE.... 58np thyroid.................................. 53NPLATE.................................... 33NUCALA................................... 64nufol.......................................... 43nulev......................................... 44nutricap..................................... 43nutrifac zx..................................43nutrilipid.....................................41NUTROPIN AQ NUSPIN 10..... 48NUTROPIN AQ NUSPIN 20..... 49NUTROPIN AQ NUSPIN 5....... 49nyamyc......................................21nystatin......................................21nystatin-triamcinolone............... 21nystop....................................... 21OBIZUR.................................... 33ocella.........................................51OCTAGAM................................55octreotide acetate..................... 53ODEFSEY.................................29OFEV........................................ 64ofloxacin..............................17, 61ogestrel..................................... 51okebo........................................ 18olanzapine.................................28olanzapine-fluoxetine hcl.......... 19olmesartan medoxomil..............34olmesartan medoxomil-hctz...... 34olmesartan-amlodipine-hctz......34olopatadine hcl....................60, 62OMECLAMOX-PAK.................. 44omega-3-acid ethyl esters.........37

omeprazole............................... 45OMIDRIA...................................60OMNARIS................................. 62ONCASPAR..............................24ondansetron hcl........................ 21ondansetron odt........................ 21ONE-A-DAY WOMENS PRENATAL 1............................ 43ONETOUCH DELICA LANCING DEV..........................30ONETOUCH DELICA PLUS LANCING.................................. 30ONETOUCH ULTRA 2..............30ONETOUCH ULTRA BLUE TEST STRIPS...........................30ONETOUCH ULTRA MINI KIT W/DEVICE................................ 30ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE..........31ONETOUCH VERIO IQ SYSTEM................................... 31ONETOUCH VERIO KIT W/DEVICE................................ 31ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE..........31ONIVYDE..................................24OPDIVO.................................... 26OPSUMIT..................................63OPTIONS CONCEPTROL........46oralone...................................... 39ORENCIA..................................54ORENCIA CLICKJECT............. 54ORENITRAM............................ 63ORFADIN..................................46ORKAMBI................................. 63orphenadrine citrate.................. 64orphenadrine citrate er..............64orsythia..................................... 51oscimin......................................44oseltamivir phosphate............... 29osmitrol..................................... 36OSPHENA................................ 53OTEZLA.................................... 55oxacillin sodium.........................17oxaliplatin.................................. 23oxandrolone.............................. 49oxaprozin.................................. 12oxazepam................................. 30oxcarbazepine...........................19OXISTAT...................................21oxybutynin chloride................... 46oxybutynin chloride er............... 46oxycodone hcl........................... 13

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OXYCODONE HCL ER............ 12oxycodone-acetaminophen.......13oxycodone-aspirin.....................13oxycodone-ibuprofen................ 13OXYCONTIN.............................12oxymorphone hcl.......................13oxymorphone hcl er.................. 12oxytocin.....................................49OZEMPIC..................................31pacerone................................... 35paclitaxel................................... 24paliperidone er.......................... 28palonosetron hcl........................21pamidronate disodium...............56pancuronium bromide............... 64PANDA MASK LARGE............. 58PANDA MASK MEDIUM...........58PANDA MASK SMALL..............58PANRETIN................................26pantoprazole sodium.................45PARAGARD INTRAUTERINE COPPER...................................58paraplatin.................................. 23paricalcitol................................. 56paroex....................................... 39paromomycin sulfate.................15paroxetine hcl............................20paroxetine hcl er....................... 20paroxetine mesylate..................20PASER......................................22PAXIL........................................20PAZEO......................................60PEDIARIX................................. 55PEDIATRIC PANDA MASK...... 58PEDVAX HIB............................ 55peg 3350-kcl-na bicarb-nacl......45peg-3350/electrolytes................45PEGANONE..............................19PEGASYS.................................28PEGASYS PROCLICK............. 28peg-prep....................................45penicillamine............................. 46penicillin g potassium................17penicillin g procaine.................. 17penicillin g sodium.....................17penicillin v potassium................ 17PENTACEL............................... 55pentamidine isethionate............ 26PENTASA................................. 56pentazocine-naloxone hcl......... 13pentobarbital sodium.................18pentosan polysulfate sodium.... 46pentoxifylline er......................... 36

