four-tier covered drug list 2019 prescription drug list.pdfbefore your plan will cover other drugs...

Four-Tier Covered Drug List

Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company. HMO Louisiana, Inc. is a subsidiary of Blue Cross and Blue Shield of Louisiana. Both companies are independent licensees of the Blue Cross and Blue Shield Association.

04HQ1444 R10/18

2019

04HQ1444 11/17 1

Understanding Your Covered Drug List Blue Cross and Blue Shield of Louisiana and our subsidiary, HMO Louisiana, Inc., along with Express Scripts, an independent company that serves as our pharmacy benefit manager, created this Covered Drug List to help you understand your drug benefits. Because drug benefits can be complex, understanding your benefits is key to getting the most from your health plan. Throughout the year, our clinical staff works with our Pharmacy and Therapeutics Committee, a group of Louisiana doctors and pharmacists who are not employed by Blue Cross, to review published literature about the safety, efficacy and cost of prescription drugs. You and your doctor always make the final decision for your healthcare needs. The information in this List can help you and your doctor make informed decisions before you fill your next prescription. That way, together you may choose the best drug for you while keeping your costs down. Please talk to your doctor or pharmacist about any questions or concerns you may have about your drug therapy. Please Note: Inclusion of a drug in a drug formulary does not guarantee that your doctor or other authorized prescriber will prescribe the drug for a particular medical condition or mental illness. Before you fill a prescription for any drug, you should take the following steps, if needed: 1) Check to see if the drugs you take are on the drug List. 2) Talk to your doctor about switching to a drug that is on the List, if needed. Important Notes: • This List is intended to include all drugs that your plan covers as of the time the document was created. But the

List may change as changes occur in the marketplace. • This List may not apply to all benefit plans. Some benefit plans may have different coverage for specific drugs. • The List applies only to prescription drugs that network pharmacies dispense on an outpatient basis. • See your member contract or certificate for pharmacy coverage for any exclusions and limitations that apply. How can you find information about your drugs? Use the index at the end of this List to look up a drug you may take to quickly learn several important things: • If you must first try one or more prescription drugs before your plan will cover a specific drug for your condition • If your doctor must get prior authorization before your plan will pay for a drug • If your plan limits the quantity that will be covered each time you fill a prescription How are prescription drugs classified? Your plan offers a 4-tier structure for drugs that are covered:

Tier Description of prescription drugs

1 Value Drugs: Primarily generic drugs, although some brand-name drugs may fall into this category.

2 Brand drugs.

3 Primarily brand drugs that may have a therapeutic alternative that is in Tier 1 or Tier 2, although some generic drugs may fall into this category. Covered compounded drugs are included in this tier.

4 Specialty Drugs: High-cost brand or generic drugs that are identified as specialty drugs. Generally, you will pay the least out of for value drugs, or drugs that are in Tier 1. You will pay the most out of pocket for drugs in Tier 3 and specialty drugs in Tier 4.

What does it mean when there is a “+” sign in the Tier section? You will pay more for some covered brand- drugs marked with a “+” that have lost patent protection because a generic equivalent has become available. If you or your doctor decides you should continue to take the brand drug instead of the generic drug, you will be responsible for the generic (or value drug) copay, plus the difference in cost between that brand and the generic drug. This is called “brand buy up.” This will also apply to covered brand drugs for which a generic equivalent becomes available after the publishing of this List. Please Note: Brand buy up will not apply to certain brand drugs. Examples are select anti-seizure medications, select thyroid hormones and Coumadin. What does it mean when the Tier section shows “*” next to the number? Certain drugs may be eligible for first-dollar coverage. That means you do not pay out of pocket for them and you do not pay a deductible. Drugs in these programs are marked with an “*” next to the number in the tier column. Because some benefit plans do not have this type of coverage, you should read your plan materials to find out if you have it. If you do not have this type of coverage, you may be responsible for some or all of the cost of the drug. Restrictions or limitations apply, including age, gender or frequency. Broad categories of drugs that may be eligible for this coverage include:

X* Selected contraceptives for women

X* Selected preventive drugs as recommended by the U.S. Preventive Services Task Force (USPSTF). For example, selected bowel prep products when used with a wellness screening colonoscopy or selected generic cholesterol lowering drugs for people who qualify may be covered.

Example of How Drugs Are Listed:

04HQ1444 11/17 2

Drug Tier Requirements/Limits

generic drug name 1 QPD

BRAND DRUG NAME 2 PA; ST Key: • generic drugs are in lowercase italics • BRAND NAME drugs are in ALL CAPS

Key: PA = Prior authorization QPD = Quantity per dispensing limitsST = Step therapy restrictions

What do the abbreviations in the Requirements/Limits column mean? PA: Medications requiring prior authorization We must authorize certain drugs before your plan will pay for them. After considering current medical

literature, the Pharmacy and Therapeutics Committee sets up the criteria needed for the drugs to be authorized. Then, Express Scripts processes the prior authorization requests. If you need prior authorization, have your doctor contact Express Scripts: Call: 1-800-842-2015 Fax: 1-877-251-5896 For the physician fax form, go to: www.bcbsla.com > Provider > Pharmacy.

ST: Medications requiring participation in the Fill This First step therapy program

For drugs in our Fill This First step therapy program, you must first try certain prescription drugs (Step 1) before your plan will cover other drugs (Step 2) for your condition. If one or more of the Step 1 drugs are not

04HQ1444 11/17 3

right for you, your doctor may call us for a prior authorization for a Step 2 drug. You can find more information about drugs that you must try first at www.bcbsla.com/CoveredDrugs.

QPD: Medications that have quantity per dispensing limitations Covered prescriptions have a day-supply limitation (typically up to a 30-day supply at a retail pharmacy and

up to a 90-day supply for mail-order). Your plan also limits the amount of certain drugs that can be dispensed at one time. We call those restrictions Quantity Per Dispensing (QPD) limitations.

QPD limits are additional to the day-supply limitation and are based on the manufacturer’s recommended

dosage and duration of therapy, common usage for episodic or intermittent treatment, FDA-approved recommendations or clinical studies, and as determined by Blue Cross. QPD limits or allowances are subject to quantity limits per day supply, per dispensing event, or any combination of the two. See your member contract or certificate for the limits for your plan. For a complete list of Quantity per Dispensing (QPD) Level Limits/Allowances, go to www.bcbsla.com/CoveredDrugs.

Additional Requirements:

Specialty drug restrictions Certain drugs are commonly called specialty drugs. Specialty drugs include biotechnology drugs or other drug products that may require special ordering, handling or customer service. Your policy may limit specialty drugs to the retail day supply listed in your plan (typically a 30-day supply). Read your Schedule of Benefits for any restrictions that apply to you. For a complete list of specialty drugs, go to: www.bcbsla.com/CoveredDrugs.

Questions?

If your doctor prescribes a drug that is not on this List, or if you have any questions, call Express Scripts at 1-866-781-7533.

For more information and updates, go to: www.bcbsla.com/CoveredDrugs or www.express-scripts.com.

Table of Contents

*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants*.................................................................................................................5*Aminoglycosides*....................................................................................................................................................................6*Analgesics - Anti-Inflammatory*............................................................................................................................................. 6*Analgesics - Nonnarcotic*....................................................................................................................................................... 8*Analgesics - Opioid*.............................................................................................................................................................. 10*Androgens-Anabolic*............................................................................................................................................................ 12*Anorectal Agents*................................................................................................................................................................. 12*Anthelmintics*.......................................................................................................................................................................13*Antianginal Agents*...............................................................................................................................................................13*Antianxiety Agents*...............................................................................................................................................................14*Antiarrhythmics*................................................................................................................................................................... 14*Antiasthmatic And Bronchodilator Agents*..........................................................................................................................15*Anticoagulants*.....................................................................................................................................................................17*Anticonvulsants*................................................................................................................................................................... 17*Antidepressants*...................................................................................................................................................................20*Antidiabetics*........................................................................................................................................................................21*Antidiarrheals*...................................................................................................................................................................... 24*Antidotes And Specific Antagonists*.....................................................................................................................................24*Antidotes*............................................................................................................................................................................. 24*Antiemetics*..........................................................................................................................................................................25*Antifungals*...........................................................................................................................................................................25*Antihistamines*.....................................................................................................................................................................26*Antihyperlipidemics*.............................................................................................................................................................26*Antihypertensives*................................................................................................................................................................27*Anti-Infective Agents - Misc.*................................................................................................................................................29*Antimalarials*........................................................................................................................................................................30*Antimyasthenic Agents*........................................................................................................................................................30*Antimyasthenic/Cholinergic Agents*.................................................................................................................................... 30*Antimycobacterial Agents*................................................................................................................................................... 30*Antineoplastic - Bcl-2 Inhibitors***...................................................................................................................................... 31*Antineoplastics And Adjunctive Therapies*.......................................................................................................................... 31*Antiparkinson Agents*.......................................................................................................................................................... 35*Antipsychotics/Antimanic Agents*........................................................................................................................................35*Antiretrovirals Adjuvants***.................................................................................................................................................37*Antivirals*..............................................................................................................................................................................37*Assorted Classes*.................................................................................................................................................................. 40*Beta Blockers*....................................................................................................................................................................... 41*Bile Acid Synthesis Disorder Agents***................................................................................................................................ 41*Calcitonin Gene-Related Peptide (Cgrp) Receptor Antag***................................................................................................42*Calcium Channel Blockers*....................................................................................................................................................42*Cardiotonics*.........................................................................................................................................................................42*Cardiovascular Agents - Misc.*..............................................................................................................................................43*Cephalosporins*.................................................................................................................................................................... 43*Contraceptives*.....................................................................................................................................................................44*Corticosteroids*.................................................................................................................................................................... 49*Cough/Cold/Allergy*............................................................................................................................................................. 49*Cyclin-Dependent Kinases (Cdk) Inhibitors***......................................................................................................................51*Cystic Fibrosis Agent - Combinations***...............................................................................................................................51*Dermatologicals*...................................................................................................................................................................51*Diagnostic Products*.............................................................................................................................................................56*Digestive Aids*...................................................................................................................................................................... 57

1

*Direct-Acting P2y12 Inhibitors***.........................................................................................................................................57*Diuretics*...............................................................................................................................................................................57*Endocrine And Metabolic Agents - Misc.*.............................................................................................................................58*Estrogens*............................................................................................................................................................................. 60*Estrogen-Selective Estrogen Receptor Modulator Comb***................................................................................................61*Fluoroquinolones*.................................................................................................................................................................61*Gastrointestinal Agents - Misc.*............................................................................................................................................61*Genitourinary Agents - Miscellaneous*................................................................................................................................ 62*Glycopeptides***..................................................................................................................................................................63*Gout Agents*.........................................................................................................................................................................63*Hematological Agents - Misc.*.............................................................................................................................................. 63*Hematopoietic Agents*.........................................................................................................................................................64*Hemostatics*.........................................................................................................................................................................65*Hepatitis C Agent - Combinations***....................................................................................................................................65*Hereditary Orotic Aciduria Treatment - Agents**.................................................................................................................65*Hypnotics*.............................................................................................................................................................................65*Hypophosphatasia (Hpp) Agents***..................................................................................................................................... 65*Ibs Agent - Mu-Opioid Receptor Agonists***....................................................................................................................... 65*Insulin-Incretin Mimetic Combinations***........................................................................................................................... 66*Isocitrate Dehydrogenase-1 (Idh1) Inhibitors***..................................................................................................................66*Isocitrate Dehydrogenase-2 (Idh2) Inhibitors***..................................................................................................................66*Laxatives*.............................................................................................................................................................................. 66*Leptin Analogues***............................................................................................................................................................. 69*Lymphocyte Function-Associated Antigen-1 (Lfa-1) Antag***............................................................................................. 69*Macrolides*........................................................................................................................................................................... 69*Medical Devices*...................................................................................................................................................................69*Migraine Products*............................................................................................................................................................... 70*Minerals & Electrolytes*....................................................................................................................................................... 70*Monobactams***..................................................................................................................................................................71*Mouth/Throat/Dental Agents*............................................................................................................................................. 71*Multivitamins*.......................................................................................................................................................................72*Musculoskeletal Therapy Agents*.........................................................................................................................................77*Nasal Agents - Systemic And Topical*................................................................................................................................... 77*Neprilysin Inhib (Arni)-Angiotensin Ii Recept Antag Comb***..............................................................................................78*Neurogenic Orthostatic Hypotension (Noh) - Agents***......................................................................................................78*Neuromuscular Agents*........................................................................................................................................................ 78*Ophthalmic Agents*.............................................................................................................................................................. 78*Otic Agents*.......................................................................................................................................................................... 81*Oxytocics*............................................................................................................................................................................. 82*Passive Immunizing Agents*................................................................................................................................................. 82*Pcsk9 Inhibitors***............................................................................................................................................................... 82*Penicillins*.............................................................................................................................................................................82*Pharmaceutical Adjuvants*...................................................................................................................................................83*Phosphatidylinositol 3-Kinase (Pi3k) Inhibitors***............................................................................................................... 83*Phosphodiesterase 4 (Pde4) Inhibitors***............................................................................................................................83*Poly (Adp-Ribose) Polymerase (Parp) Inhibitors**...............................................................................................................83*Poly (Adp-Ribose) Polymerase (Parp) Inhibitors***..............................................................................................................83*Potassium Removing Agents***........................................................................................................................................... 83*Progestins*............................................................................................................................................................................ 84*Protease-Activated Receptor-1 (Par-1) Antagonists***........................................................................................................84*Psychotherapeutic And Neurological Agents - Misc.*...........................................................................................................84*Pulmonary Fibrosis Agents - Kinase Inhibitors***................................................................................................................ 88*Pulmonary Fibrosis Agents***.............................................................................................................................................. 88*Pulmonary Hypertension - Prostacyclin Receptor Agonist***..............................................................................................88

2

*Respiratory Agents - Misc.*...................................................................................................................................................88*Serotonin Modulators***..................................................................................................................................................... 88*Sglt2 Inhibitor - Dpp-4 Inhibitor Combinations***............................................................................................................... 88*Sinus Node Inhibitors**........................................................................................................................................................ 88*Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb***........................................................................................ 89*Sulfonamides*....................................................................................................................................................................... 89*Tetracyclines*........................................................................................................................................................................89*Thyroid Agents*.....................................................................................................................................................................89*Toxoids*................................................................................................................................................................................ 90*Ulcer Drugs*.......................................................................................................................................................................... 90*Urinary Anti-Infectives*.........................................................................................................................................................92*Urinary Antispasmodics*.......................................................................................................................................................92*Vaccines*...............................................................................................................................................................................93*Vaginal Products*..................................................................................................................................................................95*Vasopressors*....................................................................................................................................................................... 95*Vitamins*...............................................................................................................................................................................96

3

Drug Name Drug Tier Requirements/Limits

*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants*

*Adhd Agent - Selective Alpha Adrenergic Agonists***

clonidine hcl er 1 QPD

guanfacine hcl er oral tablet extended release 24 hour1 mg, 2 mg, 3 mg, 4 mg

1 QPD

*Adhd Agent - Selective Norepinephrine Reuptake Inhibitor***

atomoxetine hcl 3 QPD

*Amphetamine Mixtures***

amphetamine-dextroamphet er oral capsule extended release 24 hour 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg

1 QPD

amphetamine-dextroamphetamine 1 QPD

MYDAYIS 2 QPD

*Amphetamines***

dextroamphetamine sulfate er 1 QPD

dextroamphetamine sulfate oral solution 1

dextroamphetamine sulfate oral tablet 1 QPD

methamphetamine hcl 1 QPD

VYVANSE 2 QPD

*Analeptics***

caffeine citrate oral 1

*Stimulants - Misc.***

armodafinil 1 PA; QPD

DAYTRANA 3 QPD

dexmethylphenidate hcl 1 QPD

dexmethylphenidate hcl er 1 QPD

metadate er oral tablet extended release 20 mg 1 QPD

methylphenidate hcl er (cd) 1 QPD

methylphenidate hcl er (la) 1 QPD

methylphenidate hcl er oral tablet extended release10 mg, 18 mg, 20 mg, 27 mg, 36 mg, 54 mg

1 QPD

methylphenidate hcl er oral tablet extended release 24 hour

1 QPD

methylphenidate hcl oral 1 QPD

modafinil 1 PA; QPD

QUILLIVANT XR 3 QPD

You can find information on what the symbols and abbreviations on this

table mean by going to the beginning of this List.

5


*Aminoglycosides*

*Aminoglycosides***

BETHKIS 4 PA; QPD

neomycin sulfate oral 1

paromomycin sulfate oral 1

TOBI PODHALER 4 PA; QPD

tobramycin inhalation 4 PA; QPD

*Analgesics - Anti-Inflammatory*

*Antirheumatic - Janus Kinase (Jak) Inhibitors***

XELJANZ 4 PA; QPD

XELJANZ XR 4 PA; QPD

*Antirheumatic Antimetabolites***

RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.2ML, 12.5 MG/0.25ML, 15 MG/0.3ML, 17.5 MG/0.35ML, 20 MG/0.4ML, 22.5 MG/0.45ML, 25 MG/0.5ML, 30 MG/0.6ML, 7.5 MG/0.15ML

4 QPD

*Anti-Tnf-Alpha - Monoclonal Antibodies***

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML, 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML

4 PA; QPD

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 4 PA; QPD

HUMIRA PEN-CD/UC/HS STARTER 4 PA; QPD

HUMIRA PEN-PS/UV STARTER 4 PA; QPD

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 4 PA; QPD

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 4 PA; QPD

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

4 PA; QPD

*Anti-Tnf-Alpha - Monoclonoal Antibodies***

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML, 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML

4 PA; QPD

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 4 PA; QPD

HUMIRA PEN-CD/UC/HS STARTER 4 PA; QPD

HUMIRA PEN-PS/UV STARTER 4 PA; QPD

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 4 PA; QPD

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 4 PA; QPD

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

4 PA; QPD

*Cyclooxygenase 2 (Cox-2) Inhibitors***

celecoxib oral 1 QPD



6


*Gold Compounds***

RIDAURA 3

*Interleukin-1 Blockers***

ARCALYST 4 QPD

*Interleukin-1 Receptor Antagonist (Il-1Ra)***

KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

4 PA; QPD

*Interleukin-6 Receptor Inhibitors***

ACTEMRA SUBCUTANEOUS 4 PA; QPD

*Nonsteroidal Anti-Inflammatory Agent Combinations***

diclofenac-misoprostol oral tablet delayed release 1

*Nonsteroidal Anti-Inflammatory Agents (Nsaids)***

diclofenac potassium 1

diclofenac sodium er 1

diclofenac sodium oral 1

etodolac er 1

etodolac oral 1

fenoprofen calcium oral tablet 1 PA

flurbiprofen oral 1

ibu 1

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

indomethacin er 1

indomethacin oral 1

ketoprofen er 1 PA

ketoprofen oral capsule 25 mg 1 QPD

ketorolac tromethamine oral 1 QPD

meclofenamate sodium oral 1

mefenamic acid oral 1 PA

meloxicam oral tablet 1 QPD

nabumetone oral 1

naproxen dr 1

naproxen oral tablet 1

naproxen sodium oral tablet 275 mg, 550 mg 1

oxaprozin 1

piroxicam oral 1

sulindac oral 1



7


tolmetin sodium 3 PA

*Pyrimidine Synthesis Inhibitors***

leflunomide oral 1 QPD

*Selective Costimulation Modulators***

ORENCIA CLICKJECT 4 PA; QPD

ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

4 PA; QPD

*Soluble Tumor Necrosis Factor Receptor Agents***

ENBREL MINI 4 PA; QPD

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

4 PA; QPD

ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED 4 PA; QPD

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

4 PA; QPD

*Analgesics - Nonnarcotic*

*Analgesics-Sedatives***

butalbital-acetaminophen oral tablet 50-325 mg 1 QPD

butalbital-apap 1 QPD

butalbital-apap-caffeine oral capsule 3 QPD

butalbital-apap-caffeine oral tablet 50-325-40 mg 1 QPD

butalbital-asa-caffeine 1

butalbital-aspirin-caffeine 1

tencon oral tablet 50-325 mg 1 QPD

zebutal oral capsule 50-325-40 mg 3 QPD

*Salicylates***

adult aspirin regimen 1*

aspir-81 1*

aspirin 81 1*

aspirin adult low dose 1*

aspirin adult low strength 1*

aspirin childrens 1*

aspirin ec adult low strength 1*

aspirin ec low dose 1*

aspirin ec low strength 1*

aspirin ec oral tablet delayed release 81 mg 1*

aspirin low dose adult 1*

aspirin low dose oral tablet chewable 1*

aspirin low dose oral tablet delayed release 1*



8


aspirin low strength 1*

aspirin oral tablet chewable 1*

aspirin oral tablet delayed release 81 mg 1*

aspir-low 1*

bayer aspirin ec low dose 1*

bayer low dose 1*

careall aspirin 1*

childrens aspirin 1*

childrens aspirin low strength 1*

cvs aspirin adult low dose 1*

cvs aspirin adult low strength 1*

cvs aspirin ec oral tablet delayed release 81 mg 1*

cvs aspirin low dose 1*

cvs aspirin low strength oral tablet delayed release 1*

diflunisal oral 1

ec-81 aspirin 1*

ecotrin low strength 1*

eq aspirin adult low dose 1*

eq aspirin low dose oral tablet chewable 1*

eq childrens aspirin 1*

eql aspirin low dose 1*

gnp adult aspirin low strength oral tablet chewable 1*

gnp aspirin low dose 1*

gnp aspirin oral tablet delayed release 81 mg 1*

goodsense aspirin adult low st 1*

goodsense aspirin low dose 1*

goodsense aspirin oral tablet chewable 1*

hm aspirin ec low dose 1*

hm aspirin oral tablet chewable 1*

kls aspirin low dose 1*

kp aspirin 1*

miniprin low dose 1*

px aspirin oral tablet chewable 1*

px enteric aspirin oral tablet delayed release 81 mg 1*

qc aspirin low dose 1*

qc childrens aspirin 1*

ra aspirin adult low dose 1*

ra aspirin adult low strength 1*



9


ra aspirin childrens 1*

ra aspirin ec adult low st 1*

ra aspirin ec oral tablet delayed release 81 mg 1*

ra childrens aspirin 1*

salsalate oral 1

sb aspirin adult low strength 1*

sb aspirin oral tablet delayed release 1*

sb childrens aspirin 1*

sb low dose asa ec 1*

sm aspirin adult low strength 1*

sm aspirin ec low strength 1*

sm aspirin low dose oral tablet chewable 1*

sm childrens aspirin 1*

st joseph low dose 1*

tgt aspirin low dose oral tablet delayed release 1*

tgt aspirin oral tablet chewable 1*

tgt aspirin oral tablet delayed release 1*

tgt childrens aspirin 1*

*Analgesics - Opioid*

*Codeine Combinations***

acetaminophen-codeine 1 PA; QPD

acetaminophen-codeine #2 1 PA; QPD



ascomp-codeine 1 PA; QPD

butalbital-apap-caff-cod 1 PA; QPD

butalbital-asa-caff-codeine 1 PA; QPD

*Hydrocodone Combinations***

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

1 PA; QPD

hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 2.5-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg

1 PA; QPD

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

1 PA; QPD

lorcet 1 PA; QPD

lorcet hd 1 PA; QPD

lorcet plus oral tablet 7.5-325 mg 1 PA; QPD



10


verdrocet 1 PA; QPD

vicodin es oral tablet 7.5-300 mg 1 PA; QPD

vicodin hp oral tablet 10-300 mg 1 PA; QPD

vicodin oral tablet 5-300 mg 1 PA; QPD

*Opioid Agonists***

codeine sulfate oral tablet 1 PA

EMBEDA 3 PA; ST; QPD

fentanyl citrate buccal 1 PA; QPD

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

1 PA; QPD

hydromorphone hcl er 1 PA; QPD

hydromorphone hcl oral 1 PA

hydromorphone hcl rectal 1 PA

HYSINGLA ER 2 PA; QPD

levorphanol tartrate oral 1 PA

meperidine hcl oral 1 PA

methadone hcl intensol 1 PA

methadone hcl oral 1 PA

methadose oral concentrate 10 mg/ml 1 PA

methadose oral tablet soluble 1 PA

methadose sugar-free 1 PA

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

1 PA

morphine sulfate er beads 1 PA; QPD

morphine sulfate er oral capsule extended release 24 hour

1 PA; QPD

morphine sulfate er oral tablet extended release 1 PA; QPD

morphine sulfate oral 1 PA

morphine sulfate rectal 1 PA

NUCYNTA 3 PA

oxycodone hcl oral capsule 1 PA

oxycodone hcl oral concentrate 100 mg/5ml 1 PA

oxycodone hcl oral solution 1 PA

oxycodone hcl oral tablet 1 PA

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT

2 PA; QPD

oxymorphone hcl 1 PA

oxymorphone hcl er 1 PA; QPD



11


tramadol hcl er (biphasic) oral tablet extended release 24 hour 100 mg, 200 mg, 300 mg

