VERSION 04.01.19

Special Pharmaceutical

Benefits Program (SPBP) -

HIV/AIDS Drugs

PA Department of Health Phone: (800) 922-9384 Special Pharmaceutical Benefits Program Email: spbp@pa.gov 625 Forster St, H&W Bldg, Rm 611 Harrisburg, PA 17120

Drug Formulary

Updated April 1st, 2019

Section 1 – Guidelines Section 2 – List of Covered Drugs by Class Section 3 – List of Covered Drugs by Alphabetical Order

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Section Special Pharmaceutical Benefits Program (SPBP) -

HIV/AIDS Drugs 1

Drug Formulary

Guidelines

SPBP Pharmacy Services Goals

To provide access for low-income Pennsylvanians with a diagnosis of HIV/AIDS to:

◼ Critical, life-saving medications, and

◼ Selected drugs, biologics, and devices to prevent and treat opportunistic infections and promote overall health

General SPBP Formulary Coverage Guidelines

1) The formulary includes coverage of antiretroviral drugs

2) The formulary includes selected brand name, generic, and over-the-counter (OTC) non-antiretroviral drugs,

biologics, and devices

3) The formulary includes selected nutrients and nutritional agents

4) Formulary coverage for Group 1 and 2 is limited to drugs, biologics, and devices approved by the Food and

Drug Administration (FDA)

5) Formulary exclusions include but are not limited to the following:

a. Drugs and other products when prescribed for obesity or weight loss

b. Drugs prescribed for the symptomatic relief of cough and colds

c. Drugs when used to promote fertility

d. Drugs when used for contraception

e. Drugs when used for cosmetic purposes or hair growth

f. Placebos

g. Nonlegend soaps, cleansing agents, dentifrices, mouthwashes, douche solutions, ear wax removal

agents, deodorants, liniments, antiseptics, irrigants, emollients, and other personal care and medicine

chest items

h. Nonlegend aqueous saline solutions for use other than for intravenous administration

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i. Nonlegend water preparations, such as distilled water, water for injection, and identical, similar or related

products

j. DESI drugs

k. Agents when used for the treatment of sexual or erectile dysfunction

6) All drugs (Rx and OTC) on the formulary require a written prescription from a licensed medical provider

7) The Special Pharmaceutical Benefits Program is considered the “Payer of Last Resort”. Pharmacies and

dispensing providers must ask the enrollee about other drug coverage and, if applicable, submit the claim to

that payer prior to submitting the claim to the SPBP.

Please Note: The Special Pharmaceutical Benefits Program drug formulary list may not be all-inclusive. Coverage of specific drugs may change in between the publication of this document.

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Section Special Pharmaceutical Benefits Program

(HIV/AIDS Drugs) 2

Drug Formulary

List of Covered Drugs by Class

Group 1 Antiretroviral Agents

abacavir abacavir/lamivudine/zidovudine Aptivus atazanavir Atripla Biktarvy Cimduo Combivir Complera Crixivan Delstrigo Descovy didanosine Edurant efavirenz Emtriva Epivir Epzicom Evotaz fosamprenavir Fuzeon Genvoya Intelence Invirase Isentress Juluca Kaletra lamivudine lamivudine/zidovudine Lexiva lopinavir/ritonavir nevirapine nevirapine ER Norvir Odefsey Pifeltro Prezcobix Prezista Rescriptor Retrovir Reyataz Selzentry stavudine Stribild Sustiva Symfi Symfi Lo Symtuza tenofovir disoproxil fumarate Tivicay Triumeq Trizivir Trogarzo Truvada Tybost Vemlidy Videx EC Videx Pediatric

Viracept Viramune Viramune XR Viread Zerit Ziagen zidovudine

Group 2 Analgesic Agents

Abstral acetaminophen acetaminophen children's acetaminophen extra strength acetaminophen infants acetaminophen pediatric acetaminophen PM extra strength acetaminophen/butalbital acetaminophen/butalbital/caffeine acetaminophen/butalbital/caffeine/ codeine acetaminophen/codeine acetaminophen/hydrocodone acetaminophen/hydrocodone HS

acetaminophen/oxycodone acetaminophen/tramadol Actiq Aleve Arthritis Alfenta alfentanil All Day Pain Relief Allzital Arthritis Pain Formula Arthrotec Arymo ER Ascomp W/Codeine Aspir 81 aspirin aspirin adult low strength aspirin chewable aspirin children's aspirin EC aspirin extra strength aspirin lite coated aspirin low dose aspirin maximum strength aspirin/butalbital/caffeine aspirin/butalbital/caffeine/codeine aspirin/carisoprodol/codeine

aspirin/oxycodone Aspir-Low Astramorph/PF Belbuca belladonna/opium benzhydrocodone/acetaminophen Bunavail Bupap buprenorphine buprenorphine/naloxone butalbital compound/codeine butorphanol

Butrans Caldolor Cambia Capacet Capital W/Codeine Celebrex celecoxib choline magnesium trisalicylate codeine Conzip Daypro Demerol diclofenac

diclofenac DR diclofenac/misoprostol diflunisal Dilaudid Disalcid Dologesic Dolophine Hcl Duragesic Duramorph EC Naprosyn Ecpirin Ed APAP Embeda

Endocet Esgic etodolac Exalgo Excedrin Back & Body Excedrin Extra Strength Excedrin Migraine Excedrin Tension Headache Extra Pain Relief Feldene fenoprofen fentanyl fentanyl transdermal system

Fentora Fever Reducer Feverall Fioricet Fiorinal Fiorinal W/Codeine Flector flurbiprofen Good Neighbor Arthritis Pain Relief Good Neighbor Ibuprofen Good Neighbor Ibuprofen Infants' Good Neighbor Ibuprofen Junior Strength Good Sense Aspirin Good Sense Children's Aspirin Good Sense Children's Ibuprofen Good Sense Children's Pain Relief Good Sense Children's Pain Reliever Good Sense Headache Relief Good Sense Ibuprofen Good Sense Ibuprofen Junior Strength Good Sense Infants' Ibuprofen Good Sense Migraine Relief

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Good Sense Pain Relief Good Sense Pain Reliever Good Sense Pain Reliever & Sleep Aid PM Headache PM Formula Histaflex Hycet hydrocodone/ibuprofen

hydromorphone Hysingla ER IBU ibuprofen ibuprofen children's ibuprofen IB Indocin indomethacin indomethacin ER Infumorph Kadian ketoprofen ketorolac

Lazanda levorphanol Lorcet Lorcet HD Lorcet Plus Lortab Solution Mapap Mapap Arthritis Pain Mapap Children's Mapap Extra Strength Mapap-PM Marten-Tab meclofenamate

mefenamic acid meloxicam meperidine methadone methadone intensol Methadose Migraine Formula Mobic Morphabond ER morphine sulfate MS Contin nabumetone nalbuphine

Nalocet Nalfon naloxone/pentazocine Naprelan naproxen naproxen delayed release naproxen EC Non-Aspirin Non-Aspirin Children's Non-Aspirin Extra Strength Non-Aspirin Infant's Non-Aspirin Pain Reliever Non-Aspirin Pain Reliever Childrens Non-Aspirin Pain Reliever Infant's Non-Aspirin PM Extra Strength Non-Aspirin Regular Strength Norco Nucynta Nucynta ER Opana oxaprozin Oxaydo oxycodone oxycodone/ibuprofen Oxycontin oxymorphone Pain & Fever Relief Pain & Fever Relief Children's Pain & Fever Relief Extra Strength Pain Relief Pain Reliever Pain Reliever Added Strength Pain Reliever Children's Pain Reliever Child's

Pain Reliever Infants' Pain Reliever Junior Strength Pain Reliever PM Extra Strength Pain Reliever W/O Aspirin Pain Reliever W/O Aspirin Children Panlor Pennsaid Percocet piroxicam Ponstel Prialt Probuphine Provil QC Non-Aspirin Extra Strength QC Pain Reliever Quality Choice Arthritis Pain Relief Quality Choice Children's Ibuprofen Quality Choice Effervescent Pain Relief Quality Choice Ibuprofen Quality Choice Non-Aspirin Quality Choice Non-Aspirin Pain Relief remifentanil Reprexain Roxicodone Roxybond salsalate Silapap Children's Sublimaze Subsys Sufenta sufentanil sulindac Tactinal Tactinal Children's Tactinal Extra Strength Talwin Theracodophen Theracodophen-Low Theraproxen Theratramadol Tivorbex tolmetin tramadol tramadol ER Tylenol W/Codeine Ultiva Ultracet Ultram Vanatol S Verdrocet Vicodin Vicodin ES Vicodin HP Vimovo Vivlodex Voltaren Gel Voltaren-XR Xrylix Xtampza ER Zebutal Zipsor Zohydro ER Zorvolex Zubsolv

Androgenic Agents

Anadrol Androderm Androgel Android Aveed Axiron depo-testosterone Fortesta Intrarosa Methitest methyltestosterone oxandrolone Striant Testim

Testopel testosterone cypionate testosterone enanthate Testred Vogelxo

Antialcoholic Agents

acamprosate Antabuse disulfiram Vivitrol

Antianxiety Agents

alprazolam alprazolam intensol alprazolam xr

Ativan buspirone chlordiazepoxide chlordiazepoxide/clidinium clorazepate diazepam diazepam intensol lorazepam lorazepam intensol meprobamate oxazepam Tanxene T-Tab Xanax Xanax XR

Antibiotics

albendazole Albenza amikacin Amoclan amoxicillin amoxicillin/clavulanate ampicillin

ampicillin/sulbactam atovaquone atovaquone/proguanil Augmentin Augmentin ES-600 Augmentin XR Avelox Avelox I.V. Azactam azithromycin aztreonam Baciim bacitracin

bacitracin/neomycin/polymyxin B Bactrim Bactrim DS Bactroban Baxdela benznidazole Bethkis Bicillin C-R Bicillin L-A Biltricide Capastat Cayston Cedax

cefaclor cefadroxil cefazolin cefazolin cefdinir cefepime cefotaxime cefotetan cefoxitin cefpodoxime proxetil cefprozil ceftazidime ceftibuten

Ceftin

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ceftriaxone cefuroxime cephalexin chloramphenicol chlorhexidine chloroquine Cipro Cipro IV Cipro XR ciprofloxacin Claforan clarithromycin Cleocin Cleocin Pediatric Cleocin Vaginal Cleocin Vaginal Ovules clindamycin Clindesse Coartem colistimethate

Coly-Mycin M Cubicin cycloserine Dalvance Dapsone daptomycin Daraprim demeclocycline dicloxacillin Dificid doripenem Doryx Doxy doxycycline E.E.S. 400 E.E.S. Granules ertapenem Eryped Ery-Tab Erythrocin Lactobionate Erythrocin Stearate erythromycin ethambutol Factive Flagyl Fortaz Furadantin gentamicin Good Sense Triple Antibiotic hydroxychloroquine imipenem/cilastatin Invanz isoniazid ivermectin Keflex Kitabis Pak Levaquin levofloxacin

