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Anthem MediBlue Access (PPO) Formulario 2018 (lista de medicamentos cubiertos) Por favor, lea: Este documento contiene información sobre los medicamentos que cubrimos en este plan.

Este formulario se actualizó el 1.º de octubre de 2018. Para obtener la información más reciente o otras preguntas, póngase en contacto con el Anthem MediBlue Access (PPO) Servicio al Cliente al 1-877-811-3107 o, para usuarios de TTY, 711, de 8 a. m. a 8 p. m., los siete días a la semana (excepto el Día de Acción de Gracias y Navidad) desde el 1.º de octubre hasta el 14 de febrero, y de lunes a viernes (excepto los feriados) desde el 15 de febrero hasta el 30 de septiembre, o visite https://shop.anthem.com/medicare/ca.

H8552_020 Y0114_18_31139_U_SP_158 CMS Accepted 08/13/2017 Core_18355_v17_1811_1

Importante para los miembros existentes: Este formulario se ha modificado desde el año pasado. Consulte este documento para asegurarse de que aún comprenda los medicamentos que usted toma.

Cuando esta lista de medicamentos (formulario) se refiere a “nosotros,” “nos” o “nuestro,” está hablando de Anthem Blue Cross Life and Health Insurance Company. Cuando se refiere a “plan” o “nuestro plan,” está hablando de Anthem MediBlue Access (PPO).

Este documento incluye una lista de los medicamentos (formulario) de nuestro plan, la cual está actualizada al 1.º de noviembre de 2018. Para obtener un formulario actualizado, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del formulario, figura en la portada y contraportada.

Para poder utilizar su beneficio para medicamentos recetados, por lo general, debe recurrir a farmacias de la red. Los beneficios, el formulario, la red de farmacias, y/o los copagos/coseguros pueden cambiar a partir del 1.° de enero de 2019, y periódicamente durante el año.

El formulario, la red de farmacias y/o la red de proveedores pueden cambiar en cualquier momento. Recibirá una notificación cuando sea necesario.

Fecha de entrada en vigencia 1.º de noviembre de 2018 2 Core_18355_v17_1811_1

¿Qué es el formulario Anthem MediBlue Access (PPO)? Un formulario es una lista de medicamentos cubiertos seleccionados por nuestro plan en consulta con un equipo de proveedores de atención de la salud, que representa las terapias recetadas consideradas como una parte necesaria de un programa de tratamiento de calidad. Nuestro plan, generalmente, cubrirá los medicamentos enumerados en nuestro formulario siempre y cuando el mismo sea médicamente necesario, la receta se complete en una farmacia de la red y se cumplan otras normas del plan. Para obtener más información sobre cómo abastecer sus recetas, consulte su Evidencia de Cobertura.

¿Puede cambiar el formulario (lista de medicamentos)? Por lo general, si está tomando un medicamento de nuestro formulario 2018 que tenía cobertura a principios de año, no discontinuaremos ni reduciremos la cobertura del medicamento durante el año de cobertura 2018, excepto si está disponible un medicamento genérico más barato o cuando se divulgue nueva información adversa sobre la seguridad o efectividad de un medicamento. Otros tipos de cambios en el formulario, como eliminar un medicamento de nuestro formulario, no afectarán a los miembros que estén tomando actualmente dicho medicamento. Seguirá disponible con la misma distribución de costos para los miembros que lo tomen durante el resto del año de cobertura. Consideramos que es importante que usted tenga acceso continuo durante el resto del año de cobertura a los medicamentos del formulario que estaban disponibles cuando eligió nuestro plan, excepto para casos en los que usted pueda ahorrar dinero adicional o que podamos garantizar su seguridad.

Si eliminamos medicamentos de nuestro formulario o agregamos una autorización previa, límites de cantidad y/o restricciones de terapia escalonada de un medicamento, o cambiamos un medicamento a un nivel superior de distribución de costos, debemos notificar dicho cambio a los miembros afectados al menos 60 días antes de que dicho cambio se haga efectivo o en el momento en que el miembro solicite que le resurtan el medicamento, momento en el que el miembro recibirá suministro del medicamento por 60 días. Si la Administración de Alimentos y Medicamentos (Food and Drug Administration, FDA) considera que un medicamento de nuestro formulario no es seguro o si el

fabricante del medicamento lo retira del mercado, retiraremos inmediatamente el medicamento de nuestro formulario e informaremos a los miembros que toman dicho medicamento. El formulario adjunto está actualizado al 1.º de noviembre de 2018. Para obtener información actualizada sobre los medicamentos que cubre nuestro plan, comuníquese con nosotros. Nuestra información de contacto figura en la portada y contraportada. Si se realiza cualquier otro tipo de cambio en el formulario aprobado (que no sea de mantenimiento) durante el año, lo notificaremos enviándole una lista de dichos cambios o un formulario actualizado.

¿Cómo utilizo el formulario? Existen dos maneras de encontrar su medicamento dentro del formulario:

Afección médica

El formulario comienza en la página 9. Los medicamentos en este formulario están agrupados en categorías basadas en el tipo de afección médica para los que se utilizan. Por ejemplo, los medicamentos para tratar una afección cardíaca están enumerados en la categoría “Cardiovascular, Hypertension/Lipids”. Si usted sabe para qué se usa su medicamento, busque el nombre de la categoría en la lista que empieza en la página 9. Luego busque su medicamento bajo el nombre de la categoría correspondiente.

Lista en orden alfabético

Si no está seguro en qué categoría buscar, debe buscar su medicamento en el Índice que comienza en la página 86. El Índice brinda una lista alfabética de todos los medicamentos incluidos en este documento. Tanto los medicamentos de marca como los medicamentos genéricos se enumeran en el Índice. Busque en el Índice y encuentre su medicamento. Al lado de su medicamento verá el número de página en la que puede encontrar información de cobertura. Vaya a la página que se enumera en el Índice y encuentre el nombre de su medicamento en la primera columna de la lista.

¿Qué son los medicamentos genéricos? Nuestro plan cubre medicamentos de marca y medicamentos genéricos. Un medicamento genérico es


aquel aprobado por la FDA porque tiene el mismo ingrediente activo que el medicamento de marca. Generalmente, los medicamentos genéricos son más económicos que los medicamentos de marca.

¿Existen restricciones para mi cobertura? Algunos medicamentos cubiertos pueden tener requisitos adicionales o límites de cobertura. Estos requisitos y límites pueden incluir:

Autorización previa: Nuestro plan requiere que usted o su médico tengan una autorización previa para determinados medicamentos. Esto significa que necesita obtener aprobación de nuestro plan antes de poder abastecer su receta. Si no obtiene la aprobación, nuestro plan podría no cubrir el medicamento.

Límites de cantidad: Para ciertos medicamentos, nuestro plan limita la cantidad del medicamento que nuestro plan cubrirá. Por ejemplo, nuestro plan ofrece 30 tabletas por receta de donepezil. Esto puede ser adicional a un suministro estándar de un mes o tres meses.

Terapia escalonada: En algunos casos, nuestro plan requiere que usted pruebe ciertos medicamentos para tratar su afección médica antes de cubrir otro medicamento para esa afección. Por ejemplo, si ambos medicamentos A y B tratan su afección médica, nuestro plan puede no cubrir el medicamento B a menos que usted pruebe primero el medicamento A. Si el medicamento A no es efectivo para usted, entonces nuestro plan cubrirá el medicamento B.

Usted puede averiguar si su medicamento tiene requisitos o límites adicionales consultando el formulario que empieza en la página 9. También puede obtener más información sobre las restricciones que se aplican a determinados medicamentos cubiertos visitando nuestro sitio web. Hemos publicado documentos en línea que explican nuestra autorización previa y las restricciones de terapia escalonada. También puede solicitarnos que le enviemos una copia. Nuestra información de contacto, junto con la fecha de la última actualización del formulario, figura en la portada y contraportada.

Puede solicitar una excepción a nuestro plan para estas restricciones o límites, o solicitar una lista de otros medicamentos similares que puedan tratar su afección

médica. Consulte la sección “¿Cómo solicito una excepción al formulario de Anthem MediBlue Access (PPO)?” en la página 5 para obtener información sobre cómo solicitar una excepción.

¿Qué sucede si mi medicamento no se encuentra en el formulario? Si su medicamento no está incluido en este formulario (lista de medicamentos cubiertos), primero debe comunicarse con el Servicio al Cliente y consultar si su medicamento está cubierto.

Si le informan que nuestro plan no cubre su medicamento, tiene dos opciones:

Puede solicitar al Servicio al Cliente una lista de medicamentos similares que estén cubiertos por nuestro plan. Cuando reciba la lista, muéstresela a su médico y pídale que le recete un medicamento similar que esté cubierto por nuestro plan.

Puede solicitar al plan que realice una excepción y brindar cobertura para su medicamento. Consulte lo que se describe a continuación para obtener información sobre cómo solicitar una excepción.


¿Cómo solicito una excepción para el formulario de Anthem MediBlue Access (PPO)? Puede solicitar que nuestro plan haga una excepción a nuestras reglas de cobertura. Existen varios tipos de excepciones que puede solicitarnos:

Puede solicitarnos que cubramos un medicamento aunque no esté en nuestro formulario. Si se aprueba, este medicamento estará cubierto a un nivel de distribución de costos predeterminado, y usted no podrá solicitarnos que le suministremos dicho medicamento a un nivel de distribución de costos menor. Puede solicitarnos que cubramos un medicamento del formulario en un nivel de distribución de costos más bajo. Si se aprueba, esto disminuiría la cantidad que debe pagar por su medicamento.

Puede solicitar que eximamos las restricciones o limitaciones de cobertura de su medicamento. Por ejemplo, para ciertos medicamentos, nuestro plan limita la cantidad del medicamento que cubriremos. Si su medicamento tiene un límite de cantidad, puede solicitar que eximamos el límite y que cubramos más.

Por lo general, nuestro plan aprobará su solicitud de una excepción únicamente si los medicamentos alternativos incluidos en el formulario del plan, el medicamento de menor nivel o las restricciones de utilización adicional no son favorables para tratar su afección y/o harán que padezca efectos médicos adversos.

Debe comunicarse con nosotros para solicitarnos una decisión de cobertura inicial para obtener una excepción de formulario, nivel o restricción de utilización. Al solicitar una excepción de formulario, nivel o restricción de utilización deberá enviar una declaración de su emisor de recetas o médico justificando su solicitud. Por lo general, debemos tomar nuestra decisión dentro de las 72 horas después de obtener la declaración en la que su emisor de recetas realiza la justificación. Puede solicitar una excepción urgente (rápida) si usted o su médico creen que su salud corre un riesgo grave al esperar hasta 72 horas por una decisión. Si se le otorga la solicitud de agilización, debemos darle una respuesta dentro de las 24 horas luego de recibir la declaración justificatoria del médico o de otro emisor de recetas.

¿Qué hago antes de hablar con mi médico sobre cambiar mis medicamentos o solicitar una excepción? Como miembro nuevo o que continúa en nuestro plan, podría estar tomando medicamentos que no están en nuestro formulario. O podría estar tomando un medicamento que está en nuestro formulario, pero su capacidad para obtenerlo es limitada. Por ejemplo, puede necesitar una autorización previa de nuestra parte antes de poder abastecer su receta. Deberá hablar con su médico para decidir si debe cambiar a un medicamento adecuado que cubramos o solicitar una excepción al formulario para que cubramos el medicamento que está tomando. Mientras consulta con su médico el curso de acción acorde para usted, podemos cubrir su medicamento en ciertos casos durante los primeros 90 días en los que usted es miembro de nuestro plan.

Para cada uno de sus medicamentos que no esté en nuestro formulario o si su capacidad para obtener sus medicamentos es limitada, cubriremos un suministro temporal para 30 días (a menos que tenga una receta por escrito para menos días) cuando vaya a una farmacia de la red. Luego de su primer suministro para 30 días, no pagaremos estos medicamentos, aunque sea miembro del plan por menos de 90 días.

Si es residente de un centro de atención a largo plazo, permitiremos que vuelva a abastecer su receta hasta que le hayamos proporcionado un suministro de transición de 98 días, de acuerdo con el incremento de distribución (a menos que tenga una receta por escrito por menos días). Cubriremos más de un reabastecimiento de estos medicamentos durante los primeros 90 días en los que ha sido miembro de nuestro plan. Si necesita un medicamento que no está en nuestro formulario o si su capacidad para obtener sus medicamentos es limitada, pero ya pasaron los primeros 90 días de membresía en nuestro plan, cubriremos un suministro de emergencia de 34 días para ese medicamento (a menos que tenga una receta por menos días) mientras solicita una excepción al formulario.

Mientras obtenga el suministro temporal de un medicamento, debe hablar con su médico o con el médico emisor de la receta para decidir qué debe hacer cuando se termine el suministro temporal. Puede llamar


al Servicio al Cliente para solicitar una lista de medicamentos cubiertos que traten la misma afección médica. Esta lista puede ayudar a que su médico encuentre un medicamento cubierto que le dé resultado mientras usted sigue tramitando una excepción al formulario. Consulte la Evidencia de Cobertura para obtener más información sobre las excepciones.

Para obtener más información Para obtener información más detallada sobre la cobertura de medicamentos recetados de nuestro plan, consulte su Evidencia de Cobertura y otros materiales del plan.

Si tiene alguna pregunta sobre nuestro plan, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del formulario, figura en la portada y contraportada.

Si tiene preguntas generales sobre la cobertura de medicamentos recetados de Medicare, llame a Medicare al 1-800-MEDICARE (1-800-633-4227), las 24 horas del día, los 7 días a la semana. Los usuarios de TTY deben llamar al 1-877-486-2048. O visite http://www.medicare.gov.

El formulario de nuestro plan El formulario en la página 9 proporciona información de cobertura sobre los medicamentos cubiertos por nuestro plan. Si tiene problemas para encontrar su medicamento en la lista, consulte el Índice que comienza en la página 86.

La primera columna del cuadro enumera el nombre del medicamento. Los medicamentos de marca figuran en letra mayúscula (por ej., SPIRIVA) y los medicamentos genéricos están enumerados en letra minúscula y cursiva (por ej., atenolol).

La información en la columna Requisitos/Límites le indica si nuestro plan tiene algunos requisitos especiales para la cobertura de su medicamento.

QLL - Límites de cantidad: Limita la frecuencia, cantidad o dosis de medicamento para la cual puede obtener beneficios cada vez que se le abastezca una receta (generalmente una vez por mes).

PAR - Autorización previa: El proceso de obtener la aprobación para determinadas recetas antes de aprobar

los beneficios. Usted, su médico u otro proveedor de la red necesitarán solicitar autorización previa antes de abastecer la receta.

ST - Terapia escalonada: El proceso de probar por primera vez determinado medicamento o medicamentos para determinar si el o los mismos tratarán su afección médica antes de que su plan cubra otro medicamento para dicha afección.

B/D - Parte B vs. Parte D: Este medicamento puede estar cubierto por los beneficios para los medicamentos recetados de la Parte D o como un medicamento de la Parte B bajo sus beneficios médicos, según lo determine Medicare.

LA - Acceso limitado: Esta receta puede estar disponible solo en ciertas farmacias. Para más información, consulte su Directorio de Farmacias o llame al Servicio al Cliente al 1-877-811-3107, de 8 a. m. a 8 p. m., los siete días a la semana (excepto el Día de Acción de Gracias y Navidad) desde el 1.º de octubre hasta el 14 de febrero, y de lunes a viernes (excepto los feriados) desde el 15 de febrero hasta el 30 de septiembre. Los usuarios de TTY/ TDD deben llamar al 711.

INJ - Inyectable: El medicamento está disponible en formato inyectable.

MO - Pedidos por correo: Medicamentos recetados que se pueden ordenar por correo.


Distribución de costos por un suministro de un mes de un medicamento recetado y cubierto de la Parte D durante la Etapa de Cobertura Inicial: Distribución de costos Nivel 1: Genérico Preferido

$5.00 Farmacia de la red con distribución de costos preferida (suministro para 30 días) o Farmacia de venta por correo** (suministro para 30 días)

$10.00

Farmacia de la red con distribución de costos estándar (suministro para 30 días) o Farmacia especializada en cuidados a largo plazo (suministro para 34 días)

Distribución de costos Nivel 2: Genérico


$16.00


Distribución de costos Nivel 3: Marca Preferida


$47.00


Distribución de costos Nivel 4: Marca No Preferida


$100.00


Distribución de costos Nivel 5: Medicamentos Especiales*

25% Farmacia de la red con distribución de costos preferida (suministro para 30 días) o Farmacia de venta por correo** (suministro para 30 días)

25%



Distribución de costos Nivel 6: Medicamentos de Cuidados Selectos


$0.00


Tenga a bien consultar nuestra Evidencia de Cobertura para obtener más información sobre la distribución de costos.

Farmacia de la red con distribución de costos preferida - Una farmacia de la red que brinda a los miembros de nuestro plan medicamentos cubiertos que pueden tener niveles de distribución de costos menores a los de otras farmacias de la red con distribución de costos estándar. * El suministro prolongado no está disponible para los medicamentos del Nivel 5: Medicamentos Especiales ** Farmacia de venta por correo – Servicio de venta por correo que le permite ordenar medicamentos con suministros para 30 a 90 días. Los medicamentos disponibles a través del servicio de venta por correo de nuestro plan figuran como medicamentos de “venta por correo” en nuestra lista de medicamentos.


Medicamentos cubiertos por categoría terapéutica Leyenda Los medicamentos genéricos figuran en letra minúscula y cursiva (por ej., atenolol). Los medicamentos de marca figuran en letra mayúscula (por ej., SPIRIVA).

QLL - Límites de cantidad: Limita la frecuencia, cantidad o dosis de medicamento para la cual puede obtener beneficios cada vez que se le abastezca una receta (generalmente una vez por mes).

PAR - Autorización previa: El proceso de obtener la aprobación para determinadas recetas antes de aprobar los beneficios. Usted, su médico u otro proveedor de la red necesitarán solicitar autorización previa antes de abastecer la receta.

ST - Terapia escalonada: El proceso de probar por primera vez determinado medicamento o medicamentos para determinar si el o los mismos tratarán su afección médica antes de que su plan cubra otro medicamento para dicha afección.

B/D - Parte B vs. Parte D: Este medicamento puede estar cubierto por los beneficios para los medicamentos recetados de la Parte D o como un medicamento de la Parte B bajo sus beneficios médicos, según lo determine Medicare.

LA - Acceso limitado: Esta receta puede estar disponible solo en ciertas farmacias. Para más información, consulte su Directorio de Farmacias o llame al Servicio al Cliente al 1-877-811-3107, de 8 a. m. a 8 p. m., los siete días a la semana (excepto el Día de Acción de Gracias y Navidad) desde el 1.º de octubre hasta el 14 de febrero, y de lunes a viernes (excepto los feriados) desde el 15 de febrero hasta el 30 de septiembre. Los usuarios de TTY/TDD deben llamar al 711.

INJ - Inyectable: El medicamento está disponible en formato inyectable.

MO - Pedidos por correo:Medicamentos recetados que se pueden ordenar por correo.

Requisitos /Límites

Nivel de medicamento

Nombre del medicamento

Anti - Infectives MO; QLL (960 per 30 days)

4 abacavir oral solution

MO; QLL (60 per 30 days)

4 abacavir oral tablet


5 abacavir-lamivudine


5 abacavir-lamivudine- zidovudine

B/D PAR; MO

5 ABELCET

MO 2 acyclovir oral capsule




MO 4 acyclovir oral suspension 200 mg/5 ml

MO 2 acyclovir oral tablet B/D PAR; MO

4 acyclovir sodium 50 mg/ml intravenous solution

PAR; MO 5 adefovir MO 5 ALBENZA MO; QLL (180 per 30 days)

4 ALINIA ORAL SUSPENSION FOR RECONSTITUTION


5 ALINIA ORAL TABLET

MO 3 amantadine hcl B/D PAR; MO

5 AMBISOME

Puede encontrar información sobre lo que significan los símbolos y las abreviaturas de esta tabla visitando la Leyenda en la página número 9. Core_18355_v17_1811_1 9 Fecha de entrada en vigencia 1.º de noviembre de 2018




MO 4 AMIKACIN INJECTION SOLUTION 1,000 MG/4 ML

MO 4 amikacin injection solution 500 mg/2 ml

MO 1 amoxicillin oral capsule MO 1 amoxicillin oral

suspension for reconstitution

MO 1 amoxicillin oral tablet MO 2 amoxicillin oral tablet,

chewable 125 mg MO 1 amoxicillin oral tablet,

chewable 250 mg MO 3 amoxicillin-pot

clavulanate oral suspension for reconstitution 200-28.5 mg/5 ml, 400-57 mg/5 ml, 600-42.9 mg/5 ml

MO 4 amoxicillin-pot clavulanate oral suspension for reconstitution 250-62.5 mg/5 ml

MO 3 amoxicillin-pot clavulanate oral tablet 250-125 mg

MO 2 amoxicillin-pot clavulanate oral tablet 500-125 mg, 875-125 mg

MO 4 amoxicillin-pot clavulanate oral tablet extended release 12 hr

MO 3 amoxicillin-pot clavulanate oral tablet, chewable

B/D PAR; MO

4 amphotericin b

MO 1 ampicillin oral capsule 500 mg

MO 4 ampicillin sodium injection




4 ampicillin sodium intravenous

MO 4 ampicillin-sulbactam injection recon soln 1.5 gram, 3 gram

4 ampicillin-sulbactam injection recon soln 15 gram

4 ampicillin-sulbactam intravenous recon soln 1.5 gram

MO 4 ampicillin-sulbactam intravenous recon soln 3 gram


5 APTIVUS ORAL CAPSULE

QLL (380 per 30 days)

5 APTIVUS ORAL SOLUTION


5 atazanavir oral capsule 150 mg, 200 mg


5 atazanavir oral capsule 300 mg

PAR; MO 5 atovaquone MO 4 atovaquone-proguanil MO; QLL (30 per 30 days)

5 ATRIPLA

MO 4 azithromycin intravenous

MO 3 azithromycin oral packet

MO 4 azithromycin oral suspension for reconstitution 100 mg/ 5 ml

MO 2 azithromycin oral suspension for reconstitution 200 mg/ 5 ml

MO 1 azithromycin oral tablet 250 mg, 250 mg (6 pack)





MO 2 azithromycin oral tablet 500 mg, 600 mg

MO 4 aztreonam PAR; MO 5 BARACLUDE ORAL

SOLUTION MO 4 BICILLIN C-R MO 4 BICILLIN L-A MO; QLL (30 per 30 days)

5 BIKTARVY

B/D PAR; MO

5 CANCIDAS

4 CAPASTAT PAR; MO; LA

5 CAYSTON

MO 3 cefaclor oral capsule MO 2 cefaclor oral suspension

for reconstitution 125 mg/5 ml, 250 mg/5 ml

2 cefaclor oral suspension for reconstitution 375 mg/5 ml

MO 3 cefaclor oral tablet extended release 12 hr

MO 2 cefadroxil oral capsule MO 3 cefadroxil oral

suspension for reconstitution 250 mg/ 5 ml, 500 mg/5 ml

MO 4 cefadroxil oral tablet MO 3 cefazolin in dextrose

(iso-os) intravenous piggyback 1 gram/50 ml

MO 4 cefazolin in dextrose (iso-os) intravenous piggyback 2 gram/50 ml

MO 4 cefazolin injection recon soln 1 gram

4 cefazolin injection recon soln 10 gram, 100 gram, 20 gram, 300 g

MO 3 cefazolin injection recon soln 500 mg

4 cefazolin intravenous MO 2 cefdinir oral capsule




MO 4 cefdinir oral suspension for reconstitution

MO 4 cefepime 4 cefepime in dextrose,iso-

osm intravenous piggyback 1 gram/50 ml

MO 4 cefepime in dextrose,iso- osm intravenous piggyback 2 gram/100 ml

4 cefotaxime injection recon soln 1 gram, 2 gram, 500 mg

4 cefotetan 4 cefoxitin in dextrose,

iso-osm MO 4 cefoxitin intravenous

recon soln 1 gram, 2 gram

4 cefoxitin intravenous recon soln 10 gram

MO 4 cefpodoxime oral suspension for reconstitution 100 mg/ 5 ml

MO 3 cefpodoxime oral suspension for reconstitution 50 mg/5 ml

MO 3 cefpodoxime oral tablet 100 mg

MO 4 cefpodoxime oral tablet 200 mg

MO 3 cefprozil oral suspension for reconstitution

MO 2 cefprozil oral tablet 250 mg

MO 3 cefprozil oral tablet 500 mg

4 CEFTAZIDIME IN D5W

MO 4 ceftazidime injection recon soln 1 gram, 2 gram

4 ceftazidime injection recon soln 6 gram





MO 4 ceftriaxone in dextrose, iso-os

MO 3 ceftriaxone injection recon soln 1 gram, 250 mg

4 ceftriaxone injection recon soln 10 gram

4 CEFTRIAXONE INJECTION RECON SOLN 100 GRAM

MO 4 ceftriaxone injection recon soln 2 gram, 500 mg

MO 3 ceftriaxone intravenous recon soln 1 gram

MO 4 ceftriaxone intravenous recon soln 2 gram

MO 1 cefuroxime axetil oral tablet 250 mg

MO 2 cefuroxime axetil oral tablet 500 mg

MO 4 cefuroxime sodium injection recon soln 750 mg

MO 4 cefuroxime sodium intravenous recon soln 1.5 gram

4 cefuroxime sodium intravenous recon soln 7.5 gram

MO 1 cephalexin oral capsule 250 mg, 500 mg

MO 1 cephalexin oral suspension for reconstitution 125 mg/ 5 ml

MO 2 cephalexin oral suspension for reconstitution 250 mg/ 5 ml

MO 1 cephalexin oral tablet 4 chloramphenicol sod

succinate MO 2 chloroquine phosphate




B/D PAR; MO

5 cidofovir


5 CIMDUO

MO 3 ciprofloxacin er oral tablet, er multiphase 24 hr 1,000 mg

MO 2 ciprofloxacin er oral tablet, er multiphase 24 hr 500 mg

MO 2 ciprofloxacin hcl oral tablet 100 mg, 750 mg

MO 1 ciprofloxacin hcl oral tablet 250 mg, 500 mg

MO 4 ciprofloxacin in 5 % dextrose

4 ciprofloxacin oral suspension

MO 2 clarithromycin oral suspension for reconstitution 125 mg/ 5 ml

MO 4 clarithromycin oral suspension for reconstitution 250 mg/ 5 ml

MO 3 clarithromycin oral tablet

MO 3 clarithromycin oral tablet extended release 24 hr

MO 2 clindamycin hcl MO 4 clindamycin in 5 %

dextrose intravenous piggyback 300 mg/50 ml, 600 mg/50 ml

MO 3 clindamycin in 5 % dextrose intravenous piggyback 900 mg/50 ml

MO 4 clindamycin phosphate injection

4 clindamycin phosphate intravenous





MO 3 clotrimazole mucous membrane

MO 4 COARTEM MO 4 colistin (colistimethate

na) MO; QLL (30 per 30 days)

5 COMPLERA


4 CRIXIVAN ORAL CAPSULE 200 MG


4 CRIXIVAN ORAL CAPSULE 400 MG

MO 5 CUBICIN MO 3 dapsone oral MO 5 daptomycin intravenous

recon soln 500 mg MO 3 DARAPRIM MO 4 demeclocycline MO; QLL (30 per 30 days)

5 DESCOVY

MO 2 dicloxacillin MO; QLL (60 per 30 days)

3 didanosine oral capsule, delayed release(dr/ec) 200 mg


3 didanosine oral capsule, delayed release(dr/ec) 250 mg, 400 mg

PAR; MO 5 DIFICID 4 DORIPENEM

MO 4 doxy-100 4 doxycycline hyclate

intravenous MO 3 doxycycline hyclate oral

capsule MO 3 doxycycline hyclate oral

tablet 100 mg, 150 mg, 20 mg, 75 mg

MO 2 doxycycline monohydrate oral capsule 100 mg, 50 mg




MO 3 doxycycline monohydrate oral suspension for reconstitution

MO 2 doxycycline monohydrate oral tablet 100 mg

MO 3 doxycycline monohydrate oral tablet 150 mg, 50 mg, 75 mg

MO 3 e.e.s. 400 oral tablet MO; QLL (30 per 30 days)

5 EDURANT


4 efavirenz oral capsule 200 mg


4 efavirenz oral capsule 50 mg


5 efavirenz oral tablet


4 EMTRIVA ORAL CAPSULE


4 EMTRIVA ORAL SOLUTION

PAR; MO 5 entecavir PAR; MO; QLL (30 per 30 days)

5 EPCLUSA

MO 3 EPIVIR HBV ORAL SOLUTION


4 EPIVIR ORAL SOLUTION


5 EPZICOM

4 ertapenem MO 3 ery-tab oral tablet,

delayed release (dr/ec) 250 mg, 333 mg





MO 4 ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 500 MG

MO 3 erythrocin (as stearate) oral tablet 250 mg

MO 4 ERYTHROCIN INTRAVENOUS RECON SOLN 500 MG

MO 3 erythromycin ethylsuccinate oral tablet

MO 2 erythromycin oral capsule,delayed release(dr/ec)

MO 4 erythromycin oral tablet MO 4 ethambutol MO; QLL (30 per 30 days)

5 EVOTAZ


3 famciclovir oral tablet 125 mg, 250 mg


3 famciclovir oral tablet 500 mg

4 fluconazole in dextrose(iso-o)

4 FLUCONAZOLE IN NACL (ISO-OSM) INTRAVENOUS PIGGYBACK 100 MG/50 ML

MO 4 fluconazole in nacl (iso- osm) intravenous piggyback 200 mg/100 ml

4 fluconazole in nacl (iso- osm) intravenous piggyback 400 mg/200 ml

MO 3 fluconazole oral suspension for reconstitution 10 mg/ml




MO 4 fluconazole oral suspension for reconstitution 40 mg/ml

MO 2 fluconazole oral tablet 100 mg, 150 mg, 50 mg

MO 3 fluconazole oral tablet 200 mg

MO 4 flucytosine oral capsule 250 mg

MO 5 flucytosine oral capsule 500 mg


5 fosamprenavir


5 FUZEON SUBCUTANEOUS RECON SOLN

B/D PAR; MO

3 ganciclovir sodium intravenous recon soln

MO 3 gentamicin in nacl (iso- osm) intravenous piggyback 100 mg/100 ml, 60 mg/50 ml

4 GENTAMICIN IN NACL (ISO-OSM) INTRAVENOUS PIGGYBACK 100 MG/50 ML, 120 MG/100 ML

4 gentamicin in nacl (iso- osm) intravenous piggyback 70 mg/50 ml, 80 mg/100 ml, 90 mg/ 100 ml

MO 4 gentamicin in nacl (iso- osm) intravenous piggyback 80 mg/50 ml

MO 4 gentamicin injection solution 20 mg/2 ml

MO 3 gentamicin injection solution 40 mg/ml

MO 4 gentamicin sulfate (ped) (pf)





MO 4 gentamicin sulfate (pf) intravenous solution 100 mg/10 ml

4 GENTAMICIN SULFATE (PF) INTRAVENOUS SOLUTION 60 MG/ 6 ML


5 GENVOYA

MO 4 griseofulvin microsize MO 4 griseofulvin

ultramicrosize PAR; MO; QLL (28 per 28 days)

5 HARVONI

MO 2 hydroxychloroquine MO 3 imipenem-cilastatin

intravenous recon soln 250 mg

MO 4 imipenem-cilastatin intravenous recon soln 500 mg


5 INTELENCE ORAL TABLET 100 MG





MO 4 INVANZ INJECTION

4 INVANZ INTRAVENOUS


5 INVIRASE ORAL CAPSULE


5 INVIRASE ORAL TABLET


5 ISENTRESS HD




MO 4 ISENTRESS ORAL POWDER IN PACKET


5 ISENTRESS ORAL TABLET


5 ISENTRESS ORAL TABLET, CHEWABLE 100 MG


3 ISENTRESS ORAL TABLET, CHEWABLE 25 MG

4 isoniazid injection MO 4 isoniazid oral solution MO 1 isoniazid oral tablet

100 mg MO 2 isoniazid oral tablet

300 mg PAR; MO 4 itraconazole oral

capsule MO 3 ivermectin MO; QLL (30 per 30 days)

5 JULUCA


4 KALETRA ORAL SOLUTION


4 KALETRA ORAL TABLET 100-25 MG


5 KALETRA ORAL TABLET 200-50 MG

MO 3 ketoconazole oral MO; QLL (960 per 30 days)

4 lamivudine oral solution

MO 4 lamivudine oral tablet 100 mg


4 lamivudine oral tablet 150 mg


4 lamivudine oral tablet 300 mg






4 lamivudine-zidovudine

4 levofloxacin in d5w intravenous piggyback 250 mg/50 ml

MO 4 levofloxacin in d5w intravenous piggyback 500 mg/100 ml, 750 mg/150 ml

MO 4 levofloxacin intravenous MO 4 levofloxacin oral

solution MO 1 levofloxacin oral tablet

250 mg, 500 mg MO 2 levofloxacin oral tablet

750 mg MO; QLL (1800 per 30 days)

4 LEXIVA ORAL SUSPENSION


5 LEXIVA ORAL TABLET

MO 4 LINCOCIN 4 lincomycin 4 linezolid in dextrose

5% PAR; MO; QLL (1800 per 30 days)

4 linezolid oral suspension for reconstitution

PAR; MO; QLL (60 per 30 days)

5 linezolid oral tablet

5 linezolid-0.9% sodium chloride


4 lopinavir-ritonavir

MO 4 MALARONE MO 2 mefloquine MO 4 meropenem MO 4 methenamine hippurate MO 2 methenamine

mandelate MO 4 metro i.v.




MO 3 metronidazole in nacl (iso-os)

MO 4 metronidazole oral capsule

MO 2 metronidazole oral tablet

MO 2 minocycline oral capsule MO 4 minocycline oral tablet MO 4 morgidox oral capsule

50 mg MO 3 moxifloxacin oral MO 5 MYCAMINE

INTRAVENOUS RECON SOLN 100 MG

MO 4 MYCAMINE INTRAVENOUS RECON SOLN 50 MG

4 nafcillin in dextrose iso- osm intravenous piggyback 1 gram/50 ml

MO 4 nafcillin in dextrose iso- osm intravenous piggyback 2 gram/100 ml

MO 4 nafcillin injection recon soln 1 gram, 2 gram

MO 5 nafcillin injection recon soln 10 gram

MO 4 nafcillin intravenous B/D PAR; MO

3 NEBUPENT

MO 2 neomycin QLL (1200 per 30 days)

4 nevirapine oral suspension


2 nevirapine oral tablet

MO 4 nevirapine oral tablet extended release 24 hr 100 mg


4 nevirapine oral tablet extended release 24 hr 400 mg

PAR; MO 4 nitrofurantoin





PAR; MO 4 nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg

PAR; MO 4 nitrofurantoin monohyd/m-cryst


4 NORVIR ORAL CAPSULE


4 NORVIR ORAL POWDER IN PACKET


4 NORVIR ORAL SOLUTION


3 NORVIR ORAL TABLET

PAR; MO 5 NOXAFIL ORAL MO 2 nystatin oral suspension MO 2 nystatin oral tablet MO; QLL (30 per 30 days)

5 ODEFSEY

3 ofloxacin oral tablet 300 mg

MO 3 ofloxacin oral tablet 400 mg

MO 3 oseltamivir 4 oxacillin in dextrose(iso-

osm) intravenous piggyback 1 gram/50 ml

MO 5 oxacillin in dextrose(iso- osm) intravenous piggyback 2 gram/50 ml

4 oxacillin injection recon soln 1 gram

5 oxacillin injection recon soln 10 gram

MO 4 oxacillin injection recon soln 2 gram

MO 4 paromomycin MO 4 PASER




4 PENICILLIN G POT IN DEXTROSE INTRAVENOUS PIGGYBACK 1 MILLION UNIT/50 ML, 2 MILLION UNIT/50 ML

MO 4 PENICILLIN G POT IN DEXTROSE INTRAVENOUS PIGGYBACK 3 MILLION UNIT/50 ML

MO 4 penicillin g potassium MO 4 penicillin g procaine

intramuscular syringe 1.2 million unit/2 ml

4 penicillin g procaine intramuscular syringe 600,000 unit/ml

MO 4 penicillin g sodium MO 1 penicillin v potassium MO 4 PENTAM

4 pfizerpen-g MO 4 piperacillin-tazobactam

intravenous recon soln 2.25 gram, 3.375 gram, 4.5 gram, 40.5 gram

MO 4 polymyxin b sulfate MO; QLL (30 per 30 days)

5 PREZCOBIX


5 PREZISTA ORAL SUSPENSION


4 PREZISTA ORAL TABLET 150 MG


5 PREZISTA ORAL TABLET 600 MG, 800 MG


4 PREZISTA ORAL TABLET 75 MG

MO 4 PRIFTIN





MO 3 PRIMAQUINE MO 4 pyrazinamide PAR; MO 4 quinine sulfate MO; QLL (60 per 180 days)

3 RELENZA DISKHALER


4 RESCRIPTOR ORAL TABLET


4 RESCRIPTOR ORAL TABLET, DISPERSIBLE

MO 4 RETROVIR INTRAVENOUS


5 REYATAZ ORAL CAPSULE 150 MG, 200 MG


5 REYATAZ ORAL CAPSULE 300 MG


4 REYATAZ ORAL POWDER IN PACKET

MO 4 ribasphere oral capsule MO 4 ribasphere oral tablet

200 mg MO 4 ribavirin oral capsule MO 5 ribavirin oral tablet

200 mg MO 4 rifabutin MO 4 rifampin MO 4 RIFATER MO 3 rimantadine MO; QLL (360 per 30 days)

3 ritonavir


5 SELZENTRY ORAL SOLUTION


5 SELZENTRY ORAL TABLET 150 MG, 300 MG


4 SELZENTRY ORAL TABLET 25 MG





4 SELZENTRY ORAL TABLET 75 MG

PAR; MO; LA

5 SIRTURO

PAR 5 SIVEXTRO INTRAVENOUS


5 SIVEXTRO ORAL


3 stavudine oral capsule 15 mg







MO 4 STREPTOMYCIN MO; QLL (30 per 30 days)

5 STRIBILD

MO 3 STROMECTOL MO 4 sulfadiazine MO 3 sulfamethoxazole-

trimethoprim intravenous

MO 2 sulfamethoxazole- trimethoprim oral suspension

MO 1 sulfamethoxazole- trimethoprim oral tablet


4 SUSTIVA ORAL CAPSULE 200 MG


4 SUSTIVA ORAL CAPSULE 50 MG


5 SUSTIVA ORAL TABLET






5 SYMFI


5 SYMFI LO

PAR; MO; LA

5 SYNAGIS

5 SYNERCID MO 3 TAMIFLU ORAL

CAPSULE 30 MG, 45 MG

MO 3 tamiflu oral capsule 75 mg

MO 3 TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION


5 TECHNIVIE

MO 5 TEFLARO MO; QLL (30 per 30 days)

5 tenofovir disoproxil fumarate

MO 2 terbinafine hcl oral MO 4 tetracycline

5 TIGECYCLINE MO 2 tinidazole oral tablet

250 mg MO 4 tinidazole oral tablet


4 TIVICAY ORAL TABLET 10 MG


5 TIVICAY ORAL TABLET 25 MG, 50 MG

B/D PAR; MO; QLL

5 tobramycin in 0.225% nacl for nebulization

(280 per 28 days)

4 tobramycin sulfate injection recon soln

MO 4 tobramycin sulfate injection solution

MO 4 TRECATOR




MO 2 trimethoprim MO; QLL (30 per 30 days)

5 TRIUMEQ

MO; QLL (10.64 per 28 days)

