medicaid-approved preferred drug list · 2019. 9. 14. · new jersey medicaid-approved preferred...

New Jersey

Medicaid-Approved

Preferred Drug List

Effective August 1, 2019

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.

Drug Name Reference Notes

ALTERNATIVE THERAPY

ALTERNATIVE THERAPY

antioxidant a/c/e/selenium oral capsule OTC

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

eye health plus lutein oral tablet OTC; QL

glucosamine-chondroitin complx oral capsule

OTC

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

kelp-lecithin-b6 oral tablet OTC

lecithin-kelp-b6 (100-8.3) oral tablet OTC

lecithin-kelp-b6 (400-20) oral tablet OTC

lecithin-kelp-b6 oral capsule OTC

opti-vitamins oral tablet OTC; QL

prosight oral tablet OTC; QL

super antioxidant oral capsule OTC

ultra antioxidant formula oral tablet OTC

ANALGESIC, ANTI-INFLAMMATORY OR ANTIPYRETIC

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 pain relief pm oral tablet OTC

non-aspirin pm oral tablet OTC

pain relief pm oral tablet OTC

2


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

ANALGESIC/ANTIPYRETICS, SALICYLATES

added strength headache relief oral tablet OTC

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

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


Adult Aspirin Regimen 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

butalbital-aspirin-caffeine oral capsule Fiorinal QL

butalbital-aspirin-caffeine oral tablet QL

children's aspirin oral tablet,chewable OTC; QL

choline,magnesium salicylate oral liquid

diflunisal oral tablet

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

3


efferves pain relief antacid oral tablet, effervescent

OTC

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

lite coat aspirin oral tablet OTC; QL

migraine formula oral tablet OTC

migraine relief oral tablet OTC

pain reliever (acetam-aspirin) oral tablet OTC

pain reliever plus oral tablet OTC

pain-off oral tablet OTC

tri-buffered aspirin oral tablet OTC

ANALGESICS, NARCOTICS

acetaminophen-codeine oral solution PA; AL; QL

acetaminophen-codeine oral tablet 300-15 mg

AL; QL


Tylenol-Codeine #3 PA; AL; QL


Tylenol-Codeine #4 PA; AL; QL

ascomp with codeine oral capsule PA; AL; QL

butalbital compound w/codeine oral capsule

PA; AL; QL

butalbital-acetaminop-caf-cod oral capsule PA; AL; QL

butorphanol tartrate nasal spray,non-aerosol

PA; QL

codeine sulfate oral tablet PA; AL; QL

diskets oral tablet,soluble QL

endocet oral tablet PA; QL

fentanyl citrate buccal lozenge on a handle

Actiq PA; QL

fentanyl transdermal patch 72 hour Duragesic PA; QL

hydrocodone-acetaminophen oral solution PA; QL

hydrocodone-acetaminophen oral tablet Lorcet (hydrocodone) PA; QL

hydrocodone-ibuprofen oral tablet PA; QL

hydromorphone oral liquid Dilaudid PA; QL

hydromorphone oral tablet Dilaudid PA; QL

meperidine oral solution PA; QL

meperidine oral tablet PA; QL

methadone intensol oral concentrate PA; QL

methadone oral concentrate Methadone Intensol PA; QL

4


methadone oral solution PA; QL

methadone oral tablet Dolophine PA; QL

methadone oral tablet,soluble Diskets PA; QL

methadose oral concentrate PA; QL

methadose oral tablet,soluble PA; QL

morphine concentrate oral solution PA; QL

morphine oral solution PA; QL

morphine oral tablet QL

morphine oral tablet extended release MS Contin PA; QL

oxycodone oral capsule PA; QL

oxycodone oral concentrate PA; QL

oxycodone oral solution PA; QL

oxycodone oral tablet Roxicodone PA; QL

oxycodone-acetaminophen oral tablet Endocet PA; QL

oxycodone-aspirin oral tablet PA; QL

pentazocine-naloxone oral tablet PA; QL

tramadol oral tablet Ultram PA; AL; QL

tramadol-acetaminophen oral tablet Ultracet PA; AL; QL

vicodin es oral tablet PA; QL

vicodin hp oral tablet PA; QL

vicodin oral tablet PA; QL

ANALGESICS, NON-NARCOTIC

8 hour pain reliever oral tablet extended release

OTC; QL

acetaminophen extra strength oral tablet OTC; QL

acetaminophen oral elixir Non-Aspirin OTC

acetaminophen oral liquid Children's Silapap OTC; QL

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,disintegrating Children's Acetaminophen OTC

acetaminophen pain relief oral tablet OTC; QL

acetaminophen rectal suppository Feverall OTC

5


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

BUTALBITAL-ACETAMINOPHEN ORAL CAPSULE

QL

butalbital-acetaminophen oral tablet Tencon QL

butalbital-acetaminophen-caff oral capsule Esgic QL

butalbital-acetaminophen-caff oral tablet Esgic 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 non-aspirin oral suspension OTC; QL

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

children's pain relief oral suspension OTC; QL

children's pain reliever oral suspension OTC; QL

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

children's pain-fever relief oral tablet,disintegrating

OTC

children's silapap oral liquid OTC; QL

children's tactinal oral tablet,chewable OTC; QL

ed-apap oral liquid OTC; QL

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

infants' pain and fever oral suspension OTC; QL

6


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

little remedies fever and pain oral liquid OTC; QL

mapap (acetaminophen) oral capsule OTC; QL

mapap (acetaminophen) oral liquid 160 mg/5 ml

OTC; QL

mapap (acetaminophen) oral liquid 500 mg/15 ml

OTC

mapap (acetaminophen) oral tablet OTC

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 extra strength oral liquid OTC

non-aspirin extra strength oral tablet 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; QL

pain relief oral tablet OTC; QL

7


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 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

pharbetol oral tablet 500 mg OTC; QL

pre-menstrual relief oral tablet OTC

premsyn pms oral tablet OTC

tactinal extra strength oral tablet OTC; QL

tactinal oral tablet OTC

tencon oral tablet QL

tylophen oral capsule OTC; QL

ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITOR

ENBREL MINI SUBCUTANEOUS CARTRIDGE

PA; QL

ENBREL SUBCUTANEOUS RECON SOLN

PA; QL

ENBREL SUBCUTANEOUS SYRINGE PA; QL

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR

PA; QL

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS SYRINGE KIT

PA; QL

HUMIRA PEN CROHNS-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA PEN PSOR-UVEITS-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA SUBCUTANEOUS SYRINGE KIT

PA; QL

HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT

PA; QL

HUMIRA(CF) PEN CROHNS-UC-HS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

8


HUMIRA(CF) PEN PSOR-UV-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT

PA; QL

ANTI-INFLAMMATORY, PYRIMIDINE SYNTHESIS INHIBITOR

leflunomide oral tablet Arava

RIDAURA ORAL CAPSULE

DISEASE MODIFYING ANTI-RHEUMATOID DRUGS (DMARD)

DEPEN TITRATABS ORAL TABLET PA

minocycline oral capsule

minocycline oral tablet

sulfasalazine oral tablet Azulfidine QL

sulfasalazine oral tablet,delayed release (dr/ec)

Azulfidine EN-tabs QL

IMMUNOSUPRESSANTS

cyclosporine modified oral capsule Gengraf

cyclosporine modified oral solution Gengraf

cyclosporine oral capsule Sandimmune

gengraf oral capsule

gengraf oral solution

mycophenolate mofetil oral suspension for reconstitution

CellCept

SANDIMMUNE ORAL SOLUTION

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

children's advil oral suspension OTC; QL

children's ibuprofen oral suspension OTC; QL

children's profen ib oral suspension OTC; QL

diclofenac potassium oral tablet

diclofenac sodium oral tablet extended release 24 hr

Voltaren-XR PA

9


diclofenac sodium oral tablet,delayed release (dr/ec)

ec-naproxen oral tablet,delayed release (dr/ec)

etodolac oral capsule

etodolac oral tablet Lodine

etodolac oral tablet extended release 24 hr

fenoprofen oral tablet Nalfon QL

flanax (naproxen) oral tablet OTC; QL

flurbiprofen oral tablet

ibu oral tablet

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 Infant's Advil OTC; QL

ibuprofen oral suspension Children's Advil OTC; QL

ibuprofen oral tablet 100 mg Advil OTC

ibuprofen oral tablet 200 mg Addaprin OTC; QL

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

IBU

ibuprofen pm oral tablet OTC

indomethacin oral capsule

indomethacin oral capsule, extended release

infant's ibuprofen oral drops,suspension OTC; QL

infants profenib oral drops,suspension OTC; QL

i-prin oral tablet OTC; QL

ketoprofen oral capsule

ketoprofen oral capsule,ext rel. pellets 24 hr

QL

ketorolac oral tablet QL

meclofenamate oral capsule QL

mediproxen oral tablet OTC; QL

meloxicam oral suspension

meloxicam oral tablet 15 mg Mobic

meloxicam oral tablet 7.5 mg Mobic PA

10


motrin pm oral tablet OTC

nabumetone oral tablet

naproxen oral suspension Naprosyn PA

naproxen oral tablet

naproxen oral tablet,delayed release (dr/ec)

EC-Naprosyn PA

naproxen sodium oral capsule Aleve OTC

naproxen sodium oral tablet 220 mg Aleve OTC; QL

naproxen sodium oral tablet 275 mg

naproxen sodium oral tablet 550 mg Anaprox DS

oxaprozin oral tablet Daypro

piroxicam oral capsule Feldene PA

provil oral tablet OTC; QL

sulindac oral tablet

tolmetin oral capsule

tolmetin oral tablet

wal-profen oral capsule OTC

wal-profen oral tablet OTC; QL

wal-proxen oral tablet OTC; QL

ANESTHETICS

LOCAL ANESTHETICS

lidocaine hcl laryngotracheal solution LTA Pre-Attached QL

lidocaine topical ointment QL

ANORECTAL PREPARATIONS

ANORECTAL AGENTS

hydrocortisone topical cream with perineal applicator

Anusol-HC QL

proctosol hc topical cream with perineal applicator

QL

proctozone-hc topical cream with perineal applicator

QL

HEMORRHOIDAL PREPARATIONS

hemorrhoid rectal ointment OTC

hemorrhoidal (phenyleph-cocoa) rectal suppository

OTC

hemorrhoidal rectal ointment OTC

hemorrhoidal rectal suppository OTC

11


hemorrhoidal suppository rectal suppository

OTC

ANTIDOTES AND OTHER REVERSAL AGENTS

ANTIDOTES

acetylcysteine solution

CHELATING AGENTS

deferoxamine injection recon soln Desferal

DEPEN TITRATABS ORAL TABLET PA

trientine oral capsule Syprine PA; QL

NARCOTIC ANTAGONISTS

naloxone injection solution QL

naloxone injection syringe QL

naltrexone oral tablet

NARCAN NASAL SPRAY,NON-AEROSOL

QL

ANTI-INFECTIVE AGENTS

ABSORBABLE SULFONAMIDES

sulfamethoxazole-trimethoprim oral suspension

Sulfatrim

sulfamethoxazole-trimethoprim oral tablet Bactrim

sulfatrim oral suspension

trimethoprim oral tablet

AMEBICIDES

paromomycin oral capsule

AMINOGLYCOSIDES

neomycin oral tablet

AMINOPENICILLINS

amoxicillin oral capsule

amoxicillin oral suspension for reconstitution

QL

amoxicillin oral tablet

amoxicillin oral tablet,chewable

amoxicillin-pot clavulanate oral suspension for reconstitution

Augmentin ES-600

amoxicillin-pot clavulanate oral tablet

amoxicillin-pot clavulanate oral tablet extended release 12 hr

Augmentin XR QL

12


amoxicillin-pot clavulanate oral tablet,chewable

ampicillin oral capsule

ANTHELMINTIC AGENTS - MACROCYCLIC LACTONES

ivermectin oral tablet Stromectol

ANTHELMINTICS

ivermectin oral tablet Stromectol

praziquantel oral tablet Biltricide

reese's pinworm medicine oral suspension OTC

ANTIBACTERIAL AGENTS, OTHER

nitrofurantoin macrocrystal oral capsule Macrodantin

nitrofurantoin monohyd/m-cryst oral capsule

Macrobid

ANTIFUNGAL ANTIBIOTICS

fluconazole oral suspension for reconstitution

Diflucan QL

fluconazole oral tablet Diflucan QL

flucytosine oral capsule Ancobon PA

griseofulvin microsize oral suspension

griseofulvin ultramicrosize oral tablet

itraconazole oral capsule Sporanox PA

ketoconazole oral tablet QL

nystatin oral tablet

terbinafine hcl oral tablet QL

voriconazole intravenous solution Vfend IV PA

voriconazole oral suspension for reconstitution

Vfend PA

voriconazole oral tablet 200 mg Vfend PA; QL

voriconazole oral tablet 50 mg Vfend PA

ANTI-INFECTIVE AGENTS, OTHER

methenamine hippurate oral tablet Hiprex

ANTILEPROTIC - SULFONE AGENTS

dapsone oral tablet

ANTIMYCOBACTERIUM AGENTS

ethambutol oral tablet Myambutol

isoniazid oral solution

13


isoniazid oral tablet

PRIFTIN ORAL TABLET

pyrazinamide oral tablet

rifabutin oral capsule Mycobutin

rifampin oral capsule Rifadin

RIFATER ORAL TABLET

ANTIPROTOZOAL ANTIBACTERIAL AGENTS

metronidazole oral capsule Flagyl

metronidazole oral tablet Flagyl

tinidazole oral tablet QL

ANTIVIRALS, GENERAL

acyclovir oral capsule Zovirax

acyclovir oral suspension Zovirax

acyclovir oral tablet Zovirax

famciclovir oral tablet QL

oseltamivir oral capsule Tamiflu QL

oseltamivir oral suspension for reconstitution

Tamiflu QL

RELENZA DISKHALER INHALATION BLISTER WITH DEVICE

QL

rimantadine oral tablet Flumadine

TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION

QL

valacyclovir oral tablet Valtrex QL

valganciclovir oral recon soln Valcyte

valganciclovir oral tablet Valcyte

ANTIVIRALS, HIV SPECIFIC

abacavir oral solution Ziagen

abacavir oral tablet Ziagen

abacavir-lamivudine oral tablet Epzicom

abacavir-lamivudine-zidovudine oral tablet Trizivir

APTIVUS ORAL CAPSULE

APTIVUS ORAL SOLUTION

atazanavir oral capsule Reyataz

BIKTARVY ORAL TABLET

CIMDUO ORAL TABLET

COMPLERA ORAL TABLET

14


DELSTRIGO ORAL TABLET

DESCOVY ORAL TABLET

didanosine oral capsule,delayed release(dr/ec)

