medicaid-approved over-the-counter preferred drug list · louisiana healthy blue medicaid-approved...

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Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class, drugs are listed alphabetically by either brand name or generic name. Brand name drug: Uppercase in bold type Generic drug: Lowercase in plain type AL: Age Limit Restrictions DO: Dose Optimization Program GR: Gender Restriction OTC: Over the counter medication available with a prescription. (Prescribers please indicate OTC on the prescription) PA: Prior authorization is required. Prior authorization is the process of obtaining approval of benefits before certain prescriptions are filled. QL: Quantity limits; certain prescription medications have specific quantity limits per prescription or per month. SP: Specialty Pharmacy ST: Step therapy is required. You may need to use one medication before benefits for the use of another medication can be authorized.

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Page 1: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Louisiana Healthy Blue

Medicaid-Approved

Over-the-Counter Preferred Drug List

Effective November 1, 2017

Legend

In each class, drugs are listed alphabetically by either brand name or generic name.

Brand name drug: Uppercase in bold type

Generic drug: Lowercase in plain type

AL: Age Limit Restrictions

DO: Dose Optimization Program

GR: Gender Restriction

OTC: Over the counter medication available with a prescription. (Prescribers please indicate OTC on the prescription)

PA: Prior authorization is required. Prior authorization is the process of obtaining approval of benefits before certain prescriptions are filled.

QL: Quantity limits; certain prescription medications have specific quantity limits per prescription or per month.

SP: Specialty Pharmacy

ST: Step therapy is required. You may need to use one medication before benefits for the use of another medication can be authorized.

Page 2: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

ALTERNATIVE THERAPY

ALTERNATIVE THERAPY - ANTIOXIDANT

antioxidant a/c/e/selenium oral capsule OTC

antioxidant vitamins oral tablet OTC; QL

e-400 c-500 and beta carotene oral tablet OTC

eye health plus lutein oral tablet OTC; QL

healthy eyes oral tablet OTC; QL

healthy eyes supervision oral capsule OTC

ICAPS AREDS ORAL CAPSULE OTC

i-vite oral tablet OTC; QL

i-vite protect oral tablet OTC; QL

MACUVITE WITH LUTEIN ORAL TABLET

OTC

multi-betic oral tablet OTC; QL

OCUVITE LUTEIN AND ZEAXANTHIN ORAL CAPSULE

OTC

OCUVITE ORAL CAPSULE OTC

OCUVITE WITH LUTEIN ORAL TABLET OTC; QL

opti-vitamins oral tablet OTC; QL

PRESERVISION AREDS ORAL CAPSULE

OTC

PRESERVISION AREDS ORAL TABLET OTC; QL

prosight oral tablet OTC; QL

SAVISION ORAL TABLET OTC; QL

super antioxidant oral capsule OTC

ultra antioxidant formula oral tablet OTC

vision formula (with lutein) oral tablet OTC; QL

vision-vite + zinc oral tablet OTC; QL

ALTERNATIVE THERAPY - UNCLASSIFIED

CHEW Q ORAL TABLET,CHEWABLE OTC

CHEW Q ORAL WAFER OTC

co q-10 (with vit e) oral capsule OTC

co q-10 oral capsule OTC

coenzyme q10 oral capsule OTC

coenzyme q10 oral tablet OTC

coenzyme q10-vitamin e oral capsule Co Q-10 (with Vit E) OTC

1

Page 3: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

coq-10 oral capsule OTC

echinacea angust-purpr root xt oral capsule

OTC

echinacea oral capsule OTC

echinacea purp leaf-ang rt ext oral capsule

OTC

echinacea purpurea aerial oral capsule OTC

effervescent formula oral tablet, effervescent

OTC

goldenseal root oral capsule OTC

h2q oral capsule OTC

healthy heart complex oral tablet OTC

melatonin (with b6) oral tablet OTC; QL

melatonin-pyridoxine (vit b6) oral tablet Melatonin (with B6) OTC; QL

mg-plus-protein oral tablet OTC

q-gel forte oral capsule OTC

q-gel mega oral capsule OTC

q-gel oral capsule OTC

q-gel ultra oral capsule OTC

q-sorb co q-10 oral capsule OTC

q-up oral liquid OTC

ESTROGENIC AGENTS

MENOPAUSE SUPPORT ORAL TABLET

OTC

ANALGESIC, ANTI-INFLAMMATORY OR ANTIPYRETIC

ANALGESIC/ANTIPYRETICS, SALICYLATES

added strength headache relief oral tablet OTC

adult low dose aspirin oral tablet,delayed release (dr/ec)

OTC; QL

antacid and pain relief oral tablet, effervescent

OTC

aspir-81 oral tablet,delayed release (dr/ec) OTC; QL

aspirin childrens oral tablet,chewable OTC; QL

aspirin low dose oral tablet,delayed release (dr/ec)

OTC; QL

aspirin oral tablet Bayer Aspirin OTC; QL

aspirin oral tablet,chewable Aspirin Childrens OTC; QL

2

Page 4: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

aspirin oral tablet,delayed release (dr/ec) 325 mg

Aspir-Trin OTC; QL

aspirin oral tablet,delayed release (dr/ec) 500 mg, 650 mg

OTC

aspirin oral tablet,delayed release (dr/ec) 81 mg

Adult Low Dose Aspirin OTC; QL

aspirin rectal suppository OTC

aspirin, buffered oral tablet Buffered Aspirin OTC

aspir-low oral tablet,delayed release (dr/ec)

OTC; QL

aspir-trin oral tablet,delayed release (dr/ec)

OTC; QL

back and body pain reliever oral tablet OTC

bayer advanced oral tablet OTC

bayer aspirin oral tablet OTC; QL

bufferin oral tablet OTC

child aspirin oral tablet,chewable OTC; QL

children's aspirin oral tablet,chewable OTC; QL

e.c. prin oral tablet,delayed release (dr/ec) OTC; QL

efferves pain relief antacid oral tablet, effervescent

OTC

enteric coated aspirin oral tablet,delayed release (dr/ec)

OTC; QL

headache relief (asa-acet-caf) oral tablet OTC

lite coat aspirin oral tablet OTC; QL

lo-dose aspirin oral tablet,delayed release (dr/ec)

OTC; QL

migraine formula oral tablet OTC

migraine relief oral tablet OTC

pain relief (acetamin-asp-caf) oral tablet OTC

pain reliever (acetam-aspirin) oral tablet OTC

pain reliever plus oral tablet OTC

pain-off oral tablet OTC

pamprin max oral tablet OTC

super pain relief oral tablet OTC

tri-buffered aspirin oral tablet OTC

ANALGESICS, NON-NARCOTIC

8 hour pain reliever oral tablet extended release

OTC; QL

3

Page 5: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

acephen rectal suppository OTC

acetaminophen extra strength oral tablet OTC; QL

acetaminophen oral drops,suspension Infant's Pain Relief OTC; QL

acetaminophen oral elixir Non-Aspirin OTC

acetaminophen oral liquid Children's Pain-Fever Relief OTC

acetaminophen oral solution Mapap (acetaminophen) OTC

acetaminophen oral suspension BetaTemp OTC; QL

acetaminophen oral tablet 325 mg Athenol OTC

acetaminophen oral tablet 500 mgAcetaminophen Extra Strength

OTC; QL

acetaminophen oral tablet extended release

8 Hour Pain Reliever OTC; QL

acetaminophen oral tablet,chewable Children's Acetaminophen OTC; QL

acetaminophen oral tablet,disintegrating Children's Acetaminophen OTC

acetaminophen pain relief oral tablet OTC; QL

acetaminophen rectal suppository Acephen OTC

arthritis pain relief (acetam) oral tablet extended release

OTC; QL

arthritis pain reliever oral tablet extended release

OTC; QL

athenol oral tablet OTC

betatemp oral suspension OTC; QL

child pain rel-fever reducer rectal suppository

OTC

children's acetaminophen oral suspension OTC; QL

children's acetaminophen oral tablet,chewable

OTC; QL

children's acetaminophen oral tablet,disintegrating

OTC

children's easy-melts oral tablet,disintegrating

OTC

children's fever reducing rectal suppository

OTC

children's mapap oral tablet,disintegrating OTC

children's non-aspirin oral suspension OTC; QL

children's non-aspirin oral tablet,chewable OTC; QL

children's non-aspirin pain oral tablet,chewable

OTC; QL

children's pain relief oral suspension OTC; QL

4

Page 6: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

children's pain reliever oral suspension OTC; QL

children's pain reliever oral tablet,disintegrating

OTC

children's pain-fever relief oral liquid OTC

children's pain-fever relief oral suspension OTC; QL

children's pain-fever relief oral tablet,chewable

OTC; QL

children's pain-fever relief oral tablet,disintegrating

OTC

children's q-pap oral suspension OTC

children's silapap oral liquid OTC

children's tactinal oral tablet,chewable OTC; QL

ed-apap oral liquid OTC

fever reducer an pain reliever oral suspension

OTC; QL

fever reducer rectal suppository OTC

feverall rectal suppository OTC

infant fever reducer-pain relf oral suspension

OTC; QL

infant pain reliever oral suspension OTC; QL

infant's non-aspirin oral drops,suspension OTC; QL

infants' pain and fever oral suspension OTC; QL

infant's pain relief oral drops,suspension OTC; QL

infants' pain relief oral suspension OTC; QL

infant's pain relief oral suspension OTC; QL

infant's pain reliever oral drops,suspension

OTC; QL

jr. acetaminophen oral tablet,disintegrating

OTC

jr. str non-aspirin pain oral tablet,disintegrating

OTC

jr. strength pain reliever oral tablet,disintegrating

OTC

junior mapap oral tablet,disintegrating OTC

little remedies fever and pain oral liquid OTC; QL

mapap (acetaminophen) oral capsule OTC; QL

mapap (acetaminophen) oral drops,suspension

OTC; QL

mapap (acetaminophen) oral liquid OTC

5

Page 7: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

mapap (acetaminophen) oral suspension OTC; QL

mapap (acetaminophen) oral tablet OTC

mapap (acetaminophen) oral tablet,chewable

OTC; QL

mapap arthritis pain oral tablet extended release

OTC; QL

mapap extra strength oral tablet OTC; QL

masophen oral tablet 325 mg OTC

masophen oral tablet 500 mg OTC; QL

non-aspirin childrens oral drops OTC

non-aspirin children's oral tablet,chewable OTC; QL

non-aspirin extra strength oral liquid OTC

non-aspirin extra strength oral tablet OTC; QL

non-aspirin jr strength oral tablet,chewable

OTC; QL

non-aspirin oral elixir OTC

non-aspirin oral suspension OTC; QL

non-aspirin oral tablet OTC

non-aspirin oral tablet,chewable OTC; QL

non-aspirin pain relief oral tablet OTC; QL

nortemp oral drops OTC

nortemp oral suspension OTC; QL

pain and fever oral tablet 325 mg OTC

pain and fever oral tablet 500 mg OTC; QL

pain relief adult oral liquid OTC

pain relief extra strength oral tablet OTC; QL

pain relief oral liquid OTC

pain relief oral tablet OTC; QL

pain relief oral tablet extended release OTC; QL

pain relief regular strength oral tablet OTC

pain reliever extra strength oral tablet OTC; QL

pain reliever jr strength oral tablet,chewable

OTC; QL

pain reliever oral capsule OTC; QL

pain reliever oral tablet 325 mg OTC

pain reliever oral tablet 500 mg OTC; QL

pediacare fever reducer oral suspension OTC; QL

pharbetol oral tablet 325 mg OTC

6

Page 8: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

pharbetol oral tablet 500 mg OTC; QL

pms maximum strength oral tablet OTC

pre-menstrual relief oral tablet OTC

premsyn pms oral tablet OTC

q-pap extra strength oral tablet OTC; QL

q-pap oral drops OTC

q-pap oral liquid OTC

q-pap oral tablet 325 mg OTC

q-pap oral tablet 500 mg OTC; QL

tactinal extra strength oral tablet OTC; QL

tactinal oral tablet OTC

tylophen oral capsule OTC; QL

NSAIDS

ADVIL ORAL TABLET OTC

ADVIL ORAL TABLET,CHEWABLE OTC; QL

all day pain relief oral tablet OTC; QL

all day relief oral tablet OTC; QL

child ibuprofen oral suspension OTC; QL

CHILDREN'S ADVIL ORAL SUSPENSION

OTC; QL

children's ibuprofen oral suspension OTC; QL

children's profen ib oral suspension OTC; QL

flanax (naproxen) oral tablet OTC; QL

ibu-drops oral drops,suspension OTC

ibuprofen ib oral tablet OTC; QL

ibuprofen ib oral tablet,chewable OTC; QL

ibuprofen jr strength oral tablet,chewable OTC; QL

ibuprofen oral capsule Advil Liqui-Gel OTC

ibuprofen oral drops,suspension Ibu-Drops OTC; QL

ibuprofen oral suspension Child Ibuprofen OTC; QL

ibuprofen oral tablet 100 mg Advil OTC

ibuprofen oral tablet 200 mg Advil OTC; QL

ibuprofen pm oral tablet OTC

ibuprofen-diphenhydramine cit oral tablet Advil PM OTC

infants ibu-drops oral drops,suspension OTC; QL

infant's ibuprofen oral drops,suspension OTC; QL

infants profenib oral drops,suspension OTC; QL

7

Page 9: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

i-prin oral tablet OTC; QL

mediproxen oral tablet OTC; QL

motrin pm oral tablet OTC

naproxen sodium oral capsule Aleve OTC

naproxen sodium oral tablet Aleve OTC; QL

provil oral tablet OTC; QL

wal-profen oral capsule PA; OTC

wal-profen oral tablet OTC; QL

wal-proxen oral tablet OTC; QL

ANORECTAL PREPARATIONS

HEMORRHOIDAL PREPARATIONS

anu-med rectal suppository OTC

hemorrhoid rectal ointment OTC

hemorrhoidal (phenyleph-cocoa) rectal suppository

OTC

hemorrhoidal rectal ointment OTC

hemorrhoidal rectal suppository OTC

hemorrhoidal suppository rectal suppository

OTC

ANTI-INFECTIVE AGENTS

ANTHELMINTICS

pin-x oral suspension OTC

pin-x oral tablet,chewable OTC

reese's pinworm medicine oral suspension OTC

ANTISEPTICS AND DISINFECTANTS

ANTISEPTICS, GENERAL

alcohol pads topical pads, medicated OTC

alcohol prep pads topical pads, medicated OTC

alcohol prep swabs topical pads, medicated

OTC

alcohol swabs topical pads, medicated Alcohol Pads OTC

alcohol wipes topical pads, medicated OTC

alcoh-wipe towelette OTC

antiseptic skin clnsr(chlorhe) topical liquid OTC; QL

betasept surgical scrub topical liquid OTC; QL

chlorhexidine gluconate topical liquid Hand Wash OTC

curity alcohol swabs topical pads, medicated

OTC

8

Page 10: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

easy touch alcohol prep pads topical pads, medicated

OTC

hibiclens topical liquid OTC; QL

hydrogen peroxide solution OTC

sure comfort alcohol prep pads topical pads, medicated

OTC

webcol topical pads, medicated OTC

CARDIOVASCULAR THERAPY AGENTS

LIPOTROPICS

ALGAL-900 DHA ORAL CAPSULE OTC; QL

DHA ALGAL-900 ORAL CAPSULE OTC; QL

fish oil concentrate oral capsule OTC

fish oil oral capsule 1,000 mg (120 mg-180 mg), 100-160-1,000 mg, 120-180 mg, 138-183-1,000 mg, 300 mg, 300-1,000 mg, 300-500 mg, 340-1,000 mg

OTC

fish oil oral capsule 360-1,200 mg OTC; QL

fish oil oral capsule,delayed release(dr/ec) 150-217-840 mg, 300-1,000 mg, 300-108-162-600 mg, 60-90-500 mg, 900-1,400 mg

OTC

FISH OIL ORAL CAPSULE,DELAYED RELEASE(DR/EC) 360 MG-144 MG- 216 MG-1,200 MG

OTC; QL

fish oil oral capsule,delayed release(dr/ec) 360-1,200 mg

OTC; QL

fish oil-dha-epa oral capsule OTC

GRAM-O-LECI ORAL TABLET,CHEWABLE

OTC

inositol oral tablet OTC

lecithin oral capsule OTC

lecithin, soy oral capsule OTC

maxepa oral capsule OTC

niacin oral tablet Niacor OTC

omega 3-dha-epa-fish oil oral capsule OTC

omega-3 (with dpa) oral capsule OTC; QL

omega-3 2100 oral capsule PA; OTC; QL

omega-3 fatty acids oral capsule Fish Oil Concentrate OTC

9

Page 11: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

omega-3 fatty acids-fish oil oral capsule 300-1,000 mg

Fish Oil OTC

omega-3 fatty acids-fish oil oral capsule 360-1,200 mg

Fish Oil OTC; QL

omega-3 fatty acids-fish oil oral capsule 440-880 mg

OTC

omega-3 fish oil oral capsule OTC

omega-3s-dha-epa-fish oil oral capsule,delayed release(dr/ec)

OTC

one-per-day omega-3 oral capsule,delayed release(dr/ec)