1 QPD

tramadol hcl er oral tablet extended release 24 hour 1 QPD

tramadol hcl oral 1

*Opioid Combinations***

endocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1 PA; QPD

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

1 PA; QPD

oxycodone-aspirin oral tablet 4.8355-325 mg 1 PA; QPD

oxycodone-ibuprofen 1 PA; QPD

*Opioid Partial Agonists***

butorphanol tartrate nasal 1 QPD

BUTRANS 2 PA; QPD

pentazocine-naloxone hcl 1

SUBOXONE SUBLINGUAL FILM 2 QPD

ZUBSOLV 2 QPD

*Tramadol Combinations***

tramadol-acetaminophen 1 QPD

*Androgens-Anabolic*

*Anabolic Steroids***

ANADROL-50 3

oxandrolone oral 1

*Androgens***

danazol oral 1

METHITEST 3

testosterone cypionate intramuscular solution 100 mg/ml, 200 mg/ml

1

testosterone enanthate intramuscular solution 1

testosterone gel 12.5 mg/act (1%) transdermal 1 PA; QPD

testosterone gel 50 mg/5gm (1%) transdermal 1 PA; QPD

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

1 PA; QPD

testosterone transdermal solution 1 PA; QPD

*Anorectal Agents*

*Intrarectal Steroids***

colocort 1



12


CORTIFOAM 3

hydrocortisone rectal enema 1

UCERIS RECTAL 3

*Nitrate Vasodilating Agents***

RECTIV 3

*Rectal Anesthetic/Steroids***

hydrocortisone ace-pramoxine rectal cream 1-1 % 1

hydrocortisone ace-pramoxine rectal cream 2.5-1 % 1 QPD

lidocaine-hydrocortisone ace rectal cream 1

pramcort rectal 1

*Rectal Steroids***

anucort-hc 1

hydrocortisone acetate rectal 1

hydrocortisone rectal cream 1

procto-med hc 1

procto-pak 1

proctosol hc 1

proctozone-hc rectal 1

*Anthelmintics*

*Anthelmintics***

albendazole oral 3

EMVERM 3 QPD

ivermectin oral 1

praziquantel oral 3

*Antianginal Agents*

*Antianginals-Other***

RANEXA 3

*Nitrates***

isosorbide dinitrate er 1

isosorbide dinitrate oral 1

isosorbide mononitrate 1

isosorbide mononitrate er 1

nitro-bid 1

nitroglycerin er 1

nitroglycerin sublingual 1

nitroglycerin transdermal patch 24 hour 1

nitro-time 1



13


*Antianxiety Agents*

*Antianxiety Agents - Misc.***

buspirone hcl oral 1

hydroxyzine hcl oral syrup 1

hydroxyzine hcl oral tablet 1

hydroxyzine pamoate oral 1

meprobamate 1

*Benzodiazepines***

alprazolam er 1

alprazolam intensol 1

alprazolam oral 1

alprazolam xr 1

chlordiazepoxide hcl 1

clorazepate dipotassium 1

diazepam intensol 1

diazepam oral tablet 1

lorazepam intensol 1

lorazepam oral 1

oxazepam 1

*Antiarrhythmics*

*Antiarrhythmics Type I-A***

disopyramide phosphate oral 1

NORPACE CR 3

quinidine gluconate er 1

quinidine sulfate oral 1

*Antiarrhythmics Type I-B***

mexiletine hcl oral 1

*Antiarrhythmics Type I-C***

flecainide acetate 1

propafenone hcl 1

propafenone hcl er 1

*Antiarrhythmics Type Iii***

amiodarone hcl oral 1

dofetilide 1

MULTAQ 3

pacerone oral tablet 100 mg, 200 mg, 400 mg 1



14


*Antiasthmatic And Bronchodilator Agents*

*5-Lipoxygenase Inhibitors***

zileuton er 3 PA; QPD

ZYFLO 3 PA; QPD

*Adrenergic Combinations***

ADVAIR DISKUS 2 QPD

ADVAIR HFA 2 QPD

ANORO ELLIPTA 2 QPD

BEVESPI AEROSPHERE 3 PA; QPD

BREO ELLIPTA 2 QPD

COMBIVENT RESPIMAT 3 QPD

DULERA 2 QPD

FLUTICASONE-SALMETEROL 2 QPD

ipratropium-albuterol 1 QPD

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 2.5-2.5 MCG/ACT

2 QPD

SYMBICORT 2 QPD

TRELEGY ELLIPTA 2 QPD

UTIBRON NEOHALER 3 PA; QPD

*Anti-Inflammatory Agents***

cromolyn sodium inhalation 1

*Beta Adrenergics***

albuterol sulfate er 1

albuterol sulfate inhalation 1

albuterol sulfate oral 1

ARCAPTA NEOHALER 3 PA; QPD

BROVANA 3 PA; QPD

levalbuterol hcl inhalation nebulization solution 0.31 mg/3ml, 0.63 mg/3ml, 1.25 mg/0.5ml, 1.25 mg/3ml

1

LEVALBUTEROL TARTRATE 3 PA; QPD

metaproterenol sulfate oral 1

PERFOROMIST 3 PA; QPD

PROAIR HFA 2 QPD

PROAIR RESPICLICK 2 QPD

PROVENTIL HFA 3 PA; QPD

SEREVENT DISKUS 2 QPD

STRIVERDI RESPIMAT 2 QPD

terbutaline sulfate oral 1



15


VENTOLIN HFA 2 QPD

XOPENEX HFA 3 PA; QPD

*Bronchodilators - Anticholinergics***

ATROVENT HFA 2 QPD

INCRUSE ELLIPTA 2 QPD

ipratropium bromide inhalation 1

SEEBRI NEOHALER 3 PA; QPD

SPIRIVA HANDIHALER 2 QPD

SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 1.25 MCG/ACT, 2.5 MCG/ACT

2 QPD

TUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED

3 PA; QPD

*Leukotriene Receptor Antagonists***

montelukast sodium oral 1 QPD

zafirlukast 1 QPD

*Selective Phosphodiesterase 4 (Pde4) Inhibitors***

DALIRESP 3 QPD

*Steroid Inhalants***

ALVESCO 3 PA; QPD

ARNUITY ELLIPTA 2 QPD

ASMANEX 120 METERED DOSES 3 PA; QPD





ASMANEX HFA 3 PA; QPD

budesonide inhalation 1 QPD

FLOVENT DISKUS 2 QPD

FLOVENT HFA 2 QPD

PULMICORT FLEXHALER 3 PA; QPD

QVAR REDIHALER 2 QPD

*Xanthines***

THEO-24 3

theochron oral tablet extended release 12 hour 100 mg, 200 mg, 300 mg

1

theophylline 1

theophylline er 1



16


*Anticoagulants*

*Coumarin Anticoagulants***

COUMADIN ORAL 2

jantoven 1

warfarin sodium oral 1

*Direct Factor Xa Inhibitors***

ELIQUIS 2 QPD

ELIQUIS STARTER PACK 2 QPD

SAVAYSA 3 PA; QPD

XARELTO ORAL TABLET 10 MG, 15 MG, 20 MG 2 QPD

XARELTO STARTER PACK 2 QPD

*Heparins And Heparinoid-Like Agents***

heparin lock flush intravenous solution 1 unit/ml, 10 unit/ml, 100 unit/ml

1

heparin sodium (porcine) injection solution 1000 unit/ml, 10000 unit/ml, 20000 unit/ml, 5000 unit/ml

1

heparin sodium (porcine) pf 1

heparin sodium lock flush intravenous solution 100 unit/ml

1

*Low Molecular Weight Heparins***

enoxaparin sodium 1

FRAGMIN SUBCUTANEOUS SOLUTION 10000 UNIT/ML, 12500 UNIT/0.5ML, 15000 UNIT/0.6ML, 18000 UNT/0.72ML, 2500 UNIT/0.2ML, 5000 UNIT/0.2ML, 7500 UNIT/0.3ML, 95000 UNIT/3.8ML