Videx EC

EDURANT ORAL TABLET

EMTRIVA ORAL CAPSULE

EMTRIVA ORAL SOLUTION

EVOTAZ ORAL TABLET

FUZEON SUBCUTANEOUS RECON SOLN

PA

GENVOYA ORAL TABLET

INTELENCE ORAL TABLET AL

ISENTRESS HD ORAL TABLET

ISENTRESS ORAL POWDER IN PACKET

ISENTRESS ORAL TABLET

ISENTRESS ORAL TABLET,CHEWABLE

JULUCA ORAL TABLET

lamivudine oral solution Epivir AL

lamivudine oral tablet Epivir

lamivudine-zidovudine oral tablet Combivir

lopinavir-ritonavir oral solution Kaletra

nevirapine oral suspension Viramune

nevirapine oral tablet Viramune

nevirapine oral tablet extended release 24 hr

Viramune XR

NORVIR ORAL CAPSULE

NORVIR ORAL SOLUTION

ODEFSEY ORAL TABLET

PIFELTRO ORAL TABLET

PREZCOBIX ORAL TABLET

PREZISTA ORAL SUSPENSION

PREZISTA ORAL TABLET

RETROVIR INTRAVENOUS SOLUTION

REYATAZ ORAL POWDER IN PACKET

ritonavir oral tablet Norvir

SELZENTRY ORAL SOLUTION

15


SELZENTRY ORAL TABLET

stavudine oral capsule

STRIBILD ORAL TABLET

SYMTUZA ORAL TABLET

tenofovir disoproxil fumarate oral tablet Viread PA; QL

TIVICAY ORAL TABLET

TRIUMEQ ORAL TABLET

TROGARZO INTRAVENOUS SOLUTION PA

TRUVADA ORAL TABLET

VIREAD ORAL POWDER PA; QL

VIREAD ORAL TABLET PA; QL

zidovudine oral capsule Retrovir

zidovudine oral syrup Retrovir

zidovudine oral tablet

CEPHALOSPORIN ANTIBIOTICS

cefaclor oral capsule

cefaclor oral suspension for reconstitution

cefaclor oral tablet extended release 12 hr

cefadroxil oral capsule

cefadroxil oral suspension for reconstitution

cefadroxil oral tablet

cefdinir oral capsule QL

cefdinir oral suspension for reconstitution QL

cefpodoxime oral suspension for reconstitution

cefpodoxime oral tablet

cefprozil oral suspension for reconstitution

cefprozil oral tablet

ceftriaxone injection recon soln 1 gram, 2 gram, 250 mg, 500 mg

QL

ceftriaxone injection recon soln 10 gram

cefuroxime axetil oral tablet

cephalexin oral capsule Keflex

cephalexin oral suspension for reconstitution

cephalexin oral tablet

16


HEPATITIS B TREATMENT AGENTS

adefovir oral tablet Hepsera PA; QL

BARACLUDE ORAL SOLUTION PA; QL

entecavir oral tablet Baraclude PA; QL

EPIVIR HBV ORAL SOLUTION PA; QL

lamivudine oral tablet Epivir HBV PA; QL

HEPATITIS C TREATMENT AGENTS

MAVYRET ORAL TABLET PA; QL

PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR

PEGASYS SUBCUTANEOUS SOLUTION

QL

PEGASYS SUBCUTANEOUS SYRINGE

PEGINTRON SUBCUTANEOUS KIT

ribavirin oral capsule Ribasphere QL

ribavirin oral tablet Moderiba QL

SOFOSBUVIR-VELPATASVIR ORAL TABLET

Epclusa PA; QL

INFLUENZA ANTIVIRAL AGENTS - PA ENDONUCLEASE INHIBITOR

XOFLUZA ORAL TABLET QL

LINCOSAMIDES

clindamycin hcl oral capsule Cleocin HCl

clindamycin palmitate hcl oral recon soln Cleocin Pediatric

clindamycin pediatric oral recon soln

MACROLIDES

azithromycin oral packet Zithromax QL

azithromycin oral suspension for reconstitution

Zithromax QL

azithromycin oral tablet Zithromax QL

clarithromycin oral suspension for reconstitution

clarithromycin oral tablet

clarithromycin oral tablet extended release 24 hr

e.e.s. 400 oral tablet

ery-tab oral tablet,delayed release (dr/ec)

erythrocin (as stearate) oral tablet

17


erythromycin ethylsuccinate oral tablet E.E.S. 400

erythromycin oral capsule,delayed release(dr/ec)

erythromycin oral tablet

PENICILLINS

dicloxacillin oral capsule

penicillin v potassium oral recon soln

penicillin v potassium oral tablet

PLASMOCIDES COMBINATION

atovaquone-proguanil oral tablet Malarone Pediatric

PLASMOCIDES

chloroquine phosphate oral tablet

hydroxychloroquine oral tablet Plaquenil

mefloquine oral tablet QL

PRIMAQUINE ORAL TABLET

QUINOLONES

ciprofloxacin (mixture) oral tablet, er multiphase 24 hr 1,000 mg

Cipro XR

ciprofloxacin (mixture) oral tablet, er multiphase 24 hr 500 mg

Cipro XR QL

ciprofloxacin hcl oral tablet QL

levofloxacin oral solution QL

levofloxacin oral tablet QL

ofloxacin oral tablet QL

SULFONAMIDE ANTIBIOTIC

sulfadiazine oral tablet

TETRACYCLINES

demeclocycline oral tablet

doxycycline monohydrate oral capsule 100 mg, 50 mg

Mondoxyne NL QL

doxycycline monohydrate oral capsule 150 mg

doxycycline monohydrate oral capsule 75 mg

Mondoxyne NL

doxycycline monohydrate oral suspension for reconstitution

Vibramycin

minocycline oral capsule

minocycline oral tablet

18


tetracycline oral capsule

VANCOMYCIN AND DERIVATIVES

linezolid oral suspension for reconstitution Zyvox PA; QL

linezolid oral tablet Zyvox PA; QL

vancomycin oral capsule Vancocin PA

ANTINEOPLASTICS

ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS

anastrozole oral tablet Arimidex QL

bicalutamide oral tablet Casodex

EMCYT ORAL CAPSULE PA

exemestane oral tablet Aromasin QL

flutamide oral capsule

hydroxyurea oral capsule Hydrea

imatinib oral tablet Gleevec PA; QL

IRESSA ORAL TABLET PA; QL

letrozole oral tablet Femara QL

leucovorin calcium injection recon soln

leucovorin calcium oral tablet

megestrol oral tablet PA

melphalan oral tablet Alkeran

MESNEX ORAL TABLET PA

MYLERAN ORAL TABLET

tamoxifen oral tablet

tretinoin (chemotherapy) oral capsule

VANTAS IMPLANT KIT PA

VELCADE INJECTION RECON SOLN PA

ANTISEPTICS AND DISINFECTANTS

ANTISEPTICS, GENERAL

alcohol pads topical pads, medicated OTC

alcohol prep pads topical pads, medicated OTC

alcohol swabs topical pads, medicated Alcohol Pads OTC

alcohol wipes topical pads, medicated OTC

antiseptic skin clnsr(chlorhe) topical liquid OTC; QL

betasept surgical scrub topical liquid OTC; QL

chlorhexidine gluconate topical liquid Dyna-Hex OTC

19


curity alcohol swabs topical pads, medicated

OTC

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

DISINFECTANTS - OTHER

alcoh-wipe towelette OTC

BIOLOGICALS

ANTIVIRAL MONOCLONAL ANTIBODIES - RESPIRATORY SYNCYTIAL VIRUS (RSV)