Lincocin lincomycin linezolid Macrobid Macrodantin Malarone Malarone Pediatric Maxipime mefloquine Mepron meropenem Merrem Merrem IV methenamine Metrocream Metrogel Metrogel-Vaginal Metrolotion metronidazole minocycline minocycline ER moxifloxacin

mupirocin Myambutol Mycobutin nafcillin Nebupent nitrofurantoin Noritate Nuvessa ofloxacin Oracea Oraxyl Orbactiv oxacillin paromomycin Paser PCE penicillin G penicillin VK Pentam Pfizerpen piperacillin/tazobactam Plaquenil polymyxin B praziquantel primaquine Primaxin IV pyrazinamide Qualaquin quinine Rifadin Rifadin IV Rifamate rifampin

Silvadene silver sulfadiazine Sirturo Sivextro smz-tmp smz-tmp DS Solodyn Solosec Spectracef SSD streptomycin Stromectol sulfadiazine

sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS Sulfatrim Suprax Synercid Tazicef tetracycline tigecycline Tindamax tinidazole Tobi tobramycin

Trecator trimethoprim Triple Antibiotic Triple Antibiotic Extra Triple Antibiotic Plus Triple Antibiotic with Lidocaine Tygacil Unasyn Urimar-T Vabomere Vancocin vancomycin Vandazole Vibativ Vibramycin Xifaxan Zemdri Zerbaxa Zinacef Zithromax Zithromax Tri-Pak Zithromax Z-Pak

Zmax Zosyn Zyvox

Anticoagulants

anticoagulant cpd Arixtra Coumadin enoxaparin fondaparinux Fragmin heparin Jantoven Lovenox Oxtellar XR Savaysa warfarin

Anticonvulsants

Austedo Banzel Briviact carbamazepine Carbatrol Celontin Kapseals Cerebyx clobazam clonazepam

Depacon Depakene Depakote Depakote ER Depakote Sprinkles Diastat Acudial Diastat Pediatric Dilantin Dilantin Infatabs Dilantin-125 divalproex divalproex ER Epitol Equetro ethosuximide felbamate Felbatol fosphenytoin sodium Fycompa gabapentin Gabitril Gralise Horizant Ingrezza Keppra Keppra XR Klonopin Lamictal Lamictal CD Lamictal ODT Lamictal XR lamotrigine lamotrigine ER lamotrigine ODT levetiracetam Lyrica Lyrica CR Mysoline Neurontin oxcarbazepine Peganone pentobarbital phenobarbital Phenytek phenytoin primidone Qudexy XR Roweepra XR Spritam Tegretol Tegretol-XR

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tiagabine Topamax topiramate Trileptal Trokendi XR valproic acid vigabatrin

Vigadrone Vimpat Zarontin Zonegran zonisamide

Antidementia Agents

Aricept donepezil donepezil ODT ergoloid mesylates

Exelon galantamine galantamine ER memantine memantine ER Razadyne Razadyne ER rivastigmine

Antidepressants

amitriptyline amitriptyline/chlordiazepoxide amitriptyline/perphenazine amoxapine Anafranil Aplenzin Brisdelle bupropion bupropion SR bupropion XL citalopram clomipramine Cymbalta desipramine desvenlafaxine ER doxepin duloxetine Effexor-XR escitalopram fluoxetine fluvoxamine Forfivo XL imipramine Khedezla maprotiline Marplan mirtazapine Nardil nefazodone Norpramin nortriptyline olanzapine/fluoxetine Parnate paroxetine Paxil Paxil Cr Pexeva phenelzine Pristiq protriptyline Prozac Remeron Remeron Soltab sertraline Silenor Surmontil Symbyax Tofranil tranylcypromine trazodone trimipramine

Trintellix venlafaxine Wellbutrin SR Wellbutrin XL Zoloft

Antidiarrheal Agents

Anti-Diarrheal atropine sulfate/diphenoxylate Bismatrol Good Sense Anti-Diarrheal Good Sense Pink Bismuth Good Sense Stomach Relief Kao-Tin Lomotil loperamide Motofen Mytesi Paregoric Peptic Relief Pink Bismuth Pink Bismuth Maximum Strength QC Anti-Diarrheal QC Anti-Diarrheal Advanced Stomach Relief Extra Strength Xermelo

Antiemetics

Akynzeo Aloxi Anzemet Cesamet Cinvanti Compro dronabinol droperidol Emend granisetron meclizine ondansetron ondansetron ODT

palonosetron Phenadoz prochlorperazine promethazine Promethegan Sancuso scopolamine patch Sustol Syndros Tigan Transderm Scop trimethobenzamide Varubi Zofran Zofran ODT Zuplenz

Antifungal Agents

3 Day Vaginal Cream Abelcet Alevazol Ambisome amphotericin B Ancobon

Antifungal Athlete's Foot Baza Antfungal Skin Care Pack Baza Antifungal Bensal HP betamethasone/clotrimazole Cancidas Carrington Antifungal caspofungin ciclopirox Clotrim Antifungal clotrimazole clotrimazole 3

clotrimazole A/F

clotrimazole troche Cresemba Critic-Aid Clear AF Desenex Diflucan econazole Eraxis Ertaczo Extina fluconazole flucytosine Fungoid Fungoid-D Gentian Violet Good Sense Jockitch Spray griseofulvin Gris-Peg Gynazole-1 itraconazole Jublia Kerydin ketoconazole ketoconazole shampoo Lamisil Lamisil AF Lamisil AT Loprox Lotrimin AF Lotrisone luliconazole Luzu Mentax miconazole

miconazole 1 miconazole 3 miconazole 3 combination pack miconazole 7 Micro-Guard Mycamine naftifine Naftin Nizoral Noxafil Nyamyc nystatin nystatin/triamcinolone

Nystop Onmel Oravig oxiconazole Oxistat Penlac Secura Antifungal Extra Thick Secura Antifungal Greaseless Sporanox Terazol 7 terbinafine terconazole

Tinactin tioconazole 1 tolnaftate Vfend Vfend I.V. voriconazole Vusion Zeasorb AF

Antihistamines

cetirizine Rx

Clarinex Clarinex-D 12 Hour desloratadine hydroxyzine levocetirizine Phenergan promethazine Semprex-D Vistaril

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Antimigraine Agents Ajovy almotriptan Amerge APAP/dichloral/isometheptene Axert Cafergot D.H.E. 45 dihydroergotamine eletriptan Ergomar Frova frovatriptan Imitrex Imitrex Statdose Maxalt Maxalt-MLT Migergot Migranal Migranow naratriptan Onzetra Xsail Relpax rizatriptan sumatriptan

sumatriptan/naproxen Sumavel Dosepro Treximet Zembrace Symtouch zolmitriptan zolmitriptan ODT

Antineoplastic Agents

abiraterone Abraxane Adcetris Adriamycin Adrucil Afinitor Aldara Alecensa Alimta Aliqopa Alkeran Alunbrig amifostine anastrozole Arimidex Aromasin Arranon arsenic trioxide Arzerra Avastin azacitidine Bavencio Beleodaq bendamustine Bendeka Besponsa bexarotene bicalutamide Bicnu bleomycin Blincyto bortezomib Bosulif Braftovi busulfan Busulfex Cabometyx Calquence Camptosar capecitabine Carac carboplatin

Casodex cisplatin cladribine clofarabine Cometriq

Cosmegen Cotellic cyclophosphamide Cyramza cytarabine dacarbazine Dacogen dactinomycin Darzalex daunorubicin decitabine dexrazoxane diclofenac Docefrez docetaxel Doxil doxorubicin Droxia Efudex Eligard Ellence Emcyt epirubicin Erbitux Erivedge Erleada Erwinaze Etopophos etoposide Evomela exemestane Fareston Farydak Faslodex Femara Firmagon floxuridine fludarabine fluorouracil flutamide Folotyn Fusilev Gazyva gemcitabine Gemzar Gilotrif Gleevec Gliadel Halaven Herceptin Hexalen Hycamtin Hydrea hydroxyurea Iclusig Ibrance Idamycin PFS idarubicin

Ifex ifosfamide ifosfamide/mesna imatinib Imbruvica Imfinzi imiquimod Imlygic Inlyta Iressa irinotecan Istodax Ixempra Jakafi Kadcycla Keytruda Kisqali Kisqali Femara Co-Pack Kymriah Kyprolis Lartruvo Lenvima

letrozole leucovorin Leukeran leuprolide levoleucovorin Lonsurf Lupron Depot Lynparza Lysodren Marqibo Matulane Mekinist Mektovi melphalan mercaptopurine mesna Mesnex methotrexate mitomycin mitoxantrone

Mustargen Myleran Mylotarg Navelbine Nerlynx Nexavar Nilandron Ninlaro Nipent Odomzo Oncaspar Onivyde Opdivo oxaliplatin paclitaxel Panretin Perjeta Pomalyst Portrazza Poteligeo Prostascint Provenge Purixan Revlimid Rituxan Rituxan Hycela romidepsin Rubraca Rydapt Siklos Solaraze Soltamox Sprycel Stivarga Sutent Sylatron Synribo Tabloid Tafinlar Tagrisso tamoxifen Tarceva Targretin Tasigna Taxotere Tecentriq Temodar temozolomide temsirolimus teniposide Tepadina thiotepa Tibsovo Tolak Toposar topotecan Torisel Treanda tretinoin Trexall

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Triptodur Trisenox Tykerb Unituxin Valstar Vectibix Velcade Venclexta Venclexta Starting Pack Verzenio Vidaza vinblastine vincristine vinorelbine Vitrakvi Votrient Vyxeos Liposome Xalkori Xatmep Xeloda Xgeva Xtandi Yervoy Yondelis Yonsa Zanosar Zelboraf Zevalin Y-90 Zinecard Zoladex Zolinza Zyclara Zydelig Zykadia Zytiga

Antiparasitic Agents

Elimite Lindane malathion Ovide Permethrin Sklice

Antiparkinsons Agents

amantadine Apokyn Azilect benztropine bromocriptine carbidopa carbidopa/levodopa carbidopa/levodopa/entacapone Comtan Duopa Eldepryl Emsam entacapone Gocovri Lodosyn Mirapex Mirapex ER Neupro Osmolex ER Parlodel pergolide pramipexole

pramipexole ER rasagiline Requip Requip XL ropinirole selegiline Sinemet Sinemet CR Stalevo Tasmar trihexyphenidyl Xadago

Zelapar

Antiplatelet Agents

Aggrastat Aggrenox Agrylin anagrelide aspirin/dipyridamole ER Brilinta cilostazol clopidogrel dipyridamole Effient eptifibatide Integrilin Plavix prasugrel Reopro ticlopidine Yosprala Zontivity