5 TROGARZO


5 TRUVADA


3 TYBOST


3 valacyclovir oral tablet 1 gram


3 valacyclovir oral tablet 500 mg

MO 5 valganciclovir oral tablet

B/D PAR 4 VANCOMYCIN IN 0.9 % SODIUM CHL INTRAVENOUS PIGGYBACK

B/D PAR; MO

4 VANCOMYCIN IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK 1 GRAM/200 ML

B/D PAR 4 VANCOMYCIN IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK 500 MG/100 ML, 750 MG/150 ML

MO 4 vancomycin intravenous recon soln 1,000 mg, 10 gram, 5 gram, 500 mg

4 VANCOMYCIN INTRAVENOUS RECON SOLN 250 MG





B/D PAR; MO

4 VANCOMYCIN INTRAVENOUS RECON SOLN 750 MG


4 vancomycin oral capsule 125 mg


5 vancomycin oral capsule 250 mg


4 VIDEX 2 GRAM PEDIATRIC


4 VIDEX 4 GRAM PEDIATRIC


4 VIDEX EC ORAL CAPSULE, DELAYED RELEASE(DR/EC) 125 MG


5 VIRACEPT ORAL TABLET 250 MG


5 VIRACEPT ORAL TABLET 625 MG


4 VIRAMUNE ORAL SUSPENSION

MO 4 VIRAMUNE XR ORAL TABLET EXTENDED RELEASE 24 HR 100 MG


5 VIREAD ORAL POWDER


5 VIREAD ORAL TABLET

MO 4 voriconazole intravenous

PAR; MO 5 voriconazole oral suspension for reconstitution




PAR; MO 5 voriconazole oral tablet 200 mg

PAR; MO 4 voriconazole oral tablet 50 mg


5 VOSEVI


5 XIFAXAN ORAL TABLET 550 MG


4 ZERIT ORAL RECON SOLN


4 ZIAGEN ORAL SOLUTION


4 zidovudine oral capsule


2 zidovudine oral syrup


2 zidovudine oral tablet

MO 4 ZITHROMAX ORAL PACKET

MO 4 ZITHROMAX ORAL TABLET 250 MG

MO 4 ZITHROMAX Z- PAK

5 ZYVOX INTRAVENOUS PIGGYBACK 200 MG/100 ML

MO 5 ZYVOX INTRAVENOUS PIGGYBACK 600 MG/300 ML


5 ZYVOX ORAL SUSPENSION FOR RECONSTITUTION Antineoplastic / Immunosuppressant Drugs

PAR; MO 5 ABRAXANE





B/D PAR 4 adriamycin intravenous recon soln 10 mg

B/D PAR 4 adriamycin intravenous solution

B/D PAR 4 adrucil intravenous solution 2.5 gram/50 ml

B/D PAR; MO

4 adrucil intravenous solution 5 gram/100 ml, 500 mg/10 ml

PAR; MO 5 AFINITOR PAR; MO 5 AFINITOR

DISPERZ PAR; MO; QLL (240 per 30 days)

5 ALECENSA

PAR; MO 5 ALIMTA PAR; MO; LA

5 ALIQOPA

B/D PAR; MO

4 ALKERAN ORAL


5 ALUNBRIG ORAL TABLET 180 MG






5 ALUNBRIG ORAL TABLETS,DOSE PACK


2 anastrozole

B/D PAR 4 ARRANON PAR; MO 5 ARZERRA PAR; MO 5 AVASTIN PAR; MO 5 azacitidine B/D PAR; MO

2 azathioprine

B/D PAR 4 azathioprine sodium PAR; MO; LA

5 BAVENCIO

PAR; MO 5 BELEODAQ




B/D PAR; MO

5 BENDEKA

B/D PAR; MO

5 BESPONSA

PAR; MO 5 bexarotene MO; QLL (30 per 30 days)

3 bicalutamide

B/D PAR; MO

5 BICNU

B/D PAR; MO

4 bleomycin

PAR; MO 5 BLINCYTO INTRAVENOUS KIT

PAR; MO 5 BORTEZOMIB PAR; MO; QLL (120 per 30 days)

5 BOSULIF ORAL TABLET 100 MG


5 BOSULIF ORAL TABLET 400 MG, 500 MG


5 BRAFTOVI ORAL CAPSULE 50 MG


5 BRAFTOVI ORAL CAPSULE 75 MG

B/D PAR 4 busulfan B/D PAR 4 BUSULFEX PAR; MO; LA; QLL (90 per 30 days)

5 CABOMETYX ORAL TABLET 20 MG

PAR; MO; LA; QLL (30 per 30 days)

5 CABOMETYX ORAL TABLET 40 MG, 60 MG

PAR; MO; LA

5 CALQUENCE


5 CAPRELSA ORAL TABLET 100 MG


5 CAPRELSA ORAL TABLET 300 MG

B/D PAR; MO

4 carboplatin intravenous solution





B/D PAR; MO

4 CELLCEPT INTRAVENOUS

B/D PAR; MO

4 cisplatin

B/D PAR; MO

5 cladribine

5 clofarabine B/D PAR 5 CLOLAR PAR; MO; QLL (56 per 28 days)

5 COMETRIQ ORAL CAPSULE 100 MG/ DAY(80 MG X1-20 MG X1)


5 COMETRIQ ORAL CAPSULE 140 MG/ DAY(80 MG X1-20 MG X3)


5 COMETRIQ ORAL CAPSULE 60 MG/ DAY (20 MG X 3/ DAY)

B/D PAR; MO

5 COSMEGEN


5 COTELLIC

B/D PAR; MO

4 CYCLOPHOSPHAMIDE ORAL CAPSULE

B/D PAR 4 cyclosporine intravenous B/D PAR; MO

4 cyclosporine modified oral capsule

B/D PAR; MO

5 cyclosporine modified oral solution

B/D PAR; MO

4 cyclosporine oral capsule

PAR; MO 5 CYRAMZA B/D PAR; MO

4 cytarabine

B/D PAR; MO

4 cytarabine (pf) injection solution 100 mg/5 ml (20 mg/ml), 2 gram/20 ml (100 mg/ml)

B/D PAR 4 cytarabine (pf) injection solution 20 mg/ml

B/D PAR; MO

4 dacarbazine

B/D PAR 5 dactinomycin




PAR; MO; LA

5 DARZALEX

B/D PAR 4 daunorubicin intravenous solution

B/D PAR; MO

5 decitabine

5 dexrazoxane hcl intravenous recon soln 250 mg

MO 5 dexrazoxane hcl intravenous recon soln 500 mg

B/D PAR 5 docetaxel intravenous solution 160 mg/16 ml (10 mg/ml), 20 mg/2 ml (10 mg/ml)

B/D PAR; MO

5 docetaxel intravenous solution 160 mg/8 ml (20 mg/ml), 20 mg/ml (1 ml), 80 mg/4 ml (20 mg/ml), 80 mg/8 ml (10 mg/ml)

B/D PAR 5 DOCETAXEL INTRAVENOUS SOLUTION 20 MG/ ML

B/D PAR 4 doxorubicin intravenous recon soln 10 mg

B/D PAR; MO

4 doxorubicin intravenous recon soln 50 mg

B/D PAR; MO

4 doxorubicin intravenous solution

PAR; MO 5 doxorubicin, peg- liposomal

MO 3 DROXIA PAR; MO 5 ELITEK MO 5 EMCYT PAR; MO 5 EMPLICITI B/D PAR; MO

4 ENVARSUS XR

B/D PAR; MO

4 epirubicin intravenous solution

PAR; MO 5 ERBITUX






5 ERIVEDGE

PAR; MO 5 ERLEADA PAR; MO 5 ERWINAZE B/D PAR; MO

5 ETOPOPHOS

B/D PAR; MO

3 etoposide intravenous

B/D PAR; MO

5 EVOMELA


4 exemestane


5 FARESTON


5 FARYDAK ORAL CAPSULE 10 MG


5 FARYDAK ORAL CAPSULE 15 MG, 20 MG

PAR; MO 5 FASLODEX PAR; MO; QLL (4 per 365 days)

5 FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 120 MG


4 FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG

B/D PAR; MO

4 fludarabine intravenous recon soln

B/D PAR 4 fludarabine intravenous solution

B/D PAR; MO

4 fluorouracil intravenous solution 1 gram/20 ml, 500 mg/10 ml

B/D PAR; MO

3 fluorouracil intravenous solution 2.5 gram/50 ml, 5 gram/100 ml

MO 4 flutamide




B/D PAR; MO

5 FOLOTYN

PAR; MO 5 FUSILEV PAR; MO 5 GAZYVA B/D PAR; MO

5 gemcitabine intravenous recon soln 1 gram, 200 mg

B/D PAR 5 gemcitabine intravenous recon soln 2 gram

B/D PAR; MO

5 gemcitabine intravenous solution 1 gram/26.3 ml (38 mg/ ml), 200 mg/5.26 ml (38 mg/ml)

B/D PAR 5 GEMCITABINE INTRAVENOUS SOLUTION 100 MG/ML

B/D PAR 5 gemcitabine intravenous solution 2 gram/52.6 ml (38 mg/ ml)

B/D PAR; MO

4 gengraf oral capsule 100 mg, 25 mg

B/D PAR; MO

4 gengraf oral solution


5 GILOTRIF


5 GLEEVEC ORAL TABLET 100 MG


5 GLEEVEC ORAL TABLET 400 MG

PAR; MO 4 GLEOSTINE PAR; MO 5 HALAVEN B/D PAR; MO

5 HERCEPTIN

MO 5 HEXALEN MO 2 hydroxyurea PAR; MO; QLL (30 per 30 days)

5 IBRANCE






5 ICLUSIG ORAL TABLET 15 MG


5 ICLUSIG ORAL TABLET 45 MG

B/D PAR 5 idarubicin PAR; MO; LA; QLL (30 per 30 days)

5 IDHIFA ORAL TABLET 100 MG


5 IDHIFA ORAL TABLET 50 MG

B/D PAR; MO

4 IFEX

B/D PAR; MO

4 ifosfamide intravenous recon soln

B/D PAR 4 ifosfamide intravenous solution


5 imatinib oral tablet 100 mg


5 imatinib oral tablet 400 mg


5 IMBRUVICA ORAL CAPSULE 140 MG


5 IMBRUVICA ORAL CAPSULE 70 MG


5 IMBRUVICA ORAL TABLET

PAR; MO; LA

5 IMFINZI


5 INLYTA ORAL TABLET 1 MG


5 INLYTA ORAL TABLET 5 MG

MO 5 IRESSA B/D PAR; MO

4 irinotecan intravenous solution 100 mg/5 ml




B/D PAR; MO

5 irinotecan intravenous solution 40 mg/2 ml

B/D PAR 4 irinotecan intravenous solution 500 mg/25 ml

PAR; MO 5 ISTODAX PAR; MO 5 IXEMPRA PAR; MO; QLL (150 per 30 days)

5 JAKAFI ORAL TABLET 10 MG









PAR; MO 5 JEVTANA PAR; MO 5 KADCYLA PAR; MO 5 KEYTRUDA

INTRAVENOUS SOLUTION


5 KISQALI FEMARA CO-PACK ORAL TABLET 200 MG/ DAY(200 MG X 1)- 2.5 MG






5 KISQALI ORAL TABLET 200 MG/ DAY (200 MG X 1)









PAR; MO 5 KYPROLIS PAR; MO; LA

5 LARTRUVO


5 LENVIMA ORAL CAPSULE 10 MG/ DAY (10 MG X 1), 12 MG/DAY (4 MG X 3), 4 MG


5 LENVIMA ORAL CAPSULE 14 MG/ DAY(10 MG X 1-4 MG X 1), 20 MG/ DAY (10 MG X 2), 8 MG/DAY (4 MG X 2)


5 LENVIMA ORAL CAPSULE 18 MG/ DAY (10 MG X 1-4 MG X2), 24 MG/ DAY(10 MG X 2-4 MG X 1)


2 letrozole

MO 4 leucovorin calcium injection recon soln 100 mg, 200 mg, 350 mg, 50 mg

4 leucovorin calcium injection recon soln 500 mg

MO 4 leucovorin calcium oral tablet 10 mg, 25 mg

MO 2 leucovorin calcium oral tablet 15 mg, 5 mg

MO 4 LEUKERAN PAR; MO 4 leuprolide subcutaneous

kit PAR 5 levoleucovorin

intravenous recon soln 50 mg




PAR; MO 5 LONSURF PAR; MO; QLL (1 per 28 days)

5 LUPRON DEPOT


5 LUPRON DEPOT (3 MONTH)






4 LUPRON DEPOT- PED INTRAMUSCULAR KIT 11.25 MG, 15 MG


5 LUPRON DEPOT- PED INTRAMUSCULAR KIT 7.5 MG (PED)


5 LYNPARZA ORAL CAPSULE


5 LYNPARZA ORAL TABLET

MO 3 LYSODREN MO 5 MARQIBO MO 5 MATULANE PAR 3 megestrol oral

suspension 400 mg/10 ml (10 ml)

PAR; MO 2 megestrol oral suspension 400 mg/10 ml (40 mg/ml)

PAR 4 megestrol oral suspension 800 mg/20 ml (20 ml)

PAR; MO 3 megestrol oral tablet PAR; MO; QLL (90 per 30 days)

5 MEKINIST ORAL TABLET 0.5 MG






5 MEKINIST ORAL TABLET 2 MG


5 MEKTOVI

B/D PAR; MO

4 melphalan

B/D PAR 3 melphalan hcl MO 3 mercaptopurine MO 4 mesna MO 5 MESNEX ORAL

2 methotrexate sodium (pf) injection recon soln

MO 2 methotrexate sodium (pf) injection solution

MO 4 methotrexate sodium injection

MO 2 methotrexate sodium oral

B/D PAR; MO

4 mitomycin intravenous recon soln 20 mg, 5 mg

B/D PAR; MO

5 mitomycin intravenous recon soln 40 mg

B/D PAR; MO

3 mitoxantrone

B/D PAR; MO

4 MUSTARGEN

B/D PAR 4 mycophenolate mofetil hcl

B/D PAR; MO

3 mycophenolate mofetil oral capsule

B/D PAR; MO

5 mycophenolate mofetil oral suspension for reconstitution

B/D PAR; MO

3 mycophenolate mofetil oral tablet

B/D PAR; MO

4 mycophenolate sodium

PAR; MO; LA

5 MYLOTARG

PAR; MO; LA; QLL

5 NERLYNX

(180 per 30 days)




PAR; MO; LA; QLL

5 NEXAVAR

(120 per 30 days) MO; QLL (30 per 30 days)

5 NILANDRON


5 nilutamide


5 NINLARO

B/D PAR; MO

5 NIPENT

PAR; MO 5 NULOJIX PAR; MO 5 octreotide acetate

injection solution 1,000 mcg/ml

PAR; MO 4 octreotide acetate injection solution 100 mcg/ml, 200 mcg/ml, 50 mcg/ml, 500 mcg/ml

PAR; MO 4 octreotide acetate injection syringe 100 mcg/ml (1 ml), 50 mcg/ ml (1 ml)

PAR; MO 5 octreotide acetate injection syringe 500 mcg/ml (1 ml)


5 ODOMZO

PAR; MO 5 ONCASPAR PAR; MO 5 OPDIVO B/D PAR; MO

5 oxaliplatin intravenous recon soln 100 mg

B/D PAR 5 oxaliplatin intravenous recon soln 50 mg

B/D PAR; MO

4 oxaliplatin intravenous solution 100 mg/20 ml

B/D PAR; MO

5 oxaliplatin intravenous solution 50 mg/10 ml (5 mg/ml)

B/D PAR; MO

4 paclitaxel





PAR; MO 5 PERJETA PAR; MO; QLL (120 per 30 days)

5 POMALYST ORAL CAPSULE 1 MG


5 POMALYST ORAL CAPSULE 2 MG


5 POMALYST ORAL CAPSULE 3 MG, 4 MG

MO 5 PORTRAZZA B/D PAR; MO

4 PROGRAF INTRAVENOUS

PAR; MO 5 PURIXAN B/D PAR; MO

5 RAPAMUNE ORAL SOLUTION


5 REVLIMID ORAL CAPSULE 10 MG


5 REVLIMID ORAL CAPSULE 15 MG, 2.5 MG, 20 MG, 25 MG

PAR; MO; LA; QLL

5 REVLIMID ORAL CAPSULE 5 MG

(150 per 30 days) B/D PAR; MO

5 RITUXAN

B/D PAR; MO

5 RITUXAN HYCELA

PAR 5 ROMIDEPSIN PAR; MO; LA; QLL

5 RUBRACA ORAL TABLET 200 MG

(180 per 30 days) PAR; MO; LA; QLL

5 RUBRACA ORAL TABLET 250 MG, 300 MG (120 per 30

days) PAR; MO; QLL (240 per 30 days)

5 RYDAPT

B/D PAR; MO

4 SANDIMMUNE ORAL SOLUTION




PAR; MO 5 SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION, EXTENDED REL RECON

PAR; MO 5 SIGNIFOR B/D PAR 5 SIMULECT

INTRAVENOUS RECON SOLN 10 MG

B/D PAR; MO

5 SIMULECT INTRAVENOUS RECON SOLN 20 MG

B/D PAR; MO

4 sirolimus

MO 4 SOLTAMOX PAR; MO 5 SOMATULINE

DEPOT PAR; MO; QLL (30 per 30 days)

5 SPRYCEL


5 STIVARGA


5 SUTENT ORAL CAPSULE 12.5 MG


5 SUTENT ORAL CAPSULE 25 MG, 37.5 MG, 50 MG

PAR; MO 5 SYNRIBO MO 4 TABLOID B/D PAR; MO

4 tacrolimus oral capsule 0.5 mg, 1 mg

B/D PAR; MO

5 tacrolimus oral capsule 5 mg


5 TAFINLAR


5 TAGRISSO ORAL TABLET 40 MG






5 TAGRISSO ORAL TABLET 80 MG

MO 2 tamoxifen PAR; MO; QLL (30 per 30 days)

5 TARCEVA ORAL TABLET 100 MG, 150 MG


5 TARCEVA ORAL TABLET 25 MG


5 TARGRETIN ORAL


5 TARGRETIN TOPICAL


5 TASIGNA ORAL CAPSULE 150 MG, 200 MG


5 TASIGNA ORAL CAPSULE 50 MG

B/D PAR; MO

5 TAXOTERE INTRAVENOUS SOLUTION 20 MG/ ML (1 ML), 80 MG/ 4 ML (20 MG/ML)


5 TECENTRIQ

PAR; MO 5 temsirolimus PAR; MO; QLL (30 per 30 days)

5 THALOMID ORAL CAPSULE 100 MG, 50 MG


5 THALOMID ORAL CAPSULE 150 MG, 200 MG

B/D PAR; MO

4 thiotepa

B/D PAR; MO

4 toposar

B/D PAR 5 topotecan intravenous recon soln

B/D PAR; MO

5 topotecan intravenous solution

PAR; MO 5 TORISEL




B/D PAR; MO

5 TREANDA INTRAVENOUS RECON SOLN


5 TRELSTAR INTRAMUSCULAR SYRINGE 11.25 MG/ 2 ML





MO 5 tretinoin (chemotherapy)

B/D PAR; MO

5 TRISENOX INTRAVENOUS SOLUTION 2 MG/ ML

PAR; MO; LA; QLL

5 TYKERB

(180 per 30 days) B/D PAR; MO

5 UNITUXIN

PAR; MO 5 VECTIBIX PAR; MO 5 VELCADE PAR; MO; LA; QLL (60 per 30 days)

4 VENCLEXTA ORAL TABLET 10 MG

PAR; MO; LA; QLL


(120 per 30 days) PAR; MO; LA; QLL (30 per 30 days)



5 VENCLEXTA STARTING PACK


5 VERZENIO





B/D PAR; MO

4 vinblastine intravenous solution

B/D PAR 4 vincasar pfs intravenous solution 1 mg/ml

B/D PAR; MO

4 vincasar pfs intravenous solution 2 mg/2 ml

B/D PAR; MO

3 vincristine intravenous solution 1 mg/ml

B/D PAR; MO

4 vincristine intravenous solution 2 mg/2 ml

B/D PAR; MO

4 vinorelbine


5 VOTRIENT

B/D PAR; MO

5 VYXEOS


5 XALKORI

MO 4 XATMEP PAR; MO; QLL (1.7 per 28 days)

5 XGEVA


5 XTANDI

PAR; MO 5 YERVOY B/D PAR; MO

5 YONDELIS


5 YONSA

PAR; MO 5 ZALTRAP B/D PAR; MO

4 ZANOSAR


5 ZEJULA


5 ZELBORAF


5 ZOLINZA




B/D PAR; MO

4 ZORTRESS ORAL TABLET 0.25 MG

B/D PAR; MO

5 ZORTRESS ORAL TABLET 0.5 MG, 0.75 MG


5 ZYDELIG


5 ZYKADIA


5 ZYTIGA ORAL TABLET 250 MG


5 ZYTIGA ORAL TABLET 500 MG

Autonomic / Cns Drugs, Neurology / Psych MO; QLL (1 per 28 days)

5 ABILIFY MAINTENA


3 acetaminophen-codeine oral solution 120 mg- 12 mg /5 ml (5 ml), 240 mg-24 mg /10 ml (10 ml), 300 mg-30 mg /12.5 ml


3 acetaminophen-codeine oral solution 120-12 mg/5 ml


3 acetaminophen-codeine oral tablet 300-15 mg






4 ADASUVE


2 alprazolam oral tablet


3 alprazolam oral tablet extended release 24 hr






3 alprazolam oral tablet, disintegrating 0.25 mg, 0.5 mg, 1 mg

PAR; MO 2 amitriptyline MO 3 amoxapine oral tablet

100 mg, 50 mg MO 2 amoxapine oral tablet

150 mg, 25 mg PAR; MO; LA; QLL (60 per 30 days)

5 AMPYRA

PAR; MO; LA

5 APOKYN

ST; MO 5 APTIOM ORAL TABLET 200 MG, 400 MG, 600 MG

ST; MO 4 APTIOM ORAL TABLET 800 MG


5 aripiprazole oral solution


4 aripiprazole oral tablet 10 mg






5 aripiprazole oral tablet 20 mg, 30 mg




5 aripiprazole oral tablet, disintegrating 10 mg


5 aripiprazole oral tablet, disintegrating 15 mg

QLL (4.8 per 365 days)

5 ARISTADA INITIO





5 ARISTADA INTRAMUSCULAR SUSPENSION, EXTENDED REL SYRING 1,064 MG/ 3.9 ML


5 ARISTADA INTRAMUSCULAR SUSPENSION, EXTENDED REL SYRING 441 MG/1.6 ML






4 armodafinil oral tablet 150 mg, 200 mg, 250 mg


4 armodafinil oral tablet 50 mg


4 atomoxetine oral capsule 10 mg, 18 mg, 25 mg, 40 mg


4 atomoxetine oral capsule 100 mg, 60 mg, 80 mg


5 AUBAGIO

MO 3 AZILECT MO 2 baclofen PAR; MO; QLL (2400 per 30 days)

5 BANZEL ORAL SUSPENSION






5 BANZEL ORAL TABLET 200 MG


5 BANZEL ORAL TABLET 400 MG

PAR; MO 4 benztropine injection PAR; MO 2 benztropine oral PAR 4 BRIVIACT

INTRAVENOUS PAR; MO; QLL (600 per 30 days)

4 BRIVIACT ORAL SOLUTION


5 BRIVIACT ORAL TABLET 10 MG


5 BRIVIACT ORAL TABLET 100 MG, 75 MG





MO 4 bromocriptine MO; QLL (90 per 30 days)

4 buprenorphine hcl injection solution


4 buprenorphine hcl injection syringe


2 buprenorphine hcl sublingual tablet 2 mg


2 buprenorphine hcl sublingual tablet 8 mg


3 buprenorphine- naloxone sublingual tablet 2-0.5 mg


3 buprenorphine- naloxone sublingual tablet 8-2 mg


2 bupropion hcl oral tablet 100 mg





2 bupropion hcl oral tablet 75 mg


2 bupropion hcl oral tablet extended release 24 hr 150 mg


2 bupropion hcl oral tablet extended release 24 hr 300 mg


2 bupropion hcl oral tablet sustained-release 12 hr 100 mg


2 bupropion hcl oral tablet sustained-release 12 hr 150 mg, 200 mg

MO 2 buspirone oral tablet 10 mg, 15 mg, 5 mg

MO 4 buspirone oral tablet 30 mg

MO 3 buspirone oral tablet 7.5 mg


4 butalbital compound w/ codeine


4 butalbital-acetaminop- caf-cod


4 butalbital- acetaminophen oral tablet 50-325 mg


4 butalbital- acetaminophen-caff oral capsule


4 butalbital- acetaminophen-caff oral tablet 50-325-40 mg


4 butalbital-aspirin- caffeine oral capsule

MO 4 butorphanol tartrate injection


4 butorphanol tartrate nasal

MO 4 carbamazepine oral capsule, er multiphase 12 hr





MO 4 carbamazepine oral suspension 100 mg/5 ml

4 carbamazepine oral suspension 200 mg/10 ml

MO 2 carbamazepine oral tablet

MO 4 carbamazepine oral tablet extended release 12 hr

MO 2 carbamazepine oral tablet,chewable

MO 2 carbidopa-levodopa oral tablet

MO 2 carbidopa-levodopa oral tablet extended release

MO 3 carbidopa-levodopa oral tablet,disintegrating

MO 4 carbidopa-levodopa- entacapone

PAR; MO 3 carisoprodol oral tablet 350 mg

PAR; MO 4 celecoxib oral capsule 100 mg, 200 mg, 400 mg

PAR; MO 3 celecoxib oral capsule 50 mg

MO 4 CELONTIN ORAL CAPSULE 300 MG


3 chlordiazepoxide hcl

PAR; MO 4 chlorpromazine MO; QLL (600 per 30 days)

4 citalopram oral solution


1 citalopram oral tablet 10 mg





PAR; MO 4 clomipramine





2 clonazepam oral tablet 0.5 mg


2 clonazepam oral tablet 1 mg


2 clonazepam oral tablet 2 mg


4 clonazepam oral tablet, disintegrating 0.125 mg






4 clonazepam oral tablet, disintegrating 1 mg


4 clonazepam oral tablet, disintegrating 2 mg

MO 3 clorazepate dipotassium MO; QLL (270 per 30 days)

3 clozapine oral tablet 100 mg








4 clozapine oral tablet, disintegrating 100 mg


4 clozapine oral tablet, disintegrating 12.5 mg


5 CLOZAPINE ORAL TABLET, DISINTEGRATING 150 MG






4 CLOZAPINE ORAL TABLET, DISINTEGRATING 200 MG


3 clozapine oral tablet, disintegrating 25 mg


5 COPAXONE SUBCUTANEOUS SYRINGE 20 MG/ ML


5 COPAXONE SUBCUTANEOUS SYRINGE 40 MG/ ML

PAR; MO 2 cyclobenzaprine oral tablet 10 mg, 5 mg

PAR; MO 4 cyclobenzaprine oral tablet 7.5 mg


5 dalfampridine

MO 4 dantrolene PAR; MO 4 desipramine MO; QLL (120 per 30 days)

4 DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24 HR 100 MG


4 DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24 HR 50 MG


4 DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24HR 100 MG


4 DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24HR 50 MG


4 desvenlafaxine succinate oral tablet extended release 24 hr 100 mg









4 dextroamphetamine oral tablet 10 mg


4 dextroamphetamine oral tablet 5 mg


4 dextroamphetamine- amphetamine oral capsule,extended release 24hr


3 dextroamphetamine- amphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 5 mg, 7.5 mg


3 dextroamphetamine- amphetamine oral tablet 30 mg

MO 4 DIASTAT MO 4 DIASTAT ACUDIAL MO; QLL (240 per 30 days)

2 diazepam intensol


2 diazepam oral concentrate


2 diazepam oral solution 5 mg/5 ml (1 mg/ml)


2 diazepam oral tablet 10 mg





MO 4 diazepam rectal MO 2 diclofenac potassium





MO 2 diclofenac sodium oral tablet extended release 24 hr

MO 3 diclofenac sodium oral tablet,delayed release (dr/ec) 25 mg




4 diclofenac sodium topical drops


3 diclofenac sodium topical gel 1 %

MO 3 diflunisal PAR; MO 5 dihydroergotamine

injection MO; QLL (8 per 28 days)

5 dihydroergotamine nasal

MO 4 DILANTIN EXTENDED ORAL CAPSULE 100 MG

MO 3 DILANTIN INFATABS

MO 3 DILANTIN ORAL CAPSULE 30 MG

MO 4 divalproex oral capsule, delayed rel sprinkle

MO 4 divalproex oral tablet extended release 24 hr

MO 2 divalproex oral tablet, delayed release (dr/ec) 125 mg, 250 mg

MO 3 divalproex oral tablet, delayed release (dr/ec) 500 mg


1 donepezil oral tablet 10 mg, 5 mg


1 donepezil oral tablet, disintegrating




MO 2 doxepin oral MO; QLL (180 per 30 days)

4 duloxetine oral capsule, delayed release(dr/ec) 20 mg








4 duramorph (pf) injection solution 0.5 mg/ml


4 duramorph (pf) injection solution 1 mg/ ml


5 EMSAM


4 endocet oral tablet 10- 325 mg, 7.5-325 mg


3 endocet oral tablet 5- 325 mg

MO 4 entacapone MO 1 epitol MO; QLL (480 per 30 days)

4 EQUETRO ORAL CAPSULE, ER MULTIPHASE 12 HR 100 MG





PAR; MO 4 ergoloid MO; QLL (600 per 30 days)

4 escitalopram oxalate oral solution






2 escitalopram oxalate oral tablet 10 mg






4 eszopiclone

MO 4 ethosuximide oral capsule

MO 3 ethosuximide oral solution

MO 3 etodolac oral capsule MO 2 etodolac oral tablet MO 3 etodolac oral tablet

extended release 24 hr ST; MO; QLL (720 per 30 days)

4 FANAPT ORAL TABLET 1 MG

ST; MO; QLL (60 per 30 days)

5 FANAPT ORAL TABLET 10 MG, 12 MG










4 FANAPT ORAL TABLETS,DOSE PACK

MO 4 felbamate MO 4 FELBATOL ORAL

TABLET 400 MG MO 4 fenoprofen oral tablet





5 fentanyl citrate


4 fentanyl transdermal patch 72 hour 100 mcg/ hr, 12 mcg/hr, 25 mcg/ hr, 50 mcg/hr, 75 mcg/ hr


4 FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK


4 FETZIMA ORAL CAPSULE, EXTENDED RELEASE 24 HR 120 MG, 80 MG


4 FETZIMA ORAL CAPSULE, EXTENDED RELEASE 24 HR 20 MG


4 FETZIMA ORAL CAPSULE, EXTENDED RELEASE 24 HR 40 MG


1 fluoxetine oral capsule 10 mg






4 fluoxetine oral capsule, delayed release(dr/ec)


2 fluoxetine oral solution


2 fluoxetine oral tablet 10 mg


3 fluoxetine oral tablet 20 mg





MO 4 fluphenazine decanoate MO 4 fluphenazine hcl

injection MO 2 fluphenazine hcl oral MO 2 flurbiprofen MO; QLL (90 per 30 days)

3 fluvoxamine oral tablet 100 mg





MO 4 fosphenytoin MO; QLL (720 per 30 days)

4 FYCOMPA ORAL SUSPENSION


4 FYCOMPA ORAL TABLET 10 MG, 12 MG


4 FYCOMPA ORAL TABLET 2 MG








2 gabapentin oral capsule 100 mg






4 gabapentin oral solution 250 mg/5 ml





4 GABAPENTIN ORAL SOLUTION 250 MG/5 ML (5 ML), 300 MG/6 ML (6 ML)


4 gabapentin oral tablet 600 mg


4 gabapentin oral tablet 800 mg

MO 4 GABITRIL ORAL TABLET 12 MG

MO 5 GABITRIL ORAL TABLET 16 MG


4 galantamine oral capsule,ext rel. pellets 24 hr


3 galantamine oral solution


4 galantamine oral tablet


4 GEODON INTRAMUSCULAR


5 GILENYA ORAL CAPSULE 0.5 MG


5 glatiramer subcutaneous syringe 20 mg/ml


5 glatiramer subcutaneous syringe 40 mg/ml


5 glatopa subcutaneous syringe 20 mg/ml


5 glatopa subcutaneous syringe 40 mg/ml


4 guanfacine oral tablet extended release 24 hr

MO 4 guanidine MO 2 haloperidol





MO 4 haloperidol decanoate intramuscular solution 100 mg/ml, 100 mg/ml (1 ml)

MO 3 haloperidol decanoate intramuscular solution 50 mg/ml

MO 3 haloperidol lactate injection

3 haloperidol lactate intramuscular

MO 2 haloperidol lactate oral PAR; MO; QLL (30 per 30 days)

5 HETLIOZ


4 hydrocodone- acetaminophen oral solution 7.5-325 mg/15 ml


3 hydrocodone- acetaminophen oral tablet 10-325 mg, 5- 325 mg, 7.5-325 mg


3 hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg


4 HYDROMORPHONE (PF) INJECTION SOLUTION 1 MG/ ML


4 hydromorphone (pf) injection solution 10 mg/ml


4 hydromorphone (pf) injection solution 2 mg/ ml


4 hydromorphone (pf) injection solution 4 mg/ ml


4 HYDROMORPHONE INJECTION SOLUTION 1 MG/ ML


4 hydromorphone injection solution 2 mg/ ml





4 HYDROMORPHONE INJECTION SOLUTION 4 MG/ ML

4 hydromorphone injection syringe 1 mg/ ml


4 hydromorphone injection syringe 2 mg/ ml

MO 4 hydromorphone injection syringe 4 mg/ ml


3 hydromorphone oral tablet 2 mg, 4 mg


4 hydromorphone oral tablet 8 mg

MO 1 ibu oral tablet 600 mg, 800 mg

MO 1 ibuprofen oral suspension

MO 1 ibuprofen oral tablet 400 mg, 600 mg, 800 mg


4 ibuprofen-oxycodone

PAR; MO 2 imipramine hcl PAR; MO 2 indomethacin oral

capsule PAR; MO 3 indomethacin oral

capsule, extended release MO; QLL (240 per 30 days)

5 INVEGA ORAL TABLET EXTENDED RELEASE 24HR 1.5 MG


5 INVEGA ORAL TABLET EXTENDED RELEASE 24HR 3 MG










5 INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/ 0.75 ML


5 INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 156 MG/ ML






5 INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 78 MG/0.5 ML


5 INVEGA TRINZA INTRAMUSCULAR SYRINGE 273 MG/ 0.875 ML










3 ketoprofen oral capsule 25 mg

MO 3 ketoprofen oral capsule 75 mg

PAR; MO 4 ketorolac oral ST; MO; QLL (120 per 30 days)

4 KHEDEZLA ORAL TABLET EXTENDED RELEASE 24HR 100 MG


4 KHEDEZLA ORAL TABLET EXTENDED RELEASE 24HR 50 MG

MO 2 lamotrigine oral tablet MO 3 lamotrigine oral tablet,

chewable dispersible 25 mg

MO 2 lamotrigine oral tablet, chewable dispersible 5 mg


5 LATUDA ORAL TABLET 120 MG, 60 MG


5 LATUDA ORAL TABLET 20 MG









4 LEVETIRACETAM IN NACL (ISO-OS) INTRAVENOUS PIGGYBACK 1,000 MG/100 ML, 1,500 MG/100 ML

MO 4 LEVETIRACETAM IN NACL (ISO-OS) INTRAVENOUS PIGGYBACK 500 MG/100 ML

MO 4 levetiracetam intravenous

MO 3 levetiracetam oral solution 100 mg/ml

4 levetiracetam oral solution 500 mg/5 ml (5 ml)

MO 3 levetiracetam oral tablet 1,000 mg

MO 2 levetiracetam oral tablet 250 mg, 500 mg, 750 mg


3 levetiracetam oral tablet extended release 24 hr 500 mg


3 levetiracetam oral tablet extended release 24 hr 750 mg

MO 1 lithium carbonate oral capsule 150 mg, 300 mg

MO 2 lithium carbonate oral capsule 600 mg

MO 2 lithium carbonate oral tablet

MO 2 lithium carbonate oral tablet extended release

MO 3 lithium citrate oral solution 8 meq/5 ml

MO 3 lorazepam intensol MO 3 lorazepam oral

concentrate MO 2 lorazepam oral tablet MO 3 loxapine succinate oral

capsule 10 mg, 5 mg




MO 4 loxapine succinate oral capsule 25 mg, 50 mg


4 LYRICA ORAL CAPSULE 100 MG






4 LYRICA ORAL CAPSULE 225 MG, 300 MG








4 LYRICA ORAL SOLUTION


4 maprotiline oral tablet 25 mg


4 maprotiline oral tablet 50 mg

MO 4 maprotiline oral tablet 75 mg

MO 4 MARPLAN MO 4 meclofenamate MO 1 meloxicam oral tablet PAR; MO; QLL (30 per 30 days)

3 memantine oral capsule,sprinkle,er 24hr


3 memantine oral solution


2 memantine oral tablet 10 mg






2 memantine oral tablet 5 mg

MO 5 MESTINON ORAL SYRUP

MO 5 MESTINON TIMESPAN


4 metadate er


3 methadone intensol


3 methadone oral concentrate


3 methadone oral solution 10 mg/5 ml


3 methadone oral solution 5 mg/5 ml


3 methadone oral tablet 10 mg


3 methadone oral tablet 5 mg


3 methadose oral concentrate

PAR; MO 4 methocarbamol oral PAR; MO; QLL (900 per 30 days)

3 methylphenidate hcl oral solution 10 mg/5 ml


3 methylphenidate hcl oral solution 5 mg/5 ml


3 methylphenidate hcl oral tablet


4 methylphenidate hcl oral tablet extended release 10 mg, 20 mg




MO 4 MIRAPEX ORAL TABLET 0.25 MG, 0.75 MG


1 mirtazapine oral tablet 15 mg






3 mirtazapine oral tablet 7.5 mg


3 mirtazapine oral tablet, disintegrating 15 mg






4 modafinil oral tablet 100 mg


4 modafinil oral tablet 200 mg


4 morphine (pf) injection solution 0.5 mg/ml


4 morphine (pf) injection solution 1 mg/ml


4 morphine (pf) intravenous patient control.analgesia soln 150 mg/30 ml


4 morphine (pf) intravenous patient control.analgesia soln 30 mg/30 ml


3 morphine concentrate oral solution






4 morphine injection solution 10 mg/ml


4 MORPHINE INJECTION SOLUTION 4 MG/ ML






4 morphine injection syringe 10 mg/ml


4 morphine injection syringe 2 mg/ml, 4 mg/ ml


4 morphine injection syringe 5 mg/ml


4 morphine intravenous cartridge 10 mg/ml


4 morphine intravenous cartridge 2 mg/ml, 4 mg/ml


4 MORPHINE INTRAVENOUS CARTRIDGE 8 MG/ ML


4 morphine intravenous solution 10 mg/ml


4 MORPHINE INTRAVENOUS SOLUTION 4 MG/ ML, 8 MG/ML


4 morphine intravenous syringe 2 mg/ml, 4 mg/ ml


3 morphine oral solution 10 mg/5 ml


3 morphine oral solution 20 mg/5 ml (4 mg/ml)





3 morphine oral tablet 15 mg


3 morphine oral tablet 30 mg


4 morphine oral tablet extended release 100 mg, 30 mg, 60 mg


3 morphine oral tablet extended release 15 mg


4 morphine oral tablet extended release 200 mg

MO 2 nabumetone MO; QLL (180 per 30 days)

4 nalbuphine injection solution 10 mg/ml


4 nalbuphine injection solution 20 mg/ml

MO 2 naloxone MO 2 naltrexone PAR; MO; QLL (56 per 365 days)