SYNAGIS INTRAMUSCULAR SOLUTION

PA

IMMUNE GLOBULINS

GAMUNEX-C INJECTION SOLUTION PA

OCTAGAM INTRAVENOUS SOLUTION PA

IMMUNOLOGICALS VACCINES

BEXSERO INTRAMUSCULAR SYRINGE QL

PREVNAR 13 (PF) INTRAMUSCULAR SYRINGE

SYNAGIS INTRAMUSCULAR SOLUTION

PA

TRUMENBA INTRAMUSCULAR SYRINGE

AL

CARDIOVASCULAR THERAPY AGENTS

ACE INHIBITOR/CALCIUM CHANNEL BLOCK COMBINATION

amlodipine-benazepril oral capsule QL

ADRENERGIC VASOPRESSOR

midodrine oral tablet

ALDOSTERONE RECEPTOR ANTAGONISTS

spironolactone oral tablet Aldactone

20


ALPHA/BETA-ADRENERGIC BLOCKING AGENTS

carvedilol oral tablet Coreg QL

labetalol oral tablet

ALPHA-ADRENERGIC BLOCKING AGENTS

doxazosin oral tablet Cardura QL

prazosin oral capsule Minipress

terazosin oral capsule QL

ANAPHYLAXIS THERAPY AGENTS

epinephrine injection auto-injector EpiPen Jr QL

epinephrine injection solution Adrenalin

SYMJEPI INJECTION SYRINGE QL

ANTIARRHYTHMICS

amiodarone oral tablet 200 mg Pacerone QL

amiodarone oral tablet 400 mg Pacerone

disopyramide phosphate oral capsule Norpace

flecainide oral tablet QL

mexiletine oral capsule

pacerone oral tablet 200 mg QL

pacerone oral tablet 400 mg

propafenone oral capsule,extended release 12 hr

Rythmol SR

propafenone oral tablet

quinidine gluconate oral tablet extended release

quinidine sulfate oral tablet

sorine oral tablet QL

sotalol af oral tablet QL

sotalol oral tablet Betapace QL

verapamil oral tablet QL

BETA-ADRENERGIC BLOCKING AGENTS

acebutolol oral capsule

atenolol oral tablet Tenormin

betaxolol oral tablet

bisoprolol fumarate oral tablet

21


metoprolol succinate oral tablet extended release 24 hr

Toprol XL

metoprolol tartrate oral tablet 100 mg, 50 mg

Lopressor QL

metoprolol tartrate oral tablet 25 mg, 37.5 mg, 75 mg

nadolol oral tablet 20 mg, 40 mg Corgard

nadolol oral tablet 80 mg Corgard PA

pindolol oral tablet

propranolol oral capsule,extended release 24 hr

Inderal LA

propranolol oral solution

propranolol oral tablet

sorine oral tablet QL

sotalol af oral tablet QL

sotalol oral tablet Betapace QL

timolol maleate oral tablet

CALCIUM CHANNEL BLOCKING AGENTS

afeditab cr oral tablet extended release 30 mg

DO; QL

afeditab cr oral tablet extended release 60 mg

QL

amlodipine oral tablet 10 mg Norvasc QL

amlodipine oral tablet 2.5 mg, 5 mg Norvasc DO; QL

cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg

DO; QL

cartia xt oral capsule,extended release 24hr 300 mg

QL

diltiazem hcl oral capsule,ext.rel 24h degradable 120 mg, 180 mg

DILT-XR DO; QL

diltiazem hcl oral capsule,ext.rel 24h degradable 240 mg

DILT-XR QL

diltiazem hcl oral capsule,extended release 12 hr

QL

diltiazem hcl oral capsule,extended release 24 hr 120 mg, 180 mg

Taztia XT DO; QL

diltiazem hcl oral capsule,extended release 24 hr 240 mg, 300 mg, 360 mg

Taztia XT QL

22


diltiazem hcl oral capsule,extended release 24 hr 420 mg

Tiazac QL

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

Cardizem CD DO; QL

diltiazem hcl oral capsule,extended release 24hr 300 mg, 360 mg

Cardizem CD QL

diltiazem hcl oral tablet Cardizem QL

diltiazem hcl oral tablet extended release 24 hr 180 mg, 240 mg

Cardizem LA DO; QL

diltiazem hcl oral tablet extended release 24 hr 300 mg, 360 mg, 420 mg

Cardizem LA QL

dilt-xr oral capsule,ext.rel 24h degradable 120 mg, 180 mg

DO; QL

dilt-xr oral capsule,ext.rel 24h degradable 240 mg

QL

felodipine oral tablet extended release 24 hr 10 mg

QL

felodipine oral tablet extended release 24 hr 2.5 mg, 5 mg

DO; QL

isradipine oral capsule QL

matzim la oral tablet extended release 24 hr 180 mg, 240 mg

DO; QL

matzim la oral tablet extended release 24 hr 300 mg, 360 mg, 420 mg

QL

nicardipine oral capsule QL

nifedipine oral capsule QL

nifedipine oral tablet extended release 24hr 30 mg

Procardia XL DO; QL

nifedipine oral tablet extended release 24hr 60 mg, 90 mg

Procardia XL QL

nifedipine oral tablet extended release 30 mg

Adalat CC DO; QL

nifedipine oral tablet extended release 60 mg, 90 mg

Adalat CC QL

taztia xt oral capsule,extended release 24 hr 120 mg, 180 mg

DO; QL

taztia xt oral capsule,extended release 24 hr 240 mg, 300 mg, 360 mg

QL

verapamil oral capsule, 24 hr er pellet ct Verelan PM DO; QL

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

Verelan DO; QL

23


verapamil oral capsule,ext rel. pellets 24 hr 240 mg, 360 mg

Verelan QL

verapamil oral tablet QL

verapamil oral tablet extended release Calan SR QL

DIGITALIS GLYCOSIDES

digitek oral tablet

digox oral tablet

digoxin oral solution

digoxin oral tablet Digitek

DIURETIC AGENTS, OTHER

acetazolamide oral capsule, extended release

acetazolamide oral tablet

methazolamide oral tablet

spironolactone oral tablet Aldactone

HYPOTENSIVES, ACE INHIBITORS, COMBINATIONS

benazepril oral tablet QL

benazepril-hydrochlorothiazide oral tablet QL

captopril oral tablet QL

captopril-hydrochlorothiazide oral tablet QL

enalapril maleate oral tablet Vasotec QL

enalapril-hydrochlorothiazide oral tablet QL

fosinopril oral tablet QL

fosinopril-hydrochlorothiazide oral tablet QL

lisinopril oral tablet 10 mg, 20 mg, 5 mg Prinivil DO; QL

lisinopril oral tablet 2.5 mg Zestril DO; QL

lisinopril oral tablet 30 mg, 40 mg Zestril QL

lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg

Zestoretic DO; QL

lisinopril-hydrochlorothiazide oral tablet 20-12.5 mg, 20-25 mg

Zestoretic QL

moexipril oral tablet

perindopril erbumine oral tablet QL

quinapril oral tablet Accupril QL

quinapril-hydrochlorothiazide oral tablet Accuretic QL

ramipril oral capsule Altace QL

trandolapril oral tablet

24


HYPOTENSIVES, ANGIOTENSIN RECEPTOR ANTAGONIST

candesartan oral tablet Atacand

candesartan-hydrochlorothiazid oral tablet Atacand HCT

irbesartan oral tablet 150 mg, 75 mg Avapro DO; QL

irbesartan oral tablet 300 mg Avapro QL

irbesartan-hydrochlorothiazide oral tablet Avalide QL

losartan oral tablet Cozaar QL

losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg

Hyzaar QL

losartan-hydrochlorothiazide oral tablet 50-12.5 mg

Hyzaar DO; QL

valsartan oral tablet Diovan QL

valsartan-hydrochlorothiazide oral tablet Diovan HCT QL

HYPOTENSIVES, MISCELLANEOUS

atenolol-chlorthalidone oral tablet Tenoretic 100

bisoprolol-hydrochlorothiazide oral tablet Ziac

clonidine hcl oral tablet Catapres

guanfacine oral tablet

methyldopa oral tablet

methyldopa-hydrochlorothiazide oral tablet

metoprolol ta-hydrochlorothiaz oral tablet Lopressor HCT QL

nadolol-bendroflumethiazide oral tablet QL

propranolol-hydrochlorothiazid oral tablet

HYPOTENSIVES, VASODILATORS

hydralazine oral tablet

minoxidil oral tablet

LIPOTROPICS

atorvastatin oral tablet 10 mg, 20 mg, 40 mg

Lipitor DO; QL

atorvastatin oral tablet 80 mg Lipitor QL

cholestyramine (with sugar) oral powder Questran

cholestyramine (with sugar) oral powder in packet

Questran

cholestyramine light oral powder

cholestyramine light oral powder in packet

colestipol oral granules Colestid

25


colestipol oral packet Colestid

colestipol oral tablet Colestid

fenofibrate micronized oral capsule 130 mg, 200 mg, 43 mg

QL

fenofibrate micronized oral capsule 134 mg

fenofibrate micronized oral capsule 67 mg PA; QL

fenofibrate nanocrystallized oral tablet Tricor QL

fenofibrate oral tablet QL

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

Trilipix QL

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

Trilipix PA; QL

fenofibric acid oral tablet Fibricor PA; QL

fish oil concentrate oral capsule OTC

fish oil oral capsule,delayed release(dr/ec) OTC

gemfibrozil oral tablet Lopid

GRAM-O-LECI ORAL TABLET,CHEWABLE

OTC

inositol oral tablet OTC

lecithin oral capsule OTC

lecithin, soy oral capsule OTC

lovastatin oral tablet 10 mg, 20 mg DO; QL

lovastatin oral tablet 40 mg QL

maxepa oral capsule OTC

niacin oral tablet Niacor OTC

omega-3 fatty acids oral capsule Fish Oil Concentrate OTC

pravastatin oral tablet Pravachol QL

prenatal dha oral capsule OTC

prevalite oral powder

prevalite oral powder in packet

simvastatin oral tablet 10 mg, 20 mg, 40 mg

Zocor DO; QL

simvastatin oral tablet 5 mg DO; QL

simvastatin oral tablet 80 mg Zocor PA; QL

super omega-3 oral capsule OTC

super twin epa-dha oral capsule OTC

vitamin e oral capsule OTC

26


LOOP DIURETICS

bumetanide oral tablet

furosemide oral solution

furosemide oral tablet Lasix

torsemide oral tablet Demadex

PCSK-9 INHIBITORS

REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR

PA; QL

REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR

PA; QL

REPATHA SYRINGE SUBCUTANEOUS SYRINGE

PA; QL

POTASSIUM SPARING DIURETICS

amiloride oral tablet

amiloride-hydrochlorothiazide oral tablet

spironolacton-hydrochlorothiaz oral tablet Aldactazide

triamterene-hydrochlorothiazid oral capsule

triamterene-hydrochlorothiazid oral tablet Maxzide-25mg

PULMONARY ARTERIAL HYPERTENSION

ambrisentan oral tablet Letairis PA; QL

sildenafil (antihypertensive) oral tablet Revatio PA; QL

tadalafil (antihypertensive) oral tablet Adcirca PA; QL

THIAZIDE AND RELATED DIURETICS

chlorothiazide oral tablet

chlorthalidone oral tablet

hydrochlorothiazide oral capsule Microzide QL

hydrochlorothiazide oral tablet 12.5 mg QL

hydrochlorothiazide oral tablet 25 mg, 50 mg

indapamide oral tablet

metolazone oral tablet

VASODILATORS, CORONARY

isosorbide dinitrate oral tablet

isosorbide dinitrate oral tablet extended release

ISOCHRON

27


isosorbide mononitrate oral tablet

isosorbide mononitrate oral tablet extended release 24 hr

nitro-bid transdermal ointment

NITRO-DUR TRANSDERMAL PATCH 24 HOUR

nitroglycerin sublingual tablet Nitrostat

nitroglycerin transdermal patch 24 hour Minitran

CENTRAL NERVOUS SYSTEM AGENTS

ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS

mirtazapine oral tablet Remeron

mirtazapine oral tablet,disintegrating Remeron SolTab

ANTI-ANXIETY DRUGS

alprazolam intensol oral concentrate

alprazolam oral tablet Xanax

alprazolam oral tablet,disintegrating

buspirone oral tablet

chlordiazepoxide hcl oral capsule

clonazepam oral tablet Klonopin

clonazepam oral tablet,disintegrating

clorazepate dipotassium oral tablet

diazepam intensol oral concentrate

diazepam oral concentrate Diazepam Intensol

diazepam oral solution

diazepam oral tablet Valium

hydroxyzine hcl oral tablet

hydroxyzine pamoate oral capsule

lorazepam oral tablet Ativan

oxazepam oral capsule

ANTICONVULSANTS

carbamazepine oral capsule, er multiphase 12 hr

Carbatrol QL

carbamazepine oral suspension Tegretol

carbamazepine oral tablet Epitol

carbamazepine oral tablet extended release 12 hr

Tegretol XR

28


carbamazepine oral tablet,chewable



diazepam rectal kit Diastat QL

divalproex oral capsule, delayed rel sprinkle

Depakote Sprinkles QL

divalproex oral tablet extended release 24 hr

Depakote ER QL

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

Depakote QL

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

Depakote

epitol oral tablet

ethosuximide oral capsule Zarontin

ethosuximide oral solution Zarontin

felbamate oral suspension Felbatol

felbamate oral tablet Felbatol

gabapentin oral capsule Neurontin QL

gabapentin oral solution Neurontin QL

gabapentin oral tablet Neurontin QL

lamotrigine oral tablet 100 mg, 150 mg, 200 mg

Lamictal

lamotrigine oral tablet 25 mg Lamictal QL

lamotrigine oral tablet disintegrating, dose pk

Lamictal ODT Starter (Orange)

lamotrigine oral tablet extended release 24hr

Lamictal XR

lamotrigine oral tablet, chewable dispersible

Lamictal

lamotrigine oral tablet,disintegrating 100 mg, 50 mg

Lamictal ODT QL

lamotrigine oral tablet,disintegrating 200 mg, 25 mg

Lamictal ODT

lamotrigine oral tablets,dose pack Lamictal Starter (Blue) Kit

levetiracetam oral solution Keppra

levetiracetam oral tablet Keppra QL

levetiracetam oral tablet extended release 24 hr

Keppra XR QL

oxcarbazepine oral suspension Trileptal

oxcarbazepine oral tablet Trileptal

29


phenobarbital oral elixir

phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 60 mg, 64.8 mg, 97.2 mg

phenobarbital oral tablet 32.4 mg QL

phenytoin oral suspension Dilantin-125

phenytoin oral tablet,chewable Dilantin Infatabs

phenytoin sodium extended oral capsule Phenytek

primidone oral tablet Mysoline

ROWEEPRA ORAL TABLET 1,000 MG, 750 MG

QL

roweepra oral tablet 500 mg QL

roweepra xr oral tablet extended release 24 hr

QL

tiagabine oral tablet Gabitril

topiramate oral capsule, sprinkle Topamax

topiramate oral tablet Topamax

valproic acid (as sodium salt) oral solution

valproic acid oral capsule Depakene QL

zonisamide oral capsule Zonegran QL

ANTIDEPRESSANTS, OTHER

perphenazine-amitriptyline oral tablet

ANTIMANIA DRUGS

lithium carbonate oral capsule

lithium carbonate oral tablet

lithium carbonate oral tablet extended release

Lithobid

lithium citrate oral solution AL

ANTIMIGRAINE PREPARATIONS

divalproex oral tablet extended release 24 hr

Depakote ER QL

ergotamine-caffeine oral tablet Cafergot

isometh-dichloral-acetaminophn oral capsule

migergot rectal suppository

naratriptan oral tablet Amerge QL

sumatriptan nasal spray,non-aerosol Imitrex PA; QL

sumatriptan succinate oral tablet Imitrex QL

30


sumatriptan succinate subcutaneous cartridge

Imitrex STATdose Refill PA; QL

sumatriptan succinate subcutaneous pen injector

Imitrex STATdose Pen PA; QL

sumatriptan succinate subcutaneous solution

Imitrex PA; QL

sumatriptan succinate subcutaneous syringe

QL

ANTIPARKINSONISM DRUGS, ANTICHOLINERGIC

benztropine oral tablet

trihexyphenidyl oral elixir

trihexyphenidyl oral tablet

ANTIPARKINSONISM DRUGS, OTHER

amantadine hcl oral capsule QL

amantadine hcl oral solution

amantadine hcl oral tablet

bromocriptine oral capsule Parlodel

bromocriptine oral tablet Parlodel

carbidopa-levodopa oral tablet Sinemet

carbidopa-levodopa oral tablet extended release

Sinemet CR

carbidopa-levodopa oral tablet,disintegrating

carbidopa-levodopa-entacapone oral tablet

Stalevo 50 QL

entacapone oral tablet Comtan

pramipexole oral tablet Mirapex QL

ropinirole oral tablet

selegiline hcl oral capsule

selegiline hcl oral tablet

ANTIPSYCHOTICS, ATYPICAL DOPAMINE AND SEROTONIN ANTAGONISTS

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

PA; AL; QL

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING

PA; AL

aripiprazole oral tablet Abilify AL; QL

31


ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING

PA; AL

clozapine oral tablet Clozaril AL; QL

INVEGA SUSTENNA INTRAMUSCULAR SYRINGE

PA; AL; QL

INVEGA TRINZA INTRAMUSCULAR SYRINGE

PA; AL; QL

olanzapine intramuscular recon soln Zyprexa AL

olanzapine oral tablet Zyprexa AL; QL

paliperidone oral tablet extended release 24hr

Invega AL

quetiapine oral tablet Seroquel AL; QL

RISPERDAL CONSTA INTRAMUSCULAR SYRINGE

PA; AL; QL

risperidone oral solution Risperdal AL; QL

risperidone oral tablet Risperdal AL; QL

ziprasidone hcl oral capsule Geodon AL; QL

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION

PA; AL

ANTIPSYCHOTICS, TYPICAL

chlorpromazine oral tablet AL

fluphenazine decanoate injection solution AL

fluphenazine hcl injection solution AL

fluphenazine hcl oral concentrate AL

fluphenazine hcl oral elixir AL

fluphenazine hcl oral tablet AL

haloperidol decanoate intramuscular solution 100 mg/ml

Haldol Decanoate AL; QL

haloperidol decanoate intramuscular solution 50 mg/ml

Haldol Decanoate AL

haloperidol lactate injection solution Haldol AL

haloperidol lactate intramuscular syringe AL

haloperidol lactate oral concentrate AL

haloperidol oral tablet AL

loxapine succinate oral capsule AL

perphenazine oral tablet AL

pimozide oral tablet Orap PA

prochlorperazine maleate oral tablet Compazine

32


thioridazine oral tablet

thiothixene oral capsule AL

trifluoperazine oral tablet AL

ATTENTION DEFICIT - HYPERACTIVITY (ADHD)/NARCOLEPSY

atomoxetine oral capsule Strattera AL; QL

clonidine hcl oral tablet extended release 12 hr

Kapvay AL; QL

dexmethylphenidate oral capsule,er biphasic 50-50

Focalin XR AL; QL

dexmethylphenidate oral tablet 10 mg Focalin AL; QL

dexmethylphenidate oral tablet 2.5 mg Focalin AL

dexmethylphenidate oral tablet 5 mg Focalin PA; QL

dextroamphetamine oral capsule, extended release

Dexedrine Spansule AL; QL

dextroamphetamine oral tablet Zenzedi AL; QL

dextroamphetamine-amphetamine oral capsule,extended release 24hr

Adderall XR AL; QL

dextroamphetamine-amphetamine oral tablet

Adderall AL

metadate er oral tablet extended release AL; QL

methylphenidate hcl oral capsule, er biphasic 30-70

AL; QL

methylphenidate hcl oral capsule,er biphasic 50-50

Ritalin LA AL; QL

methylphenidate hcl oral solution Methylin AL

methylphenidate hcl oral tablet Ritalin AL

methylphenidate hcl oral tablet extended release 10 mg

AL

methylphenidate hcl oral tablet extended release 20 mg

Metadate ER AL; QL

methylphenidate hcl oral tablet extended release 24hr

Concerta AL; QL

ATTENTION DEFICIT-HYPERACTIVITY (ADHD)/NARCOLEPSY

caffeine citrate intravenous solution Cafcit

caffeine citrate oral solution

33


BENZODIAZEPINES

alprazolam intensol oral concentrate

alprazolam oral tablet Xanax

alprazolam oral tablet,disintegrating

chlordiazepoxide hcl oral capsule



clorazepate dipotassium oral tablet

estazolam oral tablet

flurazepam oral capsule QL

oxazepam oral capsule

temazepam oral capsule Restoril QL

triazolam oral tablet Halcion QL

CNS STIMULANTS

dextroamphetamine oral capsule, extended release

Dexedrine Spansule AL; QL

dextroamphetamine oral tablet Zenzedi AL; QL

dextroamphetamine-amphetamine oral capsule,extended release 24hr

Adderall XR AL; QL

dextroamphetamine-amphetamine oral tablet

Adderall AL

MAO INHIBITORS

phenelzine oral tablet Nardil

tranylcypromine oral tablet Parnate

NOREPINEPHRINE AND DOPAMINE REUPTAKE INHIBITORS (NDRIS)

bupropion hcl oral tablet

bupropion hcl oral tablet extended release 24 hr

Wellbutrin XL QL

bupropion hcl oral tablet sustained-release 12 hr

Wellbutrin SR

SEDATIVE-HYPNOTICS, BARBITURATES

phenobarbital oral elixir

phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 60 mg, 64.8 mg, 97.2 mg

phenobarbital oral tablet 32.4 mg QL

34


SEDATIVE-HYPNOTICS, NON-BARBITURATES

alka-seltzer plus allergy oral tablet OTC

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

diphenhydramine hcl oral capsule 50 mg Banophen OTC

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

estazolam oral tablet

flurazepam oral capsule QL

nightime sleep oral capsule OTC

nighttime sleep aid (diphen) oral capsule OTC

nighttime sleep aid (diphen) oral tablet OTC

simply sleep oral tablet OTC

sleep aid (diphenhydramine) oral capsule OTC

sleep aid (diphenhydramine) oral tablet OTC

sleep aid (doxylamine) oral tablet OTC

sleep aid max str (diphenhydr) oral capsule

OTC

sleep ii oral tablet OTC

sleep tablet (diphenhydramine) oral tablet OTC

sleep-tabs oral tablet OTC

temazepam oral capsule Restoril QL

triazolam oral tablet Halcion QL

UNISOM SLEEPGELS ORAL CAPSULE OTC

wal-som (diphenhydramine) oral capsule OTC

zaleplon oral capsule QL

zolpidem oral tablet Ambien QL

SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS)

citalopram oral solution QL

citalopram oral tablet 10 mg, 40 mg Celexa

citalopram oral tablet 20 mg Celexa QL

escitalopram oxalate oral solution

escitalopram oxalate oral tablet Lexapro QL

fluoxetine oral capsule Prozac QL

fluoxetine oral capsule,delayed release(dr/ec)

fluoxetine oral solution

fluoxetine oral tablet Sarafem QL

35


fluvoxamine oral tablet

paroxetine hcl oral tablet Paxil QL

paroxetine hcl oral tablet extended release 24 hr 12.5 mg, 37.5 mg

Paxil CR

paroxetine hcl oral tablet extended release 24 hr 25 mg

Paxil CR QL

sertraline oral concentrate Zoloft QL

sertraline oral tablet Zoloft QL

SEROTONIN-2 ANTAGONIST REUPTAKE INHIBITORS (SARIS)

nefazodone oral tablet

trazodone oral tablet

SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)

venlafaxine oral capsule,extended release 24hr

Effexor XR QL

venlafaxine oral tablet QL

venlafaxine oral tablet extended release 24hr

QL

TRICYCLIC ANTIDEPRESSANT/BENZODIAZEPINE COMBINATIONS

amitriptyline-chlordiazepoxide oral tablet

TRICYCLIC ANTIDEPRESSANTS AND RELATED NON-SELECT REUPTAKE INHIBITORS

amitriptyline oral tablet

amoxapine oral tablet

clomipramine oral capsule Anafranil

desipramine oral tablet Norpramin

doxepin oral capsule

doxepin oral concentrate

imipramine hcl oral tablet Tofranil

imipramine pamoate oral capsule

maprotiline oral tablet

nortriptyline oral capsule Pamelor

nortriptyline oral solution

protriptyline oral tablet

trimipramine oral capsule

36


CHEMICAL DEPENDENCY, AGENTS TO TREAT

ALCOHOL ANTAGONIST

acamprosate oral tablet,delayed release (dr/ec)