PERFOROMIST........................63perindopril erbumine................. 35periogard...................................39PERJETA..................................26permethrin.................................27perphenazine............................ 20perphenazine-amitriptyline........19phenadoz.................................. 62phenazo.................................... 47phenazopyridine hcl.................. 47phenelzine sulfate..................... 19phenobarbital............................ 18phenobarbital sodium................18phenobarbital-belladonna alk....44phenoxybenzamine hcl............. 34phentolamine mesylate............. 34phenylephrine hcl................36, 60phenytoin.................................. 19phenytoin infatabs.....................19phenytoin sodium......................19phenytoin sodium extended...... 19philith.........................................51PHOSLYRA.............................. 42PHOSPHOLINE IODIDE...........60phosphorous............................. 41phytonadione............................ 43PICATO.....................................24pilocarpine hcl..................... 39, 60pimecrolimus.............................40pimozide....................................27pimtrea...................................... 51pindolol......................................35pioglitazone hcl......................... 31pioglitazone hcl-glimepiride.......31pioglitazone hcl-metformin hcl.. 31piperacillin sod-tazobactam so..17PIQRAY (200 MG DAILY DOSE).......................................24PIQRAY (250 MG DAILY DOSE).......................................24PIQRAY (300 MG DAILY DOSE).......................................24pirmella 1/35............................. 51pirmella 7/7/7............................ 51piroxicam...................................12PNEUMOVAX 23...................... 55pnv prenatal plus multivit+dha.. 43pocket spacer............................58podofilox....................................40POLIVY..................................... 26polocaine...................................14polocaine-mpf........................... 14polycin.......................................59

poly-iron 150 forte..................... 41polymyxin b sulfate................... 15polymyxin b-trimethoprim..........59polysaccharide iron forte...........41POMALYST.............................. 23portia-28....................................51posaconazole............................21pot bicarb-pot chloride.............. 41potassium acetate.....................41potassium chloride.................... 42potassium chloride crys er........ 41potassium chloride er................41potassium chloride in dextrose. 41potassium chloride in nacl.........42potassium citrate er...................42PRADAXA.................................33pralidoxime chloride.................. 58PRALUENT...............................37pramipexole dihydrochloride..... 27pramipexole dihydrochloride er.27prasugrel hcl............................. 34pravastatin sodium....................37praziquantel.............................. 26prazosin hcl...............................34PRED MILD.............................. 61prednicarbate............................ 48prednisolone............................. 48prednisolone acetate.................61prednisolone sodium phosphate........................... 48, 61prednisone................................ 48prednisone intensol...................48pregabalin................................. 38pregnyl...................................... 49PREMARIN............................... 51PREMPHASE........................... 51PREMPRO................................51prenatal..................................... 43prenatal multi +dha................... 43prenatal plus iron...................... 43PREPOPIK................................45prevalite.................................... 37preventeza................................ 52prevident................................... 39previfem.................................... 51PREVNAR 13............................55PREZCOBIX............................. 29PREZISTA................................ 29PRIFTIN.................................... 22primaquine phosphate.............. 26primidone.................................. 18PRIMSOL..................................15PRIVIGEN.................................55