3 NAMENDA XR ORAL CAP, SPRINKLE,ER 24HR DOSE PACK


3 NAMENDA XR ORAL CAPSULE, SPRINKLE,ER 24HR

PAR; MO 3 NAMZARIC MO 2 naproxen oral

suspension MO 1 naproxen oral tablet MO 1 naproxen oral tablet,

delayed release (dr/ec) MO 1 naproxen sodium oral

tablet 275 mg, 550 mg MO; QLL (9 per 30 days)

4 naratriptan

MO 3 NARCAN NASAL SPRAY,NON- AEROSOL 4 MG/ ACTUATION






3 nefazodone oral tablet 100 mg










3 NEUPRO

MO 1 nortriptyline oral capsule 10 mg, 25 mg

MO 2 nortriptyline oral capsule 50 mg, 75 mg

MO 4 NORTRIPTYLINE ORAL SOLUTION


3 NUEDEXTA


5 NUPLAZID ORAL CAPSULE


5 NUPLAZID ORAL TABLET 10 MG


5 NUPLAZID ORAL TABLET 17 MG


4 olanzapine intramuscular


3 olanzapine oral tablet 10 mg







3 olanzapine oral tablet 2.5 mg






3 olanzapine oral tablet 7.5 mg


4 olanzapine oral tablet, disintegrating 10 mg








4 olanzapine-fluoxetine oral capsule 12-25 mg, 12-50 mg, 6-50 mg


4 olanzapine-fluoxetine oral capsule 3-25 mg, 6-25 mg


5 ONFI ORAL SUSPENSION


5 ONFI ORAL TABLET 10 MG


5 ONFI ORAL TABLET 20 MG

MO 4 ORAP MO 4 oxaprozin MO; QLL (120 per 30 days)

4 oxazepam

MO 4 oxcarbazepine oral suspension





MO 3 oxcarbazepine oral tablet 150 mg, 300 mg

MO 4 oxcarbazepine oral tablet 600 mg


4 oxycodone oral capsule


4 oxycodone oral concentrate


4 oxycodone oral solution


3 oxycodone oral tablet 10 mg, 5 mg


4 oxycodone oral tablet 15 mg, 20 mg, 30 mg


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


3 oxycodone- acetaminophen oral tablet 5-325 mg


4 oxycodone-aspirin


5 paliperidone oral tablet extended release 24hr 1.5 mg


5 paliperidone oral tablet extended release 24hr 3 mg






1 paroxetine hcl oral tablet 10 mg











4 paroxetine hcl oral tablet extended release 24 hr 12.5 mg


4 paroxetine hcl oral tablet extended release 24 hr 25 mg


4 paroxetine hcl oral tablet extended release 24 hr 37.5 mg


4 PAXIL ORAL SUSPENSION

MO 4 PEGANONE MO 4 perphenazine PAR; MO 4 perphenazine-

amitriptyline oral tablet 2-10 mg, 2-25 mg, 4- 10 mg, 4-50 mg

PAR; MO 3 perphenazine- amitriptyline oral tablet 4-25 mg

MO 3 phenelzine PAR; MO; QLL (3000 per 30 days)

4 phenobarbital oral elixir


2 phenobarbital oral tablet 100 mg




2 phenobarbital oral tablet 16.2 mg















MO 4 PHENYTEK 3 phenytoin oral

suspension 100 mg/4 ml MO 3 phenytoin oral

suspension 125 mg/5 ml MO 3 phenytoin oral tablet,

chewable MO 2 phenytoin sodium

extended MO 4 phenytoin sodium

intravenous solution 4 phenytoin sodium

intravenous syringe MO 3 pimozide MO 3 piroxicam MO 2 pramipexole oral tablet MO 2 primidone MO; QLL (120 per 30 days)

4 PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 100 MG





MO 4 protriptyline MO 3 pyridostigmine bromide





2 quetiapine oral tablet 100 mg












4 quetiapine oral tablet extended release 24 hr 150 mg









MO 3 rasagiline MO 4 RAZADYNE ORAL

TABLET 4 MG 4 regonol

MO 4 REQUIP ORAL TABLET 1 MG, 4 MG, 5 MG


5 REXULTI ORAL TABLET 0.25 MG, 0.5 MG, 1 MG, 2 MG






5 REXULTI ORAL TABLET 3 MG, 4 MG


4 RISPERDAL CONSTA INTRAMUSCULAR SYRINGE 12.5 MG/ 2 ML


5 RISPERDAL CONSTA INTRAMUSCULAR SYRINGE 25 MG/2 ML, 37.5 MG/2 ML, 50 MG/2 ML


3 risperidone oral solution


2 risperidone oral tablet 0.25 mg


2 risperidone oral tablet 0.5 mg


2 risperidone oral tablet 1 mg








4 risperidone oral tablet, disintegrating 0.25 mg


4 risperidone oral tablet, disintegrating 0.5 mg


4 risperidone oral tablet, disintegrating 1 mg











4 rivastigmine tartrate


4 rivastigmine transdermal patch


4 rizatriptan

MO 2 ropinirole oral tablet MO 4 ropinirole oral tablet

extended release 24 hr MO 2 roweepra oral tablet


3 ROZEREM

PAR; MO; LA; QLL

4 SABRIL ORAL POWDER IN PACKET (180 per 30

days) PAR; MO; LA; QLL

5 SABRIL ORAL TABLET


5 SAPHRIS SUBLINGUAL TABLET 10 MG


4 SAPHRIS SUBLINGUAL TABLET 2.5 MG


4 SAPHRIS SUBLINGUAL TABLET 5 MG

MO 3 selegiline hcl






4 SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 150 MG










4 sertraline oral concentrate


1 sertraline oral tablet 100 mg





MO 4 SINEMET CR ORAL TABLET EXTENDED RELEASE 25-100 MG





4 SPRITAM ORAL TABLET FOR SUSPENSION 1,000 MG, 250 MG, 500 MG


4 SPRITAM ORAL TABLET FOR SUSPENSION 750 MG


4 STRATTERA ORAL CAPSULE 10 MG, 18 MG, 25 MG, 40 MG


4 STRATTERA ORAL CAPSULE 100 MG, 60 MG, 80 MG

MO 1 sulindac oral tablet 150 mg

MO 2 sulindac oral tablet 200 mg

MO 4 sumatriptan nasal spray MO; QLL (9 per 30 days)

2 sumatriptan succinate oral

MO 4 sumatriptan succinate subcutaneous cartridge

MO 4 sumatriptan succinate subcutaneous pen injector

MO 4 sumatriptan succinate subcutaneous solution

PAR; MO 4 SURMONTIL MO; QLL (30 per 30 days)

4 SYMBYAX ORAL CAPSULE 12-25 MG, 12-50 MG, 6-50 MG


4 SYMBYAX ORAL CAPSULE 3-25 MG

PAR; MO 5 TECFIDERA MO 4 TEGRETOL XR

ORAL TABLET EXTENDED RELEASE 12 HR 100 MG


2 temazepam oral capsule 15 mg, 30 mg






5 tetrabenazine oral tablet 12.5 mg


5 tetrabenazine oral tablet 25 mg

ST; MO 2 thioridazine oral tablet 10 mg, 25 mg, 50 mg

ST; MO 3 thioridazine oral tablet 100 mg

MO 2 thiothixene MO 4 tiagabine MO 2 tizanidine oral tablet PAR; MO; QLL (180 per 30 days)

5 tolcapone

PAR; MO 4 topiramate oral capsule, sprinkle


2 topiramate oral tablet 100 mg








3 tramadol oral tablet


4 tramadol- acetaminophen

MO 4 tranylcypromine MO 1 trazodone oral tablet

100 mg, 150 mg, 50 mg

MO 4 trazodone oral tablet 300 mg

MO 3 trifluoperazine oral tablet 1 mg, 2 mg

MO 4 trifluoperazine oral tablet 10 mg, 5 mg




PAR; MO 2 trihexyphenidyl PAR; MO 4 trimipramine ST; MO; QLL (60 per 30 days)

4 TRINTELLIX ORAL TABLET 10 MG





PAR; MO; LA

5 TYSABRI

MO 2 valproate sodium MO 3 valproic acid MO 2 valproic acid (as sodium

salt) oral solution 250 mg/5 ml

2 valproic acid (as sodium salt) oral solution 250 mg/5 ml (5 ml), 500 mg/10 ml (10 ml)


2 venlafaxine oral capsule,extended release 24hr 150 mg


2 venlafaxine oral capsule,extended release 24hr 37.5 mg


2 venlafaxine oral capsule,extended release 24hr 75 mg


3 venlafaxine oral tablet 100 mg




3 venlafaxine oral tablet 37.5 mg










4 venlafaxine oral tablet extended release 24hr 150 mg


4 VENLAFAXINE ORAL TABLET EXTENDED RELEASE 24HR 225 MG


4 venlafaxine oral tablet extended release 24hr 37.5 mg


4 venlafaxine oral tablet extended release 24hr 75 mg


4 VERSACLOZ

PAR; MO; LA; QLL

5 vigabatrin

(180 per 30 days) ST; MO; QLL (120 per 30 days)

4 VIIBRYD ORAL TABLET 10 MG






4 VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23)


4 VIMPAT INTRAVENOUS


5 VIMPAT ORAL SOLUTION


4 VIMPAT ORAL TABLET 100 MG


4 VIMPAT ORAL TABLET 150 MG, 200 MG





4 VIMPAT ORAL TABLET 50 MG


3 VOLTAREN TOPICAL


5 VRAYLAR ORAL CAPSULE


4 VRAYLAR ORAL CAPSULE,DOSE PACK

PAR; MO; LA; QLL

5 XENAZINE ORAL TABLET 12.5 MG


5 XENAZINE ORAL TABLET 25 MG


5 XYREM

(540 per 30 days) PAR; MO; QLL (60 per 30 days)

2 zaleplon oral capsule 10 mg


2 zaleplon oral capsule 5 mg

MO 4 ZARONTIN ORAL CAPSULE


4 zenzedi oral tablet 10 mg


4 zenzedi oral tablet 5 mg


4 ziprasidone hcl oral capsule 20 mg


4 ziprasidone hcl oral capsule 40 mg






4 ziprasidone hcl oral capsule 60 mg, 80 mg


2 zolpidem oral tablet


4 zolpidem oral tablet,ext release multiphase

MO 3 zonisamide oral capsule 100 mg, 50 mg

MO 2 zonisamide oral capsule 25 mg


4 ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 210 MG


5 ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 300 MG, 405 MG Cardiovascular, Hypertension / Lipids

MO 4 ACCUPRIL MO 4 ACCURETIC ORAL

TABLET 20-12.5 MG, 20-25 MG

MO 2 acebutolol MO 4 ADALAT CC MO 2 afeditab cr ST; MO; QLL (60 per 30 days)

4 AGGRENOX

MO 4 ALDACTAZIDE ORAL TABLET 25- 25 MG

MO 4 ALTACE ORAL CAPSULE 10 MG, 2.5 MG, 5 MG

PAR; MO 4 ALTOPREV MO 3 amiloride MO 1 amiloride-

hydrochlorothiazide




B/D PAR; MO

4 amiodarone intravenous solution

B/D PAR 4 amiodarone intravenous syringe

MO 2 amiodarone oral tablet 100 mg, 200 mg

MO 4 amiodarone oral tablet 400 mg

MO 1 amlodipine besylate oral tablet

MO 3 amlodipine-atorvastatin MO 2 amlodipine-benazepril

oral capsule 10-20 mg, 10-40 mg, 5-10 mg, 5- 20 mg, 5-40 mg

MO 3 amlodipine-benazepril oral capsule 2.5-10 mg

MO 3 amlodipine-olmesartan MO 2 amlodipine-valsartan MO 4 amlodipine-valsartan-

hydrochlorothiazide ST; MO; QLL (60 per 30 days)

3 aspirin-dipyridamole

MO 4 ATACAND MO 4 ATACAND HCT MO 1 atenolol MO 1 atenolol-chlorthalidone MO 6 atorvastatin MO 4 AVALIDE MO 4 AVAPRO MO 3 AZOR MO 6 benazepril MO 6 benazepril-

hydrochlorothiazide MO 3 BENICAR MO 3 BENICAR HCT MO 2 betaxolol oral MO; QLL (180 per 30 days)

3 BIDIL

MO 2 bisoprolol fumarate MO 1 bisoprolol-

hydrochlorothiazide






3 BRILINTA

MO 3 bumetanide injection MO 2 bumetanide oral tablet

0.5 mg, 1 mg MO 3 bumetanide oral tablet

2 mg ST; MO 4 BYSTOLIC ORAL

TABLET 10 MG, 20 MG, 5 MG

MO 4 BYSTOLIC ORAL TABLET 2.5 MG

MO 4 CALAN ORAL TABLET 120 MG

MO 4 CALAN SR ORAL TABLET EXTENDED RELEASE 120 MG

MO 3 candesartan MO 3 candesartan-

hydrochlorothiazid MO 1 captopril MO 1 captopril-

hydrochlorothiazide MO 4 CARDIZEM LA MO 2 cartia xt MO 1 carvedilol MO 1 chlorothiazide oral

tablet 250 mg MO 2 chlorothiazide oral

tablet 500 mg MO 4 chlorothiazide sodium MO 2 chlorthalidone oral

tablet 25 mg, 50 mg MO 2 cholestyramine (with

sugar) MO 2 cholestyramine light MO 2 cilostazol MO 1 clonidine hcl oral tablet MO; QLL (4 per 28 days)

4 clonidine transdermal patch


3 clopidogrel oral tablet 300 mg





2 clopidogrel oral tablet 75 mg

MO 3 colesevelam MO 2 colestipol PAR; MO; QLL (60 per 30 days)

4 CORLANOR

MO 4 CORZIDE ORAL TABLET 40-5 MG

MO 4 COUMADIN ORAL MO 4 COZAAR MO 3 CRESTOR MO 5 DEMSER MO 2 digitek oral tablet 125

mcg PAR; MO 2 digitek oral tablet 250

mcg MO 3 digox oral tablet 125

mcg PAR; MO 4 digoxin injection

solution MO 3 digoxin oral solution 50

mcg/ml MO 2 digoxin oral tablet 125

mcg PAR; MO 2 digoxin oral tablet 250

mcg MO 2 dilt-xr

4 diltiazem hcl intravenous

MO 2 diltiazem hcl oral capsule,ext.rel 24h degradable

MO 3 diltiazem hcl oral capsule,extended release 12 hr

MO 2 diltiazem hcl oral capsule,extended release 24 hr

MO 2 diltiazem hcl oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg





MO 4 diltiazem hcl oral capsule,extended release 24hr 360 mg

MO 1 diltiazem hcl oral tablet MO 4 DIOVAN HCT PAR; MO 4 disopyramide phosphate

oral capsule MO 4 dofetilide MO 2 doxazosin MO 4 DYAZIDE MO; QLL (30 per 30 days)

3 EFFIENT


3 ELIQUIS ORAL TABLET 2.5 MG


3 ELIQUIS ORAL TABLET 5 MG

MO 6 enalapril maleate MO 6 enalapril-

hydrochlorothiazide MO; QLL (84 per 28 days)

4 enoxaparin subcutaneous solution


4 enoxaparin subcutaneous syringe 100 mg/ml, 150 mg/ml


4 enoxaparin subcutaneous syringe 120 mg/0.8 ml, 80 mg/ 0.8 ml


4 enoxaparin subcutaneous syringe 30 mg/0.3 ml





PAR; MO 4 ENTRESTO MO 4 eplerenone MO 3 eprosartan MO 4 EXFORGE MO 4 EXFORGE HCT




MO 4 ezetimibe MO 2 felodipine MO 4 fenofibrate micronized

oral capsule 130 mg MO 2 fenofibrate micronized

oral capsule 134 mg, 67 mg

MO 3 fenofibrate micronized oral capsule 200 mg, 43 mg

MO 3 fenofibrate nanocrystallized oral tablet 145 mg

MO 2 fenofibrate nanocrystallized oral tablet 48 mg

MO 3 fenofibrate oral tablet 160 mg

MO 2 fenofibrate oral tablet 54 mg

MO 3 fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 mg

MO 2 fenofibric acid (choline) oral capsule,delayed release(dr/ec) 45 mg

MO 2 flecainide MO 3 fluvastatin oral capsule

20 mg MO 4 fluvastatin oral capsule


5 fondaparinux subcutaneous syringe 10 mg/0.8 ml


5 fondaparinux subcutaneous syringe 2.5 mg/0.5 ml


5 fondaparinux subcutaneous syringe 5 mg/0.4 ml


5 fondaparinux subcutaneous syringe 7.5 mg/0.6 ml

MO 6 fosinopril MO 1 fosinopril-

hydrochlorothiazide





MO 3 furosemide injection MO 1 furosemide oral solution

10 mg/ml, 40 mg/5 ml (8 mg/ml)

MO 1 furosemide oral tablet MO 2 gemfibrozil PAR; MO 2 guanfacine oral tablet

4 heparin (porcine) in 5 % dex intravenous parenteral solution 20, 000 unit/500 ml (40 unit/ml)

MO 4 heparin (porcine) in 5 % dex intravenous parenteral solution 25, 000 unit/250 ml(100 unit/ml), 25,000 unit/ 500 ml (50 unit/ml)

B/D PAR 4 heparin (porcine) in nacl (pf)

B/D PAR; MO

4 heparin (porcine) injection cartridge

B/D PAR; MO

4 heparin (porcine) injection solution

MO 4 heparin (porcine) injection syringe 5,000 unit/ml

B/D PAR 4 HEPARIN(PORCINE) IN 0.45% NACL INTRAVENOUS PARENTERAL SOLUTION 12,500 UNIT/250 ML

MO 4 heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/ 250 ml

B/D PAR; MO

4 heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/ 500 ml

MO 4 heparin, porcine (pf) injection

MO 4 hydralazine injection




MO 2 hydralazine oral MO 1 hydrochlorothiazide MO 4 HYZAAR MO 1 indapamide MO 6 irbesartan MO 1 irbesartan-

hydrochlorothiazide MO 3 isosorbide dinitrate oral

tablet 3 isosorbide dinitrate oral

tablet extended release MO 2 isosorbide mononitrate MO 3 isradipine MO 1 jantoven PAR; MO; LA; QLL (30 per 30 days)

5 JUXTAPID


5 KYNAMRO

MO 4 labetalol intravenous solution

MO 2 labetalol oral tablet 100 mg, 200 mg

MO 3 labetalol oral tablet 300 mg

MO 3 LANOXIN ORAL TABLET 125 MCG, 62.5 MCG

MO 4 LIPITOR ORAL TABLET 10 MG

MO 6 lisinopril MO 6 lisinopril-

hydrochlorothiazide MO 4 LIVALO MO 4 LOPID MO 6 losartan MO 6 losartan-

hydrochlorothiazide MO 4 LOTENSIN ORAL


MO 6 lovastatin MO 4 matzim la MO 4 MAXZIDE MO 4 MAXZIDE-25MG





MO 3 methyclothiazide PAR; MO 2 methyldopa MO 3 metolazone oral tablet

10 mg, 5 mg MO 2 metolazone oral tablet

2.5 mg MO 2 metoprolol succinate MO 4 metoprolol tartrate

intravenous solution 4 metoprolol tartrate

intravenous syringe MO 1 metoprolol tartrate oral MO 3 metoprolol tartrate-

hydrochlorothiazide oral tablet 100-25 mg, 100-50 mg

MO 2 metoprolol tartrate- hydrochlorothiazide oral tablet 50-25 mg

MO 3 mexiletine oral capsule 150 mg, 250 mg

MO 4 mexiletine oral capsule 200 mg

MO 4 MICARDIS MO 4 MICARDIS HCT MO 4 MICROZIDE MO 4 MINIPRESS ORAL

CAPSULE 2 MG MO 2 minoxidil oral MO 1 moexipril MO 1 moexipril-

hydrochlorothiazide MO; QLL (60 per 30 days)

4 MULTAQ

MO 3 nadolol oral tablet 20 mg, 40 mg

MO 4 nadolol oral tablet 80 mg

MO 3 nadolol- bendroflumethiazide

MO 4 niacin oral tablet extended release 24 hr

MO 2 NIACOR MO 4 nicardipine intravenous

solution




MO 2 nicardipine oral MO 2 nifedipine oral tablet

extended release MO 2 nifedipine oral tablet

extended release 24hr MO 4 nimodipine MO 3 nitro-bid B/D PAR 4 nitroglycerin

intravenous MO 3 nitroglycerin sublingual MO 2 nitroglycerin

transdermal patch 24 hour

MO 4 nitroglycerin translingual spray,non- aerosol

MO 3 NITROSTAT PAR; MO 4 NORPACE MO 4 NORVASC MO 3 olmesartan MO 3 olmesartan-amlodipine-

hydrochlorothiazide MO 3 olmesartan-

hydrochlorothiazide MO 3 omega-3 acid ethyl

esters PAR; MO 3 ORENITRAM ORAL

TABLET EXTENDED RELEASE 0.125 MG

PAR; MO 5 ORENITRAM ORAL TABLET EXTENDED RELEASE 0.25 MG, 1 MG, 2.5 MG, 5 MG

MO 4 pacerone oral tablet 100 mg, 400 mg

MO 2 pacerone oral tablet 200 mg

MO 2 pentoxifylline MO 1 perindopril erbumine MO 3 pindolol oral tablet 10

mg MO 2 pindolol oral tablet 5

mg






4 PRADAXA


5 PRALUENT PEN


3 prasugrel

MO 4 PRAVACHOL ORAL TABLET 20 MG

MO 6 pravastatin MO 2 prazosin oral capsule 1

mg, 2 mg MO 3 prazosin oral capsule 5

mg MO 2 prevalite MO 4 PRINIVIL ORAL


MO 4 procainamide injection solution 100 mg/ml

4 procainamide injection solution 500 mg/ml

PAR; MO 4 PROCARDIA MO 4 PROCARDIA XL

ORAL TABLET EXTENDED RELEASE 24HR 30 MG


5 PROMACTA ORAL TABLET 12.5 MG, 25 MG, 75 MG


5 PROMACTA ORAL TABLET 50 MG

MO 2 propafenone oral tablet 150 mg



4 propranolol intravenous MO 3 propranolol oral

capsule,extended release 24 hr 120 mg, 160 mg




MO 2 propranolol oral capsule,extended release 24 hr 60 mg, 80 mg

MO 2 propranolol oral solution

MO 1 propranolol oral tablet 10 mg, 20 mg, 40 mg, 80 mg

MO 2 propranolol oral tablet 60 mg

MO 2 propranolol- hydrochlorothiazid

MO 6 quinapril MO 1 quinapril-

hydrochlorothiazide MO 4 quinidine gluconate

injection MO 2 quinidine sulfate oral

tablet MO 6 ramipril ST; MO 3 RANEXA PAR; MO; LA

5 REMODULIN

PAR; MO; QLL (3.5 per 28 days)

5 REPATHA PUSHTRONEX


5 REPATHA SURECLICK


5 REPATHA SYRINGE

MO 3 rosuvastatin MO 6 simvastatin MO 2 sorine oral tablet 120

mg, 160 mg 2 sorine oral tablet 240

mg MO 1 sorine oral tablet 80 mg MO 2 sotalol af oral tablet

120 mg, 160 mg MO 1 sotalol af oral tablet 80

mg MO 2 sotalol oral tablet 120

mg, 160 mg, 240 mg MO 1 sotalol oral tablet 80 mg





MO 2 spironolacton- hydrochlorothiaz

MO 1 spironolactone MO 4 SULAR ORAL

TABLET EXTENDED RELEASE 24 HR 17 MG

MO 2 taztia xt MO 3 TEKTURNA MO 3 TEKTURNA HCT MO 3 telmisartan MO 3 telmisartan-amlodipine MO 3 telmisartan-

hydrochlorothiazid MO 4 TENORETIC 100 MO 4 TENORETIC 50 MO 1 terazosin oral capsule MO 4 TIAZAC MO 4 TIKOSYN MO 2 timolol maleate oral

tablet 10 mg, 5 mg MO 3 timolol maleate oral

tablet 20 mg MO 4 TOPROL XL MO 2 torsemide oral MO 6 trandolapril MO 4 trandolapril-verapamil MO 3 tranexamic acid

intravenous MO 1 triamterene-

hydrochlorothiazid oral capsule 37.5-25 mg

MO 4 triamterene- hydrochlorothiazid oral capsule 50-25 mg

MO 1 triamterene- hydrochlorothiazid oral tablet

MO 3 TRIBENZOR MO 4 TRICOR ORAL

TABLET 48 MG




MO 4 TRILIPIX ORAL CAPSULE, DELAYED RELEASE(DR/EC) 45 MG

MO 4 TWYNSTA ORAL TABLET 40-10 MG, 40-5 MG, 80-5 MG


5 UPTRAVI ORAL TABLET

PAR; MO; LA; QLL

5 UPTRAVI ORAL TABLETS,DOSE PACK (400 per 365

days) MO 1 valsartan MO 6 valsartan-

hydrochlorothiazide MO 4 VASCEPA MO 4 VASERETIC MO 4 VASOTEC ORAL

TABLET 2.5 MG 4 VECAMYL

MO 2 verapamil intravenous solution

4 verapamil intravenous syringe

MO 2 verapamil oral capsule, 24 hr er pellet ct

MO 2 verapamil oral capsule, ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg

MO 3 verapamil oral capsule, ext rel. pellets 24 hr 360 mg

MO 1 verapamil oral tablet MO 2 verapamil oral tablet

extended release 120 mg MO 1 verapamil oral tablet

extended release 180 mg, 240 mg

MO 1 warfarin MO 3 WELCHOL






3 XARELTO ORAL TABLET 10 MG, 20 MG


3 XARELTO ORAL TABLET 15 MG


3 XARELTO ORAL TABLETS,DOSE PACK

MO 4 ZESTORETIC MO 4 ZESTRIL ORAL

TABLET 10 MG, 20 MG, 40 MG, 5 MG

MO 4 ZETIA MO 4 ZIAC ORAL

TABLET 10-6.25 MG, 5-6.25 MG

MO 4 ZOCOR ORAL TABLET 10 MG Dermatologicals/Topical Therapy

MO 4 acitretin oral capsule 10 mg

MO 5 acitretin oral capsule 17.5 mg, 25 mg


4 acyclovir topical

MO 4 adapalene topical cream MO 4 adapalene topical gel

0.1 % MO 1 ala-cort topical cream

2.5 % MO 4 alclometasone topical

cream MO 3 alclometasone topical

ointment MO 4 amcinonide topical

cream MO 4 amcinonide topical

lotion 4 amcinonide topical

ointment MO 2 ammonium lactate PAR; MO; QLL (45 per 30 days)

4 avita topical cream




MO 4 betamethasone dipropionate topical cream

MO 3 betamethasone dipropionate topical lotion

MO 4 betamethasone dipropionate topical ointment

MO 2 betamethasone valerate topical cream

MO 4 betamethasone valerate topical lotion

MO 3 betamethasone valerate topical ointment

MO 2 betamethasone, augmented topical cream

MO 4 betamethasone, augmented topical gel

MO 4 betamethasone, augmented topical lotion

MO 4 betamethasone, augmented topical ointment


4 calcipotriene scalp


4 calcipotriene topical

MO 4 calcitriol topical MO 3 ciclodan MO 3 ciclopirox topical cream MO 4 ciclopirox topical gel MO 4 ciclopirox topical

shampoo MO 2 ciclopirox topical

solution MO 3 ciclopirox topical

suspension MO 4 claravis MO 3 clindamycin phosphate

topical gel





MO 3 clindamycin phosphate topical lotion

MO 3 clindamycin phosphate topical solution

MO 2 clindamycin phosphate topical swab

MO 4 clindamycin-benzoyl peroxide topical gel

MO 2 clobetasol scalp MO; QLL (120 per 30 days)

2 clobetasol topical cream


4 clobetasol topical foam

MO 2 clobetasol topical gel MO 4 clobetasol topical lotion MO; QLL (120 per 30 days)

3 clobetasol topical ointment

MO 4 clobetasol topical shampoo


3 clobetasol-emollient topical cream


4 clobetasol-emollient topical foam

MO 4 CLOBEX TOPICAL LOTION

MO 3 clotrimazole topical cream

MO 2 clotrimazole topical solution

MO 3 clotrimazole- betamethasone topical cream

MO 4 clotrimazole- betamethasone topical lotion


5 DENAVIR

MO 4 DERMATOP TOPICAL OINTMENT

MO 4 desonide




MO 4 desoximetasone topical cream

MO 4 desoximetasone topical gel

MO 4 desoximetasone topical ointment 0.25 %


5 diclofenac sodium topical gel 3 %

MO 4 diflorasone MO 2 econazole PAR; MO; QLL (100 per 90 days)

4 ELIDEL

MO 3 ery pads MO 2 erythromycin with

ethanol MO 3 erythromycin-benzoyl

peroxide MO 4 EXELDERM MO; QLL (120 per 30 days)

4 fluocinolone


4 fluocinolone and shower cap


2 fluocinonide topical cream 0.05 %


5 fluocinonide topical cream 0.1 %


3 fluocinonide topical gel


3 fluocinonide topical ointment


4 fluocinonide topical solution


2 fluocinonide-e


2 FLUOCINONIDE- EMOLLIENT





MO 3 fluorouracil topical cream 5 %

MO 4 fluorouracil topical solution 2 %

MO 3 fluorouracil topical solution 5 %

MO 3 fluticasone topical cream

MO 4 fluticasone topical lotion

MO 3 fluticasone topical ointment

MO 3 gentamicin topical MO 4 halobetasol propionate MO 4 HALOG MO 2 hydrocortisone butyrate

topical cream MO 4 hydrocortisone butyrate

topical ointment MO 2 hydrocortisone butyrate

topical solution MO 1 hydrocortisone topical

cream 1 %, 2.5 % MO 3 hydrocortisone topical

lotion 2.5 % MO 1 hydrocortisone topical

ointment 1 %, 2.5 % MO 4 hydrocortisone valerate MO 2 hydrocortisone-min oil-

wht pet MO 4 imiquimod topical

cream in packet MO 3 ketoconazole topical

cream MO 2 ketoconazole topical

shampoo MO 4 lidocaine (pf) injection

solution 5 mg/ml (0.5 %)

MO 3 lidocaine hcl injection solution 20 mg/ml (2 %)


2 lidocaine hcl laryngotracheal




MO 2 lidocaine hcl mucous membrane jelly

MO 2 lidocaine hcl mucous membrane jelly in applicator


2 lidocaine hcl mucous membrane solution 4 % (40 mg/ml)


4 lidocaine topical adhesive patch, medicated


4 lidocaine topical ointment

MO 2 lidocaine viscous MO; QLL (30 per 30 days)

4 lidocaine-prilocaine topical cream

MO 4 lindane topical shampoo MO 4 malathion PAR; MO 5 methoxsalen MO 4 metronidazole topical

cream MO 3 metronidazole topical

gel 0.75 % MO 4 metronidazole topical

gel 1 % MO 4 metronidazole topical

lotion MO 2 mometasone topical MO 4 mupirocin topical

cream MO 2 mupirocin topical

ointment MO 4 myorisan oral capsule

10 mg, 20 mg, 40 mg MO 3 nyamyc MO 2 nystatin topical cream MO 2 nystatin topical

ointment MO 3 nystatin topical powder MO 4 nystatin-triamcinolone MO 3 nystop MO 5 PANRETIN MO 3 permethrin topical

cream





MO 4 PICATO MO 4 podofilox MO 4 prednicarbate MO 2 rosadan topical cream MO 2 rosadan topical gel MO; QLL (30 per 30 days)

4 SANTYL

MO 2 selenium sulfide topical lotion

MO 3 SILVADENE MO 3 silver sulfadiazine MO 3 ssd topical cream 1% PAR; MO; QLL (1 per 28 days)

5 STELARA SUBCUTANEOUS SYRINGE

MO 4 sulfacetamide sodium (acne)

MO 4 SULFAMYLON TOPICAL CREAM


4 tacrolimus topical

PAR; MO 5 TALTZ SYRINGE PAR; MO 4 tazarotene PAR; MO 4 TAZORAC MO; QLL (120 per 30 days)

4 TEMOVATE TOPICAL CREAM


4 TEMOVATE TOPICAL OINTMENT


3 tretinoin topical cream


3 tretinoin topical gel 0.01 %, 0.025 %

MO 1 triamcinolone acetonide topical cream 0.025 %

MO 2 triamcinolone acetonide topical cream 0.1 %, 0.5 %

MO 3 triamcinolone acetonide topical lotion




MO 2 triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 %

MO 5 trianex MO 1 triderm topical cream B/D PAR 4 UVADEX PAR; MO 5 VALCHLOR MO 4 zenatane oral capsule

10 mg, 20 mg, 40 mg MO 3 zenatane oral capsule

30 mg Diagnostics / Miscellaneous Agents

MO 4 acamprosate MO 2 acetic acid irrigation MO 2 acetylcysteine

intravenous MO 5 ADAGEN MO; QLL (30 per 30 days)

6 alendronate oral tablet 40 mg

MO 3 anagrelide PAR; MO; LA

5 ARALAST NP

PAR; MO 5 BUPHENYL ORAL TABLET


2 bupropion hcl (smoking deter)

PAR; MO; LA

5 CARBAGLU

MO 4 cevimeline PAR; MO; QLL (60 per 30 days)

4 CHANTIX


4 CHANTIX CONTINUING MONTH BOX


4 CHANTIX STARTING MONTH BOX

B/D PAR 4 CLINIMIX 4.25%/ D5W SULFIT FREE

B/D PAR 4 CLINIMIX E 2.75%/ D10W SUL FREE

B/D PAR 4 CLINIMIX E 2.75%/ D5W SULF FREE





B/D PAR 4 CLINIMIX N9G20E 2.75%-D10W(SF)

4 d10 %-0.45 % sodium chloride

4 d2.5 %-0.45 % sodium chloride

MO 3 d5 % and 0.9 % sodium chloride

MO 3 d5 %-0.45 % sodium chloride

4 dextrose 10 % and 0.2 % nacl

MO 4 dextrose 10 % in water (d10w)

4 dextrose 25 % in water (d25w)




MO 3 dextrose 5 %-lactated ringers

4 dextrose 5%-0.2 % sod chloride

4 dextrose 5%-0.3 % sod.chloride

MO 4 dextrose 50 % in water (d50w) intravenous parenteral solution

4 dextrose 50 % in water (d50w) intravenous syringe


4 dextrose with sodium chloride

MO 4 disulfiram MO 2 etidronate disodium PAR; MO; LA

5 EXJADE

PAR; MO; LA

5 INCRELEX

MO 3 kionex (with sorbitol)




MO 4 lactated ringers irrigation

B/D PAR; MO

3 levocarnitine (with sugar)

MO 3 levocarnitine oral tablet MO 4 midodrine MO 4 neomycin-polymyxin b

gu MO; QLL (120 per 30 days)

3 NICOTROL NS


5 NORTHERA ORAL CAPSULE 100 MG





PAR; LA 5 ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG

PAR; MO; LA

5 ORFADIN ORAL CAPSULE 20 MG

PAR; MO; LA

5 ORFADIN ORAL SUSPENSION

4 PHYSIOLYTE 4 PHYSIOSOL

IRRIGATION MO 4 pilocarpine hcl oral PAR; LA 5 PROLASTIN-C

INTRAVENOUS RECON SOLN

PAR; MO 5 PROLASTIN-C INTRAVENOUS SOLUTION


5 RAVICTI


3 RENVELA ORAL TABLET

MO 4 riluzole MO 4 ringer's irrigation






4 risedronate oral tablet 30 mg


5 sevelamer carbonate oral powder in packet 0.8 gram


5 sevelamer carbonate oral powder in packet 2.4 gram


3 sevelamer carbonate oral tablet

MO 3 sodium chloride 0.9 % intravenous

MO 3 sodium chloride irrigation

PAR; MO 5 sodium phenylbutyrate MO 4 sodium polystyrene (sorb

free) MO 4 sodium polystyrene

sulfonate oral 4 sodium polystyrene

sulfonate rectal enema 30 gram/120 ml

4 SODIUM POLYSTYRENE SULFONATE RECTAL ENEMA 50 GRAM/200 ML

MO 4 sps (with sorbitol) oral 4 sps (with sorbitol) rectal

MO 5 SYPRINE PAR; MO 5 THIOLA MO 5 trientine MO 3 water for irrigation,

sterile PAR; MO 4 zoledronic acid-

mannitol-water 5 mg/ 100 ml Ear, Nose / Throat Medications

MO 1 acetic acid otic (ear) MO; QLL (30 per 25 days)

3 azelastine nasal aerosol, spray





4 azelastine nasal spray, non-aerosol

MO 1 chlorhexidine gluconate mucous membrane

MO 3 CIPRODEX MO 4 COLY-MYCIN S MO 2 denta 5000 plus MO 2 dentagel MO 4 fluocinolone acetonide

oil otic MO 4 hydrocortisone-acetic

acid MO; QLL (30 per 30 days)

2 ipratropium bromide nasal

MO 2 neomycin-polymyxin-hc otic (ear)

MO 2 ofloxacin otic (ear) MO 1 paroex oral rinse MO 1 periogard MO 2 sf 5000 plus MO 3 triamcinolone acetonide

dental Endocrine/Diabetes

MO 4 a-hydrocort MO; QLL (90 per 30 days)

3 acarbose oral tablet 100 mg





PAR; MO 5 ACTHAR H.P. MO; QLL (60 per 30 days)

4 ACTOPLUS MET XR ORAL TABLET, ER MULTIPHASE 24 HR 15-1,000 MG


4 ACTOPLUS MET XR ORAL TABLET, ER MULTIPHASE 24 HR 30-1,000 MG

MO 1 alcohol pads PAR; MO 5 ALDURAZYME






4 AMARYL ORAL TABLET 1 MG





PAR; MO 5 ANADROL-50 PAR; MO; QLL (150 per 30 days)

3 ANDROGEL TRANSDERMAL GEL IN METERED- DOSE PUMP 20.25 MG/1.25 GRAM (1.62 %)


3 ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (20.25 MG/ 1.25 GRAM)


3 ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (40.5 MG/2.5 GRAM)

PAR; MO 2 armour thyroid PAR; MO; QLL (120 per 30 days)

4 AVANDIA ORAL TABLET 2 MG


4 AVANDIA ORAL TABLET 4 MG


3 BYDUREON


3 BYDUREON BCISE


3 BYETTA SUBCUTANEOUS PEN INJECTOR 10 MCG/DOSE(250 MCG/ML) 2.4 ML





3 BYETTA SUBCUTANEOUS PEN INJECTOR 5 MCG/DOSE (250 MCG/ML) 1.2 ML

MO 3 cabergoline MO; QLL (4 per 30 days)

3 calcitonin (salmon)

MO 4 calcitriol intravenous solution 1 mcg/ml

MO 2 calcitriol oral capsule B/D PAR; MO

3 calcitriol oral solution

PAR; MO 5 CEREZYME INTRAVENOUS RECON SOLN 400 UNIT

MO 4 cortisone ST; MO; QLL (180 per 30 days)

4 CYCLOSET

MO 4 CYTOMEL MO 3 danazol MO 4 desmopressin injection MO 4 desmopressin nasal spray

with pump MO 4 desmopressin nasal

spray,non-aerosol MO 4 desmopressin oral MO 4 dexamethasone intensol MO 4 dexamethasone oral

elixir MO 4 dexamethasone oral

solution MO 1 dexamethasone oral

tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

MO 2 dexamethasone oral tablet 2 mg, 4 mg, 6 mg

MO 4 dexamethasone sodium phos (pf)