QL

disulfiram oral tablet Antabuse

VIVITROL INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

NARCOTIC ANTAGONISTS

buprenorphine hcl sublingual tablet QL

buprenorphine-naloxone sublingual film Suboxone QL

buprenorphine-naloxone sublingual tablet QL

PROBUPHINE SUBDERMAL IMPLANT

SUBLOCADE SUBCUTANEOUS SOLUTION, EXTENDED REL SYRINGE

QL

SMOKING DETERRENT AGENTS

bupropion hcl (smoking deter) oral tablet extended release 12 hr

Zyban QL

bupropion hcl oral tablet sustained-release 12 hr

Wellbutrin SR

CHANTIX CONTINUING MONTH BOX ORAL TABLET

AL; QL

CHANTIX ORAL TABLET QL

CHANTIX STARTING MONTH BOX ORAL TABLETS,DOSE PACK

AL; QL

nicorelief buccal gum 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

nicotine transdermal patch, td daily, sequential

OTC

NICOTROL INHALATION CARTRIDGE

NICOTROL NS NASAL SPRAY,NON-AEROSOL

quit 2 buccal gum OTC; QL

quit 4 buccal gum OTC; QL

stop smoking aid buccal lozenge OTC; QL

37


CHEMICALS-PHARMACEUTICAL ADJUVANTS

CHEMICALS - SOLVENTS

alcohol, rubbing solution OTC

isopropyl alcohol solution OTC

PHARMACEUTICAL ADJUVANT

NEBUSAL INHALATION SOLUTION FOR NEBULIZATION

petrolatum topical ointment OTC

petroleum jelly topical gel OTC

petroleum jelly, white topical gel OTC

pulmosal inhalation solution for nebulization

sodium chloride inhalation solution for nebulization

NebuSal

white petrolatum topical gel Lip Treatment OTC

white petroleum jelly topical gel OTC

COGNITIVE DISORDER THERAPY

CHOLINESTERASE INHIBITORS

donepezil oral tablet 10 mg, 5 mg Aricept QL

donepezil oral tablet 23 mg Aricept PA; QL

donepezil oral tablet,disintegrating QL

galantamine oral capsule,ext rel. pellets 24 hr

Razadyne ER

galantamine oral solution

galantamine oral tablet Razadyne QL

memantine oral solution

memantine oral tablet Namenda QL

memantine oral tablets,dose pack Namenda Titration Pak QL

NAMENDA TITRATION PAK ORAL TABLETS,DOSE PACK

QL

rivastigmine tartrate oral capsule

CONTRACEPTIVES

CONTRACEPTIVES

altavera (28) oral tablet AL; QL

alyacen 1/35 (28) oral tablet AL

alyacen 7/7/7 (28) oral tablet AL

amethia lo oral tablets,dose pack,3 month AL; QL

38


amethia oral tablets,dose pack,3 month AL; QL

amethyst (28) oral tablet AL

apri oral tablet AL

aranelle (28) oral tablet AL

ashlyna oral tablets,dose pack,3 month AL; QL

aubra eq oral tablet AL

aubra oral tablet AL

AUROVELA 1.5/30 (21) ORAL TABLET AL

AUROVELA 1/20 (21) ORAL TABLET

AUROVELA 24 FE ORAL TABLET AL

AUROVELA FE 1-20 (28) ORAL TABLET

AL

aviane oral tablet AL

azurette (28) oral tablet AL

balziva (28) oral tablet AL

bekyree (28) oral tablet AL

blisovi 24 fe oral tablet AL

blisovi fe 1.5/30 (28) oral tablet AL

blisovi fe 1/20 (28) oral tablet AL

briellyn oral tablet AL

camila oral tablet AL

camrese lo oral tablets,dose pack,3 month AL; QL

camrese oral tablets,dose pack,3 month AL; QL

caziant (28) oral tablet AL

chateal (28) oral tablet AL; QL

chateal eq (28) oral tablet AL; QL

cryselle (28) oral tablet AL

cyclafem 1/35 (28) oral tablet AL

cyclafem 7/7/7 (28) oral tablet AL

cyred eq oral tablet AL

cyred oral tablet AL

dasetta 1/35 (28) oral tablet AL

dasetta 7/7/7 (28) oral tablet AL

daysee oral tablets,dose pack,3 month AL; QL

deblitane oral tablet AL

delyla (28) oral tablet AL

desog-e.estradiol/e.estradiol oral tablet Azurette (28) AL

39


desogestrel-ethinyl estradiol oral tablet Apri AL

drospirenone-e.estradiol-lm.fa oral tablet Beyaz AL

drospirenone-ethinyl estradiol oral tablet Ocella AL

elinest oral tablet AL

emoquette oral tablet AL

enpresse oral tablet AL

enskyce oral tablet AL

errin oral tablet AL

estarylla oral tablet AL

ethynodiol diac-eth estradiol oral tablet Kelnor 1-50 AL

falmina (28) oral tablet AL

fayosim oral tablets,dose pack,3 month AL; QL

femynor oral tablet AL

gianvi (28) oral tablet AL

heather oral tablet AL

incassia oral tablet AL

introvale oral tablets,dose pack,3 month AL; QL

isibloom oral tablet AL

jencycla oral tablet AL

jolessa oral tablets,dose pack,3 month AL; QL

juleber oral tablet AL

junel 1.5/30 (21) oral tablet AL

junel 1/20 (21) oral tablet AL

junel fe 1.5/30 (28) oral tablet AL

junel fe 1/20 (28) oral tablet AL

junel fe 24 oral tablet AL

kaitlib fe oral tablet,chewable AL

kariva (28) oral tablet AL

kelnor 1/35 (28) oral tablet AL

kelnor 1-50 oral tablet

kurvelo (28) oral tablet AL; QL

l norgest/e.estradiol-e.estrad oral tablets,dose pack,3 month

Amethia AL; QL

larin 1.5/30 (21) oral tablet AL

larin 1/20 (21) oral tablet AL

larin 24 fe oral tablet AL

larin fe 1.5/30 (28) oral tablet AL

40


larin fe 1/20 (28) oral tablet AL

larissia oral tablet AL

layolis fe oral tablet,chewable AL

leena 28 oral tablet AL

lessina oral tablet AL

levonest (28) oral tablet AL

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg

Afirmelle AL

levonorgestrel-ethinyl estrad oral tablet 0.15-0.03 mg

Altavera (28) AL; QL

levonorgestrel-ethinyl estrad oral tablet 90-20 mcg (28)

Amethyst (28) AL

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

Introvale AL; QL

levonorg-eth estrad triphasic oral tablet Enpresse AL

levora-28 oral tablet AL; QL

lillow (28) oral tablet AL; QL

loryna (28) oral tablet AL

low-ogestrel (28) oral tablet AL

lutera (28) oral tablet AL

lyza oral tablet AL

marlissa (28) oral tablet AL; QL

medroxyprogesterone intramuscular suspension

Depo-Provera AL; QL

medroxyprogesterone intramuscular syringe

Depo-Provera AL; QL

melodetta 24 fe oral tablet,chewable AL

mibelas 24 fe oral tablet,chewable AL

microgestin 1.5/30 (21) oral tablet AL

microgestin 1/20 (21) oral tablet AL

microgestin fe 1.5/30 (28) oral tablet AL

microgestin fe 1/20 (28) oral tablet AL

mili oral tablet AL

mono-linyah oral tablet AL

necon 0.5/35 (28) oral tablet AL

nikki (28) oral tablet AL

nora-be oral tablet AL

noreth-ethinyl estradiol-iron oral tablet,chewable

Wymzya Fe AL

41


norethindrone (contraceptive) oral tablet Camila AL

norethindrone ac-eth estradiol oral tablet Aurovela 1/20 (21) AL

norethindrone-e.estradiol-iron oral tablet Aurovela Fe 1-20 (28) AL

norethindrone-e.estradiol-iron oral tablet,chewable

Melodetta 24 Fe AL

norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-25 mcg

Tri-Lo-Estarylla AL; QL

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

Ortho Tri-Cyclen (28) AL

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

Estarylla AL

norlyda oral tablet AL

norlyroc oral tablet AL

nortrel 0.5/35 (28) oral tablet AL

nortrel 1/35 (21) oral tablet AL

nortrel 1/35 (28) oral tablet AL

nortrel 7/7/7 (28) oral tablet AL

NUVARING VAGINAL RING AL; QL

ocella oral tablet AL

ogestrel (28) oral tablet AL

orsythia oral tablet AL

philith oral tablet AL

pimtrea (28) oral tablet AL

pirmella oral tablet AL

portia 28 oral tablet AL; QL

previfem oral tablet AL

rajani oral tablet AL

reclipsen (28) oral tablet AL

RIVELSA ORAL TABLETS,DOSE PACK,3 MONTH

AL; QL

setlakin oral tablets,dose pack,3 month AL; QL

sharobel oral tablet AL

sprintec (28) oral tablet AL

sronyx oral tablet AL

syeda oral tablet AL

tarina 24 fe oral tablet AL

tarina fe 1/20 (28) oral tablet AL

tarina fe 1-20 eq (28) oral tablet

42


tilia fe oral tablet AL; QL

TODAY CONTRACEPTIVE SPONGE VAGINAL CONTRACEPTIVE SPONGE

OTC

tri femynor oral tablet AL

tri-estarylla oral tablet AL

tri-legest fe oral tablet AL; QL

tri-linyah oral tablet AL

tri-lo-estarylla oral tablet AL; QL

tri-lo-marzia oral tablet AL; QL

tri-lo-sprintec oral tablet AL; QL

tri-mili oral tablet AL

tri-previfem (28) oral tablet AL

tri-sprintec (28) oral tablet AL

trivora (28) oral tablet AL

tri-vylibra lo oral tablet AL; QL

tri-vylibra oral tablet AL

tulana oral tablet AL

tydemy oral tablet AL

vaginal contraceptive film vaginal film OTC

vaginal contraceptive foam vaginal foam OTC

vcf contraceptive film vaginal film OTC

velivet triphasic regimen (28) oral tablet AL

vienva oral tablet AL

viorele (28) oral tablet AL

vyfemla (28) oral tablet AL

vylibra oral tablet AL

wera (28) oral tablet AL

wymzya fe oral tablet,chewable AL

xulane transdermal patch weekly AL; QL

zarah oral tablet AL

zenchent (28) oral tablet AL

zovia 1/35e (28) oral tablet AL

EMERGENCY CONTRACEPTIVES

econtra ez oral tablet OTC; QL

econtra one-step oral tablet OTC; QL

ELLA ORAL TABLET QL

levonorgestrel oral tablet Aftera OTC; QL

43


my choice oral tablet OTC; QL

my way oral tablet OTC; QL

new day 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

DENTAL AIDS AND PREPARATIONS

ANTISEPTICS, GENERAL

chloraseptic mucous membrane aerosol,spray

OTC

chlorhexidine gluconate mucous membrane mouthwash

Paroex Oral Rinse QL

paroex oral rinse mucous membrane mouthwash

QL

periogard mucous membrane mouthwash QL

sore throat (hexylresorcinol) mucous membrane lozenge

OTC

FLUORIDE PREPARATIONS

fluoride (sodium) oral drops OTC; QL

fluoride (sodium) oral tablet,chewable Fluoritab OTC

fluoritab oral tablet,chewable OTC

ludent fluoride oral tablet,chewable OTC

perio med dental solution OTC

MOUTH AND THROAT AGENTS

cherry cough drops mucous membrane lozenge

OTC

cherry menthol mucous membrane lozenge

OTC

chloraseptic sore throat mucous membrane lozenge

OTC

chloraseptic throat spray mucous membrane aerosol,spray

OTC

clotrimazole mucous membrane troche QL

cough drops (with eucalyptus) mucous membrane lozenge

OTC

honey lemon mucous membrane lozenge OTC

lidocaine hcl mucous membrane jelly

lidocaine hcl mucous membrane solution QL

44


lidocaine viscous mucous membrane solution

QL

medikoff drops mucous membrane lozenge

OTC

menthol drops mucous membrane lozenge

OTC

nystatin oral suspension

oralone dental paste

pilocarpine hcl oral tablet Salagen (pilocarpine) QL

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

throat lozenges mucous membrane lozenge

OTC

triamcinolone acetonide dental paste Oralone

zinc with vitamins a and c oral lozenge OTC

DERMATOLOGICAL

ACNE AGENTS, SYSTEMIC

amnesteem oral capsule PA

claravis oral capsule PA

isotretinoin oral capsule Absorica PA

myorisan oral capsule PA

zenatane oral capsule PA

ACNE AGENTS, TOPICAL

acne cleanser topical cleanser OTC

acne cleansing bar topical bar 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 gel OTC; QL

acne vanishing topical cream OTC

acne-clear topical gel OTC; QL

advanced acne wash topical cleanser,extended release

OTC

45


benzepro topical foam OTC

benzoyl peroxide topical cleanser 10 % Acne Control Cleanser OTC

benzoyl peroxide topical cleanser 5 %Advanced Exfoliating Cleanser

OTC; QL

benzoyl peroxide topical cleanser 6 % OTC; QL

benzoyl peroxide topical foam BenzePrO OTC

benzoyl peroxide topical gel 10 % Acne Medication OTC; QL

benzoyl peroxide topical gel 2.5 % OTC

benzoyl peroxide topical gel 5 % Acne Medication OTC

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

clindamycin phosphate topical gel Cleocin T

clindamycin phosphate topical solution Cleocin T QL

clindamycin phosphate topical swab Cleocin T QL

clindamycin-benzoyl peroxide topical gel Duac QL

creamy acne face topical cleanser OTC

daily face wash topical cleanser OTC

ery pads topical swab QL

erythromycin with ethanol topical solution QL

erythromycin with ethanol topical swab Ery Pads QL

foaming acne face wash topical cleanser OTC

metronidazole topical cream MetroCream QL

metronidazole topical lotion MetroLotion

panoxyl topical cleanser OTC

persa-gel topical gel OTC; QL

rapid clear treatment pads topical pads, medicated

OTC

RIAX TOPICAL FOAM OTC

rosadan topical cream QL

46


ANTIPSORIATIC AGENTS

calcipotriene scalp solution QL

calcipotriene topical cream Dovonex QL

calcipotriene topical ointment Calcitrene

calcitrene topical ointment

ROSACEA AGENTS, TOPICAL

metronidazole topical gel 0.75 % Rosadan

metronidazole topical gel 1 % Metrogel QL

metronidazole topical gel with pump Metrogel QL

rosadan topical gel

SCABICIDE AND PEDICULICIDES

complete lice treatment topical kit OTC; QL

lice bedding spray aerosol,spray OTC

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

lice killing (permethrin) topical liquid OTC; QL

lice killing topical shampoo OTC

lice pyrinyl shampoo topical shampoo OTC

lice solution topical kit OTC; QL

lice treatment (permethrin) topical liquid OTC; QL

lice treatment topical liquid OTC; QL

lice treatment topical shampoo OTC

permethrin topical cream Elimite QL

rid complete lice elim kit topical kit OTC; QL

spinosad topical suspension Natroba

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

47


aqua glycolic topical shampoo OTC

aqua lube topical lubricant OTC

arthricream rub topical cream 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-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