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PRO COMFORT SPACER ADULT...................................... 58PRO COMFORT SPACER CHILD....................................... 58PROAIR HFA............................ 63PROAIR RESPICLICK..............63probenecid................................ 22procainamide hcl.......................35PROCARE SPACER/ADULT MASK........................................58PROCARE SPACER/CHILD MASK........................................58prochlorperazine....................... 20prochlorperazine edisylate........ 20prochlorperazine maleate......... 20procto-med hc........................... 56procto-pak................................. 56proctosol hc...............................56proctozone-hc........................... 56PROFILNINE............................ 33PROFILNINE SD...................... 33progesterone.............................52progesterone micronized.......... 52PROGLYCEM........................... 31PROGRAF................................ 54PROLASTIN-C..........................46PROLENSA.............................. 61PROLEUKIN............................. 24PROLIA.....................................56PROMACTA..............................33promethazine hcl.......................62promethegan.............................62propafenone hcl........................ 35propafenone hcl er.................... 35proparacaine hcl....................... 60propranolol hcl.......................... 35propranolol hcl er...................... 35propranolol-hctz........................ 35propylthiouracil ..........................53PROQUAD................................55protamine sulfate...................... 33protriptyline hcl..........................20PULMICORT FLEXHALER.......62pulmosal....................................64PULMOZYME........................... 63PURE COMFORT ALCOHOL PREP........................................ 58PURE COMFORT PEN NEEDLE....................................58purevit dualfe plus.....................42PYLERA....................................44pyrazinamide.............................22pyridostigmine bromide.............22

pyridostigmine bromide er.........22pyridoxine hcl............................ 43qc aspirin low dose................... 12qc magnesium citrate................45QUADRACEL............................55quazepam................................. 30quetiapine fumarate.................. 28quetiapine fumarate er.............. 28QUILLIVANT XR....................... 38quinapril hcl...............................35quinapril-hydrochlorothiazide.... 35quinidine gluconate er...............35quinidine sulfate........................ 35quinine sulfate...........................26rabeprazole sodium.................. 45raloxifene hcl.............................53ramelteon.................................. 65ramipril ...................................... 35ranitidine hcl..............................44ranolazine er............................. 36rasagiline mesylate................... 27RAVICTI....................................46RAYALDEE...............................56REBLOZYL............................... 33reclipsen....................................51RECOMBINATE........................33RECOMBIVAX HB.................... 55RECTIV.....................................38REGRANEX..............................40RELENZA DISKHALER............ 29relexxii .......................................38remifentanil hcl..........................13RENACIDIN.............................. 47renal.......................................... 43RENFLEXIS.............................. 54repaglinide................................ 31REPATHA................................. 37REPATHA PUSHTRONEX SYSTEM................................... 38REPATHA SURECLICK........... 38RESCRIPTOR.......................... 29RESTASIS................................ 60RESTASIS MULTIDOSE.......... 60RETACRIT................................ 33RETROVIR............................... 29REVCOVI..................................46REVLIMID................................. 23revonto...................................... 64REXULTI...................................28REYATAZ................................. 29RHOGAM ULTRA-FILTERED PLUS.........................................55RHOPHYLAC............................55

RHOPRESSA........................... 60RIASTAP...................................33ribavirin..................................... 28rifabutin..................................... 22rifampin..................................... 22RIFATER...................................22riluzole.......................................38rimantadine hcl..........................29ringers....................................... 42ringers irrigation........................ 58RINVOQ....................................55risedronate sodium................... 56RISPERDAL CONSTA..............28risperidone................................ 28ritonavir..................................... 29RITUXAN.................................. 26RITUXAN HYCELA...................26rivastigmine...............................19rivastigmine tartrate.................. 19rivelsa........................................51RIXUBIS....................................33rizatriptan benzoate.................. 22rocuronium bromide.................. 64ROMIDEPSIN........................... 24ropinirole hcl..............................27ropinirole hcl er......................... 27ropivacaine hcl.......................... 14rosadan..................................... 40rosuvastatin calcium................. 37ROTARIX.................................. 55ROTATEQ.................................55roweepra................................... 18roweepra xr............................... 18ROZLYTREK............................ 24RUBRACA................................ 24RUXIENCE............................... 26RYDAPT................................... 25ryvent........................................ 62saline flush................................ 58saline flush zr............................ 58SAMSCA...................................42SANDIMMUNE......................... 54SANTYL.................................... 40SAPHRIS.................................. 28SAVAYSA................................. 33SAVELLA.................................. 39SAVELLA TITRATION PACK... 39scopolamine..............................20selegiline hcl............................. 27selenium sulfide........................ 40SELZENTRY.............................29sensorcaine...............................14sensorcaine/epinephrine...........14