Antipsychotic Agents Abilify Abilify Maintena Abilify Mycite Adasuve aripiprazole Aristada chlorpromazine clozapine clozapine ODT Clozaril Fazaclo fluphenazine Geodon Haldol haloperidol Invega Invega Sustenna Invega Trinza lithium loxapine molindone Nuplazid olanzapine olanzapine ODT Orap paliperidone ER

perphenazine Pimozide quetiapine Rexulti Risperdal Risperdal Consta Risperdal M-Tab risperidone risperidone m-tab Seroquel Seroquel XR thioridazine thiothixene

trifluoperazine Versacloz Vraylar ziprasidone Zyprexa Zyprexa Relprevv Zyprexa Zydis

Antiviral Agents

Abreva acyclovir cidofovir Condylox Cytovene Denavir famciclovir Flumadine

foscarnet ganciclovir podofilox Prevymis Relenza ribavirin inhalation rimantadine

Sitavig Synagis Tamiflu valacyclovir Valcyte Valtrex Veregen Virazole Xerese Zovirax

Asthma/COPD Agents Accolate Advair Diskus Advair HFA Aerospan Airduo Respiclick albuterol

Alvesco aminophylline Anora Ellipta Armonair Respiclick Arnuity Ellipta Asmanex Asmanex HFA Asmanex Twisthaler Atrovent HFA Bevespi Aerosphere Breo Ellipta budesonide Cinqair Combivent Respimat cromolyn Daliresp Dulera Elixophyllin Fasenra Flovent Diskus Flovent HFA Incruse Ellipta ipratropium ipratropium/albuterol levalbuterol metaproterenol

montelukast Nucala Perforomist Proair HFA Proventil HFA Pulmicort Flexhaler Pulmicort Respules QVAR QVAR Redihaler Serevent Diskus Singulair Spiriva Spiriva Respimat Striverdi Respimat Symbicort terbutaline Theo-24 theophylline Trelegy Ellipta Tudorza Pressair Utibron Neohaler Ventolin HFA Wixela Inhub Xolair Xopenex zafirlukast

zileuton zileuton ER Zyflo

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Zyflo CR

Bladder Relaxant Agents

darifenacin ER Detrol Detrol LA Ditropan XL flavoxate Myrbetriq oxybutynin oxybutynin ER Oxytrol tolterodine tolterodine ER Toviaz trospium trospium ER

Bone Resorption Suppression and Related Agents

alendronate Binosto Boniva calcitonin-salmon etidronate Evista Forteo Fosamax Fosamax Plus D Miacalcin pamidronate Prolia raloxifene Reclast risedronate Tymlos zoledronic acid Zometa

BPH Treatments

alfuzosin Avodart dutasteride dutasteride/tamsulosin finasteride Flomax Jalyn Proscar tamsulosin

Cardiovascular Agents Accupril Accuretic acebutolol acetazolamide Adalat CC Adcirca Adempas Adenocard adenosine Afeditab CR Aldactazide Aldactone Altace amiloride amiloride/hydrochlorothiazide amiodarone amlodipine amlodipine/atorvastatin amlodipine/benazepril

amlodipine/hydrochlorothiazide/olmesartan amlodipine/hydrochlorothiazide/valsartan amlodipine/olmesartan amlodipine/valsartan Atacand Atacand HCT atenolol atenolol/chlorthalidone Azor

benazepril benazepril/hydrochlorothiazide Benicar Benicar HCT Betapace Betapace AF betaxolol

Bidil bisoprolol bisoprolol/hydrochlorothiazide Brevibloc bumetanide Caduet Calan Calan SR candesartan candesartan/hydrochlorothiazide Capoten captopril captopril/hydrochlorothiazide

Cardene IV Cardene SR Cardizem Cardizem CD Cardizem LA Cardura Cardura XL Carospir Cartia XT carvedilol carvedilol ER Catapres Catapres-TTS chlorothiazide chlorthalidone Cleviprex clonidine Clorpres Coreg Coreg CR Corlopam Corvert Corzide Cozaar Demadex Demser digoxin Dilatrate-SR diltiazem diltiazem CD Dilt-XR Diovan Diovan HST disopyramide Diuril dobutamine dofetelide doxazosin

Dyazide Edarbi edarbyclor Edecrin Eliquis enalapril enalapril/hydrochlorothiazide enalaprilat Entresto Epaned eplerenone epoprostenol eprosartan

esmolol ethacrynate Exforge Exforge HCT felodipine flecainide fosinopril fosinopril/hydrochlorothiazide furosemide

GoNitro guanfacine hydrochlorothiazide/lisinopril hydrochlorothiazide/methyldopa hydrochlorothiazide/propranolol hydrochlorothiazide/spironolactone hydrochlorothiazide/triamterene

hydrochlorothiazide/metoprolol hydralazine hydrochlorothiazide Hydrocot Hyzaar ibuprofen lysine ibutilide indapamide Inderal LA Inderal XL Innopran XL Inspra irbesartan

irbesartan/hydrochlorothiazide Isordil Titradose isosorbide isosorbide dinitrate isosorbide mononitrate isradipine labetalol Lanoxin Lanoxin Pediatric Lasix Letairis Levatol lidocaine

lisinopril lisinopril/hydrochlorothiazide Lokelma Lopressor Lopressor HCT losartan losartan/hydrochlorothiazide Lotensin Lotensin HCT Lotrel Matzim LA Maxzide methazolamide

methyclothiazide methyldopa metolazone metoprolol metoprolol/hydrochlorothiazide mexiletine Micardis Micardis HCT Microzide midodrine milrinone Minipress Minitran minoxidil moexipril moexipril/hydrochlorothiazide nadolol nadolol/bendroflumethiazide Natrecor Neoprofen Nexterone nicardipine nifedipine nifedipine ER Nifendiac CC nimodipine Nipride RTU nisoldipine Nitro-Bid Nitro-Dur nitroglycerin nitroglycerin transdermal system Nitrolingual Nitromist

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Nitropress Nitrostat Norpace Norpace CR Norvasc Nymalize olmesartan

olmesartan/hydrochlorothiazide Orenitram ER Pacerone pentoxifylline perindopril phenoxybenzamine phentolamine pindolol Pradaxa prazosin Prestalia Prinivil procainamide

Procardia Procardia XL propafenone propanolol Qbrelis quinapril quinapril/hydrochlorothiazide quinidine ramipril Ranexa ranolazine ER Remodulin Revatio Rythmol SR sildenafil (PAH) sodium nitroprusside Sorine sotalol sotalol AF Sotylize spironolactone Sular Tarka Taztia XT Tekturna Tekturna HCT telmisartan telmisartan/amlodipine telmisartan/hydrochlorothiazide Tenoretic Tenormin terazosin Tiazac Tikosyn timolol Toprol XL torsemide Tracleer trandolapril trandolapril/verapamil treprostinil triamterene/hydrochlorothiazide Tribenzor Tyvaso Uptravi valsartan valsartan/hydrochlorothiazide Vaseretic Vasotec Vecamyl Veletri Ventavis verapamil verapamil PM Xarelto Zestoretic Zestril Ziac

Diabetic Agents acarbose Actoplus Met Actoplus Met XR Actos Afrezza alogliptin alogliptin/metformin alogliptin/pioglitazone Amaryl Avandamet Avandia Basaglar KwikPen Bydureon Bydureon Bcise Byetta chlorpropamide Cycloset Duetact Farxiga Fiasp Fiasp Flextouch Fortamet Glimepiride glipizide

glipizide XL glipizide/metformin Glucagen Glucagen Hypokit Glucophage Glucophage XR Glucotrol Glucotrol XL Glucovance Glumetza glyburide glyburide/metformin Glynase Pres-Tab Glyset Glyxambi Humalog Humalog Junior Kwikpen Humalog Kwikpen Humalog Mix 50/50 Humalog Mix 75/25 Humapen Luxura HD Humulin 70/30 Humulin 70/30 Kwikpen Humulin N Humulin N Kwikpen Humulin R Humulin R U-500 Humulin R U-500 Kwikpen Invokamet XR Invokana Janumet Janumet XR Januvia Jardiance Jentadueto Jentadueto XR Kazano Kombiglyze XR Levemir metformin metformin ER metformin/repaglinide miglitol Nesina Novolin 70/30 Novolin 70/30 Flexpen Novolin N Novolin R Novolog Novolog Flexpen Novolog Mix 70/30 Onglyza Oseni Ozempic pioglitazone/glimepiride

Prandin Precose Qtern repaglinide Segluromet Starlix Steglatro Steglujan SymlinPen Synjardy Tanzeum tolazamide tolbutamide Tradjenta Tresiba Tresiba Flextouch Trulicity Victoza Xigduo XR Xultophy

Diabetic Supplies

Blood Sugar (Glucose) Meters Blood Sugar (Glucose) Test Strips Control Solutions/Reagent Strips Insulin Syringes/Needles Ketone Tests Lancets/Lancing Devices

Digestive Enzymes

Creon Palcaps Pancreaze Pertzye Zenpep

Endocrine and Metabolic Agents

Activella allopurinol

Aloprim Alora Angeliq Aygestin cabergoline cinacalcet Climara Climara Pro colchicine colchicine/probenecid Colcrys Combipatch Cytomel danazol Delestrogen Depo-Estradiol Depo-Provera 400 Divigel Duavee Duzallo Elestrin estradiol estradiol transdermal estradiol/norethindrone Estring estrogen/methyltestosterone

estropipate Evamist fludrocortisone Jevantique Lo Jinteli Jynarque leuprolide levothyroxine Levoxyl liothyronine Lopreeza Lupaneta Pack Makena medroxyprogesterone

11

Megace ES megestrol Menest Menostar methimazole Mimvey Minivelle Mitigare naloxone naltrexone Narcan Natpara norethindrone Onpattro Orilissa Osphena Parsabiv paricalcitol Praxbind Prefest Premarin Prempro probenecid progesterone Prometrium propylthiouracil Provera Rayaldee Sensipar Serostim Synthroid Tapazole Thyroid Tirosint Tirosint-Sol Triostat Uloric Unithroid Vagifem Vivelle-Dot Yuvafem Zemplar Zurampic Zyloprim

Gastrointestinal Agents

Acid Controller Acid Reducer Aciphex Actigall Anaspaz Apriso atropine Azulfidine Azulfidine Entabs balsalazide

Cantil Chenodal chlordiazepoxide/clidinium cimetidine Colazal Cytotec Dexilant dicyclomine Dipentum Dispas Esomp-EZS famotidine Giazo Glycate glycopyrrolate Glyrx-PF Heartburn Relief Hyoscyamine Hyosyne lansoprazole Levbid Levsin Levsin SL Lialda

Lotronex mesalamine methscopolamine metoclopramide misoprostol Movantik Nexium Nexium I.V. nizatidine Nulev Ocaliva Omeclamox-Pak omeprazole omeprazole/sodium bicarbonate Oscimin Oscimin SR pantoprazole Pentasa Pepcid Prevacid Prevacid Solutab Prevpac Prilosec propantheline Protonix ranitidine Reglan Relistor Robinul Robinul Forte Rowasa scopolamine SfRowasa Sucralfate sulfasalazine Symax Duotab Symax Fastabs Symax-SL Symax-SR Symproic ursodiol Viberzi Zantac Zegerid