OTC; QL

salmon oil-omega-3 fatty acids oral capsule

OTC

sea-omega 30 oral capsule OTC; QL

super omega-3 oral capsule OTC

super twin epa-dha oral capsule OTC

THEROMEGA ORAL CAPSULE OTC

vitamin e oral capsule OTC

CENTRAL NERVOUS SYSTEM AGENTS

SEDATIVE-HYPNOTIC - ANTIHISTAMINES

ALKA-SELTZER PLUS ALLERGY ORAL TABLET

OTC

diphenhydramine 50 mg capsule (otc) Banophen OTC

diphenhydramine 50 mg capsule u-d (otc) Banophen OTC

diphenhydramine hcl oral capsule 25 mg Aler-Cap OTC; QL

diphenhydramine hcl oral tablet Alka-Seltzer Plus Allergy OTC; QL

nightime sleep oral capsule OTC

nighttime sleep aid (diphen) oral capsule OTC

nighttime sleep aid (diphen) oral tablet OTC

rest simply nighttime sleep oral tablet OTC

restfully sleep oral tablet OTC

sleep aid (diphenhydramine) oral capsule OTC

sleep aid (diphenhydramine) oral liquid OTC

sleep aid (diphenhydramine) oral tablet OTC

sleep aid (doxylamine) oral tablet OTC

sleep aid max str (diphenhydr) oral capsule

OTC

10

Page 12: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

sleep ii oral tablet OTC

sleep oral tablet OTC

sleep tablet (diphenhydramine) oral tablet OTC

sleep-tabs oral tablet OTC

ultra sleep (doxylamine succ) oral tablet OTC

UNISOM SLEEPGELS ORAL CAPSULE OTC

wal-sleep z oral liquid OTC

wal-som (diphenhydramine) oral capsule OTC

ZZZQUIL ORAL CAPSULE OTC

ZZZQUIL ORAL LIQUID OTC

SEDATIVE-HYPNOTICS, NON-BARBITURATES

melatonin (with b6) oral tablet OTC; QL

melatonin-pyridoxine (vit b6) oral tablet Melatonin (with B6) OTC; QL

CHEMICAL DEPENDENCY, AGENTS TO TREAT

SMOKING DETERRENT AGENTS

nicorelief buccal gum OTC; QL

NICORETTE BUCCAL LOZENGE OTC; QL

NICORETTE BUCCAL MINI LOZENGE OTC; QL

nicotine (polacrilex) buccal gum Nicorelief OTC; QL

nicotine (polacrilex) buccal lozenge Nicorette OTC; QL

nicotine (polacrilex) buccal mini lozenge Nicorette OTC; QL

nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL

nts step 1 transdermal patch 24 hour OTC; QL

QUIT 2 BUCCAL GUM OTC; QL

QUIT 4 BUCCAL GUM OTC; QL

stop smoking aid buccal lozenge OTC; QL

CHEMICALS-PHARMACEUTICAL ADJUVANTS

CHEMICALS - SOLVENTS

alcohol, rubbing solution OTC

isopropyl alcohol solution OTC

PHARMACEUTICAL ADJUVANT - CREAM/OINTMENT VEHICLES

dermafix topical ointment OTC

petrolatum topical ointment OTC

11

Page 13: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

petroleum jelly topical gel OTC

petroleum jelly, white topical gel OTC

white petrolatum topical gel Lip Treatment OTC

white petroleum jelly topical gel OTC

CONTRACEPTIVES

EMERGENCY CONTRACEPTIVES

econtra ez oral tablet OTC; QL

fallback solo oral tablet OTC; QL

levonorgestrel oral tablet Aftera OTC; QL

my way oral tablet OTC; QL

next choice one dose oral tablet OTC; QL

opcicon one-step oral tablet OTC; QL

option-2 oral tablet OTC; QL

react oral tablet OTC; QL

SPERMICIDES

TODAY CONTRACEPTIVE SPONGE VAGINAL CONTRACEPTIVE SPONGE

OTC

vaginal contraceptive film vaginal film OTC

vaginal contraceptive foam vaginal foam OTC

vcf contraceptive film vaginal film OTC

DERMATOLOGICAL

KERATOLYTICS

acne cleanser topical cleanser OTC

acne cleansing bar topical bar OTC

acne control cleanser topical cream OTC

acne foaming wash topical cleanser OTC

acne medication topical gel 10 % OTC; QL

acne medication topical gel 5 % OTC

acne medication topical lotion OTC; QL

acne pads topical pads, medicated OTC

acne treatment (benzoyl perox) topical cream

OTC

acne treatment (benzoyl perox) topical gel OTC; QL

acne vanishing topical cream OTC

acne-clear topical gel OTC; QL

advanced acne wash topical cleanser,extended release

OTC

12

Page 14: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

benzepro topical foam OTC

benzoyl peroxide 10% gel (otc) Acne Medication OTC; QL

benzoyl peroxide 10% gel aqueous (otc) Acne Medication OTC; QL

benzoyl peroxide 10% gel extra strength (otc)

Acne Medication OTC; QL

benzoyl peroxide 10% gel maximum strength (otc)

Acne Medication OTC; QL

benzoyl peroxide 10% gel max-str, aqueous (otc)