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

daylogic advanced healing topical ointment

OTC

dermabase topical cream OTC

dermacerin topical cream OTC; QL

dermaphor topical ointment OTC

48


dermarest psoriasis medicated topical lotion

OTC

dermarest psoriasis medicated topical shampoo

OTC

dermavantage topical lotion OTC; QL

DESENEX FOOT-SNEAKER DEODORANT TOPICAL AEROSOL POWDER

OTC

diaper rash relief topical ointment OTC

diaper rash topical ointment OTC; QL

diclofenac sodium topical drops PA; QL

dr scholl's clear away topical adhesive patch,medicated

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

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

hydrocerin (with petrolatum) topical cream OTC; QL

hydrocerin topical lotion OTC

hydrolatum topical ointment OTC

HYPERCARE TOPICAL LIQUID OTC

ice blue gel topical gel OTC

INSECT REPELLENT (PICARIDIN) TOPICAL SPRAY WITH PUMP

OTC

lan-o-soothe topical cream OTC

lidocaine hcl mucous membrane jelly

lidocaine topical adhesive patch,medicated

Lidoderm PA; QL

lidocaine topical ointment QL

49


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

mediplast corn-callus-wart topical adhesive patch,medicated

OTC

mineral oil light topical oil OTC

mineral oil topical oil Lobana Bath OTC

minerin creme topical cream OTC; QL

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

nivatopic plus topical cream

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

50


plantar wart remover topical adhesive patch,medicated

OTC

podofilox topical solution PA

protective ointment topical ointment OTC

prumyx topical cream

psoriasis medicated topical shampoo OTC

REPEL SPORTSMEN DRY TOPICAL AEROSOL,SPRAY

OTC

REPEL SPORTSMEN MAX TOPICAL AEROSOL,SPRAY

OTC

REPEL SPORTSMEN TOPICAL AEROSOL,SPRAY

OTC

salactic film topical liquid OTC

salicylic acid topical cream,extended release

salicylic acid topical lotion,extended release

sal-plant topical gel OTC

scar gel topical gel OTC

sebex topical shampoo OTC

secura protective topical ointment OTC

selenium sulfide topical lotion QL

selsun blue (salicylic acid) topical shampoo

OTC

selsun blue naturals topical shampoo OTC

selsun blue topical shampoo OTC

silver sulfadiazine topical cream Silvadene

skin treatment topical lotion OTC

sorbidon hydrate topical cream OTC

special care lotion topical lotion OTC

ssd topical cream

sween cream topical cream OTC

sween topical cream OTC

thera bath topical oil OTC

thera-derm topical lotion OTC; QL

therapeutic blue topical gel OTC

therapeutic dandruff shampoo topical shampoo

OTC

therapeutic moisturizing topical cream OTC; QL

51


therapeutic t plus topical shampoo OTC

ultra mide 25 topical lotion OTC

unscented cold cream topical cream OTC

urea topical cream 10 % Aqua Care OTC

urea topical cream 20 % Gormel OTC

urea topical cream 40 % QL

urea topical cream 45 % Uramaxin QL

urea topical cream 50 % Ure-K

urea topical gel CEM-Urea

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 Gordons-Vite E OTC

vitamin e topical oil OTC

vits a and d-white pet-lanolin topical ointment

A and D (lan, pet) OTC; QL

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 topical ointment OTC; QL

zinc oxide topical ointment 20 % OTC

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

TOPICAL ANESTHETICS

hydrocortisone-pramoxine topical cream Pramosone

lidocaine-prilocaine topical cream QL

52


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

gentamicin topical cream

gentamicin topical ointment

mupirocin topical ointment Centany QL

NEOSPORIN PLUS PAINRELIEF(BAC) TOPICAL OINTMENT

OTC; QL

POLY BACITRACIN (ZINC) TOPICAL OINTMENT

OTC

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 (miconazole) topical cream

OTC

antifungal spray topical aerosol powder OTC

antifungal topical liquid OTC

53


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

ciclopirox topical cream Ciclodan PA; QL

ciclopirox topical solution Ciclodan PA; QL

ciclopirox topical suspension Loprox (as olamine) QL

clotrimazole af topical cream OTC; QL

clotrimazole topical cream Antifungal (clotrimazole) OTC; QL

clotrimazole topical solution OTC

clotrimazole-betamethasone topical cream Lotrisone QL

clotrimazole-betamethasone topical lotion QL

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

ketoconazole topical cream QL

54


ketoconazole topical shampoo Nizoral QL

lamisil (aerosol) topical aerosol,spray OTC

lamisil af topical aerosol powder OTC

lamisil at topical cream 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

micatin topical cream OTC

miconazole nitrate topical aerosol powder Athlete's Foot OTC

miconazole nitrate topical creamAntifungal Cream (miconazole)

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

nyamyc topical powder QL

nystatin topical cream QL

nystatin topical ointment QL

nystatin topical powder Nyamyc QL

nystop topical powder QL

odor control foot-sneaker topical aerosol powder

OTC

remedy antifungal topical cream OTC

remedy antifungal topical powder OTC

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

55


tinactin topical cream OTC

tolnaftate topical aerosol powder AF OTC

tolnaftate topical cream Antifungal (tolnaftate) OTC

tolnaftate topical powder Antifungal (tolnaftate) OTC

zeasorb af topical powder OTC

TOPICAL ANTI-INFLAMMATORY STEROIDAL AGENTS

amcinonide topical lotion

amcinonide topical ointment QL

anti-itch (hc) topical cream OTC; QL

anti-itch (hc) topical ointment OTC

anti-itch plus topical cream OTC; QL

betamethasone dipropionate topical lotion QL

betamethasone valerate topical cream QL

betamethasone valerate topical ointment QL

betamethasone, augmented topical cream

clobetasol scalp solution Cormax QL

clobetasol topical cream Temovate QL

clobetasol topical gel

clobetasol topical ointment Temovate QL

clobetasol-emollient topical cream QL

cormax scalp solution QL

cortisone (hydrocortisone) topical cream OTC; QL

cortisone with aloe topical cream OTC; QL

diflorasone topical cream Psorcon QL

eczema anti-itch topical cream OTC; QL

fluocinonide-e topical cream

fluocinonide-emollient topical cream Fluocinonide-E

fluticasone propionate topical cream Cutivate QL

fluticasone propionate topical ointment QL

halobetasol propionate topical cream Ultravate QL

halobetasol propionate topical ointment Ultravate QL

hydrocortisone acetate topical cream Vanicream HC OTC; QL

hydrocortisone acetate topical ointment OTC

hydrocortisone plus topical cream OTC; QL

hydrocortisone topical cream 0.5 % OTC; QL

hydrocortisone topical cream 1 % Ala-Cort OTC; QL

56


hydrocortisone topical cream 2.5 % QL

hydrocortisone topical cream in packet OTC

hydrocortisone topical cream with perineal applicator

Anusol-HC QL

hydrocortisone topical ointment 0.5 % OTC

hydrocortisone topical ointment 1 % Anti-Itch (HC) OTC

hydrocortisone topical ointment 2.5 % QL

hydrocortisone-aloe vera topical creamAnti-Itch(hydrocortisone)-Aloe

OTC; QL

hydrocortisone-pramoxine topical cream Pramosone

hydrocream topical cream OTC; QL

mometasone topical cream Elocon QL

mometasone topical ointment QL

mometasone topical solution QL

noble formula hc topical cream OTC; QL

prednicarbate topical ointment Dermatop QL

proctosol hc topical cream with perineal applicator

QL

proctozone-hc topical cream with perineal applicator

QL

scalp relief topical solution OTC

scalpicin anti-itch topical solution OTC

TEXACORT TOPICAL SOLUTION

triamcinolone acetonide topical cream Triderm QL

triamcinolone acetonide topical ointment QL

trianex topical ointment QL

triderm topical cream QL

TOPICAL ANTINEOPLASTIC AND PREMALIGNANT

fluorouracil topical cream Efudex QL

fluorouracil topical solution QL

TOPICAL ANTIPARASITICS

CUTTER BACKWOODS TOPICAL AEROSOL,SPRAY

OTC

CUTTER SKINSATIONS TOPICAL SPRAY,NON-AEROSOL

OTC

INSECT REPELLENT (PICARIDIN) TOPICAL SPRAY WITH PUMP

OTC

57


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

acyclovir topical ointment Zovirax PA; QL

TOPICAL IMMUNOMODULATORS

imiquimod topical cream in packet Aldara PA; QL

tacrolimus topical ointment Protopic PA; AL; QL

VITAMIN A DERIVATIVES

DIFFERIN TOPICAL GEL OTC; QL

tretinoin (emollient) topical cream Refissa PA; AL

tretinoin microspheres topical gel Retin-A Micro PA; AL; QL

tretinoin topical cream Retin-A PA

tretinoin topical gel Retin-A PA; QL

DIAGNOSTIC AGENTS

DIAGNOSTIC - MULTIPLE URINE TESTS

AZO TEST STRIPS STRIP OTC

CHEMSTRIP 10 MD STRIP OTC

MULTISTIX 9 SG STRIP OTC

MULTISTIX 9 STRIP OTC

URINARY TRACT INF.TEST (WBCS) STRIP

OTC

58


DIAGNOSTIC DRUGS - GASTROINTESTINAL RADIOLOGICAL ADJUNCT

GLUCAGEN DIAGNOSTIC KIT INJECTION RECON SOLN

QL

DIAGNOSTIC DRUGS - PITUITARY FUNCTION

cosyntropin injection recon soln Cortrosyn QL

DRUGS TO TREAT MULTIPLE SCLEROSIS

DRUGS TO TREAT MULTIPLE SCLEROSIS

AVONEX (WITH ALBUMIN) INTRAMUSCULAR KIT

PA; QL

AVONEX INTRAMUSCULAR PEN INJECTOR KIT

PA; QL

AVONEX INTRAMUSCULAR SYRINGE KIT

PA; QL

BETASERON SUBCUTANEOUS KIT PA; QL

EXTAVIA SUBCUTANEOUS KIT PA; QL

EXTAVIA SUBCUTANEOUS RECON SOLN

PA

GILENYA ORAL CAPSULE PA; QL

glatiramer subcutaneous syringe Copaxone PA; QL

glatopa subcutaneous syringe PA; QL

REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE

PA

REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR

PA

REBIF TITRATION PACK SUBCUTANEOUS SYRINGE

PA

TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC)

PA; QL

EATING DISORDER THERAPY

ANTI-OBESITY AGENTS

ALLI ORAL CAPSULE PA; OTC; QL

APPETITE STIMULANT AGENTS

megestrol oral suspension PA

59


ELECTROLYTE BALANCE-NUTRITIONAL PRODUCTS

AMINO ACIDS

levocarnitine oral tablet Carnitor OTC

BIOFLAVONOID COMBINATIONS

ear care oral tablet OTC

ear health formula oral tablet OTC

CALCIUM REPLACEMENT

bone meal-vitamin d2 oral tablet OTC

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

Calcium 600-D3 Plus OTC

ca-d3-mag ox-zinc-cop-mang-bor oral tablet,chewable 600 mg calcium- 400 unit-40 mg

OTC; QL

CA-D3-MAG OX-ZINC-COP-MANG-BOR ORAL TABLET,CHEWABLE 600 MG CALCIUM- 800 UNIT-40 MG

OTC

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

calci-chew oral tablet,chewable OTC; QL

calcitrate oral tablet OTC

calcium 500 + d (d3) oral tablet OTC

calcium 500 + d oral tablet OTC

calcium 500 + d oral tablet,chewable OTC

calcium 500 oral tablet,chewable OTC; QL

calcium 500 with d oral tablet OTC

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 600 mg calcium- 200 unit

OTC

calcium 600 + minerals oral tablet 600 mg calcium- 400 unit

OTC; QL

calcium 600 oral tablet OTC

calcium 600 with vitamin d3 oral capsule OTC

calcium 600 with vitamin d3 oral tablet OTC

calcium 600 with vitamin d3 oral tablet,chewable

OTC; QL

60


CALCIUM 600-D3 PLUS ORAL TABLET OTC

calcium acetate oral tablet Calphron

calcium carb and citrate-vitd3 oral tablet extended release

Citracal + D Slow Release OTC

calcium carbonate oral suspension OTC

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,chewable 300 mg (750 mg)

Antacid Ext Str (calcium carb)

OTC

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

Calci-Chew OTC; QL

calcium carbonate-vit d3-min oral tablet Calcium 600 + Minerals OTC; QL

calcium carbonate-vitamin d3 oral capsule 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, 500 mg(1,250mg) -400 unit

Calcium 500 + D OTC

calcium carbonate-vitamin d3 oral tablet 500mg (1,250mg) -600 unit

Os-Cal 500 + D3 OTC


Calcium 600 + D(3) OTC; QL


Caltrate with Vitamin D3 OTC

calcium carbonate-vitamin d3 oral tablet,chewable 500 mg(1,250mg) -400 unit

Calcium 500 + D OTC

calcium carbonate-vitamin d3 oral tablet,chewable 500-100 mg-unit

OTC; QL

calcium citrate + d oral tablet OTC

calcium citrate oral tablet Calcitrate OTC

calcium citrate-vitamin d2 oral tablet OTC

calcium citrate-vitamin d3 oral tablet Calcium Citrate + D OTC

calcium for women oral tablet,chewable OTC

calcium gluconate oral tablet 45 mg (500 mg)

OTC; QL

61


calcium gluconate oral tablet 60 mg calcium (650 mg)