3

*Synthetic Heparinoid-Like Agents***

fondaparinux sodium 1

*Thrombin Inhibitors - Selective Direct & Reversible***

PRADAXA 3 PA; QPD

*Anticonvulsants*

*Ampa Glutamate Receptor Antagonists***

FYCOMPA 3

*Anticonvulsants - Benzodiazepines***

clonazepam oral 1

DIASTAT ACUDIAL 3

DIASTAT PEDIATRIC 3

diazepam rectal 1

KLONOPIN 3



17


ONFI ORAL SUSPENSION 2

ONFI ORAL TABLET 10 MG, 20 MG 2

*Anticonvulsants - Misc.***

APTIOM 3 QPD

BANZEL 2

carbamazepine er 1

carbamazepine oral 1

CARBATROL 3

epitol 1

gabapentin oral capsule 1

gabapentin oral solution 250 mg/5ml 1

gabapentin oral tablet 1

KEPPRA ORAL 3

KEPPRA XR 3

LAMICTAL ODT 3

LAMICTAL ORAL TABLET 3

LAMICTAL ORAL TABLET CHEWABLE 25 MG, 5 MG 3

LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

lamotrigine er 1

lamotrigine oral tablet 1

lamotrigine oral tablet chewable 1

lamotrigine oral tablet dispersible 1

levetiracetam er 1

levetiracetam oral 1

LYRICA 3

MYSOLINE 3

oxcarbazepine 1

OXTELLAR XR 3

primidone oral 1

QUDEXY XR 3 PA; QPD

roweepra 1

TEGRETOL ORAL SUSPENSION 2

TEGRETOL ORAL TABLET 2

TEGRETOL-XR 3

TOPAMAX 3

TOPAMAX SPRINKLE 3

topiramate oral 1



18


TRILEPTAL 3

TROKENDI XR 3 PA; QPD

VIMPAT ORAL 3

ZONEGRAN 3

zonisamide oral 1

*Carbamates***

felbamate 1

FELBATOL 3

*Gaba Modulators***

GABITRIL ORAL TABLET 12 MG, 16 MG 2

GABITRIL ORAL TABLET 2 MG, 4 MG 3

SABRIL 4 PA; QPD

tiagabine hcl 1

vigabatrin 4 PA; QPD

*Hydantoins***

DILANTIN 2

DILANTIN INFATABS 2

PEGANONE 3

PHENYTEK 3

phenytoin infatabs 1

phenytoin oral suspension 125 mg/5ml 1

phenytoin oral tablet chewable 1

phenytoin sodium extended 1

*Succinimides***

CELONTIN 3

ethosuximide oral 1

ZARONTIN 3

*Valproic Acid***

DEPAKENE ORAL CAPSULE 3

DEPAKENE ORAL SOLUTION 3

DEPAKOTE 3

DEPAKOTE ER 3

DEPAKOTE SPRINKLES ORAL CAPSULE DELAYED RELEASE SPRINKLE

3

divalproex sodium er oral tablet extended release 24 hour

1

divalproex sodium oral capsule delayed release sprinkle

1



19


divalproex sodium oral tablet delayed release 1

valproate sodium oral solution 1

valproic acid oral capsule 1

valproic acid oral solution 1

*Antidepressants*

*Alpha-2 Receptor Antagonists (Tetracyclics)***

mirtazapine oral 1 QPD

*Antidepressants - Misc.***

bupropion hcl er (sr) 1 QPD

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

1 QPD

bupropion hcl oral 1

maprotiline hcl 1

*Modified Cyclics***

nefazodone hcl 1

trazodone hcl oral 1

TRINTELLIX 3 ST

VIIBRYD ORAL TABLET 3 ST; QPD

VIIBRYD STARTER PACK 3 ST; QPD

*Monoamine Oxidase Inhibitors (Maois)***

EMSAM 3 QPD

MARPLAN 3

phenelzine sulfate oral 1

tranylcypromine sulfate 1

*Selective Serotonin Reuptake Inhibitors (Ssris)***

citalopram hydrobromide 1 QPD

escitalopram oxalate 1 QPD

fluoxetine hcl oral capsule 1 QPD

fluoxetine hcl oral capsule delayed release 1 QPD

fluoxetine hcl oral solution 1 QPD

fluoxetine hcl oral tablet 10 mg, 20 mg 1 QPD

fluvoxamine maleate 1 QPD

fluvoxamine maleate er 1 QPD

paroxetine hcl er 1 QPD

paroxetine hcl oral tablet 1 QPD

sertraline hcl oral 1 QPD



20


*Serotonin-Norepinephrine Reuptake Inhibitors (Snris)***

desvenlafaxine succinate er 3 QPD

duloxetine hcl oral capsule delayed release particles20 mg, 30 mg, 60 mg

1 QPD

FETZIMA 3 ST

FETZIMA TITRATION 3 ST

venlafaxine hcl 1 QPD

venlafaxine hcl er oral capsule extended release 24 hour

1 QPD

*Tricyclic Agents***

amitriptyline hcl oral 1

amoxapine 1

clomipramine hcl oral 1

desipramine hcl oral 1

doxepin hcl oral 1

imipramine hcl oral 1

imipramine pamoate 1

nortriptyline hcl oral 1

protriptyline hcl 1

trimipramine maleate oral 1

*Antidiabetics*

*Alpha-Glucosidase Inhibitors***

acarbose 1

miglitol 1

*Antidiabetic - Amylin Analogs***

SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 PA; QPD

SYMLINPEN 60 SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 PA; QPD

*Biguanides***

metformin hcl er 1 QPD

metformin hcl oral tablet 1 QPD

*Diabetic Other***

GLUCAGEN HYPOKIT 3

GLUCAGON EMERGENCY 2

PROGLYCEM 4

*Dipeptidyl Peptidase-4 (Dpp-4) Inhibitors***

ALOGLIPTIN BENZOATE 3 PA; QPD



21


JANUVIA 2 QPD

TRADJENTA 2 QPD

*Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations***

JANUMET 2 QPD

JANUMET XR 2 QPD

JENTADUETO 2 QPD

JENTADUETO XR 2 QPD

*Dopamine Receptor Agonists - Ergot Derivatives***

CYCLOSET 3

*Human Insulin***

APIDRA 3 PA

APIDRA SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 PA

BASAGLAR KWIKPEN 3

FIASP 2

FIASP FLEXTOUCH 2

HUMALOG 3 PA

HUMALOG JUNIOR KWIKPEN 3 PA

HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML, 200 UNIT/ML

3 PA

HUMALOG MIX 50/50 3 PA

HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

3 PA

HUMALOG MIX 75/25 3 PA

HUMALOG MIX 75/25 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

3 PA

HUMULIN R U-500 (CONCENTRATED) 2

HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

LANTUS 2

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

LEVEMIR 2

LEVEMIR FLEXTOUCH 2

NOVOLIN 70/30 2

NOVOLIN 70/30 RELION 2

NOVOLIN N 2

NOVOLIN N RELION 2



22


NOVOLIN R 2

NOVOLIN R RELION 2

NOVOLOG 2

NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

NOVOLOG MIX 70/30 2

NOVOLOG MIX 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

2

NOVOLOG PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE

2

TOUJEO MAX SOLOSTAR 2

TOUJEO SOLOSTAR 2

TRESIBA FLEXTOUCH 2

*Incretin Mimetic Agents (Glp-1 Receptor Agonists)***

OZEMPIC 2 PA; QPD

TRULICITY 2 PA; QPD

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR 2 PA; QPD

*Meglitinide Analogues***

nateglinide 1

repaglinide 1

*Meglitinide-Biguanide Combinations***

repaglinide-metformin hcl 1 QPD

*Progesterone Receptor Antagonists***

KORLYM 4 PA; QPD

*Sodium-Glucose Co-Transporter 2 (Sglt2) Inhibitors***

FARXIGA 2 QPD

JARDIANCE 2 QPD

STEGLATRO 2 QPD

*Sulfonylurea-Biguanide Combinations***

glipizide-metformin hcl 1 QPD

glyburide-metformin 1 QPD

*Sulfonylureas***

chlorpropamide 1 QPD

glimepiride 1 QPD

glipizide er 1 QPD

glipizide oral 1 QPD

glipizide xl 1 QPD



23


glyburide micronized 1 QPD

glyburide oral 1 QPD

tolazamide 1 QPD

tolbutamide 1 QPD

*Sulfonylurea-Thiazolidinedione Combinations***

pioglitazone hcl-glimepiride 1 QPD

*Thiazolidinedione-Biguanide Combinations***

ACTOPLUS MET XR 2 QPD

pioglitazone hcl-metformin hcl 1 QPD

*Thiazolidinediones***

AVANDIA ORAL TABLET 2 MG, 4 MG 3 QPD

pioglitazone hcl 1 QPD

*Antidiarrheals*

*Antidiarrheal - Chloride Channel Antagonists***

MYTESI 4 QPD

*Antiperistaltic Agents***

diphenoxylate-atropine 1

loperamide hcl oral capsule 1

opium 1

paregoric 1

*Antidotes And Specific Antagonists*

*Antidotes And Specific Antagonists***

VISTOGARD 4 QPD

*Antidotes*

*Antidotes - Chelating Agents***

CHEMET 4

EXJADE 4

FERRIPROX 4

JADENU 4

JADENU SPRINKLE 4

*Antidotes***

VISTOGARD 4 QPD

*Opioid Antagonists***

naloxone hcl injection solution 0.4 mg/ml, 4 mg/10ml 1 QPD

naloxone hcl injection solution cartridge 1 QPD

naloxone hcl injection solution prefilled syringe 1 QPD

naltrexone hcl oral 1



24


NARCAN 3 QPD

*Antiemetics*

*5-Ht3 Receptor Antagonists***

ANZEMET ORAL 3 QPD

granisetron hcl oral 1 QPD

ondansetron 1 QPD

ondansetron hcl oral 1 QPD

*Antiemetic Combinations***

AKYNZEO ORAL 3 QPD

BONJESTA 3 QPD

DICLEGIS 3 QPD

*Antiemetics - Anticholinergic***

meclizine hcl oral tablet 1

trimethobenzamide hcl oral 1

*Antiemetics - Miscellaneous***

dronabinol 1

*Substance P/Neurokinin 1 (Nk1) Receptor Antagonists***

aprepitant 3 QPD

EMEND ORAL SUSPENSION RECONSTITUTED 3 QPD

*Antifungals*

*Antifungals***

flucytosine oral 1

griseofulvin microsize oral 1

griseofulvin ultramicrosize 1

nystatin oral tablet 1

terbinafine hcl oral 1 QPD

*Imidazoles***

ketoconazole oral 1

*Triazoles***

CRESEMBA ORAL 3 QPD

fluconazole oral suspension reconstituted 1

fluconazole oral tablet 100 mg, 200 mg, 50 mg 1

fluconazole oral tablet 150 mg 1 QPD

itraconazole oral capsule 1 QPD

itraconazole oral solution 3 QPD

NOXAFIL ORAL 3 QPD

voriconazole oral 1 QPD



25


*Antihistamines*

*Antihistamines - Ethanolamines***

carbinoxamine maleate oral solution 1

carbinoxamine maleate oral tablet 4 mg 1

clemastine fumarate oral tablet 2.68 mg 1

diphenhydramine hcl oral capsule 50 mg 1

*Antihistamines - Non-Sedating***

desloratadine oral tablet 1 QPD

*Antihistamines - Phenothiazines***

phenadoz 1

promethazine hcl oral 1

promethazine hcl rectal 1

promethegan 1

*Antihistamines - Piperidines***

cyproheptadine hcl oral 1

*Antihyperlipidemics*

*Antihyperlipidemics - Misc.***

omega-3-acid ethyl esters 1 PA

*Bile Acid Sequestrants***

cholestyramine light 1

cholestyramine oral 1

colesevelam hcl 3

colestipol hcl 1

prevalite 1

*Fibric Acid Derivatives***

choline fenofibrate 1

fenofibrate micronized 1

fenofibrate oral capsule 134 mg, 200 mg, 67 mg 1

fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg 1

fenofibric acid 1

gemfibrozil oral 1

*Hmg Coa Reductase Inhibitors***

atorvastatin calcium oral tablet 10 mg, 20 mg 1* QPD

atorvastatin calcium oral tablet 40 mg, 80 mg 1 QPD

fluvastatin sodium 3* QPD

fluvastatin sodium er 3* QPD

LIVALO 3 PA; ST; QPD



26


lovastatin 1* QPD

pravastatin sodium 1* QPD

rosuvastatin calcium oral tablet 10 mg, 5 mg 1* QPD

rosuvastatin calcium oral tablet 20 mg, 40 mg 1 QPD

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1* QPD

simvastatin oral tablet 80 mg 1 QPD

*Intest Cholest Absorp Inhib-Hmg Coa Reductase Inhib Comb***

ezetimibe-simvastatin 3 QPD

*Intestinal Cholesterol Absorption Inhibitors***

ezetimibe 3 QPD

*Nicotinic Acid Derivatives***

niacin er (antihyperlipidemic) 1

NIACOR 3

*Antihypertensives*

*Ace Inhibitor & Calcium Channel Blocker Combinations***

amlodipine besy-benazepril hcl 1

trandolapril-verapamil hcl er 1

*Ace Inhibitors & Thiazide/Thiazide-Like***

benazepril-hydrochlorothiazide 1

captopril-hydrochlorothiazide 1

enalapril-hydrochlorothiazide 1

fosinopril sodium-hctz 1

lisinopril-hydrochlorothiazide 1 QPD

moexipril-hydrochlorothiazide 1

quinapril-hydrochlorothiazide 1

*Ace Inhibitors***

benazepril hcl oral 1 QPD

captopril oral 1 QPD

enalapril maleate oral 1 QPD

EPANED ORAL SOLUTION 3 ST; QPD

fosinopril sodium 1 QPD

lisinopril oral 1 QPD

moexipril hcl 1 QPD

perindopril erbumine 1 QPD

QBRELIS 3 ST; QPD

quinapril hcl 1 QPD



27


ramipril 1 QPD

trandolapril 1 QPD

*Adrenolytics-Central & Thiazide/Thiazide-Like Comb***

methyldopa-hydrochlorothiazide 1

*Agents For Pheochromocytoma***

DEMSER 4 PA

phenoxybenzamine hcl oral 1 PA

*Angiotensin Ii Receptor Antag & Ca Channel Blocker Comb***

amlodipine besylate-valsartan 1 QPD

amlodipine-olmesartan 1 QPD

telmisartan-amlodipine 1 QPD

*Angiotensin Ii Receptor Antag & Thiazide/Thiazide-Like***

candesartan cilexetil-hctz 1

irbesartan-hydrochlorothiazide 1

losartan potassium-hctz 1

olmesartan medoxomil-hctz 1 QPD

telmisartan-hctz 1

valsartan-hydrochlorothiazide 1

*Angiotensin Ii Receptor Antagonists***

candesartan cilexetil 1 QPD

eprosartan mesylate 1 QPD

irbesartan 1 QPD

losartan potassium 1 QPD

olmesartan medoxomil oral 1 QPD

telmisartan 1 QPD

valsartan 1 QPD

*Angiotensin Ii Receptor Ant-Ca Channel Blocker-Thiazides***

amlodipine-valsartan-hctz 1 QPD

olmesartan-amlodipine-hctz 1 QPD

*Antiadrenergics - Centrally Acting***

clonidine hcl oral 1

guanfacine hcl oral 1

methyldopa oral 1

*Antiadrenergics - Peripherally Acting***

doxazosin mesylate oral 1 QPD



28


prazosin hcl oral 1 QPD

terazosin hcl oral 1 QPD

*Beta Blocker & Diuretic Combinations***

atenolol-chlorthalidone 1

bisoprolol-hydrochlorothiazide 1

metoprolol-hydrochlorothiazide 1

nadolol-bendroflumethiazide oral tablet 40-5 mg 1

propranolol-hctz 1

*Direct Renin Inhibitors & Thiazide/Thiazide-Like Comb***

TEKTURNA HCT 3 ST

*Direct Renin Inhibitors***

TEKTURNA 3 ST; QPD

*Selective Aldosterone Receptor Antagonists (Saras)***

eplerenone 1

*Vasodilators***

hydralazine hcl oral 1

minoxidil oral 1

*Anti-Infective Agents - Misc.*

*Anti-Infective Agents - Misc.***

metronidazole oral 1

NEBUPENT 2

PRIMSOL 3

tinidazole oral 1

trimethoprim oral 1

XIFAXAN 3 QPD

*Anti-Infective Misc. - Combinations***

sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5ml

1

sulfamethoxazole-trimethoprim oral tablet 1

sulfatrim pediatric 1

*Antiprotozoal Agents***

ALINIA 3 QPD

atovaquone oral 1 QPD

*Leprostatics***

dapsone oral 1



29


*Lincosamides***

clindamycin hcl oral 1

clindamycin palmitate hcl 1

*Oxazolidinones***

linezolid oral 1 QPD

*Antimalarials*

*Antimalarial Combinations***

atovaquone-proguanil hcl 1

COARTEM 3

*Antimalarials***

chloroquine phosphate oral 1

DARAPRIM 4 PA

hydroxychloroquine sulfate oral 1

mefloquine hcl 1

PRIMAQUINE PHOSPHATE ORAL 3

quinine sulfate oral 1

*Antimyasthenic Agents*

*Antimyasthenic Agents***

guanidine hcl oral 1

MESTINON ORAL SYRUP 4

pyridostigmine bromide er 1

pyridostigmine bromide oral 1

*Antimyasthenic/Cholinergic Agents***





*Antimyasthenic/Cholinergic Agents*





*Antimycobacterial Agents*

*Anti Tb Combinations***

RIFAMATE 3

RIFATER 3



30


*Antimycobacterial Agents***

CYCLOSERINE ORAL 3

ethambutol hcl oral 1

isoniazid oral 1

PASER 3

PRIFTIN 3

pyrazinamide oral 1

rifabutin 1

rifampin oral 1

SIRTURO 4

TRECATOR 3

*Antineoplastic - Bcl-2 Inhibitors***

*Antineoplastic - Bcl-2 Inhibitors***

VENCLEXTA 4 QPD

VENCLEXTA STARTING PACK 4 QPD

*Antineoplastics And Adjunctive Therapies*

*Alkylating Agents***

MYLERAN 4

*Androgen Biosynthesis Inhibitors***

YONSA 4 QPD

ZYTIGA 4 QPD

*Antiadrenals***

LYSODREN 4

*Antiandrogens***

bicalutamide 1 QPD

ERLEADA 4 QPD

flutamide 1 QPD

nilutamide 4

XTANDI 4 PA; QPD

*Antiestrogens***

FARESTON 2

SOLTAMOX 3

tamoxifen citrate oral 1*

*Antimetabolites***

capecitabine 4

mercaptopurine oral 1

methotrexate oral 1



31


methotrexate sodium (pf) injection solution 1 gm/40ml, 250 mg/10ml, 50 mg/2ml

4

methotrexate sodium injection solution 250 mg/10ml, 50 mg/2ml

4

methotrexate sodium oral 1

TABLOID 2

*Antineoplastic - Braf Kinase Inhibitors***

BRAFTOVI 4 QPD

TAFINLAR 4 QPD

ZELBORAF 4 QPD

*Antineoplastic - Hedgehog Pathway Inhibitors***

ERIVEDGE 4 QPD

ODOMZO 4 QPD

*Antineoplastic - Histone Deacetylase Inhibitors***

FARYDAK 4

ZOLINZA 4 QPD

*Antineoplastic - Immunomodulators***

POMALYST 4 QPD

*Antineoplastic - Mek Inhibitors***

COTELLIC 4

MEKINIST 4 QPD

MEKTOVI 4 QPD

*Antineoplastic - Mtor Kinase Inhibitors***

AFINITOR 4 QPD

AFINITOR DISPERZ 4 QPD

*Antineoplastic - Multikinase Inhibitors***

NEXAVAR 4 QPD

RYDAPT 4 QPD

STIVARGA 4 QPD

SUTENT 4 PA; QPD

*Antineoplastic - Proteasome Inhibitors***

NINLARO 4 QPD

*Antineoplastic - Tyrosine Kinase Inhibitors***

ALECENSA 4 QPD

ALUNBRIG ORAL TABLET 4 QPD

ALUNBRIG ORAL TABLET THERAPY PACK 4 QPD

BOSULIF 4 QPD

CABOMETYX ORAL TABLET 20 MG, 40 MG, 60 MG 4 PA; QPD



32


CALQUENCE 4 QPD

CAPRELSA 4 QPD

COMETRIQ (100 MG DAILY DOSE) 4 QPD



GILOTRIF 4 QPD

ICLUSIG 4 QPD

imatinib mesylate 4 PA

IMBRUVICA 4 QPD

INLYTA 4 QPD

IRESSA 4 QPD

LENVIMA 10 MG DAILY DOSE 4 QPD








NERLYNX 4 QPD

SPRYCEL 4 PA; QPD

TAGRISSO 4 QPD

TARCEVA 4 QPD

TASIGNA ORAL CAPSULE 150 MG, 200 MG, 50 MG 4 QPD

TYKERB 4 QPD

VIZIMPRO 4 QPD

VOTRIENT 4 QPD

XALKORI 4 QPD

ZYKADIA 4 QPD

*Antineoplastic Combinations***

KISQALI FEMARA 200 DOSE 4 QPD



LONSURF 4

*Antineoplastics Misc.***

ACTIMMUNE 4 PA

hydroxyurea oral 1

MATULANE 4



33


SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG

4 QPD

SYNRIBO 4

*Aromatase Inhibitors***

anastrozole oral 1 QPD

exemestane 1 QPD

letrozole oral 1 QPD

*Estrogens-Antineoplastic***

EMCYT 2

*Folic Acid Antagonists Rescue Agents***

leucovorin calcium oral 1

*Imidazotetrazines***

temozolomide 4

*Janus Associated Kinase (Jak) Inhibitors***

JAKAFI 4 QPD

*Mitotic Inhibitors***

etoposide oral 4

*Nitrogen Mustards***

CYCLOPHOSPHAMIDE ORAL CAPSULE 3

LEUKERAN 2

melphalan 4

*Nitrosoureas***

GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG 4

*Progestins-Antineoplastic***

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

2

megestrol acetate oral suspension 40 mg/ml 1

megestrol acetate oral tablet 1

*Retinoids***

tretinoin oral 1

*Selective Retinoid X Receptor Agonists***

bexarotene 4

*Topoisomerase I Inhibitors***

HYCAMTIN ORAL 4

*Urinary Tract Protective Agents***

MESNEX ORAL 4



34


*Antiparkinson Agents*

*Antiparkinson Anticholinergics***

benztropine mesylate oral 1

trihexyphenidyl hcl 1

*Antiparkinson Dopaminergics***

amantadine hcl oral 1

bromocriptine mesylate oral 1

*Antiparkinson Monoamine Oxidase Inhibitors***

rasagiline mesylate oral 3

selegiline hcl oral 1

*Central/Peripheral Comt Inhibitors***

tolcapone 1

*Decarboxylase Inhibitors***

carbidopa oral 1

*Levodopa Combinations***

carbidopa-levodopa 1

carbidopa-levodopa er oral tablet extended release25-100 mg, 50-200 mg

1

carbidopa-levodopa-entacapone 1

RYTARY 3

*Nonergoline Dopamine Receptor Agonists***

APOKYN SUBCUTANEOUS SOLUTION CARTRIDGE 4

NEUPRO 3 QPD

pramipexole dihydrochloride 1

pramipexole dihydrochloride er 1

ropinirole hcl 1

ropinirole hcl er 1 QPD

*Peripheral Comt Inhibitors***

entacapone 1

*Antipsychotics/Antimanic Agents*

*Antimanic Agents***

lithium 1

lithium carbonate er 1

lithium carbonate oral 1

*Antipsychotics - Misc.***

EQUETRO 3

LATUDA 2 QPD

NUPLAZID 4 QPD



35


VRAYLAR 3 QPD

ziprasidone hcl 1 QPD

*Benzisoxazoles***

FANAPT 3 QPD

FANAPT TITRATION PACK 3 QPD

paliperidone er 1 QPD

risperidone 1

risperidone m-tab oral tablet dispersible 0.5 mg, 1 mg, 2 mg

1

*Butyrophenones***

haloperidol lactate oral 1

haloperidol oral 1

*Dibenzodiazepines***

clozapine oral tablet 1

clozapine oral tablet dispersible 100 mg, 12.5 mg, 25 mg

1

CLOZAPINE ORAL TABLET DISPERSIBLE 150 MG, 200 MG

3

*Dibenzo-Oxepino Pyrroles***

SAPHRIS 3 QPD

*Dibenzothiazepines***

quetiapine fumarate 1 QPD

quetiapine fumarate er 1 QPD

*Dibenzoxazepines***

loxapine succinate oral 1

*Dihydroindolones***

molindone hcl 1

*Phenothiazines***

chlorpromazine hcl oral 1

compro 1

fluphenazine hcl oral 1

perphenazine oral 1

prochlorperazine 1

prochlorperazine maleate oral 1

thioridazine hcl oral 1

trifluoperazine hcl oral 1

*Quinolinone Derivatives***

aripiprazole 1 QPD



36


REXULTI 3 QPD

*Thienbenzodiazepines***

olanzapine oral 1 QPD

*Thioxanthenes***

thiothixene oral 1

*Antiretrovirals Adjuvants***

*Antiretrovirals Adjuvants***

TYBOST 4

*Antivirals*

*Antiretroviral Combinations***

abacavir sulfate-lamivudine 4

abacavir-lamivudine-zidovudine 4

ATRIPLA 4

BIKTARVY 4 QPD

CIMDUO 4 QPD

COMPLERA 4

DELSTRIGO 4 QPD

DESCOVY 4

EVOTAZ 4 QPD

GENVOYA 4

JULUCA 4 QPD

KALETRA ORAL TABLET 4

lamivudine-zidovudine 1

lopinavir-ritonavir 4

ODEFSEY 4

PREZCOBIX 4 QPD

STRIBILD 4

SYMFI 4 QPD

SYMFI LO 4 QPD

SYMTUZA 4 QPD

TRIUMEQ 4

TRUVADA 4

*Antiretrovirals - Ccr5 Antagonists (Entry Inhibitor)***

SELZENTRY 4

*Antiretrovirals - Fusion Inhibitors***

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED 4



37


*Antiretrovirals - Integrase Inhibitors***

ISENTRESS 4

ISENTRESS HD 4

TIVICAY 4

*Antiretrovirals - Protease Inhibitors***

APTIVUS 4

atazanavir sulfate 4

CRIXIVAN ORAL CAPSULE 200 MG, 400 MG 4

fosamprenavir calcium 4

INVIRASE 4

LEXIVA ORAL SUSPENSION 4

NORVIR ORAL PACKET 4

NORVIR ORAL SOLUTION 4

PREZISTA ORAL SUSPENSION 4

PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG

4

REYATAZ ORAL PACKET 4

ritonavir 4

VIRACEPT ORAL TABLET 4

*Antiretrovirals - Rti-Non-Nucleoside Analogues***

EDURANT 4

efavirenz 4

INTELENCE 4

nevirapine 1

nevirapine er 1

PIFELTRO 4 QPD

RESCRIPTOR 4

*Antiretrovirals - Rti-Nucleoside Analogues-Purines***

abacavir sulfate oral solution 4

abacavir sulfate oral tablet 1

didanosine oral capsule delayed release 200 mg, 250 mg, 400 mg

1

VIDEX 4

*Antiretrovirals - Rti-Nucleoside Analogues-Pyrimidines***

EMTRIVA 4

lamivudine oral solution 1

lamivudine oral tablet 150 mg, 300 mg 1



38


*Antiretrovirals - Rti-Nucleoside Analogues-Thymidines***

stavudine oral capsule 1

zidovudine 1

*Antiretrovirals - Rti-Nucleotide Analogues***

tenofovir disoproxil fumarate 4

VIREAD ORAL POWDER 4

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG 4

*Cmv Agents***

PREVYMIS ORAL 2 QPD

valganciclovir hcl 1

*Hepatitis B Agents***

adefovir dipivoxil 4

BARACLUDE ORAL SOLUTION 4

entecavir 4

EPIVIR HBV ORAL SOLUTION 4

lamivudine oral tablet 100 mg 1

VEMLIDY 4

*Hepatitis C Agents***

moderiba 1200 dose pack 1 QPD

moderiba 800 dose pack 1 QPD

moderiba oral tablet 200 mg 1 QPD

moderiba oral tablet therapy pack 1 QPD

PEGASYS PROCLICK 4 PA; QPD

PEGASYS SUBCUTANEOUS SOLUTION 4 PA; QPD

PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5ML 4 PA; QPD

REBETOL ORAL SOLUTION 4 QPD

ribasphere 1 QPD

ribasphere ribapak oral tablet 400 mg, 600 mg 1 QPD

ribasphere ribapak oral tablet therapy pack 1 QPD

ribavirin oral capsule 1 QPD

ribavirin oral tablet 200 mg 1 QPD

SOVALDI 4 PA

*Herpes Agents - Purine Analogues***

acyclovir oral 1

valacyclovir hcl oral 1 QPD

*Herpes Agents - Thymidine Analogues***

famciclovir oral 1 QPD



39


*Influenza Agents***

rimantadine hcl 1

*Neuraminidase Inhibitors***

oseltamivir phosphate oral 3 QPD

RELENZA DISKHALER 3 QPD

*Assorted Classes*

*Antileprotics***

THALOMID 4

*B-Lymphocyte Stimulator (Blys)-Specific Inhibitors***

BENLYSTA SUBCUTANEOUS 4 PA; QPD

*Chelating Agents***

DEPEN TITRATABS 4

*Cyclosporine Analogs***

cyclosporine modified 1

cyclosporine oral capsule 1

gengraf oral capsule 100 mg, 25 mg 1

gengraf oral solution 1

SANDIMMUNE ORAL SOLUTION 3

*Immunomodulators For Myelodysplastic Syndromes***

REVLIMID 4 PA; QPD

*Inosine Monophosphate Dehydrogenase Inhibitors***

mycophenolate mofetil 1

mycophenolate sodium 1

*Irrigation Solutions***

lactated ringers irrigation 1

ringers irrigation 1

sterile water for irrigation 1

tis-u-sol 1

*Macrolide Immunosuppressants***

RAPAMUNE ORAL SOLUTION 3

sirolimus oral 1

tacrolimus oral 1

ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG 3

*Potassium Removing Resins***

kionex oral suspension 1



40


sodium polystyrene sulfonate oral 1

sodium polystyrene sulfonate rectal suspension 30 gm/120ml

1

SODIUM POLYSTYRENE SULFONATE RECTAL SUSPENSION 50 GM/200ML

3

sps 1

VELTASSA 3 QPD

*Purine Analogs***

azathioprine oral 1

*Beta Blockers*

*Alpha-Beta Blockers***

carvedilol 1

carvedilol phosphate er 3

labetalol hcl oral 1

*Beta Blockers Cardio-Selective***

acebutolol hcl oral 1

atenolol oral 1 QPD

betaxolol hcl oral 1

bisoprolol fumarate 1

BYSTOLIC 3 ST

metoprolol succinate er 1

metoprolol tartrate oral 1 QPD

*Beta Blockers Non-Selective***

HEMANGEOL 4

nadolol oral tablet 20 mg, 40 mg, 80 mg 1

pindolol 1

propranolol hcl er 1

propranolol hcl oral 1

sotalol hcl (af) 1

sotalol hcl oral 1

timolol maleate oral 1

*Bile Acid Synthesis Disorder Agents***

*Bile Acid Synthesis Disorder Agents***

CHOLBAM 4 PA



41


*Calcitonin Gene-Related Peptide (Cgrp) Receptor Antag***

*Calcitonin Gene-Related Peptide (Cgrp) Receptor Antag***

AIMOVIG 2 PA; QPD

AIMOVIG 140 DOSE 2 PA; QPD

*Calcium Channel Blockers*

*Calcium Channel Blockers***

afeditab cr 1

amlodipine besylate oral 1

cartia xt 1

diltiazem hcl er beads 1

diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg

1

diltiazem hcl er oral capsule extended release 24 hour120 mg, 180 mg, 240 mg

1

diltiazem hcl oral 1

dilt-xr 1

felodipine er 1

isradipine 1

nicardipine hcl oral 1

nifedical xl oral tablet extended release 24 hour 60 mg 1

nifedipine er 1

nifedipine er osmotic release 1

nifedipine oral 1

nimodipine oral 1 QPD

nisoldipine er 1

NYMALIZE ORAL SOLUTION 60 MG/20ML 3

taztia xt 1

verapamil hcl er oral capsule extended release 24 hour

1

verapamil hcl er oral tablet extended release 120 mg, 180 mg, 240 mg

1

verapamil hcl oral 1

*Cardiotonics*

*Cardiac Glycosides***

digitek 1

digox 1

digoxin oral 1



42


LANOXIN ORAL TABLET 187.5 MCG, 62.5 MCG 2

*Cardiovascular Agents - Misc.*

*Calcium Channel Blocker & Hmg Coa Reductase Inhibit Comb***

amlodipine-atorvastatin 1 QPD

*Nitrate & Vasodilator Combinations***

BIDIL 3

*Prostaglandin Vasodilators***

ORENITRAM 4 PA

TYVASO 4 PA

TYVASO REFILL 4 PA

TYVASO STARTER 4 PA

VENTAVIS 4 PA

*Pulm Hyperten-Soluble Guanylate Cyclase Stimulator (Sgc)***

ADEMPAS 4 PA; QPD

*Pulmonary Hypertension - Endothelin Receptor Antagonists***

LETAIRIS 4 PA; QPD

OPSUMIT 4 PA

TRACLEER 4 PA

*Pulmonary Hypertension - Phosphodiesterase Inhibitors***

REVATIO ORAL SUSPENSION RECONSTITUTED 4 PA; QPD

sildenafil citrate intravenous 4 PA; QPD

sildenafil citrate oral tablet 20 mg 1 PA; QPD

tadalafil (pah) 4 PA; QPD

*Selective Cgmp Phosphodiesterase Type 5 Inhibitors***

tadalafil oral tablet 5 mg 3 PA; QPD

*Cephalosporins*

*Cephalosporins - 1St Generation***

cefadroxil 1

cephalexin 1

*Cephalosporins - 2Nd Generation***

cefaclor 1

cefaclor er 1

cefprozil 1

cefuroxime axetil oral tablet 1



43


*Cephalosporins - 3Rd Generation***

cefdinir 1

cefditoren pivoxil 1

cefixime 1

cefpodoxime proxetil 1

SUPRAX ORAL CAPSULE 3

SUPRAX ORAL SUSPENSION RECONSTITUTED 500 MG/5ML

3

SUPRAX ORAL TABLET CHEWABLE 3

*Contraceptives*

*Biphasic Contraceptives - Oral***

azurette 1*

bekyree 1*

desogestrel-ethinyl estradiol oral tablet 0.15-0.02/0.01 mg (21/5)

1*

kariva 1*

pimtrea 1*

viorele 1*

*Combination Contraceptives - Oral***

altavera 1*

alyacen 1/35 1*

apri 1*

aubra 1*

aubra eq 1*

aviane 1*

balziva 1*

blisovi 24 fe 1*

blisovi fe 1.5/30 1*

blisovi fe 1/20 1*

briellyn 1*

chateal 1*

chateal eq 1*

cryselle-28 1*

cyclafem 1/35 1*

cyred 1*

dasetta 1/35 1*

delyla 1*



44


desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg

1*

drospiren-eth estrad-levomefol 1*

drospirenone-ethinyl estradiol 1*

elinest 1*

emoquette 1*

enskyce oral tablet 0.15-30 mg-mcg 1*

estarylla 1*

ethynodiol diac-eth estradiol 1*

falmina 1*

femynor 1*

gianvi 1*

gildess fe 1.5/30 1*

gildess fe 1/20 1*

isibloom 1*

juleber 1*

junel 1.5/30 1*

junel 1/20 1*

junel fe 1.5/30 1*

junel fe 1/20 1*

junel fe 24 1*

kaitlib fe 1*

kelnor 1/35 1*

kelnor 1/50 1*

kurvelo 1*

larin 1.5/30 1*

larin 1/20 1*

larin 24 fe 1*

larin fe 1.5/30 1*

larin fe 1/20 1*

larissia 1*

layolis fe 1*

lessina 1*

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg

1*

levora 0.15/30 (28) 1*

lillow 1*

loryna 1*



45


low-ogestrel 1*

lutera 1*

marlissa 1*

melodetta 24 fe 1*

mibelas 24 fe 1*

microgestin 1.5/30 1*

microgestin 1/20 1*

microgestin fe 1.5/30 1*

microgestin fe 1/20 1*

mono-linyah 1*

mononessa 1*

necon 0.5/35 (28) 1*

necon 1/35 (28) 1*

nikki 1*

norethin ace-eth estrad-fe 1*

norethindrone acet-ethinyl est 1*

norethin-eth estradiol-fe 1*

norgestimate-eth estradiol oral tablet 0.25-35 mg-mcg

1*

nortrel 0.5/35 (28) 1*

nortrel 1/35 (21) 1*

nortrel 1/35 (28) 1*

ocella 1*

ogestrel 1*

orsythia 1*

philith 1*

pirmella 1/35 1*

portia-28 1*

previfem 1*

rajani 1*

reclipsen 1*

sprintec 28 1*

sronyx 1*

syeda 1*

tarina fe 1/20 1*

tydemy 1*

vestura 1*

vienva 1*



46


vyfemla 1*

wera 1*

wymzya fe 1*

zarah 1*

zovia 1/35e (28) 1*

*Combination Contraceptives - Transdermal***

xulane 1*

*Combination Contraceptives - Vaginal***

NUVARING 3*

*Continuous Contraceptives - Oral***

amethyst 1*

levonorgestrel-ethinyl estrad oral tablet 90-20 mcg 1*

*Emergency Contraceptives***

econtra ez 1* QPD

econtra one-step 1* QPD

ELLA 3* QPD

levonorgestrel oral tablet 1.5 mg 1* QPD

my choice 1* QPD

my way 1* QPD

new day 1* QPD

next choice one dose 1* QPD

opcicon one-step 1* QPD

option 2 1* QPD

react 1* QPD

*Extended-Cycle Contraceptives - Oral***

amethia 1* QPD

amethia lo 1* QPD

ashlyna 1* QPD

camrese 1* QPD

camrese lo 1* QPD

daysee 1* QPD

fayosim 1* QPD

introvale 1* QPD

jolessa 1* QPD

levonorgest-eth est & eth est 1* QPD

levonorgest-eth estrad 91-day 1* QPD

quasense 1* QPD

rivelsa 1* QPD



47


setlakin 1* QPD

*Progestin Contraceptives - Injectable***

medroxyprogesterone acetate intramuscular 1* QPD

*Progestin Contraceptives - Oral***

camila 1*

deblitane 1*

errin 1*

heather 1*

jencycla 1*

jolivette 1*

lyza 1*

nora-be 1*

norethindrone oral 1*

norlyda 1*

norlyroc 1*

sharobel 1*

*Triphasic Contraceptives - Oral***

alyacen 7/7/7 1*

aranelle 1*

caziant 1*

cyclafem 7/7/7 1*

dasetta 7/7/7 1*

enpresse-28 1*

leena 1*

levonest 1*

levonorg-eth estrad triphasic 1*

myzilra 1*

norgestim-eth estrad triphasic 1*

nortrel 7/7/7 1*

pirmella 7/7/7 1*

tilia fe 1*

tri femynor 1*

tri-estarylla 1*

tri-legest fe 1*

tri-linyah 1*

tri-lo-estarylla 1*

tri-lo-marzia 1*

tri-lo-sprintec 1*



48


trinessa (28) 1*

tri-previfem 1*

tri-sprintec 1*

trivora (28) 1*

velivet 1*

*Corticosteroids*

*Glucocorticosteroids***

budesonide er oral tablet extended release 24 hour 3

budesonide oral 1

cortisone acetate oral 1

deltasone 1

dexamethasone intensol 1

dexamethasone oral elixir 1

dexamethasone oral solution 1

dexamethasone oral tablet 1

hydrocortisone oral 1

methylprednisolone oral 1

millipred dp oral tablet therapy pack 1

millipred oral tablet 1

prednisolone oral solution 1

prednisolone oral syrup 15 mg/5ml 1

prednisolone sodium phosphate oral solution 15 mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml

1

prednisolone sodium phosphate oral tablet dispersible 1

prednisone intensol 1

prednisone oral 1

*Mineralocorticoids***

fludrocortisone acetate oral 1

*Cough/Cold/Allergy*

*Antitussive - Nonnarcotic***

benzonatate oral capsule 100 mg, 200 mg 1

*Antitussive - Opioid***

hydrocodone-homatropine 1

hydromet 1

*Antitussive-Expectorant***

cheratussin ac oral syrup 1

g tussin ac 1

guaiatussin ac 1



49


guaifenesin ac 1

guaifenesin-codeine oral solution 1

MAR-COF CG EXPECTORANT 3

m-clear wc 1

robafen ac oral solution 1

virtussin a/c 1

*Antitussive-Expectorants-Decongestant***

guaifenesin dac 1

lortuss ex oral liquid 30-10-100 mg/5ml 1

tusnel c 1

virtussin dac 1

*Decongestant & Antihistamine***

promethazine vc plain oral solution 1

promethazine-phenylephrine 1

*Iodine Expectorants***

SSKI 3

*Misc. Respiratory Inhalants***

HYPERSAL 3

nebusal inhalation nebulization solution 3 % 1

NEBUSAL INHALATION NEBULIZATION SOLUTION 6 % 3

pulmosal 1

sodium chloride inhalation nebulization solution 0.9 %, 10 %, 3 %, 7 %

1

*Mucolytics***

acetylcysteine inhalation 1

*Non-Narc Antitussive-Antihistamine***

promethazine-dm 1

*Non-Narc Antitussive-Decongestant-Antihistamine***

pseudoeph-bromphen-dm oral syrup 30-2-10 mg/5ml 1

*Opioid Antitussive-Antihistamine***

hydrocod polst-cpm polst er oral suspension extended release

1

promethazine-codeine oral syrup 1 QPD

*Opioid Antitussive-Decongestant-Antihistamine***

MAR-COF BP 3

promethazine vc/codeine 1

promethazine-phenyleph-codeine 1



50


pseudoeph-chlorphen-hydrocod 1

rydex 1

*Cyclin-Dependent Kinases (Cdk) Inhibitors***

*Cyclin-Dependent Kinases (Cdk) Inhibitors***

IBRANCE 4 PA; QPD

KISQALI 200 DOSE 4 QPD



VERZENIO 4 QPD

*Cystic Fibrosis Agent - Combinations***

*Cystic Fibrosis Agent - Combinations***

ORKAMBI 4 PA; QPD

SYMDEKO 4 PA; QPD

*Dermatologicals*

*Acne Antibiotics***

ACZONE EXTERNAL GEL 7.5 % 3 ST

clindacin-p 1 QPD

clindamycin phosphate external 1 QPD

dapsone external 3

ery 1 QPD

erygel 1 QPD

erythromycin external 1 QPD

sulfacetamide sodium (acne) 1 QPD

*Acne Combinations***

avar cleanser 1

benzoyl peroxide-erythromycin 1

bp 10-1 1

bp cleansing wash 1

clindamycin phos-benzoyl perox external gel 1-5 %, 1.2-5 %

1

clindamycin-tretinoin 1 PA

neuac external gel 1

sss 10-5 1

sulfacetamide sodium-sulfur external cream 1

sulfacetamide sodium-sulfur external emulsion 1

sulfacetamide sodium-sulfur external liquid 1

sulfacetamide sodium-sulfur external lotion 1

sulfacetamide sodium-sulfur external pad 10-4 % 1



51


sulfacetamide sodium-sulfur external suspension 1

sulfacetamide-sulfur in urea external emulsion 1

sulfacleanse 8/4 1

*Acne Products***

ABSORICA 3

adapalene external cream 1

adapalene external gel 0.3 % 1

amnesteem 3

avita external cream 1 PA

claravis 3

isotretinoin oral 3

myorisan 3

tretinoin external 1 PA

tretinoin microsphere 1 PA

tretinoin microsphere pump 1 PA

zenatane 3

*Antibiotic Steroid Combinations - Topical***

CORTISPORIN EXTERNAL 3

*Antibiotics - Topical***

ALTABAX 3 QPD

gentamicin sulfate external 1

mupirocin calcium 1 QPD

mupirocin external 1 QPD

*Antifungals - Topical Combinations***

clotrimazole-betamethasone 1 QPD

nystatin-triamcinolone 1 QPD

*Antifungals - Topical***

ciclodan external solution 1 QPD

ciclopirox 1 QPD

ciclopirox olamine external 1 QPD

MENTAX 3 PA; QPD

naftifine hcl 1 QPD

NAFTIN EXTERNAL GEL 3 PA; QPD

nyamyc 1 QPD

nystatin external 1 QPD

nystop 1 QPD

*Anti-Inflammatory Agents - Topical***

diclofenac sodium transdermal gel 1 % 1 QPD



52


diclofenac sodium transdermal solution 1 QPD

klofensaid ii 1 QPD

*Antineoplastic Alkylating Agents - Topical***

VALCHLOR 4

*Antineoplastic Antimetabolites - Topical***

CARAC 2 PA

fluorouracil external cream 5 % 1

fluorouracil external solution 1

*Antineoplastic Or Premalignant Lesions - Topical Misc.***

PICATO 2

*Antineoplastic Or Premalignant Lesions - Topical Nsaid's***

diclofenac sodium transdermal gel 3 % 3 PA; QPD

*Antineoplastic Retinoids - Topical***

PANRETIN 4

*Antipruritics - Topical***

doxepin hcl external 3 PA; QPD

prudoxin 3 PA; QPD

*Antipsoriatics - Systemic***

acitretin 1

COSENTYX 4 PA; QPD

COSENTYX 300 DOSE 4 PA; QPD

COSENTYX SENSOREADY 300 DOSE 4 PA; QPD

COSENTYX SENSOREADY PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG/ML

4 PA; QPD

methoxsalen oral 4

methoxsalen rapid 4

SILIQ 4 PA; QPD

STELARA SUBCUTANEOUS SOLUTION 45 MG/0.5ML 4 PA; QPD

STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

4 PA; QPD

TALTZ 4 PA; QPD

TREMFYA 4 PA; QPD

*Antipsoriatics***

calcipotriene external 1 QPD

calcitrene 1 QPD

calcitriol external 1 QPD

tazarotene external 3



53


TAZORAC EXTERNAL CREAM 0.05 % 3

*Antiseborrheic Combinations***

sodium sulfacetamide wash 1

*Antiseborrheic Products***

selenium sulfide external lotion 1

sodium sulfacetamide external shampoo 1

sulfacetamide sodium external gel 1

sulfacetamide sodium external liquid 1

*Antivirals - Topical***

acyclovir external 1 PA

DENAVIR 3 PA

*Burn Products***

silver sulfadiazine external 1

ssd 1

SULFAMYLON 3

thermazene 1

*Corticosteroids - Topical***

ala-cort external cream 1 QPD

alclometasone dipropionate 1 QPD

amcinonide 1 QPD

apexicon e 1 QPD

betamethasone dipropionate aug 1 QPD

betamethasone dipropionate external 1 QPD

betamethasone valerate external 1 QPD

clobetasol prop emollient base 1 QPD

clobetasol propionate e 1 QPD

clobetasol propionate emulsion 1 QPD

clobetasol propionate external 1 QPD

clodan external shampoo 1 QPD

CORDRAN EXTERNAL TAPE 3 ST; QPD

desonide external 1 QPD

desoximetasone external cream 1 QPD

desoximetasone external gel 1 QPD

desoximetasone external ointment 1 QPD

diflorasone diacetate external 1 QPD

fluocinolone acetonide body 1 QPD

fluocinolone acetonide external 1 QPD

fluocinolone acetonide scalp 1 QPD



54


fluocinonide emulsified base 1 QPD

fluocinonide external cream 0.05 %, 0.1 % 1 QPD

fluocinonide external gel 1 QPD

fluocinonide external ointment 1 QPD

fluocinonide external solution 1 QPD

fluticasone propionate external 1 QPD

halobetasol propionate 1 QPD

HALOG EXTERNAL OINTMENT 3 ST; QPD

hydrocortisone butyr lipo base 1 QPD

hydrocortisone butyrate external cream 1 QPD

hydrocortisone butyrate external ointment 1 QPD

hydrocortisone butyrate external solution 1 QPD

hydrocortisone external cream 1 %, 2.5 % 1 QPD

hydrocortisone external lotion 2.5 % 1 QPD

hydrocortisone external ointment 1 %, 2.5 % 1 QPD

hydrocortisone valerate 1 QPD

mometasone furoate external 1 QPD

prednicarbate 1 QPD

triamcinolone acetonide external 1 QPD

triderm external cream 1 QPD

*Enzymes - Topical***

SANTYL 3 QPD

*Imidazole-Related Antifungals - Topical***

clotrimazole external 1 QPD

econazole nitrate external 1 QPD

ERTACZO 3 PA; QPD

EXELDERM 3 PA; QPD

ketoconazole external 1 QPD

LUZU 3 PA; QPD

oxiconazole nitrate 1 QPD

*Immunomodulators Imidazoquinolinamines - Topical***

imiquimod external 1

*Keratolytic/Antimitotic Agents***

podofilox external 1

*Local Anesthetics - Topical***

glydo 1 QPD

lidocaine external ointment 1 PA; QPD



55


lidocaine external patch 5 % 1 PA

lidocaine hcl external gel 2 % 1 QPD

lidocaine hcl external solution 1 QPD

lidocaine pak 1 PA; QPD

*Macrolide Immunosuppressants - Topical***

ELIDEL 3 PA; QPD

tacrolimus external 1 PA; QPD

*Rosacea Agents***

FINACEA 2

metronidazole external 1

MIRVASO 3

rosadan external cream 1

rosadan external gel 1

*Scabicides & Pediculicides***

EURAX 2 QPD

lindane external shampoo 1

malathion external 1

permethrin external cream 1

SKLICE 3

spinosad 1 QPD

ULESFIA 3

*Steroid-Local Anesthetic Combinations***

hydrocortisone ace-pramoxine external cream 2.5-1 % 1 QPD

*Topical Anesthetic Combinations***

lidocaine-prilocaine external cream 1 PA; QPD

*Topical Selective Retinoid X Receptor Agonists***

TARGRETIN EXTERNAL 4

*Topical Steroid Combinations***

calcipotriene-betameth diprop 1 QPD

ENSTILAR 3 QPD

*Wound Care - Growth Factor Agents***

REGRANEX 3 QPD

*Diagnostic Products*

*Diagnostic Drugs***

METOPIRONE 3 QPD

*Diagnostic Tests***

BAYER BREEZE 2 TEST 2



56


BAYER CONTOUR TEST 2

GHT TEST 2

TRUE METRIX BLOOD GLUCOSE TEST 2

TRUETEST TEST 2

TRUETRACK TEST 2

*Digestive Aids*

*Digestive Enzymes***

CREON 2

SUCRAID 4

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT, 15000-47000 UNIT, 20000-63000 UNIT, 25000-79000 UNIT, 3000-14000 UNIT, 40000-126000 UNIT, 5000-24000 UNIT

2

*Direct-Acting P2y12 Inhibitors***

*Direct-Acting P2y12 Inhibitors***

BRILINTA 2 QPD

*Diuretics*

*Carbonic Anhydrase Inhibitors***

acetazolamide er 1

acetazolamide oral 1

KEVEYIS 4 PA; QPD

methazolamide oral 1

*Diuretic Combinations***

amiloride-hydrochlorothiazide 1

spironolactone-hctz 1

triamterene-hctz oral capsule 37.5-25 mg 1 QPD

triamterene-hctz oral tablet 1 QPD

*Loop Diuretics***

bumetanide oral 1

ethacrynic acid oral 3 PA

furosemide oral solution 10 mg/ml, 8 mg/ml 1 QPD

furosemide oral tablet 1 QPD

torsemide oral 1

*Potassium Sparing Diuretics***

amiloride hcl oral 1

DYRENIUM 3

spironolactone oral 1



57


*Thiazides And Thiazide-Like Diuretics***

chlorothiazide oral 1

chlorthalidone oral tablet 25 mg, 50 mg 1

DIURIL 3

hydrochlorothiazide oral 1 QPD

indapamide oral 1

methyclothiazide oral 1

metolazone 1

*Endocrine And Metabolic Agents - Misc.*

*Bisphosphonates***

alendronate sodium 1 QPD

etidronate disodium 1

ibandronate sodium oral 1 QPD

risedronate sodium oral tablet 150 mg, 30 mg, 35 mg, 5 mg

1 QPD

risedronate sodium oral tablet delayed release 1 QPD

*Calcimimetic Agents***

SENSIPAR 3 PA

*Calcitonins***

calcitonin (salmon) 1 QPD

MIACALCIN INJECTION 3

*Carnitine Replenisher - Agents***

levocarnitine oral solution 1

levocarnitine oral tablet 1

*Corticotropin***

HP ACTHAR 4 PA; QPD

*Dopamine Receptor Agonists***

cabergoline 1

*Growth Hormone Receptor Antagonists***

SOMAVERT 4 QPD

*Growth Hormone Releasing Hormones (Ghrh)***

EGRIFTA SUBCUTANEOUS SOLUTION RECONSTITUTED 1 MG

4 PA

*Growth Hormones***

HUMATROPE 4 PA

NORDITROPIN FLEXPRO 4 PA

NUTROPIN AQ NUSPIN 10 4 PA




58



*Hereditary Tyrosinemia Type 1 (Ht-1) Treatment - Agents***

NITYR 4 PA

ORFADIN 4 PA

*Homocystinuria Treatment - Agents***

CYSTADANE 4 QPD

*Hyperparathyroid Treatment - Vitamin D Analogs***

calcitriol oral 1

doxercalciferol oral 1

paricalcitol oral 1

*Insulin-Like Growth Factors (Somatomedins)***

INCRELEX 4 PA

*Lhrh/Gnrh Agonist Analog Pituitary Suppressants***

SYNAREL 4

*Parathyroid Hormone And Derivatives***

FORTEO SUBCUTANEOUS SOLUTION 600 MCG/2.4ML 4 PA; QPD

NATPARA 4 PA; QPD

TYMLOS 4 PA; QPD

*Phenylketonuria Treatment - Agents***

KUVAN 4 PA

*Selective Estrogen Receptor Modulators (Serms)***

raloxifene hcl 1* QPD

*Selective Vasopressin V2-Receptor Antagonists***

JYNARQUE 4 PA; QPD

SAMSCA 4

*Somatostatic Agents***

octreotide acetate injection solution 100 mcg/ml, 1000 mcg/ml, 200 mcg/ml, 50 mcg/ml, 500 mcg/ml

4

SIGNIFOR 4 PA; QPD

*Urea Cycle Disorder - Agents***

RAVICTI 4 PA; QPD

sodium phenylbutyrate oral powder 3 gm/tsp 4 PA; QPD

sodium phenylbutyrate oral tablet 4 PA; QPD

*Vasopressin***

desmopressin ace spray refrig 1



59


desmopressin acetate oral 1

desmopressin acetate spray 1

STIMATE 4

*Estrogens*

*Estrogen & Androgen***

covaryx 1

covaryx hs 1

eemt 1

eemt hs 1

est estrogens-methyltest 1

est estrogens-methyltest ds 1

est estrogens-methyltest hs 1

*Estrogen & Progestin***

amabelz 1

CLIMARA PRO 2 QPD

COMBIPATCH 3 QPD

estradiol-norethindrone acet 1

fyavolv 1

jevantique lo 1

jinteli 1

lopreeza 1

mimvey 1

mimvey lo 1

norethindrone-eth estradiol 1

PREMPHASE 2 QPD

PREMPRO 2 QPD

*Estrogens***

DELESTROGEN INTRAMUSCULAR OIL 10 MG/ML 3

DEPO-ESTRADIOL 3

DIVIGEL 2 QPD

ELESTRIN 3 QPD

estradiol oral 1

estradiol transdermal 1 QPD

estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml

1

EVAMIST 2 QPD

MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG 3

MINIVELLE 3 QPD



60


PREMARIN ORAL 2 QPD

*Estrogen-Selective Estrogen Receptor Modulator Comb***

*Estrogen-Selective Estrogen Receptor Modulator Comb***

DUAVEE 3

*Fluoroquinolones*

*Fluoroquinolones***

ciprofloxacin hcl oral 1

ciprofloxacin oral suspension reconstituted 500 mg/5ml (10%)

1

ciprofloxacin-ciproflox hcl er 1

levofloxacin oral 1

moxifloxacin hcl oral 1

ofloxacin oral tablet 300 mg, 400 mg 1

*Gastrointestinal Agents - Misc.*

*Gallstone Solubilizing Agents***

CHENODAL 4

ursodiol oral 1

*Gastrointestinal Antiallergy Agents***

cromolyn sodium oral 1

*Gastrointestinal Chloride Channel Activators***

AMITIZA 2 QPD

*Gastrointestinal Stimulants***

metoclopramide hcl oral solution 10 mg/10ml, 5 mg/5ml

1

metoclopramide hcl oral tablet 1

*Glucagon-Like Peptide-2 (Glp-2) Analogs***

GATTEX 4 PA

*Ibs Agent - Guanylate Cyclase-C (Gc-C) Agonists***

LINZESS 2 QPD

*Ibs Agent - Selective 5-Ht3 Receptor Antagonists***

alosetron hcl 1 QPD

*Inflammatory Bowel Agents***

balsalazide disodium 1

CANASA 2 QPD

DELZICOL 2

DIPENTUM 3



61


mesalamine oral 3

mesalamine rectal 1

PENTASA 2

sulfasalazine oral 1

sulfazine 1

*Intestinal Acidifiers***

enulose 1

generlac 1

lactulose encephalopathy 1

*Peripheral Opioid Receptor Antagonists***

MOVANTIK 3 QPD

RELISTOR ORAL 4 QPD

RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6ML, 8 MG/0.4ML

4 QPD

*Phosphate Binder Agents***

calcium acetate (phos binder) 1

PHOSLYRA 3 PA

sevelamer carbonate 3 PA

VELPHORO 3 PA

*Tumor Necrosis Factor Alpha Blockers***

CIMZIA PREFILLED 4 PA; QPD

CIMZIA STARTER KIT 4 PA; QPD

*Genitourinary Agents - Miscellaneous*

*5-Alpha Reductase Inhibitors***

dutasteride oral 1 QPD

finasteride oral tablet 5 mg 1 QPD

*Alpha 1-Adrenoceptor Antagonists***

alfuzosin hcl er 1

RAPAFLO 3 QPD

tamsulosin hcl 1 QPD

*Citrates***

cytra k crystals 1

potassium citrate er 1

*Cystinosis Agents***

CYSTAGON 4

PROCYSBI 4 PA

*Genitourinary Irrigants***

acetic acid irrigation 1



62


glycine urologic 1

sodium chloride irrigation solution 0.9 % 1

*Interstitial Cystitis Agents***

ELMIRON 2

*Prostatic Hypertrophy Agent Combinations***

dutasteride-tamsulosin hcl 1 QPD

*Urinary Analgesics***

phenazopyridine hcl oral tablet 100 mg, 200 mg 1

*Urinary Stone Agents***

LITHOSTAT 4

THIOLA 4

*Glycopeptides***

*Glycopeptides***

FIRVANQ 2 QPD

vancomycin hcl oral 1 QPD

*Gout Agents*

*Gout Agent Combinations***

colchicine-probenecid 1

*Gout Agents***

allopurinol oral 1

COLCHICINE ORAL 2

ULORIC 2 QPD

*Uricosurics***

probenecid oral 1

*Hematological Agents - Misc.*

*Bradykinin B2 Receptor Antagonists***

FIRAZYR 4 PA; QPD

*C1 Inhibitors***

CINRYZE 4 PA; QPD

HAEGARDA 4 PA; QPD

RUCONEST 4 PA; QPD

*Cyclopentyltriazolopyrimidine (Cptp) Derivatives***

BRILINTA 2 QPD

*Hematorheologic Agents***

pentoxifylline er 1

*Phosphodiesterase Iii Inhibitors***

cilostazol 1 QPD



63


*Platelet Aggregation Inhibitor Combinations***

aspirin-dipyridamole er 1 QPD

*Platelet Aggregation Inhibitors***

dipyridamole oral 1

*Quinazoline Agents***

anagrelide hcl 1

*Thienopyridine Derivatives***

clopidogrel bisulfate oral 1 QPD

prasugrel hcl 3 QPD

*Hematopoietic Agents*

*Agents For Gaucher Disease***

CERDELGA 4 PA

miglustat 4 PA

*Cobalamins***

cyanocobalamin injection 1

NASCOBAL 3 QPD

*Cxcr4 Receptor Antagonist***

MOZOBIL 4

*Cytotoxic Agents***

DROXIA 3

*Folic Acid/Folate Combinations***

foltabs 800 1*

*Folic Acid/Folates***

cvs folic acid oral tablet 800 mcg 1*

folic acid oral tablet 1 mg 1

folic acid oral tablet 400 mcg, 800 mcg 1*

gnp folic acid 1*

hm folic acid 1*

kp folic acid oral tablet 800 mcg 1*

ra folic acid 1*

sm folic acid 1*

*Iron Combinations***

fe c tab plus 1

*Iron-B12-Folate***

hemetab 1

*Thrombopoietin (Tpo) Receptor Agonists***

PROMACTA 4 PA



64


*Hemostatics*

*Hemostatics - Systemic***

tranexamic acid oral 1

*Hepatitis C Agent - Combinations***

*Hepatitis C Agent - Combinations***

EPCLUSA 4 PA; QPD

HARVONI 4 PA; QPD

MAVYRET 4 PA; QPD

VOSEVI 4 PA; QPD

*Hereditary Orotic Aciduria Treatment - Agents**

*Hereditary Orotic Aciduria Treatment - Agents**

XURIDEN 4 PA; QPD

*Hypnotics*

*Barbiturate Hypnotics***

BUTISOL SODIUM ORAL TABLET 30 MG 3 QPD

phenobarbital oral 1

seconal 1

*Benzodiazepine Hypnotics***

estazolam 1 QPD

flurazepam hcl 1 QPD

quazepam 1 QPD

temazepam 1 QPD

triazolam 1 QPD

*Non-Benzodiazepine - Gaba-Receptor Modulators***

eszopiclone 1 QPD

zaleplon 1 QPD

zolpidem tartrate er 1 QPD

zolpidem tartrate oral 1 QPD

*Selective Melatonin Receptor Agonists***

HETLIOZ 4 PA; QPD

*Hypophosphatasia (Hpp) Agents***

*Hypophosphatasia (Hpp) Agents***

STRENSIQ 4 PA

*Ibs Agent - Mu-Opioid Receptor Agonists***

*Ibs Agent - Mu-Opioid Receptor Agonists***

VIBERZI 3 QPD



65


*Insulin-Incretin Mimetic Combinations***

*Insulin-Incretin Mimetic Combinations***

XULTOPHY 2 PA; QPD

*Isocitrate Dehydrogenase-1 (Idh1) Inhibitors***


TIBSOVO 4 QPD



IDHIFA 4 QPD

*Laxatives*

*Bowel Evacuant Combinations***

gavilyte-c 1*

gavilyte-g 1*

gavilyte-h 1*

gavilyte-n with flavor pack 1*

MOVIPREP 3

peg 3350/electrolytes 1*

peg 3350-kcl-na bicarb-nacl 1*

peg-3350/electrolytes 1*

peg-prep 1*

PREPOPIK 3

SUPREP BOWEL PREP KIT 2

trilyte 1*

*Laxatives - Miscellaneous***

clearlax oral powder 1*

constulose 1

cvs purelax 1*

eq clearlax 1*

eql clearlax 1*

gavilax oral powder 1*

gentlelax oral powder 1*

glycolax 1*

gnp clearlax 1*

goodsense clearlax 1*

healthylax 1*

hm clearlax 1*



66


kls laxaclear 1*

lactulose oral solution 10 gm/15ml 1

miralax oral packet 1*

peg 3350 1*

polyethylene glycol 3350 oral 1*

qc natura-lax 1*

ra laxative oral packet 1*

ra laxative oral powder 1*

sb polyethylene glycol 3350 1*

sm clearlax 1*

smooth lax 1*

tgt powderlax 1*

*Saline Laxative Mixtures***

cvs phosphate saline laxative 1*

phosphate laxative oral solution 0.9-2.4 gm/5ml 1*

ra saline laxative 1*

saline laxative oral solution 0.9-2.4 gm/5ml 1*

sm oral saline laxative oral solution 2.7-7.2 gm/5ml 1*

*Saline Laxatives***

citrate of magnesia 1*

citroma 1*

cvs citrate of magnesia 1*

cvs magnesium citrate oral solution 1*

cvs milk of magnesia 1*

eq magnesium citrate 1*

eql magnesium citrate 1*

eql milk of magnesia 1*

gnp magnesium citrate 1*

gnp milk of magnesia 1*

goodsense magnesium citrate 1*

hm magnesium citrate 1*

hm milk of magnesia 1*

magnesium citrate oral solution 1.745 gm/30ml 1*

milk of magnesia 1*

milk of magnesia concentrate 1*

px milk of magnesia 1*

qc magnesium citrate 1*

qc milk of magnesia 1*



67


ra magnesium citrate 1*

ra milk of magnesia oral suspension 1*

sb milk of magnesia 1*

sm magnesium citrate 1*

sm milk of magnesia oral suspension 1200 mg/15ml 1*

*Stimulant Laxatives***

alophen 1*

bisacodyl ec 1*

cvs bisacodyl oral 1*

cvs gentle laxative oral 1*

cvs gentle laxative womens 1*

ducodyl 1*

eq gentle laxative 1*

eq womans laxative 1*

eql gentle laxative 1*

eql laxative oral tablet delayed release 1*

gentle laxative oral 1*

gnp bisa-lax oral 1*

gnp laxative oral 1*

gnp womens laxative 1*

hm laxative oral 1*

kp bisacodyl 1*

laxative oral tablet delayed release 1*

px laxative 1*

qc gentle laxative oral 1*

ra laxative oral tablet delayed release 1*

ra womens laxative 1*

sb bisacodyl laxative ec 1*

sb gentle laxative womens 1*

sm gentle laxative 1*

sm womans laxative 1*

stimulant laxative 1*

tgt gentle laxative 1*

tgt womens laxative 1*

womans laxative oral tablet delayed release 1*

womens laxative 1*



68


*Leptin Analogues***

*Leptin Analogues***

MYALEPT 4 PA

*Lymphocyte Function-Associated Antigen-1 (Lfa-1) Antag***

*Lymphocyte Function-Associated Antigen-1 (Lfa-1) Antag***

XIIDRA 3 QPD

*Macrolides*

*Azithromycin***

azithromycin oral packet 1

azithromycin oral suspension reconstituted 1

azithromycin oral tablet 250 mg, 500 mg, 600 mg 1

*Clarithromycin***

clarithromycin er 1

clarithromycin oral 1

*Erythromycins***

e.e.s. 400 oral tablet 1

ERYPED 200 3

ERYPED 400 3

ery-tab oral tablet delayed release 250 mg, 333 mg 1

ERY-TAB ORAL TABLET DELAYED RELEASE 500 MG 3

erythrocin stearate oral tablet 250 mg 1

erythromycin base oral capsule delayed release particles

1

erythromycin base oral tablet 1

erythromycin ethylsuccinate oral 1

*Fidaxomicin***

DIFICID 3 QPD

*Medical Devices*

*Cervical Caps***

FEMCAP 3*

*Condoms - Female***

fc female condom 1*

FC2 FEMALE CONDOM 3*

*Diaphragms***

CAYA 3*

WIDE-SEAL DIAPHRAGM 60 3*



69









*Migraine Products*

*Ergot Combinations***

ergotamine-caffeine 3 PA; QPD

migergot 1 PA; QPD

*Migraine Products***

dihydroergotamine mesylate injection 1 PA; QPD

dihydroergotamine mesylate nasal 1 PA; QPD

ERGOMAR 3 PA; QPD

*Selective Serotonin Agonists 5-Ht(1)***

almotriptan malate 1 QPD

eletriptan hydrobromide 3 QPD

frovatriptan succinate 1 QPD

naratriptan hcl 1 QPD

rizatriptan benzoate 1 QPD

sumatriptan nasal 1 QPD

sumatriptan succinate oral 1 QPD

sumatriptan succinate refill subcutaneous solution cartridge

1 QPD

sumatriptan succinate subcutaneous solution 6 mg/0.5ml

1 QPD

sumatriptan succinate subcutaneous solution auto-injector 4 mg/0.5ml, 6 mg/0.5ml

1 QPD

zolmitriptan oral 1 QPD

ZOMIG NASAL 2 QPD

*Minerals & Electrolytes*

*Calcium***

calcium oral tablet chewable 500 mg 1*

*Fluoride***

fluoritab oral tablet chewable 1.1 (0.5 f) mg 1*

ludent oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

1*



70


sodium fluoride oral solution 1*

sodium fluoride oral tablet 1.1 (0.5 f) mg 1*

sodium fluoride oral tablet 2.2 (1 f) mg 1

sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

1*

*Phosphate***

K-PHOS 3

*Potassium Combinations***

EFFER-K ORAL TABLET EFFERVESCENT 10 MEQ, 20 MEQ

3

effervescent pot chloride 1

*Potassium***

effer-k oral tablet effervescent 25 meq 1

k-effervescent 1

klor-con 10 1

klor-con m10 1

klor-con m15 1

klor-con m20 1

klor-con oral tablet extended release 1

klor-con/ef 1

k-tab oral tablet extended release 8 meq 1

k-vescent oral tablet effervescent 1

potassium chloride crys er 1

potassium chloride er 1

potassium chloride oral packet 1

potassium chloride oral solution 20 meq/15ml (10%), 40 meq/15ml (20%)