Acne Medication OTC; QL

benzoyl peroxide topical cleanser 10 % Acne Foaming Wash OTC

benzoyl peroxide topical cleanser 5 %Advanced Exfoliating Cleanser

OTC; QL

benzoyl peroxide topical foam BenzEFoam OTC

benzoyl peroxide topical gel 2.5 % OTC

benzoyl peroxide topical gel 5 % Acne Medication OTC

benzoyl peroxide topical lotion Acne Medication OTC; QL

bp foam topical foam OTC

bp gel topical gel OTC

bp topical gel 10 % OTC; QL

bp topical gel 5 % OTC

bp wash acne treatment topical kit OTC

bp wash topical cleanser 10 %, 2.5 %, 7 %

OTC

bp wash topical cleanser 5 % OTC; QL

bpo-10 topical cleanser OTC

bpo-5 topical cleanser OTC; QL

creamy acne face topical cleanser OTC

daily face wash topical cleanser OTC

foaming acne face wash topical cleanser OTC

panoxyl topical cleanser OTC

panoxyl topical cream OTC

panoxyl-4 topical cleanser OTC

persa-gel topical gel OTC; QL

rapid clear treatment pads topical pads, medicated

OTC

RIAX TOPICAL FOAM OTC

SCABICIDE AND PEDICULICIDE COMBINATIONS

complete lice treatment topical kit OTC; QL

13

Page 15: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

lice complete kit 1-2-3 topical kit OTC; QL

lice killing topical shampoo OTC

lice pyrinyl shampoo topical shampoo OTC

lice solution topical kit OTC; QL

lice treatment topical shampoo OTC

pediculicide 11 topical kit OTC

rid complete lice elim kit topical kit OTC; QL

SCABICIDE AND PEDICULICIDE SINGLE AGENTS

lice bedding spray aerosol,spray OTC

lice cream rinse topical liquid OTC; QL

lice killing (permethrin) topical liquid OTC; QL

lice treatment (permethrin) topical liquid OTC; QL

lice treatment topical liquid OTC; QL

permethrin topical liquid Lice Killing (permethrin) OTC; QL

TOPICAL AGENTS, MISCELLANEOUS

a and d (lan, pet) topical ointment OTC; QL

absorbine pain relieving topical gel OTC

advanced healing (petrolatum) topical ointment

OTC

alphabath topical oil OTC

ameriphor topical ointment OTC

AMLACTIN TOPICAL LOTION OTC

ammonium lactate topical cream Geri-Hydrolac OTC; QL

ammonium lactate topical lotion AmLactin OTC

anti-dandruff topical shampoo OTC

aqua glycolic face topical cream OTC

aqua glycolic topical shampoo OTC

aqua lube topical lubricant OTC

AVEENO INTENSE RELIEF TOPICAL CREAM

OTC

bath oil topical oil OTC

beta care topical cream OTC

beta care topical lotion OTC

blue gel topical gel OTC

calamine phenolated topical lotion OTC

calamine topical lotion OTC

14

Page 16: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

calamine-zinc oxide topical lotion OTC

calamine-zinc oxide-phenol topical suspension

OTC

callus remover topical adhesive patch,medicated

OTC

callus removers topical adhesive patch,medicated

OTC

cam topical lotion OTC

cameo oil topical oil OTC

CERAVE PM TOPICAL LOTION,EXTENDED RELEASE

OTC

CERAVE SUNSCREEN TOPICAL LOTION

OTC

CERAVE TOPICAL CLEANSER OTC

CERAVE TOPICAL CREAM OTC

CETAPHIL MOISTURIZING TOPICAL CREAM

OTC

cloverine topical ointment OTC

COMPOUND W TOPICAL LIQUID OTC

corn remover topical adhesive patch,medicated

OTC

corn-callus remover topical liquid OTC

CUTTER BACKWOODS TOPICAL AEROSOL,SPRAY

OTC

CUTTER SKINSATIONS TOPICAL SPRAY,NON-AEROSOL

OTC

daily moisturizing lotion topical lotion OTC

dermabase topical cream OTC

dermacerin topical cream OTC

DERMAPHOR TOPICAL OINTMENT OTC

DERMAREST PSORIASIS MEDICATED TOPICAL LOTION

OTC

DERMAREST PSORIASIS MEDICATED TOPICAL SHAMPOO

OTC

dermavantage topical lotion OTC

DESENEX TOPICAL AEROSOL POWDER

OTC

diaper rash relief topical ointment OTC

diaper rash topical ointment OTC; QL

15

Page 17: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

dr scholl's clear away topical adhesive patch,medicated

OTC

dry skin bath oil topical oil OTC

dry skin care topical lotion OTC

dry skin therapy moisturizing topical lotion OTC

dry skin therapy topical cream OTC

duofilm topical liquid OTC

emollient topical cream Aqua Glycolic Face OTC

EUCERIN ORIGINAL TOPICAL LOTION OTC; QL

excel-gel topical gel OTC

finger cream topical cream OTC

gentle moisturizing lotion topical lotion OTC

geri-hydrolac topical cream OTC; QL

geri-hydrolac topical lotion OTC

glycerin topical liquid OTC

glycerin topical solution OTC

gordon's vite a topical cream OTC

gordons-vite e topical cream OTC

gordo-vite a topical cream OTC

gordo-vite e topical cream OTC

hydrating healing topical ointment OTC

hydrocerin (with petrolatum) topical cream OTC

hydrocerin topical lotion OTC

hydrolatum topical ointment OTC

ice blue gel topical gel OTC

INSECT REPELLENT (PICARIDIN) TOPICAL SPRAY WITH PUMP

OTC

johnson's baby oil topical oil OTC

lan-o-soothe topical cream OTC

liquid corn and callus remover topical liquid

OTC

LUBRIDERM DAILY MOISTURE (PET) TOPICAL LOTION

OTC

LUBRIDERM SKIN NOURISHING TOPICAL LOTION

OTC

lubrisilk topical lotion OTC

lubrisoft topical lotion OTC

mapo bath topical oil OTC

16

Page 18: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

mediplast corn-callus-wart topical adhesive patch,medicated

OTC

menthol topical gel Pain Relief (menthol) OTC

mineral oil light topical oil OTC

mineral oil topical oil Lobana Bath OTC

minerin topical cream OTC

minerin topical lotion OTC

moisturizing cream topical cream OTC

moiturizing lotion topical lotion OTC

mosco callus-corn remover topical liquid OTC

mosco corn remover topical adhesive patch,medicated

OTC

NATRAPEL TOPICAL AEROSOL,SPRAY

OTC

natural oatmeal bath treatment topical packet

OTC

oatmeal bath regular topical packet OTC

OFF ACTIVE TOPICAL AEROSOL,SPRAY

OTC

OFF DEEP WOODS DRY TOPICAL AEROSOL POWDER

OTC

OFF DEEP WOODS TOPICAL AEROSOL,SPRAY

OTC

OFF FAMILYCARE (WITH DEET) TOPICAL AEROSOL POWDER

OTC

pain relief (menthol) topical gel OTC

pain relieving (menthol) topical gel OTC

pediatric oint (cod liver oil) topical ointment

OTC

petrolatum topical ointment OTC

petroleum jelly topical gel OTC

petroleum jelly, white topical gel OTC

plantar wart remover topical adhesive patch,medicated

OTC

protective ointment topical ointment OTC

psoriasis medicated topical shampoo OTC

renewal daily moisture lotion topical lotion OTC

renewal healing topical ointment OTC

REPEL SPORTSMEN DRY TOPICAL AEROSOL,SPRAY

OTC

17

Page 19: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

REPEL SPORTSMEN MAX TOPICAL AEROSOL,SPRAY

OTC

REPEL SPORTSMEN TOPICAL AEROSOL,SPRAY

OTC

salactic film topical liquid OTC

sal-plant topical gel OTC

scalp itch-dandruff relief topical liquid OTC

scar gel topical gel OTC

scar topical gel OTC

sebex topical shampoo OTC

secura protective topical ointment OTC

selsun blue (salicylic acid) topical shampoo

OTC

selsun blue naturals topical shampoo OTC

selsun blue topical shampoo OTC

skin treatment topical lotion OTC

sorbidon hydrate topical cream OTC

special care lotion topical lotion OTC

sween cream topical cream OTC

sween topical cream OTC

thera bath topical oil OTC

thera-derm topical lotion OTC

therapeutic blue topical gel OTC

therapeutic moisturizing topical cream OTC

therapeutic shampoo topical shampoo OTC

therapeutic t plus topical shampoo OTC

ultra mide 25 topical lotion OTC

unscented cold cream topical cream OTC

urea topical cream Gormel OTC

urea topical lotion Aqua Care OTC

vanicream topical cream OTC

vitamin a and d topical ointment OTC

vitamin e plus topical cream OTC

vitamin e topical cream Gordo-Vite E OTC

vitamin e topical oil OTC

vitamin e-vitamins a and d topical cream OTC

vits a and d-white pet-lanolin topical ointment

A and D (lan, pet) OTC; QL

18

Page 20: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

vits a and d-white pet-lanolin topical ointment in packet

Vitamin A and D GRx OTC

walgreens dry skin treatment topical ointment

OTC

wart remover topical adhesive patch,medicated

OTC

wart remover topical gel OTC

wart remover topical liquid OTC

wart remover topical plaster OTC

white petrolatum topical ointment Cloverine OTC

white petrolatum topical ointment in packet

Vaseline White Petroleum OTC

white petroleum jelly topical gel OTC

x-seb t pearl topical shampoo OTC

zinc oxide diaper cream topical cream OTC

zinc oxide topical ointment Triple Paste OTC; QL

zinc oxide topical ointment 20 % OTC

zinc oxide topical ointment 40 % Boudreauxs Butt Paste OTC; QL

TOPICAL ANTIBIOTICS

antibiotic (bacitracin zinc) topical ointment OTC; QL

antibiotic (neomy-bacit-polym) topical ointment

OTC; QL

antibiotic-pain relief (bacit) topical ointment

OTC; QL

bacitracin topical ointment Bacitraycin Plus OTC; QL

bacitracin topical packet OTC; QL

bacitracin zinc topical ointment Antibiotic (bacitracin zinc) OTC; QL

bacitracin zinc topical packet OTC; QL

bacitracin-polymyxin b topical ointment Double Antibiotic OTC

bacitracin-polymyxin b topical packet Polysporin OTC

bacitraycin plus topical ointment OTC; QL

double antibiotic (b.tracn zn) topical ointment

OTC

double antibiotic topical ointment OTC

NEOSPORIN PLUS PAINRELIEF(BAC) TOPICAL OINTMENT

OTC; QL

poly bacitracin topical ointment OTC

tri-biozene topical ointment OTC; QL

19

Page 21: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

triple antibiotic (pram) extra topical ointment

OTC; QL

triple antibiotic plus topical ointment OTC; QL

triple antibiotic topical ointment OTC; QL

triple antibiotic topical ointment in packet OTC

wal-sporin topical ointment OTC

TOPICAL ANTIFUNGALS

af topical aerosol powder OTC

ALEVAZOL TOPICAL OINTMENT OTC

antifungal (clotrimazole) topical cream OTC; QL

antifungal (tolnaftate) topical aerosol,spray

OTC

antifungal (tolnaftate) topical cream OTC

antifungal (tolnaftate) topical powder OTC

antifungal cream topical cream OTC

antifungal spray topical aerosol powder OTC

antifungal topical liquid OTC

anti-fungal topical powder OTC

antifungal topical solution OTC

athlete's foot (clotrimazole) topical cream OTC; QL

athlete's foot (terbinafine) topical cream OTC

athlete's foot (tolnaftate) topical aerosol powder

OTC

athlete's foot (tolnaftate) topical aerosol,spray

OTC

athlete's foot (tolnaftate) topical cream OTC

athlete's foot af topical cream OTC

athlete's foot topical aerosol powder OTC

athlete's foot topical powder OTC

athletic foot cream topical cream OTC; QL

baza antifungal topical cream OTC

baza cream hospital care pack topical combo pack

OTC

blis-to-sol (tolnaftate) topical solution OTC

clotrimazole af topical cream OTC; QL

clotrimazole topical cream Antifungal (clotrimazole) OTC; QL

clotrimazole topical solution OTC

desenex topical powder OTC

20

Page 22: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

ELON DUAL DEFENSE TOPICAL SOLUTION

OTC

foot and sneaker topical aerosol powder OTC

FUNGI-NAIL TOPICAL SOLUTION OTC

fungoid-d topical cream OTC

GORDOCHOM TOPICAL SOLUTION OTC

HONGO CURA SPRAY TOPICAL AEROSOL,SPRAY

OTC

inzo antifungal topical cream OTC

itch relief (clotrimazole) topical cream OTC; QL

jock itch (clotrimazole) topical cream OTC; QL

jock itch (terbinafine) topical cream OTC

jock itch topical aerosol powder OTC

lamisil (aerosol) topical aerosol,spray OTC

lamisil af topical aerosol powder OTC

lamisil af topical powder OTC

lamisil at topical cream OTC

lamisil at topical gel OTC

lotrimin af (clotrimazole) topical cream OTC; QL

lotrimin af jock itch powder topical aerosol powder

OTC

lotrimin af powder topical aerosol powder OTC

lotrimin af topical aerosol,spray OTC

lotrimin af topical powder OTC

lotrimin ultra topical cream PA; OTC; QL

medi-first anti-fungal topical packet OTC

micatin topical cream OTC

miconazole nitrate topical aerosol powder Athlete's Foot OTC

miconazole nitrate topical cream Antifungal Cream OTC

miconazorb af topical powder OTC

micro-guard topical powder OTC

MYCO NAIL A TOPICAL SOLUTION OTC

MYCO NAIL TOPICAL LIQUID OTC

NIZORAL A-D TOPICAL SHAMPOO OTC

odor control foot-sneaker topical aerosol powder

OTC

remedy antifungal topical cream OTC

remedy antifungal topical powder OTC

21

Page 23: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

remedy phytoplex antifungal topical ointment

OTC

remedy phytoplex antifungal topical powder

OTC

ringworm topical cream OTC; QL

secura antifungal extra thick topical cream OTC

secura antifungal topical cream OTC

terbinafine hcl topical cream Antifungal (terbinafine) OTC

TINACTIN TOPICAL AEROSOL POWDER

OTC

TINACTIN TOPICAL CREAM OTC

TINACTIN TOPICAL POWDER OTC

tolnaftate topical aerosol powder AF OTC

tolnaftate topical cream Antifungal (tolnaftate) OTC

tolnaftate topical powder Antifungal (tolnaftate) OTC

tolnaftate topical solution Blis-To-Sol (tolnaftate) OTC

zeasorb (miconazole) topical powder OTC

TOPICAL ANTI-INFLAMMATORY STEROIDAL AGENTS

anti-itch (hc) topical cream OTC; QL

anti-itch (hc) topical ointment OTC

anti-itch (hc) with aloe-vit e topical cream OTC; QL

anti-itch plus topical cream OTC; QL

cortisone (hydrocortisone) topical cream OTC; QL

eczema anti-itch topical cream OTC; QL

hydrocortisone acetate topical cream OTC; QL

hydrocortisone acetate topical ointment OTC

hydrocortisone plus topical cream OTC; QL

hydrocortisone topical cream OTC; QL

hydrocortisone topical cream in packet OTC

hydrocortisone topical ointment OTC

hydrocortisone-aloe vera topical cream Cortizone-10 with aloe PA; OTC; QL

hydrocream topical cream OTC; QL

NOBLE FORMULA HC TOPICAL CREAM

OTC; QL

scalp relief topical solution OTC

scalpicin anti-itch topical solution OTC

22

Page 24: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

TOPICAL ANTIPARASITICS

CUTTER BACKWOODS TOPICAL AEROSOL,SPRAY

OTC

CUTTER SKINSATIONS TOPICAL SPRAY,NON-AEROSOL

OTC

INSECT REPELLENT (PICARIDIN) TOPICAL SPRAY WITH PUMP

OTC

NATRAPEL TOPICAL AEROSOL,SPRAY

OTC

OFF ACTIVE TOPICAL AEROSOL,SPRAY

OTC

OFF DEEP WOODS DRY TOPICAL AEROSOL POWDER

OTC

OFF DEEP WOODS TOPICAL AEROSOL,SPRAY

OTC

OFF FAMILYCARE (WITH DEET) TOPICAL AEROSOL POWDER

OTC

REPEL SPORTSMEN DRY TOPICAL AEROSOL,SPRAY

OTC

REPEL SPORTSMEN MAX TOPICAL AEROSOL,SPRAY

OTC

REPEL SPORTSMEN TOPICAL AEROSOL,SPRAY

OTC

TOPICAL ANTIVIRALS

ABREVA TOPICAL CREAM OTC; QL

VITAMIN A DERIVATIVES

differin topical gel OTC; QL

DIAGNOSTIC AGENTS

DIAGNOSTIC - MULTIPLE URINE TESTS

CHEMSTRIP 10 MD STRIP OTC

MULTISTIX 9 SG STRIP OTC

MULTISTIX 9 STRIP OTC

DIAGNOSTIC - URINE TEST OTHERS

URINARY TRACT INF.TEST (WBCS) STRIP

OTC

23

Page 25: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

EATING DISORDER THERAPY

ANTI-OBESITY - FAT ABSORPTION DECREASING AGENTS

ALLI ORAL CAPSULE PA; OTC; QL

ELECTROLYTE BALANCE-NUTRITIONAL PRODUCTS

AMINO ACID - CARNITINE DERIVATIVES

l-carnitine (tartrate) oral capsule OTC

BIOFLAVONOID COMBINATIONS

bioflex oral tablet OTC

ear care oral tablet OTC

ear health formula oral tablet OTC

CALCIUM REPLACEMENT

BIOCAL ORAL CAPSULE OTC

ca-d3-mag-zinc-cop-mang-bor oral tablet OTC

cal mag zinc + d3 oral tablet OTC

calci-chew oral tablet,chewable OTC; QL

calci-mix oral capsule OTC

calcionate oral syrup OTC; QL

calcitrate oral tablet OTC

calcium 500 + d (d3) oral tablet OTC

calcium 500 + d oral tablet OTC

calcium 500 oral tablet,chewable OTC; QL

calcium 600 + d(3) oral capsule OTC

calcium 600 + d(3) oral tablet 600 mg(1,500mg) -200 unit

OTC

calcium 600 + d(3) oral tablet 600 mg(1,500mg) -400 unit

OTC; QL

calcium 600 + minerals oral tablet OTC

calcium 600 oral tablet OTC

calcium 600 with vitamin d3 oral capsule OTC; QL

calcium 600 with vitamin d3 oral tablet OTC

calcium amino acid chelate oral tablet OTC

calcium carb-d3-mag cmb11-zinc oral tablet

OTC

calcium carbonate oral powder OTC

calcium carbonate oral suspension OTC

24

Page 26: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

calcium carbonate oral tablet 500 mg calcium (1,250 mg)

Calcium 500 OTC; QL

calcium carbonate oral tablet 600 mg calcium (1,500 mg)

Calcium 600 OTC

calcium carbonate oral tablet 650 mg calcium (1,625 mg)

OTC; QL

calcium carbonate oral tablet,chewable 260 mg calcium (650 mg)

Cal-Mint OTC

calcium carbonate oral tablet,chewable 500 mg calcium (1,250 mg)

Calci-Chew OTC; QL

calcium carbonate-vitamin d3 oral capsuleCalcium 600 with Vitamin D3

OTC; QL

calcium carbonate-vitamin d3 oral tablet 250-125 mg-unit

Oyster Shell + D3 OTC; QL

calcium carbonate-vitamin d3 oral tablet 500 mg(1,250mg) -125 unit

Calcium 500 + D (D3) OTC

calcium carbonate-vitamin d3 oral tablet 500 mg(1,250mg) -200 unit

Calcium 500 + D OTC

calcium carbonate-vitamin d3 oral tablet 600 mg(1,500mg) -400 unit

Calcium 600 + D(3) OTC; QL

calcium carbonate-vitamin d3 oral tablet 600 mg(1,500mg) -800 unit

Caltrate with Vitamin D3 OTC

calcium citrate malate-vit d3 oral tablet OTC

calcium citrate oral tablet Calcitrate OTC

calcium gluconate oral tablet 45 mg (500 mg)

OTC; QL

calcium gluconate oral tablet 50 mg calcium, 60 mg (650 mg), 61 mg (648 mg)

OTC

calcium with vitamin d oral tablet OTC; QL

calcium-magnesium-zinc oral tablet OTC

cal-mag oral tablet,chewable OTC

cal-mint oral tablet,chewable OTC

cal-quick oral liquid OTC

CITRACAL + BONE DENSITY ORAL TABLET

OTC

CITRACAL PLUS MAGNESIUM ORAL TABLET

OTC

FEM-CAL CITRATE ORAL TABLET OTC

hi-cal plus vit d oral tablet OTC

liquid calcium with vitamin d oral capsule OTC

LOCALNESIUM ORAL TABLET OTC

25

Page 27: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

OS-CAL 500 + D3 ORAL TABLET OTC

oysco 500/d oral tablet OTC

oysco-500 oral tablet OTC; QL

oyst-cal-500 oral tablet OTC; QL

oyster shell + d3 oral tablet OTC; QL

oyster shell calcium 500 oral tablet OTC; QL

oyster shell calcium oral tablet OTC; QL

oyster shell calcium-vit d2 oral tablet OTC; QL

oyster shell calcium-vit d3 oral tablet 250-125 mg-unit

OTC; QL

oyster shell calcium-vit d3 oral tablet 500 mg(1,250mg) -200 unit, 500 mg(1,250mg) -400 unit

OTC

parva-cal 250 oral tablet OTC

parva-cal 500 oral tablet OTC

PRO-CAL ORAL TABLET OTC

PROSTEON ORAL TABLET OTC

THERACAL D2000 ORAL TABLET OTC

THERACAL D4000 ORAL TABLET OTC

THERACAL ORAL TABLET OTC

DIETARY PRODUCT - DIETARY SUPPLEMENTS

AIRSHIELD ORAL TABLET, EFFERVESCENT

OTC

BRAIN MIGHT-DHA-CO Q10 ORAL TABLET

OTC

DIABETIC SUPPORT FORMULA ORAL TABLET

OTC

ESTROPLUS ORAL TABLET OTC

hair, skin and nails advanced oral tablet OTC

MEGAVITE GOLDEN YEARS 55+ ORAL TABLET

OTC

MEGAVITE ORAL TABLET OTC

one daily oral tablet OTC

one daily women's metabolism oral tablet OTC

sea-omega oral capsule OTC

vitamin d3 complete oral tablet OTC

ELECTROLYTE REPLACEMENT

electrolytes-dextrose oral solution Enfamil Enfalyte OTC

26

Page 28: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

oralyte oral solution OTC; QL

pedialyte freezer pops oral solution OTC; QL

pedialyte oral solution OTC; QL

pedialyte singles oral solution OTC; QL

pediatric electrolyte oral solution OTC; QL

pediatric freezer pops oral solution OTC; QL

FOLIC ACID PREPARATIONS

folic acid oral tablet OTC

IRON REPLACEMENT

children's iron oral drops OTC

ezfe 200 oral capsule OTC

fe c oral tablet OTC

fe c plus oral tablet OTC

feosol oral tablet OTC; QL

ferate oral tablet OTC; QL

fer-iron oral drops OTC

ferosul oral elixir OTC

ferosul oral tablet OTC; QL

ferretts oral tablet OTC

ferrex 150 oral capsule OTC

ferrex 150 plus oral capsule OTC

ferric x-150 oral capsule OTC

ferrocite oral tablet OTC

ferro-sequels (iron-vit c) oral tablet extended release

OTC

ferro-time oral tablet OTC; QL

ferrous fumarate oral tablet Ferrocite OTC

ferrous gluconate oral tablet Ferate OTC; QL

ferrous sulfate oral drops Children's Iron OTC

ferrous sulfate oral elixir FeroSul OTC

ferrous sulfate oral liquid OTC

ferrous sulfate oral solution OTC

ferrous sulfate oral tablet Feosol OTC; QL

ferrous sulfate oral tablet extended release

OTC

ferrous sulfate oral tablet,delayed release (dr/ec) 324 mg (65 mg iron)

OTC; QL

27

Page 29: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

ferrous sulfate oral tablet,delayed release (dr/ec) 325 mg (65 mg iron)

OTC

ferrousul oral tablet OTC; QL

folitab oral tablet extended release OTC

high potency iron oral tablet OTC

ICAR ORAL SUSPENSION OTC; QL

iferex 150 oral capsule OTC

iron (dried) oral tablet extended release OTC

iron (ferrous sulfate) oral tablet OTC; QL

iron 100 plus oral tablet OTC

iron chews oral tablet,chewable OTC

iron high potency oral tablet OTC; QL

iron oral tablet OTC; QL

iron oral tablet extended release OTC

iron, carbonyl oral tablet Feosol OTC

iron,carbonyl-vitamin c oral tablet FE C OTC

IRONUP ORAL DROPS OTC

multigen oral tablet OTC

myferon 150 oral capsule OTC

PARVLEX ORAL TABLET OTC

poly-iron oral capsule OTC

slow release iron oral tablet extended release

OTC

stress formula oral tablet OTC; QL

wee care oral suspension OTC; QL

IRRIGATION SOLUTIONS

sterile saline irrigation solution OTC

MINERALS AND ELECTROLYTES - MAGNESIUM

mag 64 oral tablet,delayed release (dr/ec) OTC; QL

mag-delay oral tablet,delayed release (dr/ec)

OTC

magnesium oxide oral tablet 200 mg magnesium

OTC

magnesium oxide oral tablet 400 mg MagOx OTC; QL

MULTIVITAMINS

a thru z advanced formula oral tablet OTC; QL

a thru z high potency oral tablet OTC; QL

28

Page 30: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

a thru z oral tablet OTC; QL

a thru z select 50+ formula oral tablet OTC

a thru z select oral tablet OTC; QL

a thru z select women's oral tablet OTC; QL

abc plus oral tablet OTC

actical oral capsule OTC

adult multivitamin gummies oral tablet,chewable

OTC

adult one daily gummies oral tablet,chewable

OTC

adults 50 plus oral tablet OTC

AIRSHIELD ORAL TABLET, EFFERVESCENT

OTC

antioxidant a/c/e/selenium oral capsule OTC

antioxidant vitamins oral tablet OTC; QL

apatate forte oral liquid OTC; QL

AQUADEKS ORAL TABLET,CHEWABLE

OTC

bee-zee oral tablet OTC; QL

BIO-35, GLUTEN FREE ORAL CAPSULE

OTC

biosupp oral liquid OTC; QL

biotect plus oral liquid OTC

BIOTIN PLUS-CALCIUM AND VIT D3 ORAL TABLET

OTC

biovol oral syrup OTC; QL

body, hair, skin and nails oral capsule OTC

calcium citrate + d with mag oral tablet OTC

calcium citrate plus (vit b6) oral tablet OTC

centamin oral liquid OTC

central vite oral tablet OTC; QL

central-vite energy oral tablet OTC

central-vite men's under 50 oral tablet OTC; QL

central-vite oral tablet OTC; QL

central-vite select oral tablet OTC; QL

central-vite senior oral tablet OTC

central-vite women's under 50 oral tablet OTC; QL

centravites 50 plus oral tablet OTC; QL

29

Page 31: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

centravites 50 plus oral tablet 0.4-300-250 mg-mcg-mcg

OTC

centravites oral tablet OTC; QL

CENTRUM COMPLETE ORAL TABLET OTC; QL

CENTRUM SILVER ORAL TABLET,CHEWABLE

OTC

CENTRUM SPECIALIST ENERGY ORAL TABLET

OTC

CENTRUM SPECIALIST HEART ORAL TABLET

OTC; QL

CENTRUM ULTRA MEN'S ORAL TABLET

OTC; QL

century adults 50+ oral tablet OTC

century cardio oral tablet OTC; QL

century energy metabolism oral tablet OTC

century mature oral tablet 0.4-300-250 mg-mcg-mcg

OTC

century mature oral tablet 400-30 mcg OTC; QL

century oral tablet OTC; QL

century ultimate men's oral tablet 300-600-300 mcg

OTC

century ultimate men's oral tablet 8 mg iron- 200 mcg-600 mcg

OTC; QL

century ultimate women's oral tablet 18-400 mg-mcg

OTC; QL

century ultimate women's oral tablet 8 mg iron-400 mcg-300 mcg

OTC

cerovite advanced formula oral tablet OTC; QL

cerovite oral liquid OTC

cerovite senior oral tablet OTC; QL

certa plus oral tablet OTC; QL

certavite senior-antioxidant oral tablet OTC

certavite-antioxid (iron gluc) oral liquid OTC

certavite-antioxidant oral tablet OTC; QL

chewable-vite oral tablet,chewable OTC

compete oral tablet OTC; QL

complete 50+ oral tablet OTC

complete multi 50+ oral tablet OTC; QL

complete multi oral tablet OTC; QL

30

Page 32: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

complete multivitamin oral tablet OTC; QL

complete multivitamin oral tablet 0.4-300-250 mg-mcg-mcg

OTC

complete multivitamin-mineral oral liquid OTC

complete multivitamin-mineral oral tablet OTC; QL

complete oral tablet OTC; QL

complete premium vitamin oral tablet OTC; QL

complete senior oral tablet OTC; QL

complete senior oral tablet 0.4-300-250 mg-mcg-mcg

OTC

daily gummies oral tablet,chewable OTC

daily multiple for men 50+ oral tablet OTC; QL

daily multiple for men oral tablet OTC; QL

daily multiple for women 50+ oral tablet OTC; QL

daily multiple for women oral tablet OTC; QL

daily multiple oral tablet , 18-400 mg-mcg OTC; QL

daily multiple oral tablet 400-120 mcg-mg OTC

daily multiple vitamins/iron oral tablet OTC; QL

daily multi-vitamin oral tablet OTC; QL

daily multivitamin with iron oral tablet OTC; QL

daily multivitamin-minerals oral tablet OTC; QL

daily multi-vitamins/iron oral tablet OTC; QL

daily value oral tablet OTC; QL

daily vitamin formula oral tablet OTC; QL

daily vitamin formula-iron oral tablet OTC; QL

daily vitamin formula-minerals oral tablet OTC; QL

daily vitamin with iron and ca oral tablet OTC; QL

daily vitamin with iron oral tablet OTC; QL

daily vites/iron oral tablet OTC; QL

daily-vite oral tablet OTC; QL

DECUBI VITE ORAL CAPSULE OTC

DIABETES HEALTH FORMULA ORAL TABLET

OTC

e-400 c-500 and beta carotene oral tablet OTC

eldertonic oral elixir OTC; QL

ellis tonic oral elixir OTC; QL

ELON MATRIX COMPLETE ORAL TABLET

OTC; QL

31

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Drug Name Reference Notes

essentia oral tablet OTC; QL

essential balance with lutein oral tablet OTC; QL

essential daily oral tablet OTC; QL

essential man 50+ oral tablet OTC

essential man oral tablet OTC

essential woman 50+ oral tablet OTC; QL

eye health plus lutein oral tablet OTC; QL

fosfree oral tablet OTC; QL

FREEDAVITE ORAL TABLET OTC

geriaton oral liquid OTC; QL

GERITOL COMPLETE ORAL TABLET OTC

GERITOL TONIC WITH FERREX 18 ORAL LIQUID

OTC

hair vitamins oral tablet OTC; QL

hair,skin and nails oral tablet OTC; QL

hair,skin and nails oral tablet 1 mg iron-66.7 mcg-1,000 mcg

OTC

healthy eyes oral tablet OTC; QL

healthy eyes supervision oral capsule OTC

ICAPS AREDS ORAL CAPSULE OTC

ICAPS MV ORAL TABLET,DELAYED RELEASE (DR/EC)