OTC

calcium lactate oral tablet OTC

calcium magnesium oral tablet OTC

calcium soft chew oral tablet,chewable OTC

calcium with vitamin d oral tablet OTC; QL

calcium-folic acid-vitamin d oral wafer OTC

calcium-magnesium-zinc oral tablet OTC

calcium-vitamin d3-vitamin k oral tablet,chewable

Calcium Soft Chew OTC

citrus calcium oral tablet OTC

hi-cal plus vit d oral tablet OTC

oysco 500/d oral tablet OTC

oysco-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

oystercal-d oral tablet OTC

risacal-d oral tablet OTC

super calcium oral tablet OTC

DIETARY PRODUCTS

hair, skin and nails advanced oral tablet OTC

ELECTROLYTE REPLACEMENT

CERALYTE-70 ORAL SOLUTION OTC; QL

electrolytes-dextrose oral solution Enfamil Enfalyte OTC; QL

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

62


FOLIC ACID PREPARATIONS

elfolate oral tablet OTC

fabb oral tablet OTC

folbee oral tablet OTC

folbic oral tablet OTC; QL

folic acid injection solution

folic acid oral tablet OTC

folic acid-vit b6-vit b12 oral tablet Folplex 2.2 OTC

folplex 2.2 oral tablet OTC

levomefolate calcium oral tablet Elfolate OTC

l-methylfolate oral tablet OTC

virt-gard oral tablet OTC

virt-vite oral tablet OTC

IRON REPLACEMENT

centratex oral capsule OTC

chewable iron oral tablet,chewable OTC

children's iron oral drops OTC

corvita 150 oral tablet OTC

duofer oral tablet OTC

ezfe 200 oral capsule OTC

fe c oral tablet OTC

fe c plus oral tablet OTC; QL

ferate oral tablet OTC; QL

ferocon oral capsule OTC; QL

ferosul oral elixir OTC

ferosul oral tablet OTC; QL

ferraplus 90 oral tablet OTC

ferretts oral tablet OTC

ferrex 150 forte plus oral capsule OTC

ferrex 150 oral capsule OTC

ferrex 150 plus oral capsule OTC

ferric x-150 oral capsule OTC

ferrocite oral tablet OTC

ferrocite plus oral tablet OTC

ferro-time oral tablet OTC; QL

ferrous fumarate oral tablet Ferrocite OTC

ferrous gluconate oral tablet Ferate OTC; QL

63


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,delayed release (dr/ec) 324 mg (65 mg iron)

OTC; QL

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

folivane-f oral capsule OTC

folivane-plus oral capsule OTC

hematinic plus vit/minerals oral tablet OTC

hematinic/folic acid oral tablet OTC

hematogen fa oral capsule OTC

hematogen forte oral capsule OTC

hematogen oral capsule OTC

hemetab oral tablet OTC; QL

high potency iron oral tablet OTC

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; QL

iron chews oral tablet,chewable OTC

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

multigen folic oral tablet OTC

multigen oral tablet OTC

multigen plus oral tablet OTC

myferon 150 forte oral capsule OTC

myferon 150 oral capsule OTC

pedia iron oral drops OTC

poly-iron oral capsule OTC

slow release iron oral tablet extended release

OTC

64


sodium ferric gluconat-sucrose intravenous solution

Ferrlecit

stress formula oral tablet OTC; QL

taron forte oral capsule OTC

tricon oral capsule OTC; QL

trigels-f forte oral capsule OTC

wee care oral suspension OTC; QL

IRRIGATION SOLUTIONS

sodium chloride irrigation solution Aqua Care Sodium Chloride

sterile saline irrigation solution OTC

MINERALS AND ELECTROLYTES AGENTS

calcium-magnesium-copper-zinc oral tablet

OTC

k-phos-neutral oral tablet OTC

laxative dietary supplement oral tablet OTC

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

mag-g oral tablet OTC

magnesium gluconate oral tablet Mag-G OTC

magnesium oral tablet OTC

magnesium oxide oral capsule OTC

magnesium oxide oral tablet 200 mg magnesium, 250 mg magnesium, 420 mg

OTC

magnesium oxide oral tablet 400 mg (241.3 mg magnesium)

MagOx OTC; QL

magnesium oxide oral tablet 400 mg magnesium

OTC; QL

magnesium oxide oral tablet 500 mgLaxative Dietary Supplement

OTC

mgo oral tablet OTC; QL

phospha 250 neutral oral tablet OTC

phosphorous oral tablet OTC

phospho-trin 250 neutral oral tablet OTC

virt-phos 250 neutral oral tablet OTC

MULTIVITAMINS

a thru z advanced formula oral tablet OTC; QL

a thru z high potency oral tablet OTC; QL

a thru z oral tablet OTC; QL

65


a thru z select 50plus 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

adults 50 plus oral tablet OTC

antioxidant a/c/e/selenium oral capsule OTC

apatate forte oral liquid OTC; QL

biosupp oral liquid OTC; QL

biotect plus oral liquid OTC

biovol oral syrup OTC; QL

calcium citrate plus (vit b6) oral tablet OTC

centamin oral liquid OTC

centravites 50 plus oral tablet OTC; QL

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

OTC

centravites oral tablet OTC; QL

centrum women oral tablet OTC; QL

century adults 50 plus oral tablet OTC

century cardio oral tablet OTC; QL

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 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 senior oral tablet OTC; QL

certa plus oral tablet OTC; QL

certavite senior-antioxidant oral tablet 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

66


complete multivitamin oral tablet OTC; QL

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

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

complete women oral tablet OTC; QL

corvita oral tablet OTC

daily multiple for men oral tablet OTC; QL

daily multiple oral tablet OTC; QL

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 oral tablet OTC; QL

daily vites/iron oral tablet OTC; QL

daily-vite oral tablet OTC; QL

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

eldertonic oral elixir OTC; QL

essentia oral tablet OTC; QL

essential daily oral tablet OTC; QL

eye health plus lutein oral tablet OTC; QL

fosfree oral tablet OTC; QL

hair vitamins oral tablet OTC; QL

hair,skin and nails 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

67


i-vite protect oral tablet OTC; QL

m.v.i. adult intravenous solution

macuvite eye care oral tablet OTC; QL

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 one daily oral tablet OTC; QL

milltrium senior oral tablet OTC; QL

multi complete with iron oral tablet OTC; QL

multi for her oral tablet OTC

multi-day with iron oral tablet OTC; QL

multi-delyn with iron oral liquid OTC

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 Multiple Vitamins/Iron OTC; QL

multivitamin with minerals oral liquid OTC

multivitamin with minerals oral tablet Daily Multivitamin-Minerals OTC; QL

multivitamin women 50 plus oral tablet OTC

my-vitalife oral capsule OTC; QL

ocutabs 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 OTC; QL

one daily for men 50+ advanced oral tablet

OTC; QL

one daily for women oral tablet OTC; QL

one daily maximum oral tablet OTC; QL

68


one daily men's 50 plus memory oral tablet

OTC; QL

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

one daily multivitamin oral tablet OTC; QL

one daily multivit-iron(folic) oral tablet OTC; QL

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 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 ESSENTIAL ORAL TABLET

OTC; QL

ONE-A-DAY MAXIMUM FORMULA ORAL TABLET

OTC; QL

ONE-A-DAY TEEN ADVANTAGE ORAL TABLET

OTC; QL

opti-vitamins oral tablet OTC; QL

purevit dualfe plus oral capsule OTC

quintabs-m iron free oral tablet OTC; QL

senior tabs oral tablet OTC

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

se-tan plus oral capsule OTC

spectravite adult 50 plus oral tablet OTC

spectravite advanced formula oral tablet OTC; QL

spectravite men's oral tablet OTC; QL

spectravite senior oral tablet OTC; QL

spectravite ultra women oral tablet OTC; QL

spectravite ultra women's sr oral tablet OTC

sunvite oral tablet OTC

super antioxidant oral capsule OTC

super multiple oral tablet OTC; QL

super multivitamin oral tablet OTC; QL

super thera vite m oral tablet OTC; QL

69


support oral liquid OTC; QL

tab-a-vite oral tablet OTC; QL

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

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

thera oral tablet OTC; QL

theralogix companion oral tablet OTC; QL

thera-m oral tablet OTC; QL

therapeutic liquid oral liquid OTC

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

theratrum complete 50 plus/lut oral tablet OTC; QL

theratrum complete 50 plus-lyc oral tablet OTC

theratrum complete with lutein oral tablet OTC; QL

therems oral tablet OTC; QL

therems-m oral tablet OTC; QL

thrivite-19 oral tablet AL; OTC; QL

tyr cooler oral liquid OTC

ultimate women's complete 50+ oral tablet OTC

ultra antioxidant formula oral tablet OTC

unicomplex-m oral tablet OTC; QL

UROSEX ORAL TABLET OTC

v-c forte oral capsule OTC

vic-forte oral capsule OTC

vit 3 oral capsule OTC

vitacel (with lutein) oral tablet OTC

vitalee oral tablet OTC; QL

vitamins a and d oral capsule 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

women's daily formula oral tablet OTC; QL

yelets oral tablet OTC; QL

70


PEDIATRIC VITAMIN PREPARATIONS

animal chews oral tablet,chewable OTC

animal shape vitamins oral tablet,chewable

OTC

animal shapes complete oral tablet,chewable

OTC

cerovite jr oral tablet,chewable OTC; QL

chewable-vite oral tablet,chewable OTC

chewable-vite with iron oral tablet,chewable

OTC

children's chewable multivitmn oral tablet,chewable

OTC

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

childs chew vite oral tablet,chewable OTC

child's chewable vitamins/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 MULTI-VIT GUMMIES ORAL TABLET,CHEWABLE

OTC

gummi bear multivitamin oral tablet,chewable

OTC

gummy dinos oral tablet,chewable OTC

honey bears oral tablet,chewable OTC

little animals oral tablet,chewable OTC

little animals-iron oral tablet,chewable OTC

lysiplex plus oral liquid OTC; QL

multi-vit with fluoride-iron oral drops OTC

multi-vitamin with fluoride oral drops OTC

multivitamin with fluoride oral tablet,chewable

OTC

71


multi-vitamin with fluoride oral tablet,chewable

OTC

multivitamins with fluoride oral tablet,chewable

OTC

mvc-fluoride oral tablet,chewable OTC

PEDIA POLY-VITE ORAL DROPS OTC

polyvitamin with iron oral tablet,chewable OTC; QL

poly-vitamins oral tablet,chewable OTC

triple vitamin with fluoride oral drops OTC

tri-vitamin with fluoride oral drops OTC

tri-vite with fluoride oral drops AL; OTC

vitalets oral tablet,chewable OTC

vitamins a,c,d and fluoride oral drops OTC

zoo chews oral tablet,chewable OTC

POTASSIUM REMOVING RESINS

sodium polystyrene sulfonate oral suspension

sodium polystyrene sulfonate rectal enema

sps (with sorbitol) oral suspension

sps (with sorbitol) rectal enema

POTASSIUM REPLACEMENT

klor-con 10 oral tablet extended release

klor-con 8 oral tablet extended release

klor-con m10 oral tablet,er particles/crystals



klor-con oral packet

k-tab oral tablet extended release

potassium chloride oral capsule, extended release

potassium chloride oral liquid

potassium chloride oral packet Klor-Con

potassium chloride oral tablet extended release

K-Tab

72


potassium chloride oral tablet,er particles/crystals

Klor-Con M20

potassium gluconate oral tablet OTC; QL

PRENATAL VITAMIN PREPARATIONS

classic prenatal oral tablet AL; OTC; QL

daily prenatal oral combo pack AL; OTC; QL

kpn 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 19 (with docusate) oral tablet AL; OTC; QL

prenatal 19 oral tablet,chewable AL; OTC; QL

prenatal complete oral tablet AL; OTC; QL

prenatal formula oral tablet AL; OTC; QL

prenatal multi-dha (algal oil) oral capsule 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 vit-iron fum-folic ac oral tablet Prenatal Tablet AL; OTC; QL

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

thrivite-19 oral tablet AL; OTC; QL

VITAMIN A PREPARATIONS

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

OTC

vitamin a oral capsule 25,000 unit OTC; QL

VITAMIN B PREPARATIONS

activite oral tablet OTC

apetigen plus oral liquid OTC

b complex 1 oral tablet OTC

b complex 100 oral tablet OTC

b complex-vitamin b12 oral tablet OTC

b complex-vitamin c-folic acid oral tablet OTC

73


b-100 complex oral tablet extended release

OTC

b-12 dots oral tablet OTC

balance b-100 oral tablet OTC

balance b-50 oral tablet OTC

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

b-complex with vitamin c oral tablet extended release

OTC; QL

complex b-100 oral tablet extended release

OTC

cyanocobalamin (vitamin b-12) injection solution

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

OTC

cyanocobalamin (vitamin b-12) sublingual lozenge

OTC

cyanocobalamin (vitamin b-12) sublingual tablet

Vitamin B-12 OTC

DIALYVITE 800 ORAL TABLET OTC

DIALYVITE ORAL TABLET OTC

fabb oral tablet OTC

folbee oral tablet OTC

folbee plus oral tablet OTC

folbic oral tablet OTC; QL

folic acid-vit b6-vit b12 oral tablet Folplex 2.2 OTC

folplex 2.2 oral tablet OTC

74


foltabs 800 oral tablet OTC

full spectrum b-vitamin c oral tablet OTC

hydroxocobalamin intramuscular solution

kobee oral tablet OTC

mynephrocaps oral capsule OTC

mynephron oral capsule OTC

natural b-100 complex oral tablet OTC

nephplex rx oral tablet OTC

nephronex oral liquid OTC

nephronex-sl oral tablet,disintegrating OTC

NEPHRO-VITE RX ORAL TABLET OTC

niacin (inositol niacinate) oral capsule Niacin Flush Free OTC

niacin (niacinamide) oral tablet OTC

niacin flush free oral capsule OTC

niacin oral capsule, extended release OTC; QL

niacin oral tablet OTC

niacin oral tablet extended release Endur-Acin OTC

niacinamide oral tablet Niacin (niacinamide) OTC

pantothenic acid (vit b5) oral tablet OTC

pyridoxine (vitamin b6) injection solution

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

renal caps oral capsule OTC

rena-vite oral tablet OTC

rena-vite rx oral tablet OTC

reno caps oral capsule 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 b with zinc oral tablet OTC; QL

stress formula 600 c oral tablet OTC; QL

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

super b complex-vitamin c oral tablet OTC; QL

super b maxi complex oral tablet OTC

75


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) injection solution

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

triphrocaps oral capsule OTC

ultra b-100 complex oral tablet OTC

virt-gard oral tablet OTC

virt-vite oral tablet 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 complex-folic acid oral tablet B Complex 100 OTC

vitamin b-1 (mononitrate) oral tablet OTC

vitamin b-1 oral tablet OTC


vitamin b-12 oral tablet extended release OTC

vitamin b-12 sublingual tablet OTC



vitamins b complex oral capsule OTC

vitamins b complex oral tablet OTC

vitamins for hair oral tablet OTC; QL

vp-vite rx oral tablet OTC

VITAMIN C PREPARATIONS

acerola c-500 oral wafer OTC

ascorbate calcium (vitamin c) oral tablet OTC

ascorbic acid (vitamin c) injection solution

ascorbic acid (vitamin c) oral capsule, extended release

Vitamin C OTC

ascorbic acid (vitamin c) oral syrup OTC

76


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

C-500 OTC; QL

ascorbic acid (vitamin c) oral tablet extended release

OTC

ascorbic acid (vitamin c) oral tablet,chewable

Acerola C 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

endur-c with rose hips oral tablet extended release

OTC

fruit c oral tablet,chewable OTC

fruit c-500 oral tablet,chewable OTC; QL

halls defense oral lozenge OTC

soothing pureway-c oral tablet OTC; QL

strawberry c oral tablet,chewable OTC; QL

vita-c oral crystals OTC

vitamin c drops oral lozenge OTC

vitamin c oral capsule, extended release OTC

vitamin c oral powder 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

77


VITAMIN D PREPARATIONS

calcidol oral drops OTC

calcitriol oral capsule Rocaltrol PA

calcitriol oral solution Rocaltrol PA

cholecalciferol (vitamin d3) oral capsule 1,000 unit, 400 unit

Vitamin D3 OTC

cholecalciferol (vitamin d3) oral capsule 10,000 unit

Decara OTC


D3-2000 OTC; QL


Dialyvite Vitamin D OTC; QL


D3-50 Cholecalciferol OTC

cholecalciferol (vitamin d3) oral drops 10 mcg/ml (400 unit/ml)