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sensorcaine-mpf....................... 14sensorcaine-mpf/epinephrine....14SEREVENT DISKUS................ 63sertraline hcl..............................20se-tan plus................................ 42setlakin......................................51sevelamer carbonate................ 42sevelamer hcl............................42sf............................................... 39sf 5000 plus...............................39sharobel.................................... 53SHINGRIX.................................55siderol....................................... 43SIGNIFOR.................................53sildenafil citrate......................... 63silodosin.................................... 46silver sulfadiazine......................15SIMBRINZA.............................. 60simliya....................................... 51simpesse...................................51SIMPONI...................................54SIMPONI ARIA......................... 54simvastatin................................ 37sirolimus....................................54SIRTURO..................................22SKLICE..................................... 26SKYLA...................................... 53SLYND...................................... 53sod benz-sod phenylacet.......... 46sod citrate-citric acid................. 42sodium acetate..........................42sodium bicarbonate.............42, 44sodium chloride.............42, 47, 64sodium chloride (pf).................. 42sodium chloride flush................ 58sodium fluoride....................39, 42sodium fluoride 5000 plus......... 39sodium nitrite.............................58sodium phenylbutyrate..............46sodium phosphates...................42sodium polystyrene sulfonate... 42sodium sulfacetamide............... 40sodium thiosulfate..................... 58solifenacin succinate.................46SOLIRIS....................................32SOLTAMOX.............................. 23SOLU-CORTEF........................ 48SOMATULINE DEPOT............. 53SOMAVERT..............................53sorbitol...................................... 47sorbitol-mannitol........................47sorine........................................ 35sotalol hcl.................................. 35

sotalol hcl (af)............................35sotalol hydrochloride................. 35spinosad....................................27SPIRIVA HANDIHALER............62SPIRIVA RESPIMAT................ 62spironolactone...........................37spironolactone-hctz...................36sprintec 28................................ 51SPRYCEL................................. 25sps............................................ 42sronyx....................................... 51ssd............................................ 15ST JOSEPH LOW DOSE..........12stavudine...................................29STELARA..................................40sterile water for irrigation...........59STIOLTO RESPIMAT............... 62STIVARGA................................25STRENSIQ................................46streptomycin sulfate.................. 15STRIANT...................................49STRIBILD..................................28subvenite...................................18subvenite starter kit-blue...........18subvenite starter kit-green........ 18subvenite starter kit-orange...... 19succinylcholine chloride............ 64SUCRAID..................................46sucralfate.................................. 45sulfacetamide sodium............... 61sulfacetamide sodium (acne).... 40sulfacetamide-prednisolone...... 60sulfadiazine............................... 17sulfamethoxazole-trimethoprim.17SULFAMYLON..........................15sulfasalazine............................. 56sulfatrim pediatric......................17sulfurated lime...........................27sulindac.....................................12sumatriptan............................... 22sumatriptan succinate............... 22sumatriptan succinate refill ....... 22SUPPRELIN LA........................ 53SUPREP BOWEL PREP KIT....45SURESTEP PRO HIGH GLUCOSE................................ 31SURESTEP PRO LOW GLUCOSE................................ 31SURESTEP PRO NORMAL GLUCOSE................................ 31SUTENT....................................25swabflush saline flush............... 59syeda........................................ 51