Glucocorticoids

A-Hydrocort alclometasone amcinonide Apexicon E Aquanil HC Aristospan betamethasone budesonide Capex Celestone Celestone Soluspan clobetasol Clobex clocortolone Cloderm Cormax Cortef cortisone Cutivate Depo-Medrol Dermacinrx Silapak Dermatop Desonate desonide Desowen desoximetasone dexamethasone Dexpak diflorasone Diprolene Elocon Emflaza Entocort Ec fluocinolone

fluocinonide fluticasone halobetasol hydrocortisone hydrocortisone with aloe Hydroskin Impoyz Locoid Locoid Lipocream Luxiq Medrol methylprednisolone Millipred mometasone Olux Oralone Pandel prednicarbate prednisolone prednisone

prednisone intensol Psorcon Rayos Sernivo Solu-Cortef Solu-Medrol Taperdex Temovate Texacort Topicort triamcinolone Trianex Uceris Vanos Veripred Zilretta Zodex Zonacort

Hematopoietic Agents

Aranesp Doptelet Epogen Fulphila Granix Mircera Mulpleta Neulasta Neupogen nivestym Nplate Procrit Promacta Retacrit Zarxio

Hepatitis Agents

adefovir Baraclude Copegus Daklinza entecavir Epclusa Epivir HBV Harvoni Hepsera Intron A lamivudine HBV ledipasvir/sofosbuvir Mavyret Moderiba Pegasys Rebetol Ribapak Ribasphere ribavirin sofosbuvir/velpatasvir Sovaldi Zepatier

12

Immunomodulators Ilumya Tavalisse

Immunosuppressives Astagraf XL Azasan azathioprine Cellcept cyclosporine cyclosporine modified Envarsus XR Gengraf mycophenolate mofetil mycophenolic acid Myfortic Neoral Prograf Rapamune Sandimmune sirolimus tacrolimus Zortress

Intranasal Rhinitis Agents Astepro azelastine Beconase AQ cromolyn Dymista Flonase Flonase Sensimist flunisolide fluticasone ipratropium Nasonex olopatadine Omnaris Patanase Qnasl Qnasl Children Rhinocort Allergy Sinuva Ticanase Triamcinolone Xhance Zetonna

Laxatives

Amitiza bisacodyl Clenpiq Colace 2-in-1 Colyte Constulose docusate docusate/senna Gavilyte-C Gavilyte-G Gavilyte-N Golytely Healthylax Kristalose lactulose Moviprep Nulytely Osmoprep polyethylene glycol 3350 Reguloid senna Suprep Trilyte W/Flavor Packs

Lipid Lowering Agents

Altoprev Antara atorvastatin cholestyramine cholestyramine light

Colestid colesevelam colestipol Crestor ezetimibe ezetimibe/simvastatin fenofibrate

fenofibric acid Fenoglide Fibricor fluvastatin gemfibrozil Juxtapid Kynamro Lescol Lescol XL Lipitor Lipofen Liptruzet Livalo Lopid lovastatin Lovaza niacin niacin time release niacinamide Niaspan omega-3 fatty acid Rx Pravachol pravastatin Prevalite Questran Questran Light Repatha Sureclick Repatha Syringe rosuvastatin simvastatin Slo-Niacin Tricor Triglide Trilipix Vascepa Vytorin Welchol Zetia Zocor Zypitamag

Miscellaneous Rheumatological Agents

Actemra Cimzia Enbrel Humira Humira Pediatric Inflectra Kineret leflunomide Olumiant Orencia Otezla Otrexup Rasuvo Remicade Renflexis Simponi Xeljanz

Miscellaneous Topical Agents lidocaine lidocaine/prilocaine Lidoderm

Multiple Sclerosis Agents

Ampyra Avonex Betaseron Copaxone dalfampridine ER Extavia

Gilenya glatiramer Glatopa Ocrevus Plegridy Rebif Rebif Rebidose Tecfidera Zinbryta

Muscle Relaxants

Amrix aspirin/carisoprodol baclofen carisoprodol chlorzoxazone cyclobenzaprine Dantrium dantrolene Fexmid Gablofen Lioresal Lorzone metaxalone methocarbamol orphenadrine Prazolamine Revonto Robaxin Ryanodex Skelaxin Soma tizanidine Zanaflex

Narcotic Withdrawal Therapy Agents

Lucemyra

Ophthalmic/Otic Agents

acetic acid acetic acid/hc Aktob Alomide Alrex apraclonidine Azasite azelastine Azopt bacitracin bacitracin/polymyxin B bacitracin/neomycin/polymyxin B bacitracin/HC/neomycin/polymyxin

Bepreve Besivance betaxolol Betoptic S bimatoprost brimonidine bromfenac carteolol Ciloxan Cipro HC Ciprodex ciprofloxacin Coly-Mycin S

cromolyn dexamethasone dexamethasone/neomycin/polymyxin Dexycu diclofenac dorzolamide dorzolamide/timolol Durezol Emadine epinastine Erygel erythromycin Eylea Flarex

13

Floxin fluorometholone flurbiprofen gatifloxacin Gentak gentamicin gramicidin/neomycin/polymyxin B

hydrocortisone/acetic acid hydrocortisone/neomycin/polymyxin B Ilevro Iopidine Isopto Carpine Istalol ketorolac latanoprost levobunolol levofloxacin Lotemax Lumify Lucentis Macugen Maxidex Maxitrol metipranolol Miochol-E Moxeza moxifloxacin Natacyn Nevanac ofloxacin olopatadine Omidria Omnipred Pataday Patanol Pazeo Phospholine pilocarpine Polycin polymyxin B/trimethoprim prednisolone prednisolone/sulfacet Prolensa Retisert Simbrinza sulfacetamide

timolol Timoptic Timoptic Ocudose Timoptic Ocumeter Plus Timoptic-XE Timoptic-XE Ocumeter Plus Tobradex Tobradex ST tobramycin tobramycin/dexamethasone Tobrex Travatan Z Triesence trifluridine Triple Antibiotic Trusopt Ocumeter Plus Vigamox Viroptic Vosol Vyzulta Xalatan Xiidra Zioptan Zirgan Zylet

Sedative Hypnotics

Belsomra Butisol dexmedetomidine Edluar estazolam flurazepam Halcion

Hetlioz Intermezzo midazolam Precedex quazepam Restoril Rozerem Seconal Sonata temazepam triazolam zaleplon zolpidem Zolpimist

Smoking Cessation Agents bupropion bupropion SR Chantix Nicoderm CQ Nicorelief Nicorette nicotine lozenge nicotine polacrilex nicotine polacrilex gum

nicotine transdermal Nicotrol Inhaler Nicotrol NS Zyban

Stimulants and Related Agents

Adderall Adderall XR Adzenys ER amphetamine salt combo Aptensio XR armodafinil atomoxetine Concerta Cotempla XR-ODT Daytrana Desoxyn Dexedrine Spansules dexmethylphenidate dextroamph sacc/amph asp/dextroam sulf/amphet sulf dextroamphetamine Dyanavel XR Evekeo Focalin Focalin XR Metadate ER methamphetamine Methylin methylphenidate modafinil Mydayis Nuvigil Procentra Provigil Quillichew ER Quillivant XR Relexxii Ritalin Ritalin LA Strattera Vyvanse Zenzedi

Vaccines, Biologicals and Toxoids

Acthib Adacel Adacel TDAP Afluria Afluria Quad BCG Vaccine Bexsero Boostrix Boostrix TDAP

Daptacel Daptacel DTAP Engerix-B Fluarix Quad Flublok Flulaval Quad Flumist Quad Fluvirin Fluzone High-Dose Fluzone Intraderm Quad Fluzone Quad Fluzone Quad Pedi Gardasil 9 Havrix Havrix Pediatric Imovax Rabies Infanrix Ipol Ixiaro Kinrix Menactra Menveo M-M-R II PedvaxHIB Pentacel Pentacel Acthib Pentacel DTAP-IPV Pneumovax 23 Prevnar 13 Proquad Quadracel DTAP-IPV Rabavert Recombivax HB Recombivax HB Pediatric/Adolescent Rotarix Rotateq Shingrix Stamaril Tenivac tetanus and diphtheria toxoid Tice BCG Typhim VI Vaqta Vaqta Pediatric Varivax Vaxchora Vivotif YF-Vax Zinplava Zostavax

Vitamins and Minerals

Actical Active OB Bal-Care DHA Bal-Care DHA Essential Calcet Calci-Chew Calci-Mix Calcitrate calcitriol calcium calcium acetate calcium carbonate calcium carbonate/vitamin D calcium chloride calcium citrate calcium citrate + D calcium gluconate

calcium lactate calcium/magnesium calcium/magnesium w/vitamin D calcium/magnesium/zinc calcium/vitamin D Caltrate Plus Citranatal 90 DHA Citranatal Assure Citranatal B-Calm Citranatal DHA Citranatal Harmony

14

Citranatal Rx Complete Natal DHA Concept DHA Concept OB cyanocobalamin Delta D3 Dothelle DHA Drisdol Duet DHA 400 Duet DHA Balanced Effer-K effervescent potassium/chloride Eliphos Elite-OB Elite-OB With DHA Enbrace HR Enfamil D-Vi-Sol ergocalciferol Fe C Tab Plus ferrous fumarate

ferrous gluconate ferrous sulfate Folcaps Omega 3 Folet One Folgard OS folic acid Folivane-OB Fosfree Fosrenol Icar-C Plus Kalexate K-Effervescent Kionex Klor-Con Klor-Con M Klor-Con Sprinkle Klor-Con/EF K-Phos Neutral K-Phos No. 2 K-Phos Original K-Tab K-Vescent lanthanum Liquid Calcium Plus Vitamin D Mag Delay Mag64 Mag-G Magnebind 400 Rx magnesium magnesium elemental magnesium gluconate magnesium oxide Mag-Tab SR Marnatal-F Marnatal-F Plus Maximum D3 Mynatal Mynatal Advance Mynatal Plus Mynatal Ultra Mynatal-Z Mynate 90 Plus Nascobal Natelle One Neevo DHA Nestabs One Newgen Nexa Plus Nexa Select Niva-Plus OB Complete OB Complete Gold OB Complete Petite OB Complete Premier OB Complete With DHA Obtrex DHA O-Cal FA O-Cal Prenatal

Oysco Oysco D Oyster Shell Calcium Oyster Shell Calcium/Vit D P-D Natal W/Folic Acid Phoslyra Phos-Nak Phospha 250 Neutral phytonadione potassium acetate potassium chloride potassium phosphate PR Natal Prefera OB Prefera OB One Prefera OB Plus DHA Prena1 Chew Prena1 Pearl Prena1 True Prenatabs FA Prenatabs RX Prenatal 19 Prenatal Low Iron Prenatal Plus Prenatal-U Prenate AM Prenate DHA Prenate Essential Prenate Star Primacare Provida DHA pyridoxine Renagel Replesta Revesta Risacal-D R-Natal OB Rocaltrol Select-OB Select-OB DHA sevelamer Slow-Mag sodium phosphate sodium polystyrene sulfonate SPS Suspension Taron-C DHA Taron-Prex Prenatal With DHA Thrivite 19 Triadvance Trinatal Rx Trinate Tristart DHA Trust Natal DHA Ultimatecare One Ultimatecare One NF Uromag Velphoro Veltassa Vinate Care Vinate DHA RF Vinate M Vinate One Virt-PN Plus Vitafol FE Vitafol Nano Vitafol OB Vitafol OB DHA Vitafol One Vitafol Ultra Vitamin B1 Vitamin B12 Vitamin B6 Vitamin D Vitamin K1 VP-Heme One Zatean-PN DHA Zatean-PN Plus Zinc