MO 3 dexamethasone sodium phosphate injection solution





MO 4 dexamethasone sodium phosphate injection syringe

4 doxercalciferol intravenous

B/D PAR; MO

4 doxercalciferol oral capsule 0.5 mcg

MO 5 doxercalciferol oral capsule 1 mcg, 2.5 mcg


4 DUETACT ORAL TABLET 30-4 MG

PAR; MO 5 ELAPRASE PAR; MO 5 FABRAZYME MO 3 fludrocortisone MO; QLL (200 per 30 days)

1 gauze pads 2 x 2


6 glimepiride oral tablet 1 mg






6 glipizide oral tablet 10 mg


6 glipizide oral tablet 5 mg


6 glipizide oral tablet extended release 24hr 10 mg


6 glipizide oral tablet extended release 24hr 2.5 mg


6 glipizide oral tablet extended release 24hr 5 mg


6 glipizide-metformin oral tablet 2.5-250 mg





6 glipizide-metformin oral tablet 2.5-500 mg, 5-500 mg

MO 3 GLUCAGEN HYPOKIT

MO 4 GLUCAGON EMERGENCY KIT (HUMAN)


4 GLUCOPHAGE ORAL TABLET 1, 000 MG


4 GLUCOPHAGE ORAL TABLET 500 MG


4 GLUCOPHAGE ORAL TABLET 850 MG


4 GLUCOPHAGE XR ORAL TABLET EXTENDED RELEASE 24 HR 500 MG


4 GLUCOPHAGE XR ORAL TABLET EXTENDED RELEASE 24 HR 750 MG


4 GLUCOTROL ORAL TABLET 10 MG


4 GLUCOTROL ORAL TABLET 5 MG


4 GLUCOTROL XL ORAL TABLET EXTENDED RELEASE 24HR 10 MG


4 GLUCOTROL XL ORAL TABLET EXTENDED RELEASE 24HR 2.5 MG






4 GLUCOTROL XL ORAL TABLET EXTENDED RELEASE 24HR 5 MG


4 GLUCOVANCE


5 GLUMETZA ORAL TABLET,ER GAST.RETENTION 24 HR 1,000 MG


5 GLUMETZA ORAL TABLET,ER GAST.RETENTION 24 HR 500 MG


2 glyburide micronized oral tablet 1.5 mg


2 glyburide micronized oral tablet 3 mg


2 glyburide micronized oral tablet 6 mg


2 glyburide oral tablet 1.25 mg


2 glyburide oral tablet 2.5 mg


2 glyburide oral tablet 5 mg


2 glyburide-metformin oral tablet 1.25-250 mg


2 glyburide-metformin oral tablet 2.5-500 mg, 5-500 mg


4 GLYSET ORAL TABLET 100 MG








MO 3 HUMALOG JUNIOR KWIKPEN U-100

MO 3 HUMALOG KWIKPEN INSULIN

MO 3 HUMALOG MIX 50- 50 INSULN U-100

MO 3 HUMALOG MIX 50- 50 KWIKPEN

MO 3 HUMALOG MIX 75- 25 KWIKPEN

MO 3 HUMALOG MIX 75- 25(U-100)INSULN

MO 3 HUMALOG U-100 INSULIN

MO 3 HUMULIN 70/30 U- 100 INSULIN

MO 3 HUMULIN 70/30 U- 100 KWIKPEN

MO 3 HUMULIN N NPH INSULIN KWIKPEN

MO 3 HUMULIN N NPH U-100 INSULIN

MO 3 HUMULIN R REGULAR U-100 INSULN

MO 3 HUMULIN R U-500 (CONC) INSULIN

MO 3 HUMULIN R U-500 (CONC) KWIKPEN

MO 3 hydrocortisone oral tablet 10 mg, 5 mg

MO 2 hydrocortisone oral tablet 20 mg


2 insulin pen needle


2 insulin syringe (disp) u- 100 0.3 ml, 1 ml, 1/2 ml


3 JANUMET






3 JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG


3 JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 50-1,000 MG, 50-500 MG


3 JANUVIA ORAL TABLET 100 MG






3 JARDIANCE


3 JENTADUETO


3 JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG


3 JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 5-1,000 MG

PAR; MO 5 KORLYM PAR; MO 5 KUVAN ORAL

TABLET,SOLUBLE MO 3 LANTUS

SOLOSTAR U-100 INSULIN

MO 3 LANTUS U-100 INSULIN

MO 3 LEVEMIR FLEXTOUCH U-100 INSULN

MO 3 LEVEMIR U-100 INSULIN

MO 1 levothyroxine oral




MO 3 levoxyl oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg

MO 5 liothyronine intravenous

MO 2 liothyronine oral MO; QLL (60 per 30 days)

6 metformin oral tablet 1,000 mg


6 metformin oral tablet 500 mg


6 metformin oral tablet 850 mg


6 metformin oral tablet extended release 24 hr 500 mg


6 metformin oral tablet extended release 24 hr 750 mg


4 metformin oral tablet extended release 24 hrs osm-tab 500mg


4 metformin oral tablet extended release 24hr 1, 000 mg


5 metformin oral tablet,er gast.retention 24 hr 1, 000 mg


5 metformin oral tablet,er gast.retention 24 hr 500 mg

MO 2 methimazole oral tablet 10 mg, 5 mg

MO 3 methylprednisolone acetate

MO 3 methylprednisolone oral tablet 16 mg, 32 mg, 4 mg

MO 4 methylprednisolone oral tablet 8 mg





MO 3 methylprednisolone oral tablets,dose pack

MO 4 methylprednisolone sodium succ injection recon soln 125 mg, 40 mg

MO 4 methylprednisolone sodium succ intravenous

B/D PAR; MO

5 MIACALCIN INJECTION


4 miglitol oral tablet 100 mg





PAR; MO; LA

5 miglustat

PAR; MO; LA

5 NAGLAZYME


4 nateglinide oral tablet 120 mg


4 nateglinide oral tablet 60 mg


5 NATPARA


2 needles, insulin disp., safety


5 oxandrolone oral tablet 10 mg


3 oxandrolone oral tablet 2.5 mg

MO 3 OZEMPIC MO 4 pamidronate

intravenous recon soln




MO 4 pamidronate intravenous solution 30 mg/10 ml (3 mg/ml), 90 mg/10 ml (9 mg/ml)

B/D PAR; MO

2 pamidronate intravenous solution 60 mg/10 ml (6 mg/ml)

MO 4 paricalcitol oral MO; QLL (90 per 30 days)

2 pioglitazone oral tablet 15 mg






4 pioglitazone-glimepiride


4 pioglitazone-metformin


4 PRECOSE ORAL TABLET 100 MG





MO 3 prednisolone oral solution 15 mg/5 ml

MO 3 prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml)

MO 4 prednisolone sodium phosphate oral solution 5 mg base/5 ml (6.7 mg/5 ml)

MO 4 prednisolone sodium phosphate oral tablet, disintegrating

MO 4 prednisone intensol MO 3 prednisone oral solution





MO 1 prednisone oral tablet MO 1 prednisone oral tablets,

dose pack MO 5 PROGLYCEM MO 3 propylthiouracil MO; QLL (960 per 30 days)

4 repaglinide oral tablet 0.5 mg


4 repaglinide oral tablet 1 mg


4 repaglinide oral tablet 2 mg


4 RIOMET


5 SAMSCA ORAL TABLET 15 MG


5 SAMSCA ORAL TABLET 30 MG

B/D PAR; MO; QLL

3 SENSIPAR ORAL TABLET 30 MG

(60 per 30 days) B/D PAR; MO; QLL




(120 per 30 days) PAR; MO 5 SOMAVERT MO 5 STIMATE PAR; MO; QLL (11 per 30 days)

5 SYMLINPEN 120


5 SYMLINPEN 60

PAR; MO 5 SYNAREL





3 SYNJARDY


3 SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 12.5-1, 000 MG, 5-1,000 MG


3 SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 25-1,000 MG

MO 3 SYNTHROID MO; QLL (4 per 28 days)

4 TANZEUM

MO 3 TAPAZOLE PAR; MO 2 testosterone cypionate PAR; MO 4 testosterone enanthate PAR; MO; QLL (300 per 30 days)

3 TESTOSTERONE TRANSDERMAL GEL


3 TESTOSTERONE TRANSDERMAL GEL IN METERED- DOSE PUMP 10 MG/0.5 GRAM / ACTUATION


3 TESTOSTERONE TRANSDERMAL GEL IN METERED- DOSE PUMP 12.5 MG/ 1.25 GRAM (1 %)


3 testosterone transdermal gel in packet 1 % (25 mg/2.5gram)


3 TESTOSTERONE TRANSDERMAL GEL IN PACKET 1 % (50 MG/5 GRAM)

PAR 2 thyroid (pork) oral tablet 30 mg, 60 mg

PAR; MO 2 thyroid (pork) oral tablet 90 mg






1 tolazamide oral tablet 250 mg


1 tolazamide oral tablet 500 mg


2 tolbutamide

MO 3 TOUJEO MAX U- 300 SOLOSTAR

MO 3 TOUJEO SOLOSTAR U-300 INSULIN


3 TRADJENTA

MO 4 triamcinolone acetonide injection


3 TRULICITY

MO 3 unithroid oral tablet 100 mcg, 112 mcg, 125 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

MO 1 unithroid oral tablet 137 mcg


3 VICTOZA 2-PAK


3 VICTOZA 3-PAK

PAR; MO 5 VPRIV PAR; MO; LA

5 ZAVESCA

PAR; MO 4 zoledronic acid intravenous solution 4 mg/5 ml intravenous solution

PAR; MO 5 ZOMETA INTRAVENOUS PIGGYBACK Gastroenterology





5 alosetron


3 AMITIZA

B/D PAR; MO; QLL (5 per 30 days)

3 aprepitant oral capsule 125 mg



B/D PAR; MO; QLL



3 aprepitant oral capsule, dose pack

(15 per 30 days) MO 3 APRISO MO 3 ASACOL HD MO 4 atropine injection

solution 0.4 mg/ml 4 atropine injection

syringe 0.05 mg/ml, 0.1 mg/ml

MO 4 balsalazide MO 5 budesonide oral MO 5 CANASA MO 4 carafate oral suspension MO 3 cimetidine MO 3 cimetidine hcl oral MO 4 compro MO 2 constulose MO 3 CREON MO 4 cromolyn oral MO 5 CYSTADANE MO 3 DELZICOL ORAL

CAPSULE (WITH DEL REL TABLETS)


4 DEXILANT

MO 1 dicyclomine oral capsule





MO 4 dicyclomine oral solution

MO 2 dicyclomine oral tablet MO 5 DIPENTUM MO 1 diphenoxylate-atropine

oral liquid MO 3 diphenoxylate-atropine

oral tablet B/D PAR; MO; QLL

5 dronabinol oral capsule 10 mg


4 dronabinol oral capsule 2.5 mg, 5 mg

(120 per 30 days) B/D PAR; MO; QLL (5 per 30 days)

3 EMEND ORAL CAPSULE 125 MG



B/D PAR; MO; QLL



3 EMEND ORAL CAPSULE,DOSE PACK (15 per 30

days) B/D PAR; MO; QLL

3 EMEND ORAL SUSPENSION FOR RECONSTITUTION (15 per 30

days) MO 2 enulose MO; QLL (30 per 30 days)

4 esomeprazole magnesium

4 esomeprazole sodium intravenous recon soln 20 mg

MO 4 esomeprazole sodium intravenous recon soln 40 mg

MO 3 famotidine (pf)




MO 3 famotidine (pf)-nacl (iso-os)

MO 4 famotidine intravenous solution

MO 4 famotidine oral suspension

MO 1 famotidine oral tablet 20 mg, 40 mg

PAR; MO 5 GATTEX 30-VIAL PAR; MO 5 GATTEX ONE-VIAL MO 2 gavilyte-c MO 2 gavilyte-g MO 2 gavilyte-n MO 2 generlac MO 4 glycopyrrolate injection MO 3 glycopyrrolate oral

tablet 1 mg, 2 mg MO 4 granisetron (pf)

intravenous solution 100 mcg/ml

MO 4 granisetron hcl intravenous

B/D PAR; MO; QLL

4 granisetron hcl oral

(30 per 30 days) MO 4 hydrocortisone rectal MO 1 hydrocortisone topical

cream with perineal applicator 2.5 %

MO 2 lactulose oral solution MO; QLL (30 per 30 days)

4 lansoprazole oral capsule,delayed release(dr/ec)

MO 3 LIALDA MO; QLL (30 per 30 days)

3 LINZESS

MO 3 loperamide oral capsule MO 2 meclizine oral tablet

12.5 mg, 25 mg MO 3 mesalamine oral tablet,

delayed release (dr/ec) 1.2 gram





MO 3 MESALAMINE ORAL TABLET, DELAYED RELEASE (DR/EC) 800 MG

MO 3 mesalamine rectal MO 4 mesalamine with

cleansing wipe MO 4 methscopolamine MO 3 metoclopramide hcl

injection solution 4 metoclopramide hcl

injection syringe MO 2 metoclopramide hcl oral

solution MO 1 metoclopramide hcl oral

tablet MO 3 misoprostol oral tablet

100 mcg MO 4 misoprostol oral tablet

200 mcg MO; QLL (30 per 30 days)

3 MOVANTIK

MO 4 MOVIPREP MO 3 nizatidine oral capsule MO; QLL (30 per 30 days)

2 omeprazole oral capsule, delayed release(dr/ec)

MO 4 ondansetron hcl (pf) injection solution

MO 3 ondansetron hcl (pf) injection syringe

MO 4 ondansetron hcl intravenous

B/D PAR; MO; QLL

4 ondansetron hcl oral solution

(450 per 30 days) B/D PAR; QLL (30 per 30 days)

4 ondansetron hcl oral tablet 24 mg

B/D PAR; MO; QLL

3 ondansetron hcl oral tablet 4 mg, 8 mg

(90 per 30 days)




B/D PAR; MO; QLL

4 ondansetron oral tablet, disintegrating 4 mg


3 ondansetron oral tablet, disintegrating 8 mg

(90 per 30 days) MO 2 opium tincture MO 4 OSMOPREP MO 4 pantoprazole

intravenous MO; QLL (30 per 30 days)

1 pantoprazole oral

MO 2 paregoric MO 2 peg 3350-electrolytes

oral recon soln 236- 22.74-6.74 -5.86 gram

2 peg 3350-electrolytes oral recon soln 240- 22.72-6.72 -5.84 gram

2 peg-electrolyte soln MO 3 PENTASA MO 2 polyethylene glycol 3350 MO 4 prochlorperazine MO 4 prochlorperazine

edisylate injection solution 10 mg/2 ml (5 mg/ml)

MO 2 prochlorperazine maleate

MO 4 procto-med hc MO 2 procto-pak MO 2 proctosol hc topical MO 1 proctozone-hc MO 4 propantheline MO 4 ranitidine hcl injection MO 3 ranitidine hcl oral

capsule MO 4 ranitidine hcl oral syrup MO 1 ranitidine hcl oral

tablet 150 mg, 300 mg PAR; MO; QLL (18 per 30 days)

5 RELISTOR SUBCUTANEOUS SOLUTION






5 RELISTOR SUBCUTANEOUS SYRINGE 12 MG/0.6 ML


5 RELISTOR SUBCUTANEOUS SYRINGE 8 MG/0.4 ML

PAR; MO 5 REMICADE MO; QLL (10 per 30 days)

4 scopolamine base

MO 5 SUCRAID MO 2 sucralfate oral tablet MO 2 sulfasalazine MO 3 SUPREP BOWEL

PREP KIT MO; QLL (10 per 30 days)

4 transderm-scop

MO 2 trilyte with flavor packets

MO 5 UCERIS ORAL MO 3 ursodiol

Immunology, Vaccines / Biotechnology MO 3 ACTHIB (PF) PAR; MO 5 ACTIMMUNE MO 3 ADACEL(TDAP

ADOLESN/ ADULT)(PF)

PAR; MO 5 ARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 300 MCG/ML

PAR; MO 4 ARANESP (IN POLYSORBATE) INJECTION SOLUTION 25 MCG/ML, 40 MCG/ ML, 60 MCG/ML




PAR; MO 4 ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/ 0.4 ML, 25 MCG/ 0.42 ML, 40 MCG/ 0.4 ML, 60 MCG/0.3 ML

PAR; MO 5 ARANESP (IN POLYSORBATE) INJECTION SYRINGE 100 MCG/ 0.5 ML, 150 MCG/ 0.3 ML, 200 MCG/ 0.4 ML, 300 MCG/ 0.6 ML, 500 MCG/ ML

PAR; MO 5 ARCALYST PAR; MO; QLL (4 per 28 days)

5 AVONEX (WITH ALBUMIN)


5 AVONEX INTRAMUSCULAR PEN INJECTOR KIT


5 AVONEX INTRAMUSCULAR SYRINGE KIT

MO 4 BCG VACCINE, LIVE (PF)

PAR; MO 5 BETASERON SUBCUTANEOUS KIT

MO 3 BEXSERO MO 3 BOOSTRIX TDAP PAR; MO 4 BOTOX MO 3 DAPTACEL (DTAP

PEDIATRIC) (PF) PAR; MO 4 DYSPORT PAR; MO 5 EGRIFTA

SUBCUTANEOUS RECON SOLN 1 MG

B/D PAR; MO

3 ENGERIX-B (PF)





B/D PAR; MO

3 ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE

5 fomepizole PAR; MO 5 GAMUNEX-C MO 3 GARDASIL 9 (PF) MO 3 HAVRIX (PF)

INTRAMUSCULAR SUSPENSION

MO 3 HAVRIX (PF) INTRAMUSCULAR SYRINGE 1,440 ELISA UNIT/ML

3 HAVRIX (PF) INTRAMUSCULAR SYRINGE 720 ELISA UNIT/0.5 ML

MO 3 HIBERIX (PF) 5 HYPERRAB (PF)

PAR; MO; LA

5 ILARIS (PF) SUBCUTANEOUS SOLUTION

MO 3 IMOVAX RABIES VACCINE (PF)

MO 3 INFANRIX (DTAP) (PF)

PAR; MO 5 INTRON A INJECTION

MO 3 IPOL MO 3 IXIARO (PF)

3 KEDRAB (PF) 3 KINRIX (PF)

INTRAMUSCULAR SUSPENSION

MO 3 KINRIX (PF) INTRAMUSCULAR SYRINGE

MO 3 M-M-R II (PF) MO 3 MENACTRA (PF)

INTRAMUSCULAR SOLUTION

MO 3 MENVEO A-C-Y-W- 135-DIP (PF)

PAR; MO 5 MOZOBIL





5 NEULASTA

PAR; MO 5 NEUPOGEN PAR; MO 5 NORDITROPIN

FLEXPRO PAR; MO 5 OCTAGAM PAR; MO 5 OMNITROPE MO 3 PEDIARIX (PF) MO 3 PEDVAX HIB (PF) PAR; MO 5 PEGASYS PAR; MO 5 PEGASYS

PROCLICK PAR; MO 5 PEGINTRON

SUBCUTANEOUS KIT 50 MCG/0.5 ML

MO 3 PENTACEL (PF) PAR; MO; QLL (1 per 28 days)

5 PLEGRIDY

PAR; MO 4 PROCRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 3,000 UNIT/ML, 4,000 UNIT/ML

PAR; MO 5 PROCRIT INJECTION SOLUTION 20,000 UNIT/ML, 40,000 UNIT/ML

B/D PAR; MO

5 PROLEUKIN

MO 3 PROQUAD (PF) MO 3 QUADRACEL (PF) MO 4 RABAVERT (PF) B/D PAR; MO

3 RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION





B/D PAR; MO

3 RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10 MCG/ ML

B/D PAR 3 RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 5 MCG/ 0.5 ML

3 ROTARIX MO 3 ROTATEQ

VACCINE MO 3 SHINGRIX (PF)

3 STAMARIL (PF) PAR; MO 5 SYLATRON MO 4 TENIVAC (PF)

INTRAMUSCULAR SYRINGE

MO 3 TETANUS, DIPHTHERIA TOX PED(PF)

MO 3 TETANUS- DIPHTHERIA TOXOIDS-TD

B/D PAR 5 THYMOGLOBULIN B/D PAR; MO

4 TICE BCG

MO 3 TRUMENBA MO 3 TWINRIX (PF)

INTRAMUSCULAR SYRINGE

3 TYPHIM VI INTRAMUSCULAR SOLUTION

MO 3 TYPHIM VI INTRAMUSCULAR SYRINGE

MO 3 VAQTA (PF) MO 3 VARIVAX (PF) MO 3 VARIZIG

INTRAMUSCULAR SOLUTION




PAR; MO 4 XEOMIN INTRAMUSCULAR RECON SOLN 100 UNIT, 50 UNIT

PAR; MO 5 XEOMIN INTRAMUSCULAR RECON SOLN 200 UNIT

MO 3 YF-VAX (PF) MO 3 ZOSTAVAX (PF)

Musculoskeletal / Rheumatology MO; QLL (300 per 28 days)

3 alendronate oral solution


6 alendronate oral tablet 10 mg, 5 mg


6 alendronate oral tablet 35 mg, 70 mg

MO 1 allopurinol 4 allopurinol sodium

intravenous 4 aloprim

PAR; MO 5 BENLYSTA B/D PAR; MO

4 BONIVA INTRAVENOUS

MO 3 COLCRYS MO 5 DEPEN TITRATABS PAR; MO; QLL (8 per 28 days)

5 ENBREL MINI


5 ENBREL SUBCUTANEOUS RECON SOLN


5 ENBREL SUBCUTANEOUS SYRINGE 25 MG/ 0.5ML (0.51)


5 ENBREL SUBCUTANEOUS SYRINGE 50 MG/ ML (0.98 ML)


5 ENBREL SURECLICK






5 FORTEO


4 FOSAMAX ORAL TABLET 70 MG


4 FOSAMAX PLUS D


5 HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML (6 PACK)


5 HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML, 80 MG/ 0.8 ML


5 HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML-40 MG/ 0.4 ML


5 HUMIRA PEN


5 HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML


5 HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML





5 HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML


5 HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML- 40 MG/0.4 ML


5 HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.1 ML, 10 MG/ 0.2 ML, 20 MG/0.2 ML, 20 MG/0.4 ML


5 HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.4 ML, 40 MG/ 0.8 ML

B/D PAR; MO

4 ibandronate intravenous solution

MO 4 ibandronate intravenous syringe


3 ibandronate oral

MO 4 leflunomide oral tablet 10 mg

MO 3 leflunomide oral tablet 20 mg

MO 3 probenecid MO 3 probenecid-colchicine PAR; MO; QLL (2 per 365 days)

4 PROLIA


3 raloxifene

MO 5 RIDAURA ST; MO; QLL (1 per 28 days)







4 risedronate oral tablet 35 mg, 35 mg (12 pack), 35 mg (4 pack)




4 risedronate oral tablet, delayed release (dr/ec)


3 SAVELLA ORAL TABLET 100 MG


3 SAVELLA ORAL TABLET 12.5 MG






3 SAVELLA ORAL TABLETS,DOSE PACK

ST; MO 3 ULORIC PAR; MO; QLL (60 per 30 days)

5 XELJANZ

Obstetrics / Gynecology MO 4 altavera (28) MO 4 alyacen 1/35 (28) MO 4 alyacen 7/7/7 (28) MO 4 amethia MO 3 apri MO 4 aranelle (28) MO 4 aubra MO 3 aviane MO 4 azurette (28) MO 4 balziva (28) MO 4 blisovi fe 1.5/30 (28) MO 4 briellyn MO 3 camila MO 4 CAZIANT (28) MO 4 clindamycin phosphate

vaginal MO 3 cryselle (28) MO 3 cyclafem 1/35 (28)




MO 3 cyclafem 7/7/7 (28) MO 4 dasetta 1/35 (28) MO 4 dasetta 7/7/7 (28) MO 4 DELESTROGEN MO 3 DEPO-ESTRADIOL MO 4 DEPO-PROVERA

INTRAMUSCULAR SUSPENSION 400 MG/ML

MO 4 drospirenone-ethinyl estradiol

PAR; MO 4 ELESTRIN MO 4 elinest

3 ELLA MO 3 emoquette MO 3 enpresse MO 3 errin MO 4 estarylla MO 4 ESTRACE VAGINAL PAR; MO 1 estradiol oral PAR; MO; QLL (8 per 28 days)

4 estradiol transdermal patch semiweekly


4 estradiol transdermal patch weekly

MO 4 estradiol vaginal MO 4 estradiol valerate

intramuscular oil 20 mg/ml, 40 mg/ml

PAR; MO 4 estradiol-norethindrone acet


4 ESTRING

PAR; MO 2 estropipate oral tablet 0.75 mg

PAR; MO 4 EVAMIST MO 3 falmina (28) MO; QLL (1 per 90 days)

4 FEMRING

MO 4 gianvi (28) MO 4 heather MO 5 hydroxyprogesterone

caproate MO 3 introvale PAR; MO 4 jinteli





MO 4 jolessa MO 3 jolivette MO 3 junel 1.5/30 (21) MO 3 junel 1/20 (21) MO 3 junel fe 1.5/30 (28) MO 3 junel fe 1/20 (28) MO 4 junel fe 24 MO 4 kariva (28) MO 3 kelnor 1/35 (28) MO 4 l norgest/e.estradiol-

e.estrad oral tablets,dose pack,3 month 0.15 mg- 30 mcg (84)/10 mcg (7)

MO 4 larin 1/20 (21) MO 4 larin fe 1.5/30 (28) MO 3 larin fe 1/20 (28) MO 3 leena 28 MO 4 lessina MO 3 levonest (28) MO 4 levonorg-eth estrad

triphasic MO 3 levonorgestrel-ethinyl

estrad oral tablet 0.1- 20 mg-mcg, 90-20 mcg

MO 4 levonorgestrel-ethinyl estrad oral tablet 0.15- 0.03 mg

MO 4 levonorgestrel-ethinyl estrad oral tablets,dose pack,3 month

MO 3 levora-28 MO 4 LO LOESTRIN FE MO 4 loryna (28) MO 4 low-ogestrel (28) MO 3 lutera (28) MO 4 lyza MO 3 marlissa MO 3 medroxyprogesterone

intramuscular suspension

MO 4 medroxyprogesterone intramuscular syringe

MO 1 medroxyprogesterone oral

PAR; MO 4 MENEST




MO 4 methylergonovine oral MO 2 metronidazole vaginal MO 3 miconazole-3 vaginal

suppository MO 3 microgestin 1.5/30 (21) MO 3 microgestin 1/20 (21) MO 3 microgestin fe 1.5/30

(28) MO 3 microgestin fe 1/20 (28) PAR; MO 4 mimvey PAR; MO 4 mimvey lo MO 4 mono-linyah MO 3 mononessa (28) MO 4 MYZILRA MO 3 necon 0.5/35 (28) MO 3 necon 7/7/7 (28) MO 4 nikki (28) MO 3 nora-be MO 3 norethindrone

(contraceptive) MO 3 norethindrone acetate MO 4 norgestimate-ethinyl

estradiol oral tablet 0.18/0.215/0.25 mg- 35 mcg (28), 0.25-35 mg-mcg

MO 3 nortrel 0.5/35 (28) MO 4 nortrel 1/35 (21) MO 4 nortrel 1/35 (28) MO 3 nortrel 7/7/7 (28) MO 4 NUVARING MO 4 ocella MO 4 ogestrel (28) MO 3 orsythia MO 4 ORTHO

MICRONOR MO 4 philith MO 4 pimtrea (28) MO 3 pirmella oral tablet 1-

35 mg-mcg MO 3 portia PAR; MO 3 PREMARIN ORAL MO 3 PREMARIN

VAGINAL PAR; MO 3 PREMPHASE





PAR; MO 3 PREMPRO MO 3 previfem MO 3 progesterone micronized MO 4 quasense MO 3 reclipsen (28) MO 3 sharobel MO 3 sprintec (28) MO 3 sronyx MO 4 syeda MO 3 terconazole vaginal

cream MO 4 terconazole vaginal

suppository MO 4 tilia fe MO 4 tranexamic acid oral MO 4 tri-estarylla MO 4 tri-legest fe MO 4 tri-linyah MO 3 tri-previfem (28) MO 3 tri-sprintec (28) MO 3 trinessa (28) MO 3 trivora (28) MO 4 VAGIFEM MO 3 vandazole MO 3 velivet triphasic regimen

(28) MO 4 viorele (28) PAR; MO; QLL (8 per 28 days)

4 VIVELLE-DOT

MO 4 vyfemla (28) MO 4 xulane MO 4 yuvafem MO 4 ZARAH MO 3 zenchent (28) MO 3 zovia 1/35e (28)

Ophthalmology MO 4 acetazolamide oral

capsule, extended release MO 2 acetazolamide oral

tablet 125 mg MO 3 acetazolamide oral

tablet 250 mg MO 4 acetazolamide sodium

solution for injection




MO 3 ALPHAGAN P OPHTHALMIC (EYE) DROPS 0.1 %

MO 4 ALPHAGAN P OPHTHALMIC (EYE) DROPS 0.15 %

MO 3 apraclonidine MO 3 atropine ophthalmic

(eye) drops MO 3 azelastine ophthalmic

(eye) MO 4 AZOPT MO 3 bacitracin ophthalmic

(eye) MO 2 bacitracin-polymyxin b

ophthalmic (eye) MO 4 BESIVANCE MO 4 BETAGAN

OPHTHALMIC (EYE) DROPS 0.5 %

MO 3 betaxolol ophthalmic (eye)

MO 4 BETIMOL MO 4 BETOPTIC S MO 3 bimatoprost ophthalmic

(eye) MO 4 BLEPHAMIDE

S.O.P. MO 3 brimonidine

ophthalmic (eye) drops 0.15 %

MO 2 brimonidine ophthalmic (eye) drops 0.2 %

MO 4 bromfenac MO 1 carteolol MO 2 ciprofloxacin hcl

ophthalmic (eye) MO 3 COMBIGAN MO 4 COSOPT MO 2 cromolyn ophthalmic

(eye) MO 5 CYSTARAN





MO 2 dexamethasone sodium phosphate ophthalmic (eye)

MO 2 diclofenac sodium ophthalmic (eye)

MO 2 dorzolamide MO 2 dorzolamide-timolol MO 3 DUREZOL MO 3 epinastine MO 2 erythromycin

ophthalmic (eye) MO 2 fluorometholone MO 1 flurbiprofen ophthalmic

drops MO 4 gatifloxacin MO 2 gentak ophthalmic (eye)

ointment MO 2 gentamicin ophthalmic

(eye) drops 2 gentamicin ophthalmic

(eye) ointment MO 3 ILEVRO MO 4 IOPIDINE

OPHTHALMIC (EYE) DROPS

MO 4 ISOPTO CARPINE MO 2 ketorolac ophthalmic

(eye) MO; QLL (60 per 30 days)

3 LACRISERT

MO 1 latanoprost MO 2 levobunolol ophthalmic

(eye) drops 0.5 % MO 4 levofloxacin ophthalmic

(eye) MO 3 LUMIGAN

OPHTHALMIC (EYE) DROPS 0.01 %

MO 4 methazolamide 2 metipranolol

MO 3 MOXEZA MO 3 MOXIFLOXACIN

OPHTHALMIC (EYE)




MO 4 NATACYN MO 2 neo-polycin MO 2 neo-polycin hc MO 3 neomycin-bacitracin-

poly-hc MO 3 neomycin-bacitracin-

polymyxin MO 2 neomycin-polymyxin b-

dexameth MO 3 neomycin-polymyxin-

gramicidin MO 3 neomycin-polymyxin-hc

ophthalmic (eye) MO 3 NEVANAC MO 2 ofloxacin ophthalmic

(eye) MO 4 olopatadine ophthalmic

(eye) drops 0.1 % MO 3 olopatadine ophthalmic

(eye) drops 0.2 % MO 3 PAZEO MO 4 PHOSPHOLINE

IODIDE MO 3 pilocarpine hcl

ophthalmic (eye) drops 1 %, 2 %, 4 %

MO 2 polycin MO 1 polymyxin b sulf-

trimethoprim MO 2 prednisolone acetate MO 2 prednisolone sodium

phosphate ophthalmic (eye)

MO 4 SIMBRINZA MO 2 sulfacetamide sodium

ophthalmic (eye) drops MO 3 sulfacetamide sodium

ophthalmic (eye) ointment

MO 2 sulfacetamide- prednisolone

MO 1 timolol maleate ophthalmic (eye) drops

MO 3 timolol maleate ophthalmic (eye) gel forming solution





MO 4 TIMOPTIC OCUDOSE (PF) OPHTHALMIC (EYE) DROPPERETTE 0.25 %

MO 4 TIMOPTIC OPHTHALMIC (EYE) DROPS 0.25 %

MO 4 TIMOPTIC-XE MO 3 TOBRADEX

OPHTHALMIC (EYE) OINTMENT

MO 3 TOBRADEX ST MO 2 tobramycin MO 3 tobramycin-

dexamethasone opthalmic suspension

MO 3 TRAVATAN Z MO 3 trifluridine MO 3 VIGAMOX MO 4 XALATAN PAR; MO; QLL (60 per 30 days)

3 XIIDRA

MO 4 ZIOPTAN (PF) MO 4 ZIRGAN

Respiratory And Allergy B/D PAR; MO

2 acetylcysteine solution 100 mg/ml (10 %)

B/D PAR; MO

3 acetylcysteine solution 200 mg/ml (20 %)

PAR; MO; LA

5 ADEMPAS


3 ADVAIR DISKUS


3 ADVAIR HFA


4 AEROSPAN




B/D PAR; MO; QLL

3 albuterol sulfate inhalation solution for nebulization 0.63 mg/ 3 ml, 1.25 mg/3 ml


2 albuterol sulfate inhalation solution for nebulization 2.5 mg /3 ml (0.083 %)


2 albuterol sulfate inhalation solution for nebulization 2.5 mg/ 0.5 ml, 5 mg/ml

(60 per 30 days) MO 1 albuterol sulfate oral

syrup MO 4 albuterol sulfate oral

tablet MO 3 albuterol sulfate oral

tablet extended release 12 hr 4 mg

MO 4 albuterol sulfate oral tablet extended release 12 hr 8 mg

4 aminophylline intravenous


3 ANORO ELLIPTA


3 ARNUITY ELLIPTA


3 ASMANEX HFA


3 ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 110 MCG (30 DOSES), 220 MCG (120 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES)





QLL (2 per 30 days)

3 ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 220 MCG (14 DOSES)


4 ATROVENT HFA


3 BREO ELLIPTA

B/D PAR; MO; QLL

4 budesonide inhalation suspension for nebulization 0.25 mg/ 2 ml, 0.5 mg/2 ml

(120 per 30 days) MO 2 cetirizine oral solution

1 mg/ml PAR; MO 5 CINRYZE PAR; MO 2 clemastine oral tablet

2.68 mg MO; QLL (8 per 30 days)

4 COMBIVENT RESPIMAT

B/D PAR; MO; QLL

2 cromolyn inhalation

(240 per 30 days) PAR; MO 3 cyproheptadine PAR; MO; QLL (30 per 30 days)

4 DALIRESP

MO 2 desloratadine PAR; MO 3 diphenhydramine hcl

injection solution 50 mg/ml

PAR; MO 4 diphenhydramine hcl injection syringe


3 DULERA

MO 3 ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML





3 epinephrine injection auto-injector 0.15 mg/ 0.15 ml, 0.15 mg/0.3 ml


3 EPINEPHRINE INJECTION AUTO- INJECTOR 0.3 MG/ 0.3 ML


5 ESBRIET ORAL CAPSULE


5 ESBRIET ORAL TABLET 267 MG


5 ESBRIET ORAL TABLET 801 MG

PAR; MO 5 FIRAZYR MO; QLL (60 per 30 days)

3 FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ ACTUATION, 50 MCG/ACTUATION


3 FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 250 MCG/ ACTUATION


3 FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ACTUATION


3 FLOVENT HFA INHALATION HFA AEROSOL INHALER 220 MCG/ACTUATION


3 FLOVENT HFA INHALATION HFA AEROSOL INHALER 44 MCG/ ACTUATION






2 flunisolide nasal spray, non-aerosol 25 mcg (0.025 %)


1 fluticasone nasal

PAR; MO 4 hydroxyzine hcl intramuscular solution 25 mg/ml

PAR; MO 3 hydroxyzine hcl intramuscular solution 50 mg/ml

PAR; MO 3 hydroxyzine hcl oral solution 10 mg/5 ml

PAR; MO 3 hydroxyzine hcl oral tablet

PAR; MO 3 hydroxyzine pamoate B/D PAR; MO

2 ipratropium bromide inhalation

B/D PAR; MO; QLL

2 ipratropium-albuterol inhalation

(540 per 30 days) PAR; MO; QLL (60 per 30 days)

5 KALYDECO ORAL TABLET


5 LETAIRIS

B/D PAR; MO; QLL

4 levalbuterol hcl inhalation solution for nebulization 0.31 mg/ 3 ml, 1.25 mg/0.5 ml, 1.25 mg/3 ml

(270 per 30 days)

B/D PAR; MO; QLL

4 levalbuterol hcl inhalation solution for nebulization 0.63 mg/ 3 ml


4 LEVALBUTEROL TARTRATE

MO 4 levocetirizine oral solution

MO 2 levocetirizine oral tablet MO 2 metaproterenol MO 3 mometasone nasal




MO 4 montelukast oral granules in packet

MO 2 montelukast oral tablet MO 3 montelukast oral tablet,

chewable MO 3 NASONEX PAR; MO; QLL (60 per 30 days)

5 OFEV


5 ORKAMBI ORAL TABLET

B/D PAR; MO; QLL

5 PERFOROMIST


3 PROAIR HFA


3 PROAIR RESPICLICK

PAR; MO 3 promethazine injection solution 25 mg/ml

PAR; MO 4 promethazine injection solution 50 mg/ml

PAR; MO 2 promethazine oral B/D PAR; MO

5 PULMOZYME


3 QVAR REDIHALER INHALATION HFA AEROSOL BREATH ACTIVATED 40 MCG/ACTUATION


3 QVAR REDIHALER INHALATION HFA AEROSOL BREATH ACTIVATED 80 MCG/ACTUATION


3 SEREVENT DISKUS


5 sildenafil (antihypertensive) oral


3 SPIRIVA RESPIMAT






3 SPIRIVA WITH HANDIHALER


3 STIOLTO RESPIMAT


3 SYMBICORT

MO 3 terbutaline oral MO 4 terbutaline

subcutaneous 2 theophylline oral elixir

MO 2 theophylline oral solution

MO 2 theophylline oral tablet extended release 12 hr

MO 2 theophylline oral tablet extended release 24 hr


5 TRACLEER ORAL TABLET

PAR; MO; LA; QLL

5 TRACLEER ORAL TABLET FOR SUSPENSION (120 per 30

days) MO; QLL (34 per 30 days)

4 triamcinolone acetonide nasal


5 VENTAVIS


3 VENTOLIN HFA


5 XOLAIR

MO 4 zafirlukast Urologicals

MO 2 alfuzosin MO 3 bethanechol chloride

oral tablet 10 mg, 25 mg, 5 mg

MO 4 bethanechol chloride oral tablet 50 mg

MO; LA 3 CYSTAGON





4 dutasteride


3 dutasteride-tamsulosin

MO 4 ELMIRON MO 2 finasteride oral tablet 5

mg MO 3 flavoxate MO; QLL (30 per 30 days)

4 MYRBETRIQ


2 oxybutynin chloride oral syrup


2 oxybutynin chloride oral tablet


3 oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg


3 oxybutynin chloride oral tablet extended release 24hr 5 mg

MO 4 potassium citrate oral tablet extended release 10 meq (1,080 mg), 15 meq

MO 3 potassium citrate oral tablet extended release 5 meq (540 mg)

MO 2 tamsulosin MO; QLL (30 per 30 days)