D-Vi-Sol OTC; QL

cholecalciferol (vitamin d3) oral drops 5,000 unit/ml

OTC

cholecalciferol (vitamin d3) oral tablet 1,000 unit (25 mcg), 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

cholecalciferol (vitamin d3) oral tablet,chewable

Kids First Vitamin D3 OTC

d3-2000 oral capsule OTC; QL

delta d3 oral tablet OTC; QL

DIALYVITE VITAMIN D ORAL CAPSULE OTC; QL

ergocalciferol (vitamin d2) oral capsule Drisdol

ergocalciferol (vitamin d2) oral drops Calcidol OTC

ergocalciferol (vitamin d2) oral tablet OTC

replesta oral wafer OTC

thera-d oral tablet OTC

vitajoy daily d oral tablet,chewable OTC

vitamin d2 oral capsule

vitamin d3 oral capsule 1,000 unit, 400 unit

OTC

vitamin d3 oral capsule 2,000 unit OTC; QL

78


vitamin d3 oral tablet 1,000 unit (25 mcg), 2,000 unit, 5,000 unit

OTC

vitamin d3 oral tablet 400 unit OTC; QL

vitamin d3 oral tablet,chewable OTC

VITAMIN E PREPARATIONS

vitamin e (dl, acetate) oral capsule OTC

vitamin e acetate oral capsule OTC

vitamin e mixed oral capsule OTC

vitamin e oral capsule OTC

wheat germ oil oral capsule OTC

VITAMIN K PREPARATIONS

phytonadione (vitamin k1) oral tablet 100 mcg

OTC

phytonadione (vitamin k1) oral tablet 5 mg Mephyton

vitamin k injection solution

vitamin k1 injection solution

VITAMINS

biotin oral capsule Meribin OTC

biotin oral tablet OTC

ZINC REPLACEMENT

chelated zinc oral tablet OTC; QL

zinc amino acid chelate oral tablet OTC; QL

zinc gluconate oral tablet 100 mg, 30 mg OTC

zinc gluconate oral tablet 50 mg OTC; QL

zinc oral tablet Chelated Zinc OTC; QL

zinc sulfate oral capsule Orazinc OTC

zinc sulfate oral tablet OTC

zinc-220 oral capsule OTC

zinc-vit c-pyridoxine (vit b6) oral lozenge OTC

ENDOCRINE

ANDROGENIC AGENTS

testosterone cypionate intramuscular oil Depo-Testosterone PA

testosterone enanthate intramuscular oil PA

testosterone transdermal gel Testim PA; QL

testosterone transdermal gel in metered-dose pump

Vogelxo PA; QL

testosterone transdermal gel in packet AndroGel PA; QL

79


ANTIDIURETIC AND VASOPRESSOR HORMONES

DDAVP NASAL SOLUTION

desmopressin nasal spray with pump DDAVP

desmopressin nasal spray,non-aerosol

desmopressin oral tablet DDAVP QL

ANTIHYPERGLYCEMIC, AMYLIN ANALOG-TYPE

SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR

PA; QL

SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR

PA; QL

ANTIHYPERGLYCEMIC, INCRETIN MIMETIC (GLP-1 RECEPTOR AGONIST)

OZEMPIC SUBCUTANEOUS PEN INJECTOR

PA; QL

VICTOZA 2-PAK SUBCUTANEOUS PEN INJECTOR

PA; QL

VICTOZA 3-PAK SUBCUTANEOUS PEN INJECTOR

PA; QL

ANTITHYROID PREPARATIONS

methimazole oral tablet Tapazole

propylthiouracil oral tablet

BONE RESORPTION INHIBITORS

alendronate oral solution QL

alendronate oral tablet QL

CALCITONINS

calcitonin (salmon) nasal spray,non-aerosol

DIPEPTIDYL PEPTIDASE - IV INHIBITOR & COMBINATIONS

JANUMET ORAL TABLET PA; QL

JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR

PA; QL

JANUVIA ORAL TABLET PA; QL

ESTROGENIC AGENTS

amabelz oral tablet

estradiol oral tablet Estrace

80


estradiol transdermal patch weekly Climara QL

estradiol-norethindrone acet oral tablet Activella

fyavolv oral tablet

jinteli oral tablet

lopreeza oral tablet

mimvey lo oral tablet

mimvey oral tablet

norethindrone ac-eth estradiol oral tablet Fyavolv

PREMPHASE ORAL TABLET

PREMPRO ORAL TABLET

raloxifene oral tablet Evista

FERTILITY ENHANCER

hydroxyprogest(pf)(preg presv) intramuscular oil

Makena PA; QL

hydroxyprogesterone cap(ppres) intramuscular oil

Makena PA; QL

MAKENA (PF) SUBCUTANEOUS AUTO-INJECTOR

PA; QL

MAKENA INTRAMUSCULAR OIL PA; QL

GLUCOCORTICOIDS

a-hydrocort injection recon soln

cortisone oral tablet

decadron oral elixir

decadron oral tablet

deltasone oral tablet

dexamethasone in 0.9 % sod chl intravenous piggyback

dexamethasone intensol oral drops

dexamethasone oral elixir Decadron

dexamethasone oral solution

dexamethasone oral tablet Decadron

dexamethasone oral tablets,dose pack DexPak 6 Day

dexamethasone sodium phos (pf) injection solution

dexamethasone sodium phosphate injection solution

dexamethasone sodium phosphate injection syringe

hydrocortisone oral tablet Cortef

81


methylprednisolone acetate injection suspension

Depo-Medrol

methylprednisolone oral tablet Medrol

methylprednisolone oral tablets,dose pack Medrol (Pak)

methylprednisolone sodium succ injection recon soln

methylprednisolone sodium succ intravenous recon soln

Solu-Medrol

millipred dp oral tablets,dose pack

millipred oral tablet

prednisolone oral solution

prednisolone sodium phosphate oral solution

prednisolone sodium phosphate oral tablet,disintegrating

Orapred ODT QL

prednisone intensol oral concentrate

prednisone oral solution

prednisone oral tablet

prednisone oral tablets,dose pack

triamcinolone acetonide injection suspension

Kenalog

veripred 20 oral solution

GROWTH HORMONES

ZOMACTON SUBCUTANEOUS RECON SOLN

PA; QL

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

GLUCAGEN HYPOKIT INJECTION RECON SOLN

QL

GLUCAGON EMERGENCY KIT (HUMAN) INJECTION RECON SOLN

QL

gluco burst oral gel OTC

glucose bits oral tablet,chewable OTC

82


glucose gel oral gel OTC

glucose oral tablet,chewable Dex4 Glucose OTC

HYPOGLYCEMICS, ALPHA GLUCOSIDASE INHIBITOR TYPE

acarbose oral tablet 100 mg Precose

acarbose oral tablet 25 mg, 50 mg Precose QL

HYPOGLYCEMICS, BIGUANIDINE TYPE

metformin oral tablet Glucophage

metformin oral tablet extended release 24 hr

Glucophage XR

HYPOGLYCEMICS, INSULIN - RELEASE STIMULANT TYPE

glimepiride oral tablet Amaryl PA

glipizide oral tablet Glucotrol PA

glipizide oral tablet extended release 24hr Glucotrol XL PA

glipizide-metformin oral tablet PA

glyburide micronized oral tablet Glynase PA

glyburide oral tablet PA

glyburide-metformin oral tablet PA

nateglinide oral tablet Starlix PA; QL

repaglinide oral tablet Prandin PA

HYPOGLYCEMICS, INSULIN - RESPONSE ENHANCER

pioglitazone oral tablet Actos PA; QL

pioglitazone-glimepiride oral tablet DUETACT PA

pioglitazone-metformin oral tablet Actoplus MET PA

INSULINS

ADMELOG SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN

QL

ADMELOG U-100 INSULIN LISPRO SUBCUTANEOUS SOLUTION

QL

BASAGLAR KWIKPEN U-100 INSULIN SUBCUTANEOUS INSULIN PEN

QL

HUMALOG MIX 50-50 INSULN U-100 SUBCUTANEOUS SUSPENSION

QL

HUMALOG MIX 50-50 KWIKPEN SUBCUTANEOUS INSULIN PEN

QL

83


HUMALOG MIX 75-25 KWIKPEN SUBCUTANEOUS INSULIN PEN

QL

HUMALOG MIX 75-25(U-100)INSULN SUBCUTANEOUS SUSPENSION

QL

HUMULIN 70/30 U-100 INSULIN SUBCUTANEOUS SUSPENSION

OTC; QL

HUMULIN 70/30 U-100 KWIKPEN SUBCUTANEOUS INSULIN PEN

OTC; QL

HUMULIN N NPH INSULIN KWIKPEN SUBCUTANEOUS INSULIN PEN

OTC; QL

HUMULIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION

OTC; QL

HUMULIN R REGULAR U-100 INSULN INJECTION SOLUTION

OTC; QL

HUMULIN R U-500 (CONC) INSULIN SUBCUTANEOUS SOLUTION

PA; QL

HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN

PA; QL

NOVOLIN 70/30 U-100 INSULIN SUBCUTANEOUS SUSPENSION

OTC; QL

NOVOLIN 70-30 FLEXPEN U-100 SUBCUTANEOUS INSULIN PEN

OTC; QL

NOVOLIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION

OTC; QL

NOVOLIN R REGULAR U-100 INSULN INJECTION SOLUTION

OTC; QL

NOVOLOG MIX 70-30 U-100 INSULN SUBCUTANEOUS SOLUTION

QL

NOVOLOG MIX 70-30FLEXPEN U-100 SUBCUTANEOUS INSULIN PEN

QL

MINERALOCORTICOIDES

fludrocortisone oral tablet

OXYTOCICS

methylergonovine injection solution

methylergonovine oral tablet Methergine

PITUITARY SUPPRESSIVE AGENTS

cabergoline oral tablet QL

PROGESTATIONAL AGENTS

hydroxyprogest(pf)(preg presv) intramuscular oil

Makena PA; QL

84


hydroxyprogesterone cap(ppres) intramuscular oil

Makena PA; QL

hydroxyprogesterone caproate intramuscular oil

PA; QL

MAKENA (PF) SUBCUTANEOUS AUTO-INJECTOR

PA; QL

MAKENA INTRAMUSCULAR OIL PA; QL

medroxyprogesterone oral tablet Provera QL

norethindrone acetate oral tablet Aygestin

progesterone micronized oral capsule Prometrium QL

SODIUM GLUCOSE (SGLT2) INHIBITORS

JARDIANCE ORAL TABLET PA; QL

SYNJARDY ORAL TABLET PA; QL

SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR

PA; QL

THYROID HORMONES

levothyroxine oral tablet Euthyrox

levoxyl oral tablet

liothyronine oral tablet Cytomel

nature-throid oral tablet QL

np thyroid oral tablet QL

thyroid (pork) oral tablet Armour Thyroid QL

unithroid oral tablet

westhroid oral tablet 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

alcalak oral tablet,chewable 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

85


antacid anti-gas oral suspension OTC

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

OTC

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), 430 mg calcium (1,000 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 300 mg (750 mg)

Antacid Ext Str (calcium carb)

OTC

calcium carbonate oral tablet,chewable 320 mg calcium (750 mg)

Antacid (calcium carbonate) OTC

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

86


children's soothe oral tablet,chewable OTC

comfort gel extra strength oral suspension OTC

comfort gel oral suspension OTC

flavor chews antacid oral tablet,chewable OTC

foaming antacid oral suspension OTC

foaming antacid oral tablet,chewable OTC; QL

geri-lanta oral suspension OTC

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

magnesium oxide oral tablet MagOx OTC; QL

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-diarrheal (loperamide) oral capsule OTC; QL

anti-diarrheal (loperamide) oral liquid OTC; QL

87


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 oral tablet OTC

bismuth oral tablet,chewable OTC

bismuth subsalicylate oral tablet,chewable Bismatrol OTC

diamode oral tablet OTC; QL

diarrhea relief (bismuth subs) oral suspension

OTC; QL

diotame oral tablet,chewable OTC

diphenoxylate-atropine oral liquid

diphenoxylate-atropine oral tablet Lomotil

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 Anti-Diarrheal (loperamide) OTC; QL

loperamide oral tablet Anti-Diarrheal (loperamide) 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

88


stomach relief max strength oral suspension

OTC

stomach relief oral suspension 262 mg/15 ml

OTC; QL

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

compro rectal suppository

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,chewableMotion Sickness Relief(mecliz)

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

ondansetron oral tablet,disintegrating QL

phenadoz rectal suppository

prochlorperazine edisylate injection solution

prochlorperazine maleate oral tablet Compazine

prochlorperazine rectal suppository Compazine

promethazine rectal suppository Phenadoz AL

89


promethegan rectal suppository AL

travel sickness (meclizine) oral tablet,chewable

OTC

travel sickness oral tablet OTC

trimethobenzamide oral capsule Tigan

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

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

simethicone oral capsule Anti-Gas Ultra Strength OTC

simethicone oral drops,suspension Gas Relief OTC

simethicone oral tablet,chewable Gas Relief OTC

ANTISPASMODICS

dicyclomine oral capsule

dicyclomine oral solution

dicyclomine oral tablet

glycopyrrolate oral tablet

hyosyne oral drops

hyosyne oral elixir

propantheline oral tablet

symax fastabs oral tablet,disintegrating

BILE SALTS

ursodiol oral capsule Actigall

ursodiol oral tablet URSO 250

CHRONIC INFLAMMATION, COLON DISEASE, 5-AMINOSALICYLATES

APRISO ORAL CAPSULE,EXTENDED RELEASE 24HR

QL

90


balsalazide oral capsule Colazal QL

mesalamine rectal enema Rowasa QL

mesalamine with cleansing wipe rectal enema kit

Rowasa QL

sulfasalazine oral tablet Azulfidine QL

sulfasalazine oral tablet,delayed release (dr/ec)