1

*Zinc***

GALZIN 3

*Monobactams***

*Monobactams***

CAYSTON 4 PA

*Mouth/Throat/Dental Agents*

*Anesthetics Topical Oral***

lidocaine viscous 1 QPD

*Anti-Infectives - Throat***

clotrimazole mouth/throat 1

nystatin mouth/throat 1



71


ORAVIG 3 PA

*Antiseptics - Mouth/Throat***

chlorhexidine gluconate mouth/throat 1

paroex 1

*Fluoride Dental Products***

denta 5000 plus 1

dentagel 1

neutral sodium fluoride 1

sf 1

sf 5000 plus 1

*Saliva Stimulants***

cevimeline hcl 1

pilocarpine hcl oral 1

*Steroids - Mouth/Throat***

oralone 1

triamcinolone acetonide mouth/throat 1

*Multivitamins*

*B-Complex Vitamins***

b complex oral tablet 1*

b-complex/b-12 oral 1*

pa b-complex with b-12 1*

ra b-complex 1*

ra b-complex with b-12 1*

vitamin b complex oral tablet 1*

vitamin b-complex 1*

vitamin-b complex 1*

*B-Complex W/ C & Folic Acid***

b complex-c-folic acid 1*

b-complex balanced 1*

b-complex/vitamin c 1*

b-plex 1

dialyvite 800 oral tablet 1*

eql super b complex/vitamin c 1*

full spectrum b/vitamin c 1*

hm super vitamin b complex/c 1*

hm vitamin b complex/vitamin c 1*

px b complex/vitamin c 1*



72


rena-vite 1*

sm b-complex/vitamin c 1*

stress formula 1*

super b complex/fa/vit c 1*

super b-complex/vit c/fa 1*

*B-Complex W/ C***

b complex-c oral tablet 1*

b-complex-c oral tablet 1*

cvs b complex plus c 1*

cvs super b complex/c 1*

sm super b complex/c 1*

superplex-t 1*

total b/c 1*

vitamin b complex-c 1*

*B-Complex W/ C-Biotin-E & Folic Acid***

b complex-c-biotin-e-fa 1*

*B-Complex W/ Folic Acid***

b complex formula 1 1*

kobee 1*

sm balanced b-100 1*

sm balanced b-50 1*

super b complex maxi 1*

*B-Complex W/Biotin & Folic Acid***

b complete 1*

b-100 tr 1*

b-50 complex oral tablet extended release 1*

balance b-50 tablet oral 1*

balanced b-100 oral tablet extended release 1*

b-complex oral tablet 1*

eql b complex 50 oral tablet 1*

eql b-100 complex 1*

gnp b-100 complex 1*

hm vitamin b100 complex 1*

hm vitamin b50 complex 1*

ra balanced b-100 1*

ra balanced b-50 1*

sm b100 complex 1*

sm b-complex 1*



73


super quints b-50 1*

*Multiple Vitamins W/ Iron***

stress formula/iron 1*

*Multiple Vitamins W/ Minerals & Folic Acid***

SYNAGEX 3

*Ped Multiple Vitamins W/ Minerals & C***

VITAMAX 3

*Ped Mv W/ Fluoride***

multi vit/fl 1*

multi-vit/fluoride oral solution 0.25 mg/ml 1*

multivitamin/fluoride oral solution 1*

multi-vitamin/fluoride oral solution 0.5 mg/ml 1*

multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg

1*

multi-vitamin/fluoride solution 0.25 mg/ml oral 1*

multivitamin/fluoride tablet chewable 1 mg oral 1

multivitamins/fluoride oral tablet chewable 0.5 mg 1*

mvc-fluoride oral tablet chewable 0.25 mg, 0.5 mg 1*

polyvitamin/fluoride oral solution 0.25 mg/ml 1*

*Ped Vitamins Acd W/ Fluoride***

tri-vitamin/fluoride 1*

tri-vite/fluoride 1*

vitamins acd-fluoride 1*

*Prenatal Mv & Min W/Fe-Fa***

bal-care dha 1

classic prenatal 1*

c-nate dha 1

completenate 1

cvs prenatal 1*

dothelle dha 1

eql prenatal formula 1*

folivane-ob 1

gnp daily prenatal 1*

gnp prenatal 1*

hemenatal ob 1

hemenatal ob + dha 1

hm prenatal 1*

inatal gt 1



74


kp prenatal multivitamins 1*

mynatal 1

mynatal advance 1

mynatal plus 1

mynatal-z 1

mynate 90 plus 1

newgen 1

obstetrix dha 1

perry prenatal 1*

pnv prenatal plus multivitamin 1

pnv tabs 29-1 1

pnv-omega 1

pnv-select 1

prena1 pearl 1

prenatabs rx 1

prenatal complete 1*

prenatal low iron oral tablet 27-0.8 mg 1*

prenatal low iron oral tablet 27-1 mg 1

prenatal one daily 1*

prenatal oral tablet 27-0.8 mg, 28-0.8 mg 1*

prenatal oral tablet 27-1 mg 1

prenatal plus 1

prenatal plus iron 1

prenatal vitamin and mineral 1*

prenatal vitamin plus low iron 1

prenatal vitamins oral tablet 28-0.8 mg 1*

prenatal/iron 1*

prenatal-u 1

preplus 1

pretab 1

qc prenatal 1*

ra one daily 1*

ra prenatal 1*

relnate dha 1

se-natal 19 1

sm prenatal vitamins 1*

taron-bc 1

taron-c dha 1



75


tl-care dha 1

trinatal rx 1 1

trinate 1

tri-tabs dha 1

ultimatecare one 1

vena-bal dha 1

vinate ii 1

vinate m 1

vinate one 1

virt-c dha 1

virt-nate dha 1

virt-pn 1

virt-pn plus 1

VITAFOL GUMMIES 3

VITAFOL-OB 3

zatean-pn plus 1

*Prenatal Mv & Min W/Fe-Fa-Ca-Omega 3 Fish Oil***

complete natal dha 1

pr natal 400 1

pr natal 400 ec 1

pr natal 430 1

pr natal 430 ec 1

triveen-duo dha 1

*Prenatal Mv & Min W/Fe-Fa-Dha***

cvs prenatal multi+dha 1*

pnv-dha 1

pnv-dha+docusate 1

prena 1 true 1

prenaissance 1

prenaissance plus 1

prenatal multi +dha oral capsule 27-0.8-250 mg 1*

taron-prex 1

tl-select 1

virt-pn dha 1

VITATRUE 3

zatean-pn dha 1



76


*Prenatal Vitamins***

prena1 1

*Vitamins W/ Lipotropics***

b-100 complex oral tablet 1*

balance b-100 1*

balanced b-50 complex oral tablet 1*

balanced b-50 oral tablet 1*

complex b-100 1*

ultra b-100 complex 1*

*Musculoskeletal Therapy Agents*

*Central Muscle Relaxants***

baclofen oral tablet 10 mg, 20 mg 1

carisoprodol oral tablet 350 mg 1 QPD

chlorzoxazone oral tablet 500 mg 1

cyclobenzaprine hcl oral tablet 10 mg, 5 mg 1

metaxall 1

metaxalone 1

methocarbamol oral 1

orphenadrine citrate er 1

tizanidine hcl oral 1

*Direct Muscle Relaxants***

dantrolene sodium oral 1

*Muscle Relaxant Combinations***

carisoprodol-aspirin 1

carisoprodol-aspirin-codeine 1 PA; QPD

*Nasal Agents - Systemic And Topical*

*Nasal Antibiotics***

BACTROBAN NASAL 2

*Nasal Anticholinergics***

ipratropium bromide nasal 1

*Nasal Antihistamines***

azelastine hcl nasal 1 QPD

olopatadine hcl nasal 1 QPD

*Nasal Steroids***

budesonide nasal 1 QPD

flunisolide nasal solution 25 mcg/act (0.025%) 1 QPD

fluticasone propionate nasal 1 QPD



77


mometasone furoate nasal 1 QPD

triamcinolone acetonide nasal aerosol 1 QPD

*Neprilysin Inhib (Arni)-Angiotensin Ii Recept Antag Comb***

*Neprilysin Inhib (Arni)-Angiotensin Ii Recept Antag Comb***

ENTRESTO 2 QPD

*Neurogenic Orthostatic Hypotension (Noh) - Agents***

*Neurogenic Orthostatic Hypotension (Noh) - Agents***

NORTHERA 4 PA

*Neuromuscular Agents*

*Benzathiazoles***

riluzole 1

*Ophthalmic Agents*

*Alpha Adrenergic Agonist & Carbonic Anhydrase Inhib Comb***

SIMBRINZA 3

*Artificial Tear Inserts***

LACRISERT 2 QPD

*Beta-Blockers - Ophthalmic Combinations***

COMBIGAN 3

dorzolamide hcl-timolol mal 1

dorzolamide hcl-timolol mal pf 3

*Beta-Blockers - Ophthalmic***

betaxolol hcl ophthalmic 1

BETIMOL 3

BETOPTIC-S 3

carteolol hcl 1

levobunolol hcl ophthalmic solution 0.5 % 1

metipranolol 1

timolol maleate ophthalmic gel forming solution 1

timolol maleate ophthalmic solution 0.25 %, 0.5 % 1

timolol maleate ophthalmic solution 0.5 % (daily) 3

TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 0.5 % 3

*Cycloplegic Mydriatics***

atropine sulfate ophthalmic solution 1



78


cyclopentolate hcl ophthalmic 1

homatropaire 1

homatropine hbr ophthalmic 1

*Miotics - Cholinesterase Inhibitors***

PHOSPHOLINE IODIDE 2

*Miotics - Direct Acting***

pilocarpine hcl ophthalmic solution 1 %, 2 %, 4 % 1

*Ophthalmic Antiallergic***

ALOCRIL 3

ALOMIDE 3

azelastine hcl ophthalmic 1

BEPREVE 3

cromolyn sodium ophthalmic 1

EMADINE 3

epinastine hcl 1

LASTACAFT 3

olopatadine hcl ophthalmic solution 0.1 % 1

olopatadine hcl ophthalmic solution 0.2 % 3

PAZEO 3

*Ophthalmic Antibiotics***

AZASITE 3

bacitracin ophthalmic 1

BESIVANCE 3

CILOXAN OPHTHALMIC OINTMENT 3

ciprofloxacin hcl ophthalmic 1

erythromycin ophthalmic 1

gatifloxacin ophthalmic 1

gentak ophthalmic ointment 1

gentamicin sulfate ophthalmic solution 1

levofloxacin ophthalmic 1

MOXEZA 2

moxifloxacin hcl ophthalmic 1

ofloxacin ophthalmic 1

tobramycin ophthalmic 1

TOBREX OPHTHALMIC OINTMENT 3

*Ophthalmic Antifungal***

NATACYN 3



79


*Ophthalmic Anti-Infective Combinations***

ak-poly-bac 1

bacitracin-polymyxin b ophthalmic ointment 500-10000 unit/gm

1

neomycin-bacitracin zn-polymyx ophthalmic ointment5-400-10000

1

neomycin-polymyxin-gramicidin ophthalmic solution1.75-10000-.025

1

neo-polycin 1

polycin 1

polymyxin b-trimethoprim 1

*Ophthalmic Antivirals***

trifluridine ophthalmic 1

ZIRGAN 3

*Ophthalmic Carbonic Anhydrase Inhibitors***

AZOPT 3

dorzolamide hcl ophthalmic 1

*Ophthalmic Decongestants***

phenylephrine hcl ophthalmic solution 10 %, 2.5 % 1

*Ophthalmic Nonsteroidal Anti-Inflammatory Agents***

ACUVAIL 3

bromfenac sodium (once-daily) 1

diclofenac sodium ophthalmic 1

flurbiprofen sodium 1

ILEVRO 3

ketorolac tromethamine ophthalmic 1

NEVANAC 3

PROLENSA 2

*Ophthalmic Selective Alpha Adrenergic Agonists***

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % 2

apraclonidine hcl 1

brimonidine tartrate ophthalmic 1

IOPIDINE OPHTHALMIC SOLUTION 1 % 3

*Ophthalmic Steroid Combinations***

bacitra-neomycin-polymyxin-hc 1

BLEPHAMIDE 3

BLEPHAMIDE S.O.P. 3

neomycin-polymyxin-dexameth ophthalmic ointment 1



80


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

1

neomycin-polymyxin-hc ophthalmic suspension 3.5-10000-1

1

neo-polycin hc 1

PRED-G 3

PRED-G S.O.P. 3

sulfacetamide-prednisolone ophthalmic solution 1

TOBRADEX OPHTHALMIC OINTMENT 2

TOBRADEX ST 3

tobramycin-dexamethasone 1

ZYLET 3

*Ophthalmic Steroids***

ALREX 2

dexamethasone sodium phosphate ophthalmic 1

DUREZOL 3

fluorometholone ophthalmic 1

FML 3

FML FORTE 3

LOTEMAX OPHTHALMIC GEL 3

LOTEMAX OPHTHALMIC OINTMENT 3

LOTEMAX OPHTHALMIC SUSPENSION 2

PRED MILD 2

prednisolone acetate ophthalmic 1

prednisolone sodium phosphate ophthalmic 1

*Ophthalmic Sulfonamides***

sulfacetamide sodium ophthalmic 1

*Ophthalmics - Cystinosis Agents**

CYSTARAN 4

*Prostaglandins - Ophthalmic***

bimatoprost ophthalmic 1

latanoprost ophthalmic 1

TRAVATAN Z 2

*Otic Agents*

*Otic Agents - Miscellaneous***

acetic acid otic 1

*Otic Anti-Infectives***

ciprofloxacin hcl otic 1



81


floxin otic 1

ofloxacin otic 1

*Otic Steroid-Anti-Infective Combinations***

CIPRO HC 3

CIPRODEX 3

COLY-MYCIN S 3

neomycin-polymyxin-hc otic 1

*Otic Steroids***

acetasol hc 1

fluocinolone acetonide otic 1

hydrocortisone-acetic acid 1

*Oxytocics*

*Oxytocics***

methergine oral 1 QPD

methylergonovine maleate oral 1 QPD

*Passive Immunizing Agents*

*Immune Serums***

VARIZIG INTRAMUSCULAR SOLUTION 3*

*Pcsk9 Inhibitors***

*Pcsk9 Inhibitors***

PRALUENT SUBCUTANEOUS SOLUTION PEN-INJECTOR 4 PA; QPD

REPATHA 4 PA; QPD

REPATHA PUSHTRONEX SYSTEM 4 PA; QPD

REPATHA SURECLICK 4 PA; QPD

*Penicillins*

*Aminopenicillins***

amoxicillin oral capsule 1

amoxicillin oral suspension reconstituted 1

amoxicillin oral tablet 1

amoxicillin oral tablet chewable 125 mg, 250 mg 1

ampicillin oral capsule 500 mg 1

*Natural Penicillins***

penicillin v potassium 1

*Penicillin Combinations***

amoxicillin-pot clavulanate er 1

amoxicillin-pot clavulanate oral 1

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

3



82


*Penicillinase-Resistant Penicillins***

dicloxacillin sodium 1

*Pharmaceutical Adjuvants*

*Semi Solid Vehicles***

polyethylene glycol 3350 powder 1*

*Phosphatidylinositol 3-Kinase (Pi3k) Inhibitors***

*Phosphatidylinositol 3-Kinase (Pi3k) Inhibitors***

COPIKTRA 4 QPD

ZYDELIG 4

*Phosphodiesterase 4 (Pde4) Inhibitors***

*Phosphodiesterase 4 (Pde4) Inhibitors***

OTEZLA ORAL TABLET 4 PA; QPD

OTEZLA ORAL TABLET THERAPY PACK 4 PA; QPD

*Poly (Adp-Ribose) Polymerase (Parp) Inhibitors**

*Poly (Adp-Ribose) Polymerase (Parp) Inhibitors**

LYNPARZA ORAL TABLET 4 QPD

RUBRACA 4 QPD

ZEJULA 4 QPD

*Poly (Adp-Ribose) Polymerase (Parp) Inhibitors***

*Poly (Adp-Ribose) Polymerase (Parp) Inhibitors***

LYNPARZA ORAL TABLET 4 QPD

RUBRACA 4 QPD

ZEJULA 4 QPD

*Potassium Removing Agents***

*Potassium Removing Agents***

kionex oral suspension 1

sodium polystyrene sulfonate oral 1

sodium polystyrene sulfonate rectal suspension 30 gm/120ml

1

SODIUM POLYSTYRENE SULFONATE RECTAL SUSPENSION 50 GM/200ML

3

sps 1

VELTASSA 3 QPD



83


*Progestins*

*Progestins***

hydroxyprogesterone caproate intramuscular oil 4 PA; QPD

MAKENA 4 PA; QPD

medroxyprogesterone acetate oral 1

norethindrone acetate oral 1

progesterone micronized oral 1

*Protease-Activated Receptor-1 (Par-1) Antagonists***

*Protease-Activated Receptor-1 (Par-1) Antagonists***

ZONTIVITY 3

*Psychotherapeutic And Neurological Agents - Misc.*

*Alcohol Deterrents***

acamprosate calcium 1

disulfiram oral 1

*Anti-Cataplectic Agents***

XYREM 4 PA; QPD

*Benzodiazepines & Tricyclic Agents***

chlordiazepoxide-amitriptyline 1

*Cholinomimetics - Ache Inhibitors***

donepezil hcl 1 QPD

galantamine hydrobromide 1 QPD

galantamine hydrobromide er 1 QPD

rivastigmine 1 QPD

rivastigmine tartrate 1 QPD

*Fibromyalgia Agent - Snris***

SAVELLA 3 QPD

SAVELLA TITRATION PACK 3 QPD

*Movement Disorder Drug Therapy***

INGREZZA 4 PA; QPD

tetrabenazine 4 PA

*Ms Agents - Pyrimidine Synthesis Inhibitors***

AUBAGIO 4 QPD

*Multiple Sclerosis Agents - Interferons***

AVONEX 4 QPD

AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT 4 QPD



84


AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT

4 QPD

BETASERON SUBCUTANEOUS KIT 4 QPD

EXTAVIA SUBCUTANEOUS KIT 4 QPD

PLEGRIDY 4 QPD

PLEGRIDY STARTER PACK 4 QPD

REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR

4 QPD

REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

4 QPD

REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 4 QPD

REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

4 QPD

*Multiple Sclerosis Agents - Nrf2 Pathway Activators***

TECFIDERA 4 QPD

*Multiple Sclerosis Agents - Potassium Channel Blockers***

dalfampridine er 4 PA; QPD

*Multiple Sclerosis Agents***

glatiramer acetate 4 QPD

glatopa 4 QPD

*N-Methyl-D-Aspartate (Nmda) Receptor Antagonists***

memantine hcl er 3

memantine hcl oral solution 1

memantine hcl oral tablet 10 mg, 5 mg 1

NAMENDA XR TITRATION PACK 2 QPD

*Phenothiazines & Tricyclic Agents***

perphenazine-amitriptyline 1

*Premenstrual Dysphoric Disorder (Pmdd) Agents - Ssris***

fluoxetine hcl (pmdd) 1 QPD

*Pseudobulbar Affect Agent Combinations***

NUEDEXTA 4 PA; QPD

*Psychotherapeutic And Neurological Agents - Misc.***

ergoloid mesylates oral 1

pimozide 1



85


*Smoking Deterrents***

bupropion hcl er (smoking det) 1* QPD

CHANTIX 3*

CHANTIX CONTINUING MONTH PAK 3*

CHANTIX STARTING MONTH PAK 3*

cvs nicotine lozenge 2 mg mouth/throat 1*

CVS NICOTINE LOZENGE 2 MG MOUTH/THROAT 3*

CVS NICOTINE MOUTH/THROAT LOZENGE 2 MG 3*

CVS NICOTINE POLACRILEX LOZENGE 2 MG MOUTH/THROAT

2*

cvs nicotine polacrilex lozenge 2 mg mouth/throat 1*


3*


3*


2*

cvs nicotine polacrilex mouth/throat gum 1*

cvs nicotine polacrilex mouth/throat lozenge 2 mg, 4 mg

1*

cvs nicotine transdermal 1*

EQ NICOTINE LOZENGE 4 MG MOUTH/THROAT 3*

eq nicotine mouth/throat lozenge 4 mg 1*

eq nicotine polacrilex mouth/throat gum 1*

EQ NICOTINE POLACRILEX MOUTH/THROAT LOZENGE 3*

eq nicotine step 3 1*

eq nicotine transdermal 1*

eql nicotine polacrilex 1*

GNP NICOTINE MINI 2*

gnp nicotine polacrilex lozenge 4 mg mouth/throat 1*

gnp nicotine polacrilex mouth/throat gum 1*

gnp nicotine polacrilex mouth/throat lozenge 2 mg 1*

GNP NICOTINE POLACRILEX MOUTH/THROAT LOZENGE 4 MG

2*

goodsense nicotine mouth/throat gum 1*

goodsense nicotine mouth/throat lozenge 4 mg 1*

hm nicotine 1*

hm nicotine polacrilex 1*

kls quit2 mouth/throat gum 1*



86


KLS QUIT2 MOUTH/THROAT LOZENGE 2*

kls quit4 mouth/throat gum 1*

KLS QUIT4 MOUTH/THROAT LOZENGE 3*

nicorelief mouth/throat gum 1*

NICORETTE MINI 2*

NICORETTE MOUTH/THROAT LOZENGE 2*

nicotine 1*

NICOTINE MINI 2*

NICOTINE POLACRILEX LOZENGE 2 MG MOUTH/THROAT

3*


2*


3*

nicotine polacrilex mouth/throat gum 1*

nicotine polacrilex mouth/throat lozenge 2 mg, 4 mg 1*

nicotine step 1 1*

nicotine step 2 1*

nicotine step 3 1*

NICOTROL 3*

NICOTROL NS 2*

px stop smoking aid 1*

ra mini nicotine 1*

ra nicotine 1*

ra nicotine gum mouth/throat gum 2 mg, 4 mg 1*

ra nicotine polacrilex 1*

sm nicotine 1*

sm nicotine polacrilex 1*

tgt nicotine mouth/throat gum 4 mg 1*

tgt nicotine polacrilex lozenge 2 mg mouth/throat 1*

TGT NICOTINE POLACRILEX LOZENGE 2 MG MOUTH/THROAT

3*

tgt nicotine polacrilex mouth/throat gum 1*

TGT NICOTINE POLACRILEX MOUTH/THROAT LOZENGE 2 MG

3*

tgt nicotine polacrilex mouth/throat lozenge 4 mg 1*

tgt nicotine step one 1*

tgt nicotine step three 1*

tgt nicotine step two 1*



87


*Sphingosine 1-Phosphate (S1p) Receptor Modulators***

GILENYA ORAL CAPSULE 0.5 MG 4 QPD

*Pulmonary Fibrosis Agents - Kinase Inhibitors***

*Pulmonary Fibrosis Agents - Kinase Inhibitors***

OFEV 4 PA

*Pulmonary Fibrosis Agents***

*Pulmonary Fibrosis Agents***

ESBRIET 4 PA

*Pulmonary Hypertension - Prostacyclin Receptor Agonist***

*Pulmonary Hypertension - Prostacyclin Receptor Agonist***

UPTRAVI ORAL TABLET 4 PA; QPD

UPTRAVI ORAL TABLET THERAPY PACK 4 PA; QPD

*Respiratory Agents - Misc.*

*Cftr Potentiators***

KALYDECO 4 PA; QPD

*Hydrolytic Enzymes***

PULMOZYME 4 QPD

*Serotonin Modulators***

*Serotonin Modulators***

nefazodone hcl 1

trazodone hcl oral 1

TRINTELLIX 3 ST

VIIBRYD ORAL TABLET 3 ST; QPD

VIIBRYD STARTER PACK 3 ST; QPD

*Sglt2 Inhibitor - Dpp-4 Inhibitor Combinations***

*Sglt2 Inhibitor - Dpp-4 Inhibitor Combinations***

GLYXAMBI 2 QPD

*Sinus Node Inhibitors**

*Sinus Node Inhibitors**

CORLANOR 3 QPD



88


*Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb***

*Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb***

SEGLUROMET 2 QPD

SYNJARDY 2 QPD

SYNJARDY XR 2 QPD

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 10-500 MG, 2.5-1000 MG, 5-1000 MG, 5-500 MG

2 QPD

*Sulfonamides*

*Sulfonamides***

sulfadiazine oral 1

*Tetracyclines*

*Tetracyclines***

avidoxy 1

demeclocycline hcl oral 1

doxycycline hyclate oral capsule 1

doxycycline hyclate oral tablet 100 mg, 20 mg 1

doxycycline monohydrate oral capsule 100 mg, 50 mg 1

doxycycline monohydrate oral suspension reconstituted

1

doxycycline monohydrate oral tablet 1

minocycline hcl oral capsule 1

mondoxyne nl oral capsule 100 mg, 50 mg 1

morgidox oral capsule 100 mg 1

tetracycline hcl oral 1

*Thyroid Agents*

*Antithyroid Agents***

methimazole oral 1

propylthiouracil oral 1

*Thyroid Hormones***

ARMOUR THYROID 3

CYTOMEL 3

LEVO-T 3

levothyroxine sodium oral 1

levothyroxine-liothyronine 1

levoxyl 1



89


liothyronine sodium oral 1

nature-throid 1

np thyroid 1

SYNTHROID 2

THYROLAR-1 ORAL TABLET 60 MG 3

THYROLAR-1/2 ORAL TABLET 30 MG 3

THYROLAR-1/4 ORAL TABLET 15 MG 3



TIROSINT 3

unithroid 1

westhroid oral tablet 130 mg, 195 mg, 32.5 mg, 65 mg, 97.5 mg

1

WP THYROID 3

*Toxoids*

*Toxoid Combinations***

ADACEL INTRAMUSCULAR SUSPENSION 5-2-15.5 LF-MCG/0.5

3*

BOOSTRIX INTRAMUSCULAR SUSPENSION 5-2.5-18.5 LF-MCG/0.5

3*

DAPTACEL INTRAMUSCULAR SUSPENSION 15-23-5 LF-MCG/0.5

3*

DIPHTHERIA-TETANUS TOXOIDS DT 3*

INFANRIX 2*

KINRIX INTRAMUSCULAR SUSPENSION 3*

PEDIARIX 3*

PENTACEL 3*

QUADRACEL 3*

TENIVAC 3*

TETANUS-DIPHTHERIA TOXOIDS TD 3*

*Ulcer Drugs*

*Anticholinergic Combinations***

belladonna alkaloids-opium 1 PA

belladonna-opium 1 PA

chlordiazepoxide-clidinium 1

*Antispasmodics***

dicyclomine hcl oral 1



90


*Belladonna Alkaloids***

anaspaz 1

ed-spaz 1

hyoscyamine sulfate er oral tablet extended release 12 hour

1

hyoscyamine sulfate oral 1

hyoscyamine sulfate sl 1

hyoscyamine sulfate sublingual 1

hyosyne 1

oscimin 1

oscimin sr 1

symax-sl 1

symax-sr 1

*H-2 Antagonists***

cimetidine hcl oral 1

cimetidine oral 1

famotidine oral suspension reconstituted 1

famotidine oral tablet 20 mg, 40 mg 1

nizatidine 1

ranitidine hcl oral syrup 15 mg/ml, 75 mg/5ml 1 QPD

ranitidine hcl oral tablet 150 mg, 300 mg 1 QPD

*Misc. Anti-Ulcer***

CARAFATE ORAL SUSPENSION 3

sucralfate oral tablet 1

*Proton Pump Inhibitors***

esomeprazole magnesium 1 QPD

lansoprazole oral capsule delayed release 1 QPD

NEXIUM ORAL PACKET 2 QPD

omeprazole oral capsule delayed release 1 QPD

pantoprazole sodium oral 1 QPD

rabeprazole sodium 1 QPD

*Quaternary Anticholinergics***

glycopyrrolate oral tablet 1 mg, 2 mg 1

methscopolamine bromide oral 1

propantheline bromide oral 1

*Ulcer Anti-Infective W/ Bismuth Combinations***

PYLERA 2



91


*Ulcer Anti-Infective W/ Proton Pump Inhibitors***

amoxicill-clarithro-lansopraz 1

OMECLAMOX-PAK 3

*Ulcer Drugs - Prostaglandins***

misoprostol oral 1

*Urinary Anti-Infectives*

*Urinary Anti-Infectives***

methenamine hippurate 1

methenamine mandelate oral 1

MONUROL 3

nitrofurantoin macrocrystal oral 1

nitrofurantoin monohyd macro 1

nitrofurantoin oral suspension 1

*Urinary Antiseptic-Antispasmodic &/Or Analgesics***

hyophen 1

me/naphos/mb/hyo1 1

phosphasal 1

uretron d/s 1

urimar-t 1

urin ds 1

uro-458 1

urogesic-blue 1

uro-mp 1

uryl 1

utira-c 1

*Urinary Antispasmodics*

*Beta-3 Adrenergic Agonists***

MYRBETRIQ 2 ST; QPD

*Urinary Antispasmodic - Antimuscarinic (Anticholinergic)***

darifenacin hydrobromide er 1 QPD

oxybutynin chloride er 1 QPD

oxybutynin chloride oral 1 QPD

tolterodine tartrate 1 QPD

tolterodine tartrate er 1 QPD

TOVIAZ 3 ST; QPD

trospium chloride 1 QPD



92


trospium chloride er 1 QPD

VESICARE 2 ST; QPD

*Urinary Antispasmodic - Antimuscarinics (Antichol)***(New)