SYLATRON...............................28SYMBICORT.............................62SYMFI....................................... 29SYMFI LO................................. 29SYMPROIC...............................44SYNAGIS.................................. 55SYNAREL................................. 53SYNJARDY...............................31SYNJARDY XR.........................31SYNRIBO..................................24TABLOID...................................23TACLONEX...............................40tacrolimus............................40, 54tadalafil ......................................46tadalafil (pah)............................ 63TAFINLAR.................................25TAGRISSO............................... 25tamoxifen citrate........................23tamsulosin hcl........................... 46TARGRETIN............................. 26tarina 24 fe................................ 51tarina fe 1/20............................. 51tarina fe 1/20 eq........................ 51TASIGNA.................................. 25tazarotene................................. 40tazicef........................................16TAZORAC.................................40taztia xt......................................36TDVAX...................................... 56TECENTRIQ............................. 26TECFIDERA..............................39TEGSEDI.................................. 46telmisartan................................ 34telmisartan-amlodipine..............34telmisartan-hctz.........................34temazepam............................... 64TEMODAR................................ 23temozolomide............................23temsirolimus..............................54tencon....................................... 11teniposide..................................24TENIVAC.................................. 56tenofovir disoproxil fumarate.....29terazosin hcl..............................46terbinafine hcl............................21terbutaline sulfate......................63terconazole............................... 21testosterone.............................. 49testosterone cypionate..............49testosterone enanthate............. 49tetcaine..................................... 60tetrabenazine............................ 38tetracaine hcl.............................60

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tetracycline hcl.......................... 18TEXACORT.............................. 48THALOMID............................... 23THEO-24...................................63theophylline...............................63theophylline er...........................63theophylline in d5w................... 63thiamine hcl...............................43thioridazine hcl.......................... 27thiotepa..................................... 23thiothixene.................................27THROMBATE III ....................... 33THYMOGLOBULIN...................55thyroid....................................... 53tiadylt er.................................... 36tiagabine hcl..............................18tigecycline................................. 18tilia fe.........................................51timolol maleate....................35, 60tinidazole...................................16tis-u-sol..................................... 59TIVICAY.................................... 28tizanidine hcl............................. 64tl-hem 150................................. 42TOBRADEX.............................. 59TOBRADEX ST.........................59tobramycin.......................... 59, 63tobramycin sulfate.....................15tobramycin-dexamethasone......59TOBREX................................... 59tolbutamide............................... 31tolcapone.................................. 27tolmetin sodium.........................12tolterodine tartrate.....................46tolterodine tartrate er.................46topiramate................................. 19topiramate er.............................19toposar...................................... 24topotecan hcl.............................24toremifene citrate...................... 23torsemide.................................. 37TOTECT....................................24TOUJEO MAX SOLOSTAR...... 32TOUJEO SOLOSTAR...............32tovet.......................................... 48TOVIAZ..................................... 46tpn electrolytes..........................42TRACLEER...............................63TRADJENTA.............................31tramadol hcl er.......................... 12tramadol hcl er (biphasic)..........12tramadol hcl ir ........................... 13tramadol-acetaminophen.......... 13

trandolapril ................................ 35trandolapril-verapamil hcl er......35tranexamic acid.........................33tranylcypromine sulfate............. 19travoprost (bak free)..................61TRAZIMERA............................. 26trazodone hcl............................ 20TREANDA.................................23TRECATOR.............................. 22TREMFYA.................................40treprostinil ................................. 63TRESIBA...................................32TRESIBA FLEXTOUCH............32tretinoin............................... 26, 40tretinoin microsphere................ 40tretinoin microsphere pump...... 40TREXALL.................................. 54tri femynor................................. 51triamcinolone acetonide...... 39, 48triamterene................................37triamterene-hctz........................ 36trianex....................................... 48triazolam................................... 30tricon......................................... 42triderm.......................................48trientine hcl................................42tri-estarylla................................ 52trifluoperazine hcl......................27trifluridine.................................. 59trigels-f forte.............................. 42trihexyphenidyl hcl.................... 27tri-legest fe................................ 52tri-linyah.................................... 52tri-lo-estarylla............................ 52tri-lo-marzia............................... 52tri-lo-mili .................................... 52tri-lo-sprintec............................. 52trilyte......................................... 45trimethobenzamide hcl..............20trimethoprim.............................. 16tri-mili ........................................ 52trimipramine maleate................ 20trinate........................................ 43TRINTELLIX..............................20triphrocaps................................ 43tri-previfem................................ 52tri-sprintec................................. 52TRIUMEQ................................. 28tri-vitamin/fluoride......................43tri-vite/fluoride........................... 43trivora (28).................................52tri-vylibra................................... 52tri-vylibra lo................................52