Zinc Chelated Zinc Chloride Zinc Gluconate Zinc Picolinate Zinc Sulfate

Group 3 Nutritional Supplements

Boost Boost Breeze Boost Calorie Smart Boost Glucose Control Boost High Protein Boost Kid Essentials Boost Plus Ensure Ensure Active Heart Health Ensure Active Light Ensure Active Protein-Muscle Ensure Clear Ensure Compact Ensure Enlive Ensure Fiber W/ FOS Ensure Glucerna Shake Ensure High Protein Ensure High Protein-Muscle Ensure Liquid Ensure Max Protein Ensure Muscle Health Ensure Original Ensure Plus Ensure Pre-Surgery Ensure Surgery Fibersource HN Glucerna Impact 1 Isosource 1.5 Cal Isosource HN Nepro Nepro Carb Steady Nutren 1.0 Nutren 1.0 With Fiber Nutren 1.5 Nutren 2.0 Nutren Junior Nutren Junior With Fiber Osmolite Pediasure Pediasure Enteral Pediasure Harvest Pediasure W/Fiber Pediasure W/Fiber Enteral Peptamen 1.5 Peptamen Junior Peptamen Junior 1.5 Peptamen Junior Fiber Peptamen Junior HP Peptamen OS Peptamen OS 1.5 Perative Polycose Promote Promote W/ Fiber Pulmocare Replete

Replete Ultrapak Replete With Fiber Resource Breeze Suplena Carb Steady Twocal HN Vital High Nitrogen Vivonex Vivonex Plus Vivonex T.E.N.

15

Section Special Pharmaceutical Benefits Program

(HIV/AIDS Drugs) 3

Drug Formulary

List of Covered Drugs by Alphabetical Order

A abacavir abacavir/lamivudine/zidovudine Abelcet Abilify Abilify Maintena Abilify Mycite abiraterone Abraxane Abreva Abstral acamprosate acarbose Accolate Accupril Accuretic acebutolol acetaminophen

acetaminophen children's acetaminophen extra strength acetaminophen infants acetaminophen pediatric acetaminophen PM extra strength acetaminophen/butalbital acetaminophen/butalbital/caffeine acetaminophen/butalbital/caffeine/codeine acetaminophen/codeine acetaminophen/hydrocodone acetaminophen/hydrocodone HS acetaminophen/oxycodone acetaminophen/tramadol

acetazolamide acetic acid acetic acid/hc Acid Controller Acid Reducer Aciphex Actemra Acthib Actical Actigall Actiq Active OB Activella Actoplus Met Actoplus Met XR Actos acyclovir Adacel Adacel TDAP Adalat CC Adasuve Adcetris Adcirca Adderall Adderall XR adefovir

Adempas Adenocard adenosine Adriamycin

Adrucil Advair Diskus Advair HFA Adzenys ER Aerospan Afeditab CR Afinitor Afluria Afluria Quad Afrezza Aggrastat Aggrenox Agrylin A-Hydrocort Airduo Respiclick Ajovy Aktob Akynzeo albendazole Albenza albuterol alclometasone Aldactazide Aldactone Aldara Alecensa

alendronate Alevazol Aleve Arthritis Alfenta alfentanil alfuzosin Alimta Aliqopa Alkeran All Day Pain Relief allopurinol Allzital almotriptan

alogliptin alogliptin/metformin alogliptin/pioglitazone Alomide Aloprim Alora Aloxi alprazolam alprazolam intensol alprazolam xr Alrex Altace Altoprev Alunbrig Alvesco amantadine Amaryl Ambisome amcinonide Amerge amifostine amikacin

amiloride amiloride/hydrochlorothiazide aminophylline amiodarone Amitiza amitriptyline amitriptyline/chlordiazepoxide amitriptyline/perphenazine amlodipine amlodipine/atorvastatin amlodipine/benazepril amlodipine/hydrochlorothiazide/olmesartan amlodipine/hydrochlorothiazide/valsartan

amlodipine/olmesartan amlodipine/valsartan Amoclan amoxapine amoxicillin amoxicillin/clavulanate amphetamine salt combo amphotericin B ampicillin ampicillin/sulbactam Ampyra Amrix Anadrol

Anafranil anagrelide Anaspaz anastrozole Ancobon Androderm Androgel Android Angeliq Anora Ellipta Antabuse Antara anticoagulant cpd

Anti-Diarrheal Antifungal Anzemet APAP/dichloral/isometheptene Apexicon E Aplenzin Apokyn apraclonidine Apriso Aptensio XR Aptivus Aquanil HC Aranesp Aricept Arimidex aripiprazole Aristada Aristospan Arixtra armodafinil Armonair Respiclick Arnuity Ellipta

16

Aromasin Arranon arsenic trioxide Arthritis Pain Formula Arthrotec Arymo ER Arzerra Ascomp W/Codeine Asmanex Asmanex HFA Asmanex Twisthaler Aspir 81 aspirin aspirin adult low strength aspirin chewable aspirin children's aspirin EC aspirin extra strength aspirin lite coated aspirin low dose

aspirin maximum strength aspirin/butalbital/caffeine aspirin/butalbital/caffeine/codeine aspirin/carisoprodol aspirin/carisoprodol/codeine aspirin/dipyridamole ER aspirin/oxycodone Aspir-Low Astagraf XL Astepro Astramorph/PF Atacand Atacand HCT atazanavir atenolol atenolol/chlorthalidone Athlete's Foot Ativan atomoxetine atorvastatin atovaquone atovaquone/proguanil Atripla atropine atropine sulfate/diphenoxylate Atrovent HFA Augmentin Augmentin ES-600 Augmentin XR Austedo Avandamet Avandia Avastin Aveed Avelox Avelox I.V. Avodart Avonex Axert Axiron Aygestin azacitidine Azactam Azasan Azasite azathioprine azelastine Azilect azithromycin Azopt Azor aztreonam Azulfidine Azulfidine Entabs

B

Baciim bacitracin bacitracin/HC/neomycin/polymyxin bacitracin/neomycin/polymyxin B

bacitracin/polymyxin B baclofen Bactrim Bactrim DS Bactroban Bal-Care DHA Bal-Care DHA Essential balsalazide Banzel Baraclude Basaglar KwikPen Bavencio Baxdela Baza Antfungal Skin Care Pack Baza Antifungal BCG Vaccine Beconase AQ Belbuca Beleodaq belladonna/opium

Belsomra benazepril benazepril/hydrochlorothiazide bendamustine Bendeka Benicar Benicar HCT Bensal HP benzhydrocodone/acetaminophen benznidazole benztropine Bepreve Besivance Besponsa betamethasone betamethasone/clotrimazole Betapace Betapace AF Betaseron betaxolol Bethkis Betoptic S Bevespi Aerosphere bexarotene Bexsero bicalutamide

Bicillin C-R Bicillin L-A Bicnu Bidil Biktarvy Biltricide bimatoprost Binosto bisacodyl Bismatrol bisoprolol bisoprolol/hydrochlorothiazide

bleomycin Blincyto Blood Sugar (Glucose) Meters Blood Sugar (Glucose) Test Strips Boniva Boost Boost Breeze Boost Calorie Smart Boost Glucose Control Boost High Protein Boost Kid Essentials Boost Plus Boostrix Boostrix TDAP bortezomib Bosulif Braftovi Breo Ellipta Brevibloc Brilinta brimonidine Brisdelle

Briviact bromfenac bromocriptine budesonide bumetanide Bunavail Bupap buprenorphine buprenorphine/naloxone bupropion bupropion SR bupropion XL buspirone busulfan Busulfex butalbital compound/codeine Butisol butorphanol Butrans Bydureon Bydureon Bcise Byetta

C

cabergoline Cabometyx Caduet Cafergot Calan Calan SR Calcet Calci-Chew Calci-Mix calcitonin-salmon Calcitrate calcitriol calcium calcium acetate calcium carbonate calcium carbonate/vitamin D calcium chloride calcium citrate calcium citrate + D

calcium gluconate calcium lactate calcium/magnesium calcium/magnesium w/vitamin D calcium/magnesium/zinc calcium/vitamin D Caldolor Calquence Caltrate Plus Cambia Camptosar Cancidas candesartan

candesartan/hydrochlorothiazide Cantil Capacet Capastat capecitabine Capex Capital W/Codeine Capoten captopril captopril/hydrochlorothiazide Carac carbamazepine Carbatrol carbidopa carbidopa/levodopa carbidopa/levodopa/entacapone carboplatin Cardene IV Cardene SR Cardizem Cardizem CD Cardizem LA Cardura Cardura XL

17

carisoprodol Carospir Carrington Antifungal carteolol Cartia XT carvedilol carvedilol ER

Casodex caspofungin Catapres Catapres-TTS Cayston Cedax cefaclor cefadroxil cefazolin cefdinir cefepime cefotaxime cefotetan

cefoxitin cefpodoxime proxetil cefprozil ceftazidime ceftibuten Ceftin ceftriaxone cefuroxime Celebrex celecoxib Celestone Celestone Soluspan Cellcept Celontin Kapseals cephalexin Cerebyx Cesamet cetirizine Rx Chantix Chek-Stix Chenodal chloramphenicol chlordiazepoxide chlordiazepoxide/clidinium chlordiazepoxide/clidinium chlorhexidine

chloroquine chlorothiazide chlorpromazine chlorpropamide chlorthalidone chlorzoxazone cholestyramine cholestyramine light choline magnesium trisalicylate ciclopirox cidofovir cilostazol

Ciloxan Cimduo cimetidine Cimzia cinacalcet Cinqair Cinvanti Cipro Cipro HC Cipro IV Cipro XR Ciprodex ciprofloxacin

cisplatin citalopram Citranatal 90 DHA Citranatal Assure Citranatal B-Calm Citranatal DHA Citranatal Harmony Citranatal Rx cladribine

Claforan Clarinex Clarinex-D 12 Hour clarithromycin Clenpiq Cleocin Cleocin Pediatric Cleocin Vaginal Cleocin Vaginal Ovules Cleviprex Climara Climara Pro clindamycin Clindesse clobazam Clobex clobetasol clocortolone Cloderm clofarabine

clomipramine clonazepam clonidine clopidogrel clorazepate Clorpres Clotrim Antifungal clotrimazole clotrimazole 3 clotrimazole A/F clotrimazole troche clozapine clozapine ODT