OTC; QL

I-CAPS ORAL CAPSULE OTC

i-vite oral tablet OTC; QL

i-vite protect oral tablet OTC; QL

K-PAX IMMUNE SUPPORT ORAL TABLET

OTC; QL

K-PAX ORAL CAPSULE OTC

maximum daily green oral tablet OTC

maximum daily multivitamin oral tablet OTC; QL

mega multi for women oral tablet OTC

mega multiple/chelated mineral oral tablet OTC; QL

mega multivitamin for men oral tablet OTC

mega multivitamin with mineral oral tablet OTC

men's daily multivit-mineral oral tablet OTC; QL

men's daily oral capsule OTC; QL

men's multi-vitamin oral tablet OTC; QL

men's one daily oral tablet OTC; QL

32

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Drug Name Reference Notes

milltrium senior oral tablet OTC; QL

MONOCAPS ORAL TABLET OTC

multi complete with iron oral tablet OTC; QL

multi for her 50 plus oral capsule OTC

multi for her oral capsule OTC

multi for her oral tablet OTC

multi vitamin oral liquid OTC

multi-betic oral tablet OTC; QL

multi-day oral tablet OTC; QL

multi-day with iron oral tablet OTC; QL

multi-delyn oral liquid OTC

multi-delyn with iron oral liquid OTC

multilex oral tablet OTC; QL

multilex-t and m oral tablet OTC; QL

multiple vitamin, womens oral tablet OTC; QL

multiple vitamin-minerals oral tablet OTC; QL

multiple vitamins oral tablet OTC; QL

multivitamin 50 plus oral tablet OTC; QL

multi-vitamin hp/minerals oral capsule OTC

multivitamin oral capsule OTC

multivitamin oral tablet Daily Multi-Vitamin OTC; QL

multivitamin with iron oral tablet Daily Multi-Vitamins/Iron OTC; QL

multivitamin with minerals oral liquid OTC

multivitamin with minerals oral tablet Bee-Zee OTC; QL

mv-min-folic acid-lutein oral tablet,chewable

Adult Multivitamin (w-lutein) OTC

my-vitalife oral capsule OTC; QL

ocutabs oral tablet OTC; QL

OCUVITE ORAL CAPSULE OTC

OCUVITE WITH LUTEIN ORAL TABLET OTC; QL

omnicap oral tablet OTC; QL

once daily oral tablet OTC; QL

one daily calcium/iron oral tablet OTC; QL

one daily complete oral tablet OTC; QL

one daily energy oral tablet OTC; QL

one daily essential oral tablet , 0.4 mg OTC; QL

one daily essential oral tablet 400 mcg OTC

33

Page 35: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

one daily for men 50+ advanced oral tablet

OTC; QL

one daily for men oral tablet OTC; QL

one daily for women oral tablet OTC; QL

one daily gummy vites oral tablet,chewable

OTC

one daily healthy weight oral tablet OTC; QL

one daily maximum oral tablet OTC; QL

one daily men's 50+ oral tablet OTC; QL

one daily multi-vit w-mineral oral tablet OTC; QL

one daily multivitamin oral tablet OTC; QL

one daily multivitamin oral tablet 400 mcg OTC

one daily oral tablet OTC; QL

one daily plus iron oral tablet OTC; QL

one daily plus minerals oral tablet OTC; QL

one daily with iron oral tablet OTC; QL

one daily women 50 plus oral tablet OTC

one daily womens 50 plus oral tablet OTC; QL

one daily women's health oral tablet OTC; QL

one daily women's oral tablet OTC; QL

ONE-A-DAY ENERGY ORAL TABLET OTC

ONE-A-DAY ESSENTIAL ORAL TABLET

OTC; QL

ONE-A-DAY MAXIMUM FORMULA ORAL TABLET

OTC; QL

ONE-A-DAY MEN VITACRAVES ORAL TABLET,CHEWABLE

OTC

ONE-A-DAY MENOPAUSE FORMULA ORAL TABLET

OTC

ONE-A-DAY MEN'S 50 PLUS ORAL TABLET

OTC

ONE-A-DAY MEN'S MULTIVITAMIN ORAL TABLET

OTC; QL

ONE-A-DAY TEEN ADVANTAGE ORAL TABLET

OTC; QL

ONE-A-DAY VITACRAVES IMMUNITY ORAL TABLET,CHEWABLE

OTC

ONE-A-DAY VITACRAVES OMEGA-3 ORAL TABLET,CHEWABLE

OTC

34

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Drug Name Reference Notes

ONE-A-DAY VITACRAVES ORAL TABLET,CHEWABLE

OTC

ONE-A-DAY WEIGHTSMART ORAL TABLET

OTC; QL

ONE-A-DAY WOMEN VITACRAVES ORAL TABLET,CHEWABLE

OTC

ONE-A-DAY WOMEN'S ACTIVE ORAL TABLET

OTC

ONE-A-DAY WOMENS FORMULA ORAL TABLET 18 MG IRON-400 MCG-500 MG

OTC

ONE-A-DAY WOMENS FORMULA ORAL TABLET 18 MG IRON-400 MCG-500 MG CA

OTC; QL

ONE-A-DAY WOMEN'S HEALTHY SKIN ORAL TABLET

OTC

ONE-A-DAY WOMEN'S PETITES ORAL TABLET

OTC

one-tablet-daily oral tablet OTC; QL

OPTISOURCE ORAL TABLET,CHEWABLE

OTC

opti-vitamins oral tablet OTC; QL

PRESERVISION AREDS ORAL CAPSULE

OTC

PRESERVISION AREDS ORAL TABLET OTC; QL

PRESERVISION LUTEIN ORAL CAPSULE

OTC

PREVENT ORAL CAPSULE OTC

PROCERV HP ORAL TABLET OTC

PRORENAL QD ORAL CAPSULE OTC

quintabs oral tablet OTC

quintabs-m iron free oral tablet OTC; QL

quintabs-m oral tablet OTC

SAVISION ORAL TABLET OTC; QL

senior tabs oral tablet OTC

sentry (with lutein) oral tablet OTC; QL

sentry oral tablet OTC; QL

sentry senior oral tablet 0.4-300-250 mg-mcg-mcg

OTC

sentry senior oral tablet 500-300-250 mcg OTC; QL

35

Page 37: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

SOLO ORAL TABLET OTC

spectravite adult 50+ oral tablet OTC

spectravite adult 50+ oral tablet,chewable OTC

spectravite adult oral tablet,chewable OTC

spectravite advanced formula oral tablet OTC; QL

spectravite men's oral tablet OTC; QL

spectravite senior oral tablet OTC; QL

spectravite ultra men 50+ oral tablet OTC

spectravite ultra men's sr oral tablet OTC

spectravite ultra women oral tablet OTC; QL

spectravite ultra women's sr oral tablet OTC

stress b-complex oral tablet OTC

stress formula advanced oral tablet OTC; QL

sunvite oral tablet OTC

super antioxidant oral capsule OTC

super ginseng multivitamin oral capsule OTC

super multiple - low iron oral tablet OTC

super multiple oral capsule OTC

super multiple oral tablet OTC; QL

super multivitamin oral tablet OTC; QL

super thera vite m oral tablet OTC; QL

support oral liquid OTC; QL

tab-a-vite oral tablet OTC; QL

tab-a-vite/iron oral tablet OTC; QL

tab-a-vite-minerals oral tablet OTC; QL

thera m plus (ferrous fumarat) oral tablet OTC; QL

thera oral tablet OTC; QL

THERAGRAN-M PREMIER 50 PLUS ORAL TABLET

OTC

theralogix companion oral tablet OTC

thera-m oral tablet OTC; QL

therapeutic liquid oral liquid OTC

therapeutic m + beta-carotene oral tablet OTC; QL

therapeutic-m oral tablet OTC; QL

therapeutic-m vitamin/minerals oral tablet OTC; QL

thera-tabs m oral tablet OTC; QL

thera-tabs oral tablet OTC; QL

36

Page 38: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

theratrum complete 50 plus oral tablet OTC; QL

theratrum complete 50 plus/lut oral tablet OTC; QL

theratrum complete with lutein oral tablet OTC; QL

therems oral tablet OTC; QL

therems-h oral tablet OTC

therems-m oral tablet OTC; QL

totalday multiple oral tablet extended release

OTC; QL

ultimate men's complete 50+ oral tablet OTC

ultimate women's complete 50+ oral tablet OTC

ultra antioxidant formula oral tablet OTC

ultra freeda oral tablet OTC

unicomplex-m oral tablet OTC; QL

UROSEX ORAL TABLET OTC

vision formula (with lutein) oral tablet OTC; QL

vision-vite + zinc oral tablet OTC; QL

vitacel (with lutein) oral tablet OTC

vitalee oral tablet OTC; QL

vitamins a-d-e selenium oral tablet OTC

vitamins and minerals oral tablet OTC; QL

vitamins for hair oral tablet OTC; QL

vitatrum oral tablet OTC; QL

vitrum senior oral tablet OTC; QL

whole source multi-vitamins oral tablet OTC

women's active oral tablet OTC

women's biomultiple oral tablet OTC

women's daily caplet oral tablet OTC; QL

women's daily formula oral tablet OTC; QL

women's one daily oral tablet OTC; QL

yelets oral tablet OTC; QL

NUTRITIONAL PRODUCT - CARBOHYDRATES, ORAL

ENFAMIL GLUCOSE ORAL SOLUTION OTC

GERBER GOOD START GLUCOSE ORAL SOLUTION

OTC

PEDIATRIC VITAMIN PREPARATIONS

animal chews oral tablet,chewable OTC

37

Page 39: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

animal shape vitamins oral tablet,chewable

OTC

animal shapes complete oral tablet,chewable

OTC

AQUADEKS PEDIATRIC ORAL DROPS OTC

cerovite jr oral tablet,chewable OTC; QL

chewable-vite oral tablet,chewable OTC

chewable-vite with iron oral tablet,chewable

OTC

child multivitamins oral tablet,chewable OTC

child vitamin with minerals oral tablet,chewable

OTC; QL

children's chewable vitamin oral tablet,chewable

OTC

children's chewables extra c oral tablet,chewable

OTC

children's chewables oral tablet,chewable OTC

children's chewables with iron oral tablet,chewable

OTC

children's multi-vit gummies oral tablet,chewable

OTC

childs chew vite oral tablet,chewable OTC

child's chewable vitamins/iron oral tablet,chewable

OTC

child's gummy vitamin-mineral oral tablet,chewable

OTC

child's vitamin with iron oral tablet,chewable

OTC

childs/iron oral tablet,chewable OTC

dino-life oral tablet,chewable OTC

dino-life with extra c oral tablet,chewable OTC

dino-life with iron-zinc oral tablet,chewable OTC; QL

FLINTSTONES COMPLETE (IRON) ORAL TABLET,CHEWABLE

OTC

FLINTSTONES GUMMIES OMEGA-3 ORAL TABLET,CHEWABLE

OTC

FLINTSTONES GUMMIES ORAL TABLET,CHEWABLE

OTC

FLINTSTONES MULTI-VIT GUMMIES ORAL TABLET,CHEWABLE

OTC

38

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Drug Name Reference Notes

FLINTSTONES PLUS CALCIUM ORAL TABLET,CHEWABLE

OTC

FLINTSTONES SOUR GUMMIES ORAL TABLET,CHEWABLE

OTC

FLINTSTONES TAB CHEW ORAL TABLET,CHEWABLE

OTC

FLINTSTONES/EXTRA C ORAL TABLET,CHEWABLE

OTC

fruity vitamin oral tablet,chewable OTC

gummi bear multivitamin oral tablet,chewable

OTC

gummy dinos oral tablet,chewable OTC

honey bears with iron-zinc oral tablet,chewable

OTC; QL

little animals oral tablet,chewable OTC

little animals-iron oral tablet,chewable OTC

lysiplex plus oral liquid OTC; QL

multi-vitamins with iron oral tablet,chewable

OTC; QL

ONE-A-DAY KID'S ORAL TABLET,CHEWABLE

OTC

POLY-VI-SOL WITH IRON ORAL DROPS

OTC

poly-vita (iron) oral drops OTC; QL

poly-vita oral drops OTC

poly-vitamin oral drops OTC

poly-vitamin with iron oral drops OTC; QL

polyvitamin with iron oral tablet,chewable OTC; QL

poly-vitamins oral tablet,chewable OTC

SCOOBY-DOO ONE A DAY KIDS ORAL TABLET,CHEWABLE

OTC

tri-vita oral drops OTC

tri-vitamin oral drops OTC

vitalets oral tablet,chewable OTC

zoo chews oral tablet,chewable OTC

zoo friends original oral tablet,chewable OTC

POTASSIUM REPLACEMENT

potassium gluconate oral tablet OTC; QL

39

Page 41: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

PRENATAL VITAMIN PREPARATIONS

classic prenatal oral tablet AL; OTC; QL

daily prenatal oral combo pack AL; OTC; QL

kpn oral tablet AL; OTC; QL

MINI PRENATAL ORAL TABLET AL; OTC; QL

one daily prenatal oral combo pack AL; OTC; QL

perry prenatal oral capsule AL; OTC; QL

pnv cmb#95-ferrous fumarate-fa oral tablet

Prenatal AL; OTC; QL

prenatal + dha oral combo pack AL; OTC; QL

prenatal formula oral tablet AL; OTC; QL

prenatal gummy oral tablet,chewable AL; OTC; QL

prenatal multivitamins oral tablet AL; OTC; QL

prenatal one daily oral tablet AL; OTC; QL

prenatal oral tablet AL; OTC; QL

prenatal tablet oral tablet AL; OTC; QL

prenatal vitamin oral tablet AL; OTC; QL

prenatal vitamin with minerals oral tablet AL; OTC; QL

prenatal vits96-iron fum-folic oral tablet AL; OTC; QL

women's prenatal + dha oral combo pack AL; OTC; QL

VITAMIN B PREPARATIONS

b complete oral tablet OTC

b complex 1 oral tablet OTC

b complex 100 oral tablet OTC

b complex plus vitamin c oral capsule OTC

b complex w-vit c oral tablet OTC

b complex-vitamin b12 oral tablet OTC

b complex-vitamin c-folic acid oral tablet OTC

b-100 complex oral tablet extended release

OTC

b-12 dots oral tablet OTC

b-50 complex oral tablet extended release OTC

bal b-100 oral tablet OTC

bal b-50 oral tablet OTC

balance b-100 oral tablet OTC

balance b-50 oral tablet OTC

40

Page 42: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

balanced b-100 complex oral tablet extended release

OTC

balanced b-100 oral tablet OTC

balanced b-50 complex oral tablet OTC

balanced b-50 oral tablet OTC

b-complex oral tablet OTC

b-complex with vitamin c oral capsule Super B/C OTC; QL

b-complex with vitamin c oral tablet Super B Complex-Vitamin C OTC; QL

b-complex with vitamin c oral tablet 400-500 mcg-mg

OTC

complex b-100 oral tablet extended release

OTC

cyanocobalamin (vitamin b-12) oral liquid Liquid B 12 OTC

cyanocobalamin (vitamin b-12) oral lozenge

OTC

cyanocobalamin (vitamin b-12) oral tablet Vitamin B-12 OTC

cyanocobalamin (vitamin b-12) oral tablet extended release

Vitamin B-12 OTC

cyanocobalamin (vitamin b-12) sublingual lozenge

OTC

cyanocobalamin (vitamin b-12) sublingual tablet

Vitamin B-12 OTC

DIALYVITE 800 ORAL TABLET OTC

DIALYVITE 800-ULTRA D ORAL TABLET

OTC; QL

foltabs 800 oral tablet OTC

full spectrum b-vitamin c oral tablet OTC

kobee oral tablet OTC

liquid b 12 oral liquid OTC

MEDTYCHOLL-B COMPLEX-LIVER ORAL CAPSULE

OTC

natural b-100 complex oral tablet OTC

nephronex oral liquid OTC

nephronex-sl oral tablet,disintegrating OTC

NEPHRO-VITE ORAL TABLET OTC

niacin (niacinamide) oral tablet OTC

niacin oral capsule, extended release 125 mg, 250 mg, 500 mg

OTC; QL

niacin oral tablet OTC

41

Page 43: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

niacin oral tablet extended release Endur-Acin OTC

niacinamide oral tablet Niacin (niacinamide) OTC

pantothenic acid (vit b5) oral tablet OTC

PRORENAL ORAL TABLET OTC; QL

pyridoxine (vitamin b6) oral tablet Vitamin B-6 OTC

QUIN B STRONG ORAL TABLET OTC

RABANO YODADO ORAL LIQUID OTC

rena-vite oral tablet OTC

riboflavin (vitamin b2) oral tablet Vitamin B-2 OTC

slo-niacin oral tablet extended release OTC

stress b plus zinc oral tablet OTC; QL

stress formula 600 c oral tablet OTC; QL

stress formula energy oral tablet OTC

stress formula oral tablet OTC; QL

stress formula plus iron oral tablet OTC; QL

stress formula with iron oral tablet OTC

stress formula with iron(sulf) oral tablet OTC

stress formula with zinc oral tablet OTC; QL

stresstabs with zinc oral tablet OTC; QL

super b complex + c oral tablet OTC

super b complex-vitamin c oral tablet OTC; QL

super b maxi complex oral tablet OTC

super b/c oral capsule OTC; QL

super b-50 complex oral capsule OTC

super b-50 complex plus oral tablet OTC

super quints b-50 oral tablet OTC

super quints oral tablet OTC

superplex-t oral tablet OTC; QL

thiamine hcl (vitamin b1) oral tablet Vitamin B-1 OTC

thiamine mononitrate (vit b1) oral tablet Vitamin B-1 (mononitrate) OTC

total b/c oral tablet OTC; QL

ultra b-100 complex oral tablet OTC

vit b complex-folic acid oral tablet B Complex 100 OTC

vitamin b complex oral capsule Super B-50 Complex OTC

vitamin b complex oral tablet B Complex 1 OTC

vitamin b complex with c oral capsule OTC; QL

vitamin b-1 (mononitrate) oral tablet OTC

42

Page 44: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

vitamin b-1 oral tablet OTC

vitamin b-12 oral lozenge OTC

vitamin b-12 oral tablet OTC

vitamin b-12 oral tablet extended release OTC

vitamin b-12 sublingual drops OTC

vitamin b-12 sublingual tablet OTC

vitamin b-2 oral tablet OTC

vitamin b-6 oral tablet OTC

vitamin b-6 oral tablet extended release OTC

vitamins b complex oral capsule OTC

vitamins b complex oral tablet OTC

vitamins for hair oral tablet OTC; QL

VITAMIN D PREPARATIONS

cholecalciferol (vitamin d3) oral capsule 1,000 unit

Vitamin D3 OTC

cholecalciferol (vitamin d3) oral capsule 2,000 unit

D3-2000 OTC; QL

cholecalciferol (vitamin d3) oral capsule 5,000 unit

Dialyvite Vitamin D OTC; QL

cholecalciferol (vitamin d3) oral drops D-Vi-Sol OTC; QL

cholecalciferol (vitamin d3) oral tablet 1,000 unit, 5,000 unit

Vitamin D3 OTC

cholecalciferol (vitamin d3) oral tablet 2,000 unit

D3 DOTS OTC

cholecalciferol (vitamin d3) oral tablet 400 unit

Delta D3 OTC; QL

d3-2000 oral capsule OTC; QL

delta d3 oral tablet OTC; QL

DIALYVITE VITAMIN D ORAL CAPSULE OTC; QL

d-vi-sol oral drops OTC; QL

d-vita oral drops OTC; QL

ergocalciferol (vitamin d2) oral tablet OTC

JUST D ORAL DROPS OTC; QL

vitamin d3 oral capsule 1,000 unit OTC

vitamin d3 oral capsule 2,000 unit OTC; QL

vitamin d3 oral tablet 1,000 unit, 2,000 unit, 5,000 unit

OTC

vitamin d3 oral tablet 400 unit OTC; QL

43

Page 45: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

VITAMIN K PREPARATIONS

phytonadione (vitamin k1) oral tablet OTC

VITAMINS - A

beta carotene oral capsule OTC

vitamin a oral capsule 10,000 unit, 8,000 unit

OTC

vitamin a oral capsule 25,000 unit OTC; QL

vitamin a palmitate oral tablet OTC

VITAMINS - BIOTIN

biotin oral capsule Meribin OTC

biotin oral tablet OTC

VITAMINS - C, ASCORBIC ACID AND DERIVATIVES

acerola c-500 oral wafer OTC

ascorbate calcium oral tablet OTC

ascorbic acid (vitamin c) oral capsule, extended release

Vitamin C OTC

ascorbic acid (vitamin c) oral tablet 1,000 mg

C-1000 OTC

ascorbic acid (vitamin c) oral tablet 250 mg

Vitamin C OTC; QL

ascorbic acid (vitamin c) oral tablet 500 mg

Ascorbic Acid with Rose Hips

OTC; QL

ascorbic acid (vitamin c) oral tablet extended release

C Complex OTC

ascorbic acid (vitamin c) oral tablet,chewable

OTC; QL

ascorbic acid with rose hips oral tablet OTC; QL

c complex oral tablet extended release OTC

c-1000 oral tablet OTC

c-1000 oral tablet extended release OTC

c-1000 with rose hips oral tablet OTC

c-500 oral tablet OTC; QL

c-500 oral tablet extended release OTC

c-500 oral tablet,chewable OTC; QL

fruit c oral tablet,chewable OTC

fruit c-100 oral tablet,chewable OTC

fruit c-500 oral tablet,chewable OTC; QL

halls defense oral lozenge OTC

44

Page 46: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

soothing pureway-c oral tablet OTC; QL

strawberry c oral tablet,chewable OTC; QL

vita-c oral crystals OTC

vitamin c cough drops oral lozenge OTC

vitamin c drops oral lozenge OTC

vitamin c oral capsule, extended release OTC

vitamin c oral liquid OTC

vitamin c oral powder OTC

vitamin c oral syrup OTC

vitamin c oral tablet 1,000 mg, 100 mg OTC

vitamin c oral tablet 250 mg, 500 mg OTC; QL

vitamin c oral tablet extended release OTC

vitamin c oral tablet,chewable 250 mg OTC

vitamin c oral tablet,chewable 500 mg OTC; QL

vitamin c with rose hips oral tablet 1,000 mg

OTC

vitamin c with rose hips oral tablet 500 mg OTC; QL

vitamin c with rose hips oral tablet extended release

OTC

VITAMINS - E

aquasol e (d-alpha tocopherol) oral drops OTC

vitamin e (dl, acetate) oral capsule OTC

vitamin e acetate oral capsule OTC

vitamin e mixed oral capsule OTC

vitamin e mixed oral tablet OTC

vitamin e oral capsule OTC

vitamin e oral dropsAquasol E (d-alpha tocopherol)