tropicamide............................... 60trospium chloride.......................46trospium chloride er.................. 46TRULICITY............................... 31TRUMENBA..............................56TRUVADA.................................29tulana........................................ 53TURALIO.................................. 25TUZISTRA XR.......................... 64TWINRIX...................................56TYBOST....................................28tydemy...................................... 52TYKERB....................................25TYSABRI...................................39TYVASO................................... 63TYVASO REFILL...................... 64TYVASO STARTER..................64ULESFIA................................... 27ULTIGUARD SAFEPACK PEN NEEDLE....................................59ULTOMIRIS.............................. 55unithroid.................................... 53UNITUXIN................................. 26UPTRAVI.................................. 64ursodiol..................................... 44valacyclovir hcl..........................28valganciclovir hcl.......................28valproate sodium.......................18valproic acid.............................. 18valsartan................................... 34valsartan-hydrochlorothiazide... 34vancomycin hcl......................... 16vancomycin hcl in dextrose.......16vancomycin hcl in nacl.............. 16VANCOMYCIN HCL IN NACL.. 16vandazole..................................16VAQTA......................................56VARIVAX.................................. 56v-c forte..................................... 43vcf vaginal contraceptive...........47VECAMYL.................................36vecuronium bromide................. 64VELCADE................................. 24VELETRI................................... 64velivet........................................52VELTASSA............................... 42VEMLIDY.................................. 28VENCLEXTA.............................25VENCLEXTA STARTING PACK........................................ 26venlafaxine hcl.......................... 20venlafaxine hcl er...................... 20VENTAVIS................................ 64

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VENTOLIN HFA........................63verapamil hcl.............................36verapamil hcl er.........................36vic-forte..................................... 43vicodin hp..................................13VICTOZA.................................. 31VIDEX....................................... 29VIDEX EC................................. 29vienva........................................52vigabatrin.................................. 18vigadrone.................................. 18VIIBRYD....................................20VIIBRYD STARTER PACK....... 20VIMIZIM.................................... 46VIMPAT.....................................19vinblastine sulfate..................... 24vincristine sulfate...................... 24vinorelbine tartrate.................... 24viorele....................................... 52VIRACEPT................................ 29VIREAD.....................................29virt-caps.................................... 43virt-gard.....................................43virt-phos 250 neutral................. 42VISTOGARD.............................59vita s forte................................. 43vitacel........................................43vita-min..................................... 43vitamin b complex 100.............. 43vitamin d (ergocalciferol)...........43vitamin k1..................................43vitamins acd-fluoride................. 44VIVITROL..................................14volnea....................................... 52VONVENDI............................... 33voriconazole..............................21VOTRIENT................................26vp-pnv-dha................................ 44vp-vite rx................................... 44vyfemla......................................52vylibra........................................52VYNDAMAX..............................36VYVANSE................................. 38VYXEOS................................... 24warfarin sodium.........................33water for irrigation, sterile..........59weekly-d....................................44wera.......................................... 52westab one................................44WIDE-SEAL DIAPHRAGM 60.. 59WIDE-SEAL DIAPHRAGM 65.. 59WIDE-SEAL DIAPHRAGM 70.. 59WIDE-SEAL DIAPHRAGM 75.. 59