Clozaril Coartem codeine Colace 2-in-1 Colazal colchicine colchicine/probenecid Colcrys colesevelam Colestid colestipol colistimethate Coly-Mycin M Coly-Mycin S Colyte Combipatch Combivent Respimat Combivir Cometriq Complera Complete Natal DHA Compro Comtan Concept DHA Concept OB Concerta Condylox Constulose Control Solutions/Reagent Strips Conzip Copaxone Copegus Coreg Coreg CR Corlopam Cormax Cortef cortisone

Corvert Corzide Cosmegen Cotellic Cotempla XR-ODT Coumadin Cozaar Creon Cresemba

Crestor Critic-Aid Clear AF Crixivan cromolyn Cubicin Cutivate cyanocobalamin

cyclobenzaprine cyclophosphamide cycloserine Cycloset cyclosporine cyclosporine modified Cymbalta Cyramza cytarabine Cytomel Cytotec Cytovene

D

dacarbazine Dacogen dactinomycin Daklinza dalfampridine ER Daliresp Dalvance danazol Dantrium dantrolene

Dapsone Daptacel Daptacel DTAP daptomycin Daraprim darifenacin ER Darzalex daunorubicin 3 Day Vaginal Cream Daypro Daytrana decitabine

Delestrogen Delstrigo Delta D3 Demadex demeclocycline Demerol Demser Denavir Depacon Depakene Depakote Depakote ER Depakote Sprinkles Depo-Estradiol Depo-Medrol Depo-Provera 400 depo-testosterone Dermacinrx Silapak Dermatop Descovy Desenex desipramine desloratadine Desonate desonide Desowen desoximetasone Desoxyn desvenlafaxine ER Detrol Detrol LA dexamethasone dexamethasone/neomycin/polymyxin Dexedrine Spansules Dexilant dexmedetomidine dexmethylphenidate

18

Dexpak dexrazoxane dextroamph sacc/amph asp/dextroam sulf/amphet sulf dextroamphetamine Dexycu D.H.E. 45 Diastat Acudial Diastat Pediatric diazepam diazepam intensol diclofenac diclofenac DR diclofenac/misoprostol dicloxacillin dicyclomine didanosine Dificid diflorasone Diflucan diflunisal digoxin dihydroergotamine Dilantin Dilantin Infatabs Dilantin-125 Dilatrate-SR Dilaudid diltiazem diltiazem CD Dilt-XR Diovan Diovan HST Dipentum Diprolene dipyridamole Disalcid disopyramide Dispas disulfiram Ditropan XL Diuril divalproex divalproex ER Divigel dobutamine

Docefrez docetaxel docusate docusate/senna dofetelide Dologesic Dolophine Hcl donepezil donepezil ODT Doptelet doripenem Doryx dorzolamide dorzolamide/timolol Dothelle DHA doxazosin doxepin Doxil doxorubicin Doxy doxycycline Drisdol dronabinol droperidol Droxia Duavee Duet DHA 400 Duet DHA Balanced Duetact Dulera duloxetine Duopa Duragesic Duramorph

Durezol dutasteride dutasteride/tamsulosin Duzallo Dyanavel XR Dyazide Dymista

E

E.E.S. 400 E.E.S. Granules EC Naprosyn econazole Ecpirin Ed APAP Edarbi edarbyclor Edecrin Edluar Edurant efavirenz Effer-K effervescent potassium/chloride Effexor-XR Effient Efudex Eldepryl Elestrin eletriptan Eligard Elimite Eliphos Eliquis Elite-OB Elite-OB With DHA Elixophyllin Ellence Elocon Emadine Embeda Emcyt Emend Emflaza Emsam Emtriva enalapril enalapril/hydrochlorothiazide enalaprilat Enbrace HR Enbrel Endocet Enfamil D-Vi-Sol Engerix-B enoxaparin Ensure Ensure Active Heart Health Ensure Active Light Ensure Active Protein-Muscle Ensure Clear Ensure Compact Ensure Enlive Ensure Fiber W/ FOS Ensure Glucerna Shake Ensure High Protein Ensure High Protein-Muscle Ensure Liquid Ensure Max Protein Ensure Muscle Health Ensure Original Ensure Plus Ensure Pre-Surgery Ensure Surgery entacapone entecavir Entocort Ec Entresto Envarsus XR Epaned Epclusa epinastine

epirubicin Epitol Epivir Epivir HBV eplerenone Epogen epoprostenol

eprosartan eptifibatide Epzicom Equetro Eraxis Erbitux ergocalciferol ergoloid mesylates Ergomar Erivedge Erleada Ertaczo ertapenem

Erwinaze Erygel Eryped Ery-Tab Erythrocin Lactobionate Erythrocin Stearate erythromycin escitalopram Esgic esmolol Esomp-EZS estazolam estradiol

estradiol transdermal estradiol/norethindrone Estring estrogen/methyltestosterone estropipate ethacrynate ethambutol ethosuximide etidronate etodolac Etopophos etoposide Evamist Evekeo Evista Evomela Evotaz Exalgo Excedrin Back & Body Excedrin Extra Strength Excedrin Migraine Excedrin Tension Headache Exelon exemestane Exforge Exforge HCT Extavia Extina Extra Pain Relief Eylea ezetimibe ezetimibe/simvastatin

F

Factive famciclovir

famotidine Fareston Farxiga Farydak Fasenra Faslodex Fazaclo Fe C Tab Plus felbamate Felbatol Feldene

19

felodipine Femara fenofibrate fenofibric acid Fenoglide fenoprofen fentanyl

fentanyl transdermal system Fentora ferrous fumarate ferrous gluconate ferrous sulfate Fever Reducer Feverall Fexmid Fiasp Fiasp Flextouch Fibersource HN Fibricor finasteride

Fioricet Fiorinal Fiorinal W/Codeine Firmagon Flagyl Flarex flavoxate flecainide Flector Flomax Flonase Flonase Sensimist Flovent Diskus Flovent HFA Floxin floxuridine Fluarix Quad Flublok fluconazole flucytosine fludarabine fludrocortisone Flulaval Quad Flumadine Flumist Quad flunisolide

fluocinolone fluocinonide fluorometholone fluorouracil fluoxetine fluphenazine flurazepam flurbiprofen flutamide fluticasone fluvastatin Fluvirin fluvoxamine Fluzone High-Dose Fluzone Intraderm Quad Fluzone Quad Fluzone Quad Pedi Focalin Focalin XR Folcaps Omega 3 Folet One Folgard OS folic acid Folivane-OB Folotyn fosamprenavir Fosfree Forfivo XL Fortamet Fortaz Forteo Fortesta Fosamax Fosamax Plus D

foscarnet fosinopril fosinopril/hydrochlorothiazide fosphenytoin sodium Fosrenol Fragmin Frova frovatriptan Fulphila Fungoid Fungoid-D Furadantin furosemide Fusilev Fuzeon Fycompa

G

gabapentin Gabitril Gablofen galantamine galantamine ER ganciclovir Gardasil 9 gatifloxacin Gavilyte-C Gavilyte-G Gavilyte-N Gazyva gemcitabine

gemfibrozil Gemzar Gengraf Gentak gentamicin Gentian Violet Genvoya Geodon Giazo Gilenya Gilotrif glatiramer

Glatopa Gleevec Gliadel Glimepiride glipizide glipizide XL glipizide/metformin Glucagen Glucagen Hypokit Glucerna Glucophage Glucophage XR Glucotrol Glucotrol XL Glucovance Glumetza glyburide glyburide/metformin Glycate glycopyrrolate Glynase Pres-Tab Glyrx-PF Glyset Glyxambi Gocovri Golytely GoNitro Good Neighbor Arthritis Pain Relief Good Neighbor Ibuprofen Good Neighbor Ibuprofen Infants' Good Neighbor Ibuprofen Junior Strength Good Sense Anti-Diarrheal Good Sense Aspirin Good Sense Children's Aspirin Good Sense Children's Ibuprofen Good Sense Children's Pain Relief Good Sense Children's Pain Reliever

Good Sense Headache Relief Good Sense Ibuprofen Good Sense Ibuprofen Junior Strength Good Sense Infants' Ibuprofen Good Sense Jockitch Spray Good Sense Migraine Relief Good Sense Pain Relief Good Sense Pain Reliever Good Sense Pain Reliever & Sleep Aid PM Good Sense Pink Bismuth Good Sense Stomach Relief Good Sense Triple Antibiotic Gralise gramicidin/neomycin/polymyxin B granisetron Granix griseofulvin Gris-Peg guanfacine Gynazole-1

H

Halaven Halcion Haldol halobetasol haloperidol Harvoni Havrix Havrix Pediatric Headache PM Formula Healthylax Heartburn Relief heparin Hepsera Herceptin Hetlioz Hexalen Histaflex Horizant Humalog Humalog Junior Kwikpen Humalog Kwikpen Humalog Mix 50/50 Humalog Mix 75/25 Humapen Luxura HD Humira Humira Pediatric Humulin 70/30 Humulin 70/30 Kwikpen Humulin N Humulin N Kwikpen Humulin R Humulin R U-500 Humulin R U-500 Kwikpen Hycamtin Hycet hydralazine Hydrea hydrochlorothiazide hydrochlorothiazide/lisinopril hydrochlorothiazide/methyldopa hydrochlorothiazide/metoprolol hydrochlorothiazide/propranolol hydrochlorothiazide/spironolactone hydrochlorothiazide/triamterene hydrocodone/ibuprofen hydrocortisone hydrocortisone/acetic acid

hydrocortisone with aloe hydrocortisone/neomycin/polymyxin B Hydrocot hydromorphone Hydroskin hydroxychloroquine hydroxyurea hydroxyzine Hyoscyamine Hyosyne Hysingla ER

20

Hyzaar

I

Ibrance IBU ibuprofen ibuprofen children's ibuprofen IB ibuprofen lysine ibutilide Icar-C Plus Iclusig Idamycin PFS idarubicin Ifex ifosfamide ifosfamide/mesna Ilevro Ilumya imatinib Imbruvica Imfinzi imipenem/cilastatin imipramine imiquimod Imitrex Imitrex Statdose Imlygic Imovax Rabies Impact 1 Impoyz Incruse Ellipta indapamide Inderal LA Inderal XL Indocin indomethacin indomethacin ER Infanrix Inflectra Infumorph Ingrezza Inlyta Innopran XL Inspra Insulin Syringes/Needles Integrilin Intelence Intermezzo Intrarosa Intron A Invanz Invega Invega Sustenna Invega Trinza Invirase Invokamet XR Invokana Iopidine Ipol ipratropium ipratropium/albuterol irbesartan irbesartan/hydrochlorothiazide Iressa irinotecan Isentress isoniazid Isopto Carpine Isordil Titradose isosorbide isosorbide dinitrate isosorbide mononitrate Isosource 1.5 Cal Isosource HN isradipine Istalol Istodax itraconazole ivermectin

Ixempra Ixiaro

J

Jakafi Jalyn Jantoven Janumet Janumet XR Januvia Jardiance Jentadueto Jentadueto XR Jevantique Lo Jinteli Jublia Juluca Juxtapid Jynarque