OTC

vitamin e succinate oral tablet OTC

ZINC REPLACEMENT

chelated zinc oral tablet OTC; QL

zinc amino acid chelate oral tablet OTC; QL

zinc gluconate oral tablet OTC; QL

zinc oral tablet Chelated Zinc OTC; QL

zinc sulfate oral capsule Orazinc OTC

zinc-220 oral capsule OTC

45

Page 47: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

ENDOCRINE

HYPERGLYCEMICS

dex4 glucose bits oral tablet,chewable OTC

dex4 glucose oral tablet,chewable OTC

dex4 glucose pouch pack oral tablet,chewable

OTC

dex4 glucose quick dissolve oral tablet,chewable

OTC

dextrose oral gel Dex4 Glucose OTC

gluco burst oral gel OTC

glucose bits oral tablet,chewable OTC

glucose gel oral gel OTC

glucose oral tablet,chewable Dex4 Glucose OTC

INSULINS

HUMULIN 70/30 SUBCUTANEOUS SUSPENSION

OTC; QL

NOVOLIN 70/30 SUBCUTANEOUS SUSPENSION

OTC; QL

NOVOLIN N SUBCUTANEOUS SUSPENSION

OTC; QL

GASTROINTESTINAL THERAPY AGENTS

ANTACIDS

acid gone antacid e.strength oral tablet,chewable

OTC

acid gone antacid oral suspension OTC

advanced antacid-antigas oral suspension OTC

almacone oral suspension OTC

almacone-2 oral suspension OTC

aluminum hydroxide gel oral suspension OTC

antacid (calcium carb-mag hyd) oral tablet,chewable

OTC

antacid (calcium carbonate) oral tablet,chewable

OTC; QL

antacid anti-gas double str oral suspension

OTC

antacid anti-gas oral suspension OTC

antacid exst (mag carb-al hyd) oral tablet,chewable

OTC

46

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Drug Name Reference Notes

antacid ext str (calcium carb) oral tablet,chewable

OTC

antacid extra-strength oral suspension OTC

antacid extra-strength oral tablet,chewable

OTC

antacid liquid oral suspension OTC

antacid m oral suspension OTC

antacid maximum strength oral suspension

OTC

antacid oral suspension OTC

antacid plus anti-gas oral suspension OTC

antacid regular strength oral suspension OTC

antacid supreme oral suspension OTC

antacid ultra strength oral tablet,chewable OTC

antacid-antigas oral suspension OTC

antacid-simethicone oral suspension OTC

calcium antacid oral tablet,chewable 200 mg calcium (500 mg)

OTC; QL

calcium antacid oral tablet,chewable 300 mg (750 mg), 320 mg calcium (750 mg), 400 mg calcium (1,000 mg)

OTC

calcium antacid tropical oral tablet,chewable

OTC

calcium antacid ultra max st oral tablet,chewable

OTC

calcium carbonate oral tablet OTC; QL

calcium carbonate oral tablet,chewable 200 mg calcium (500 mg)

Antacid (calcium carbonate) OTC; QL

calcium carbonate oral tablet,chewable 400 mg calcium (1,000 mg)

Antacid Ultra Strength OTC

cal-gest antacid oral tablet,chewable OTC; QL

children's pepto oral tablet,chewable OTC

children's soothe oral tablet,chewable OTC

comfort gel extra strength oral suspension OTC

comfort gel oral suspension OTC

flanax antacid oral suspension OTC

foaming antacid oral suspension OTC

foaming antacid oral tablet,chewable OTC; QL

geri-lanta oral suspension OTC

47

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Drug Name Reference Notes

heartburn antacid oral tablet,chewable OTC

heartburn relief oral tablet,chewable OTC

liquid antacid oral suspension OTC

maalox maximum strength oral suspension

OTC

mag-al plus extra strength oral suspension

OTC

mag-al plus oral suspension OTC

masanti double strength oral suspension OTC

mi-acid oral suspension OTC

mi-acid oral tablet,chewable OTC

mintox maximum strength oral suspension OTC

mintox oral suspension OTC

mintox plus oral tablet,chewable OTC

ri-gel ii oral suspension OTC

ri-gel oral suspension OTC

riginic oral suspension OTC

ri-mag oral suspension OTC

ri-mag plus oral suspension OTC

ri-mox oral suspension OTC

ri-mox plus oral suspension OTC

smooth antacid oral tablet,chewable OTC

sodium bicarbonate oral tablet OTC

tums ultra oral tablet,chewable OTC

ultra strength antacid oral tablet,chewable OTC

ultra strength calcium antacid oral tablet,chewable

OTC

ANTIDIARRHEALS

anti-diarrhea oral tablet OTC; QL

anti-diarrheal (loperamide) oral capsule OTC; QL

anti-diarrheal (loperamide) oral liquid OTC; QL

anti-diarrheal (loperamide) oral tablet OTC; QL

bismatrol oral suspension 262 mg/15 ml OTC; QL

bismatrol oral suspension 525 mg/15 ml OTC

bismatrol oral tablet,chewable OTC

bismuth maximum strength oral suspension

OTC

bismuth oral suspension OTC; QL

48

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Drug Name Reference Notes

bismuth oral tablet OTC

bismuth oral tablet,chewable OTC

bismuth subsalicylate oral suspension Anti-Diarrheal OTC; QL

bismuth subsalicylate oral tablet,chewable Bismatrol OTC

cvs loperamide 1 mg/7.5 ml liq mint Anti-Diarrheal (loperamide) OTC

diamode oral tablet OTC; QL

diarrhea relief (bismuth subs) oral suspension

OTC; QL

diotame oral tablet,chewable OTC

kaopectate (bismuth subsalicy) oral suspension

OTC; QL

kaopectate ex str (bismuth ss) oral suspension

OTC

kao-tin (bismuth subsalicylat) oral suspension

OTC; QL

k-pec antidiarrheal (bism sub) oral suspension

OTC; QL

loperamide oral capsule Anti-Diarrheal (loperamide) OTC; QL

loperamide oral liquid 1 mg/5 ml Anti-Diarrheal (loperamide) OTC; QL

loperamide oral tablet Anti-Diarrhea OTC; QL

peptic relief oral suspension OTC; QL

peptic relief oral tablet,chewable OTC

pepto-bismol oral tablet,chewable OTC

pepto-bismol to-go oral tablet,chewable OTC

pink bismuth maximum strength oral suspension

OTC

pink bismuth oral suspension 262 mg/15 ml

OTC; QL

pink bismuth oral suspension 525 mg/15 ml

OTC

pink bismuth oral tablet OTC

pink bismuth oral tablet,chewable OTC

soothe (bismuth subsalicylate) oral tablet OTC

soothe (bismuth subsalicylate) oral tablet,chewable

OTC

soothe regular strength oral suspension OTC; QL

stomach relief max strength oral suspension

OTC

stomach relief oral suspension 262 mg/15 ml

OTC; QL

49

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Drug Name Reference Notes

stomach relief oral suspension 525 mg/15 ml

OTC

stomach relief oral tablet OTC

stomach relief oral tablet,chewable OTC

stomach relief original oral suspension OTC; QL

ANTIEMETIC/ANTIVERTIGO AGENTS

anti-nausea oral solution OTC

dimenhydrinate oral tablet Dramamine OTC

dramamine less drowsy oral tablet OTC

dramamine oral tablet OTC

driminate oral tablet OTC

formula em oral solution OTC

meclizine oral tablet OTC

meclizine oral tablet,chewable Bonine OTC

medi-meclizine oral tablet OTC

motion relief (meclizine) oral tablet OTC

motion sickness (meclizine) oral tablet OTC

motion sickness ii oral tablet OTC

motion sickness oral tablet OTC

motion sickness relief oral tablet OTC

motion sickness relief(mecliz) oral tablet OTC

motion sickness relief(mecliz) oral tablet,chewable

OTC

nausea control oral solution OTC

nausea relief oral solution OTC

travel sickness (meclizine) oral tablet,chewable

OTC

travel sickness oral tablet OTC

wal-dram oral tablet OTC

ANTIFLATULENTS

anti-gas ultra strength oral capsule OTC

bicarsim forte oral tablet OTC

gas relief 80 oral tablet,chewable OTC

gas relief extra strength oral capsule OTC

gas relief extra strength oral tablet,chewable

OTC

gas relief oral capsule OTC

50

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Drug Name Reference Notes

gas relief oral drops,suspension OTC

gas relief oral tablet,chewable OTC

gas relief ultra strength oral capsule OTC

infants gas relief oral drops,suspension OTC

mi-acid gas relief oral tablet,chewable OTC

mytab gas maximum strength oral tablet,chewable

OTC

mytab gas oral tablet,chewable OTC

simethicone oral capsule Anti-Gas Ultra Strength OTC

simethicone oral drops,suspension Gas Relief OTC

simethicone oral tablet,chewable Gas Relief OTC

GASTRIC ACID SECRETION REDUCERS

acid control (ranitidine) oral tablet OTC; QL

acid controller complete oral tablet,chewable

OTC

acid controller oral tablet 10 mg, 20 mg OTC; QL

acid reducer (famotidine) oral tablet 10 mg, 20 mg

OTC; QL

acid reducer (ranitidine) oral tablet 150 mg, 75 mg

OTC; QL

acid reducer complete (famot) oral tablet,chewable

OTC

complete oral tablet,chewable OTC

dual action complete oral tablet,chewable OTC

eq ranitidine 150 mg tablet maximum strength (otc)

Acid Control (ranitidine) OTC; QL

famotidine oral tablet 10 mg Acid Controller OTC; QL

heartburn prevention oral tablet 10 mg, 20 mg

OTC; QL

heartburn relief (famotidine) oral tablet 10 mg, 20 mg

OTC; QL

heartburn relief (ranitidine) oral tablet 150 mg, 75 mg

OTC; QL

heartburn treatment 24 hour oral capsule,delayed release(dr/ec)

PA; OTC; QL

hm famotidine 20 mg tablet maximum strength (otc)

Acid Controller OTC; QL

lansoprazole oral capsule,delayed release(dr/ec)

Heartburn Treatment 24 Hour

PA; OTC; QL

51

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Drug Name Reference Notes

NEXIUM 24HR ORAL TABLET,DELAYED RELEASE (DR/EC)

OTC; QL

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

Acid Reducer (omeprazole) OTC; QL

omeprazole oral tablet,delayed release (dr/ec)

OTC; QL

pepcid ac oral tablet OTC; QL

PREVACID 24HR ORAL CAPSULE,DELAYED RELEASE(DR/EC)

PA; OTC; QL

pub famotidine 20 mg tablet (otc) Acid Controller OTC; QL

pub ranitidine 150 mg tablet (otc) Acid Control (ranitidine) OTC; QL

ranitidine 150 mg tablet maximum strength (otc)

Acid Control (ranitidine) OTC; QL

ranitidine hcl oral tablet 75 mg Acid Reducer (ranitidine) OTC; QL

wal-zan 150 oral tablet OTC; QL

wal-zan 75 oral tablet OTC; QL

zantac 75 oral tablet OTC; QL

zantac maximum strength oral tablet OTC; QL

zantac oral tablet OTC; QL

LAXATIVES AND CATHARTICS

alophen oral tablet,delayed release (dr/ec) OTC; QL

bisac-evac rectal suppository OTC

bisacodyl oral tablet,delayed release (dr/ec)

Alophen OTC; QL

bisacodyl rectal suppository Bisac-Evac OTC

bisa-lax oral tablet,delayed release (dr/ec) OTC; QL

biscolax rectal suppository OTC

chocolate laxative oral tablet,chewable OTC

citrate of magnesia oral solution OTC

citroma oral solution OTC

citrucel oral tablet OTC

clearlax oral powder OTC

clearlax oral powder in packet OTC; QL

col-rite oral capsule 100 mg OTC; QL

col-rite oral capsule 250 mg, 50 mg OTC

daily fiber oral capsule OTC

diocto oral liquid OTC

diocto oral syrup OTC

52

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Drug Name Reference Notes

dioctyl oral syrup OTC

doc-q-lace oral capsule OTC; QL

doc-q-lax oral tablet OTC

docu oral liquid OTC

docuprene oral tablet OTC

docusate calcium oral capsule Kao-Tin (docusate calcium) OTC

docusate sodium oral capsule 100 mg Col-Rite OTC; QL

docusate sodium oral capsule 250 mg Col-Rite OTC

docusate sodium oral liquid Diocto OTC

docusate sodium oral syrup Diocto OTC

docusate sodium oral tablet Docuprene OTC

docusil oral capsule OTC; QL

dok oral capsule 100 mg OTC; QL

dok oral capsule 250 mg OTC

dok oral tablet OTC

dok plus oral tablet OTC

dss oral capsule OTC

ducodyl oral tablet,delayed release (dr/ec) OTC; QL

dulcolax stool softener (dss) oral capsule OTC; QL

easy fiber oral powder OTC

enema disposable rectal enema OTC

enema rectal enema OTC

epsom salt oral granules OTC; QL

fiber (calcium polycarbophil) oral tablet OTC; QL

fiber (dextrin) oral powder OTC

fiber (psyllium husk) oral capsule OTC

fiber (psyllium husk/sugar) oral powder OTC

fiber (with aspartame) oral powder OTC

fiber laxative (ca polycarbo) oral tablet OTC; QL

fiber laxative (husk/sugar) oral powder OTC

fiber laxative (methylcellulo) oral tablet OTC

fiber laxative (psyllium husk) oral capsule OTC

fiber oral powder OTC

fiber smooth (sucrose) oral powder OTC

fiber smooth oral powder OTC

fiber supplement (inulin) oral tablet,chewable

OTC

53

Page 55: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

fiber therapy (ca polycarboph) oral tablet OTC; QL

fiber therapy (m-cell/sugar) oral powder OTC

fiber therapy (m-cellulose) oral tablet OTC

fiber therapy laxative (husk) oral capsule OTC

fiber-caps (psyllium husk) oral capsule OTC

fiber-lax oral tablet OTC; QL

fiber-tabs oral tablet OTC; QL

fleet enema rectal enema OTC

fleet glycerin (adult) rectal suppository OTC

fleet laxative oral tablet,delayed release (dr/ec)

OTC

gavilax oral powder OTC

gavilax oral powder in packet OTC; QL

gentle laxative oral tablet,delayed release (dr/ec)

OTC; QL

gentle laxative rectal suppository OTC

gentlelax oral powder OTC

geri-kot oral tablet OTC

glycerin (adult) rectal suppository Fleet Glycerin (Adult) OTC

glycerin (child) rectal suppository Fleet Glycerin (Child) OTC

glycolax oral powder OTC

healthylax oral powder in packet OTC; QL

kao-tin (docusate calcium) oral capsule OTC

konsyl (sugar) oral powder OTC

laxacin oral tablet OTC

laxaclear oral powder OTC

laxative (bisacodyl) oral tablet OTC; QL

laxative (bisacodyl) oral tablet,delayed release (dr/ec)

OTC; QL

laxative (bisacodyl) rectal suppository OTC

laxative (sennosides) oral tablet OTC

laxative (sennosides) oral tablet,chewable OTC

laxative feminine oral tablet OTC; QL

laxative maximum strength oral tablet OTC

laxative peg 3350 oral powder OTC

laxative pills oral tablet OTC

laxative pills regular oral tablet OTC

laxative plus stool softener oral tablet OTC

54

Page 56: Medicaid-Approved Over-the-Counter Preferred Drug List · Louisiana Healthy Blue Medicaid-Approved Over-the-Counter Preferred Drug List Effective November 1, 2017 Legend In each class,

Drug Name Reference Notes

magnesium citrate oral solution Citrate of Magnesia OTC

medi-laxx oral tablet OTC

milk of magnesia concentrated oral suspension

OTC

milk of magnesia oral suspension OTC

mineral oil extra heavy oral oil OTC

mineral oil heavy oral oil OTC

mineral oil laxative oral oil OTC

mineral oil oral oil Mineral Oil Extra Heavy OTC

mineral oil rectal enema Fleet Mineral Oil OTC

miralax oral powder in packet OTC; QL

natural fiber laxative (sugar) oral powder OTC

natural fiber laxative oral capsule OTC

natural fiber laxative s/f oral powder OTC

natural fiber laxative smooth oral powder OTC

natural fiber laxative therapy oral powder OTC

natural fiber laxative(aspart) oral powder OTC

natural fiber supplement oral powder in packet

OTC

natural laxative oral tablet OTC

natural veg laxative(sennosid) oral tablet OTC

natural vegetable (psyllium) oral powder OTC

natural vegetable oral powder OTC

natural vegetable powder oral powder OTC

oral saline laxative oral liquid OTC

p-col rite oral tablet OTC

perdiem overnight relief oral tablet OTC

peri-colace oral tablet OTC

phosphate laxative oral liquid OTC

polyethylene glycol 3350 oral powder ClearLax OTC

polyethylene glycol 3350 oral powder in packet

ClearLax OTC; QL

promolaxin oral tablet OTC

psyllium husk oral capsule Daily Fiber OTC

purelax oral powder OTC

purelax oral powder in packet OTC; QL

ready-to-use enema rectal enema OTC

reguloid (psyllium husk) oral capsule OTC

55

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Drug Name Reference Notes

reguloid oral powder OTC

reguloid, sugar free oral powder OTC

sani-supp (adult) rectal suppository OTC

sani-supp (infant) rectal suppository OTC

senexon oral syrup OTC

senexon oral tablet OTC

senexon-s oral tablet OTC

senna concentrate oral tablet OTC

senna lax oral tablet OTC

senna laxative oral tablet OTC

senna laxative-stool softener oral tablet OTC

senna oral syrup OTC

senna oral tablet OTC

senna plus oral tablet OTC

senna with docusate sodium oral tablet OTC

senna-extra oral tablet OTC

SENNA-GEN ORAL TABLET OTC

senna-s oral tablet OTC

senna-time s oral tablet OTC

senno oral tablet OTC

sennosides oral tablet Evac-U-Gen (sennosides) OTC

sennosides-docusate sodium oral tablet Colace 2-In-1 OTC

sen-o-tab oral tablet OTC

silace oral liquid OTC

silace oral syrup OTC

smoothlax oral powder OTC

smoothlax oral powder in packet OTC; QL

sof-lax oral capsule OTC; QL

soluble fiber oral tablet OTC

stimulant laxative plus oral tablet OTC

stool softener (docusate cal) oral capsule OTC

stool softener oral capsule 100 mg OTC; QL

stool softener oral capsule 250 mg, 50 mg OTC

stool softener oral liquid OTC

stool softener oral syrup OTC

stool softener oral tablet OTC

stool softener-laxative oral tablet OTC

56

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Drug Name Reference Notes

stool softener-stimulant laxat oral tablet OTC

suppository adult rectal suppository OTC

surfak oral capsule OTC

the magic bullet rectal suppository OTC

vegetable laxative oral tablet OTC

wal-mucil fiber (aspartame) oral powder OTC

wal-mucil fiber (sugar) oral powder OTC

wal-mucil fiber oral capsule OTC

wal-mucil natural fiber lax oral powder OTC

woman's laxative oral tablet OTC; QL

woman's laxative oral tablet,delayed release (dr/ec)