4 tolterodine oral capsule, extended release 24hr


4 tolterodine oral tablet


4 TOVIAZ


4 trospium oral capsule, extended release 24hr






4 trospium oral tablet


4 VESICARE

Vitamins, Hematinics / Electrolytes B/D PAR 4 AMINOSYN 10 % B/D PAR 4 AMINOSYN 7 %

WITH ELECTROLYTES

B/D PAR 4 AMINOSYN 8.5 % B/D PAR 4 AMINOSYN 8.5 %-

ELECTROLYTES B/D PAR 4 AMINOSYN II 10 % B/D PAR 4 AMINOSYN II 15 % B/D PAR 4 AMINOSYN II 7 % B/D PAR 4 AMINOSYN II 8.5 % B/D PAR 4 AMINOSYN II 8.5

%-ELECTROLYTES B/D PAR 4 AMINOSYN M 3.5

% B/D PAR 4 AMINOSYN-HBC

7% B/D PAR 4 AMINOSYN-PF 10

% B/D PAR 4 AMINOSYN-PF 7 %

(SULFITE-FREE) B/D PAR 4 AMINOSYN-RF 5.2

% MO 2 calcium acetate oral

capsule B/D PAR 4 CLINIMIX 5%/

D15W SULFITE FREE

B/D PAR 4 CLINIMIX 5%/ D25W SULFITE- FREE

B/D PAR 4 CLINIMIX 2.75%/ D5W SULFIT FREE

B/D PAR 4 CLINIMIX 4.25%- D20W SULF-FREE

B/D PAR 4 CLINIMIX 4.25%- D25W SULF-FREE

B/D PAR 4 CLINIMIX 4.25%/ D10W SULF FREE




B/D PAR 4 CLINIMIX 5%- D20W(SULFITE- FREE)



B/D PAR 4 CLINIMIX E 4.25%/ D5W SULF FREE

B/D PAR 4 CLINIMIX E 5%/ D15W SULFIT FREE



B/D PAR 4 CLINIMIX N14G30E 4.25%- D15W SF

B/D PAR 4 CLINIMIX N9G15E 2.75%-D7.5W SF

MO 2 fluoride (sodium) oral tablet

MO 2 fluoride (sodium) oral tablet,chewable

MO 2 fluoritab oral tablet, chewable 1 mg (2.2 mg sod. fluoride)

B/D PAR 4 FREAMINE HBC 6.9 %

B/D PAR 4 freamine iii 10 % B/D PAR 4 HEPATAMINE 8% B/D PAR 4 intralipid intravenous

emulsion 20 % B/D PAR 4 INTRALIPID

INTRAVENOUS EMULSION 30 %

4 IONOSOL-B IN D5W

4 IONOSOL-MB IN D5W

4 ISOLYTE S PH 7.4 4 ISOLYTE-P IN 5 %

DEXTROSE 4 ISOLYTE-S

MO 1 k-effervescent





MO 3 k-tab oral tablet extended release 8 meq

MO 4 klor-con MO 3 klor-con 10 MO 3 klor-con 8 MO 2 klor-con m10 MO 2 klor-con m15 MO 2 klor-con m20 MO 4 klor-con sprinkle MO 1 klor-con/ef MO 3 lactated ringers

intravenous MO 2 ludent fluoride

4 magnesium sulfate in water intravenous parenteral solution

4 magnesium sulfate in water intravenous piggyback 2 gram/50 ml (4 %), 4 gram/50 ml (8 %)

MO 4 magnesium sulfate in water intravenous piggyback 4 gram/100 ml (4 %)

MO 3 magnesium sulfate injection solution

4 magnesium sulfate injection syringe

B/D PAR 4 NEPHRAMINE 5.4 %

4 NORMOSOL-M IN 5 % DEXTROSE

MO 4 NORMOSOL-R 4 NORMOSOL-R IN

5 % DEXTROSE 4 NORMOSOL-R PH

7.4 4 PLASMA-LYTE 148 4 PLASMA-LYTE A

MO 2 potassium bicarb and chloride

MO 1 potassium bicarb-citric acid




4 potassium chlorid-d5- 0.45%nacl intravenous parenteral solution 10 meq/l, 30 meq/l, 40 meq/l

MO 3 potassium chlorid-d5- 0.45%nacl intravenous parenteral solution 20 meq/l

4 potassium chloride in 0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l

4 potassium chloride in 5 % dex intravenous parenteral solution 20 meq/l, 30 meq/l, 40 meq/l

MO 4 potassium chloride in lr-d5 intravenous parenteral solution 20 meq/l

4 potassium chloride in lr-d5 intravenous parenteral solution 40 meq/l

MO 3 potassium chloride in water intravenous piggyback 10 meq/100 ml

MO 4 potassium chloride in water intravenous piggyback 10 meq/50 ml

3 potassium chloride in water intravenous piggyback 20 meq/100 ml

4 potassium chloride in water intravenous piggyback 30 meq/100 ml

MO 2 potassium chloride oral capsule, extended release

MO 1 potassium chloride oral liquid





MO 2 potassium chloride oral tablet extended release

MO 2 potassium chloride oral tablet,er particles/ crystals

4 potassium chloride-0.45 % nacl

MO 4 potassium chloride-d5- 0.2%nacl intravenous parenteral solution 20 meq/l

4 potassium chloride-d5- 0.2%nacl intravenous parenteral solution 30 meq/l, 40 meq/l

4 potassium chloride-d5- 0.3%nacl intravenous parenteral solution 20 meq/l

MO 4 potassium chloride-d5- 0.9%nacl intravenous parenteral solution 20 meq/l

4 potassium chloride-d5- 0.9%nacl intravenous parenteral solution 40 meq/l

B/D PAR; MO

4 premasol 10 %

B/D PAR 4 PREMASOL 6 % MO 2 prenatal vitamin oral

tablet B/D PAR 4 PROCALAMINE 3% B/D PAR; MO

4 PROSOL 20 %

4 ringer's intravenous MO 4 sodium bicarbonate

intravenous solution 1 meq/ml (8.4 %), 4.2 %

MO 4 sodium bicarbonate intravenous syringe 10 meq/10 ml (8.4 %), 7.5 % (0.9 meq/ml)




4 sodium bicarbonate intravenous syringe 4.2 % (0.5 meq/ml), 8.4 % (1 meq/ml)

MO 2 sodium chloride 0.45 % intravenous parenteral solution

4 sodium chloride 0.45 % intravenous piggyback

MO 4 sodium chloride 3 % 4 sodium chloride 5 %

MO 4 sodium chloride intravenous

4 sodium lactate B/D PAR; MO

4 travasol 10 %

B/D PAR; MO

4 TROPHAMINE 10 %

B/D PAR 4 TROPHAMINE 6%


Índice de medicamentos Leyenda Los medicamentos genéricos figuran en letra minúscula y cursiva (por ej., atenolol).

Los medicamentos de marca figuran en letra mayúscula (por ej., SPIRIVA).

El Índice brinda una lista alfabética de todos los medicamentos incluidos en este documento. Tanto los medicamentos de marca como los medicamentos genéricos se enumeran en el Índice. Encuentre su medicamento. Al lado de su medicamento verá el número de página en la que puede encontrar información de cobertura. Vaya a la página que se enumera en el Índice y encuentre el nombre de su medicamento en la primera columna de la lista.

Nombre del medicamento Página

a-hydrocort............................................................61 abacavir oral solution...............................................9 abacavir oral tablet..................................................9 abacavir-lamivudine................................................9 abacavir-lamivudine-zidovudine..............................9 ABELCET.............................................................9 ABILIFY MAINTENA........................................29 ABRAXANE........................................................20 acamprosate...........................................................59 acarbose oral tablet 100 mg....................................61 acarbose oral tablet 25 mg......................................61 acarbose oral tablet 50 mg......................................61 ACCUPRIL.........................................................49 ACCURETIC ORAL TABLET 20-12.5 MG,

20-25 MG.........................................................49 acebutolol..............................................................49 acetaminophen-codeine oral solution 120 mg-12 mg

/5 ml (5 ml), 240 mg-24 mg /10 ml (10 ml), 300 mg-30 mg /12.5 ml............................................29

acetaminophen-codeine oral solution 120-12 mg/5 ml......................................................................29

acetaminophen-codeine oral tablet 300-15 mg.........29 acetaminophen-codeine oral tablet 300-30 mg.........29 acetaminophen-codeine oral tablet 300-60 mg.........29 acetazolamide oral capsule, extended release.............77 acetazolamide oral tablet 125 mg...........................77 acetazolamide oral tablet 250 mg...........................77 acetazolamide sodium solution for injection.............77 acetic acid irrigation..............................................59 acetic acid otic (ear)...............................................61 acetylcysteine intravenous.......................................59 acetylcysteine solution 100 mg/ml (10 %)................79 acetylcysteine solution 200 mg/ml (20 %)................79 acitretin oral capsule 10 mg....................................56 acitretin oral capsule 17.5 mg, 25 mg.....................56 ACTHAR H.P.....................................................61

ACTHIB (PF)......................................................71 ACTIMMUNE...................................................71 ACTOPLUS MET XR ORAL TABLET, ER

MULTIPHASE 24 HR 15-1,000 MG..............61 ACTOPLUS MET XR ORAL TABLET, ER

MULTIPHASE 24 HR 30-1,000 MG..............61 acyclovir oral capsule................................................9 acyclovir oral suspension 200 mg/5 ml.......................9 acyclovir oral tablet..................................................9 acyclovir sodium 50 mg/ml intravenous solution........9 acyclovir topical.....................................................56 ADACEL(TDAP ADOLESN/ADULT)(PF).......71 ADAGEN............................................................59 ADALAT CC......................................................49 adapalene topical cream.........................................56 adapalene topical gel 0.1 %....................................56 ADASUVE..........................................................29 adefovir...................................................................9 ADEMPAS..........................................................79 adriamycin intravenous recon soln 10 mg................21 adriamycin intravenous solution.............................21 adrucil intravenous solution 2.5 gram/50 ml...........21 adrucil intravenous solution 5 gram/100 ml, 500

mg/10 ml...........................................................21 ADVAIR DISKUS...............................................79 ADVAIR HFA.....................................................79 AEROSPAN........................................................79 afeditab cr.............................................................49 AFINITOR..........................................................21 AFINITOR DISPERZ.........................................21 AGGRENOX......................................................49 ala-cort topical cream 2.5 %..................................56 ALBENZA.............................................................9 albuterol sulfate inhalation solution for nebulization

0.63 mg/3 ml, 1.25 mg/3 ml...............................79

Core_18355_v17_1811_1 86 Fecha de entrada en vigencia 1.º de noviembre de 2018

albuterol sulfate inhalation solution for nebulization 2.5 mg /3 ml (0.083 %).....................................79

albuterol sulfate inhalation solution for nebulization 2.5 mg/0.5 ml, 5 mg/ml......................................79

albuterol sulfate oral syrup......................................79 albuterol sulfate oral tablet.....................................79 albuterol sulfate oral tablet extended release 12 hr 4

mg.....................................................................79 albuterol sulfate oral tablet extended release 12 hr 8

mg.....................................................................79 alclometasone topical cream....................................56 alclometasone topical ointment...............................56 alcohol pads...........................................................61 ALDACTAZIDE ORAL TABLET 25-25

MG...................................................................49 ALDURAZYME..................................................61 ALECENSA.........................................................21 alendronate oral solution........................................73 alendronate oral tablet 10 mg, 5 mg.......................73 alendronate oral tablet 35 mg, 70 mg.....................73 alendronate oral tablet 40 mg.................................59 alfuzosin...............................................................82 ALIMTA..............................................................21 ALINIA ORAL SUSPENSION FOR

RECONSTITUTION........................................9 ALINIA ORAL TABLET......................................9 ALIQOPA...........................................................21 ALKERAN ORAL...............................................21 allopurinol............................................................73 allopurinol sodium intravenous...............................73 aloprim.................................................................73 alosetron................................................................68 ALPHAGAN P OPHTHALMIC (EYE) DROPS

0.1 %................................................................77 ALPHAGAN P OPHTHALMIC (EYE) DROPS

0.15 %..............................................................77 alprazolam oral tablet............................................29 alprazolam oral tablet extended release 24 hr..........29 alprazolam oral tablet,disintegrating 0.25 mg, 0.5

mg, 1 mg............................................................30 ALTACE ORAL CAPSULE 10 MG, 2.5 MG, 5

MG...................................................................49 altavera (28).........................................................75 ALTOPREV........................................................49 ALUNBRIG ORAL TABLET 180 MG...............21 ALUNBRIG ORAL TABLET 30 MG.................21 ALUNBRIG ORAL TABLET 90 MG.................21

ALUNBRIG ORAL TABLETS,DOSE PACK...............................................................21

alyacen 1/35 (28)..................................................75 alyacen 7/7/7 (28).................................................75 amantadine hcl.......................................................9 AMARYL ORAL TABLET 1 MG.......................62 AMARYL ORAL TABLET 2 MG.......................62 AMARYL ORAL TABLET 4 MG.......................62 AMBISOME.........................................................9 amcinonide topical cream.......................................56 amcinonide topical lotion.......................................56 amcinonide topical ointment..................................56 amethia.................................................................75 AMIKACIN INJECTION SOLUTION 1,000

MG/4 ML.........................................................10 amikacin injection solution 500 mg/2 ml................10 amiloride..............................................................49 amiloride-hydrochlorothiazide................................49 aminophylline intravenous.....................................79 AMINOSYN 10 %..............................................83 AMINOSYN 7 % WITH

ELECTROLYTES............................................83 AMINOSYN 8.5 %.............................................83 AMINOSYN 8.5 %-ELECTROLYTES..............83 AMINOSYN II 10 %..........................................83 AMINOSYN II 15 %..........................................83 AMINOSYN II 7 %............................................83 AMINOSYN II 8.5 %.........................................83 AMINOSYN II 8.5 %-ELECTROLYTES..........83 AMINOSYN M 3.5 %........................................83 AMINOSYN-HBC 7%.......................................83 AMINOSYN-PF 10 %........................................83 AMINOSYN-PF 7 % (SULFITE-FREE)............83 AMINOSYN-RF 5.2 %.......................................83 amiodarone intravenous solution............................49 amiodarone intravenous syringe..............................49 amiodarone oral tablet 100 mg, 200 mg.................49 amiodarone oral tablet 400 mg...............................49 AMITIZA............................................................68 amitriptyline.........................................................30 amlodipine besylate oral tablet................................49 amlodipine-atorvastatin.........................................49 amlodipine-benazepril oral capsule 10-20 mg, 10-

40 mg, 5-10 mg, 5-20 mg, 5-40 mg....................49 amlodipine-benazepril oral capsule 2.5-10 mg.........49 amlodipine-olmesartan...........................................49 amlodipine-valsartan.............................................49 amlodipine-valsartan-hydrochlorothiazide...............49


ammonium lactate.................................................56 amoxapine oral tablet 100 mg, 50 mg.....................30 amoxapine oral tablet 150 mg, 25 mg.....................30 amoxicillin oral capsule..........................................10 amoxicillin oral suspension for reconstitution...........10 amoxicillin oral tablet............................................10 amoxicillin oral tablet,chewable 125 mg.................10 amoxicillin oral tablet,chewable 250 mg.................10 amoxicillin-pot clavulanate oral suspension for

reconstitution 200-28.5 mg/5 ml, 400-57 mg/5 ml, 600-42.9 mg/5 ml........................................10

amoxicillin-pot clavulanate oral suspension for reconstitution 250-62.5 mg/5 ml.........................10

amoxicillin-pot clavulanate oral tablet 250-125 mg.....................................................................10

amoxicillin-pot clavulanate oral tablet 500-125 mg, 875-125 mg.......................................................10

amoxicillin-pot clavulanate oral tablet extended release 12 hr.......................................................10

amoxicillin-pot clavulanate oral tablet,chewable......10 amphotericin b......................................................10 ampicillin oral capsule 500 mg...............................10 ampicillin sodium injection....................................10 ampicillin sodium intravenous................................10 ampicillin-sulbactam injection recon soln 1.5 gram,

3 gram...............................................................10 ampicillin-sulbactam injection recon soln 15

gram..................................................................10 ampicillin-sulbactam intravenous recon soln 1.5

gram..................................................................10 ampicillin-sulbactam intravenous recon soln 3

gram..................................................................10 AMPYRA.............................................................30 ANADROL-50....................................................62 anagrelide.............................................................59 anastrozole............................................................21 ANDROGEL TRANSDERMAL GEL IN

METERED-DOSE PUMP 20.25 MG/1.25 GRAM (1.62 %)...............................................62

ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (20.25 MG/1.25 GRAM).............................................................62

ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (40.5 MG/2.5 GRAM).........62

ANORO ELLIPTA.............................................79 APOKYN.............................................................30 apraclonidine........................................................77 aprepitant oral capsule 125 mg...............................68

aprepitant oral capsule 40 mg.................................68 aprepitant oral capsule 80 mg.................................68 aprepitant oral capsule,dose pack............................68 apri......................................................................75 APRISO...............................................................68 APTIOM ORAL TABLET 200 MG, 400 MG,

600 MG............................................................30 APTIOM ORAL TABLET 800 MG...................30 APTIVUS ORAL CAPSULE...............................10 APTIVUS ORAL SOLUTION...........................10 ARALAST NP.....................................................59 aranelle (28).........................................................75 ARANESP (IN POLYSORBATE) INJECTION

SOLUTION 100 MCG/ML, 200 MCG/ML, 300 MCG/ML..................................................71

ARANESP (IN POLYSORBATE) INJECTION SOLUTION 25 MCG/ML, 40 MCG/ML, 60 MCG/ML.........................................................71

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 25 MCG/0.42 ML, 40 MCG/0.4 ML, 60 MCG/0.3 ML........71

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 100 MCG/0.5 ML, 150 MCG/0.3 ML, 200 MCG/0.4 ML, 300 MCG/0.6 ML, 500 MCG/ML..................................................71

ARCALYST.........................................................71 aripiprazole oral solution........................................30 aripiprazole oral tablet 10 mg................................30 aripiprazole oral tablet 15 mg................................30 aripiprazole oral tablet 2 mg..................................30 aripiprazole oral tablet 20 mg, 30 mg.....................30 aripiprazole oral tablet 5 mg..................................30 aripiprazole oral tablet,disintegrating 10 mg...........30 aripiprazole oral tablet,disintegrating 15 mg...........30 ARISTADA INITIO...........................................30 ARISTADA INTRAMUSCULAR

SUSPENSION,EXTENDED REL SYRING 1,064 MG/3.9 ML............................................30

ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 441 MG/1.6 ML...............................................30




armodafinil oral tablet 150 mg, 200 mg, 250 mg.....................................................................30

armodafinil oral tablet 50 mg................................30 armour thyroid......................................................62 ARNUITY ELLIPTA...........................................79 ARRANON.........................................................21 ARZERRA...........................................................21 ASACOL HD......................................................68 ASMANEX HFA.................................................79 ASMANEX TWISTHALER INHALATION

AEROSOL POWDR BREATH ACTIVATED 110 MCG (30 DOSES), 220 MCG (120 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES).....................................................79

ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 220 MCG (14 DOSES)....................................80

aspirin-dipyridamole..............................................49 ATACAND.........................................................49 ATACAND HCT................................................49 atazanavir oral capsule 150 mg, 200 mg................10 atazanavir oral capsule 300 mg..............................10 atenolol.................................................................49 atenolol-chlorthalidone...........................................49 atomoxetine oral capsule 10 mg, 18 mg, 25 mg, 40

mg.....................................................................30 atomoxetine oral capsule 100 mg, 60 mg, 80

mg.....................................................................30 atorvastatin...........................................................49 atovaquone............................................................10 atovaquone-proguanil............................................10 ATRIPLA.............................................................10 atropine injection solution 0.4 mg/ml......................68 atropine injection syringe 0.05 mg/ml, 0.1 mg/

ml......................................................................68 atropine ophthalmic (eye) drops..............................77 ATROVENT HFA..............................................80 AUBAGIO...........................................................30 aubra....................................................................75 AVALIDE............................................................49 AVANDIA ORAL TABLET 2 MG.....................62 AVANDIA ORAL TABLET 4 MG.....................62 AVAPRO.............................................................49 AVASTIN............................................................21 aviane...................................................................75 avita topical cream................................................56 AVONEX (WITH ALBUMIN)..........................71

AVONEX INTRAMUSCULAR PEN INJECTOR KIT..............................................71

AVONEX INTRAMUSCULAR SYRINGE KIT...................................................................71

azacitidine............................................................21 azathioprine..........................................................21 azathioprine sodium..............................................21 azelastine nasal aerosol,spray..................................61 azelastine nasal spray,non-aerosol............................61 azelastine ophthalmic (eye).....................................77 AZILECT............................................................30 azithromycin intravenous.......................................10 azithromycin oral packet........................................10 azithromycin oral suspension for reconstitution 100

mg/5 ml.............................................................10 azithromycin oral suspension for reconstitution 200

mg/5 ml.............................................................10 azithromycin oral tablet 250 mg, 250 mg (6

pack)..................................................................10 azithromycin oral tablet 500 mg, 600 mg...............11 AZOPT...............................................................77 AZOR..................................................................49 aztreonam.............................................................11 azurette (28).........................................................75 bacitracin ophthalmic (eye)....................................77 bacitracin-polymyxin b ophthalmic (eye).................77 baclofen................................................................30 balsalazide............................................................68 balziva (28)..........................................................75 BANZEL ORAL SUSPENSION.........................30 BANZEL ORAL TABLET 200 MG....................31 BANZEL ORAL TABLET 400 MG....................31 BARACLUDE ORAL SOLUTION....................11 BAVENCIO........................................................21 BCG VACCINE, LIVE (PF)...............................71 BELEODAQ.......................................................21 benazepril.............................................................49 benazepril-hydrochlorothiazide...............................49 BENDEKA..........................................................21 BENICAR...........................................................49 BENICAR HCT..................................................49 BENLYSTA.........................................................73 benztropine injection.............................................31 benztropine oral....................................................31 BESIVANCE.......................................................77 BESPONSA.........................................................21 BETAGAN OPHTHALMIC (EYE) DROPS 0.5

%......................................................................77


betamethasone dipropionate topical cream...............56 betamethasone dipropionate topical lotion...............56 betamethasone dipropionate topical ointment..........56 betamethasone valerate topical cream......................56 betamethasone valerate topical lotion......................56 betamethasone valerate topical ointment..................56 betamethasone, augmented topical cream.................56 betamethasone, augmented topical gel.....................56 betamethasone, augmented topical lotion.................56 betamethasone, augmented topical ointment............56 BETASERON SUBCUTANEOUS KIT.............71 betaxolol ophthalmic (eye)......................................77 betaxolol oral.........................................................49 bethanechol chloride oral tablet 10 mg, 25 mg, 5

mg.....................................................................82 bethanechol chloride oral tablet 50 mg....................82 BETIMOL...........................................................77 BETOPTIC S......................................................77 bexarotene.............................................................21 BEXSERO...........................................................71 bicalutamide.........................................................21 BICILLIN C-R....................................................11 BICILLIN L-A.....................................................11 BICNU................................................................21 BIDIL..................................................................49 BIKTARVY.........................................................11 bimatoprost ophthalmic (eye)..................................77 bisoprolol fumarate................................................49 bisoprolol-hydrochlorothiazide................................49 bleomycin..............................................................21 BLEPHAMIDE S.O.P.........................................77 BLINCYTO INTRAVENOUS KIT...................21 blisovi fe 1.5/30 (28).............................................75 BONIVA INTRAVENOUS................................73 BOOSTRIX TDAP.............................................71 BORTEZOMIB..................................................21 BOSULIF ORAL TABLET 100 MG..................21 BOSULIF ORAL TABLET 400 MG, 500

MG...................................................................21 BOTOX...............................................................71 BRAFTOVI ORAL CAPSULE 50 MG...............21 BRAFTOVI ORAL CAPSULE 75 MG...............21 BREO ELLIPTA..................................................80 briellyn.................................................................75 BRILINTA..........................................................50 brimonidine ophthalmic (eye) drops 0.15 %............77 brimonidine ophthalmic (eye) drops 0.2 %..............77 BRIVIACT INTRAVENOUS.............................31

BRIVIACT ORAL SOLUTION.........................31 BRIVIACT ORAL TABLET 10 MG..................31 BRIVIACT ORAL TABLET 100 MG, 75

MG...................................................................31 BRIVIACT ORAL TABLET 25 MG..................31 BRIVIACT ORAL TABLET 50 MG..................31 bromfenac.............................................................77 bromocriptine........................................................31 budesonide inhalation suspension for nebulization

0.25 mg/2 ml, 0.5 mg/2 ml.................................80 budesonide oral......................................................68 bumetanide injection.............................................50 bumetanide oral tablet 0.5 mg, 1 mg......................50 bumetanide oral tablet 2 mg...................................50 BUPHENYL ORAL TABLET............................59 buprenorphine hcl injection solution.......................31 buprenorphine hcl injection syringe.........................31 buprenorphine hcl sublingual tablet 2 mg................31 buprenorphine hcl sublingual tablet 8 mg................31 buprenorphine-naloxone sublingual tablet 2-0.5

mg.....................................................................31 buprenorphine-naloxone sublingual tablet 8-2

mg.....................................................................31 bupropion hcl (smoking deter)................................59 bupropion hcl oral tablet 100 mg............................31 bupropion hcl oral tablet 75 mg..............................31 bupropion hcl oral tablet extended release 24 hr 150

mg.....................................................................31 bupropion hcl oral tablet extended release 24 hr 300

mg.....................................................................31 bupropion hcl oral tablet sustained-release 12 hr 100

mg.....................................................................31 bupropion hcl oral tablet sustained-release 12 hr 150

mg, 200 mg........................................................31 buspirone oral tablet 10 mg, 15 mg, 5 mg...............31 buspirone oral tablet 30 mg....................................31 buspirone oral tablet 7.5 mg...................................31 busulfan................................................................21 BUSULFEX.........................................................21 butalbital compound w/codeine..............................31 butalbital-acetaminop-caf-cod................................31 butalbital-acetaminophen oral tablet 50-325

mg.....................................................................31 butalbital-acetaminophen-caff oral capsule..............31 butalbital-acetaminophen-caff oral tablet 50-325-

40 mg................................................................31 butalbital-aspirin-caffeine oral capsule....................31 butorphanol tartrate injection.................................31


butorphanol tartrate nasal......................................31 BYDUREON......................................................62 BYDUREON BCISE...........................................62 BYETTA SUBCUTANEOUS PEN INJECTOR

10 MCG/DOSE(250 MCG/ML) 2.4 ML........62 BYETTA SUBCUTANEOUS PEN INJECTOR

5 MCG/DOSE (250 MCG/ML) 1.2 ML.........62 BYSTOLIC ORAL TABLET 10 MG, 20 MG,

5 MG................................................................50 BYSTOLIC ORAL TABLET 2.5 MG.................50 cabergoline............................................................62 CABOMETYX ORAL TABLET 20 MG............21 CABOMETYX ORAL TABLET 40 MG, 60

MG...................................................................21 CALAN ORAL TABLET 120 MG......................50 CALAN SR ORAL TABLET EXTENDED

RELEASE 120 MG...........................................50 calcipotriene scalp..................................................56 calcipotriene topical...............................................56 calcitonin (salmon)................................................62 calcitriol intravenous solution 1 mcg/ml..................62 calcitriol oral capsule..............................................62 calcitriol oral solution............................................62 calcitriol topical.....................................................56 calcium acetate oral capsule....................................83 CALQUENCE....................................................21 camila...................................................................75 CANASA.............................................................68 CANCIDAS........................................................11 candesartan...........................................................50 candesartan-hydrochlorothiazid..............................50 CAPASTAT.........................................................11 CAPRELSA ORAL TABLET 100 MG................21 CAPRELSA ORAL TABLET 300 MG................21 captopril................................................................50 captopril-hydrochlorothiazide.................................50 carafate oral suspension..........................................68 CARBAGLU........................................................59 carbamazepine oral capsule, er multiphase 12

hr......................................................................31 carbamazepine oral suspension 100 mg/5 ml...........32 carbamazepine oral suspension 200 mg/10 ml.........32 carbamazepine oral tablet......................................32 carbamazepine oral tablet extended release 12

hr......................................................................32 carbamazepine oral tablet,chewable........................32 carbidopa-levodopa oral tablet................................32 carbidopa-levodopa oral tablet extended release........32

carbidopa-levodopa oral tablet,disintegrating...........32 carbidopa-levodopa-entacapone..............................32 carboplatin intravenous solution.............................21 CARDIZEM LA..................................................50 carisoprodol oral tablet 350 mg..............................32 carteolol................................................................77 cartia xt................................................................50 carvedilol..............................................................50 CAYSTON..........................................................11 CAZIANT (28)...................................................75 cefaclor oral capsule................................................11 cefaclor oral suspension for reconstitution 125 mg/5

ml, 250 mg/5 ml................................................11 cefaclor oral suspension for reconstitution 375 mg/5

ml......................................................................11 cefaclor oral tablet extended release 12 hr................11 cefadroxil oral capsule............................................11 cefadroxil oral suspension for reconstitution 250 mg/

5 ml, 500 mg/5 ml.............................................11 cefadroxil oral tablet..............................................11 cefazolin in dextrose (iso-os) intravenous piggyback

1 gram/50 ml.....................................................11 cefazolin in dextrose (iso-os) intravenous piggyback

2 gram/50 ml.....................................................11 cefazolin injection recon soln 1 gram.......................11 cefazolin injection recon soln 10 gram, 100 gram,

20 gram, 300 g..................................................11 cefazolin injection recon soln 500 mg......................11 cefazolin intravenous.............................................11 cefdinir oral capsule...............................................11 cefdinir oral suspension for reconstitution................11 cefepime................................................................11 cefepime in dextrose,iso-osm intravenous piggyback

1 gram/50 ml.....................................................11 cefepime in dextrose,iso-osm intravenous piggyback

2 gram/100 ml...................................................11 cefotaxime injection recon soln 1 gram, 2 gram, 500

mg.....................................................................11 cefotetan................................................................11 cefoxitin in dextrose, iso-osm...................................11 cefoxitin intravenous recon soln 1 gram, 2 gram......11 cefoxitin intravenous recon soln 10 gram.................11 cefpodoxime oral suspension for reconstitution 100

mg/5 ml.............................................................11 cefpodoxime oral suspension for reconstitution 50

mg/5 ml.............................................................11 cefpodoxime oral tablet 100 mg..............................11 cefpodoxime oral tablet 200 mg..............................11


cefprozil oral suspension for reconstitution...............11 cefprozil oral tablet 250 mg....................................11 cefprozil oral tablet 500 mg....................................11 CEFTAZIDIME IN D5W..................................11 ceftazidime injection recon soln 1 gram, 2 gram......11 ceftazidime injection recon soln 6 gram...................11 ceftriaxone in dextrose,iso-os...................................12 ceftriaxone injection recon soln 1 gram, 250 mg......12 ceftriaxone injection recon soln 10 gram..................12 CEFTRIAXONE INJECTION RECON SOLN

100 GRAM.......................................................12 ceftriaxone injection recon soln 2 gram, 500 mg......12 ceftriaxone intravenous recon soln 1 gram................12 ceftriaxone intravenous recon soln 2 gram................12 cefuroxime axetil oral tablet 250 mg.......................12 cefuroxime axetil oral tablet 500 mg.......................12 cefuroxime sodium injection recon soln 750 mg.......12 cefuroxime sodium intravenous recon soln 1.5

gram..................................................................12 cefuroxime sodium intravenous recon soln 7.5

gram..................................................................12 celecoxib oral capsule 100 mg, 200 mg, 400 mg......32 celecoxib oral capsule 50 mg...................................32 CELLCEPT INTRAVENOUS............................22 CELONTIN ORAL CAPSULE 300 MG............32 cephalexin oral capsule 250 mg, 500 mg.................12 cephalexin oral suspension for reconstitution 125 mg/

5 ml...................................................................12 cephalexin oral suspension for reconstitution 250 mg/

5 ml...................................................................12 cephalexin oral tablet.............................................12 CEREZYME INTRAVENOUS RECON SOLN

400 UNIT........................................................62 cetirizine oral solution 1 mg/ml..............................80 cevimeline.............................................................59 CHANTIX..........................................................59 CHANTIX CONTINUING MONTH

BOX.................................................................59 CHANTIX STARTING MONTH BOX............59 chloramphenicol sod succinate.................................12 chlordiazepoxide hcl...............................................32 chlorhexidine gluconate mucous membrane..............61 chloroquine phosphate............................................12 chlorothiazide oral tablet 250 mg...........................50 chlorothiazide oral tablet 500 mg...........................50 chlorothiazide sodium............................................50 chlorpromazine......................................................32 chlorthalidone oral tablet 25 mg, 50 mg..................50

cholestyramine (with sugar)....................................50 cholestyramine light...............................................50 ciclodan................................................................56 ciclopirox topical cream..........................................56 ciclopirox topical gel...............................................56 ciclopirox topical shampoo......................................56 ciclopirox topical solution.......................................56 ciclopirox topical suspension....................................56 cidofovir................................................................12 cilostazol...............................................................50 CIMDUO...........................................................12 cimetidine.............................................................68 cimetidine hcl oral.................................................68 CINRYZE...........................................................80 CIPRODEX........................................................61 ciprofloxacin er oral tablet, er multiphase 24 hr 1,

000 mg..............................................................12 ciprofloxacin er oral tablet, er multiphase 24 hr 500

mg.....................................................................12 ciprofloxacin hcl ophthalmic (eye)...........................77 ciprofloxacin hcl oral tablet 100 mg, 750 mg...........12 ciprofloxacin hcl oral tablet 250 mg, 500 mg...........12 ciprofloxacin in 5 % dextrose..................................12 ciprofloxacin oral suspension...................................12 cisplatin................................................................22 citalopram oral solution.........................................32 citalopram oral tablet 10 mg..................................32 citalopram oral tablet 20 mg..................................32 citalopram oral tablet 40 mg..................................32 cladribine..............................................................22 claravis.................................................................56 clarithromycin oral suspension for reconstitution 125

mg/5 ml.............................................................12 clarithromycin oral suspension for reconstitution 250

mg/5 ml.............................................................12 clarithromycin oral tablet.......................................12 clarithromycin oral tablet extended release 24

hr......................................................................12 clemastine oral tablet 2.68 mg................................80 clindamycin hcl.....................................................12 clindamycin in 5 % dextrose intravenous piggyback

300 mg/50 ml, 600 mg/50 ml.............................12 clindamycin in 5 % dextrose intravenous piggyback

900 mg/50 ml....................................................12 clindamycin phosphate injection.............................12 clindamycin phosphate intravenous.........................12 clindamycin phosphate topical gel............................56 clindamycin phosphate topical lotion.......................57


clindamycin phosphate topical solution....................57 clindamycin phosphate topical swab........................57 clindamycin phosphate vaginal...............................75 clindamycin-benzoyl peroxide topical gel.................57 CLINIMIX 2.75%/D5W SULFIT FREE............83 CLINIMIX 4.25%-D20W SULF-FREE.............83 CLINIMIX 4.25%-D25W SULF-FREE.............83 CLINIMIX 4.25%/D10W SULF FREE..............83 CLINIMIX 4.25%/D5W SULFIT FREE............59 CLINIMIX 5%-D20W(SULFITE-FREE)...........83 CLINIMIX 5%/D15W SULFITE FREE............83 CLINIMIX 5%/D25W SULFITE-FREE............83 CLINIMIX E 2.75%/D10W SUL FREE.............59 CLINIMIX E 2.75%/D5W SULF FREE............59 CLINIMIX E 4.25%/D10W SUL FREE.............83 CLINIMIX E 4.25%/D25W SUL FREE.............83 CLINIMIX E 4.25%/D5W SULF FREE............83 CLINIMIX E 5%/D15W SULFIT FREE...........83 CLINIMIX E 5%/D20W SULFIT FREE...........83 CLINIMIX E 5%/D25W SULFIT FREE...........83 CLINIMIX N14G30E 4.25%-D15W SF............83 CLINIMIX N9G15E 2.75%-D7.5W SF.............83 CLINIMIX N9G20E 2.75%-D10W(SF)............60 clobetasol scalp.......................................................57 clobetasol topical cream..........................................57 clobetasol topical foam............................................57 clobetasol topical gel...............................................57 clobetasol topical lotion..........................................57 clobetasol topical ointment......................................57 clobetasol topical shampoo......................................57 clobetasol-emollient topical cream...........................57 clobetasol-emollient topical foam.............................57 CLOBEX TOPICAL LOTION..........................57 clofarabine............................................................22 CLOLAR.............................................................22 clomipramine........................................................32 clonazepam oral tablet 0.5 mg................................32 clonazepam oral tablet 1 mg...................................32 clonazepam oral tablet 2 mg...................................32 clonazepam oral tablet,disintegrating 0.125 mg.......32 clonazepam oral tablet,disintegrating 0.25 mg.........32 clonazepam oral tablet,disintegrating 0.5 mg...........32 clonazepam oral tablet,disintegrating 1 mg..............32 clonazepam oral tablet,disintegrating 2 mg..............32 clonidine hcl oral tablet..........................................50 clonidine transdermal patch...................................50 clopidogrel oral tablet 300 mg................................50 clopidogrel oral tablet 75 mg..................................50

clorazepate dipotassium..........................................32 clotrimazole mucous membrane..............................13 clotrimazole topical cream......................................57 clotrimazole topical solution...................................57 clotrimazole-betamethasone topical cream...............57 clotrimazole-betamethasone topical lotion................57 clozapine oral tablet 100 mg..................................32 clozapine oral tablet 200 mg..................................32 clozapine oral tablet 25 mg....................................32 clozapine oral tablet 50 mg....................................32 clozapine oral tablet,disintegrating 100 mg.............32 clozapine oral tablet,disintegrating 12.5 mg............32 CLOZAPINE ORAL TABLET,

DISINTEGRATING 150 MG.........................32 CLOZAPINE ORAL TABLET,

DISINTEGRATING 200 MG.........................33 clozapine oral tablet,disintegrating 25 mg...............33 COARTEM.........................................................13 COLCRYS...........................................................73 colesevelam............................................................50 colestipol...............................................................50 colistin (colistimethate na)......................................13 COLY-MYCIN S.................................................61 COMBIGAN.......................................................77 COMBIVENT RESPIMAT................................80 COMETRIQ ORAL CAPSULE 100 MG/

DAY(80 MG X1-20 MG X1)...........................22 COMETRIQ ORAL CAPSULE 140 MG/

DAY(80 MG X1-20 MG X3)...........................22 COMETRIQ ORAL CAPSULE 60 MG/DAY

(20 MG X 3/DAY)............................................22 COMPLERA.......................................................13 compro..................................................................68 constulose..............................................................68 COPAXONE SUBCUTANEOUS SYRINGE

20 MG/ML.......................................................33 COPAXONE SUBCUTANEOUS SYRINGE

40 MG/ML.......................................................33 CORLANOR......................................................50 cortisone................................................................62 CORZIDE ORAL TABLET 40-5 MG...............50 COSMEGEN......................................................22 COSOPT.............................................................77 COTELLIC.........................................................22 COUMADIN ORAL..........................................50 COZAAR............................................................50 CREON..............................................................68 CRESTOR..........................................................50


CRIXIVAN ORAL CAPSULE 200 MG.............13 CRIXIVAN ORAL CAPSULE 400 MG.............13 cromolyn inhalation...............................................80 cromolyn ophthalmic (eye)......................................77 cromolyn oral........................................................68 cryselle (28)...........................................................75 CUBICIN............................................................13 cyclafem 1/35 (28).................................................75 cyclafem 7/7/7 (28)................................................75 cyclobenzaprine oral tablet 10 mg, 5 mg..................33 cyclobenzaprine oral tablet 7.5 mg..........................33 CYCLOPHOSPHAMIDE ORAL