darifenacin hydrobromide er 1 QPD

oxybutynin chloride er 1 QPD

oxybutynin chloride oral 1 QPD

tolterodine tartrate 1 QPD

tolterodine tartrate er 1 QPD

TOVIAZ 3 ST; QPD

trospium chloride 1 QPD

trospium chloride er 1 QPD

VESICARE 2 ST; QPD

*Urinary Antispasmodics - Beta-3 Adrenergic Agonists***

MYRBETRIQ 2 ST; QPD

*Urinary Antispasmodics - Cholinergic Agonists***

bethanechol chloride oral 1

*Urinary Antispasmodics - Cholinergic Agonists*** (New)

bethanechol chloride oral 1

*Urinary Antispasmodics - Direct Muscle Relaxants***

flavoxate hcl 1 QPD

*Urinary Antispasmodics - Direct Muscle Relaxants*** (New)

flavoxate hcl 1 QPD

*Vaccines*

*Bacterial Vaccines***

ACTHIB 2*

BEXSERO 3*

HIBERIX INJECTION 3*

MENACTRA 2*

MENVEO 3*

PEDVAX HIB INTRAMUSCULAR SUSPENSION 2*

PNEUMOVAX 23 3*

PREVNAR 13 3*

TRUMENBA 3*



93


*Viral Vaccine Combinations***

M-M-R II 2*

PROQUAD SUBCUTANEOUS SUSPENSION RECONSTITUTED

3*

TWINRIX 3*

*Viral Vaccines***

AFLURIA 3*

AFLURIA PRESERVATIVE FREE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3*

AFLURIA QUADRIVALENT 3*

ENGERIX-B INJECTION SUSPENSION 10 MCG/0.5ML, 20 MCG/ML

2*

FLUAD 3*

FLUARIX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3*

FLUBLOK QUADRIVALENT 3*

FLUCELVAX QUADRIVALENT 3*

FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION

3*

FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3*

FLUMIST QUADRIVALENT 3*

FLUZONE HIGH-DOSE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3*

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION , 0.5 ML

3*

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3*

GARDASIL 9 3*

HAVRIX INTRAMUSCULAR SUSPENSION 1440 EL U/ML, 720 EL U/0.5ML

2*

HEPLISAV-B 3*

IPOL INJECTION INJECTABLE 2*

RECOMBIVAX HB INJECTION SUSPENSION 10 MCG/ML, 40 MCG/ML, 5 MCG/0.5ML

2*

ROTARIX 2*

ROTATEQ ORAL SOLUTION 3*

SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED 50 MCG/0.5ML

3*

VAQTA INTRAMUSCULAR SUSPENSION 25 UNIT/0.5ML, 50 UNIT/ML

2*



94


VARIVAX 2*

ZOSTAVAX SUBCUTANEOUS SUSPENSION RECONSTITUTED

2*

*Vaginal Products*

*Imidazole-Related Antifungals***

GYNAZOLE-1 3

miconazole 3 vaginal suppository 1

terconazole 1

*Miscellaneous Vaginal Combinations***

fem ph 1

*Spermicides***

options gynol ii contraceptive 1*

TODAY SPONGE 2*

vcf vaginal contraceptive vaginal foam 1*

*Vaginal Anti-Infectives***

AVC VAGINAL 3

CLEOCIN VAGINAL SUPPOSITORY 3

clindamycin phosphate vaginal 1

CLINDESSE 3

metronidazole vaginal 1

NUVESSA 3

vandazole 1

*Vaginal Estrogens***

estradiol vaginal cream 3

estradiol vaginal tablet 1

ESTRING 2 QPD

FEMRING 3 QPD

yuvafem 1

*Vaginal Progestins***

CRINONE VAGINAL GEL 4 % 2

*Vasopressors*

*Anaphylaxis Therapy Agents***

EPINEPHRINE INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML

2 QPD

EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML INJECTION

2 QPD

EPIPEN 2-PAK INJECTION SOLUTION AUTO-INJECTOR 2 QPD



95


EPIPEN JR 2-PAK INJECTION SOLUTION AUTO-INJECTOR

2 QPD

*Vasopressors***

midodrine hcl 1

*Vitamins*

*Vitamin D***

vitamin d (ergocalciferol) oral capsule 50000 unit 1

*Vitamin K***

PHYTONADIONE INJECTION SOLUTION 1 MG/0.5ML 3

phytonadione oral 3



96

Index

abacavir sulfate ............................... 38abacavir sulfate-lamivudine .............37abacavir-lamivudine-zidovudine ......37ABSORICA.........................................52acamprosate calcium .......................84acarbose ...........................................21acebutolol hcl ...................................41acetaminophen-codeine .................. 10acetaminophen-codeine #2 ............. 10acetaminophen-codeine #3 ............. 10acetaminophen-codeine #4 ............. 10acetasol hc ....................................... 82acetazolamide ..................................57acetazolamide er ............................. 57acetic acid .................................. 62, 81acetylcysteine .................................. 50acitretin ............................................53ACTEMRA........................................... 7ACTHIB............................................. 93ACTIMMUNE....................................33ACTOPLUS MET XR...........................24ACUVAIL........................................... 80acyclovir ..................................... 39, 54ACZONE............................................51ADACEL............................................ 90adapalene ........................................ 52adefovir dipivoxil ..............................39ADEMPAS.........................................43adult aspirin regimen .........................8ADVAIR DISKUS................................ 15ADVAIR HFA..................................... 15afeditab cr ........................................42AFINITOR..........................................32AFINITOR DISPERZ............................32AFLURIA........................................... 94AFLURIA PRESERVATIVE FREE.......... 94AFLURIA QUADRIVALENT.................94AIMOVIG.......................................... 42AIMOVIG 140 DOSE......................... 42ak-poly-bac ...................................... 80AKYNZEO..........................................25ala-cort .............................................54albendazole ......................................13albuterol sulfate ...............................15albuterol sulfate er ...........................15alclometasone dipropionate ............ 54ALECENSA........................................ 32alendronate sodium .........................58alfuzosin hcl er ................................. 62ALINIA.............................................. 29allopurinol ........................................63

almotriptan malate ..........................70ALOCRIL............................................79ALOGLIPTIN BENZOATE....................21ALOMIDE..........................................79alophen ............................................ 68alosetron hcl .................................... 61ALPHAGAN P.................................... 80alprazolam ....................................... 14alprazolam er ...................................14alprazolam intensol ......................... 14alprazolam xr ................................... 14ALREX............................................... 81ALTABAX.......................................... 52altavera ............................................44ALUNBRIG........................................ 32ALVESCO.......................................... 16alyacen 1/35 .................................... 44alyacen 7/7/7 ...................................48amabelz ........................................... 60amantadine hcl ................................ 35amcinonide ...................................... 54amethia ............................................47amethia lo ........................................47amethyst .......................................... 47amiloride hcl .................................... 57amiloride-hydrochlorothiazide .........57amiodarone hcl ................................ 14AMITIZA........................................... 61amitriptyline hcl ............................... 21amlodipine besy-benazepril hcl ........27amlodipine besylate .........................42amlodipine besylate-valsartan .........28amlodipine-atorvastatin .................. 43amlodipine-olmesartan ....................28amlodipine-valsartan-hctz ............... 28amnesteem ...................................... 52amoxapine ....................................... 21amoxicill-clarithro-lansopraz ........... 92amoxicillin ........................................ 82amoxicillin-pot clavulanate ..............82amoxicillin-pot clavulanate er ..........82amphetamine-dextroamphet er ........ 5amphetamine-dextroamphetamine ...5ampicillin ..........................................82ANADROL-50....................................12anagrelide hcl .................................. 64anaspaz ............................................91anastrozole ...................................... 34ANORO ELLIPTA............................... 15anucort-hc ........................................13ANZEMET......................................... 25

apexicon e ........................................ 54APIDRA.............................................22APIDRA SOLOSTAR........................... 22APOKYN............................................35apraclonidine hcl ..............................80aprepitant ........................................ 25apri ...................................................44APTIOM............................................18APTIVUS........................................... 38aranelle ............................................ 48ARCALYST...........................................7ARCAPTA NEOHALER....................... 15aripiprazole ...................................... 36armodafinil .........................................5ARMOUR THYROID.......................... 89ARNUITY ELLIPTA............................. 16ascomp-codeine ............................... 10ashlyna .............................................47ASMANEX 120 METERED DOSES......16ASMANEX 14 METERED DOSES........16ASMANEX 30 METERED DOSES........16ASMANEX 60 METERED DOSES........16ASMANEX 7 METERED DOSES..........16ASMANEX HFA................................. 16aspir-81 .............................................. 8aspirin ................................................ 9aspirin 81 ........................................... 8aspirin adult low dose ........................ 8aspirin adult low strength ..................8aspirin childrens ................................. 8aspirin ec ............................................8aspirin ec adult low strength ............. 8aspirin ec low dose .............................8aspirin ec low strength .......................8aspirin low dose ................................. 8aspirin low dose adult ........................ 8aspirin low strength ........................... 9aspirin-dipyridamole er ....................64aspir-low ............................................ 9atazanavir sulfate ............................ 38atenolol ............................................41atenolol-chlorthalidone ................... 29atomoxetine hcl ................................. 5atorvastatin calcium ........................ 26atovaquone ......................................29atovaquone-proguanil hcl ................30ATRIPLA............................................37atropine sulfate ................................78ATROVENT HFA................................16AUBAGIO..........................................84aubra ................................................44



97

aubra eq ...........................................44AUGMENTIN.................................... 82AVANDIA.......................................... 24avar cleanser ....................................51AVC VAGINAL................................... 95aviane .............................................. 44avidoxy .............................................89avita ................................................. 52AVONEX........................................... 84AVONEX PEN....................................84AVONEX PREFILLED..........................85AZASITE............................................ 79azathioprine .....................................41azelastine hcl ..............................77, 79azithromycin .................................... 69AZOPT.............................................. 80azurette ............................................44b complete ....................................... 73b complex .........................................72b complex formula 1 ........................ 73b complex-c ......................................73b complex-c-biotin-e-fa ....................73b complex-c-folic acid ...................... 72b-100 complex ..................................77b-100 tr ............................................ 73b-50 complex ....................................73bacitracin ......................................... 79bacitracin-polymyxin b .....................80bacitra-neomycin-polymyxin-hc .......80baclofen ........................................... 77BACTROBAN NASAL......................... 77balance b-100 .................................. 77balance b-50 .................................... 73balanced b-100 ................................ 73balanced b-50 .................................. 77balanced b-50 complex .................... 77bal-care dha ..................................... 74balsalazide disodium ........................61balziva ..............................................44BANZEL.............................................18BARACLUDE......................................39BASAGLAR KWIKPEN........................22bayer aspirin ec low dose ...................9BAYER BREEZE 2 TEST...................... 56BAYER CONTOUR TEST.....................57bayer low dose ...................................9b-complex ........................................ 73b-complex balanced .........................72b-complex/b-12 ................................72b-complex/vitamin c ........................ 72b-complex-c ......................................73bekyree ............................................ 44

belladonna alkaloids-opium .............90belladonna-opium ............................90benazepril hcl ...................................27benazepril-hydrochlorothiazide ....... 27BENLYSTA.........................................40benzonatate .....................................49benzoyl peroxide-erythromycin ........51benztropine mesylate .......................35BEPREVE...........................................79BESIVANCE....................................... 79betamethasone dipropionate .......... 54betamethasone dipropionate aug ... 54betamethasone valerate ..................54BETASERON......................................85betaxolol hcl ...............................41, 78bethanechol chloride ....................... 93BETHKIS..............................................6BETIMOL.......................................... 78BETOPTIC-S...................................... 78BEVESPI AEROSPHERE......................15bexarotene .......................................34BEXSERO.......................................... 93bicalutamide .................................... 31BIDIL.................................................43BIKTARVY......................................... 37bimatoprost ..................................... 81bisacodyl ec ......................................68bisoprolol fumarate ......................... 41bisoprolol-hydrochlorothiazide ........ 29BLEPHAMIDE....................................80BLEPHAMIDE S.O.P. ......................... 80blisovi 24 fe ...................................... 44blisovi fe 1.5/30 ................................44blisovi fe 1/20 ...................................44BONJESTA.........................................25BOOSTRIX.........................................90BOSULIF........................................... 32bp 10-1 .............................................51bp cleansing wash ............................51b-plex ............................................... 72BRAFTOVI.........................................32BREO ELLIPTA...................................15briellyn ............................................. 44BRILINTA.................................... 57, 63brimonidine tartrate ........................ 80bromfenac sodium (once-daily) ....... 80bromocriptine mesylate ................... 35BROVANA.........................................15budesonide ...........................16, 49, 77budesonide er .................................. 49bumetanide ......................................57bupropion hcl ................................... 20

bupropion hcl er (smoking det) ........ 86bupropion hcl er (sr) .........................20bupropion hcl er (xl) ......................... 20buspirone hcl ....................................14butalbital-acetaminophen ................. 8butalbital-apap .................................. 8butalbital-apap-caff-cod ..................10butalbital-apap-caffeine .................... 8butalbital-asa-caff-codeine ..............10butalbital-asa-caffeine .......................8butalbital-aspirin-caffeine ................. 8BUTISOL SODIUM.............................65butorphanol tartrate ........................12BUTRANS..........................................12BYSTOLIC..........................................41cabergoline ...................................... 58CABOMETYX.....................................32caffeine citrate ...................................5calcipotriene .................................... 53calcipotriene-betameth diprop ........ 56calcitonin (salmon) ...........................58calcitrene ......................................... 53calcitriol ......................................53, 59calcium .............................................70calcium acetate (phos binder) ..........62CALQUENCE..................................... 33camila .............................................. 48camrese ............................................47camrese lo ........................................47CANASA............................................61candesartan cilexetil ........................ 28candesartan cilexetil-hctz ................ 28capecitabine .....................................31CAPRELSA.........................................33captopril ...........................................27captopril-hydrochlorothiazide ..........27CARAC.............................................. 53CARAFATE........................................ 91carbamazepine ................................ 18carbamazepine er ............................ 18CARBATROL......................................18carbidopa ......................................... 35carbidopa-levodopa ......................... 35carbidopa-levodopa er .....................35carbidopa-levodopa-entacapone .....35carbinoxamine maleate ................... 26careall aspirin .....................................9carisoprodol ..................................... 77carisoprodol-aspirin ......................... 77carisoprodol-aspirin-codeine ........... 77carteolol hcl ..................................... 78cartia xt ............................................42



98

carvedilol ..........................................41carvedilol phosphate er ....................41CAYA................................................ 69CAYSTON..........................................71caziant ..............................................48cefaclor ............................................ 43cefaclor er ........................................ 43cefadroxil ......................................... 43cefdinir ............................................. 44cefditoren pivoxil ..............................44cefixime ............................................44cefpodoxime proxetil ....................... 44cefprozil ............................................43cefuroxime axetil ..............................43celecoxib ............................................ 6CELONTIN.........................................19cephalexin ........................................ 43CERDELGA........................................ 64cevimeline hcl ...................................72CHANTIX...........................................86CHANTIX CONTINUING MONTH PAK...................................................86CHANTIX STARTING MONTH PAK.... 86chateal ............................................. 44chateal eq ........................................ 44CHEMET........................................... 24CHENODAL....................................... 61cheratussin ac .................................. 49childrens aspirin ................................. 9childrens aspirin low strength ............9chlordiazepoxide hcl .........................14chlordiazepoxide-amitriptyline ........ 84chlordiazepoxide-clidinium .............. 90chlorhexidine gluconate ...................72chloroquine phosphate .................... 30chlorothiazide .................................. 58chlorpromazine hcl ...........................36chlorpropamide ................................23chlorthalidone ..................................58chlorzoxazone .................................. 77CHOLBAM........................................ 41cholestyramine .................................26cholestyramine light ........................ 26choline fenofibrate ...........................26ciclodan ............................................52ciclopirox ..........................................52ciclopirox olamine ............................ 52cilostazol .......................................... 63CILOXAN...........................................79CIMDUO........................................... 37cimetidine ........................................ 91cimetidine hcl ...................................91

CIMZIA PREFILLED............................62CIMZIA STARTER KIT........................ 62CINRYZE............................................63CIPRO HC..........................................82CIPRODEX.........................................82ciprofloxacin .....................................61ciprofloxacin hcl ................... 61, 79, 81ciprofloxacin-ciproflox hcl er ............61citalopram hydrobromide ................ 20citrate of magnesia ..........................67citroma .............................................67claravis .............................................52clarithromycin .................................. 69clarithromycin er ..............................69classic prenatal ................................ 74clearlax .............................................66clemastine fumarate ........................26CLEOCIN........................................... 95CLIMARA PRO.................................. 60clindacin-p ........................................51clindamycin hcl .................................30clindamycin palmitate hcl ................ 30clindamycin phos-benzoyl perox ...... 51clindamycin phosphate .............. 51, 95clindamycin-tretinoin ....................... 51CLINDESSE........................................95clobetasol prop emollient base ........ 54clobetasol propionate ...................... 54clobetasol propionate e ................... 54clobetasol propionate emulsion .......54clodan .............................................. 54clomipramine hcl ..............................21clonazepam ......................................17clonidine hcl ..................................... 28clonidine hcl er ................................... 5clopidogrel bisulfate ........................ 64clorazepate dipotassium ..................14clotrimazole ............................... 55, 71clotrimazole-betamethasone ...........52clozapine .......................................... 36CLOZAPINE....................................... 36c-nate dha ........................................74COARTEM.........................................30codeine sulfate .................................11COLCHICINE......................................63colchicine-probenecid ...................... 63colesevelam hcl ................................26colestipol hcl .................................... 26colocort ............................................ 12COLY-MYCIN S..................................82COMBIGAN...................................... 78COMBIPATCH................................... 60

COMBIVENT RESPIMAT....................15COMETRIQ (100 MG DAILY DOSE)... 33COMETRIQ (140 MG DAILY DOSE)... 33COMETRIQ (60 MG DAILY DOSE)..... 33COMPLERA.......................................37complete natal dha .......................... 76completenate ...................................74complex b-100 ..................................77compro .............................................36constulose ........................................ 66COPIKTRA.........................................83CORDRAN.........................................54CORLANOR.......................................88CORTIFOAM..................................... 13cortisone acetate ............................. 49CORTISPORIN................................... 52COSENTYX........................................ 53COSENTYX 300 DOSE....................... 53COSENTYX SENSOREADY 300 DOSE. 53COSENTYX SENSOREADY PEN.......... 53COTELLIC.......................................... 32COUMADIN...................................... 17covaryx .............................................60covaryx hs ........................................ 60CREON..............................................57CRESEMBA....................................... 25CRINONE.......................................... 95CRIXIVAN..........................................38cromolyn sodium ..................15, 61, 79cryselle-28 ........................................44cvs aspirin adult low dose .................. 9cvs aspirin adult low strength ............ 9cvs aspirin ec ...................................... 9cvs aspirin low dose ........................... 9cvs aspirin low strength ..................... 9cvs b complex plus c ......................... 73cvs bisacodyl .................................... 68cvs citrate of magnesia .................... 67cvs folic acid ..................................... 64cvs gentle laxative ............................68cvs gentle laxative womens ............. 68cvs magnesium citrate ..................... 67cvs milk of magnesia ........................67cvs nicotine ...................................... 86CVS NICOTINE.................................. 86CVS NICOTINE POLACRILEX..............86cvs nicotine polacrilex ...................... 86cvs phosphate saline laxative ...........67cvs prenatal ......................................74cvs prenatal multi+dha .................... 76cvs purelax ....................................... 66cvs super b complex/c ...................... 73



99

cyanocobalamin ...............................64cyclafem 1/35 .................................. 44cyclafem 7/7/7 .................................48cyclobenzaprine hcl ..........................77cyclopentolate hcl ............................ 79CYCLOPHOSPHAMIDE...................... 34CYCLOSERINE................................... 31CYCLOSET......................................... 22cyclosporine ..................................... 40cyclosporine modified ...................... 40cyproheptadine hcl ...........................26cyred ................................................ 44CYSTADANE......................................59CYSTAGON....................................... 62CYSTARAN........................................ 81CYTOMEL..........................................89cytra k crystals ................................. 62dalfampridine er .............................. 85DALIRESP..........................................16danazol ............................................ 12dantrolene sodium ...........................77dapsone ......................................29, 51DAPTACEL........................................ 90DARAPRIM....................................... 30darifenacin hydrobromide er ..... 92, 93dasetta 1/35 .................................... 44dasetta 7/7/7 ...................................48daysee ..............................................47DAYTRANA......................................... 5deblitane .......................................... 48DELESTROGEN..................................60DELSTRIGO....................................... 37deltasone ......................................... 49delyla ................................................44DELZICOL..........................................61demeclocycline hcl ........................... 89DEMSER........................................... 28DENAVIR.......................................... 54denta 5000 plus ............................... 72dentagel ...........................................72DEPAKENE........................................19DEPAKOTE........................................19DEPAKOTE ER...................................19DEPAKOTE SPRINKLES......................19DEPEN TITRATABS............................40DEPO-ESTRADIOL............................. 60DEPO-PROVERA............................... 34DESCOVY.......................................... 37desipramine hcl ................................21desloratadine ................................... 26desmopressin ace spray refrig ......... 59desmopressin acetate ...................... 60

desmopressin acetate spray ............ 60desogestrel-ethinyl estradiol ......44, 45desonide ...........................................54desoximetasone ............................... 54desvenlafaxine succinate er ............. 21dexamethasone ............................... 49dexamethasone intensol ..................49dexamethasone sodium phosphate . 81dexmethylphenidate hcl .....................5dexmethylphenidate hcl er .................5dextroamphetamine sulfate .............. 5dextroamphetamine sulfate er .......... 5dialyvite 800 .....................................72DIASTAT ACUDIAL............................ 17DIASTAT PEDIATRIC..........................17diazepam ....................................14, 17diazepam intensol ............................14DICLEGIS...........................................25diclofenac potassium ......................... 7diclofenac sodium ............ 7, 52, 53, 80diclofenac sodium er .......................... 7diclofenac-misoprostol .......................7dicloxacillin sodium ..........................83dicyclomine hcl .................................90didanosine ........................................38DIFICID............................................. 69diflorasone diacetate ....................... 54diflunisal .............................................9digitek .............................................. 42digox ................................................ 42digoxin ............................................. 42dihydroergotamine mesylate ...........70DILANTIN..........................................19DILANTIN INFATABS.........................19diltiazem hcl .....................................42diltiazem hcl er .................................42diltiazem hcl er beads ...................... 42diltiazem hcl er coated beads .......... 42dilt-xr ................................................42DIPENTUM....................................... 61diphenhydramine hcl ....................... 26diphenoxylate-atropine ....................24DIPHTHERIA-TETANUS TOXOIDS DT 90dipyridamole .................................... 64disopyramide phosphate ................. 14disulfiram ......................................... 84DIURIL.............................................. 58divalproex sodium ......................19, 20divalproex sodium er ........................19DIVIGEL............................................ 60dofetilide .......................................... 14donepezil hcl .................................... 84

dorzolamide hcl ................................80dorzolamide hcl-timolol mal ............ 78dorzolamide hcl-timolol mal pf ........ 78dothelle dha ..................................... 74doxazosin mesylate ..........................28doxepin hcl ................................. 21, 53doxercalciferol ..................................59doxycycline hyclate .......................... 89doxycycline monohydrate ................ 89dronabinol ........................................25drospiren-eth estrad-levomefol ....... 45drospirenone-ethinyl estradiol .........45DROXIA.............................................64DUAVEE............................................61ducodyl .............................................68DULERA............................................ 15duloxetine hcl ...................................21DUREZOL..........................................81dutasteride .......................................62dutasteride-tamsulosin hcl .............. 63DYRENIUM....................................... 57e.e.s. 400 ..........................................69ec-81 aspirin .......................................9econazole nitrate ............................. 55econtra ez ........................................ 47econtra one-step ..............................47ecotrin low strength ...........................9ed-spaz .............................................91EDURANT......................................... 38eemt .................................................60eemt hs ............................................ 60efavirenz .......................................... 38EFFER-K............................................ 71effer-k ...............................................71effervescent pot chloride ................. 71EGRIFTA........................................... 58ELESTRIN.......................................... 60eletriptan hydrobromide ..................70ELIDEL.............................................. 56elinest ...............................................45ELIQUIS............................................ 17ELIQUIS STARTER PACK....................17ELLA..................................................47ELMIRON..........................................63EMADINE..........................................79EMBEDA........................................... 11EMCYT..............................................34EMEND.............................................25emoquette ........................................45EMSAM............................................ 20EMTRIVA.......................................... 38EMVERM.......................................... 13



100

enalapril maleate .............................27enalapril-hydrochlorothiazide ..........27ENBREL...............................................8ENBREL MINI......................................8ENBREL SURECLICK............................ 8endocet ............................................ 12ENGERIX-B........................................94enoxaparin sodium .......................... 17enpresse-28 ......................................48enskyce .............................................45ENSTILAR..........................................56entacapone ...................................... 35entecavir .......................................... 39ENTRESTO........................................ 78enulose .............................................62EPANED............................................27EPCLUSA...........................................65epinastine hcl ................................... 79EPINEPHRINE................................... 95EPIPEN 2-PAK................................... 95EPIPEN JR 2-PAK...............................96epitol ................................................ 18EPIVIR HBV....................................... 39eplerenone ....................................... 29eprosartan mesylate ........................ 28eq aspirin adult low dose ................... 9eq aspirin low dose ............................ 9eq childrens aspirin ............................ 9eq clearlax ........................................66eq gentle laxative .............................68eq magnesium citrate ...................... 67EQ NICOTINE....................................86eq nicotine ....................................... 86eq nicotine polacrilex ....................... 86EQ NICOTINE POLACRILEX............... 86eq nicotine step 3 .............................86eq womans laxative ......................... 68eql aspirin low dose ........................... 9eql b complex 50 .............................. 73eql b-100 complex ............................73eql clearlax .......................................66eql gentle laxative ............................68eql laxative .......................................68eql magnesium citrate ..................... 67eql milk of magnesia ........................67eql nicotine polacrilex ...................... 86eql prenatal formula ........................ 74eql super b complex/vitamin c ......... 72EQUETRO......................................... 35ergoloid mesylates ...........................85ERGOMAR........................................ 70ergotamine-caffeine ........................ 70