OTC; QL

women's gentle laxative(bisac) oral tablet,delayed release (dr/ec)

OTC; QL

women's laxative (bisacodyl) oral tablet OTC; QL

women's laxative (bisacodyl) oral tablet,delayed release (dr/ec)

OTC; QL

PANCREATIC ENZYMES

dairy aid oral tablet,chewable OTC

dairy digestive oral tablet OTC

dairy digestive supplement oral tablet OTC

dairy relief oral tablet OTC

dairy relief oral tablet,chewable OTC

lac-dose oral tablet OTC

lactase fast acting oral tablet OTC

lactase fast acting oral tablet,chewable OTC

lactase oral tablet Dairy Relief OTC

ultra dairy digestive oral tablet OTC

GENITOURINARY THERAPY

URINARY TRACT ANESTHETIC/ANALGESIC AGENT

urinary pain relief oral tablet OTC; QL

URINARY TRACT ANTISPASMODIC/ANTI-INCONTINENCE AGENT

OXYTROL FOR WOMEN TRANSDERMAL PATCH 4 DAY

OTC

57

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Drug Name Reference Notes

HEMATOLOGICAL AGENTS

PLATELET AGGREGATION INHIBITORS

adult low dose aspirin oral tablet,delayed release (dr/ec)

OTC; QL

aspir-81 oral tablet,delayed release (dr/ec) OTC; QL

aspirin childrens oral tablet,chewable OTC; QL

aspirin low dose oral tablet,delayed release (dr/ec)

OTC; QL

aspirin oral tablet Bayer Aspirin OTC; QL

aspirin oral tablet,chewable Aspirin Childrens OTC; QL

aspirin oral tablet,delayed release (dr/ec) 325 mg

Aspir-Trin OTC; QL

aspirin oral tablet,delayed release (dr/ec) 500 mg, 650 mg

OTC

aspirin oral tablet,delayed release (dr/ec) 81 mg

Adult Low Dose Aspirin OTC; QL

aspir-low oral tablet,delayed release (dr/ec)

OTC; QL

aspir-trin oral tablet,delayed release (dr/ec)

OTC; QL

bayer advanced oral tablet OTC

bayer aspirin oral tablet OTC; QL

child aspirin oral tablet,chewable OTC; QL

children's aspirin oral tablet,chewable OTC; QL

e.c. prin oral tablet,delayed release (dr/ec) OTC; QL

enteric coated aspirin oral tablet,delayed release (dr/ec)

OTC; QL

lite coat aspirin oral tablet OTC; QL

lo-dose aspirin oral tablet,delayed release (dr/ec)

OTC; QL

MEDICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT (DME)

BLOOD SUGAR DIAGNOSTICS

TRUE METRIX GLUCOSE TEST STRIP STRIP

OTC; QL

TRUETEST TEST STRIPS STRIP OTC; QL

CONDOMS

AIMSCO LATEX CONDOM DEVICE OTC

58

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Drug Name Reference Notes

CONDOMS-PREM LUBRICATED DEVICE

OTC

FANTASY CONDOM DEVICE OTC

FC2 FEMALE CONDOM OTC

KIMONO CONDOMS(NON-LUBRICATED) DEVICE

OTC

KIMONO MAXX CONDOMS DEVICE OTC

KIMONO MICROTHIN AQUA LUBE CON DEVICE

OTC

KIMONO MICROTHIN CONDOMS DEVICE

OTC

KIMONO MICROTHIN LARGE CONDOMS DEVICE

OTC

KIMONO TEXTURED CONDOMS DEVICE

OTC

TRUSTEX LATEX CONDOM DEVICE OTC

TRUSTEX LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX NON-LUB CONDOMS DEVICE

OTC

TRUSTEX-RIA LUB/SPERMICIDE DEVICE

OTC

TRUSTEX-RIA LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX-RIA NON-LUB CONDOMS DEVICE

OTC

MEDICAL SUPPLIES AND DME - EQUIPMENT CLEANING AGENTS

alcoh-wipe towelette OTC

MEDICAL SUPPLIES AND DME - GLUCOSE MONITORING TEST SUPPLIES

1ST TIER UNILET COMFORTOUCH OTC; QL

ACCU-CHEK SOFTCLIX LANCET DEV OTC; QL

ADJUSTABLE LANCING DEVICE OTC; QL

ADVANCED LANCING DEVICE KIT OTC; QL

ADVANCED TRAVEL LANCETS OTC; QL

ADVOCATE LANCING DEVICE OTC; QL

ADVOCATE RAPID-SAFE LANCING OTC; QL

ALTERNATE SITE LANCET OTC; QL

59

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Drug Name Reference Notes

ALTERNATE SITE LANCING DEVICE OTC; QL

AQUA LANCE LANCING DEVICE OTC; QL

ASSURE HAEMOLANCE PLUS OTC; QL

ASSURE LANCE OTC; QL

ASSURE LANCE PLUS OTC; QL

AUTOLET IMPRESSION LANC DEV KIT OTC; QL

AUTOLET LANCING DEVICE OTC; QL

AUTOLET PLUS LANCING DEVICE OTC

CAREONE LANCING DEVICE OTC; QL

CAREONE THIN LANCET OTC; QL

CAREONE ULTRA THIN LANCET OTC; QL

CARETOUCH TWIST LANCET OTC; QL

COLOR LANCETS OTC; QL

COMFORT LANCETS OTC; QL

DROPLET LANCING DEVICE OTC; QL

EASY CLICK LANCING DEVICE OTC; QL

EASY TOUCH LANCETS OTC; QL

EASY TOUCH LANCING DEVICE OTC; QL

EASY TOUCH SAFETY LANCETS OTC; QL

EASY TOUCH TWIST LANCETS OTC; QL

E-Z JECT LANCETS OTC; QL

E-Z JECT THIN LANCETS OTC; QL

EZ SMART LANCETS OTC; QL

FINE 30 UNIVERSAL LANCETS OTC; QL

FORA LANCING DEVICE OTC; QL

FORACARE LANCETS OTC; QL

GLUCOCOM LANCETS OTC; QL

GMATE LANCING DEVICE OTC; QL

HEALTHY ACCENTS AUTOLET OTC; QL

HEALTHY ACCENTS UNILET LANCET OTC; QL

HYPOLANCE AST LANCING KIT OTC; QL

INCONTROL LANCING DEVICE OTC; QL

INCONTROL SUPER THIN LANCETS OTC; QL

INCONTROL ULTRA THIN LANCETS OTC; QL

INVACARE LANCETS OTC; QL

lancets Accu-Chek FastClix OTC; QL

lancets, super thin OTC; QL

60

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Drug Name Reference Notes

lancets,thin OTC; QL

lancets,ultra thin OTC; QL

lancing device Adjustable Lancing Device OTC; QL

lancing device with lancets OTC; QL

lancing device with lancets kit Accu-Chek FastClix OTC; QL

lancing system OTC; QL

LANZO LANCING DEVICE KIT OTC; QL

LITE TOUCH LANCING DEVICE OTC; QL

MEDLANCE PLUS LANCETS OTC; QL

MICRO THIN LANCETS OTC; QL

MINI LANCING DEVICE OTC; QL

MONOLET LANCETS OTC; QL

MONOLET THIN LANCETS OTC; QL

MULTI-LANCET DEVICE 2 KIT OTC; QL

MYGLUCOHEALTH LANCETS OTC; QL

ON CALL LANCING DEVICE OTC; QL

ON CALL PLUS LANCING DEVICE OTC; QL

ON-THE-GO LANCETS OTC; QL

PRODIGY LANCING DEVICE OTC; QL

RELIAMED MINI LANCING DEVICE OTC; QL

RELION THIN LANCETS OTC; QL

RELION ULTRA THIN PLUS LANCETS OTC; QL

RIGHTEST GD500 LANCING DEVICE OTC; QL

RIGHTEST GL300 LANCETS OTC; QL

SAFETY LANCETS OTC; QL

SMART SENSE LANCETS OTC; QL

SMARTDIABETES VANTAGE OTC

STERILANCE TL OTC; QL

SUPER THIN LANCETS OTC; QL

SURE COMFORT LANCING PEN OTC; QL

SURE-PEN LANCING DEVICE OTC; QL

TECHLITE LANCETS OTC; QL

THIN LANCETS OTC; QL

TOPCARE UNIVERSAL1 LANCET OTC; QL

TRUE METRIX AIR GLUCOSE METER OTC

TRUE METRIX LEVEL 1 SOLUTION OTC

TRUE METRIX LEVEL 2 SOLUTION OTC

61

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Drug Name Reference Notes

TRUE METRIX LEVEL 3 SOLUTION OTC

TRUEPLUS LANCETS OTC; QL

TRUERESULT BLOOD GLUCOSE SYSTM KIT

OTC

TRUETEST HIGH GLUCOSE CONTROL SOLUTION

OTC

TRUETEST LOW GLUCOSE CONTROL SOLUTION

OTC

TRUETEST NORMAL GLUCOSE CNTRL SOLUTION

OTC

ULTI-LANCE OTC; QL

ULTRA THIN LANCETS OTC; QL

ULTRA THIN PLUS LANCETS OTC; QL

UNILET COMFORTOUCH LANCET OTC; QL

UNILET EXCELITE II LANCET OTC; QL

UNILET EXCELITE LANCET OTC; QL

UNILET GP LANCET OTC; QL

UNILET LANCET OTC; QL

UNILET LANCETS OTC; QL

UNILET SUPER THIN LANCETS OTC; QL

UNISTIK 2 DEVICE KIT OTC; QL

UNISTIK 3 COMFORT DEVICE KIT OTC; QL

UNISTIK 3 COMFORT LANCET OTC; QL

UNISTIK 3 EXTRA LANCET OTC; QL

UNISTIK 3 GENTLE OTC; QL

UNISTIK 3 KIT OTC; QL

UNISTIK 3 LANCETS OTC; QL

UNISTIK 3 NEONATAL DEVICE KIT OTC; QL

UNISTIK 3 NEONATAL KIT OTC; QL

UNISTIK 3 NORMAL LANCET OTC; QL

UNISTIK CZT LANCET OTC; QL

UNISTIK SAFETY OTC; QL

UNISTIK TOUCH LANCETS OTC; QL

UNIVERSAL 1 LANCETS OTC; QL

MEDICAL SUPPLIES AND DME - PEAK FLOW METERS

AIRZONE PEAK FLOW METER DEVICE OTC

ASTHMA CHECK METER DEVICE OTC

62

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Drug Name Reference Notes

ASTHMAMENTOR PEAK FLOW METER DEVICE

OTC

IN-CHECK NASAL WITH MASK DEVICE OTC

IN-CHECK ORAL FLOW METER DEVICE

OTC

MICROLIFE PEAK FLOW METER DEVICE

OTC

PEAK AIR PEAK FLOW METER DEVICE

OTC

PERSONAL BEST FULL RANGE DEVICE

OTC

PERSONAL BEST LOW RANGE DEVICE

OTC

PIKO 1 DEVICE OTC

POCKET PEAK FLOW METER DEVICE OTC

NEEDLES/NEEDLELESS DEVICES, SYRINGES AND ACCESSORIES

1ST TIER UNIFINE PENTIPS NEEDLE OTC; QL

1ST TIER UNIFINE PENTIPS PLUS NEEDLE

OTC; QL

ADVOCATE PEN NEEDLE NEEDLE OTC; QL

BD AUTOSHIELD DUO PEN NEEDLE NEEDLE

OTC; QL

BD INSULIN PEN NEEDLE UF MINI NEEDLE

OTC; QL

BD INSULIN PEN NEEDLE UF ORIG NEEDLE

OTC; QL

BD INSULIN SYRINGE SLIP TIP SYRINGE

OTC; QL

BD INSULIN SYRINGE SYRINGE OTC; QL

BD LUER-LOK SYRINGE SYRINGE OTC

BD ULTRA-FINE MICRO PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE NANO PEN NEEDLES NEEDLE

OTC; QL

CAREFINE PEN NEEDLE NEEDLE OTC; QL

CARETOUCH PEN NEEDLE NEEDLE OTC; QL

CLICKFINE NEEDLE 31 GAUGE X 1/4", 31 GAUGE X 5/16"

OTC; QL

CLICKFINE NEEDLE 32 GAUGE X 5/32" OTC

63

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Drug Name Reference Notes

COMFORT EZ PEN NEEDLES NEEDLE OTC; QL

DROPLET PEN NEEDLE NEEDLE OTC; QL

EASY COMFORT PEN NEEDLES NEEDLE

OTC; QL

EASY TOUCH NEEDLE OTC

FIFTY50 PEN 31G X 5/16" NEEDLE (OTC)

OTC; QL

GNP CLICKFINE PEN NDL 31GX5/16 31GX8MM,THIN & SHORT (OTC)

OTC; QL

HEALTHY ACCENTS UNIFINE PENTIP NEEDLE

OTC; QL

INCONTROL PEN NEEDLE NEEDLE OTC; QL

insulin syringe microfine syringe OTC; QL

insulin syringe-needle u-100 syringe Lite Touch Insulin Syringe OTC; QL

INSUPEN NEEDLE 29 GAUGE X 1/2", 30 GAUGE X 5/16", 31 GAUGE X 1/4", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 5/16", 32 GAUGE X 5/32", 33 GAUGE X 5/32"

OTC

INSUPEN NEEDLE 31 GAUGE X 3/16" OTC; QL

LITE TOUCH INSULIN PEN NEEDLES NEEDLE

OTC; QL

LITE TOUCH INSULIN SYRINGE SYRINGE

OTC; QL

LIVE BETTER PEN NEEDLES 8MM 31G (OTC)

OTC; QL

MINI ULTRA-THIN II NEEDLE OTC

MONOJECT INSULIN SAFETY SYRING SYRINGE

OTC

MONOJECT INSULIN SYRINGE SYRINGE

OTC; QL

MONOJECT SAFETY SYRINGES SYRINGE

OTC

MONOJECT ULTRA COMFORT INSULIN SYRINGE

OTC

NOVOFINE 30 NEEDLE OTC

NOVOFINE 32 NEEDLE OTC

pen needle needle 29 gauge x 1/2", 31 gauge x 1/4", 32 gauge x 5/32"

OTC; QL

64

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Drug Name Reference Notes

pen needle, diabetic needle 29 gauge x 1/2", 31 gauge x 1/4", 31 gauge x 3/16", 31 gauge x 5/16", 32 gauge x 5/32"

1st Tier Unifine Pentips OTC; QL

pen needle, diabetic needle 31 gauge x 1/3", 31 gauge x 1/6"

OTC; QL

pen needle, diabetic needle 32 gauge x 1/4"

BD Ultra-Fine Micro Pen Needle

OTC; QL

PEN NEEDLE, DIABETIC NEEDLE 32 GAUGE X 3/16"

CareFine Pen Needle OTC

pen needles 5mm 31g 31gx5mm,strl,mini (otc)

OTC; QL

PEN NEEDLES 8MM 31G 31GX8MM,STRL,SHORT (OTC)

OTC; QL

PENTIPS NEEDLE OTC; QL

PRO COMFORT PEN NEEDLE NEEDLE OTC; QL

ra pen needle 31gx3/16" 5mm (otc) OTC; QL

RA PEN NEEDLE 31GX5/16" 8MM (OTC)

OTC; QL

RELION NEEDLES NEEDLE OTC

RELION PEN 31G NEEDLE 8MM (OTC) OTC; QL

RELION PEN NEEDLE 31GX5/16" SHORT (OTC)