CAPSULE.........................................................22 CYCLOSET........................................................62 cyclosporine intravenous.........................................22 cyclosporine modified oral capsule...........................22 cyclosporine modified oral solution..........................22 cyclosporine oral capsule.........................................22 cyproheptadine.......................................................80 CYRAMZA..........................................................22 CYSTADANE.....................................................68 CYSTAGON.......................................................82 CYSTARAN........................................................77 cytarabine.............................................................22 cytarabine (pf) injection solution 100 mg/5 ml (20

mg/ml), 2 gram/20 ml (100 mg/ml)....................22 cytarabine (pf) injection solution 20 mg/ml.............22 CYTOMEL.........................................................62 d10 %-0.45 % sodium chloride.............................60 d2.5 %-0.45 % sodium chloride............................60 d5 % and 0.9 % sodium chloride...........................60 d5 %-0.45 % sodium chloride...............................60 dacarbazine...........................................................22 dactinomycin.........................................................22 dalfampridine.......................................................33 DALIRESP..........................................................80 danazol.................................................................62 dantrolene.............................................................33 dapsone oral..........................................................13 DAPTACEL (DTAP PEDIATRIC) (PF)............71 daptomycin intravenous recon soln 500 mg.............13 DARAPRIM........................................................13 DARZALEX........................................................22 dasetta 1/35 (28)...................................................75 dasetta 7/7/7 (28)..................................................75 daunorubicin intravenous solution..........................22 decitabine.............................................................22 DELESTROGEN................................................75

DELZICOL ORAL CAPSULE (WITH DEL REL TABLETS)...............................................68

demeclocycline.......................................................13 DEMSER.............................................................50 DENAVIR...........................................................57 denta 5000 plus....................................................61 dentagel................................................................61 DEPEN TITRATABS.........................................73 DEPO-ESTRADIOL...........................................75 DEPO-PROVERA INTRAMUSCULAR

SUSPENSION 400 MG/ML............................75 DERMATOP TOPICAL OINTMENT.............57 DESCOVY..........................................................13 desipramine...........................................................33 desloratadine.........................................................80 desmopressin injection............................................62 desmopressin nasal spray with pump........................62 desmopressin nasal spray,non-aerosol.......................62 desmopressin oral...................................................62 desonide................................................................57 desoximetasone topical cream..................................57 desoximetasone topical gel.......................................57 desoximetasone topical ointment 0.25 %.................57 DESVENLAFAXINE ORAL TABLET

EXTENDED RELEASE 24 HR 100 MG........33 DESVENLAFAXINE ORAL TABLET

EXTENDED RELEASE 24 HR 50 MG..........33 DESVENLAFAXINE ORAL TABLET

EXTENDED RELEASE 24HR 100 MG.........33 DESVENLAFAXINE ORAL TABLET

EXTENDED RELEASE 24HR 50 MG...........33 desvenlafaxine succinate oral tablet extended release

24 hr 100 mg.....................................................33 desvenlafaxine succinate oral tablet extended release

24 hr 25 mg.......................................................33 desvenlafaxine succinate oral tablet extended release

24 hr 50 mg.......................................................33 dexamethasone intensol..........................................62 dexamethasone oral elixir.......................................62 dexamethasone oral solution...................................62 dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg,

1.5 mg...............................................................62 dexamethasone oral tablet 2 mg, 4 mg, 6 mg...........62 dexamethasone sodium phos (pf).............................62 dexamethasone sodium phosphate injection

solution..............................................................62 dexamethasone sodium phosphate injection

syringe................................................................63


dexamethasone sodium phosphate ophthalmic (eye)...................................................................78

DEXILANT.........................................................68 dexrazoxane hcl intravenous recon soln 250 mg.......22 dexrazoxane hcl intravenous recon soln 500 mg.......22 dextroamphetamine oral tablet 10 mg.....................33 dextroamphetamine oral tablet 5 mg.......................33 dextroamphetamine-amphetamine oral capsule,

extended release 24hr..........................................33 dextroamphetamine-amphetamine oral tablet 10

mg, 12.5 mg, 15 mg, 20 mg, 5 mg, 7.5 mg..........33 dextroamphetamine-amphetamine oral tablet 30

mg.....................................................................33 dextrose 10 % and 0.2 % nacl...............................60 dextrose 10 % in water (d10w)..............................60 dextrose 25 % in water (d25w)..............................60 dextrose 30 % in water (d30w)..............................60 dextrose 40 % in water (d40w)..............................60 dextrose 5 % in water (d5w)..................................60 dextrose 5 %-lactated ringers..................................60 dextrose 5%-0.2 % sod chloride..............................60 dextrose 5%-0.3 % sod.chloride..............................60 dextrose 50 % in water (d50w) intravenous

parenteral solution..............................................60 dextrose 50 % in water (d50w) intravenous

syringe................................................................60 dextrose 70 % in water (d70w)..............................60 dextrose with sodium chloride.................................60 DIASTAT............................................................33 DIASTAT ACUDIAL.........................................33 diazepam intensol..................................................33 diazepam oral concentrate......................................33 diazepam oral solution 5 mg/5 ml (1 mg/ml)...........33 diazepam oral tablet 10 mg....................................33 diazepam oral tablet 2 mg......................................33 diazepam oral tablet 5 mg......................................33 diazepam rectal.....................................................33 diclofenac potassium...............................................33 diclofenac sodium ophthalmic (eye).........................78 diclofenac sodium oral tablet extended release 24

hr......................................................................34 diclofenac sodium oral tablet,delayed release (dr/ec)

25 mg................................................................34 diclofenac sodium oral tablet,delayed release (dr/ec)

50 mg................................................................34 diclofenac sodium oral tablet,delayed release (dr/ec)

75 mg................................................................34 diclofenac sodium topical drops...............................34

diclofenac sodium topical gel 1 %...........................34 diclofenac sodium topical gel 3 %...........................57 dicloxacillin...........................................................13 dicyclomine oral capsule.........................................68 dicyclomine oral solution........................................69 dicyclomine oral tablet...........................................69 didanosine oral capsule,delayed release(dr/ec) 200

mg.....................................................................13 didanosine oral capsule,delayed release(dr/ec) 250

mg, 400 mg........................................................13 DIFICID.............................................................13 diflorasone.............................................................57 diflunisal...............................................................34 digitek oral tablet 125 mcg.....................................50 digitek oral tablet 250 mcg.....................................50 digox oral tablet 125 mcg.......................................50 digoxin injection solution.......................................50 digoxin oral solution 50 mcg/ml..............................50 digoxin oral tablet 125 mcg....................................50 digoxin oral tablet 250 mcg....................................50 dihydroergotamine injection...................................34 dihydroergotamine nasal........................................34 DILANTIN EXTENDED ORAL CAPSULE

100 MG............................................................34 DILANTIN INFATABS.....................................34 DILANTIN ORAL CAPSULE 30 MG...............34 dilt-xr...................................................................50 diltiazem hcl intravenous.......................................50 diltiazem hcl oral capsule,ext.rel 24h

degradable..........................................................50 diltiazem hcl oral capsule,extended release 12 hr......50 diltiazem hcl oral capsule,extended release 24 hr......50 diltiazem hcl oral capsule,extended release 24hr 120

mg, 180 mg, 240 mg, 300 mg.............................50 diltiazem hcl oral capsule,extended release 24hr 360

mg.....................................................................51 diltiazem hcl oral tablet.........................................51 DIOVAN HCT...................................................51 DIPENTUM.......................................................69 diphenhydramine hcl injection solution 50 mg/

ml......................................................................80 diphenhydramine hcl injection syringe.....................80 diphenoxylate-atropine oral liquid..........................69 diphenoxylate-atropine oral tablet...........................69 disopyramide phosphate oral capsule........................51 disulfiram.............................................................60 divalproex oral capsule, delayed rel sprinkle.............34 divalproex oral tablet extended release 24 hr............34


divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg..............................................................34

divalproex oral tablet,delayed release (dr/ec) 500 mg.....................................................................34

docetaxel intravenous solution 160 mg/16 ml (10 mg/ml), 20 mg/2 ml (10 mg/ml)..........................22

docetaxel intravenous solution 160 mg/8 ml (20 mg/ ml), 20 mg/ml (1 ml), 80 mg/4 ml (20 mg/ml), 80 mg/8 ml (10 mg/ml)......................................22

DOCETAXEL INTRAVENOUS SOLUTION 20 MG/ML.......................................................22

dofetilide...............................................................51 donepezil oral tablet 10 mg, 5 mg...........................34 donepezil oral tablet,disintegrating..........................34 DORIPENEM.....................................................13 dorzolamide..........................................................78 dorzolamide-timolol...............................................78 doxazosin..............................................................51 doxepin oral..........................................................34 doxercalciferol intravenous.....................................63 doxercalciferol oral capsule 0.5 mcg.........................63 doxercalciferol oral capsule 1 mcg, 2.5 mcg..............63 doxorubicin intravenous recon soln 10 mg...............22 doxorubicin intravenous recon soln 50 mg...............22 doxorubicin intravenous solution............................22 doxorubicin, peg-liposomal.....................................22 doxy-100...............................................................13 doxycycline hyclate intravenous...............................13 doxycycline hyclate oral capsule...............................13 doxycycline hyclate oral tablet 100 mg, 150 mg, 20

mg, 75 mg..........................................................13 doxycycline monohydrate oral capsule 100 mg, 50

mg.....................................................................13 doxycycline monohydrate oral suspension for

reconstitution.....................................................13 doxycycline monohydrate oral tablet 100 mg............13 doxycycline monohydrate oral tablet 150 mg, 50 mg,

75 mg................................................................13 dronabinol oral capsule 10 mg................................69 dronabinol oral capsule 2.5 mg, 5 mg.....................69 drospirenone-ethinyl estradiol.................................75 DROXIA.............................................................22 DUETACT ORAL TABLET 30-4 MG..............63 DULERA.............................................................80 duloxetine oral capsule,delayed release(dr/ec) 20

mg.....................................................................34 duloxetine oral capsule,delayed release(dr/ec) 30

mg.....................................................................34

duloxetine oral capsule,delayed release(dr/ec) 40 mg.....................................................................34

duloxetine oral capsule,delayed release(dr/ec) 60 mg.....................................................................34

duramorph (pf) injection solution 0.5 mg/ml...........34 duramorph (pf) injection solution 1 mg/ml..............34 DUREZOL..........................................................78 dutasteride............................................................82 dutasteride-tamsulosin...........................................82 DYAZIDE...........................................................51 DYSPORT...........................................................71 e.e.s. 400 oral tablet...............................................13 econazole...............................................................57 EDURANT.........................................................13 efavirenz oral capsule 200 mg.................................13 efavirenz oral capsule 50 mg...................................13 efavirenz oral tablet...............................................13 EFFIENT............................................................51 EGRIFTA SUBCUTANEOUS RECON SOLN

1 MG................................................................71 ELAPRASE..........................................................63 ELESTRIN..........................................................75 ELIDEL...............................................................57 elinest...................................................................75 ELIQUIS ORAL TABLET 2.5 MG....................51 ELIQUIS ORAL TABLET 5 MG.......................51 ELITEK...............................................................22 ELIXOPHYLLIN ORAL ELIXIR 80 MG/15

ML....................................................................80 ELLA...................................................................75 ELMIRON..........................................................82 EMCYT...............................................................22 EMEND ORAL CAPSULE 125 MG..................69 EMEND ORAL CAPSULE 40 MG....................69 EMEND ORAL CAPSULE 80 MG....................69 EMEND ORAL CAPSULE,DOSE PACK..........69 EMEND ORAL SUSPENSION FOR

RECONSTITUTION......................................69 emoquette..............................................................75 EMPLICITI.........................................................22 EMSAM..............................................................34 EMTRIVA ORAL CAPSULE.............................13 EMTRIVA ORAL SOLUTION..........................13 enalapril maleate...................................................51 enalapril-hydrochlorothiazide.................................51 ENBREL MINI...................................................73 ENBREL SUBCUTANEOUS RECON

SOLN...............................................................73


ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51)............................................73

ENBREL SUBCUTANEOUS SYRINGE 50 MG/ML (0.98 ML)..........................................73

ENBREL SURECLICK.......................................73 endocet oral tablet 10-325 mg, 7.5-325 mg............34 endocet oral tablet 5-325 mg..................................34 ENGERIX-B (PF)................................................71 ENGERIX-B PEDIATRIC (PF)

INTRAMUSCULAR SYRINGE......................72 enoxaparin subcutaneous solution...........................51 enoxaparin subcutaneous syringe 100 mg/ml, 150

mg/ml................................................................51 enoxaparin subcutaneous syringe 120 mg/0.8 ml, 80

mg/0.8 ml..........................................................51 enoxaparin subcutaneous syringe 30 mg/0.3 ml........51 enoxaparin subcutaneous syringe 40 mg/0.4 ml.......51 enoxaparin subcutaneous syringe 60 mg/0.6 ml........51 enpresse.................................................................75 entacapone............................................................34 entecavir...............................................................13 ENTRESTO........................................................51 enulose..................................................................69 ENVARSUS XR..................................................22 EPCLUSA............................................................13 epinastine..............................................................78 epinephrine injection auto-injector 0.15 mg/0.15

ml, 0.15 mg/0.3 ml............................................80 EPINEPHRINE INJECTION AUTO-

INJECTOR 0.3 MG/0.3 ML...........................80 epirubicin intravenous solution...............................22 epitol....................................................................34 EPIVIR HBV ORAL SOLUTION......................13 EPIVIR ORAL SOLUTION...............................13 eplerenone.............................................................51 eprosartan.............................................................51 EPZICOM..........................................................13 EQUETRO ORAL CAPSULE, ER

MULTIPHASE 12 HR 100 MG......................34 EQUETRO ORAL CAPSULE, ER

MULTIPHASE 12 HR 200 MG......................34 EQUETRO ORAL CAPSULE, ER

MULTIPHASE 12 HR 300 MG......................34 ERBITUX............................................................22 ergoloid.................................................................34 ERIVEDGE.........................................................23 ERLEADA...........................................................23 errin.....................................................................75

ertapenem.............................................................13 ERWINAZE........................................................23 ery pads.................................................................57 ery-tab oral tablet,delayed release (dr/ec) 250 mg,

333 mg..............................................................13 ERY-TAB ORAL TABLET,DELAYED

RELEASE (DR/EC) 500 MG...........................14 erythrocin (as stearate) oral tablet 250 mg...............14 ERYTHROCIN INTRAVENOUS RECON

SOLN 500 MG................................................14 erythromycin ethylsuccinate oral tablet....................14 erythromycin ophthalmic (eye)................................78 erythromycin oral capsule,delayed release(dr/ec)........14 erythromycin oral tablet.........................................14 erythromycin with ethanol......................................57 erythromycin-benzoyl peroxide................................57 ESBRIET ORAL CAPSULE...............................80 ESBRIET ORAL TABLET 267 MG...................80 ESBRIET ORAL TABLET 801 MG...................80 escitalopram oxalate oral solution............................34 escitalopram oxalate oral tablet 10 mg....................35 escitalopram oxalate oral tablet 20 mg....................35 escitalopram oxalate oral tablet 5 mg......................35 esomeprazole magnesium........................................69 esomeprazole sodium intravenous recon soln 20

mg.....................................................................69 esomeprazole sodium intravenous recon soln 40

mg.....................................................................69 estarylla.................................................................75 ESTRACE VAGINAL.........................................75 estradiol oral.........................................................75 estradiol transdermal patch semiweekly...................75 estradiol transdermal patch weekly..........................75 estradiol vaginal....................................................75 estradiol valerate intramuscular oil 20 mg/ml, 40

mg/ml................................................................75 estradiol-norethindrone acet...................................75 ESTRING............................................................75 estropipate oral tablet 0.75 mg...............................75 eszopiclone.............................................................35 ethambutol............................................................14 ethosuximide oral capsule.......................................35 ethosuximide oral solution......................................35 etidronate disodium...............................................60 etodolac oral capsule...............................................35 etodolac oral tablet.................................................35 etodolac oral tablet extended release 24 hr...............35 ETOPOPHOS....................................................23


etoposide intravenous.............................................23 EVAMIST...........................................................75 EVOMELA..........................................................23 EVOTAZ.............................................................14 EXELDERM.......................................................57 exemestane............................................................23 EXFORGE..........................................................51 EXFORGE HCT.................................................51 EXJADE..............................................................60 ezetimibe...............................................................51 FABRAZYME......................................................63 falmina (28).........................................................75 famciclovir oral tablet 125 mg, 250 mg..................14 famciclovir oral tablet 500 mg................................14 famotidine (pf)......................................................69 famotidine (pf)-nacl (iso-os)...................................69 famotidine intravenous solution..............................69 famotidine oral suspension......................................69 famotidine oral tablet 20 mg, 40 mg.......................69 FANAPT ORAL TABLET 1 MG........................35 FANAPT ORAL TABLET 10 MG, 12 MG........35 FANAPT ORAL TABLET 2 MG........................35 FANAPT ORAL TABLET 4 MG........................35 FANAPT ORAL TABLET 6 MG........................35 FANAPT ORAL TABLET 8 MG........................35 FANAPT ORAL TABLETS,DOSE PACK.........35 FARESTON........................................................23 FARYDAK ORAL CAPSULE 10 MG.................23 FARYDAK ORAL CAPSULE 15 MG, 20

MG...................................................................23 FASLODEX........................................................23 felbamate..............................................................35 FELBATOL ORAL TABLET 400 MG...............35 felodipine..............................................................51 FEMRING..........................................................75 fenofibrate micronized oral capsule 130 mg.............51 fenofibrate micronized oral capsule 134 mg, 67

mg.....................................................................51 fenofibrate micronized oral capsule 200 mg, 43

mg.....................................................................51 fenofibrate nanocrystallized oral tablet 145 mg........51 fenofibrate nanocrystallized oral tablet 48 mg..........51 fenofibrate oral tablet 160 mg................................51 fenofibrate oral tablet 54 mg..................................51 fenofibric acid (choline) oral capsule,delayed

release(dr/ec) 135 mg..........................................51 fenofibric acid (choline) oral capsule,delayed

release(dr/ec) 45 mg............................................51

fenoprofen oral tablet.............................................35 fentanyl citrate......................................................35 fentanyl transdermal patch 72 hour 100 mcg/hr, 12

mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr............35 FETZIMA ORAL CAPSULE,EXT REL 24HR

DOSE PACK....................................................35 FETZIMA ORAL CAPSULE,EXTENDED

RELEASE 24 HR 120 MG, 80 MG.................35 FETZIMA ORAL CAPSULE,EXTENDED

RELEASE 24 HR 20 MG.................................35 FETZIMA ORAL CAPSULE,EXTENDED

RELEASE 24 HR 40 MG.................................35 finasteride oral tablet 5 mg.....................................82 FIRAZYR............................................................80 FIRMAGON KIT W DILUENT SYRINGE

SUBCUTANEOUS RECON SOLN 120 MG...................................................................23

FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG...................................................................23

flavoxate...............................................................82 flecainide..............................................................51 FLOVENT DISKUS INHALATION BLISTER

WITH DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION..................................80

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 250 MCG/ ACTUATION..................................................80

FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ ACTUATION..................................................80



fluconazole in dextrose(iso-o)..................................14 FLUCONAZOLE IN NACL (ISO-OSM)

INTRAVENOUS PIGGYBACK 100 MG/50 ML....................................................................14

fluconazole in nacl (iso-osm) intravenous piggyback 200 mg/100 ml..................................................14

fluconazole in nacl (iso-osm) intravenous piggyback 400 mg/200 ml..................................................14

fluconazole oral suspension for reconstitution 10 mg/ ml......................................................................14


fluconazole oral suspension for reconstitution 40 mg/ ml......................................................................14

fluconazole oral tablet 100 mg, 150 mg, 50 mg.......14 fluconazole oral tablet 200 mg................................14 flucytosine oral capsule 250 mg...............................14 flucytosine oral capsule 500 mg...............................14 fludarabine intravenous recon soln..........................23 fludarabine intravenous solution.............................23 fludrocortisone.......................................................63 flunisolide nasal spray,non-aerosol 25 mcg (0.025

%).....................................................................81 fluocinolone...........................................................57 fluocinolone acetonide oil otic.................................61 fluocinolone and shower cap...................................57 fluocinonide topical cream 0.05 %.........................57 fluocinonide topical cream 0.1 %...........................57 fluocinonide topical gel...........................................57 fluocinonide topical ointment.................................57 fluocinonide topical solution...................................57 fluocinonide-e........................................................57 FLUOCINONIDE-EMOLLIENT.....................57 fluoride (sodium) oral tablet...................................83 fluoride (sodium) oral tablet,chewable.....................83 fluoritab oral tablet,chewable 1 mg (2.2 mg sod.

fluoride).............................................................83 fluorometholone.....................................................78 fluorouracil intravenous solution 1 gram/20 ml, 500

mg/10 ml...........................................................23 fluorouracil intravenous solution 2.5 gram/50 ml,

5 gram/100 ml...................................................23 fluorouracil topical cream 5 %...............................58 fluorouracil topical solution 2 %.............................58 fluorouracil topical solution 5 %.............................58 fluoxetine oral capsule 10 mg..................................35 fluoxetine oral capsule 20 mg..................................35 fluoxetine oral capsule 40 mg..................................35 fluoxetine oral capsule,delayed release(dr/ec)............35 fluoxetine oral solution...........................................35 fluoxetine oral tablet 10 mg....................................35 fluoxetine oral tablet 20 mg....................................35 fluphenazine decanoate..........................................36 fluphenazine hcl injection.......................................36 fluphenazine hcl oral..............................................36 flurbiprofen...........................................................36 flurbiprofen ophthalmic drops.................................78 flutamide..............................................................23 fluticasone nasal....................................................81 fluticasone topical cream........................................58

fluticasone topical lotion.........................................58 fluticasone topical ointment....................................58 fluvastatin oral capsule 20 mg................................51 fluvastatin oral capsule 40 mg................................51 fluvoxamine oral tablet 100 mg..............................36 fluvoxamine oral tablet 25 mg................................36 fluvoxamine oral tablet 50 mg................................36 FOLOTYN..........................................................23 fomepizole.............................................................72 fondaparinux subcutaneous syringe 10 mg/0.8

ml......................................................................51 fondaparinux subcutaneous syringe 2.5 mg/0.5

ml......................................................................51 fondaparinux subcutaneous syringe 5 mg/0.4 ml......51 fondaparinux subcutaneous syringe 7.5 mg/0.6

ml......................................................................51 FORTEO............................................................74 FOSAMAX ORAL TABLET 70 MG..................74 FOSAMAX PLUS D............................................74 fosamprenavir........................................................14 fosinopril...............................................................51 fosinopril-hydrochlorothiazide................................51 fosphenytoin..........................................................36 FREAMINE HBC 6.9 %.....................................83 freamine iii 10 %..................................................83 furosemide injection...............................................52 furosemide oral solution 10 mg/ml, 40 mg/5 ml (8

mg/ml)...............................................................52 furosemide oral tablet.............................................52 FUSILEV.............................................................23 FUZEON SUBCUTANEOUS RECON

SOLN...............................................................14 FYCOMPA ORAL SUSPENSION.....................36 FYCOMPA ORAL TABLET 10 MG, 12

MG...................................................................36 FYCOMPA ORAL TABLET 2 MG....................36 FYCOMPA ORAL TABLET 4 MG....................36 FYCOMPA ORAL TABLET 6 MG....................36 FYCOMPA ORAL TABLET 8 MG....................36 gabapentin oral capsule 100 mg..............................36 gabapentin oral capsule 300 mg..............................36 gabapentin oral capsule 400 mg..............................36 gabapentin oral solution 250 mg/5 ml.....................36 GABAPENTIN ORAL SOLUTION 250 MG/

5 ML (5 ML), 300 MG/6 ML (6 ML)..............36 gabapentin oral tablet 600 mg................................36 gabapentin oral tablet 800 mg................................36 GABITRIL ORAL TABLET 12 MG...................36


GABITRIL ORAL TABLET 16 MG...................36 galantamine oral capsule,ext rel. pellets 24 hr..........36 galantamine oral solution.......................................36 galantamine oral tablet..........................................36 GAMUNEX-C....................................................72 ganciclovir sodium intravenous recon soln...............14 GARDASIL 9 (PF)..............................................72 gatifloxacin...........................................................78 GATTEX 30-VIAL..............................................69 GATTEX ONE-VIAL.........................................69 gauze pads 2 x 2....................................................63 gavilyte-c...............................................................69 gavilyte-g...............................................................69 gavilyte-n..............................................................69 GAZYVA.............................................................23 gemcitabine intravenous recon soln 1 gram, 200

mg.....................................................................23 gemcitabine intravenous recon soln 2 gram..............23 gemcitabine intravenous solution 1 gram/26.3 ml

(38 mg/ml), 200 mg/5.26 ml (38 mg/ml)............23 GEMCITABINE INTRAVENOUS SOLUTION

100 MG/ML.....................................................23 gemcitabine intravenous solution 2 gram/52.6 ml

(38 mg/ml).........................................................23 gemfibrozil............................................................52 generlac.................................................................69 gengraf oral capsule 100 mg, 25 mg........................23 gengraf oral solution...............................................23 gentak ophthalmic (eye) ointment...........................78 gentamicin in nacl (iso-osm) intravenous piggyback

100 mg/100 ml, 60 mg/50 ml.............................14 GENTAMICIN IN NACL (ISO-OSM)

INTRAVENOUS PIGGYBACK 100 MG/50 ML, 120 MG/100 ML......................................14

gentamicin in nacl (iso-osm) intravenous piggyback 70 mg/50 ml, 80 mg/100 ml, 90 mg/100 ml.......14

gentamicin in nacl (iso-osm) intravenous piggyback 80 mg/50 ml......................................................14

gentamicin injection solution 20 mg/2 ml................14 gentamicin injection solution 40 mg/ml...................14 gentamicin ophthalmic (eye) drops..........................78 gentamicin ophthalmic (eye) ointment.....................78 gentamicin sulfate (ped) (pf)...................................14 gentamicin sulfate (pf) intravenous solution 100 mg/

10 ml.................................................................15 GENTAMICIN SULFATE (PF)

INTRAVENOUS SOLUTION 60 MG/6 ML....................................................................15

gentamicin topical.................................................58 GENVOYA.........................................................15 GEODON INTRAMUSCULAR........................36 gianvi (28)............................................................75 GILENYA ORAL CAPSULE 0.5 MG.................36 GILOTRIF..........................................................23 glatiramer subcutaneous syringe 20 mg/ml...............36 glatiramer subcutaneous syringe 40 mg/ml...............36 glatopa subcutaneous syringe 20 mg/ml...................36 glatopa subcutaneous syringe 40 mg/ml...................36 GLEEVEC ORAL TABLET 100 MG.................23 GLEEVEC ORAL TABLET 400 MG.................23 GLEOSTINE......................................................23 glimepiride oral tablet 1 mg...................................63 glimepiride oral tablet 2 mg...................................63 glimepiride oral tablet 4 mg...................................63 glipizide oral tablet 10 mg.....................................63 glipizide oral tablet 5 mg.......................................63 glipizide oral tablet extended release 24hr 10

mg.....................................................................63 glipizide oral tablet extended release 24hr 2.5

mg.....................................................................63 glipizide oral tablet extended release 24hr 5 mg.......63 glipizide-metformin oral tablet 2.5-250 mg............63 glipizide-metformin oral tablet 2.5-500 mg, 5-500

mg.....................................................................63 GLUCAGEN HYPOKIT....................................63 GLUCAGON EMERGENCY KIT

(HUMAN).......................................................63 GLUCOPHAGE ORAL TABLET 1,000

MG...................................................................63 GLUCOPHAGE ORAL TABLET 500 MG.......63 GLUCOPHAGE ORAL TABLET 850 MG.......63 GLUCOPHAGE XR ORAL TABLET

EXTENDED RELEASE 24 HR 500 MG........63 GLUCOPHAGE XR ORAL TABLET

EXTENDED RELEASE 24 HR 750 MG........63 GLUCOTROL ORAL TABLET 10 MG............63 GLUCOTROL ORAL TABLET 5 MG..............63 GLUCOTROL XL ORAL TABLET

EXTENDED RELEASE 24HR 10 MG...........63 GLUCOTROL XL ORAL TABLET

EXTENDED RELEASE 24HR 2.5 MG..........63 GLUCOTROL XL ORAL TABLET

EXTENDED RELEASE 24HR 5 MG.............64 GLUCOVANCE.................................................64 GLUMETZA ORAL TABLET,ER

GAST.RETENTION 24 HR 1,000 MG..........64


GLUMETZA ORAL TABLET,ER GAST.RETENTION 24 HR 500 MG.............64

glyburide micronized oral tablet 1.5 mg..................64 glyburide micronized oral tablet 3 mg.....................64 glyburide micronized oral tablet 6 mg.....................64 glyburide oral tablet 1.25 mg.................................64 glyburide oral tablet 2.5 mg...................................64 glyburide oral tablet 5 mg......................................64 glyburide-metformin oral tablet 1.25-250 mg.........64 glyburide-metformin oral tablet 2.5-500 mg, 5-500

mg.....................................................................64 glycopyrrolate injection...........................................69 glycopyrrolate oral tablet 1 mg, 2 mg.......................69 GLYSET ORAL TABLET 100 MG....................64 GLYSET ORAL TABLET 25 MG......................64 GLYSET ORAL TABLET 50 MG......................64 granisetron (pf) intravenous solution 100 mcg/

ml......................................................................69 granisetron hcl intravenous.....................................69 granisetron hcl oral................................................69 griseofulvin microsize.............................................15 griseofulvin ultramicrosize......................................15 guanfacine oral tablet.............................................52 guanfacine oral tablet extended release 24 hr...........36 guanidine..............................................................36 HALAVEN..........................................................23 halobetasol propionate............................................58 HALOG..............................................................58 haloperidol............................................................36 haloperidol decanoate intramuscular solution 100

mg/ml, 100 mg/ml (1 ml)...................................37 haloperidol decanoate intramuscular solution 50 mg/

ml......................................................................37 haloperidol lactate injection....................................37 haloperidol lactate intramuscular............................37 haloperidol lactate oral...........................................37 HARVONI..........................................................15 HAVRIX (PF) INTRAMUSCULAR

SUSPENSION.................................................72 HAVRIX (PF) INTRAMUSCULAR SYRINGE

1,440 ELISA UNIT/ML...................................72 HAVRIX (PF) INTRAMUSCULAR SYRINGE

720 ELISA UNIT/0.5 ML................................72 heather..................................................................75 heparin (porcine) in 5 % dex intravenous parenteral

solution 20,000 unit/500 ml (40 unit/ml)...........52

heparin (porcine) in 5 % dex intravenous parenteral solution 25,000 unit/250 ml(100 unit/ml), 25, 000 unit/500 ml (50 unit/ml).............................52

heparin (porcine) in nacl (pf).................................52 heparin (porcine) injection cartridge.......................52 heparin (porcine) injection solution.........................52 heparin (porcine) injection syringe 5,000 unit/

ml......................................................................52 HEPARIN(PORCINE) IN 0.45% NACL

INTRAVENOUS PARENTERAL SOLUTION 12,500 UNIT/250 ML................52

heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/250 ml...............52

heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/500 ml...............52

heparin, porcine (pf) injection................................52 HEPATAMINE 8%............................................83 HERCEPTIN......................................................23 HETLIOZ...........................................................37 HEXALEN..........................................................23 HIBERIX (PF).....................................................72 HUMALOG JUNIOR KWIKPEN U-100..........64 HUMALOG KWIKPEN INSULIN...................64 HUMALOG MIX 50-50 INSULN U-100..........64 HUMALOG MIX 50-50 KWIKPEN..................64 HUMALOG MIX 75-25 KWIKPEN..................64 HUMALOG MIX 75-25(U-100)INSULN.........64 HUMALOG U-100 INSULIN...........................64 HUMIRA PEDIATRIC CROHN'S START

SUBCUTANEOUS SYRINGE KIT 40 MG/ 0.8 ML (6 PACK).............................................74

HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT 40 MG/ 0.8 ML, 80 MG/0.8 ML...................................74

HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT 80 MG/ 0.8 ML-40 MG/0.4 ML....................................74

HUMIRA PEN....................................................74 HUMIRA PEN CROHN'S-UC-HS START

SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML......................................................74

HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML......................................................74

HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML......................................................74


HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML-40 MG/0.4 ML............................74

HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.1 ML, 10 MG/0.2 ML, 20 MG/0.2 ML, 20 MG/0.4 ML.........................................74

HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.4 ML, 40 MG/0.8 ML......................74

HUMULIN 70/30 U-100 INSULIN..................64 HUMULIN 70/30 U-100 KWIKPEN................64 HUMULIN N NPH INSULIN KWIKPEN.......64 HUMULIN N NPH U-100 INSULIN...............64 HUMULIN R REGULAR U-100 INSULN.......64 HUMULIN R U-500 (CONC) INSULIN..........64 HUMULIN R U-500 (CONC) KWIKPEN.......64 hydralazine injection.............................................52 hydralazine oral....................................................52 hydrochlorothiazide...............................................52 hydrocodone-acetaminophen oral solution 7.5-325

mg/15 ml...........................................................37 hydrocodone-acetaminophen oral tablet 10-325 mg,

5-325 mg, 7.5-325 mg.......................................37 hydrocodone-ibuprofen oral tablet 10-200 mg, 5-

200 mg, 7.5-200 mg..........................................37 hydrocortisone butyrate topical cream......................58 hydrocortisone butyrate topical ointment.................58 hydrocortisone butyrate topical solution...................58 hydrocortisone oral tablet 10 mg, 5 mg....................64 hydrocortisone oral tablet 20 mg.............................64 hydrocortisone rectal...............................................69 hydrocortisone topical cream 1 %, 2.5 %................58 hydrocortisone topical cream with perineal applicator

2.5 %................................................................69 hydrocortisone topical lotion 2.5 %.........................58 hydrocortisone topical ointment 1 %, 2.5 %............58 hydrocortisone valerate...........................................58 hydrocortisone-acetic acid.......................................61 hydrocortisone-min oil-wht pet...............................58 HYDROMORPHONE (PF) INJECTION

SOLUTION 1 MG/ML...................................37 hydromorphone (pf) injection solution 10 mg/

ml......................................................................37 hydromorphone (pf) injection solution 2 mg/ml........37 hydromorphone (pf) injection solution 4 mg/ml........37 HYDROMORPHONE INJECTION

SOLUTION 1 MG/ML...................................37 hydromorphone injection solution 2 mg/ml..............37

HYDROMORPHONE INJECTION SOLUTION 4 MG/ML...................................37

hydromorphone injection syringe 1 mg/ml................37 hydromorphone injection syringe 2 mg/ml................37 hydromorphone injection syringe 4 mg/ml................37 hydromorphone oral tablet 2 mg, 4 mg....................37 hydromorphone oral tablet 8 mg.............................37 hydroxychloroquine................................................15 hydroxyprogesterone caproate..................................75 hydroxyurea...........................................................23 hydroxyzine hcl intramuscular solution 25 mg/

ml......................................................................81 hydroxyzine hcl intramuscular solution 50 mg/

ml......................................................................81 hydroxyzine hcl oral solution 10 mg/5 ml................81 hydroxyzine hcl oral tablet......................................81 hydroxyzine pamoate..............................................81 HYPERRAB (PF)................................................72 HYZAAR.............................................................52 ibandronate intravenous solution............................74 ibandronate intravenous syringe..............................74 ibandronate oral....................................................74 IBRANCE...........................................................23 ibu oral tablet 600 mg, 800 mg..............................37 ibuprofen oral suspension........................................37 ibuprofen oral tablet 400 mg, 600 mg, 800 mg.......37 ibuprofen-oxycodone..............................................37 ICLUSIG ORAL TABLET 15 MG.....................24 ICLUSIG ORAL TABLET 45 MG.....................24 idarubicin.............................................................24 IDHIFA ORAL TABLET 100 MG.....................24 IDHIFA ORAL TABLET 50 MG.......................24 IFEX....................................................................24 ifosfamide intravenous recon soln............................24 ifosfamide intravenous solution...............................24 ILARIS (PF) SUBCUTANEOUS

SOLUTION.....................................................72 ILEVRO..............................................................78 imatinib oral tablet 100 mg...................................24 imatinib oral tablet 400 mg...................................24 IMBRUVICA ORAL CAPSULE 140 MG..........24 IMBRUVICA ORAL CAPSULE 70 MG............24 IMBRUVICA ORAL TABLET...........................24 IMFINZI.............................................................24 imipenem-cilastatin intravenous recon soln 250

mg.....................................................................15 imipenem-cilastatin intravenous recon soln 500

mg.....................................................................15


imipramine hcl......................................................37 imiquimod topical cream in packet.........................58 IMOVAX RABIES VACCINE (PF)....................72 INCRELEX.........................................................60 indapamide...........................................................52 indomethacin oral capsule......................................37 indomethacin oral capsule, extended release.............37 INFANRIX (DTAP) (PF)....................................72 INLYTA ORAL TABLET 1 MG.........................24 INLYTA ORAL TABLET 5 MG.........................24 insulin pen needle..................................................64 insulin syringe (disp) u-100 0.3 ml, 1 ml, 1/2

ml......................................................................64 INTELENCE ORAL TABLET 100 MG............15 INTELENCE ORAL TABLET 200 MG............15 INTELENCE ORAL TABLET 25 MG..............15 intralipid intravenous emulsion 20 %.....................83 INTRALIPID INTRAVENOUS EMULSION

30 %.................................................................83 INTRON A INJECTION...................................72 introvale...............................................................75 INVANZ INJECTION.......................................15 INVANZ INTRAVENOUS................................15 INVEGA ORAL TABLET EXTENDED

RELEASE 24HR 1.5 MG.................................37 INVEGA ORAL TABLET EXTENDED

RELEASE 24HR 3 MG....................................37 INVEGA ORAL TABLET EXTENDED

RELEASE 24HR 6 MG....................................38 INVEGA ORAL TABLET EXTENDED

RELEASE 24HR 9 MG....................................38 INVEGA SUSTENNA INTRAMUSCULAR

SYRINGE 117 MG/0.75 ML...........................38 INVEGA SUSTENNA INTRAMUSCULAR

SYRINGE 156 MG/ML...................................38 INVEGA SUSTENNA INTRAMUSCULAR

SYRINGE 234 MG/1.5 ML.............................38 INVEGA SUSTENNA INTRAMUSCULAR

SYRINGE 39 MG/0.25 ML.............................38 INVEGA SUSTENNA INTRAMUSCULAR

SYRINGE 78 MG/0.5 ML...............................38 INVEGA TRINZA INTRAMUSCULAR

SYRINGE 273 MG/0.875 ML.........................38 INVEGA TRINZA INTRAMUSCULAR

SYRINGE 410 MG/1.315 ML.........................38 INVEGA TRINZA INTRAMUSCULAR

SYRINGE 546 MG/1.75 ML...........................38 INVEGA TRINZA INTRAMUSCULAR

SYRINGE 819 MG/2.625 ML.........................38

INVIRASE ORAL CAPSULE.............................15 INVIRASE ORAL TABLET...............................15 IONOSOL-B IN D5W.......................................83 IONOSOL-MB IN D5W....................................83 IOPIDINE OPHTHALMIC (EYE) DROPS......78 IPOL....................................................................72 ipratropium bromide inhalation.............................81 ipratropium bromide nasal.....................................61 ipratropium-albuterol inhalation............................81 irbesartan..............................................................52 irbesartan-hydrochlorothiazide...............................52 IRESSA................................................................24 irinotecan intravenous solution 100 mg/5 ml...........24 irinotecan intravenous solution 40 mg/2 ml.............24 irinotecan intravenous solution 500 mg/25 ml.........24 ISENTRESS HD.................................................15 ISENTRESS ORAL POWDER IN

PACKET..........................................................15 ISENTRESS ORAL TABLET.............................15 ISENTRESS ORAL TABLET,CHEWABLE 100