ERIVEDGE......................................... 32ERLEADA.......................................... 31errin ..................................................48ERTACZO.......................................... 55ery .................................................... 51erygel ............................................... 51ERYPED 200......................................69ERYPED 400......................................69ery-tab ............................................. 69ERY-TAB........................................... 69erythrocin stearate .......................... 69erythromycin ..............................51, 79erythromycin base ........................... 69erythromycin ethylsuccinate ............69ESBRIET............................................ 88escitalopram oxalate ....................... 20esomeprazole magnesium ............... 91est estrogens-methyltest ................. 60est estrogens-methyltest ds .............60est estrogens-methyltest hs .............60estarylla ........................................... 45estazolam .........................................65estradiol ..................................... 60, 95estradiol valerate .............................60estradiol-norethindrone acet ........... 60ESTRING........................................... 95eszopiclone .......................................65ethacrynic acid .................................57ethambutol hcl .................................31ethosuximide ....................................19ethynodiol diac-eth estradiol ........... 45etidronate disodium .........................58etodolac ............................................. 7etodolac er ......................................... 7etoposide ......................................... 34EURAX.............................................. 56EVAMIST.......................................... 60EVOTAZ............................................ 37EXELDERM........................................55exemestane ......................................34EXJADE............................................. 24EXTAVIA........................................... 85ezetimibe ..........................................27ezetimibe-simvastatin ......................27falmina .............................................45famciclovir ........................................39famotidine ........................................91FANAPT............................................ 36FANAPT TITRATION PACK................ 36FARESTON........................................ 31FARXIGA........................................... 23FARYDAK.......................................... 32

fayosim ............................................ 47fc female condom ............................ 69FC2 FEMALE CONDOM.....................69fe c tab plus ......................................64felbamate .........................................19FELBATOL......................................... 19felodipine er ..................................... 42fem ph ..............................................95FEMCAP............................................69FEMRING..........................................95femynor ............................................45fenofibrate ....................................... 26fenofibrate micronized .....................26fenofibric acid .................................. 26fenoprofen calcium ............................ 7fentanyl ............................................11fentanyl citrate ................................ 11FERRIPROX....................................... 24FETZIMA...........................................21FETZIMA TITRATION.........................21FIASP................................................ 22FIASP FLEXTOUCH............................ 22FINACEA........................................... 56finasteride ........................................ 62FIRAZYR............................................63FIRVANQ.......................................... 63flavoxate hcl .....................................93flecainide acetate .............................14FLOVENT DISKUS..............................16FLOVENT HFA...................................16floxin otic ......................................... 82FLUAD.............................................. 94FLUARIX QUADRIVALENT.................94FLUBLOK QUADRIVALENT................94FLUCELVAX QUADRIVALENT............ 94fluconazole .......................................25flucytosine ........................................25fludrocortisone acetate ....................49FLULAVAL QUADRIVALENT.............. 94FLUMIST QUADRIVALENT................ 94flunisolide .........................................77fluocinolone acetonide ...............54, 82fluocinolone acetonide body ............54fluocinolone acetonide scalp ............54fluocinonide ..................................... 55fluocinonide emulsified base ............55fluoritab ........................................... 70fluorometholone .............................. 81fluorouracil .......................................53fluoxetine hcl ....................................20fluoxetine hcl (pmdd) ....................... 85fluphenazine hcl ............................... 36



101

flurazepam hcl ................................. 65flurbiprofen ........................................ 7flurbiprofen sodium ......................... 80flutamide ..........................................31fluticasone propionate ............... 55, 77FLUTICASONE-SALMETEROL............ 15fluvastatin sodium ........................... 26fluvastatin sodium er ....................... 26fluvoxamine maleate ....................... 20fluvoxamine maleate er ................... 20FLUZONE HIGH-DOSE.......................94FLUZONE QUADRIVALENT............... 94FML.................................................. 81FML FORTE.......................................81folic acid ...........................................64folivane-ob ....................................... 74foltabs 800 ....................................... 64fondaparinux sodium ....................... 17FORTEO............................................ 59fosamprenavir calcium .....................38fosinopril sodium ..............................27fosinopril sodium-hctz ......................27FRAGMIN......................................... 17frovatriptan succinate ......................70full spectrum b/vitamin c ................. 72furosemide ....................................... 57FUZEON............................................37fyavolv ..............................................60FYCOMPA.........................................17g tussin ac ........................................ 49gabapentin .......................................18GABITRIL.......................................... 19galantamine hydrobromide ............. 84galantamine hydrobromide er ......... 84GALZIN............................................. 71GARDASIL 9...................................... 94gatifloxacin ...................................... 79GATTEX............................................ 61gavilax ..............................................66gavilyte-c ..........................................66gavilyte-g ......................................... 66gavilyte-h ......................................... 66gavilyte-n with flavor pack ...............66gemfibrozil ....................................... 26generlac ........................................... 62gengraf ............................................ 40gentak .............................................. 79gentamicin sulfate ..................... 52, 79gentle laxative ..................................68gentlelax .......................................... 66GENVOYA......................................... 37GHT TEST..........................................57

gianvi ............................................... 45gildess fe 1.5/30 ...............................45gildess fe 1/20 ..................................45GILENYA........................................... 88GILOTRIF.......................................... 33glatiramer acetate ........................... 85glatopa .............................................85GLEOSTINE....................................... 34glimepiride ....................................... 23glipizide ............................................23glipizide er ........................................23glipizide xl ........................................ 23glipizide-metformin hcl .................... 23GLUCAGEN HYPOKIT........................ 21GLUCAGON EMERGENCY.................21glyburide .......................................... 24glyburide micronized ........................24glyburide-metformin ........................23glycine urologic ................................ 63glycolax ............................................ 66glycopyrrolate .................................. 91glydo ................................................ 55GLYXAMBI........................................ 88gnp adult aspirin low strength ...........9gnp aspirin ......................................... 9gnp aspirin low dose .......................... 9gnp b-100 complex ...........................73gnp bisa-lax ......................................68gnp clearlax ......................................66gnp daily prenatal ............................74gnp folic acid ....................................64gnp laxative ..................................... 68gnp magnesium citrate ....................67gnp milk of magnesia .......................67GNP NICOTINE MINI.........................86gnp nicotine polacrilex .....................86GNP NICOTINE POLACRILEX.............86gnp prenatal .................................... 74gnp womens laxative ....................... 68goodsense aspirin .............................. 9goodsense aspirin adult low st ...........9goodsense aspirin low dose ............... 9goodsense clearlax ...........................66goodsense magnesium citrate ......... 67goodsense nicotine .......................... 86granisetron hcl ................................. 25griseofulvin microsize .......................25griseofulvin ultramicrosize ...............25guaiatussin ac .................................. 49guaifenesin ac .................................. 50guaifenesin dac ................................50guaifenesin-codeine .........................50

guanfacine hcl ..................................28guanfacine hcl er ................................5guanidine hcl ....................................30GYNAZOLE-1.....................................95HAEGARDA.......................................63halobetasol propionate ....................55HALOG..............................................55haloperidol .......................................36haloperidol lactate ...........................36HARVONI..........................................65HAVRIX.............................................94healthylax ........................................ 66heather .............................................48HEMANGEOL....................................41hemenatal ob ...................................74hemenatal ob + dha .........................74hemetab ...........................................64heparin lock flush .............................17heparin sodium (porcine) ................. 17heparin sodium (porcine) pf .............17heparin sodium lock flush ................ 17HEPLISAV-B...................................... 94HETLIOZ............................................65HIBERIX............................................ 93hm aspirin .......................................... 9hm aspirin ec low dose .......................9hm clearlax .......................................66hm folic acid .....................................64hm laxative ...................................... 68hm magnesium citrate .....................67hm milk of magnesia ........................67hm nicotine ...................................... 86hm nicotine polacrilex ......................86hm prenatal ..................................... 74hm super vitamin b complex/c .........72hm vitamin b complex/vitamin c ..... 72hm vitamin b100 complex ................73hm vitamin b50 complex ..................73homatropaire ...................................79homatropine hbr ..............................79HP ACTHAR...................................... 58HUMALOG........................................22HUMALOG JUNIOR KWIKPEN.......... 22HUMALOG KWIKPEN........................22HUMALOG MIX 50/50......................22HUMALOG MIX 50/50 KWIKPEN......22HUMALOG MIX 75/25......................22HUMALOG MIX 75/25 KWIKPEN......22HUMATROPE....................................58HUMIRA............................................. 6HUMIRA PEDIATRIC CROHNS START................................................. 6



102

HUMIRA PEN......................................6HUMIRA PEN-CD/UC/HS STARTER.....6HUMIRA PEN-PS/UV STARTER........... 6HUMULIN R U-500 (CONCENTRATED)............................ 22HUMULIN R U-500 KWIKPEN........... 22HYCAMTIN....................................... 34hydralazine hcl ................................. 29hydrochlorothiazide ......................... 58hydrocod polst-cpm polst er ............ 50hydrocodone-acetaminophen ..........10hydrocodone-homatropine .............. 49hydrocodone-ibuprofen ................... 10hydrocortisone ..................... 13, 49, 55hydrocortisone ace-pramoxine .. 13, 56hydrocortisone acetate .................... 13hydrocortisone butyr lipo base ........ 55hydrocortisone butyrate .................. 55hydrocortisone valerate ...................55hydrocortisone-acetic acid ...............82hydromet ..........................................49hydromorphone hcl ..........................11hydromorphone hcl er ......................11hydroxychloroquine sulfate ..............30hydroxyprogesterone caproate ........84hydroxyurea ..................................... 33hydroxyzine hcl ................................ 14hydroxyzine pamoate .......................14hyophen ........................................... 92hyoscyamine sulfate ........................ 91hyoscyamine sulfate er .................... 91hyoscyamine sulfate sl ..................... 91hyosyne ............................................ 91HYPERSAL.........................................50HYSINGLA ER....................................11ibandronate sodium .........................58IBRANCE...........................................51ibu ...................................................... 7ibuprofen ............................................7ICLUSIG............................................ 33IDHIFA.............................................. 66ILEVRO............................................. 80imatinib mesylate ............................ 33IMBRUVICA...................................... 33imipramine hcl ................................. 21imipramine pamoate ....................... 21imiquimod ........................................ 55inatal gt ............................................74INCRELEX..........................................59INCRUSE ELLIPTA..............................16indapamide ...................................... 58indomethacin ..................................... 7

indomethacin er .................................7INFANRIX..........................................90INGREZZA......................................... 84INLYTA..............................................33INTELENCE....................................... 38introvale ...........................................47INVIRASE.......................................... 38IOPIDINE...........................................80IPOL..................................................94ipratropium bromide ..................16, 77ipratropium-albuterol ...................... 15irbesartan .........................................28irbesartan-hydrochlorothiazide ....... 28IRESSA.............................................. 33ISENTRESS........................................ 38ISENTRESS HD.................................. 38isibloom ............................................45isoniazid ........................................... 31isosorbide dinitrate .......................... 13isosorbide dinitrate er ......................13isosorbide mononitrate ....................13isosorbide mononitrate er ................13isotretinoin .......................................52isradipine ......................................... 42itraconazole ..................................... 25ivermectin ........................................ 13JADENU............................................ 24JADENU SPRINKLE............................24JAKAFI.............................................. 34jantoven ........................................... 17JANUMET......................................... 22JANUMET XR.................................... 22JANUVIA...........................................22JARDIANCE....................................... 23jencycla ............................................ 48JENTADUETO....................................22JENTADUETO XR...............................22jevantique lo .................................... 60jinteli ................................................ 60jolessa .............................................. 47jolivette ............................................ 48juleber .............................................. 45JULUCA.............................................37junel 1.5/30 ......................................45junel 1/20 .........................................45junel fe 1.5/30 ..................................45junel fe 1/20 .....................................45junel fe 24 ........................................ 45JYNARQUE........................................59kaitlib fe ........................................... 45KALETRA...........................................37KALYDECO........................................ 88

kariva ............................................... 44k-effervescent .................................. 71kelnor 1/35 .......................................45kelnor 1/50 .......................................45KEPPRA.............................................18KEPPRA XR....................................... 18ketoconazole .............................. 25, 55ketoprofen ......................................... 7ketoprofen er ..................................... 7ketorolac tromethamine .............. 7, 80KEVEYIS............................................ 57KINERET..............................................7KINRIX.............................................. 90kionex .........................................40, 83KISQALI 200 DOSE............................ 51KISQALI 400 DOSE............................ 51KISQALI 600 DOSE............................ 51KISQALI FEMARA 200 DOSE............. 33KISQALI FEMARA 400 DOSE............. 33KISQALI FEMARA 600 DOSE............. 33klofensaid ii ...................................... 53KLONOPIN........................................ 17klor-con ............................................ 71klor-con 10 ....................................... 71klor-con m10 .................................... 71klor-con m15 .................................... 71klor-con m20 .................................... 71klor-con/ef ....................................... 71kls aspirin low dose ............................ 9kls laxaclear ..................................... 67kls quit2 ............................................86KLS QUIT2.........................................87kls quit4 ............................................87KLS QUIT4.........................................87kobee ............................................... 73KORLYM........................................... 23kp aspirin ............................................9kp bisacodyl ..................................... 68kp folic acid ...................................... 64kp prenatal multivitamins ................75K-PHOS.............................................71k-tab .................................................71kurvelo ............................................. 45KUVAN............................................. 59k-vescent .......................................... 71labetalol hcl ......................................41LACRISERT........................................ 78lactated ringers ................................40lactulose ...........................................67lactulose encephalopathy ................ 62LAMICTAL.........................................18LAMICTAL ODT.................................18



103

LAMICTAL XR....................................18lamivudine ..................................38, 39lamivudine-zidovudine ..................... 37lamotrigine .......................................18lamotrigine er .................................. 18LANOXIN.......................................... 43lansoprazole .....................................91LANTUS............................................ 22LANTUS SOLOSTAR.......................... 22larin 1.5/30 ...................................... 45larin 1/20 ......................................... 45larin 24 fe .........................................45larin fe 1.5/30 .................................. 45larin fe 1/20 ..................................... 45larissia ..............................................45LASTACAFT.......................................79latanoprost ...................................... 81LATUDA............................................35laxative .............................................68layolis fe ........................................... 45leena ................................................ 48leflunomide ........................................ 8LENVIMA 10 MG DAILY DOSE.......... 33LENVIMA 12 MG DAILY DOSE.......... 33LENVIMA 14 MG DAILY DOSE.......... 33LENVIMA 18 MG DAILY DOSE.......... 33LENVIMA 20 MG DAILY DOSE.......... 33LENVIMA 24 MG DAILY DOSE.......... 33LENVIMA 4 MG DAILY DOSE............ 33LENVIMA 8 MG DAILY DOSE............ 33lessina .............................................. 45LETAIRIS........................................... 43letrozole ........................................... 34leucovorin calcium ........................... 34LEUKERAN........................................ 34levalbuterol hcl ................................ 15LEVALBUTEROL TARTRATE...............15LEVEMIR...........................................22LEVEMIR FLEXTOUCH.......................22levetiracetam ................................... 18levetiracetam er ...............................18levobunolol hcl ................................. 78levocarnitine .................................... 58levofloxacin ................................ 61, 79levonest ............................................48levonorgest-eth est & eth est ...........47levonorgest-eth estrad 91-day .........47levonorgestrel .................................. 47levonorgestrel-ethinyl estrad ..... 45, 47levonorg-eth estrad triphasic ...........48levora 0.15/30 (28) .......................... 45levorphanol tartrate ........................ 11

LEVO-T............................................. 89levothyroxine sodium .......................89levothyroxine-liothyronine ...............89levoxyl .............................................. 89LEXIVA..............................................38lidocaine .....................................55, 56lidocaine hcl ..................................... 56lidocaine pak ....................................56lidocaine viscous .............................. 71lidocaine-hydrocortisone ace ...........13lidocaine-prilocaine ..........................56lillow .................................................45lindane ............................................. 56linezolid ............................................30LINZESS............................................ 61liothyronine sodium ......................... 90lisinopril ............................................27lisinopril-hydrochlorothiazide .......... 27lithium ..............................................35lithium carbonate .............................35lithium carbonate er ........................ 35LITHOSTAT....................................... 63LIVALO..............................................26LONSURF..........................................33loperamide hcl ................................. 24lopinavir-ritonavir ............................ 37lopreeza ........................................... 60lorazepam ........................................ 14lorazepam intensol .......................... 14lorcet ................................................10lorcet hd ........................................... 10lorcet plus .........................................10lortuss ex ..........................................50loryna ............................................... 45losartan potassium .......................... 28losartan potassium-hctz ...................28LOTEMAX......................................... 81lovastatin ......................................... 27low-ogestrel ..................................... 46loxapine succinate ............................36ludent ...............................................70lutera ................................................46LUZU.................................................55LYNPARZA........................................ 83LYRICA.............................................. 18LYSODREN........................................ 31lyza ...................................................48magnesium citrate ...........................67MAKENA...........................................84malathion .........................................56maprotiline hcl ................................. 20MAR-COF BP.................................... 50

MAR-COF CG EXPECTORANT........... 50marlissa ............................................46MARPLAN.........................................20MATULANE...................................... 33MAVYRET......................................... 65m-clear wc ........................................50me/naphos/mb/hyo1 .......................92meclizine hcl .....................................25meclofenamate sodium ..................... 7medroxyprogesterone acetate ...48, 84mefenamic acid ..................................7mefloquine hcl ..................................30megestrol acetate ............................34MEKINIST......................................... 32MEKTOVI..........................................32melodetta 24 fe ................................46meloxicam ..........................................7melphalan ........................................ 34memantine hcl ................................. 85memantine hcl er ............................. 85MENACTRA...................................... 93MENEST............................................60MENTAX...........................................52MENVEO.......................................... 93meperidine hcl ..................................11meprobamate .................................. 14mercaptopurine ............................... 31mesalamine ......................................62MESNEX........................................... 34MESTINON....................................... 30metadate er ....................................... 5metaproterenol sulfate .................... 15metaxall ........................................... 77metaxalone ...................................... 77metformin hcl ...................................21metformin hcl er .............................. 21methadone hcl ................................. 11methadone hcl intensol ....................11methadose ....................................... 11methadose sugar-free ......................11methamphetamine hcl .......................5methazolamide ................................ 57methenamine hippurate .................. 92methenamine mandelate .................92methergine .......................................82methimazole .................................... 89METHITEST.......................................12methocarbamol ............................... 77methotrexate ................................... 31methotrexate sodium .......................32methotrexate sodium (pf) ................ 32methoxsalen .....................................53



104

methoxsalen rapid ........................... 53methscopolamine bromide .............. 91methyclothiazide ..............................58methyldopa ......................................28methyldopa-hydrochlorothiazide .....28methylergonovine maleate ..............82methylphenidate hcl .......................... 5methylphenidate hcl er ...................... 5methylphenidate hcl er (cd) ............... 5methylphenidate hcl er (la) ................5methylprednisolone ......................... 49metipranolol .................................... 78metoclopramide hcl ......................... 61metolazone ...................................... 58METOPIRONE...................................56metoprolol succinate er ................... 41metoprolol tartrate ..........................41metoprolol-hydrochlorothiazide ...... 29metronidazole ...................... 29, 56, 95mexiletine hcl ................................... 14MIACALCIN.......................................58mibelas 24 fe ....................................46miconazole 3 .................................... 95microgestin 1.5/30 ...........................46microgestin 1/20 ..............................46microgestin fe 1.5/30 .......................46microgestin fe 1/20 ..........................46midodrine hcl ................................... 96migergot .......................................... 70miglitol .............................................21miglustat ..........................................64milk of magnesia ..............................67milk of magnesia concentrate ..........67millipred ........................................... 49millipred dp ...................................... 49mimvey ............................................ 60mimvey lo .........................................60miniprin low dose ...............................9MINIVELLE........................................60minocycline hcl .................................89minoxidil ...........................................29miralax ............................................. 67mirtazapine ......................................20MIRVASO..........................................56misoprostol ...................................... 92M-M-R II ...........................................94modafinil ............................................5moderiba ..........................................39moderiba 1200 dose pack ................39moderiba 800 dose pack ..................39moexipril hcl .....................................27moexipril-hydrochlorothiazide ......... 27

molindone hcl ...................................36mometasone furoate ................. 55, 78mondoxyne nl ...................................89mono-linyah ..................................... 46mononessa .......................................46montelukast sodium ........................ 16MONUROL........................................92morgidox ..........................................89morphine sulfate ..............................11morphine sulfate (concentrate) ....... 11morphine sulfate er ..........................11morphine sulfate er beads ............... 11MOVANTIK....................................... 62MOVIPREP........................................66MOXEZA........................................... 79moxifloxacin hcl ......................... 61, 79MOZOBIL..........................................64MULTAQ...........................................14multi vit/fl ........................................ 74multi-vit/fluoride ..............................74multivitamin/fluoride .......................74multi-vitamin/fluoride ......................74multivitamins/fluoride ..................... 74mupirocin ......................................... 52mupirocin calcium ............................52mvc-fluoride ..................................... 74my choice ......................................... 47my way .............................................47MYALEPT..........................................69mycophenolate mofetil .................... 40mycophenolate sodium ....................40MYDAYIS............................................ 5MYLERAN......................................... 31mynatal ............................................75mynatal advance ............................. 75mynatal plus .................................... 75mynatal-z ......................................... 75mynate 90 plus .................................75myorisan .......................................... 52MYRBETRIQ................................92, 93MYSOLINE........................................ 18MYTESI............................................. 24myzilra ............................................. 48nabumetone .......................................7nadolol ............................................. 41nadolol-bendroflumethiazide ...........29naftifine hcl ...................................... 52NAFTIN.............................................52naloxone hcl .....................................24naltrexone hcl .................................. 24NAMENDA XR TITRATION PACK.......85naproxen ............................................ 7

naproxen dr ........................................7naproxen sodium ............................... 7naratriptan hcl ................................. 70NARCAN........................................... 25NASCOBAL........................................64NATACYN......................................... 79nateglinide ....................................... 23NATPARA..........................................59nature-throid ................................... 90NEBUPENT....................................... 29nebusal .............................................50NEBUSAL.......................................... 50necon 0.5/35 (28) .............................46necon 1/35 (28) ................................46nefazodone hcl ...........................20, 88neomycin sulfate ................................6neomycin-bacitracin zn-polymyx ..... 80neomycin-polymyxin-dexameth .80, 81neomycin-polymyxin-gramicidin ......80neomycin-polymyxin-hc ............. 81, 82neo-polycin .......................................80neo-polycin hc .................................. 81NERLYNX.......................................... 33neuac ............................................... 51NEUPRO........................................... 35neutral sodium fluoride ....................72NEVANAC......................................... 80nevirapine ........................................ 38nevirapine er .................................... 38new day ............................................47newgen ............................................ 75NEXAVAR..........................................32NEXIUM............................................91next choice one dose ........................47niacin er (antihyperlipidemic) .......... 27NIACOR............................................ 27nicardipine hcl ..................................42nicorelief .......................................... 87NICORETTE.......................................87NICORETTE MINI.............................. 87nicotine ............................................ 87NICOTINE MINI.................................87NICOTINE POLACRILEX.....................87nicotine polacrilex ............................ 87nicotine step 1 ..................................87nicotine step 2 ..................................87nicotine step 3 ..................................87NICOTROL........................................ 87NICOTROL NS................................... 87nifedical xl ........................................ 42nifedipine ......................................... 42nifedipine er ..................................... 42



105

nifedipine er osmotic release ........... 42nikki ..................................................46nilutamide ........................................31nimodipine ....................................... 42NINLARO.......................................... 32nisoldipine er ....................................42nitro-bid ........................................... 13nitrofurantoin .................................. 92nitrofurantoin macrocrystal .............92nitrofurantoin monohyd macro ....... 92nitroglycerin .....................................13nitroglycerin er .................................13nitro-time ......................................... 13NITYR................................................59nizatidine ......................................... 91nora-be ............................................ 48NORDITROPIN FLEXPRO...................58norethin ace-eth estrad-fe ............... 46norethindrone .................................. 48norethindrone acetate ..................... 84norethindrone acet-ethinyl est .........46norethindrone-eth estradiol .............60norethin-eth estradiol-fe ..................46norgestimate-eth estradiol .............. 46norgestim-eth estrad triphasic .........48norlyda .............................................48norlyroc ............................................ 48NORPACE CR.................................... 14NORTHERA....................................... 78nortrel 0.5/35 (28) ........................... 46nortrel 1/35 (21) .............................. 46nortrel 1/35 (28) .............................. 46nortrel 7/7/7 .................................... 48nortriptyline hcl ................................21NORVIR............................................ 38NOVOLIN 70/30............................... 22NOVOLIN 70/30 RELION...................22NOVOLIN N...................................... 22NOVOLIN N RELION..........................22NOVOLIN R.......................................23NOVOLIN R RELION..........................23NOVOLOG........................................ 23NOVOLOG FLEXPEN......................... 23NOVOLOG MIX 70/30...................... 23NOVOLOG MIX 70/30 FLEXPEN........23NOVOLOG PENFILL...........................23NOXAFIL........................................... 25np thyroid .........................................90NUCYNTA......................................... 11NUEDEXTA....................................... 85NUPLAZID.........................................35NUTROPIN AQ NUSPIN 10............... 58