WIDE-SEAL DIAPHRAGM 80.. 59WIDE-SEAL DIAPHRAGM 85.. 59WIDE-SEAL DIAPHRAGM 90.. 59WIDE-SEAL DIAPHRAGM 95.. 59WINRHO SDF...........................55wixela inhub.............................. 62WP THYROID........................... 53wymzya fe................................. 52XALKORI.................................. 26XARELTO................................. 33XARELTO STARTER PACK.....33XELJANZ.................................. 54XELJANZ XR............................ 54XGEVA......................................56XIAFLEX................................... 59XIFAXAN...................................16XIIDRA...................................... 60XOLAIR.....................................55XTANDI.....................................23xulane....................................... 52xylocaine dental........................ 14XYNTHA................................... 33XYNTHA SOLOFUSE...............33YERVOY................................... 26yuvafem.................................... 52zafirlukast..................................62zaleplon.....................................65ZALTRAP..................................24ZANOSAR.................................23zarah......................................... 52ZELBORAF............................... 26ZEMAIRA.................................. 46zenatane................................... 40ZENPEP....................................46ZEPATIER................................ 28zidovudine.................................29zileuton er................................. 62ziprasidone hcl.......................... 28ZIRABEV...................................26ZIRGAN.................................... 59ZITHROMAX.............................17ZOLADEX................................. 53zoledronic acid.......................... 56ZOLINZA...................................24zolmitriptan................................22zolpidem tartrate....................... 65zolpidem tartrate er................... 65ZOMIG...................................... 22zonisamide................................18ZONTIVITY............................... 33ZORTRESS.............................. 54ZOSTAVAX...............................56zovia 1/35e (28)........................ 52

zumandimine.............................52ZYDELIG...................................26ZYKADIA...................................26ZYPREXA RELPREVV............. 28ZYTIGA..................................... 23ZYVOX......................................16

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Nondiscrimination notice and access to communication services

OptumRx and its family of affiliated Optum companies does not discriminate on the basis of race, color, national origin, age, disability, or sex in its health programs or activities.

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توجه: اگر زبان شما فارسی (Farsi) است، خدمات امداد زبانی به طور رايگان در اختيار شما می باشد. لطفا با شماره تلفن رايگانی که روی کارت شناسايی شما قيد شده تماس بگيريد.

ध्यान दें: यदि आप हिंदी (Hindi) बोलत ेह,ै आपको भाषा सहायता सेबाए,ं नि:शुल्क उपलब्ध हैं। कृपया अपन ेपहचान पत्र पर सूचीबद्ध टोल-फ्री फोन नंबर पर कॉल करें।

CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu deb dawb uas teev muaj nyob rau ntawm koj daim yuaj cim qhia tus kheej.

ចំណាប់អារម្មណ៍ៈ បើសិនអ្នកនិយាយភាសាខ្មែរភាសាខ្មែរ(Khmer)សេវាជំនួយភាសាដោយឥតគិតថ្លៃ គឺមានសំរាប់អ្នក។ សូមទូរស័ព្ទទៅលេខឥតគិតថ្លៃ ដែលមាននៅលើអត្ដសញ្ញាណប័ណ្ណរបស់អ្នក។

PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti toll-free a numero ti telepono nga nakalista ayan iti identi-fication card mo.

DÍÍ BAA’ÁKONÍNÍZIN: Diné (Navajo) bizaad bee yániłti’go, saad bee áka›anída›awo›ígíí, t’áá jíík’eh, bee ná’ahóót’i’. T’áá shǫǫdí ninaaltsoos nitł’izí bee nééhozinígíí bine’dę́ę́› t’áá jíík’ehgo béésh bee hane’í biká’ígíí bee hodíilnih.

OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wac lambarka telefonka khadka bilaashka ee ku yaalla kaarkaaga aqoonsiga.

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