MG...................................................................15 ISENTRESS ORAL TABLET,CHEWABLE 25

MG...................................................................15 ISOLYTE S PH 7.4.............................................83 ISOLYTE-P IN 5 % DEXTROSE......................83 ISOLYTE-S.........................................................83 isoniazid injection.................................................15 isoniazid oral solution............................................15 isoniazid oral tablet 100 mg...................................15 isoniazid oral tablet 300 mg...................................15 ISOPTO CARPINE............................................78 isosorbide dinitrate oral tablet................................52 isosorbide dinitrate oral tablet extended release........52 isosorbide mononitrate...........................................52 isradipine..............................................................52 ISTODAX...........................................................24 itraconazole oral capsule.........................................15 ivermectin.............................................................15 IXEMPRA...........................................................24 IXIARO (PF).......................................................72 JAKAFI ORAL TABLET 10 MG........................24 JAKAFI ORAL TABLET 15 MG........................24 JAKAFI ORAL TABLET 20 MG........................24 JAKAFI ORAL TABLET 25 MG........................24 JAKAFI ORAL TABLET 5 MG..........................24 jantoven................................................................52 JANUMET..........................................................64


JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG............65

JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 50-1,000 MG, 50-500 MG...................................................................65

JANUVIA ORAL TABLET 100 MG..................65 JANUVIA ORAL TABLET 25 MG....................65 JANUVIA ORAL TABLET 50 MG....................65 JARDIANCE.......................................................65 JENTADUETO..................................................65 JENTADUETO XR ORAL TABLET, IR - ER,

BIPHASIC 24HR 2.5-1,000 MG.....................65 JENTADUETO XR ORAL TABLET, IR - ER,

BIPHASIC 24HR 5-1,000 MG........................65 JEVTANA...........................................................24 jinteli....................................................................75 jolessa....................................................................76 jolivette.................................................................76 JULUCA..............................................................15 junel 1.5/30 (21)...................................................76 junel 1/20 (21)......................................................76 junel fe 1.5/30 (28)...............................................76 junel fe 1/20 (28)..................................................76 junel fe 24.............................................................76 JUXTAPID..........................................................52 k-effervescent.........................................................83 k-tab oral tablet extended release 8 meq..................84 KADCYLA..........................................................24 KALETRA ORAL SOLUTION..........................15 KALETRA ORAL TABLET 100-25 MG............15 KALETRA ORAL TABLET 200-50 MG............15 KALYDECO ORAL TABLET............................81 kariva (28)...........................................................76 KEDRAB (PF).....................................................72 kelnor 1/35 (28)....................................................76 ketoconazole oral...................................................15 ketoconazole topical cream......................................58 ketoconazole topical shampoo..................................58 ketoprofen oral capsule 25 mg.................................38 ketoprofen oral capsule 75 mg.................................38 ketorolac ophthalmic (eye)......................................78 ketorolac oral.........................................................38 KEYTRUDA INTRAVENOUS

SOLUTION.....................................................24 KHEDEZLA ORAL TABLET EXTENDED

RELEASE 24HR 100 MG................................38 KHEDEZLA ORAL TABLET EXTENDED

RELEASE 24HR 50 MG..................................38

KINRIX (PF) INTRAMUSCULAR SUSPENSION.................................................72

KINRIX (PF) INTRAMUSCULAR SYRINGE.........................................................72

kionex (with sorbitol).............................................60 KISQALI FEMARA CO-PACK ORAL TABLET

200 MG/DAY(200 MG X 1)-2.5 MG..............24 KISQALI FEMARA CO-PACK ORAL TABLET

400 MG/DAY(200 MG X 2)-2.5 MG..............24 KISQALI FEMARA CO-PACK ORAL TABLET

600 MG/DAY(200 MG X 3)-2.5 MG..............24 KISQALI ORAL TABLET 200 MG/DAY (200

MG X 1)...........................................................24 KISQALI ORAL TABLET 400 MG/DAY (200

MG X 2)...........................................................25 KISQALI ORAL TABLET 600 MG/DAY (200

MG X 3)...........................................................25 klor-con................................................................84 klor-con 10...........................................................84 klor-con 8.............................................................84 klor-con m10.........................................................84 klor-con m15.........................................................84 klor-con m20.........................................................84 klor-con sprinkle....................................................84 klor-con/ef.............................................................84 KORLYM............................................................65 KUVAN ORAL TABLET,SOLUBLE.................65 KYNAMRO........................................................52 KYPROLIS..........................................................25 l norgest/e.estradiol-e.estrad oral tablets,dose pack,3

month 0.15 mg-30 mcg (84)/10 mcg (7).............76 labetalol intravenous solution.................................52 labetalol oral tablet 100 mg, 200 mg......................52 labetalol oral tablet 300 mg....................................52 LACRISERT........................................................78 lactated ringers intravenous....................................84 lactated ringers irrigation.......................................60 lactulose oral solution.............................................69 lamivudine oral solution........................................15 lamivudine oral tablet 100 mg...............................15 lamivudine oral tablet 150 mg...............................15 lamivudine oral tablet 300 mg...............................15 lamivudine-zidovudine..........................................16 lamotrigine oral tablet............................................38 lamotrigine oral tablet, chewable dispersible 25

mg.....................................................................38 lamotrigine oral tablet, chewable dispersible 5

mg.....................................................................38


LANOXIN ORAL TABLET 125 MCG, 62.5 MCG................................................................52

lansoprazole oral capsule,delayed release(dr/ec).........69 LANTUS SOLOSTAR U-100 INSULIN............65 LANTUS U-100 INSULIN.................................65 larin 1/20 (21)......................................................76 larin fe 1.5/30 (28)...............................................76 larin fe 1/20 (28)..................................................76 LARTRUVO.......................................................25 latanoprost............................................................78 LATUDA ORAL TABLET 120 MG, 60

MG...................................................................38 LATUDA ORAL TABLET 20 MG.....................38 LATUDA ORAL TABLET 40 MG.....................38 LATUDA ORAL TABLET 80 MG.....................38 leena 28................................................................76 leflunomide oral tablet 10 mg.................................74 leflunomide oral tablet 20 mg.................................74 LENVIMA ORAL CAPSULE 10 MG/DAY (10

MG X 1), 12 MG/DAY (4 MG X 3), 4 MG...................................................................25

LENVIMA ORAL CAPSULE 14 MG/DAY(10 MG X 1-4 MG X 1), 20 MG/DAY (10 MG X 2), 8 MG/DAY (4 MG X 2)..............................25

LENVIMA ORAL CAPSULE 18 MG/DAY (10 MG X 1-4 MG X2), 24 MG/DAY(10 MG X 2-4 MG X 1).....................................................25

lessina...................................................................76 LETAIRIS............................................................81 letrozole................................................................25 leucovorin calcium injection recon soln 100 mg, 200

mg, 350 mg, 50 mg............................................25 leucovorin calcium injection recon soln 500 mg.......25 leucovorin calcium oral tablet 10 mg, 25 mg...........25 leucovorin calcium oral tablet 15 mg, 5 mg.............25 LEUKERAN........................................................25 leuprolide subcutaneous kit.....................................25 levalbuterol hcl inhalation solution for nebulization

0.31 mg/3 ml, 1.25 mg/0.5 ml, 1.25 mg/3 ml......................................................................81

levalbuterol hcl inhalation solution for nebulization 0.63 mg/3 ml.....................................................81

LEVALBUTEROL TARTRATE.........................81 LEVEMIR FLEXTOUCH U-100 INSULN.......65 LEVEMIR U-100 INSULIN...............................65 LEVETIRACETAM IN NACL (ISO-OS)

INTRAVENOUS PIGGYBACK 1,000 MG/ 100 ML, 1,500 MG/100 ML............................39

LEVETIRACETAM IN NACL (ISO-OS) INTRAVENOUS PIGGYBACK 500 MG/100 ML....................................................................39

levetiracetam intravenous.......................................39 levetiracetam oral solution 100 mg/ml....................39 levetiracetam oral solution 500 mg/5 ml (5 ml).......39 levetiracetam oral tablet 1,000 mg..........................39 levetiracetam oral tablet 250 mg, 500 mg, 750

mg.....................................................................39 levetiracetam oral tablet extended release 24 hr 500

mg.....................................................................39 levetiracetam oral tablet extended release 24 hr 750

mg.....................................................................39 levobunolol ophthalmic (eye) drops 0.5 %...............78 levocarnitine (with sugar).......................................60 levocarnitine oral tablet..........................................60 levocetirizine oral solution......................................81 levocetirizine oral tablet.........................................81 levofloxacin in d5w intravenous piggyback 250 mg/

50 ml.................................................................16 levofloxacin in d5w intravenous piggyback 500 mg/

100 ml, 750 mg/150 ml.....................................16 levofloxacin intravenous.........................................16 levofloxacin ophthalmic (eye)..................................78 levofloxacin oral solution........................................16 levofloxacin oral tablet 250 mg, 500 mg.................16 levofloxacin oral tablet 750 mg...............................16 levoleucovorin intravenous recon soln 50 mg............25 levonest (28)..........................................................76 levonorg-eth estrad triphasic...................................76 levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-

mcg, 90-20 mcg..................................................76 levonorgestrel-ethinyl estrad oral tablet 0.15-0.03

mg.....................................................................76 levonorgestrel-ethinyl estrad oral tablets,dose pack,3

month................................................................76 levora-28..............................................................76 levothyroxine oral..................................................65 levoxyl oral tablet 100 mcg, 112 mcg, 125 mcg, 137

mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg..........................................65

LEXIVA ORAL SUSPENSION..........................16 LEXIVA ORAL TABLET....................................16 LIALDA...............................................................69 lidocaine (pf) injection solution 5 mg/ml (0.5

%).....................................................................58 lidocaine hcl injection solution 20 mg/ml (2 %)......58 lidocaine hcl laryngotracheal...................................58


lidocaine hcl mucous membrane jelly.......................58 lidocaine hcl mucous membrane jelly in

applicator...........................................................58 lidocaine hcl mucous membrane solution 4 % (40

mg/ml)...............................................................58 lidocaine topical adhesive patch,medicated..............58 lidocaine topical ointment......................................58 lidocaine viscous....................................................58 lidocaine-prilocaine topical cream...........................58 LINCOCIN.........................................................16 lincomycin.............................................................16 lindane topical shampoo.........................................58 linezolid in dextrose 5%.........................................16 linezolid oral suspension for reconstitution...............16 linezolid oral tablet................................................16 linezolid-0.9% sodium chloride..............................16 LINZESS.............................................................69 liothyronine intravenous.........................................65 liothyronine oral....................................................65 LIPITOR ORAL TABLET 10 MG.....................52 lisinopril...............................................................52 lisinopril-hydrochlorothiazide.................................52 lithium carbonate oral capsule 150 mg, 300 mg......39 lithium carbonate oral capsule 600 mg....................39 lithium carbonate oral tablet..................................39 lithium carbonate oral tablet extended release..........39 lithium citrate oral solution 8 meq/5 ml..................39 LIVALO..............................................................52 LO LOESTRIN FE.............................................76 LONSURF..........................................................25 loperamide oral capsule..........................................69 LOPID................................................................52 lopinavir-ritonavir.................................................16 lorazepam intensol.................................................39 lorazepam oral concentrate.....................................39 lorazepam oral tablet.............................................39 loryna (28)............................................................76 losartan.................................................................52 losartan-hydrochlorothiazide..................................52 LOTENSIN ORAL TABLET 10 MG, 20 MG,

40 MG..............................................................52 lovastatin..............................................................52 low-ogestrel (28)....................................................76 loxapine succinate oral capsule 10 mg, 5 mg............39 loxapine succinate oral capsule 25 mg, 50 mg..........39 ludent fluoride.......................................................84 LUMIGAN OPHTHALMIC (EYE) DROPS

0.01 %..............................................................78

LUPRON DEPOT..............................................25 LUPRON DEPOT (3 MONTH).......................25 LUPRON DEPOT (4 MONTH).......................25 LUPRON DEPOT (6 MONTH).......................25 LUPRON DEPOT-PED INTRAMUSCULAR

KIT 11.25 MG, 15 MG....................................25 LUPRON DEPOT-PED INTRAMUSCULAR

KIT 7.5 MG (PED)..........................................25 lutera (28)............................................................76 LYNPARZA ORAL CAPSULE...........................25 LYNPARZA ORAL TABLET.............................25 LYRICA ORAL CAPSULE 100 MG...................39 LYRICA ORAL CAPSULE 150 MG...................39 LYRICA ORAL CAPSULE 200 MG...................39 LYRICA ORAL CAPSULE 225 MG, 300

MG...................................................................39 LYRICA ORAL CAPSULE 25 MG.....................39 LYRICA ORAL CAPSULE 50 MG.....................39 LYRICA ORAL CAPSULE 75 MG.....................39 LYRICA ORAL SOLUTION..............................39 LYSODREN........................................................25 lyza.......................................................................76 M-M-R II (PF)....................................................72 magnesium sulfate in water intravenous parenteral

solution..............................................................84 magnesium sulfate in water intravenous piggyback

2 gram/50 ml (4 %), 4 gram/50 ml (8 %)..........84 magnesium sulfate in water intravenous piggyback

4 gram/100 ml (4 %).........................................84 magnesium sulfate injection solution.......................84 magnesium sulfate injection syringe.........................84 MALARONE......................................................16 malathion.............................................................58 maprotiline oral tablet 25 mg.................................39 maprotiline oral tablet 50 mg.................................39 maprotiline oral tablet 75 mg.................................39 marlissa................................................................76 MARPLAN..........................................................39 MARQIBO..........................................................25 MATULANE.......................................................25 matzim la.............................................................52 MAXZIDE..........................................................52 MAXZIDE-25MG...............................................52 meclizine oral tablet 12.5 mg, 25 mg......................69 meclofenamate.......................................................39 medroxyprogesterone intramuscular suspension.........76 medroxyprogesterone intramuscular syringe..............76 medroxyprogesterone oral........................................76


mefloquine............................................................16 megestrol oral suspension 400 mg/10 ml (10

ml)....................................................................25 megestrol oral suspension 400 mg/10 ml (40 mg/

ml)....................................................................25 megestrol oral suspension 800 mg/20 ml (20

ml)....................................................................25 megestrol oral tablet...............................................25 MEKINIST ORAL TABLET 0.5 MG.................25 MEKINIST ORAL TABLET 2 MG....................26 MEKTOVI..........................................................26 meloxicam oral tablet.............................................39 melphalan.............................................................26 melphalan hcl........................................................26 memantine oral capsule,sprinkle,er 24hr.................39 memantine oral solution.........................................39 memantine oral tablet 10 mg.................................39 memantine oral tablet 5 mg...................................40 MENACTRA (PF) INTRAMUSCULAR

SOLUTION.....................................................72 MENEST............................................................76 MENVEO A-C-Y-W-135-DIP (PF)....................72 mercaptopurine......................................................26 meropenem............................................................16 mesalamine oral tablet,delayed release (dr/ec) 1.2

gram..................................................................69 MESALAMINE ORAL TABLET,DELAYED

RELEASE (DR/EC) 800 MG...........................70 mesalamine rectal..................................................70 mesalamine with cleansing wipe.............................70 mesna...................................................................26 MESNEX ORAL.................................................26 MESTINON ORAL SYRUP...............................40 MESTINON TIMESPAN..................................40 metadate er...........................................................40 metaproterenol.......................................................81 metformin oral tablet 1,000 mg..............................65 metformin oral tablet 500 mg.................................65 metformin oral tablet 850 mg.................................65 metformin oral tablet extended release 24 hr 500

mg.....................................................................65 metformin oral tablet extended release 24 hr 750

mg.....................................................................65 metformin oral tablet extended release 24 hrs osm-

tab 500mg.........................................................65 metformin oral tablet extended release 24hr 1,000

mg.....................................................................65

metformin oral tablet,er gast.retention 24 hr 1,000 mg.....................................................................65

metformin oral tablet,er gast.retention 24 hr 500 mg.....................................................................65

methadone intensol................................................40 methadone oral concentrate....................................40 methadone oral solution 10 mg/5 ml.......................40 methadone oral solution 5 mg/5 ml.........................40 methadone oral tablet 10 mg..................................40 methadone oral tablet 5 mg....................................40 methadose oral concentrate.....................................40 methazolamide......................................................78 methenamine hippurate.........................................16 methenamine mandelate........................................16 methimazole oral tablet 10 mg, 5 mg......................65 methocarbamol oral...............................................40 methotrexate sodium (pf) injection recon soln...........26 methotrexate sodium (pf) injection solution.............26 methotrexate sodium injection................................26 methotrexate sodium oral.......................................26 methoxsalen...........................................................58 methscopolamine....................................................70 methyclothiazide....................................................53 methyldopa............................................................53 methylergonovine oral............................................76 methylphenidate hcl oral solution 10 mg/5 ml.........40 methylphenidate hcl oral solution 5 mg/5 ml...........40 methylphenidate hcl oral tablet...............................40 methylphenidate hcl oral tablet extended release 10

mg, 20 mg..........................................................40 methylprednisolone acetate......................................65 methylprednisolone oral tablet 16 mg, 32 mg, 4

mg.....................................................................65 methylprednisolone oral tablet 8 mg........................65 methylprednisolone oral tablets,dose pack.................66 methylprednisolone sodium succ injection recon soln

125 mg, 40 mg...................................................66 methylprednisolone sodium succ intravenous............66 metipranolol..........................................................78 metoclopramide hcl injection solution......................70 metoclopramide hcl injection syringe.......................70 metoclopramide hcl oral solution.............................70 metoclopramide hcl oral tablet................................70 metolazone oral tablet 10 mg, 5 mg........................53 metolazone oral tablet 2.5 mg.................................53 metoprolol succinate...............................................53 metoprolol tartrate intravenous solution..................53 metoprolol tartrate intravenous syringe....................53


metoprolol tartrate oral..........................................53 metoprolol tartrate-hydrochlorothiazide oral tablet

100-25 mg, 100-50 mg......................................53 metoprolol tartrate-hydrochlorothiazide oral tablet

50-25 mg...........................................................53 metro i.v...............................................................16 metronidazole in nacl (iso-os).................................16 metronidazole oral capsule......................................16 metronidazole oral tablet........................................16 metronidazole topical cream...................................58 metronidazole topical gel 0.75 %............................58 metronidazole topical gel 1 %.................................58 metronidazole topical lotion...................................58 metronidazole vaginal............................................76 mexiletine oral capsule 150 mg, 250 mg.................53 mexiletine oral capsule 200 mg...............................53 MIACALCIN INJECTION................................66 MICARDIS.........................................................53 MICARDIS HCT................................................53 miconazole-3 vaginal suppository............................76 microgestin 1.5/30 (21).........................................76 microgestin 1/20 (21)............................................76 microgestin fe 1.5/30 (28)......................................76 microgestin fe 1/20 (28).........................................76 MICROZIDE......................................................53 midodrine.............................................................60 miglitol oral tablet 100 mg.....................................66 miglitol oral tablet 25 mg.......................................66 miglitol oral tablet 50 mg.......................................66 miglustat...............................................................66 mimvey.................................................................76 mimvey lo.............................................................76 MINIPRESS ORAL CAPSULE 2 MG................53 minocycline oral capsule.........................................16 minocycline oral tablet...........................................16 minoxidil oral.......................................................53 MIRAPEX ORAL TABLET 0.25 MG, 0.75

MG...................................................................40 mirtazapine oral tablet 15 mg................................40 mirtazapine oral tablet 30 mg................................40 mirtazapine oral tablet 45 mg................................40 mirtazapine oral tablet 7.5 mg...............................40 mirtazapine oral tablet,disintegrating 15 mg...........40 mirtazapine oral tablet,disintegrating 30 mg...........40 mirtazapine oral tablet,disintegrating 45 mg...........40 misoprostol oral tablet 100 mcg..............................70 misoprostol oral tablet 200 mcg..............................70 mitomycin intravenous recon soln 20 mg, 5 mg.......26

mitomycin intravenous recon soln 40 mg.................26 mitoxantrone.........................................................26 modafinil oral tablet 100 mg..................................40 modafinil oral tablet 200 mg..................................40 moexipril...............................................................53 moexipril-hydrochlorothiazide................................53 mometasone nasal..................................................81 mometasone topical................................................58 mono-linyah..........................................................76 mononessa (28)......................................................76 montelukast oral granules in packet.........................81 montelukast oral tablet...........................................81 montelukast oral tablet,chewable............................81 morgidox oral capsule 50 mg..................................16 morphine (pf) injection solution 0.5 mg/ml.............40 morphine (pf) injection solution 1 mg/ml................40 morphine (pf) intravenous patient control.analgesia

soln 150 mg/30 ml.............................................40 morphine (pf) intravenous patient control.analgesia

soln 30 mg/30 ml...............................................40 morphine concentrate oral solution..........................40 morphine injection solution 10 mg/ml.....................41 MORPHINE INJECTION SOLUTION 4 MG/

ML....................................................................41 morphine injection solution 5 mg/ml.......................41 morphine injection solution 8 mg/ml.......................41 morphine injection syringe 10 mg/ml......................41 morphine injection syringe 2 mg/ml, 4 mg/ml..........41 morphine injection syringe 5 mg/ml........................41 morphine intravenous cartridge 10 mg/ml...............41 morphine intravenous cartridge 2 mg/ml, 4 mg/

ml......................................................................41 MORPHINE INTRAVENOUS CARTRIDGE

8 MG/ML.........................................................41 morphine intravenous solution 10 mg/ml................41 MORPHINE INTRAVENOUS SOLUTION 4

MG/ML, 8 MG/ML.........................................41 morphine intravenous syringe 2 mg/ml, 4 mg/

ml......................................................................41 morphine oral solution 10 mg/5 ml.........................41 morphine oral solution 20 mg/5 ml (4 mg/ml).........41 morphine oral tablet 15 mg....................................41 morphine oral tablet 30 mg....................................41 morphine oral tablet extended release 100 mg, 30

mg, 60 mg..........................................................41 morphine oral tablet extended release 15 mg............41 morphine oral tablet extended release 200 mg..........41 MOVANTIK.......................................................70


MOVIPREP........................................................70 MOXEZA............................................................78 MOXIFLOXACIN OPHTHALMIC (EYE).......78 moxifloxacin oral...................................................16 MOZOBIL..........................................................72 MULTAQ...........................................................53 mupirocin topical cream.........................................58 mupirocin topical ointment....................................58 MUSTARGEN....................................................26 MYCAMINE INTRAVENOUS RECON SOLN

100 MG............................................................16 MYCAMINE INTRAVENOUS RECON SOLN

50 MG..............................................................16 mycophenolate mofetil hcl.......................................26 mycophenolate mofetil oral capsule..........................26 mycophenolate mofetil oral suspension for

reconstitution.....................................................26 mycophenolate mofetil oral tablet............................26 mycophenolate sodium............................................26 MYLOTARG......................................................26 myorisan oral capsule 10 mg, 20 mg, 40 mg............58 MYRBETRIQ.....................................................82 MYZILRA...........................................................76 nabumetone..........................................................41 nadolol oral tablet 20 mg, 40 mg............................53 nadolol oral tablet 80 mg.......................................53 nadolol-bendroflumethiazide..................................53 nafcillin in dextrose iso-osm intravenous piggyback

1 gram/50 ml.....................................................16 nafcillin in dextrose iso-osm intravenous piggyback

2 gram/100 ml...................................................16 nafcillin injection recon soln 1 gram, 2 gram...........16 nafcillin injection recon soln 10 gram.....................16 nafcillin intravenous..............................................16 NAGLAZYME....................................................66 nalbuphine injection solution 10 mg/ml..................41 nalbuphine injection solution 20 mg/ml..................41 naloxone...............................................................41 naltrexone.............................................................41 NAMENDA XR ORAL CAP,SPRINKLE,ER

24HR DOSE PACK.........................................41 NAMENDA XR ORAL CAPSULE,SPRINKLE,

ER 24HR..........................................................41 NAMZARIC.......................................................41 naproxen oral suspension........................................41 naproxen oral tablet...............................................41 naproxen oral tablet,delayed release (dr/ec)..............41 naproxen sodium oral tablet 275 mg, 550 mg.........41

naratriptan...........................................................41 NARCAN NASAL SPRAY,NON-AEROSOL 4

MG/ACTUATION..........................................41 NASONEX..........................................................81 NATACYN..........................................................78 nateglinide oral tablet 120 mg................................66 nateglinide oral tablet 60 mg..................................66 NATPARA..........................................................66 NEBUPENT.......................................................16 necon 0.5/35 (28)..................................................76 necon 7/7/7 (28)....................................................76 needles, insulin disp.,safety.....................................66 nefazodone oral tablet 100 mg................................42 nefazodone oral tablet 150 mg................................42 nefazodone oral tablet 200 mg................................42 nefazodone oral tablet 250 mg................................42 nefazodone oral tablet 50 mg..................................42 neo-polycin............................................................78 neo-polycin hc........................................................78 neomycin...............................................................16 neomycin-bacitracin-poly-hc...................................78 neomycin-bacitracin-polymyxin..............................78 neomycin-polymyxin b gu.......................................60 neomycin-polymyxin b-dexameth............................78 neomycin-polymyxin-gramicidin.............................78 neomycin-polymyxin-hc ophthalmic (eye).................78 neomycin-polymyxin-hc otic (ear)...........................61 NEPHRAMINE 5.4 %........................................84 NERLYNX..........................................................26 NEULASTA........................................................72 NEUPOGEN......................................................72 NEUPRO............................................................42 NEVANAC.........................................................78 nevirapine oral suspension......................................16 nevirapine oral tablet.............................................16 nevirapine oral tablet extended release 24 hr 100

mg.....................................................................16 nevirapine oral tablet extended release 24 hr 400

mg.....................................................................16 NEXAVAR..........................................................26 niacin oral tablet extended release 24 hr..................53 NIACOR.............................................................53 nicardipine intravenous solution.............................53 nicardipine oral.....................................................53 NICOTROL NS.................................................60 nifedipine oral tablet extended release......................53 nifedipine oral tablet extended release 24hr.............53 nikki (28).............................................................76


NILANDRON....................................................26 nilutamide............................................................26 nimodipine............................................................53 NINLARO..........................................................26 NIPENT..............................................................26 nitro-bid...............................................................53 nitrofurantoin.......................................................16 nitrofurantoin macrocrystal oral capsule 100 mg, 50

mg.....................................................................17 nitrofurantoin monohyd/m-cryst.............................17 nitroglycerin intravenous........................................53 nitroglycerin sublingual..........................................53 nitroglycerin transdermal patch 24 hour..................53 nitroglycerin translingual spray,non-aerosol.............53 NITROSTAT......................................................53 nizatidine oral capsule...........................................70 nora-be.................................................................76 NORDITROPIN FLEXPRO..............................72 norethindrone (contraceptive).................................76 norethindrone acetate.............................................76 norgestimate-ethinyl estradiol oral tablet 0.18/0.215/

0.25 mg-35 mcg (28), 0.25-35 mg-mcg...............76 NORMOSOL-M IN 5 % DEXTROSE..............84 NORMOSOL-R..................................................84 NORMOSOL-R IN 5 % DEXTROSE...............84 NORMOSOL-R PH 7.4.....................................84 NORPACE..........................................................53 NORTHERA ORAL CAPSULE 100 MG..........60 NORTHERA ORAL CAPSULE 200 MG..........60 NORTHERA ORAL CAPSULE 300 MG..........60 nortrel 0.5/35 (28)................................................76 nortrel 1/35 (21)...................................................76 nortrel 1/35 (28)...................................................76 nortrel 7/7/7 (28)..................................................76 nortriptyline oral capsule 10 mg, 25 mg..................42 nortriptyline oral capsule 50 mg, 75 mg..................42 NORTRIPTYLINE ORAL SOLUTION............42 NORVASC..........................................................53 NORVIR ORAL CAPSULE................................17 NORVIR ORAL POWDER IN PACKET..........17 NORVIR ORAL SOLUTION............................17 NORVIR ORAL TABLET..................................17 NOXAFIL ORAL................................................17 NUEDEXTA.......................................................42 NULOJIX............................................................26 NUPLAZID ORAL CAPSULE...........................42 NUPLAZID ORAL TABLET 10 MG.................42 NUPLAZID ORAL TABLET 17 MG.................42

NUVARING.......................................................76 nyamyc..................................................................58 nystatin oral suspension..........................................17 nystatin oral tablet.................................................17 nystatin topical cream............................................58 nystatin topical ointment........................................58 nystatin topical powder..........................................58 nystatin-triamcinolone...........................................58 nystop...................................................................58 ocella....................................................................76 OCTAGAM........................................................72 octreotide acetate injection solution 1,000 mcg/

ml......................................................................26 octreotide acetate injection solution 100 mcg/ml, 200

mcg/ml, 50 mcg/ml, 500 mcg/ml.........................26 octreotide acetate injection syringe 100 mcg/ml (1

ml), 50 mcg/ml (1 ml)........................................26 octreotide acetate injection syringe 500 mcg/ml (1

ml)....................................................................26 ODEFSEY...........................................................17 ODOMZO..........................................................26 OFEV..................................................................81 ofloxacin ophthalmic (eye)......................................78 ofloxacin oral tablet 300 mg...................................17 ofloxacin oral tablet 400 mg...................................17 ofloxacin otic (ear).................................................61 ogestrel (28)..........................................................76 olanzapine intramuscular.......................................42 olanzapine oral tablet 10 mg..................................42 olanzapine oral tablet 15 mg..................................42 olanzapine oral tablet 2.5 mg.................................42 olanzapine oral tablet 20 mg..................................42 olanzapine oral tablet 5 mg....................................42 olanzapine oral tablet 7.5 mg.................................42 olanzapine oral tablet,disintegrating 10 mg.............42 olanzapine oral tablet,disintegrating 15 mg.............42 olanzapine oral tablet,disintegrating 20 mg.............42 olanzapine oral tablet,disintegrating 5 mg...............42 olanzapine-fluoxetine oral capsule 12-25 mg, 12-50

mg, 6-50 mg......................................................42 olanzapine-fluoxetine oral capsule 3-25 mg, 6-25

mg.....................................................................42 olmesartan............................................................53 olmesartan-amlodipine-hydrochlorothiazide............53 olmesartan-hydrochlorothiazide..............................53 olopatadine ophthalmic (eye) drops 0.1 %...............78 olopatadine ophthalmic (eye) drops 0.2 %...............78 omega-3 acid ethyl esters.........................................53


omeprazole oral capsule,delayed release(dr/ec)..........70 OMNITROPE....................................................72 ONCASPAR........................................................26 ondansetron hcl (pf) injection solution.....................70 ondansetron hcl (pf) injection syringe......................70 ondansetron hcl intravenous...................................70 ondansetron hcl oral solution..................................70 ondansetron hcl oral tablet 24 mg...........................70 ondansetron hcl oral tablet 4 mg, 8 mg...................70 ondansetron oral tablet, disintegrating 4 mg............70 ondansetron oral tablet, disintegrating 8 mg............70 ONFI ORAL SUSPENSION..............................42 ONFI ORAL TABLET 10 MG...........................42 ONFI ORAL TABLET 20 MG...........................42 OPDIVO.............................................................26 opium tincture.......................................................70 ORAP..................................................................42 ORENITRAM ORAL TABLET EXTENDED

RELEASE 0.125 MG........................................53 ORENITRAM ORAL TABLET EXTENDED

RELEASE 0.25 MG, 1 MG, 2.5 MG, 5 MG...................................................................53

ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG...................................................................60

ORFADIN ORAL CAPSULE 20 MG................60 ORFADIN ORAL SUSPENSION......................60 ORKAMBI ORAL TABLET...............................81 orsythia.................................................................76 ORTHO MICRONOR......................................76 oseltamivir............................................................17 OSMOPREP.......................................................70 oxacillin in dextrose(iso-osm) intravenous piggyback

1 gram/50 ml.....................................................17 oxacillin in dextrose(iso-osm) intravenous piggyback

2 gram/50 ml.....................................................17 oxacillin injection recon soln 1 gram.......................17 oxacillin injection recon soln 10 gram.....................17 oxacillin injection recon soln 2 gram.......................17 oxaliplatin intravenous recon soln 100 mg...............26 oxaliplatin intravenous recon soln 50 mg.................26 oxaliplatin intravenous solution 100 mg/20 ml........26 oxaliplatin intravenous solution 50 mg/10 ml (5 mg/

ml)....................................................................26 oxandrolone oral tablet 10 mg................................66 oxandrolone oral tablet 2.5 mg...............................66 oxaprozin..............................................................42 oxazepam..............................................................42 oxcarbazepine oral suspension.................................42

oxcarbazepine oral tablet 150 mg, 300 mg..............43 oxcarbazepine oral tablet 600 mg...........................43 oxybutynin chloride oral syrup................................82 oxybutynin chloride oral tablet................................82 oxybutynin chloride oral tablet extended release 24hr

10 mg, 15 mg.....................................................82 oxybutynin chloride oral tablet extended release 24hr

5 mg..................................................................82 oxycodone oral capsule............................................43 oxycodone oral concentrate......................................43 oxycodone oral solution...........................................43 oxycodone oral tablet 10 mg, 5 mg..........................43 oxycodone oral tablet 15 mg, 20 mg, 30 mg............43 oxycodone-acetaminophen oral tablet 10-325 mg,

2.5-325 mg, 7.5-325 mg....................................43 oxycodone-acetaminophen oral tablet 5-325 mg.......43 oxycodone-aspirin..................................................43 OZEMPIC..........................................................66 pacerone oral tablet 100 mg, 400 mg......................53 pacerone oral tablet 200 mg...................................53 paclitaxel...............................................................26 paliperidone oral tablet extended release 24hr 1.5

mg.....................................................................43 paliperidone oral tablet extended release 24hr 3



mg.....................................................................43 pamidronate intravenous recon soln........................66 pamidronate intravenous solution 30 mg/10 ml (3

mg/ml), 90 mg/10 ml (9 mg/ml)..........................66 pamidronate intravenous solution 60 mg/10 ml (6

mg/ml)...............................................................66 PANRETIN.........................................................58 pantoprazole intravenous.......................................70 pantoprazole oral...................................................70 paregoric...............................................................70 paricalcitol oral.....................................................66 paroex oral rinse....................................................61 paromomycin.........................................................17 paroxetine hcl oral tablet 10 mg..............................43 paroxetine hcl oral tablet 20 mg..............................43 paroxetine hcl oral tablet 30 mg..............................43 paroxetine hcl oral tablet 40 mg.............................43 paroxetine hcl oral tablet extended release 24 hr 12.5

mg.....................................................................43


paroxetine hcl oral tablet extended release 24 hr 25 mg.....................................................................43

paroxetine hcl oral tablet extended release 24 hr 37.5 mg.....................................................................43

PASER.................................................................17 PAXIL ORAL SUSPENSION.............................43 PAZEO................................................................78 PEDIARIX (PF)...................................................72 PEDVAX HIB (PF).............................................72 peg 3350-electrolytes oral recon soln 236-22.74-6.74

-5.86 gram.........................................................70 peg 3350-electrolytes oral recon soln 240-22.72-6.72

-5.84 gram.........................................................70 peg-electrolyte soln..................................................70 PEGANONE.......................................................43 PEGASYS............................................................72 PEGASYS PROCLICK.......................................72 PEGINTRON SUBCUTANEOUS KIT 50

MCG/0.5 ML...................................................72 PENICILLIN G POT IN DEXTROSE

INTRAVENOUS PIGGYBACK 1 MILLION UNIT/50 ML, 2 MILLION UNIT/50 ML....................................................................17

PENICILLIN G POT IN DEXTROSE INTRAVENOUS PIGGYBACK 3 MILLION UNIT/50 ML...................................................17

penicillin g potassium.............................................17 penicillin g procaine intramuscular syringe 1.2

million unit/2 ml................................................17 penicillin g procaine intramuscular syringe 600,000

unit/ml..............................................................17 penicillin g sodium.................................................17 penicillin v potassium.............................................17 PENTACEL (PF)................................................72 PENTAM............................................................17 PENTASA...........................................................70 pentoxifylline.........................................................53 PERFOROMIST.................................................81 perindopril erbumine.............................................53 periogard...............................................................61 PERJETA.............................................................27 permethrin topical cream........................................58 perphenazine.........................................................43 perphenazine-amitriptyline oral tablet 2-10 mg, 2-

25 mg, 4-10 mg, 4-50 mg...................................43 perphenazine-amitriptyline oral tablet 4-25 mg.......43 pfizerpen-g............................................................17 phenelzine.............................................................43

phenobarbital oral elixir.........................................43 phenobarbital oral tablet 100 mg...........................43 phenobarbital oral tablet 15 mg.............................43 phenobarbital oral tablet 16.2 mg..........................43 phenobarbital oral tablet 30 mg.............................43 phenobarbital oral tablet 32.4 mg..........................44 phenobarbital oral tablet 60 mg.............................44 phenobarbital oral tablet 64.8 mg..........................44 phenobarbital oral tablet 97.2 mg..........................44 PHENYTEK........................................................44 phenytoin oral suspension 100 mg/4 ml...................44 phenytoin oral suspension 125 mg/5 ml...................44 phenytoin oral tablet,chewable................................44 phenytoin sodium extended.....................................44 phenytoin sodium intravenous solution....................44 phenytoin sodium intravenous syringe.....................44 philith...................................................................76 PHOSPHOLINE IODIDE.................................78 PHYSIOLYTE.....................................................60 PHYSIOSOL IRRIGATION..............................60 PICATO..............................................................59 pilocarpine hcl ophthalmic (eye) drops 1 %, 2 %, 4

%......................................................................78 pilocarpine hcl oral................................................60 pimozide...............................................................44 pimtrea (28).........................................................76 pindolol oral tablet 10 mg......................................53 pindolol oral tablet 5 mg........................................53 pioglitazone oral tablet 15 mg................................66 pioglitazone oral tablet 30 mg................................66 pioglitazone oral tablet 45 mg................................66 pioglitazone-glimepiride.........................................66 pioglitazone-metformin..........................................66 piperacillin-tazobactam intravenous recon soln 2.25

gram, 3.375 gram, 4.5 gram, 40.5 gram.............17 pirmella oral tablet 1-35 mg-mcg...........................76 piroxicam..............................................................44 PLASMA-LYTE 148............................................84 PLASMA-LYTE A...............................................84 PLEGRIDY.........................................................72 podofilox...............................................................59 polycin..................................................................78 polyethylene glycol 3350.........................................70 polymyxin b sulf-trimethoprim................................78 polymyxin b sulfate................................................17 POMALYST ORAL CAPSULE 1 MG................27 POMALYST ORAL CAPSULE 2 MG................27


POMALYST ORAL CAPSULE 3 MG, 4 MG...................................................................27

portia....................................................................76 PORTRAZZA.....................................................27 potassium bicarb and chloride................................84 potassium bicarb-citric acid....................................84 potassium chlorid-d5-0.45%nacl intravenous

parenteral solution 10 meq/l, 30 meq/l, 40 meq/ l.........................................................................84

potassium chlorid-d5-0.45%nacl intravenous parenteral solution 20 meq/l................................84

potassium chloride in 0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l.................84

potassium chloride in 5 % dex intravenous parenteral solution 20 meq/l, 30 meq/l, 40 meq/l..................84

potassium chloride in lr-d5 intravenous parenteral solution 20 meq/l................................................84

potassium chloride in lr-d5 intravenous parenteral solution 40 meq/l................................................84

potassium chloride in water intravenous piggyback 10 meq/100 ml..................................................84

potassium chloride in water intravenous piggyback 10 meq/50 ml....................................................84



potassium chloride oral capsule, extended release......84 potassium chloride oral liquid.................................84 potassium chloride oral tablet extended release.........85 potassium chloride oral tablet,er particles/

crystals...............................................................85 potassium chloride-0.45 % nacl..............................85 potassium chloride-d5-0.2%nacl intravenous

parenteral solution 20 meq/l................................85 potassium chloride-d5-0.2%nacl intravenous

parenteral solution 30 meq/l, 40 meq/l.................85 potassium chloride-d5-0.3%nacl intravenous



parenteral solution 40 meq/l................................85 potassium citrate oral tablet extended release 10 meq