NUTROPIN AQ NUSPIN 20............... 58NUTROPIN AQ NUSPIN 5................. 59NUVARING....................................... 47NUVESSA..........................................95nyamyc .............................................52NYMALIZE........................................ 42nystatin ................................ 25, 52, 71nystatin-triamcinolone .....................52nystop .............................................. 52obstetrix dha ....................................75ocella ................................................46octreotide acetate ............................59ODEFSEY...........................................37ODOMZO..........................................32OFEV................................................ 88ofloxacin ...............................61, 79, 82ogestrel ............................................ 46olanzapine ........................................37olmesartan medoxomil .................... 28olmesartan medoxomil-hctz ............ 28olmesartan-amlodipine-hctz ............28olopatadine hcl .......................... 77, 79OMECLAMOX-PAK........................... 92omega-3-acid ethyl esters ................26omeprazole ...................................... 91ondansetron .....................................25ondansetron hcl ............................... 25ONFI................................................. 18opcicon one-step ..............................47opium ............................................... 24OPSUMIT..........................................43option 2 ............................................47options gynol ii contraceptive ..........95oralone .............................................72ORAVIG............................................ 72ORENCIA............................................ 8ORENCIA CLICKJECT........................... 8ORENITRAM..................................... 43ORFADIN.......................................... 59ORKAMBI......................................... 51orphenadrine citrate er ....................77orsythia ............................................ 46oscimin .............................................91oscimin sr ......................................... 91oseltamivir phosphate ..................... 40OTEZLA.............................................83oxandrolone ..................................... 12oxaprozin ........................................... 7oxazepam .........................................14oxcarbazepine ..................................18oxiconazole nitrate .......................... 55OXTELLAR XR....................................18

oxybutynin chloride ....................92, 93oxybutynin chloride er ................92, 93oxycodone hcl .................................. 11oxycodone-acetaminophen ..............12oxycodone-aspirin ............................12oxycodone-ibuprofen ....................... 12OXYCONTIN......................................11oxymorphone hcl ..............................11oxymorphone hcl er ......................... 11OZEMPIC.......................................... 23pa b-complex with b-12 ................... 72pacerone .......................................... 14paliperidone er .................................36PANRETIN.........................................53pantoprazole sodium ....................... 91paregoric ..........................................24paricalcitol ....................................... 59paroex .............................................. 72paromomycin sulfate ......................... 6paroxetine hcl .................................. 20paroxetine hcl er .............................. 20PASER...............................................31PAZEO.............................................. 79PEDIARIX.......................................... 90PEDVAX HIB......................................93peg 3350 .......................................... 67peg 3350/electrolytes ...................... 66peg 3350-kcl-na bicarb-nacl .............66peg-3350/electrolytes ......................66PEGANONE.......................................19PEGASYS...........................................39PEGASYS PROCLICK.......................... 39PEGINTRON......................................39peg-prep ...........................................66penicillin v potassium .......................82PENTACEL.........................................90PENTASA.......................................... 62pentazocine-naloxone hcl ................ 12pentoxifylline er ............................... 63PERFOROMIST..................................15perindopril erbumine ....................... 27permethrin ....................................... 56perphenazine ................................... 36perphenazine-amitriptyline ..............85perry prenatal .................................. 75phenadoz ......................................... 26phenazopyridine hcl ......................... 63phenelzine sulfate ............................ 20phenobarbital .................................. 65phenoxybenzamine hcl .....................28phenylephrine hcl .............................80PHENYTEK........................................ 19



106

phenytoin ......................................... 19phenytoin infatabs ........................... 19phenytoin sodium extended .............19philith ............................................... 46PHOSLYRA........................................ 62phosphasal .......................................92phosphate laxative ...........................67PHOSPHOLINE IODIDE..................... 79PHYTONADIONE...............................96phytonadione ...................................96PICATO............................................. 53PIFELTRO..........................................38pilocarpine hcl ............................72, 79pimozide ...........................................85pimtrea ............................................ 44pindolol ............................................ 41pioglitazone hcl ................................24pioglitazone hcl-glimepiride .............24pioglitazone hcl-metformin hcl ........ 24pirmella 1/35 ................................... 46pirmella 7/7/7 ..................................48piroxicam ........................................... 7PLEGRIDY......................................... 85PLEGRIDY STARTER PACK.................85PNEUMOVAX 23.............................. 93pnv prenatal plus multivitamin ........75pnv tabs 29-1 ................................... 75pnv-dha ............................................76pnv-dha+docusate ........................... 76pnv-omega .......................................75pnv-select .........................................75podofilox .......................................... 55polycin ..............................................80polyethylene glycol 3350 ............67, 83polymyxin b-trimethoprim ............... 80polyvitamin/fluoride ........................ 74POMALYST....................................... 32portia-28 .......................................... 46potassium chloride ...........................71potassium chloride crys er ............... 71potassium chloride er .......................71potassium citrate er .........................62pr natal 400 ......................................76pr natal 400 ec ................................. 76pr natal 430 ......................................76pr natal 430 ec ................................. 76PRADAXA..........................................17PRALUENT........................................ 82pramcort .......................................... 13pramipexole dihydrochloride ........... 35pramipexole dihydrochloride er ....... 35prasugrel hcl .................................... 64

pravastatin sodium .......................... 27praziquantel .....................................13prazosin hcl ...................................... 29PRED MILD....................................... 81PRED-G.............................................81PRED-G S.O.P. .................................. 81prednicarbate .................................. 55prednisolone .................................... 49prednisolone acetate ....................... 81prednisolone sodium phosphate 49, 81prednisone ....................................... 49prednisone intensol ..........................49PREMARIN........................................61PREMPHASE..................................... 60PREMPRO.........................................60prena 1 true ..................................... 76prena1 ..............................................77prena1 pearl .....................................75prenaissance .................................... 76prenaissance plus .............................76prenatabs rx .....................................75prenatal ........................................... 75prenatal complete ............................75prenatal low iron ..............................75prenatal multi +dha ......................... 76prenatal one daily ............................ 75prenatal plus .................................... 75prenatal plus iron .............................75prenatal vitamin and mineral .......... 75prenatal vitamin plus low iron ......... 75prenatal vitamins .............................75prenatal/iron ....................................75prenatal-u ........................................ 75preplus ............................................. 75PREPOPIK......................................... 66pretab .............................................. 75prevalite ........................................... 26previfem ...........................................46PREVNAR 13.....................................93PREVYMIS.........................................39PREZCOBIX....................................... 37PREZISTA.......................................... 38PRIFTIN.............................................31PRIMAQUINE PHOSPHATE............... 30primidone .........................................18PRIMSOL.......................................... 29PROAIR HFA..................................... 15PROAIR RESPICLICK.......................... 15probenecid ....................................... 63prochlorperazine ..............................36prochlorperazine maleate ................36procto-med hc ..................................13

procto-pak ........................................13proctosol hc ......................................13proctozone-hc .................................. 13PROCYSBI......................................... 62progesterone micronized ................. 84PROGLYCEM.....................................21PROLENSA........................................ 80PROMACTA...................................... 64promethazine hcl ............................. 26promethazine vc plain ......................50promethazine vc/codeine .................50promethazine-codeine ..................... 50promethazine-dm ............................ 50promethazine-phenyleph-codeine ... 50promethazine-phenylephrine ...........50promethegan ................................... 26propafenone hcl ............................... 14propafenone hcl er ...........................14propantheline bromide .................... 91propranolol hcl .................................41propranolol hcl er .............................41propranolol-hctz ...............................29propylthiouracil ................................89PROQUAD........................................ 94protriptyline hcl ................................21PROVENTIL HFA............................... 15prudoxin ...........................................53pseudoeph-bromphen-dm ............... 50pseudoeph-chlorphen-hydrocod ...... 51PULMICORT FLEXHALER...................16pulmosal .......................................... 50PULMOZYME....................................88px aspirin ............................................9px b complex/vitamin c ....................72px enteric aspirin ................................9px laxative ........................................68px milk of magnesia ......................... 67px stop smoking aid ......................... 87PYLERA............................................. 91pyrazinamide ................................... 31pyridostigmine bromide ...................30pyridostigmine bromide er ...............30QBRELIS............................................27qc aspirin low dose .............................9qc childrens aspirin ............................ 9qc gentle laxative .............................68qc magnesium citrate ...................... 67qc milk of magnesia ......................... 67qc natura-lax ....................................67qc prenatal .......................................75QUADRACEL..................................... 90quasense .......................................... 47



107

quazepam ........................................ 65QUDEXY XR...................................... 18quetiapine fumarate ........................ 36quetiapine fumarate er ....................36QUILLIVANT XR.................................. 5quinapril hcl ..................................... 27quinapril-hydrochlorothiazide ..........27quinidine gluconate er ..................... 14quinidine sulfate .............................. 14quinine sulfate ................................. 30QVAR REDIHALER.............................16ra aspirin adult low dose ....................9ra aspirin adult low strength ..............9ra aspirin childrens ...........................10ra aspirin ec ......................................10ra aspirin ec adult low st ..................10ra balanced b-100 ............................ 73ra balanced b-50 .............................. 73ra b-complex .................................... 72ra b-complex with b-12 .................... 72ra childrens aspirin ...........................10ra folic acid .......................................64ra laxative .................................. 67, 68ra magnesium citrate .......................68ra milk of magnesia ......................... 68ra mini nicotine ................................ 87ra nicotine ........................................ 87ra nicotine gum ................................87ra nicotine polacrilex ........................87ra one daily ...................................... 75ra prenatal ....................................... 75ra saline laxative .............................. 67ra womens laxative ..........................68rabeprazole sodium ......................... 91rajani ................................................46raloxifene hcl ....................................59ramipril ............................................ 28RANEXA............................................13ranitidine hcl .................................... 91RAPAFLO.......................................... 62RAPAMUNE......................................40rasagiline mesylate .......................... 35RASUVO............................................. 6RAVICTI............................................ 59react .................................................47REBETOL...........................................39REBIF................................................ 85REBIF REBIDOSE............................... 85REBIF REBIDOSE TITRATION PACK... 85REBIF TITRATION PACK.................... 85reclipsen ...........................................46RECOMBIVAX HB..............................94

RECTIV..............................................13REGRANEX........................................56RELENZA DISKHALER........................ 40RELISTOR..........................................62relnate dha .......................................75rena-vite ...........................................73repaglinide ....................................... 23repaglinide-metformin hcl ............... 23REPATHA.......................................... 82REPATHA PUSHTRONEX SYSTEM..... 82REPATHA SURECLICK........................82RESCRIPTOR..................................... 38REVATIO...........................................43REVLIMID......................................... 40REXULTI............................................37REYATAZ...........................................38ribasphere ........................................ 39ribasphere ribapak ...........................39ribavirin ............................................39RIDAURA............................................ 7rifabutin ........................................... 31RIFAMATE........................................ 30rifampin ........................................... 31RIFATER............................................30riluzole ............................................. 78rimantadine hcl ................................40ringers irrigation .............................. 40risedronate sodium .......................... 58risperidone ....................................... 36risperidone m-tab ............................ 36ritonavir ........................................... 38rivastigmine ..................................... 84rivastigmine tartrate ........................84rivelsa ...............................................47rizatriptan benzoate ........................ 70robafen ac ........................................50ropinirole hcl .................................... 35ropinirole hcl er ................................ 35rosadan ............................................ 56rosuvastatin calcium ........................27ROTARIX...........................................94ROTATEQ..........................................94roweepra ..........................................18RUBRACA......................................... 83RUCONEST....................................... 63RYDAPT............................................ 32rydex ................................................ 51RYTARY.............................................35SABRIL.............................................. 19saline laxative .................................. 67salsalate ...........................................10SAMSCA........................................... 59

SANDIMMUNE................................. 40SANTYL.............................................55SAPHRIS............................................36SAVAYSA.......................................... 17SAVELLA........................................... 84SAVELLA TITRATION PACK............... 84sb aspirin ..........................................10sb aspirin adult low strength ........... 10sb bisacodyl laxative ec ....................68sb childrens aspirin ...........................10sb gentle laxative womens ...............68sb low dose asa ec ........................... 10sb milk of magnesia ......................... 68sb polyethylene glycol 3350 ............. 67seconal ............................................. 65SEEBRI NEOHALER............................16SEGLUROMET...................................89selegiline hcl .....................................35selenium sulfide ............................... 54SELZENTRY....................................... 37se-natal 19 ....................................... 75SENSIPAR......................................... 58SEREVENT DISKUS............................ 15sertraline hcl .................................... 20setlakin .............................................48sevelamer carbonate ....................... 62sf ...................................................... 72sf 5000 plus ...................................... 72sharobel ........................................... 48SHINGRIX..........................................94SIGNIFOR..........................................59sildenafil citrate ............................... 43SILIQ................................................. 53silver sulfadiazine .............................54SIMBRINZA.......................................78SIMPONI.............................................6simvastatin .......................................27sirolimus ...........................................40SIRTURO...........................................31SKLICE...............................................56sm aspirin adult low strength .......... 10sm aspirin ec low strength ............... 10sm aspirin low dose ..........................10sm b100 complex ............................. 73sm balanced b-100 ...........................73sm balanced b-50 .............................73sm b-complex ...................................73sm b-complex/vitamin c ...................73sm childrens aspirin ......................... 10sm clearlax ....................................... 67sm folic acid ..................................... 64sm gentle laxative ............................68



108

sm magnesium citrate ..................... 68sm milk of magnesia ........................ 68sm nicotine .......................................87sm nicotine polacrilex ...................... 87sm oral saline laxative ..................... 67sm prenatal vitamins ....................... 75sm super b complex/c ...................... 73sm womans laxative ........................ 68smooth lax ....................................... 67sodium chloride ..........................50, 63sodium fluoride ................................ 71sodium phenylbutyrate .................... 59sodium polystyrene sulfonate .... 41, 83SODIUM POLYSTYRENE SULFONATE................................ 41, 83sodium sulfacetamide ......................54sodium sulfacetamide wash .............54SOLTAMOX.......................................31SOMAVERT.......................................58sotalol hcl .........................................41sotalol hcl (af) .................................. 41SOVALDI........................................... 39spinosad ...........................................56SPIRIVA HANDIHALER...................... 16SPIRIVA RESPIMAT........................... 16spironolactone ................................. 57spironolactone-hctz ......................... 57sprintec 28 ....................................... 46SPRYCEL........................................... 33sps .............................................. 41, 83sronyx ...............................................46ssd .................................................... 54SSKI.................................................. 50sss 10-5 ............................................ 51st joseph low dose ............................10stavudine ..........................................39STEGLATRO...................................... 23STELARA........................................... 53sterile water for irrigation ................40STIMATE...........................................60stimulant laxative ............................ 68STIOLTO RESPIMAT.......................... 15STIVARGA.........................................32STRENSIQ......................................... 65stress formula .................................. 73stress formula/iron .......................... 74STRIBILD........................................... 37STRIVERDI RESPIMAT....................... 15SUBOXONE.......................................12SUCRAID...........................................57sucralfate ......................................... 91sulfacetamide sodium ................ 54, 81

sulfacetamide sodium (acne) ........... 51sulfacetamide sodium-sulfur ......51, 52sulfacetamide-prednisolone .............81sulfacetamide-sulfur in urea ............ 52sulfacleanse 8/4 ...............................52sulfadiazine ...................................... 89sulfamethoxazole-trimethoprim ...... 29SULFAMYLON...................................54sulfasalazine .................................... 62sulfatrim pediatric ............................29sulfazine ........................................... 62sulindac .............................................. 7sumatriptan ..................................... 70sumatriptan succinate ..................... 70sumatriptan succinate refill ............. 70super b complex maxi ...................... 73super b complex/fa/vit c .................. 73super b-complex/vit c/fa ..................73super quints b-50 ............................. 74superplex-t ....................................... 73SUPRAX............................................ 44SUPREP BOWEL PREP KIT.................66SUTENT............................................ 32syeda ................................................46SYLATRON........................................ 34symax-sl ........................................... 91symax-sr ...........................................91SYMBICORT...................................... 15SYMDEKO.........................................51SYMFI............................................... 37SYMFI LO.......................................... 37SYMLINPEN 120............................... 21SYMLINPEN 60................................. 21SYMTUZA......................................... 37SYNAGEX.......................................... 74SYNAREL...........................................59SYNJARDY.........................................89SYNJARDY XR....................................89SYNRIBO...........................................34SYNTHROID...................................... 90TABLOID........................................... 32tacrolimus .................................. 40, 56tadalafil ............................................43tadalafil (pah) .................................. 43TAFINLAR......................................... 32TAGRISSO......................................... 33TALTZ............................................... 53tamoxifen citrate ............................. 31tamsulosin hcl .................................. 62TARCEVA.......................................... 33TARGRETIN.......................................56tarina fe 1/20 ...................................46

taron-bc ........................................... 75taron-c dha ...................................... 75taron-prex ........................................ 76TASIGNA...........................................33tazarotene ........................................53TAZORAC..........................................54taztia xt ............................................ 42TECFIDERA....................................... 85TEGRETOL........................................ 18TEGRETOL-XR................................... 18TEKTURNA........................................29TEKTURNA HCT................................ 29telmisartan .......................................28telmisartan-amlodipine ................... 28telmisartan-hctz ...............................28temazepam ...................................... 65temozolomide .................................. 34tencon ................................................ 8TENIVAC........................................... 90tenofovir disoproxil fumarate .......... 39terazosin hcl .....................................29terbinafine hcl .................................. 25terbutaline sulfate ........................... 15terconazole ...................................... 95testosterone .....................................12testosterone cypionate .................... 12testosterone enanthate ................... 12TETANUS-DIPHTHERIA TOXOIDS TD 90tetrabenazine ...................................84tetracycline hcl .................................89tgt aspirin .........................................10tgt aspirin low dose ..........................10tgt childrens aspirin ......................... 10tgt gentle laxative ............................68tgt nicotine .......................................87tgt nicotine polacrilex ...................... 87TGT NICOTINE POLACRILEX..............87tgt nicotine step one ........................ 87tgt nicotine step three ......................87tgt nicotine step two ........................87tgt powderlax ...................................67tgt womens laxative .........................68THALOMID....................................... 40THEO-24...........................................16theochron .........................................16theophylline ..................................... 16theophylline er ................................. 16thermazene ......................................54THIOLA............................................. 63thioridazine hcl .................................36thiothixene ....................................... 37THYROLAR-1.....................................90



109

THYROLAR-1/2................................. 90THYROLAR-1/4................................. 90THYROLAR-2.....................................90THYROLAR-3.....................................90tiagabine hcl .................................... 19TIBSOVO...........................................66tilia fe ............................................... 48timolol maleate ..........................41, 78TIMOPTIC OCUDOSE........................ 78tinidazole ......................................... 29TIROSINT.......................................... 90tis-u-sol ............................................ 40TIVICAY.............................................38tizanidine hcl .................................... 77tl-care dha ........................................76tl-select ............................................ 76TOBI PODHALER.................................6TOBRADEX........................................81TOBRADEX ST...................................81tobramycin ...................................6, 79tobramycin-dexamethasone ............81TOBREX............................................ 79TODAY SPONGE............................... 95tolazamide ....................................... 24tolbutamide ..................................... 24tolcapone ......................................... 35tolmetin sodium .................................8tolterodine tartrate ....................92, 93tolterodine tartrate er ................92, 93TOPAMAX........................................ 18TOPAMAX SPRINKLE........................ 18topiramate ....................................... 18torsemide ......................................... 57total b/c ........................................... 73TOUJEO MAX SOLOSTAR..................23TOUJEO SOLOSTAR.......................... 23TOVIAZ....................................... 92, 93TRACLEER.........................................43TRADJENTA...................................... 22tramadol hcl .....................................12tramadol hcl er .................................12tramadol hcl er (biphasic) ................ 12tramadol-acetaminophen ................12trandolapril ...................................... 28trandolapril-verapamil hcl er ........... 27tranexamic acid ............................... 65tranylcypromine sulfate ................... 20TRAVATAN Z.....................................81trazodone hcl ............................. 20, 88TRECATOR........................................ 31TRELEGY ELLIPTA..............................15TREMFYA..........................................53

TRESIBA FLEXTOUCH........................23tretinoin ..................................... 34, 52tretinoin microsphere .......................52tretinoin microsphere pump ............ 52tri femynor ....................................... 48triamcinolone acetonide ...... 55, 72, 78triamterene-hctz .............................. 57triazolam ..........................................65triderm ............................................. 55tri-estarylla .......................................48trifluoperazine hcl ............................ 36trifluridine ........................................ 80trihexyphenidyl hcl ........................... 35tri-legest fe .......................................48TRILEPTAL........................................ 19tri-linyah ...........................................48tri-lo-estarylla .................................. 48tri-lo-marzia ..................................... 48tri-lo-sprintec ................................... 48trilyte ................................................66trimethobenzamide hcl .................... 25trimethoprim ....................................29trimipramine maleate ......................21trinatal rx 1 ...................................... 76trinate .............................................. 76trinessa (28) ..................................... 49TRINTELLIX................................. 20, 88tri-previfem ...................................... 49tri-sprintec ........................................49tri-tabs dha ...................................... 76TRIUMEQ......................................... 37triveen-duo dha ................................76tri-vitamin/fluoride .......................... 74tri-vite/fluoride ................................ 74trivora (28) ....................................... 49TROKENDI XR................................... 19trospium chloride ....................... 92, 93trospium chloride er .........................93TRUE METRIX BLOOD GLUCOSE TEST..................................................57TRUETEST TEST................................ 57TRUETRACK TEST............................. 57TRULICITY.........................................23TRUMENBA...................................... 93TRUVADA......................................... 37TUDORZA PRESSAIR......................... 16tusnel c .............................................50TWINRIX...........................................94TYBOST.............................................37tydemy ............................................. 46TYKERB.............................................33TYMLOS............................................59

TYVASO............................................ 43TYVASO REFILL................................. 43TYVASO STARTER............................. 43UCERIS..............................................13ULESFIA............................................ 56ULORIC............................................. 63ultimatecare one ..............................76ultra b-100 complex ......................... 77unithroid .......................................... 90UPTRAVI...........................................88uretron d/s ....................................... 92urimar-t ............................................92urin ds .............................................. 92uro-458 ............................................ 92urogesic-blue ....................................92uro-mp ............................................. 92ursodiol ............................................ 61uryl ................................................... 92UTIBRON NEOHALER........................15utira-c ...............................................92valacyclovir hcl .................................39VALCHLOR........................................53valganciclovir hcl ..............................39valproate sodium ............................. 20valproic acid .....................................20valsartan .......................................... 28valsartan-hydrochlorothiazide .........28vancomycin hcl .................................63vandazole .........................................95VAQTA..............................................94VARIVAX...........................................95VARIZIG............................................ 82vcf vaginal contraceptive ................. 95velivet ...............................................49VELPHORO....................................... 62VELTASSA................................... 41, 83VEMLIDY...........................................39vena-bal dha .................................... 76VENCLEXTA...................................... 31VENCLEXTA STARTING PACK............31venlafaxine hcl ................................. 21venlafaxine hcl er ............................. 21VENTAVIS......................................... 43VENTOLIN HFA................................. 16verapamil hcl ....................................42verapamil hcl er ............................... 42verdrocet ..........................................11VERZENIO.........................................51VESICARE..........................................93vestura ............................................. 46VIBERZI.............................................65vicodin ..............................................11



110

vicodin es ......................................... 11vicodin hp .........................................11VICTOZA........................................... 23VIDEX............................................... 38vienva ...............................................46vigabatrin .........................................19VIIBRYD...................................... 20, 88VIIBRYD STARTER PACK..............20, 88VIMPAT............................................ 19vinate ii ............................................ 76vinate m ........................................... 76vinate one ........................................ 76viorele .............................................. 44VIRACEPT......................................... 38VIREAD............................................. 39virt-c dha ..........................................76virt-nate dha .................................... 76virt-pn .............................................. 76virt-pn dha ....................................... 76virt-pn plus ....................................... 76virtussin a/c ......................................50virtussin dac ..................................... 50VISTOGARD...................................... 24VITAFOL GUMMIES.......................... 76VITAFOL-OB......................................76VITAMAX..........................................74vitamin b complex ............................72vitamin b complex-c .........................73vitamin b-complex ........................... 72vitamin d (ergocalciferol) .................96vitamin-b complex ........................... 72vitamins acd-fluoride ....................... 74VITATRUE......................................... 76VIZIMPRO.........................................33voriconazole .....................................25VOSEVI............................................. 65VOTRIENT.........................................33VRAYLAR.......................................... 36vyfemla ............................................ 47VYVANSE............................................ 5warfarin sodium ...............................17wera ................................................. 47westhroid ......................................... 90WIDE-SEAL DIAPHRAGM 60.............69WIDE-SEAL DIAPHRAGM 65.............70WIDE-SEAL DIAPHRAGM 70.............70WIDE-SEAL DIAPHRAGM 75.............70WIDE-SEAL DIAPHRAGM 80.............70WIDE-SEAL DIAPHRAGM 85.............70WIDE-SEAL DIAPHRAGM 90.............70WIDE-SEAL DIAPHRAGM 95.............70womans laxative .............................. 68

womens laxative .............................. 68WP THYROID.................................... 90wymzya fe ........................................ 47XALKORI........................................... 33XARELTO.......................................... 17XARELTO STARTER PACK..................17XELJANZ............................................. 6XELJANZ XR........................................ 6XIFAXAN........................................... 29XIGDUO XR.......................................89XIIDRA.............................................. 69XOPENEX HFA.................................. 16XTANDI.............................................31xulane .............................................. 47XULTOPHY........................................66XURIDEN.......................................... 65XYREM..............................................84YONSA..............................................31yuvafem ........................................... 95zafirlukast ........................................ 16zaleplon ............................................65zarah ................................................ 47ZARONTIN........................................ 19zatean-pn dha ..................................76zatean-pn plus ................................. 76zebutal ............................................... 8ZEJULA..............................................83ZELBORAF.........................................32zenatane .......................................... 52ZENPEP.............................................57zidovudine ........................................39zileuton er ........................................ 15ziprasidone hcl ................................. 36ZIRGAN.............................................80ZOLINZA........................................... 32zolmitriptan ......................................70zolpidem tartrate ............................. 65zolpidem tartrate er .........................65ZOMIG..............................................70ZONEGRAN.......................................19zonisamide ....................................... 19ZONTIVITY........................................ 84ZORTRESS.........................................40ZOSTAVAX........................................ 95zovia 1/35e (28) ............................... 47ZUBSOLV.......................................... 12ZYDELIG............................................83ZYFLO............................................... 15ZYKADIA........................................... 33ZYLET................................................81ZYTIGA..............................................31



111

four-tier covered drug list 2019 prescription drug list.pdfbefore your plan will cover other drugs...

Documents