K Kadcyla Kadian

Kaletra Kalexate Kao-Tin Kazano K-Effervescent Keflex Keppra Keppra XR Kerydin ketoconazole ketoconazole shampoo Ketone Tests ketoprofen

ketorolac Keytruda Khedezla Kineret Kinrix Kionex Kisqali Kisqali Femara Co-Pack Kitabis Pak Klonopin Klor-Con Klor-Con M Klor-Con Sprinkle Klor-Con/EF Kombiglyze XR K-Phos Neutral K-Phos No. 2 K-Phos Original Kristalose K-Tab K-Vescent Kymriah Kynamro Kyprolis

L labetalol lactulose Lamictal Lamictal CD Lamictal ODT Lamictal XR Lamisil Lamisil AF Lamisil AT lamivudine lamivudine HBV lamivudine/zidovudine lamotrigine lamotrigine ER lamotrigine ODT Lancets/Lancing Devices Lanoxin

Lanoxin Pediatric lansoprazole lanthanum Lartruvo Lasix latanoprost Lazanda ledipasvir/sofosbuvir leflunomide Lenvima Lescol Lescol XL Letairis letrozole leucovorin Leukeran leuprolide levalbuterol Levaquin Levatol Levbid Levemir levetiracetam levobunolol levocetirizine levofloxacin levoleucovorin levorphanol levothyroxine Levoxyl Levsin Levsin SL Lexiva Lialda lidocaine lidocaine/prilocaine Lidoderm Lincocin lincomycin Lindane linezolid Lioresal liothyronine Lipitor Lipofen Liptruzet Liquid Calcium Plus Vitamin D lisinopril lisinopril/hydrochlorothiazide lithium Livalo Locoid Locoid Lipocream Lodosyn Lokelma Lomotil Lonsurf loperamide

Lopid lopinavir/ritonavir Lopreeza Lopressor Lopressor HCT Loprox lorazepam lorazepam intensol Lorcet Lorcet HD Lorcet Plus Lortab Solution Lorzone losartan losartan/hydrochlorothiazide Lotemax Lotensin Lotensin HCT Lotrel Lotrimin AF Lotrisone Lotronex

21

lovastatin Lovaza Lovenox loxapine Lucemyra Lucentis luliconazole

Lumify Lupaneta Pack Lupron Depot Luxiq Luzu Lynparza Lyrica Lyrica CR Lysodren

M Macrobid Macrodantin Macugen Mag Delay Mag64 Mag-G Magnacaps Magnebind 400 Rx magnesium magnesium elemental magnesium gluconate magnesium oxide Mag-Tab SR Makena Malarone Malarone Pediatric malathion Mapap Mapap Arthritis Pain Mapap Children's Mapap Extra Strength Mapap-PM maprotiline Marnatal-F Marnatal-F Plus Marplan Marqibo Marten-Tab Matulane Matzim LA Mavyret Maxalt Maxalt-MLT Maxidex Maximum D3 Maxipime Maxitrol Maxzide meclizine meclofenamate Medrol medroxyprogesterone mefenamic acid mefloquine Megace ES megestrol

Mekinist Mektovi meloxicam melphalan memantine memantine ER Menactra Menest Menostar Mentax Menveo meperidine meprobamate

Mepron mercaptopurine meropenem

Merrem Merrem IV mesalamine mesna Mesnex Metadate ER metaproterenol

metaxalone metformin metformin ER metformin/repaglinide methadone methadone intensol Methadose methamphetamine methazolamide methenamine methimazole Methitest methocarbamol

methotrexate methscopolamine methyclothiazide methyldopa Methylin methylphenidate methylprednisolone methyltestosterone metipranolol metoclopramide metolazone metoprolol metoprolol/hydrochlorothiazide

Metrocream Metrogel Metrogel-Vaginal Metrolotion metronidazole mexiletine Miacalcin Micardis Micardis HCT miconazole miconazole 1 miconazole 3 miconazole 3 combination pack

miconazole 7 Micro-Guard Microzide midazolam midodrine Migergot miglitol Migraine Formula Migranal Migranow Millipred milrinone

Mimvey Minipress Minitran Minivelle minocycline minocycline ER minoxidil Miochol-E Mirapex Mirapex ER Mircera mirtazapine misoprostol

Mitigare mitomycin mitoxantrone M-M-R II Mobic modafinil moexipril moexipril/hydrochlorothiazide Moderiba

molindone mometasone montelukast Morphabond ER morphine sulfate Motofen Movantik Moviprep Moxeza moxifloxacin MS Contin Mulpleta mupirocin Mustargen Myambutol Mycamine Mycobutin mycophenolate mofetil mycophenolic acid Mydayis Myfortic Myleran Mylotarg Mynatal Mynatal Advance Mynatal Plus Mynatal Ultra Mynatal-Z Mynate 90 Plus Myrbetriq Mysoline Mytesi

N

nabumetone nadolol nadolol/bendroflumethiazide nafcillin naftifine Naftin nalbuphine Nalfon Nalocet naloxone naloxone/pentazocine naltrexone Naprelan naproxen naproxen delayed release naproxen EC naratriptan Narcan Nardil Nascobal Nasonex Natacyn Natelle One Natpara Natrecor Navelbine Nebupent Neevo DHA nefazodone Neoprofen Neoral Nepro Nepro Carb Steady Nerlynx Nesina Nestabs One Neulasta Neupogen Neupro Neurontin Nevanac nevirapine nevirapine ER Newgen Nexa Plus Nexa Select

22

Nexavar Nexium Nexium I.V. Nexterone niacin niacin time release niacinamide

Niaspan nicardipine Nicoderm CQ Nicorelief Nicorette nicotine lozenge nicotine polacrilex nicotine polacrilex gum nicotine transdermal Nicotrol Inhaler Nicotrol NS nifedipine nifedipine ER

Nifendiac CC Nilandron nimodipine Ninlaro Nipent Nipride RTU nisoldipine Nitro-Bid Nitro-Dur nitrofurantoin nitroglycerin nitroglycerin transdermal system Nitrolingual Nitromist Nitropress Nitrostat Niva-Plus nivestym nizatidine Nizoral Non-Aspirin Non-Aspirin Children's Non-Aspirin Extra Strength Non-Aspirin Infant's Non-Aspirin Pain Reliever Non-Aspirin Pain Reliever Childrens Non-Aspirin Pain Reliever Infant's Non-Aspirin PM Extra Strength Non-Aspirin Regular Strength Norco norethindrone Noritate Norpace Norpace CR Norpramin nortriptyline Norvasc Norvir Novolin 70/30 Novolin 70/30 Flexpen Novolin N Novolin R Novolog Novolog Flexpen Novolog Mix 70/30 Noxafil Nplate Nucala Nucynta Nucynta ER Nulev Nulytely Nuplazid Nutren 1.0 Nutren 1.0 With Fiber Nutren 1.5 Nutren 2.0 Nutren Junior Nutren Junior With Fiber Nuvessa

Nuvigil Nyamyc Nymalize nystatin nystatin/triamcinolone Nystop

O OB Complete OB Complete Gold OB Complete Petite OB Complete Premier OB Complete With DHA Obtrex DHA O-Cal FA O-Cal Prenatal Ocaliva Ocrevus Odefsey Odomzo ofloxacin olanzapine olanzapine ODT olanzapine/fluoxetine olmesartan

olmesartan/hydrochlorothiazide olopatadine Olumiant Olux Omeclamox-Pak omega-3 fatty acid Rx omeprazole omeprazole/sodium bicarbonate Omidria Omnaris Omnipred Oncaspar ondansetron

ondansetron ODT Onglyza Onivyde Onmel Onpattro Onzetra Xsail Opana Opdivo Oracea Oralone Orap Oravig Oraxyl Orbactiv Orencia Orenitram ER Orilissa orphenadrine Oscimin Oscimin SR Oseni Osmolex ER Osmolite Osmoprep Osphena Otezla Otrexup Ovide oxacillin oxaliplatin oxandrolone oxaprozin Oxaydo oxazepam oxcarbazepine oxiconazole Oxistat Oxtellar XR oxybutynin

oxybutynin ER oxycodone oxycodone/ibuprofen

Oxycontin oxymorphone Oxytrol Oysco Oysco D Oyster Shell Calcium Oyster Shell Calcium/Vit D Ozempic

P

Pacerone paclitaxel Pain & Fever Relief Pain & Fever Relief Children's Pain & Fever Relief Extra Strength Pain Relief Pain Reliever Pain Reliever Added Strength Pain Reliever Children's Pain Reliever Child's Pain Reliever Infants' Pain Reliever Junior Strength Pain Reliever PM Extra Strength Pain Reliever W/O Aspirin Pain Reliever W/O Aspirin Children Palcaps paliperidone ER palonosetron pamidronate Pancreaze Pandel Panlor Panretin pantoprazole Paregoric paricalcitol Parlodel Parnate paromomycin paroxetine Parsabiv Paser Pataday Patanase Patanol Paxil Paxil Cr Pazeo PCE P-D Natal W/Folic Acid Pediasure Pediasure Enteral Pediasure Harvest Pediasure W/Fiber Pediasure W/Fiber Enteral PedvaxHIB Peganone Pegasys penicillin G penicillin VK Penlac Pennsaid Pentacel Pentacel Acthib Pentacel DTAP-IPV Pentam Pentasa pentobarbital pentoxifylline

Pepcid Peptamen 1.5 Peptamen Junior Peptamen Junior 1.5 Peptamen Junior Fiber Peptamen Junior HP Peptamen OS Peptamen OS 1.5 Peptic Relief Perative Percocet

23

Perforomist pergolide perindopril Perjeta permethrin perphenazine Pertzye Pexeva Pfizerpen Phenadoz phenelzine Phenergan phenobarbital phenoxybenzamine phentolamine Phenytek phenytoin Phoslyra Phos-Nak Phospha 250 Neutral Phospholine phytonadione Pifeltro pilocarpine Pimozide pindolol Pink Bismuth Pink Bismuth Maximum Strength pioglitazone/glimepiride piperacillin/tazobactam piroxicam Plaquenil Plavix Plegridy Pneumovax 23 podofilox Polycin Polycose polyethylene glycol 3350 polymyxin B polymyxin B/trimethoprim Pomalyst Ponstel Portrazza potassium acetate potassium chloride

potassium phosphate Poteligeo PR Natal Pradaxa pramipexole pramipexole ER Prandin prasugrel Pravachol pravastatin Praxbind praziquantel

Prazolamine prazosin Precedex Precose prednicarbate prednisolone prednisolone/sulfacet prednisone prednisone intensol Prefera OB Prefera OB One Prefera OB Plus DHA Prefest Premarin Prempro Prena1 Chew Prena1 Pearl Prena1 True Prenatabs FA Prenatabs RX Prenatal 19 Prenatal Low Iron