(1,080 mg), 15 meq...........................................82 potassium citrate oral tablet extended release 5 meq

(540 mg)...........................................................82 PRADAXA...........................................................54

PRALUENT PEN...............................................54 pramipexole oral tablet...........................................44 prasugrel...............................................................54 PRAVACHOL ORAL TABLET 20 MG.............54 pravastatin............................................................54 prazosin oral capsule 1 mg, 2 mg............................54 prazosin oral capsule 5 mg......................................54 PRECOSE ORAL TABLET 100 MG.................66 PRECOSE ORAL TABLET 25 MG...................66 PRECOSE ORAL TABLET 50 MG...................66 prednicarbate........................................................59 prednisolone acetate...............................................78 prednisolone oral solution 15 mg/5 ml.....................66 prednisolone sodium phosphate ophthalmic (eye)......78 prednisolone sodium phosphate oral solution 15 mg/

5 ml (3 mg/ml)...................................................66 prednisolone sodium phosphate oral solution 5 mg

base/5 ml (6.7 mg/5 ml)......................................66 prednisolone sodium phosphate oral tablet,

disintegrating.....................................................66 prednisone intensol.................................................66 prednisone oral solution..........................................66 prednisone oral tablet.............................................67 prednisone oral tablets,dose pack.............................67 PREMARIN ORAL.............................................76 PREMARIN VAGINAL......................................76 premasol 10 %......................................................85 PREMASOL 6 %.................................................85 PREMPHASE......................................................76 PREMPRO..........................................................77 prenatal vitamin oral tablet...................................85 prevalite................................................................54 previfem................................................................77 PREZCOBIX.......................................................17 PREZISTA ORAL SUSPENSION......................17 PREZISTA ORAL TABLET 150 MG.................17 PREZISTA ORAL TABLET 600 MG, 800

MG...................................................................17 PREZISTA ORAL TABLET 75 MG...................17 PRIFTIN.............................................................17 PRIMAQUINE...................................................18 primidone.............................................................44 PRINIVIL ORAL TABLET 10 MG, 20 MG, 5

MG...................................................................54 PRISTIQ ORAL TABLET EXTENDED

RELEASE 24 HR 100 MG...............................44 PRISTIQ ORAL TABLET EXTENDED

RELEASE 24 HR 25 MG.................................44


PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 50 MG.................................44

PROAIR HFA.....................................................81 PROAIR RESPICLICK.......................................81 probenecid.............................................................74 probenecid-colchicine.............................................74 procainamide injection solution 100 mg/ml.............54 procainamide injection solution 500 mg/ml.............54 PROCALAMINE 3%..........................................85 PROCARDIA......................................................54 PROCARDIA XL ORAL TABLET EXTENDED

RELEASE 24HR 30 MG..................................54 prochlorperazine....................................................70 prochlorperazine edisylate injection solution 10 mg/

2 ml (5 mg/ml)...................................................70 prochlorperazine maleate........................................70 PROCRIT INJECTION SOLUTION 10,000

UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/ 2 ML, 3,000 UNIT/ML, 4,000 UNIT/ML......72

PROCRIT INJECTION SOLUTION 20,000 UNIT/ML, 40,000 UNIT/ML.........................72

procto-med hc........................................................70 procto-pak.............................................................70 proctosol hc topical.................................................70 proctozone-hc........................................................70 progesterone micronized.........................................77 PROGLYCEM....................................................67 PROGRAF INTRAVENOUS.............................27 PROLASTIN-C INTRAVENOUS RECON

SOLN...............................................................60 PROLASTIN-C INTRAVENOUS

SOLUTION.....................................................60 PROLEUKIN......................................................72 PROLIA..............................................................74 PROMACTA ORAL TABLET 12.5 MG, 25

MG, 75 MG.....................................................54 PROMACTA ORAL TABLET 50 MG...............54 promethazine injection solution 25 mg/ml...............81 promethazine injection solution 50 mg/ml...............81 promethazine oral..................................................81 propafenone oral tablet 150 mg..............................54 propafenone oral tablet 225 mg..............................54 propafenone oral tablet 300 mg..............................54 propantheline........................................................70 propranolol intravenous.........................................54 propranolol oral capsule,extended release 24 hr 120

mg, 160 mg........................................................54

propranolol oral capsule,extended release 24 hr 60 mg, 80 mg..........................................................54

propranolol oral solution........................................54 propranolol oral tablet 10 mg, 20 mg, 40 mg, 80

mg.....................................................................54 propranolol oral tablet 60 mg.................................54 propranolol-hydrochlorothiazid...............................54 propylthiouracil.....................................................67 PROQUAD (PF).................................................72 PROSOL 20 %....................................................85 protriptyline..........................................................44 PULMOZYME...................................................81 PURIXAN...........................................................27 pyrazinamide........................................................18 pyridostigmine bromide..........................................44 QUADRACEL (PF)............................................72 quasense................................................................77 quetiapine oral tablet 100 mg................................44 quetiapine oral tablet 200 mg................................44 quetiapine oral tablet 25 mg..................................44 quetiapine oral tablet 300 mg................................44 quetiapine oral tablet 400 mg................................44 quetiapine oral tablet 50 mg..................................44 quetiapine oral tablet extended release 24 hr 150

mg.....................................................................44 quetiapine oral tablet extended release 24 hr 200




mg.....................................................................44 quinapril...............................................................54 quinapril-hydrochlorothiazide................................54 quinidine gluconate injection.................................54 quinidine sulfate oral tablet....................................54 quinine sulfate.......................................................18 QVAR REDIHALER INHALATION HFA

AEROSOL BREATH ACTIVATED 40 MCG/ ACTUATION..................................................81

QVAR REDIHALER INHALATION HFA AEROSOL BREATH ACTIVATED 80 MCG/ ACTUATION..................................................81

RABAVERT (PF)................................................72 raloxifene..............................................................74 ramipril................................................................54 RANEXA.............................................................54


ranitidine hcl injection...........................................70 ranitidine hcl oral capsule......................................70 ranitidine hcl oral syrup.........................................70 ranitidine hcl oral tablet 150 mg, 300 mg..............70 RAPAMUNE ORAL SOLUTION......................27 rasagiline..............................................................44 RAVICTI.............................................................60 RAZADYNE ORAL TABLET 4 MG..................44 reclipsen (28).........................................................77 RECOMBIVAX HB (PF) INTRAMUSCULAR

SUSPENSION.................................................72 RECOMBIVAX HB (PF) INTRAMUSCULAR

SYRINGE 10 MCG/ML..................................73 RECOMBIVAX HB (PF) INTRAMUSCULAR

SYRINGE 5 MCG/0.5 ML..............................73 regonol..................................................................44 RELENZA DISKHALER....................................18 RELISTOR SUBCUTANEOUS

SOLUTION.....................................................70 RELISTOR SUBCUTANEOUS SYRINGE 12

MG/0.6 ML......................................................71 RELISTOR SUBCUTANEOUS SYRINGE 8

MG/0.4 ML......................................................71 REMICADE........................................................71 REMODULIN....................................................54 RENVELA ORAL TABLET................................60 repaglinide oral tablet 0.5 mg.................................67 repaglinide oral tablet 1 mg....................................67 repaglinide oral tablet 2 mg....................................67 REPATHA PUSHTRONEX...............................54 REPATHA SURECLICK....................................54 REPATHA SYRINGE.........................................54 REQUIP ORAL TABLET 1 MG, 4 MG, 5

MG...................................................................44 RESCRIPTOR ORAL TABLET.........................18 RESCRIPTOR ORAL TABLET,

DISPERSIBLE..................................................18 RETROVIR INTRAVENOUS...........................18 REVLIMID ORAL CAPSULE 10 MG...............27 REVLIMID ORAL CAPSULE 15 MG, 2.5 MG,

20 MG, 25 MG................................................27 REVLIMID ORAL CAPSULE 5 MG.................27 REXULTI ORAL TABLET 0.25 MG, 0.5 MG,

1 MG, 2 MG....................................................44 REXULTI ORAL TABLET 3 MG, 4 MG..........45 REYATAZ ORAL CAPSULE 150 MG, 200

MG...................................................................18 REYATAZ ORAL CAPSULE 300 MG...............18 REYATAZ ORAL POWDER IN PACKET........18

ribasphere oral capsule...........................................18 ribasphere oral tablet 200 mg.................................18 ribavirin oral capsule.............................................18 ribavirin oral tablet 200 mg...................................18 RIDAURA...........................................................74 rifabutin...............................................................18 rifampin...............................................................18 RIFATER............................................................18 riluzole.................................................................60 rimantadine..........................................................18 ringer's intravenous................................................85 ringer's irrigation...................................................60 RIOMET.............................................................67 risedronate oral tablet 150 mg................................74 risedronate oral tablet 30 mg..................................61 risedronate oral tablet 35 mg, 35 mg (12 pack), 35

mg (4 pack)........................................................75 risedronate oral tablet 5 mg....................................75 risedronate oral tablet,delayed release (dr/ec)............75 RISPERDAL CONSTA INTRAMUSCULAR

SYRINGE 12.5 MG/2 ML...............................45 RISPERDAL CONSTA INTRAMUSCULAR

SYRINGE 25 MG/2 ML, 37.5 MG/2 ML, 50 MG/2 ML.........................................................45

risperidone oral solution.........................................45 risperidone oral tablet 0.25 mg...............................45 risperidone oral tablet 0.5 mg.................................45 risperidone oral tablet 1 mg....................................45 risperidone oral tablet 2 mg....................................45 risperidone oral tablet 3 mg....................................45 risperidone oral tablet 4 mg....................................45 risperidone oral tablet,disintegrating 0.25 mg..........45 risperidone oral tablet,disintegrating 0.5 mg............45 risperidone oral tablet,disintegrating 1 mg...............45 risperidone oral tablet,disintegrating 2 mg...............45 risperidone oral tablet,disintegrating 3 mg...............45 risperidone oral tablet,disintegrating 4 mg...............45 ritonavir...............................................................18 RITUXAN...........................................................27 RITUXAN HYCELA..........................................27 rivastigmine tartrate..............................................45 rivastigmine transdermal patch...............................45 rizatriptan............................................................45 ROMIDEPSIN....................................................27 ropinirole oral tablet..............................................45 ropinirole oral tablet extended release 24 hr.............45 rosadan topical cream............................................59 rosadan topical gel.................................................59


rosuvastatin...........................................................54 ROTARIX...........................................................73 ROTATEQ VACCINE.......................................73 roweepra oral tablet 500 mg...................................45 ROZEREM.........................................................45 RUBRACA ORAL TABLET 200 MG................27 RUBRACA ORAL TABLET 250 MG, 300

MG...................................................................27 RYDAPT.............................................................27 SABRIL ORAL POWDER IN PACKET............45 SABRIL ORAL TABLET....................................45 SAMSCA ORAL TABLET 15 MG.....................67 SAMSCA ORAL TABLET 30 MG.....................67 SANDIMMUNE ORAL SOLUTION................27 SANDOSTATIN LAR DEPOT

INTRAMUSCULAR SUSPENSION, EXTENDED REL RECON.............................27

SANTYL..............................................................59 SAPHRIS SUBLINGUAL TABLET 10 MG.......45 SAPHRIS SUBLINGUAL TABLET 2.5

MG...................................................................45 SAPHRIS SUBLINGUAL TABLET 5 MG.........45 SAVELLA ORAL TABLET 100 MG..................75 SAVELLA ORAL TABLET 12.5 MG.................75 SAVELLA ORAL TABLET 25 MG....................75 SAVELLA ORAL TABLET 50 MG....................75 SAVELLA ORAL TABLETS,DOSE PACK........75 scopolamine base....................................................71 selegiline hcl..........................................................45 selenium sulfide topical lotion.................................59 SELZENTRY ORAL SOLUTION.....................18 SELZENTRY ORAL TABLET 150 MG, 300

MG...................................................................18 SELZENTRY ORAL TABLET 25 MG...............18 SELZENTRY ORAL TABLET 75 MG...............18 SENSIPAR ORAL TABLET 30 MG...................67 SENSIPAR ORAL TABLET 60 MG...................67 SENSIPAR ORAL TABLET 90 MG...................67 SEREVENT DISKUS.........................................81 SEROQUEL XR ORAL TABLET EXTENDED

RELEASE 24 HR 150 MG...............................46 SEROQUEL XR ORAL TABLET EXTENDED




RELEASE 24 HR 50 MG.................................46

sertraline oral concentrate.......................................46 sertraline oral tablet 100 mg..................................46 sertraline oral tablet 25 mg....................................46 sertraline oral tablet 50 mg....................................46 sevelamer carbonate oral powder in packet 0.8

gram..................................................................61 sevelamer carbonate oral powder in packet 2.4

gram..................................................................61 sevelamer carbonate oral tablet...............................61 sf 5000 plus...........................................................61 sharobel.................................................................77 SHINGRIX (PF).................................................73 SIGNIFOR..........................................................27 sildenafil (antihypertensive) oral.............................81 SILVADENE.......................................................59 silver sulfadiazine..................................................59 SIMBRINZA.......................................................78 SIMULECT INTRAVENOUS RECON SOLN

10 MG..............................................................27 SIMULECT INTRAVENOUS RECON SOLN

20 MG..............................................................27 simvastatin............................................................54 SINEMET CR ORAL TABLET EXTENDED

RELEASE 25-100 MG.....................................46 sirolimus...............................................................27 SIRTURO...........................................................18 SIVEXTRO INTRAVENOUS............................18 SIVEXTRO ORAL..............................................18 sodium bicarbonate intravenous solution 1 meq/ml

(8.4 %), 4.2 %..................................................85 sodium bicarbonate intravenous syringe 10 meq/10

ml (8.4 %), 7.5 % (0.9 meq/ml)........................85 sodium bicarbonate intravenous syringe 4.2 % (0.5

meq/ml), 8.4 % (1 meq/ml)................................85 sodium chloride 0.45 % intravenous parenteral

solution..............................................................85 sodium chloride 0.45 % intravenous piggyback.......85 sodium chloride 0.9 % intravenous.........................61 sodium chloride 3 %..............................................85 sodium chloride 5 %..............................................85 sodium chloride intravenous...................................85 sodium chloride irrigation......................................61 sodium lactate.......................................................85 sodium phenylbutyrate...........................................61 sodium polystyrene (sorb free)..................................61 sodium polystyrene sulfonate oral.............................61 sodium polystyrene sulfonate rectal enema 30 gram/

120 ml...............................................................61


SODIUM POLYSTYRENE SULFONATE RECTAL ENEMA 50 GRAM/200 ML............61

SOLTAMOX.......................................................27 SOMATULINE DEPOT....................................27 SOMAVERT.......................................................67 sorine oral tablet 120 mg, 160 mg..........................54 sorine oral tablet 240 mg.......................................54 sorine oral tablet 80 mg.........................................54 sotalol af oral tablet 120 mg, 160 mg......................54 sotalol af oral tablet 80 mg.....................................54 sotalol oral tablet 120 mg, 160 mg, 240 mg............54 sotalol oral tablet 80 mg.........................................54 SPIRIVA RESPIMAT..........................................81 SPIRIVA WITH HANDIHALER.......................82 spironolacton-hydrochlorothiaz...............................55 spironolactone........................................................55 sprintec (28)..........................................................77 SPRITAM ORAL TABLET FOR SUSPENSION

1,000 MG, 250 MG, 500 MG..........................46 SPRITAM ORAL TABLET FOR SUSPENSION

750 MG............................................................46 SPRYCEL............................................................27 sps (with sorbitol) oral............................................61 sps (with sorbitol) rectal..........................................61 sronyx...................................................................77 ssd topical cream 1%.............................................59 STAMARIL (PF).................................................73 stavudine oral capsule 15 mg..................................18 stavudine oral capsule 20 mg..................................18 stavudine oral capsule 30 mg..................................18 stavudine oral capsule 40 mg..................................18 STELARA SUBCUTANEOUS SYRINGE.........59 STIMATE...........................................................67 STIOLTO RESPIMAT.......................................82 STIVARGA.........................................................27 STRATTERA ORAL CAPSULE 10 MG, 18

MG, 25 MG, 40 MG........................................46 STRATTERA ORAL CAPSULE 100 MG, 60

MG, 80 MG.....................................................46 STREPTOMYCIN..............................................18 STRIBILD...........................................................18 STROMECTOL.................................................18 SUCRAID...........................................................71 sucralfate oral tablet...............................................71 SULAR ORAL TABLET EXTENDED

RELEASE 24 HR 17 MG.................................55 sulfacetamide sodium (acne)...................................59 sulfacetamide sodium ophthalmic (eye) drops...........78

sulfacetamide sodium ophthalmic (eye) ointment............................................................78

sulfacetamide-prednisolone.....................................78 sulfadiazine...........................................................18 sulfamethoxazole-trimethoprim intravenous............18 sulfamethoxazole-trimethoprim oral suspension........18 sulfamethoxazole-trimethoprim oral tablet...............18 SULFAMYLON TOPICAL CREAM..................59 sulfasalazine..........................................................71 sulindac oral tablet 150 mg....................................46 sulindac oral tablet 200 mg....................................46 sumatriptan nasal spray.........................................46 sumatriptan succinate oral......................................46 sumatriptan succinate subcutaneous cartridge..........46 sumatriptan succinate subcutaneous pen injector......46 sumatriptan succinate subcutaneous solution............46 SUPREP BOWEL PREP KIT.............................71 SURMONTIL.....................................................46 SUSTIVA ORAL CAPSULE 200 MG................18 SUSTIVA ORAL CAPSULE 50 MG..................18 SUSTIVA ORAL TABLET.................................18 SUTENT ORAL CAPSULE 12.5 MG................27 SUTENT ORAL CAPSULE 25 MG, 37.5 MG,

50 MG..............................................................27 syeda.....................................................................77 SYLATRON........................................................73 SYMBICORT......................................................82 SYMBYAX ORAL CAPSULE 12-25 MG, 12-50

MG, 6-50 MG..................................................46 SYMBYAX ORAL CAPSULE 3-25 MG.............46 SYMFI.................................................................19 SYMFI LO...........................................................19 SYMLINPEN 120...............................................67 SYMLINPEN 60.................................................67 SYNAGIS............................................................19 SYNAREL...........................................................67 SYNERCID.........................................................19 SYNJARDY.........................................................67 SYNJARDY XR ORAL TABLET, IR - ER,

BIPHASIC 24HR 10-1,000 MG, 12.5-1,000 MG, 5-1,000 MG.............................................67

SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 25-1,000 MG......................67

SYNRIBO............................................................27 SYNTHROID.....................................................67 SYPRINE.............................................................61 TABLOID...........................................................27 tacrolimus oral capsule 0.5 mg, 1 mg......................27


tacrolimus oral capsule 5 mg...................................27 tacrolimus topical..................................................59 TAFINLAR.........................................................27 TAGRISSO ORAL TABLET 40 MG..................27 TAGRISSO ORAL TABLET 80 MG..................28 TALTZ SYRINGE..............................................59 TAMIFLU ORAL CAPSULE 30 MG, 45

MG...................................................................19 tamiflu oral capsule 75 mg.....................................19 TAMIFLU ORAL SUSPENSION FOR

RECONSTITUTION......................................19 tamoxifen..............................................................28 tamsulosin.............................................................82 TANZEUM.........................................................67 TAPAZOLE........................................................67 TARCEVA ORAL TABLET 100 MG, 150

MG...................................................................28 TARCEVA ORAL TABLET 25 MG...................28 TARGRETIN ORAL..........................................28 TARGRETIN TOPICAL....................................28 TASIGNA ORAL CAPSULE 150 MG, 200

MG...................................................................28 TASIGNA ORAL CAPSULE 50 MG.................28 TAXOTERE INTRAVENOUS SOLUTION 20

MG/ML (1 ML), 80 MG/4 ML (20 MG/ ML)..................................................................28

tazarotene.............................................................59 TAZORAC..........................................................59 taztia xt................................................................55 TECENTRIQ......................................................28 TECFIDERA.......................................................46 TECHNIVIE.......................................................19 TEFLARO...........................................................19 TEGRETOL XR ORAL TABLET EXTENDED

RELEASE 12 HR 100 MG...............................46 TEKTURNA.......................................................55 TEKTURNA HCT.............................................55 telmisartan............................................................55 telmisartan-amlodipine..........................................55 telmisartan-hydrochlorothiazid...............................55 temazepam oral capsule 15 mg, 30 mg....................46 TEMOVATE TOPICAL CREAM......................59 TEMOVATE TOPICAL OINTMENT..............59 temsirolimus..........................................................28 TENIVAC (PF) INTRAMUSCULAR

SYRINGE.........................................................73 tenofovir disoproxil fumarate..................................19 TENORETIC 100...............................................55

TENORETIC 50.................................................55 terazosin oral capsule.............................................55 terbinafine hcl oral................................................19 terbutaline oral......................................................82 terbutaline subcutaneous........................................82 terconazole vaginal cream.......................................77 terconazole vaginal suppository...............................77 testosterone cypionate..............................................67 testosterone enanthate.............................................67 TESTOSTERONE TRANSDERMAL GEL.......67 TESTOSTERONE TRANSDERMAL GEL IN

METERED-DOSE PUMP 10 MG/0.5 GRAM /ACTUATION................................................67

TESTOSTERONE TRANSDERMAL GEL IN METERED-DOSE PUMP 12.5 MG/ 1.25 GRAM (1 %)....................................................67

testosterone transdermal gel in packet 1 % (25 mg/ 2.5gram)............................................................67

TESTOSTERONE TRANSDERMAL GEL IN PACKET 1 % (50 MG/5 GRAM)....................67

TETANUS,DIPHTHERIA TOX PED(PF)........73 TETANUS-DIPHTHERIA TOXOIDS-TD......73 tetrabenazine oral tablet 12.5 mg...........................47 tetrabenazine oral tablet 25 mg..............................47 tetracycline............................................................19 THALOMID ORAL CAPSULE 100 MG, 50

MG...................................................................28 THALOMID ORAL CAPSULE 150 MG, 200

MG...................................................................28 theophylline oral elixir...........................................82 theophylline oral solution........................................82 theophylline oral tablet extended release 12 hr.........82 theophylline oral tablet extended release 24 hr.........82 THIOLA.............................................................61 thioridazine oral tablet 10 mg, 25 mg, 50 mg.........47 thioridazine oral tablet 100 mg..............................47 thiotepa.................................................................28 thiothixene............................................................47 THYMOGLOBULIN.........................................73 thyroid (pork) oral tablet 30 mg, 60 mg..................67 thyroid (pork) oral tablet 90 mg.............................67 tiagabine...............................................................47 TIAZAC..............................................................55 TICE BCG..........................................................73 TIGECYCLINE..................................................19 TIKOSYN...........................................................55 tilia fe...................................................................77 timolol maleate ophthalmic (eye) drops....................78


timolol maleate ophthalmic (eye) gel forming solution..............................................................78

timolol maleate oral tablet 10 mg, 5 mg..................55 timolol maleate oral tablet 20 mg...........................55 TIMOPTIC OCUDOSE (PF) OPHTHALMIC

(EYE) DROPPERETTE 0.25 %......................79 TIMOPTIC OPHTHALMIC (EYE) DROPS

0.25 %..............................................................79 TIMOPTIC-XE...................................................79 tinidazole oral tablet 250 mg.................................19 tinidazole oral tablet 500 mg.................................19 TIVICAY ORAL TABLET 10 MG.....................19 TIVICAY ORAL TABLET 25 MG, 50 MG.......19 tizanidine oral tablet.............................................47 TOBRADEX OPHTHALMIC (EYE)

OINTMENT...................................................79 TOBRADEX ST..................................................79 tobramycin............................................................79 tobramycin in 0.225% nacl for nebulization...........19 tobramycin sulfate injection recon soln....................19 tobramycin sulfate injection solution.......................19 tobramycin-dexamethasone opthalmic

suspension..........................................................79 tolazamide oral tablet 250 mg................................68 tolazamide oral tablet 500 mg................................68 tolbutamide...........................................................68 tolcapone...............................................................47 tolterodine oral capsule,extended release 24hr..........82 tolterodine oral tablet.............................................82 topiramate oral capsule, sprinkle.............................47 topiramate oral tablet 100 mg................................47 topiramate oral tablet 200 mg................................47 topiramate oral tablet 25 mg..................................47 topiramate oral tablet 50 mg..................................47 toposar..................................................................28 topotecan intravenous recon soln.............................28 topotecan intravenous solution................................28 TOPROL XL.......................................................55 TORISEL............................................................28 torsemide oral........................................................55 TOUJEO MAX U-300 SOLOSTAR...................68 TOUJEO SOLOSTAR U-300 INSULIN...........68 TOVIAZ..............................................................82 TRACLEER ORAL TABLET.............................82 TRACLEER ORAL TABLET FOR

SUSPENSION.................................................82 TRADJENTA......................................................68 tramadol oral tablet...............................................47

tramadol-acetaminophen........................................47 trandolapril...........................................................55 trandolapril-verapamil...........................................55 tranexamic acid intravenous...................................55 tranexamic acid oral..............................................77 transderm-scop.......................................................71 tranylcypromine.....................................................47 travasol 10 %........................................................85 TRAVATAN Z....................................................79 trazodone oral tablet 100 mg, 150 mg, 50 mg.........47 trazodone oral tablet 300 mg..................................47 TREANDA INTRAVENOUS RECON

SOLN...............................................................28 TRECATOR.......................................................19 TRELSTAR INTRAMUSCULAR SYRINGE

11.25 MG/2 ML...............................................28 TRELSTAR INTRAMUSCULAR SYRINGE

22.5 MG/2 ML.................................................28 TRELSTAR INTRAMUSCULAR SYRINGE

3.75 MG/2 ML.................................................28 tretinoin (chemotherapy)........................................28 tretinoin topical cream...........................................59 tretinoin topical gel 0.01 %, 0.025 %....................59 tri-estarylla............................................................77 tri-legest fe.............................................................77 tri-linyah..............................................................77 tri-previfem (28)...................................................77 tri-sprintec (28).....................................................77 triamcinolone acetonide dental...............................61 triamcinolone acetonide injection............................68 triamcinolone acetonide nasal.................................82 triamcinolone acetonide topical cream 0.025 %......59 triamcinolone acetonide topical cream 0.1 %, 0.5

%......................................................................59 triamcinolone acetonide topical lotion.....................59 triamcinolone acetonide topical ointment 0.025 %,

0.1 %, 0.5 %.....................................................59 triamterene-hydrochlorothiazid oral capsule 37.5-

25 mg................................................................55 triamterene-hydrochlorothiazid oral capsule 50-25

mg.....................................................................55 triamterene-hydrochlorothiazid oral tablet...............55 trianex..................................................................59 TRIBENZOR......................................................55 TRICOR ORAL TABLET 48 MG......................55 triderm topical cream.............................................59 trientine................................................................61 trifluoperazine oral tablet 1 mg, 2 mg.....................47


trifluoperazine oral tablet 10 mg, 5 mg...................47 trifluridine............................................................79 trihexyphenidyl......................................................47 TRILIPIX ORAL CAPSULE,DELAYED

RELEASE(DR/EC) 45 MG..............................55 trilyte with flavor packets.......................................71 trimethoprim.........................................................19 trimipramine.........................................................47 trinessa (28)..........................................................77 TRINTELLIX ORAL TABLET 10 MG..............47 TRINTELLIX ORAL TABLET 20 MG..............47 TRINTELLIX ORAL TABLET 5 MG................47 TRISENOX INTRAVENOUS SOLUTION 2

MG/ML............................................................28 TRIUMEQ..........................................................19 trivora (28)...........................................................77 TROGARZO......................................................19 TROPHAMINE 10 %........................................85 TROPHAMINE 6%...........................................85 trospium oral capsule,extended release 24hr.............82 trospium oral tablet...............................................83 TRULICITY........................................................68 TRUMENBA......................................................73 TRUVADA.........................................................19 TWINRIX (PF) INTRAMUSCULAR

SYRINGE.........................................................73 TWYNSTA ORAL TABLET 40-10 MG, 40-5

MG, 80-5 MG..................................................55 TYBOST.............................................................19 TYKERB..............................................................28 TYPHIM VI INTRAMUSCULAR

SOLUTION.....................................................73 TYPHIM VI INTRAMUSCULAR

SYRINGE.........................................................73 TYSABRI.............................................................47 UCERIS ORAL...................................................71 ULORIC.............................................................75 unithroid oral tablet 100 mcg, 112 mcg, 125 mcg,

150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg.....................................68

unithroid oral tablet 137 mcg.................................68 UNITUXIN........................................................28 UPTRAVI ORAL TABLET................................55 UPTRAVI ORAL TABLETS,DOSE PACK........55 ursodiol.................................................................71 UVADEX............................................................59 VAGIFEM...........................................................77 valacyclovir oral tablet 1 gram................................19

valacyclovir oral tablet 500 mg...............................19 VALCHLOR.......................................................59 valganciclovir oral tablet........................................19 valproate sodium...................................................47 valproic acid..........................................................47 valproic acid (as sodium salt) oral solution 250 mg/

5 ml...................................................................47 valproic acid (as sodium salt) oral solution 250 mg/

5 ml (5 ml), 500 mg/10 ml (10 ml)....................47 valsartan...............................................................55 valsartan-hydrochlorothiazide.................................55 VANCOMYCIN IN 0.9 % SODIUM CHL

INTRAVENOUS PIGGYBACK......................19 VANCOMYCIN IN DEXTROSE 5 %

INTRAVENOUS PIGGYBACK 1 GRAM/200 ML....................................................................19

VANCOMYCIN IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK 500 MG/100 ML, 750 MG/150 ML......................................19

vancomycin intravenous recon soln 1,000 mg, 10 gram, 5 gram, 500 mg........................................19

VANCOMYCIN INTRAVENOUS RECON SOLN 250 MG................................................19

VANCOMYCIN INTRAVENOUS RECON SOLN 750 MG................................................20

vancomycin oral capsule 125 mg.............................20 vancomycin oral capsule 250 mg.............................20 vandazole..............................................................77 VAQTA (PF).......................................................73 VARIVAX (PF)....................................................73 VARIZIG INTRAMUSCULAR

SOLUTION.....................................................73 VASCEPA............................................................55 VASERETIC.......................................................55 VASOTEC ORAL TABLET 2.5 MG..................55 VECAMYL..........................................................55 VECTIBIX..........................................................28 VELCADE...........................................................28 velivet triphasic regimen (28).................................77 VENCLEXTA ORAL TABLET 10 MG.............28 VENCLEXTA ORAL TABLET 100 MG...........28 VENCLEXTA ORAL TABLET 50 MG.............28 VENCLEXTA STARTING PACK.....................28 venlafaxine oral capsule,extended release 24hr 150

mg.....................................................................47 venlafaxine oral capsule,extended release 24hr 37.5

mg.....................................................................47


venlafaxine oral capsule,extended release 24hr 75 mg.....................................................................47

venlafaxine oral tablet 100 mg...............................47 venlafaxine oral tablet 25 mg.................................47 venlafaxine oral tablet 37.5 mg..............................47 venlafaxine oral tablet 50 mg.................................47 venlafaxine oral tablet 75 mg.................................47 venlafaxine oral tablet extended release 24hr 150

mg.....................................................................48 VENLAFAXINE ORAL TABLET EXTENDED

RELEASE 24HR 225 MG................................48 venlafaxine oral tablet extended release 24hr 37.5

mg.....................................................................48 venlafaxine oral tablet extended release 24hr 75

mg.....................................................................48 VENTAVIS.........................................................82 VENTOLIN HFA...............................................82 verapamil intravenous solution...............................55 verapamil intravenous syringe.................................55 verapamil oral capsule, 24 hr er pellet ct.................55 verapamil oral capsule,ext rel. pellets 24 hr 120 mg,

180 mg, 240 mg.................................................55 verapamil oral capsule,ext rel. pellets 24 hr 360

mg.....................................................................55 verapamil oral tablet..............................................55 verapamil oral tablet extended release 120 mg.........55 verapamil oral tablet extended release 180 mg, 240

mg.....................................................................55 VERSACLOZ......................................................48 VERZENIO........................................................28 VESICARE..........................................................83 VICTOZA 2-PAK...............................................68 VICTOZA 3-PAK...............................................68 VIDEX 2 GRAM PEDIATRIC...........................20 VIDEX 4 GRAM PEDIATRIC...........................20 VIDEX EC ORAL CAPSULE,DELAYED

RELEASE(DR/EC) 125 MG............................20 vigabatrin.............................................................48 VIGAMOX..........................................................79 VIIBRYD ORAL TABLET 10 MG.....................48 VIIBRYD ORAL TABLET 20 MG.....................48 VIIBRYD ORAL TABLET 40 MG.....................48 VIIBRYD ORAL TABLETS,DOSE PACK 10

MG (7)- 20 MG (23)........................................48 VIMPAT INTRAVENOUS................................48 VIMPAT ORAL SOLUTION............................48 VIMPAT ORAL TABLET 100 MG....................48

VIMPAT ORAL TABLET 150 MG, 200 MG...................................................................48

VIMPAT ORAL TABLET 50 MG......................48 vinblastine intravenous solution..............................29 vincasar pfs intravenous solution 1 mg/ml...............29 vincasar pfs intravenous solution 2 mg/2 ml............29 vincristine intravenous solution 1 mg/ml.................29 vincristine intravenous solution 2 mg/2 ml..............29 vinorelbine............................................................29 viorele (28)...........................................................77 VIRACEPT ORAL TABLET 250 MG................20 VIRACEPT ORAL TABLET 625 MG................20 VIRAMUNE ORAL SUSPENSION...................20 VIRAMUNE XR ORAL TABLET EXTENDED

RELEASE 24 HR 100 MG...............................20 VIREAD ORAL POWDER................................20 VIREAD ORAL TABLET...................................20 VIVELLE-DOT..................................................77 VOLTAREN TOPICAL.....................................48 voriconazole intravenous........................................20 voriconazole oral suspension for reconstitution.........20 voriconazole oral tablet 200 mg..............................20 voriconazole oral tablet 50 mg................................20 VOSEVI..............................................................20 VOTRIENT........................................................29 VPRIV.................................................................68 VRAYLAR ORAL CAPSULE..............................48 VRAYLAR ORAL CAPSULE,DOSE PACK.......48 vyfemla (28)..........................................................77 VYXEOS.............................................................29 warfarin...............................................................55 water for irrigation, sterile......................................61 WELCHOL.........................................................55 XALATAN..........................................................79 XALKORI...........................................................29 XARELTO ORAL TABLET 10 MG, 20

MG...................................................................56 XARELTO ORAL TABLET 15 MG...................56 XARELTO ORAL TABLETS,DOSE PACK.......56 XATMEP.............................................................29 XELJANZ............................................................75 XENAZINE ORAL TABLET 12.5 MG..............48 XENAZINE ORAL TABLET 25 MG.................48 XEOMIN INTRAMUSCULAR RECON SOLN

100 UNIT, 50 UNIT.......................................73 XEOMIN INTRAMUSCULAR RECON SOLN

200 UNIT........................................................73 XGEVA...............................................................29


XIFAXAN ORAL TABLET 550 MG..................20 XIIDRA...............................................................79 XOLAIR..............................................................82 XTANDI.............................................................29 xulane...................................................................77 XYREM...............................................................48 YERVOY.............................................................29 YF-VAX (PF).......................................................73 YONDELIS.........................................................29 YONSA...............................................................29 yuvafem................................................................77 zafirlukast.............................................................82 zaleplon oral capsule 10 mg....................................48 zaleplon oral capsule 5 mg......................................48 ZALTRAP...........................................................29 ZANOSAR..........................................................29 ZARAH...............................................................77 ZARONTIN ORAL CAPSULE..........................48 ZAVESCA...........................................................68 ZEJULA...............................................................29 ZELBORAF.........................................................29 zenatane oral capsule 10 mg, 20 mg, 40 mg............59 zenatane oral capsule 30 mg...................................59 zenchent (28)........................................................77 zenzedi oral tablet 10 mg.......................................48 zenzedi oral tablet 5 mg.........................................48 ZERIT ORAL RECON SOLN...........................20 ZESTORETIC....................................................56 ZESTRIL ORAL TABLET 10 MG, 20 MG, 40

MG, 5 MG.......................................................56 ZETIA.................................................................56 ZIAC ORAL TABLET 10-6.25 MG, 5-6.25

MG...................................................................56 ZIAGEN ORAL SOLUTION.............................20 zidovudine oral capsule..........................................20 zidovudine oral syrup.............................................20 zidovudine oral tablet............................................20 ZIOPTAN (PF)...................................................79

ziprasidone hcl oral capsule 20 mg..........................48 ziprasidone hcl oral capsule 40 mg..........................48 ziprasidone hcl oral capsule 60 mg, 80 mg...............49 ZIRGAN.............................................................79 ZITHROMAX ORAL PACKET.........................20 ZITHROMAX ORAL TABLET 250 MG..........20 ZITHROMAX Z-PAK........................................20 ZOCOR ORAL TABLET 10 MG......................56 zoledronic acid intravenous solution 4 mg/5 ml

intravenous solution............................................68 zoledronic acid-mannitol-water 5 mg/100 ml..........61 ZOLINZA...........................................................29 zolpidem oral tablet...............................................49 zolpidem oral tablet,ext release multiphase...............49 ZOMETA INTRAVENOUS PIGGYBACK.......68 zonisamide oral capsule 100 mg, 50 mg..................49 zonisamide oral capsule 25 mg...............................49 ZORTRESS ORAL TABLET 0.25 MG..............29 ZORTRESS ORAL TABLET 0.5 MG, 0.75

MG...................................................................29 ZOSTAVAX (PF)................................................73 zovia 1/35e (28)....................................................77 ZYDELIG............................................................29 ZYKADIA...........................................................29 ZYPREXA RELPREVV INTRAMUSCULAR

SUSPENSION FOR RECONSTITUTION 210 MG............................................................49

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 300 MG, 405 MG............................................49

ZYTIGA ORAL TABLET 250 MG....................29 ZYTIGA ORAL TABLET 500 MG....................29 ZYVOX INTRAVENOUS PIGGYBACK 200

MG/100 ML.....................................................20 ZYVOX INTRAVENOUS PIGGYBACK 600

MG/300 ML.....................................................20 ZYVOX ORAL SUSPENSION FOR

RECONSTITUTION......................................20


Anthem Blue Cross Life and Health Insurance Company es un plan LPPO que se brinda a través de un contrato con Medicare. La inscripción en Anthem Blue Cross Life and Health Insurance Company depende de la renovación del contrato. Anthem Blue Cross Life and Health Insurance Company es licenciatario independiente de Blue Cross Association. Anthem es una marca comercial registrada de Anthem Insurance Companies, Inc. El nombre y el símbolo de Blue Cross son marcas registradas de Blue Cross Association.

ATENCIÓN: Si usted habla español, servicios de asistencia en español, de forma gratuita, están disponibles para usted. Llame al 1-877-811-3107 (TTY: 711)

Este formulario se actualizó el 1.º de octubre de 2018. Para obtener la información más reciente o otras preguntas, póngase en contacto con el Servicio al Cliente Anthem MediBlue Access (PPO) al 1-877-811-3107 o, para usuarios de TTY, 711, de 8 a. m. a 8 p. m., los siete días a la semana (excepto el Día de Acción de Gracias y Navidad) desde el 1.º de octubre hasta el 14 de febrero, y de lunes a viernes (excepto los feriados) desde el 15 de febrero hasta el 30 de septiembre, o visite https://shop.anthem.com/medicare/ca.

Y0114_18_31139_U_SP_158 H8552_020 CA

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