OTC; QL

RELION PEN NEEDLES NEEDLE OTC; QL

SURE COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

SURE COMFORT PEN NEEDLE NEEDLE

OTC; QL

SURE-FINE PEN NEEDLES NEEDLE OTC; QL

TECHLITE PEN NEEDLE NEEDLE OTC; QL

TERUMO INSULIN SYRINGE SYRINGE OTC; QL

TOPCARE CLICKFINE NEEDLE OTC

TRUEPLUS PEN NEEDLE NEEDLE OTC; QL

ULTICARE PEN NEEDLE NEEDLE OTC; QL

ULTILET INSULIN SYRINGE SYRINGE OTC; QL

ULTILET PEN NEEDLE NEEDLE OTC; QL

ULTRA COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

ULTRA-THIN II (SHORT) PEN NDL NEEDLE

OTC; QL

65

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Drug Name Reference Notes

ULTRA-THIN II INS PEN NEEDLES NEEDLE

OTC; QL

UNIFINE PENTIPS NEEDLE OTC; QL

UNIFINE PENTIPS PLUS NEEDLE OTC; QL

URINE KETONE TEST AIDS

TRUEPLUS KETONE STRIP OTC; QL

MOUTH-THROAT-DENTAL - PREPARATIONS

ANTISEPTICS, GENERAL

chloraseptic mucous membrane aerosol,spray

OTC

sore throat (hexylresorcinol) mucous membrane lozenge

OTC

FLUORIDE PREPARATIONS

perio med dental solution OTC

MOUTH AND THROAT - LOCAL ANESTHETIC OTHERS

chloraseptic throat spray mucous membrane aerosol,spray

OTC

throat lozenges mucous membrane lozenge

OTC

MOUTH AND THROAT - LOZENGES

cherry cough drops mucous membrane lozenge

OTC

cherry menthol mucous membrane lozenge

OTC

chloraseptic sore throat mucous membrane lozenge

OTC

cough drops (with eucalyptus) mucous membrane lozenge

OTC

honey lemon mucous membrane lozenge OTC

medikoff drops mucous membrane lozenge

OTC

menthol drops mucous membrane lozenge

OTC

sore throat (benzocaine-menth) mucous membrane lozenge

OTC

sore throat relief (pectin) mucous membrane lozenge on a handle

OTC

throat drops mucous membrane lozenge OTC

66

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Drug Name Reference Notes

throat lozenges mucous membrane lozenge

OTC

zinc with vitamins a and c oral lozenge OTC

OPHTHALMIC AGENTS

ARTIFICIAL TEARS

artificial tears (petro/min) ophthalmic (eye) ointment

OTC

artificial tears (pf) ophthalmic (eye) dropperette

OTC

artificial tears (polyvin alc) ophthalmic (eye) drops

OTC

artificial tears(dext70-hypro) ophthalmic (eye) drops

OTC

bion tears (pf) ophthalmic (eye) dropperette

OTC

for sty relief ophthalmic (eye) ointment OTC

liquitears ophthalmic (eye) drops OTC

lubricant eye drops ophthalmic (eye) dropperette

OTC

lubricant eye ophthalmic (eye) ointment OTC

lubricating plus ophthalmic (eye) dropperette

OTC

lubrifresh pm ophthalmic (eye) ointment OTC

natural tears (pf) ophthalmic (eye) dropperette

OTC

polyvinyl alcohol ophthalmic (eye) drops Artificial Tears (polyvin alc) OTC

puralube ophthalmic (eye) ointment OTC

REFRESH PLUS OPHTHALMIC (EYE) DROPPERETTE

OTC

REFRESH TEARS OPHTHALMIC (EYE) DROPS

OTC

revive plus ophthalmic (eye) dropperette OTC

TEARFAIR OPHTHALMIC (EYE) DROPS OTC

tears again (pva) ophthalmic (eye) drops OTC

tears naturale free (pf) ophthalmic (eye) dropperette

OTC

ultra fresh ophthalmic (eye) drops OTC

67

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Drug Name Reference Notes

OPHTHALMIC - HYPEROSMOLAR AGENTS

artificial tears(dext70-hypro) ophthalmic (eye) drops

OTC

OPHTHALMIC ANTIHISTAMINES

alaway ophthalmic (eye) drops OTC; QL

allergy eye (ketotifen) ophthalmic (eye) drops

OTC; QL

children's alaway ophthalmic (eye) drops OTC; QL

eye allergy relief ophthalmic (eye) drops OTC; QL

eye itch relief ophthalmic (eye) drops OTC; QL

itchy eye drops ophthalmic (eye) drops OTC; QL

ketotifen fumarate ophthalmic (eye) drops Alaway OTC; QL

NAPHCON-A OPHTHALMIC (EYE) DROPS

OTC; QL

visine-a ophthalmic (eye) drops OTC; QL

wal-zyr (ketotifen) ophthalmic (eye) drops OTC; QL

ZADITOR OPHTHALMIC (EYE) DROPS OTC; QL

OPHTHALMIC VASOCONSTRICTORS

altazine ophthalmic (eye) drops OTC; QL

eye drops (tetrahydrozoline) ophthalmic (eye) drops

OTC; QL

opti-clear ophthalmic (eye) drops OTC; QL

redness reliever eye drops ophthalmic (eye) drops

OTC; QL

sterile eye drops ophthalmic (eye) drops OTC; QL

tetrahydrozoline ophthalmic (eye) drops Altazine OTC; QL

OTIC

OTIC - WAX REMOVERS-SOFTENERS

carbamide peroxide otic (ear) drops Auro Eardrops OTC

carbamoxide ear drops otic (ear) drops OTC

ear drops (carbamide peroxide) otic (ear) drops

OTC

ear drops otc otic (ear) drops OTC

ear wax drops otic (ear) drops OTC

ear wax removal drops otic (ear) drops OTC

ear wax removal kit otic (ear) drops OTC

68

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Drug Name Reference Notes

ear wax removal system otic (ear) drops OTC

murine ear wax removal system otic (ear) drops

OTC

RESPIRATORY AIDS, SPACERS, DEVICES AND EQUIPMENT

RESPIRATORY AIDS, SPACERS, DEVICES AND EQUIPMENT

1ST TIER UNIFINE PENTIPS NEEDLE OTC; QL

1ST TIER UNIFINE PENTIPS PLUS NEEDLE

OTC; QL

1ST TIER UNILET COMFORTOUCH OTC; QL

ACCU-CHEK SOFTCLIX LANCET DEV OTC; QL

ADJUSTABLE LANCING DEVICE OTC; QL

ADVANCED LANCING DEVICE KIT OTC; QL

ADVANCED TRAVEL LANCETS OTC; QL

ADVOCATE LANCING DEVICE OTC; QL

ADVOCATE PEN NEEDLE NEEDLE OTC; QL

ADVOCATE RAPID-SAFE LANCING OTC; QL

AIMSCO LATEX CONDOM DEVICE OTC

AIRZONE PEAK FLOW METER DEVICE OTC

ALTERNATE SITE LANCET OTC; QL

ALTERNATE SITE LANCING DEVICE OTC; QL

AQUA LANCE LANCING DEVICE OTC; QL

ASSURE HAEMOLANCE PLUS OTC; QL

ASSURE LANCE OTC; QL

ASSURE LANCE PLUS OTC; QL

ASTHMA CHECK METER DEVICE OTC

ASTHMAMENTOR PEAK FLOW METER DEVICE

OTC

AUTOLET IMPRESSION LANC DEV KIT OTC; QL

AUTOLET LANCING DEVICE OTC; QL

AUTOLET PLUS LANCING DEVICE OTC; QL

BD AUTOSHIELD DUO PEN NEEDLE NEEDLE

OTC; QL

BD INSULIN PEN NEEDLE UF MINI NEEDLE

OTC; QL

BD INSULIN PEN NEEDLE UF ORIG NEEDLE

OTC; QL

69

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Drug Name Reference Notes

BD INSULIN SYRINGE SLIP TIP SYRINGE

OTC; QL

BD INSULIN SYRINGE SYRINGE OTC; QL

BD LUER-LOK SYRINGE SYRINGE OTC

BD ULTRA-FINE MICRO PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE NANO PEN NEEDLES NEEDLE

OTC; QL

CAREFINE PEN NEEDLE NEEDLE OTC; QL

CAREONE LANCING DEVICE OTC; QL

CAREONE THIN LANCET OTC; QL

CAREONE ULTRA THIN LANCET OTC; QL

CARETOUCH PEN NEEDLE NEEDLE OTC; QL

CARETOUCH TWIST LANCET OTC; QL

CHEMSTRIP 10 MD STRIP OTC

CHEMSTRIP K STRIP OTC; QL

CLICKFINE NEEDLE 31 GAUGE X 1/4", 31 GAUGE X 5/16"

OTC; QL

CLICKFINE NEEDLE 32 GAUGE X 5/32" OTC

COLOR LANCETS OTC; QL

COMFORT EZ PEN NEEDLES NEEDLE OTC; QL

COMFORT LANCETS OTC; QL

CONDOMS-PREM LUBRICATED DEVICE

OTC

DROPLET LANCING DEVICE OTC; QL

DROPLET PEN NEEDLE NEEDLE OTC; QL

EASY CLICK LANCING DEVICE OTC; QL

EASY COMFORT PEN NEEDLES NEEDLE

OTC; QL

EASY TOUCH LANCETS OTC; QL

EASY TOUCH LANCING DEVICE OTC; QL

EASY TOUCH NEEDLE OTC

EASY TOUCH SAFETY LANCETS OTC; QL

EASY TOUCH TWIST LANCETS OTC; QL

E-Z JECT LANCETS OTC; QL

E-Z JECT THIN LANCETS OTC; QL

EZ SMART LANCETS OTC; QL

FANTASY CONDOM DEVICE OTC

70

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Drug Name Reference Notes

FC2 FEMALE CONDOM OTC

FIFTY50 PEN 31G X 5/16" NEEDLE (OTC)

OTC; QL

FINE 30 UNIVERSAL LANCETS OTC; QL

FORA LANCING DEVICE OTC; QL

FORACARE LANCETS OTC; QL

GLUCOCOM LANCETS OTC; QL

GMATE LANCING DEVICE OTC; QL

GNP CLICKFINE PEN NDL 31GX5/16 31GX8MM,THIN & SHORT (OTC)

OTC; QL

HEALTHY ACCENTS AUTOLET OTC; QL

HEALTHY ACCENTS UNIFINE PENTIP NEEDLE

OTC; QL

HEALTHY ACCENTS UNILET LANCET OTC; QL

HYPOLANCE AST LANCING KIT OTC; QL

IN-CHECK NASAL WITH MASK DEVICE OTC

IN-CHECK ORAL FLOW METER DEVICE

OTC

INCONTROL LANCING DEVICE OTC; QL

INCONTROL PEN NEEDLE NEEDLE OTC; QL

INCONTROL SUPER THIN LANCETS OTC; QL

INCONTROL ULTRA THIN LANCETS OTC; QL

insulin syringe microfine syringe OTC; QL

insulin syringe-needle u-100 syringe Lite Touch Insulin Syringe OTC; QL

INSUPEN NEEDLE 29 GAUGE X 1/2", 30 GAUGE X 5/16", 31 GAUGE X 1/4", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 5/16", 32 GAUGE X 5/32", 33 GAUGE X 5/32"

OTC

INSUPEN NEEDLE 31 GAUGE X 3/16" OTC; QL

INVACARE LANCETS OTC; QL

KETONE CARE STRIP OTC; QL

KETONE URINE TEST STRIP OTC; QL

KETOSTIX STRIP OTC; QL

KIMONO CONDOMS(NON-LUBRICATED) DEVICE

OTC

KIMONO MAXX CONDOMS DEVICE OTC

KIMONO MICROTHIN AQUA LUBE CON DEVICE

OTC

71

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Drug Name Reference Notes

KIMONO MICROTHIN CONDOMS DEVICE

OTC

KIMONO MICROTHIN LARGE CONDOMS DEVICE

OTC

KIMONO TEXTURED CONDOMS DEVICE

OTC

lancets Accu-Chek FastClix OTC; QL

lancets, super thin OTC; QL

lancets,thin OTC; QL

lancets,ultra thin OTC; QL

lancing device Adjustable Lancing Device OTC; QL

lancing device with lancets OTC; QL

lancing device with lancets kit Accu-Chek FastClix OTC; QL

lancing system OTC; QL

LANZO LANCING DEVICE KIT OTC; QL

LITE TOUCH INSULIN PEN NEEDLES NEEDLE

OTC; QL

LITE TOUCH INSULIN SYRINGE SYRINGE

OTC; QL

LITE TOUCH LANCING DEVICE OTC; QL

LIVE BETTER PEN NEEDLES 8MM 31G (OTC)

OTC; QL

MEDLANCE PLUS LANCETS OTC; QL

MICRO THIN LANCETS OTC; QL

MICROLIFE PEAK FLOW METER DEVICE

OTC

MINI LANCING DEVICE OTC; QL

MINI ULTRA-THIN II NEEDLE OTC

MONOJECT INSULIN SAFETY SYRING SYRINGE

OTC

MONOJECT INSULIN SYRINGE SYRINGE

OTC; QL

MONOJECT SAFETY SYRINGES SYRINGE

OTC

MONOJECT ULTRA COMFORT INSULIN SYRINGE

OTC

MONOLET LANCETS OTC; QL

MONOLET THIN LANCETS OTC; QL

MULTI-LANCET DEVICE 2 KIT OTC; QL

MULTISTIX 9 SG STRIP OTC

72

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Drug Name Reference Notes

MULTISTIX 9 STRIP OTC

MYGLUCOHEALTH LANCETS OTC; QL

NOVOFINE 30 NEEDLE OTC

NOVOFINE 32 NEEDLE OTC

ON CALL LANCING DEVICE OTC; QL

ON CALL PLUS LANCING DEVICE OTC; QL

ON-THE-GO LANCETS OTC; QL

PEAK AIR PEAK FLOW METER DEVICE

OTC

pen needle needle 29 gauge x 1/2", 31 gauge x 1/4", 32 gauge x 5/32"

OTC; QL

pen needle, diabetic needle 29 gauge x 1/2", 31 gauge x 1/4", 31 gauge x 3/16", 31 gauge x 5/16", 32 gauge x 5/32"

1st Tier Unifine Pentips OTC; QL

pen needle, diabetic needle 31 gauge x 1/3", 31 gauge x 1/6"

OTC; QL

pen needle, diabetic needle 32 gauge x 1/4"

BD Ultra-Fine Micro Pen Needle

OTC; QL

PEN NEEDLE, DIABETIC NEEDLE 32 GAUGE X 3/16"

CareFine Pen Needle OTC

pen needles 5mm 31g 31gx5mm,strl,mini (otc)

OTC; QL

PEN NEEDLES 8MM 31G 31GX8MM,STRL,SHORT (OTC)

OTC; QL

PENTIPS NEEDLE OTC; QL

PERSONAL BEST FULL RANGE DEVICE

OTC

PERSONAL BEST LOW RANGE DEVICE

OTC

PIKO 1 DEVICE OTC

POCKET PEAK FLOW METER DEVICE OTC

PRO COMFORT PEN NEEDLE NEEDLE OTC; QL

PRODIGY LANCING DEVICE OTC; QL

ra pen needle 31gx3/16" 5mm (otc) OTC; QL

RA PEN NEEDLE 31GX5/16" 8MM (OTC)

OTC; QL

RELIAMED MINI LANCING DEVICE OTC; QL

RELION NEEDLES NEEDLE OTC

RELION PEN 31G NEEDLE 8MM (OTC) OTC; QL

73

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Drug Name Reference Notes

RELION PEN NEEDLE 31GX5/16" SHORT (OTC)

OTC; QL

RELION PEN NEEDLES NEEDLE OTC; QL

RELION THIN LANCETS OTC; QL

RELION ULTRA THIN PLUS LANCETS OTC; QL

RIGHTEST GD500 LANCING DEVICE OTC; QL

RIGHTEST GL300 LANCETS OTC; QL

SAFETY LANCETS OTC; QL

SMART SENSE LANCETS OTC; QL

SMARTDIABETES VANTAGE OTC

STERILANCE TL OTC; QL

SUPER THIN LANCETS OTC; QL

SURE COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

SURE COMFORT LANCING PEN OTC; QL

SURE COMFORT PEN NEEDLE NEEDLE

OTC; QL

SURE-FINE PEN NEEDLES NEEDLE OTC; QL

SURE-PEN LANCING DEVICE OTC; QL

TECHLITE LANCETS OTC; QL

TECHLITE PEN NEEDLE NEEDLE OTC; QL

TERUMO INSULIN SYRINGE SYRINGE OTC; QL

THIN LANCETS OTC; QL

TOPCARE CLICKFINE NEEDLE OTC

TOPCARE UNIVERSAL1 LANCET OTC; QL

TRUE METRIX AIR GLUCOSE METER OTC

TRUE METRIX GLUCOSE TEST STRIP STRIP

OTC; QL

TRUE METRIX LEVEL 1 SOLUTION OTC

TRUE METRIX LEVEL 2 SOLUTION OTC

TRUE METRIX LEVEL 3 SOLUTION OTC

TRUEPLUS KETONE STRIP OTC; QL

TRUEPLUS LANCETS OTC; QL

TRUEPLUS PEN NEEDLE NEEDLE OTC; QL

TRUERESULT BLOOD GLUCOSE SYSTM KIT

OTC

TRUETEST HIGH GLUCOSE CONTROL SOLUTION

OTC

74

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Drug Name Reference Notes

TRUETEST LOW GLUCOSE CONTROL SOLUTION

OTC

TRUETEST NORMAL GLUCOSE CNTRL SOLUTION

OTC

TRUETEST TEST STRIPS STRIP OTC; QL

TRUSTEX LATEX CONDOM DEVICE OTC

TRUSTEX LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX NON-LUB CONDOMS DEVICE

OTC

TRUSTEX-RIA LUB/SPERMICIDE DEVICE

OTC

TRUSTEX-RIA LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX-RIA NON-LUB CONDOMS DEVICE