Prenatal Plus Prenatal-U Prenate AM Prenate DHA Prenate Essential Prenate Star Prestalia Prevacid Prevacid Solutab Prevalite Prevnar 13 Prevpac Prevymis Prezcobix Prezista Prialt Prilosec Primacare primaquine Primaxin IV primidone Prinivil Pristiq Proair HFA probenecid Probuphine procainamide Procardia Procardia XL Procentra prochlorperazine Procrit progesterone

Prograf Prolensa Prolia Promacta promethazine Promethegan Prometrium Promote Promote W/ Fiber propafenone propanolol propantheline propylthiouracil

Proquad Proscar Prostascint Protonix protriptyline Provenge Proventil HFA Provera Provida DHA Provigil Provil Prozac Psorcon Pulmicort Flexhaler Pulmicort Respules Pulmocare Purixan pyrazinamide pyridoxine

Q Qbrelis QC Anti-Diarrheal QC Anti-Diarrheal Advanced QC Non-Aspirin Extra Strength QC Pain Reliever Qnasl Qnasl Children Qtern Quadracel DTAP-IPV Qualaquin Quality Choice Arthritis Pain Relief Quality Choice Children's Ibuprofen Quality Choice Effervescent Pain Relief

Quality Choice Ibuprofen Quality Choice Non-Aspirin Quality Choice Non-Aspirin Pain Relief quazepam Qudexy XR Questran Questran Light quetiapine Quillichew ER Quillivant XR quinapril quinapril/hydrochlorothiazide quinidine quinine QVAR QVAR Redihaler

R Rabavert raloxifene ramipril Ranexa ranitidine ranolazine ER Rapamune rasagiline Rasuvo Rayaldee Rayos Razadyne Razadyne ER Rebetol Rebif Rebif Rebidose Reclast Recombivax HB Recombivax HB Pediatric/Adolescent Reglan Reguloid Relenza Relexxii Relistor Relpax Remeron Remeron Soltab Remicade remifentanil Remodulin Renagel Renflexis Reopro repaglinide Repatha Sureclick Repatha Syringe Replesta Replete Replete Ultrapak Replete With Fiber Reprexain Requip Requip XL Rescriptor Resource Breeze Restoril Retacrit Retisert Retrovir Revatio Revesta Revlimid Revonto Rexulti Reyataz Rhinocort Allergy Ribapak Ribasphere ribavirin

ribavirin inhalation Rifadin Rifadin IV

24

Rifamate rifampin rimantadine Risacal-D risedronate Risperdal Risperdal Consta Risperdal M-Tab risperidone risperidone m-tab Ritalin Ritalin LA Rituxan Rituxan Hycela rivastigmine rizatriptan R-Natal OB Robaxin Robinul Robinul Forte Rocaltrol romidepsin ropinirole rosuvastatin Rotarix Rotateq Rowasa Roweepra XR Roxicodone Roxybond Rozerem Rubraca Ryanodex Rydapt Rythmol SR

S salsalate

Sancuso Sandimmune Savaysa scopolamine scopolamine patch Seconal Secura Antifungal Extra Thick Secura Antifungal Greaseless Segluromet Select-OB Select-OB DHA selegiline Selzentry Semprex-D senna Sensipar Serevent Diskus Sernivo Seroquel Seroquel XR Serostim sertraline sevelamer SfRowasa Shingrix Siklos Silapap Children's sildenafil (PAH) Silenor Silvadene silver sulfadiazine Simbrinza Simponi simvastatin Sinemet Sinemet CR Singulair Sinuva sirolimus

Sirturo Sitavig Sivextro

Skelaxin Sklice Slo-Niacin Slow-Mag smz-tmp smz-tmp DS sodium nitroprusside

sodium phosphate sodium polystyrene sulfonate sofosbuvir/velpatasvir Solaraze Solodyn Solosec Soltamox Solu-Cortef Solu-Medrol Soma Sonata Sorine sotalol

sotalol AF Sotylize Sovaldi Spectracef Spiriva Spiriva Respimat spironolactone Sporanox Spritam Sprycel SPS Suspension SSD Stalevo Stamaril Starlix stavudine Steglatro Steglujan Stivarga Stomach Relief Extra Strength Strattera streptomycin Striant Stribild Striverdi Respimat Stromectol Sublimaze Subsys Sucralfate Sufenta sufentanil Sular sulfacetamide sulfadiazine sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS sulfasalazine Sulfatrim sulindac sumatriptan sumatriptan/naproxen Sumavel Dosepro Suplena Carb Steady Suprax Suprep Surmontil Sustiva Sustol Sutent Sylatron Symax Duotab Symax Fastabs Symax-SL Symax-SR Symbicort Symbyax Symfi Symfi Lo SymlinPen Symproic

Symtuza Synagis Syndros Synercid Synjardy Synribo Synthroid

T

Tabloid tacrolimus Tactinal Tactinal Children's Tactinal Extra Strength Tafinlar Tagrisso Talwin Tamiflu tamoxifen tamsulosin Tanzeum Tapazole Taperdex Tarceva Targretin Tarka Taron-C DHA Taron-Prex Prenatal With DHA Tasigna Tasmar Tavalisse Taxotere Tazicef Taztia XT Tecentriq Tecfidera Tegretol Tegretol-XR Tekturna Tekturna HCT telmisartan telmisartan/amlodipine telmisartan/hydrochlorothiazide

temazepam Temodar Temovate temozolomide temsirolimus teniposide Tenivac tenofovir disoproxil fumarate Tenoretic Tenormin Tepadina Terazol 7 terazosin

terbinafine terbutaline terconazole Testim Testopel testosterone cypionate testosterone enanthate Testred tetanus and diphtheria toxoids tetracycline Texacort Theo-24 theophylline

Theracodophen Theracodophen-Low Theraproxen Theratramadol thioridazine thiotepa thiothixene Thrivite 19 Thyroid tiagabine Tiazac

25

Tibsovo Ticanase Tice BCG ticlopidine Tigan tigecycline Tikosyn timolol Timoptic Timoptic Ocudose Timoptic Ocumeter Plus Timoptic-XE Timoptic-XE Ocumeter Plus Tinactin Tindamax tinidazole tioconazole 1 Tirosint Tirosint-Sol Tivicay Tivorbex tizanidine Tobi Tobradex Tobradex ST tobramycin tobramycin/dexamethasone Tobrex Tofranil Tolak tolazamide tolbutamide tolmetin

tolnaftate tolterodine tolterodine ER Topamax Topicort topiramate Toposar topotecan Toprol XL Torisel torsemide Toviaz Tracleer Tradjenta tramadol tramadol ER trandolapril trandolapril/verapamil Transderm Scop Tanxene T-Tab tranylcypromine Travatan Z trazodone Treanda Trecator Trelegy Ellipta treprostinil Tresiba Tresiba Flextouch tretinoin Trexall Treximet Triadvance triamcinolone triamterene/hydrochlorothiazide Trianex triazolam Tribenzor Tricor Triesence trifluoperazine trifluridine Triglide trihexyphenidyl Trileptal Trilipix Trilyte W/Flavor Packs

trimethobenzamide trimethoprim trimipramine Trinatal Rx Trinate Trintellix Triostat Triple Antibiotic Triple Antibiotic Extra Triple Antibiotic Plus Triple Antibiotic with Lidocaine Triptodur Trisenox Tristart DHA Triumeq Trizivir Trogarzo Trokendi XR trospium trospium ER

Trulance Trulicity Trusopt Ocumeter Plus Trust Natal DHA Truvada Tudorza Pressair Twocal HN Tybost Tygacil Tykerb Tylenol W/Codeine Tymlos Typhim VI Tyvaso

U

Uceris Uloric Ultimatecare One Ultimatecare One NF Ultiva Ultracet Ultram Unasyn Unithroid Unituxin Uptravi Urimar-T Uromag ursodiol Utibron Neohaler

V

Vabomere Vagifem valacyclovir Valcyte valproic acid valsartan valsartan/hydrochlorothiazide Valstar Valtrex Vanatol S Vancocin vancomycin Vandazole Vanos Vaqta Vaqta Pediatric Varivax Varubi Vascepa Vaseretic Vasotec Vaxchora Vecamyl Vectibix Velcade Veletri

Velphoro Veltassa Vemlidy Venclexta Venclexta Starting Pack venlafaxine Ventavis Ventolin HFA verapamil verapamil PM Verdrocet Veregen Veripred Versacloz Verzenio Vfend Vfend I.V. Vibativ Viberzi Vibramycin Vicodin Vicodin ES Vicodin HP Victoza Vidaza Videx EC Videx Pediatric vigabatrin Vigadrone Vigamox Vimovo Vimpat Vinate Care Vinate DHA RF Vinate M Vinate One vinblastine vincristine vinorelbine Viracept Viramune Viramune XR Virazole Viread Viroptic Virt-PN Plus Vistaril Vitafol FE Vitafol Nano Vitafol OB Vitafol OB DHA Vitafol One Vitafol Ultra Vital High Nitrogen Vitamin B1 Vitamin B12 Vitamin B6 Vitamin D Vitamin K1 Vitrakvi Vivelle-Dot Vivitrol Vivlodex Vivonex Pediatric Vivonex Plus Vivotif Vogelxo Voltaren Gel Voltaren-XR voriconazole Vosol Votrient VP-Heme One Vraylar Vusion Vytorin Vyvanse Vyxeos Liposome Vyzulta

26

W warfarin Welchol Wellbutrin SR Wellbutrin XL Wixela Inhub

X Xadago Xalatan Xalkori Xanax Xanax XR Xarelto Xatmep Xeljanz Xeloda Xerese Xermelo Xgeva Xhance Xifaxan Xigduo XR Xiidra Xolair Xopenex Xrylix Xtampza ER Xtandi Xultophy

Y Yervoy YF-Vax Yondelis Yonsa Yosprala Yuvafem

Z zafirlukast

zaleplon Zanaflex

Zanosar Zantac Zarontin Zarxio Zatean-PN DHA Zatean-PN Plus Zeasorb AF Zebutal Zegerid Zelapar Zelboraf Zembrace Symtouch Zemdri Zemplar Zenpep Zenzedi Zepatier Zerbaxa Zerit Zestoretic Zestril Zetia Zetonna Zevalin Y-90 Ziac Ziagen zidovudine zileuton zileuton ER Zilretta Zinacef Zinbryta Zinc Zinc Chelated Zinc Chloride Zinc Gluconate Zinc Sulfate Zinecard Zinplava Zioptan ziprasidone Zipsor Zirgan Zithromax

Zithromax Tri-Pak Zithromax Z-Pak Zmax Zocor Zodex Zofran Zofran ODT Zohydro ER Zoladex zoledronic acid Zolinza zolmitriptan zolmitriptan ODT Zoloft zolpidem Zolpimist Zometa Zonacort Zonegran zonisamide

Zontivity Zortress Zorvolex Zostavax Zosyn Zovirax Zubsolv Zuplenz Zurampic Zyban Zyclara Zydelig Zyflo Zyflo CR Zykadia Zylet Zyloprim Zypitamag Zyprexa Zyprexa Relprevv Zyprexa Zydis Zytiga Zyvox