OTC

ULTICARE PEN NEEDLE NEEDLE OTC; QL

ULTI-LANCE OTC; QL

ULTILET INSULIN SYRINGE SYRINGE OTC; QL

ULTILET PEN NEEDLE NEEDLE OTC; QL

ULTRA COMFORT INSULIN SYRINGE SYRINGE

OTC; QL

ULTRA THIN LANCETS OTC; QL

ULTRA THIN PLUS LANCETS OTC; QL

ULTRA-THIN II (SHORT) PEN NDL NEEDLE

OTC; QL

ULTRA-THIN II INS PEN NEEDLES NEEDLE

OTC; QL

UNIFINE PENTIPS NEEDLE OTC; QL

UNIFINE PENTIPS PLUS NEEDLE OTC; QL

UNILET COMFORTOUCH LANCET OTC; QL

UNILET EXCELITE II LANCET OTC; QL

UNILET EXCELITE LANCET OTC; QL

UNILET GP LANCET OTC; QL

UNILET LANCET OTC; QL

UNILET LANCETS OTC; QL

UNILET SUPER THIN LANCETS OTC; QL

UNISTIK 2 DEVICE KIT OTC; QL

UNISTIK 3 COMFORT DEVICE KIT OTC; QL

75

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Drug Name Reference Notes

UNISTIK 3 COMFORT LANCET OTC; QL

UNISTIK 3 EXTRA LANCET OTC; QL

UNISTIK 3 GENTLE OTC; QL

UNISTIK 3 KIT OTC; QL

UNISTIK 3 LANCETS OTC; QL

UNISTIK 3 NEONATAL DEVICE KIT OTC; QL

UNISTIK 3 NEONATAL KIT OTC; QL

UNISTIK 3 NORMAL LANCET OTC; QL

UNISTIK CZT LANCET OTC; QL

UNISTIK SAFETY OTC; QL

UNISTIK TOUCH LANCETS OTC; QL

UNIVERSAL 1 LANCETS OTC; QL

URINARY TRACT INF.TEST (WBCS) STRIP

OTC

RESPIRATORY THERAPY AGENTS

ANALGESIC/ANTIPYRETICS, NON-SALICYLATE

acetadryl oral tablet OTC

aceta-gesic oral tablet OTC

acetaminophen pm extra str oral tablet OTC

acetaminophen pm oral tablet OTC

diphenhydramine-acetaminophen oral tablet

Acetadryl OTC

headache pm oral tablet OTC

headache relief pm oral tablet OTC

mapap pm oral tablet OTC

menstrual relief oral tablet OTC

midol pm oral tablet OTC

non-aspirin nightime oral tablet OTC

non-aspirin pain relief pm oral tablet OTC

non-aspirin pm oral tablet OTC

pain relief pm oral tablet OTC

pain relief pm rapid release oral tablet OTC

pain reliever pm ex-strength oral tablet OTC

pain reliever pm oral tablet OTC

percogesic extra strength oral tablet OTC

percogesic oral tablet OTC

pm pain reliever oral tablet OTC

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Drug Name Reference Notes

ANTIHISTAMINE AND DECONGESTANT COMBINATIONS

alavert d-12 allergy-sinus oral tablet extended release 12 hr

OTC; QL

allerclear d-12hr oral tablet extended release 12 hr

OTC; QL

allerclear d-24hr oral tablet extended release 24 hr

OTC; QL

allergy and congestion relief oral tablet extended release 12 hr

OTC; QL

allergy and congestion relief oral tablet extended release 24 hr

OTC; QL

allergy relief d12 oral tablet extended release 12 hr

OTC; QL

allergy relief d-24 oral tablet extended release 24 hr

OTC; QL

allergy relief,nasal decongest oral tablet extended release 24 hr

OTC; QL

allergy relief-d (loratadine) oral tablet extended release 12 hr

OTC; QL

allergy relief-d(fexofenadine) oral tablet extended release 12 hr

OTC

allergy-congestion relief-d oral tablet extended release 24 hr

OTC; QL

aprodine oral tablet OTC

brotapp oral liquid OTC

BROVEX PEB ORAL LIQUID OTC

ed a-hist pse oral tablet OTC

fexofenadine-pseudoephedrine oral tablet extended release 12 hr

Allegra-D 12 Hour OTC

LODRANE D ORAL CAPSULE OTC

lohist - d oral liquid OTC

lorata-d oral tablet extended release 24 hr OTC; QL

lorata-dine d oral tablet extended release 24 hr

OTC; QL

loratadine-d oral tablet extended release 12 hr

OTC; QL

loratadine-d oral tablet extended release 24 hr

OTC; QL

loratadine-pseudoephedrine oral tablet extended release 24 hr

AllerClear D-24hr OTC; QL

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Drug Name Reference Notes

ritifed oral syrup OTC

rynex pse oral liquid OTC

valu-tapp oral liquid OTC

wal-act d cold and allergy oral tablet OTC

wal-fex d 12 hour oral tablet extended release 12 hr

OTC

wal-fex d 24 hour oral tablet extended release 24 hr

OTC

wal-itin d 12 hour oral tablet extended release 12 hr

OTC; QL

wal-itin d oral tablet extended release 24 hr

OTC; QL

ANTIHISTAMINES

alavert oral tablet,disintegrating OTC; QL

aler-cap oral capsule OTC; QL

ALKA-SELTZER PLUS ALLERGY ORAL TABLET

OTC

aller-chlor oral tablet OTC

allerclear oral tablet OTC; QL

aller-ease oral tablet 180 mg OTC; QL

aller-ease oral tablet 60 mg OTC

aller-fex oral tablet OTC; QL

allergy (chlorpheniramine) oral tablet OTC

allergy (diphenhydramine) oral capsule OTC; QL

allergy (diphenhydramine) oral liquid OTC; QL

allergy (diphenhydramine) oral tablet OTC; QL

allergy 4-hour oral tablet OTC

allergy medication oral capsule OTC; QL

allergy medicine oral capsule OTC; QL

allergy medicine oral liquid OTC; QL

allergy medicine oral tablet OTC; QL

allergy relief (clemastine) oral tablet OTC

allergy relief (fexofenadine) oral tablet 180 mg

OTC; QL

allergy relief (fexofenadine) oral tablet 60 mg

OTC

allergy relief (loratadine) oral solution OTC; QL

allergy relief (loratadine) oral tablet OTC; QL

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Drug Name Reference Notes

allergy relief (loratadine) oral tablet,disintegrating

OTC; QL

allergy relief(chlorpheniramn) oral tablet OTC

allergy relief(diphenhydramin) oral capsule

OTC; QL

allergy relief(diphenhydramin) oral liquid OTC; QL

allergy relief(diphenhydramin) oral tablet OTC; QL

allergy-time oral tablet OTC

allerhist-1 oral tablet OTC

banophen allergy oral liquid OTC; QL

banophen oral capsule 25 mg OTC; QL

banophen oral capsule 50 mg OTC

banophen oral liquid OTC; QL

banophen oral tablet OTC; QL

child allergy relief (diphen) oral tablet,disintegrating

OTC

children's allegra allergy oral suspension OTC; QL

children's allegra allergy oral tablet,disintegrating

OTC

children's allergy (diphenhyd) oral elixir OTC; QL

children's allergy (diphenhyd) oral liquid OTC; QL

children's allergy (diphenhyd) oral tablet,disintegrating

OTC

children's allergy relief(lor) oral solution OTC; QL

children's wal-dryl allergy oral liquid OTC; QL

children's wal-dryl allergy oral prefilled spoon

OTC; QL

children's wal-dryl allergy oral tablet,disintegrating

OTC

chlorhist oral tablet OTC

chlorpheniramine maleate oral tablet Aller-Chlor OTC

chlorpheniramine maleate oral tablet extended release

Allergy Relief(chlorpheniramn)

OTC

chlortabs oral tablet OTC

complete allergy medicine oral capsule OTC; QL

complete allergy medicine oral tablet OTC; QL

complete allergy oral capsule OTC; QL

complete allergy oral liquid OTC; QL

complete allergy oral tablet OTC; QL

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Drug Name Reference Notes

dayhist allergy oral tablet OTC

diphedryl allergy oral liquid OTC; QL

diphedryl oral capsule OTC; QL

diphedryl oral liquid OTC; QL

diphedryl oral tablet OTC; QL

diphen oral tablet OTC; QL

diphenhist oral capsule OTC; QL

diphenhist oral liquid OTC; QL

diphenhist oral tablet OTC; QL

diphenhydramine 50 mg capsule (otc) Banophen OTC

diphenhydramine 50 mg capsule u-d (otc) Banophen OTC

diphenhydramine hcl oral capsule 25 mg Aler-Cap OTC; QL

diphenhydramine hcl oral liquid Allergy (diphenhydramine) OTC; QL

diphenhydramine hcl oral syrup Silphen Cough OTC

diphenhydramine hcl oral tablet Alka-Seltzer Plus Allergy OTC; QL

ed chlorped jr oral syrup OTC

ed-chlorped oral drops OTC

ed-chlortan oral tablet OTC

fexofenadine hcl 180 mg tablet (otc) Allegra Allergy OTC; QL

fexofenadine hcl 180 mg tablet 24 hour, non-drowsy (otc)

Allegra Allergy OTC; QL

fexofenadine hcl 180 mg tablet 24hr,original str (otc)

Allegra Allergy OTC; QL

fexofenadine hcl 180 mg tablet f/c, 10x10,u-d,inner (otc)

Allegra Allergy OTC; QL

fexofenadine hcl 180 mg tablet f/c, 10x10,u-d,outer (otc)

Allegra Allergy OTC; QL

fexofenadine hcl 180 mg tablet non-drowsy, 24-hour (otc)

Allegra Allergy OTC; QL

fexofenadine oral suspension Aller-ease OTC; QL

fexofenadine oral tablet 60 mg Allegra Allergy OTC

loradamed oral tablet OTC; QL

loratadine oral solution Allergy Relief (loratadine) OTC; QL

loratadine oral tablet Allerclear OTC; QL

loratadine oral tablet,disintegrating Alavert OTC; QL

nightime sleep oral capsule OTC

nighttime sleep aid (diphen) oral capsule OTC

nighttime sleep aid (diphen) oral tablet OTC

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Drug Name Reference Notes

non-drowsy allergy oral tablet OTC; QL

pharbechlor oral tablet OTC

pharbedryl oral capsule 25 mg OTC; QL

pharbedryl oral capsule 50 mg OTC

q-dryl oral capsule OTC; QL

q-dryl oral liquid OTC; QL

rest simply nighttime sleep oral tablet OTC

restfully sleep oral tablet OTC

siladryl sa oral liquid OTC; QL

silphen cough oral syrup OTC

sleep aid (diphenhydramine) oral capsule OTC

sleep aid (diphenhydramine) oral liquid OTC

sleep aid (diphenhydramine) oral tablet OTC

sleep aid max str (diphenhydr) oral capsule

OTC

sleep ii oral tablet OTC

sleep oral tablet OTC

sleep tablet (diphenhydramine) oral tablet OTC

sleep-tabs oral tablet OTC

sm fexofenadine hcl 180 mg tab (otc) Allegra Allergy OTC; QL

sm fexofenadine hcl 180 mg tab 24hr, gluten-free (otc)

Allegra Allergy OTC; QL

sm fexofenadine hcl 180 mg tab 24hr,original str (otc)

Allegra Allergy OTC; QL

UNISOM SLEEPGELS ORAL CAPSULE OTC

valu-dryl allergy oral capsule OTC; QL

wal-dryl allergy oral capsule OTC; QL

wal-dryl allergy oral liquid OTC; QL

wal-dryl allergy oral tablet OTC; QL

wal-fex allergy oral tablet 180 mg OTC; QL

wal-fex allergy oral tablet 60 mg OTC

wal-finate oral tablet OTC

wal-itin oral solution OTC; QL

wal-itin oral tablet OTC; QL

wal-itin oral tablet,disintegrating OTC; QL

wal-sleep z oral liquid OTC

wal-som (diphenhydramine) oral capsule OTC

ZZZQUIL ORAL CAPSULE OTC

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Drug Name Reference Notes

ZZZQUIL ORAL LIQUID OTC

ANTITUSSIVES - NONNARCOTIC

cough dm er oral suspension,extended rel 12 hr

OTC

cough relief oral liquid OTC; QL

day-time cough oral syrup OTC

DELSYM 12 HOUR ORAL SUSPENSION,EXTENDED REL 12 HR

OTC

dextromethorphan polistirex oral suspension,extended rel 12 hr

12-Hour Cough Relief OTC

tussin cough (dm only) oral liquid OTC; QL

tussin maximum strength cough oral syrup OTC; QL

tussin maximum strength oral syrup OTC; QL

VICKS DAYQUIL COUGH ORAL SYRUP OTC

wal-tussin max strength cough oral syrup OTC; QL

AROMATIC ANTITUSSIVE DEMULCENTS

cough drops mucous membrane lozenge OTC

DECONGESTANT - EXPECTORANT COMBINATIONS

congestac oral tablet OTC

ENTEX T ORAL TABLET OTC

MUCINEX D MAXIMUM STRENGTH ORAL TABLET EXTENDED RELEASE 12 HR

OTC

MUCINEX D ORAL TABLET EXTENDED RELEASE 12 HR

AL; OTC; QL

RESPAIRE-30 ORAL CAPSULE OTC

SUPRESS-PE ORAL DROPS OTC

TUSNEL PEDIATRIC ORAL DROPS OTC

EXPECTORANTS

adult tussin chest congestion oral liquid OTC

allfen oral tablet OTC

chest congestion relief oral tablet OTC

CHILD MUCINEX CHEST CONGESTION ORAL LIQUID

OTC

child mucus relief expectorant oral liquid OTC

children's chest congestion oral liquid OTC

coughtab oral tablet OTC

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Drug Name Reference Notes

diabetic siltussin das-na oral liquid OTC

diabetic tussin ex oral liquid OTC

fenesin ir oral tablet OTC

guaifenesin oral liquidAdult Tussin Chest Congestion

OTC

guaifenesin oral tablet Coughtab OTC

guaifenesin oral tablet extended release 12hr

Mucinex OTC; QL

MUCINEX ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG

OTC

MUCINEX ORAL TABLET EXTENDED RELEASE 12HR 600 MG

OTC; QL

mucosa oral tablet OTC

mucus relief chest oral tablet OTC

mucus relief er oral tablet extended release 12hr

OTC; QL

mucus relief oral tablet OTC

organ-i nr oral tablet OTC

refenesen oral tablet OTC

SCOT-TUSSIN EXPECTORANT ORAL LIQUID

OTC

tussin chest congestion oral liquid OTC

tussin expectorant oral liquid OTC

tussin oral liquid OTC

tussin oral tablet OTC

MAST CELL STABILIZERS

cromolyn nasal spray,non-aerosolNasal Allergy Symptom Control

OTC

nasal allergy symptom control nasal spray,non-aerosol

OTC

NARCOTIC ANTITUSSIVE COMBINATIONS

guaifenesin dac oral syrup AL; OTC

phenylhistine dh oral liquid OTC

NASAL ANTI-INFLAMMATORY STEROIDS

aller-flo nasal spray,suspension OTC; QL

allergy relief (fluticasone) nasal spray,suspension

OTC; QL

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Drug Name Reference Notes

CHILDREN'S FLONASE ALLERGY RLF NASAL SPRAY,SUSPENSION

OTC; QL

CHILDREN'S NASACORT NASAL AEROSOL,SPRAY

OTC; QL

CLARISPRAY NASAL SPRAY,SUSPENSION

OTC; QL

FLONASE ALLERGY RELIEF NASAL SPRAY,SUSPENSION

OTC; QL

fluticasone nasal spray,suspension 24 Hour Allergy Relief OTC; QL

NASACORT NASAL AEROSOL,SPRAY OTC; QL

nasal allergy nasal aerosol,spray OTC; QL

triamcinolone acetonide nasal aerosol,spray

Children's Nasacort OTC; QL

NASAL MOISTURIZERS

altamist nasal aerosol,spray OTC

ayr saline nasal aerosol,spray AL; OTC

ayr saline nasal drops OTC; QL

baby ayr saline nasal drops AL; OTC; QL

deep sea nasal nasal aerosol,spray OTC

little remedies nasal aerosol,spray OTC

nasal mist nasal aerosol,spray OTC

nasal moisturizing nasal aerosol,spray OTC

nasal spray (sodium chloride) nasal aerosol,spray

OTC

ocean nasal nasal aerosol,spray OTC

saline mist nasal aerosol,spray AL; OTC

saline nasal mist nasal aerosol,spray OTC

saline nasal nasal aerosol,spray OTC

saline nose nasal aerosol,spray OTC

sterile saline nasal aerosol,spray OTC

NON-NARCOTIC ANTITUSSIVE COMBINATIONS

ADULT ROBITUSSIN PEAK COLD DM ORAL LIQUID

OTC; QL

adult tussin cough congest dm oral liquid OTC; QL

adult tussin dm oral syrup OTC; QL

antitussive dm oral syrup OTC; QL

biocotron oral liquid OTC; QL

biogil oral liquid OTC

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Drug Name Reference Notes

brotapp dm oral elixir OTC

BROVEX PEB DM ORAL LIQUID OTC

child chest congestion + cough oral liquid OTC

CHILD MUCINEX CONGESTION-COUGH ORAL LIQUID

OTC

child mucus relief cough oral liquid OTC

child multi-symptom cold/cough oral liquid OTC

children's cough oral liquid OTC

CHILDREN'S MUCINEX COUGH ORAL LIQUID

OTC

CHILDREN'S MUCINEX MULTI-SYMP ORAL LIQUID

OTC

cough control dm oral syrup OTC; QL

cough formula dm oral syrup OTC; QL

cough suppressant-expectorant oral syrup OTC; QL

cough syrup dm oral syrup OTC; QL

despec eda cough-cold drops oral drops OTC

dextromethorphan-guaifenesin oral syrup Adult Tussin DM OTC; QL

diabetic siltussin-dm oral liquid OTC; QL

diabetic tussin dm oral liquid OTC; QL

endacon oral liquid OTC

g-tron oral liquid OTC; QL

guaicon dms oral liquid in packet OTC

guiatuss dm oral syrup OTC; QL

G-ZYNCOF ORAL LIQUID OTC; QL

kidkare cough/cold oral liquid OTC

MAXIFED DM ORAL SUSPENSION OTC

MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HR

OTC

MUCINEX FAST-MAX CONGEST-COUGH ORAL LIQUID

OTC

MUCINEX FAST-MAX DM MAX ORAL LIQUID

OTC

mucus dm max oral tablet extended release 12 hr

OTC

mucus dm oral tablet extended release 12 hr

OTC

mucus relief congestion-cough oral liquid OTC

mucus relief cough oral liquid OTC

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Drug Name Reference Notes

mucus relief dm max oral liquid OTC

neo-tuss oral liquid OTC

neotuss-d (improved formula) oral liquid OTC

non-aspirin flu oral tablet OTC

PECGEN DMX ORAL LIQUID OTC

pedia relief cough-cold oral liquid OTC

pediatric cough and cold oral liquid OTC

PRESGEN B ORAL LIQUID OTC

ri-tussin dm oral syrup OTC; QL

robafen dm cough oral liquid OTC; QL

robafen dm cough-chest congest oral syrup

OTC; QL

robafen dm oral syrup OTC; QL

SCOT-TUSSIN SENIOR ORAL LIQUID OTC

siltussin dm das oral liquid OTC; QL

siltussin-dm oral syrup OTC; QL

sorbugen nr oral liquid OTC; QL

supress dx oral drops OTC

TUSNEL DIABETIC ORAL LIQUID OTC; QL

TUSNEL-DM PEDIATRIC ORAL DROPS OTC

tussi pres-b oral liquid OTC

tussin cf oral syrup OTC

tussin cough-chest congestion oral liquid OTC; QL

tussin dm clear oral syrup OTC; QL

tussin dm cough and chest oral syrup OTC; QL

tussin dm cough oral syrup OTC; QL

tussin dm oral liquid OTC; QL

tussin dm oral syrup OTC; QL

wal-tussin dm oral syrup OTC; QL

ZYNCOF ORAL LIQUID OTC; QL

SYSTEMIC SYMPATHOMIMETIC DECONGESTANTS

nasal decongestant (pseudoeph) oral liquid

OTC

nasal decongestant (pseudoeph) oral tablet

OTC

pedia relief infant nasal oral drops OTC

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Drug Name Reference Notes

pseudoephedrine hcl oral liquidNasal Decongestant (pseudoeph)

OTC

pseudoephedrine hcl oral tabletNasal Decongestant (pseudoeph)

AL; OTC

sudogest oral tablet OTC

suphedrin oral tablet OTC

suphedrine oral tablet OTC

wal-phed oral tablet OTC

VAGINAL PRODUCTS

VAGINAL ANTIFUNGALS

3 day vaginal vaginal cream OTC

3-day vaginal vaginal cream OTC

clotrimazole 3 day vaginal cream OTC

clotrimazole vaginal cream Clotrimazole-7 OTC; QL

clotrimazole vaginal tablet OTC

clotrimazole-3 vaginal cream OTC

clotrimazole-7 vaginal cream OTC; QL

miconazole 7 vaginal cream OTC

miconazole 7 vaginal suppository OTC

miconazole nitrate vaginal comb pack,prefill appl, cream

Miconazole-3 OTC; QL

miconazole nitrate vaginal cream Miconazole 7 OTC

miconazole nitrate vaginal kit Monistat 1 Combo Pack OTC

miconazole nitrate vaginal suppository Miconazole 7 OTC

miconazole-3 prefil,cream,wipe vaginal kit OTC; QL

miconazole-3 vaginal comb pack,prefill appl, cream

OTC; QL

miconazole-3 vaginal kit OTC; QL

miconazole-skin clnsr17 vaginal kitMiconazole-3 prefil,cream,wipe

OTC; QL

tioconazole vaginal ointment 1-Day OTC

tioconazole-1 vaginal ointment OTC

VAGISTAT-1 VAGINAL OINTMENT OTC

VAGISTAT-3 VAGINAL KIT OTC; QL

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88