Azulfidine EN-tabs QL

GASTRIC ACID SECRETION REDUCERS

acid control (ranitidine) oral tablet OTC; QL

acid controller complete oral tablet,chewable

OTC

acid controller oral tablet OTC; QL

acid reducer (famotidine) oral tablet OTC; QL

acid reducer (omeprazole) oral capsule,delayed release(dr/ec)

OTC; QL

acid reducer (ranitidine) oral tablet OTC; QL

acid reducer complete (famot) oral tablet,chewable

OTC

CARAFATE ORAL SUSPENSION

complete oral tablet,chewable OTC

dual action complete oral tablet,chewable OTC

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

Heartburn Treatment OTC; QL

famotidine (pf) intravenous solution

famotidine oral suspension PA

famotidine oral tablet 10 mg, 20 mg Acid Controller OTC; QL

famotidine oral tablet 40 mg Pepcid QL

heartburn prevention oral tablet OTC; QL

heartburn relief (famotidine) oral tablet OTC; QL

heartburn relief (ranitidine) oral tablet OTC; QL

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

OTC; QL

lansoprazole oral capsule,delayed release(dr/ec)

Heartburn Treatment 24 Hour

OTC; QL

misoprostol oral tablet Cytotec

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

OTC; QL

91


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

OTC; QL

nizatidine oral capsule

nizatidine oral solution PA

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

Acid Reducer (omeprazole) OTC; QL

omeprazole oral capsule,delayed release(dr/ec)

PA; Preferred for Members less than 6 years of age. PA required for members greater than 6.; QL

omeprazole oral tablet,delayed release (dr/ec)

OTC; QL

omeprazole oral tablet,disintegrat, delay rel

OTC

OMEPRAZOLE-SODIUM BICARBONATE ORAL CAPSULE

OmePPi OTC; QL

pepcid ac oral tablet OTC; QL

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

OTC; QL

PRILOSEC OTC ORAL TABLET,DELAYED RELEASE (DR/EC)

OTC; QL

ranitidine hcl oral capsule 150 mg

ranitidine hcl oral capsule 300 mg QL

ranitidine hcl oral syrup

ranitidine hcl oral tablet 150 mg, 75 mg Acid Control (ranitidine) OTC; QL

ranitidine hcl oral tablet 300 mg Zantac QL

sucralfate oral tablet Carafate

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

ZEGERID OTC ORAL CAPSULE OTC; QL

INFLAMMATORY BOWEL AGENTS

budesonide oral capsule,delayed,extend.release

Entocort EC QL

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS SYRINGE KIT

PA; QL

HUMIRA PEN CROHNS-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

92


HUMIRA PEN PSOR-UVEITS-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA SUBCUTANEOUS SYRINGE KIT

PA; QL

HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT

PA; QL

HUMIRA(CF) PEN CROHNS-UC-HS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA(CF) PEN PSOR-UV-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT

PA; QL

HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT

PA; QL

hydrocortisone rectal enema Cortenema

INTESTINAL MOTILITY STIMULANTS

metoclopramide hcl oral solution

metoclopramide hcl oral tablet Reglan

LAXATIVES AND CATHARTICS

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

bisacodyl oral tablet,delayed release (dr/ec)

Alophen OTC; QL

bisacodyl rectal suppository Dulcolax (bisacodyl) OTC

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

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 OTC

constulose oral solution QL

daily fiber oral capsule OTC

diocto oral liquid OTC

diocto oral syrup OTC

93


dioctyl oral syrup 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 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

dulcoease oral capsule OTC; QL

dulcolax stool softener (dss) oral capsule OTC; QL

easy fiber oral powder OTC

enema disposable rectal enema OTC

enema rectal enema OTC

enulose oral solution

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 (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

fiber therapy (ca polycarboph) oral tablet OTC; QL

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

94


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; QL

gavilax oral powder OTC

gavilyte-c oral recon soln QL

gavilyte-g oral recon soln QL

gavilyte-n oral recon soln QL

generlac oral solution

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

lactulose oral solution Constulose QL

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

95


laxative pills regular oral tablet OTC

laxative plus stool softener oral tablet OTC

magnesium citrate oral solution Citrate of Magnesia OTC

magnesium hydroxide oral suspension Milk of Magnesia 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 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 therapy oral powder OTC

natural fiber laxative(aspart) oral powder OTC

natural fiber supplement oral powder in packet

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

peg 3350-electrolytes oral recon soln Colyte with Flavor Packs QL

peg-electrolyte soln oral recon soln GaviLyte-N QL

perdiem overnight relief 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 oral powder OTC

reguloid, sugar free oral powder OTC

96


senexon-s oral tablet OTC

senna lax oral tablet OTC

senna laxative 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-s oral tablet OTC

senna-time s oral tablet OTC

senno oral tablet 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

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

stool softener-stimulant laxat oral tablet OTC

surfak oral capsule OTC

the magic bullet rectal suppository OTC

trilyte with flavor packets oral recon soln QL

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

97


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

CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,000-38,000 -60,000 UNIT, 24,000-76,000 -120,000 UNIT, 6,000-19,000 -30,000 UNIT

QL

CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 3,000-9,500- 15,000 UNIT, 36,000-114,000- 180,000 UNIT

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

BENIGN PROSTATIC HYPERTROPHY/MICTURITION AGENTS

alfuzosin oral tablet extended release 24 hr

Uroxatral QL

finasteride oral tablet Proscar QL

tamsulosin oral capsule Flomax QL

BLOOD DETOXICANTS

calcium acetate oral capsule

calcium acetate oral tablet Calphron

lanthanum oral tablet,chewable Fosrenol

sevelamer carbonate oral powder in packet

Renvela

98


sevelamer carbonate oral tablet Renvela QL

PARASYMPATHETIC AGENTS

bethanechol chloride oral tablet Urecholine QL

URINARY ACIDIFIER

k-phos-neutral oral tablet OTC

phospha 250 neutral oral tablet OTC

phosphorous oral tablet OTC

phospho-trin 250 neutral oral tablet OTC

virt-phos 250 neutral oral tablet OTC

URINARY ANTIBACTERIAL AGENTS

ciprofloxacin (mixture) oral tablet, er multiphase 24 hr 1,000 mg

Cipro XR

ciprofloxacin (mixture) oral tablet, er multiphase 24 hr 500 mg

Cipro XR QL

methenamine hippurate oral tablet Hiprex

nitrofurantoin macrocrystal oral capsule Macrodantin

nitrofurantoin monohyd/m-cryst oral capsule

Macrobid

URINARY PH MODIFIERS

cytra k crystals oral packet

cytra-2 oral solution OTC

cytra-3 oral solution OTC

cytra-k oral solution OTC

pot,sodium citrate-citric acid oral solution Cytra-3 OTC

potassium citrate oral tablet extended release

Urocit-K 10

potassium citrate-citric acid oral solution Cytra-K OTC

sodium citrate-citric acid oral solution Cytra-2 OTC

tricitrates oral solution OTC

virtrate-2 oral solution OTC

virtrate-3 oral solution OTC

virtrate-k oral solution OTC

URINARY TRACT ANESTHETIC/ANALGESIC AGENT

urinary pain relief oral tablet OTC; QL

99


URINARY TRACT ANTISPASMODIC/ANTI-INCONTINENCE AGENT

darifenacin oral tablet extended release 24 hr

Enablex

flavoxate oral tablet QL

hyosyne oral drops

hyosyne oral elixir

oxybutynin chloride oral syrup QL

oxybutynin chloride oral tablet

oxybutynin chloride oral tablet extended release 24hr

QL

OXYTROL FOR WOMEN TRANSDERMAL PATCH 4 DAY

OTC

symax fastabs oral tablet,disintegrating

tolterodine oral capsule,extended release 24hr

Detrol LA

tolterodine oral tablet Detrol

trospium oral capsule,extended release 24hr

trospium oral tablet

GOUT AND HYPERURICEMIA THERAPY

COLCHICINE COMBINATION

probenecid-colchicine oral tablet

HYPERURICEMIA TREATMENT - PURINE INHIBITORS

allopurinol oral tablet Zyloprim

URICOSURIC AGENTS

probenecid oral tablet

HEMATOLOGICAL AGENTS

ANTIFIBRINOLYTIC AGENTS

aminocaproic acid oral tablet Amicar QL

tranexamic acid oral tablet Lysteda QL

GRANULOCYTE COLONY-STIMULATING FACTOR (G-CSF)

FULPHILA SUBCUTANEOUS SYRINGE PA; QL

NEULASTA SUBCUTANEOUS SYRINGE

PA; QL

100


NEULASTA SUBCUTANEOUS SYRINGE, W/ WEARABLE INJECTOR

PA; QL

ZARXIO INJECTION SYRINGE PA

HEMATINICS, OTHER

ARANESP (IN POLYSORBATE) INJECTION SOLUTION

PA; QL

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 100 MCG/0.5 ML, 200 MCG/0.4 ML, 25 MCG/0.42 ML, 300 MCG/0.6 ML, 40 MCG/0.4 ML, 60 MCG/0.3 ML

PA

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 150 MCG/0.3 ML, 500 MCG/ML

PA; QL

EPOGEN INJECTION SOLUTION PA

RETACRIT INJECTION SOLUTION PA

HEMORRHEOLOGIC AGENTS

pentoxifylline oral tablet extended release

HEPARIN AND RELATED PREPARATIONS

enoxaparin subcutaneous solution Lovenox QL

enoxaparin subcutaneous syringe Lovenox QL

heparin (porcine) injection cartridge

heparin (porcine) injection solution

heparin (porcine) injection syringe

heparin, porcine (pf) injection solution

heparin, porcine (pf) injection syringe

ORAL ANTICOAGULANTS

ELIQUIS ORAL TABLET

ELIQUIS ORAL TABLETS,DOSE PACK QL

jantoven oral tablet

warfarin oral tablet Coumadin

PLATELET AGGREGATION INHIBITORS

anagrelide oral capsule Agrylin

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

101


aspirin oral tablet Bayer Aspirin OTC; QL

aspirin oral tablet,chewable Aspirin Childrens OTC; QL


Aspir-Trin OTC; QL

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

OTC


Adult Aspirin Regimen 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

children's aspirin oral tablet,chewable OTC; QL

cilostazol oral tablet

clopidogrel oral tablet 300 mg

clopidogrel oral tablet 75 mg Plavix QL

dipyridamole oral tablet

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

lite coat aspirin oral tablet OTC; QL

SICKLE CELL ANEMIA AGENTS

DROXIA ORAL CAPSULE

IMMUNOSUPPRESSIVE AGENTS

IMMUNOSUPRESSANTS

azathioprine oral tablet Imuran

cyclosporine modified oral capsule Gengraf

cyclosporine modified oral solution Gengraf

cyclosporine oral capsule Sandimmune

gengraf oral capsule

gengraf oral solution

mycophenolate mofetil oral capsule CellCept

mycophenolate mofetil oral suspension for reconstitution

CellCept

mycophenolate mofetil oral tablet CellCept

mycophenolate sodium oral tablet,delayed release (dr/ec)

Myfortic

SANDIMMUNE ORAL SOLUTION

102


sirolimus oral solution Rapamune

sirolimus oral tablet Rapamune

tacrolimus oral capsule Prograf

LOCOMOTOR SYSTEM

MUSCULOSKELETAL THERAPY AGENTS

EUFLEXXA INTRA-ARTICULAR SYRINGE

PA; QL

GELSYN-3 INTRA-ARTICULAR SYRINGE

PA; QL

SUPARTZ FX INTRA-ARTICULAR SYRINGE

PA; QL

OTHER CNS/AUTONOMIC DRUGS

pyridostigmine bromide oral tablet Mestinon

pyridostigmine bromide oral tablet extended release

Mestinon Timespan

SKELETAL MUSCLE RELAXANTS

baclofen oral tablet

carisoprodol oral tablet Soma QL

carisoprodol-asa-codeine oral tablet AL; QL

carisoprodol-aspirin oral tablet QL

chlorzoxazone oral tablet

cyclobenzaprine oral tablet 10 mg QL

cyclobenzaprine oral tablet 5 mg

dantrolene oral capsule Dantrium

methocarbamol oral tablet Robaxin QL

orphenadrine citrate oral tablet extended release

QL

riluzole oral tablet Rilutek PA

tizanidine oral tablet QL

MEDICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT (DME)

ANTISEPTICS - OTHER

alcoh-wipe towelette OTC

BLOOD SUGAR DIAGNOSTICS

TRUE METRIX GLUCOSE TEST STRIP STRIP

OTC; QL

103


TRUETEST TEST STRIPS STRIP OTC; QL

CONDOMS

AIMSCO LATEX CONDOM DEVICE OTC

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

DIAPHRAGMS/CERVICAL CAP

WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM





104





MEDICAL SUPPLIES AND DME - GLUCOSE MONITORING TEST SUPPLIES

1ST TIER UNILET COMFORTOUCH 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

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

AUTO-LANCET MINI OTC; QL

AUTOLET IMPRESSION LANC DEV KIT OTC; QL

AUTOLET LANCING DEVICE OTC; QL

AUTOLET PLUS LANCING DEVICE OTC; QL

CAREONE LANCING DEVICE 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 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

105


FINE 30 UNIVERSAL LANCETS OTC; QL

FORA LANCING DEVICE OTC; QL

FORACARE LANCETS OTC; QL

GLUCOCOM LANCETS 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

LANZO LANCING DEVICE KIT OTC; QL

LITE TOUCH LANCING DEVICE OTC; QL

MEDLANCE PLUS LANCETS OTC; QL

MICRO THIN LANCETS OTC; QL

MICROLET NEXT LANCING DEVICE KIT

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; QL

STERILANCE TL OTC; QL

SUPER THIN LANCETS OTC; QL

SURE COMFORT LANCING PEN OTC; QL

106


SUREFLEX LANCING DEVICE 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



TRUEDRAW LANCING DEVICE OTC; QL

TRUEPLUS LANCETS OTC; QL

TRUERESULT BLOOD GLUCOSE SYSTM KIT

OTC

TWIST LANCETS OTC; QL

ULTI-LANCE OTC; QL

ULTRA THIN LANCETS OTC; QL

ULTRA THIN PLUS LANCETS OTC; QL

ULTRA-CARE 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 PRO LANCET OTC; QL

107


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

IN-CHECK NASAL WITH MASK DEVICE OTC

IN-CHECK ORAL FLOW METER DEVICE

OTC

MICROLIFE PEAK FLOW METER DEVICE

OTC

MINI WRIGHT PEAK FLOW METER DEVICE

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

TRUZONE PEAK FLOW METER DEVICE

MEDICAL SUPPLIES AND DME

CUT N CRUSH OTC

TABLET CUTTER OTC

NEEDLES/NEEDLELESS DEVICES, SYRINGES AND ACCESSORIES

BD AUTOSHIELD DUO PEN NEEDLE NEEDLE

OTC; QL

BD ECLIPSE LUER-LOK SYRINGE OTC; QL

BD INSULIN SYRINGE HALF UNIT SYRINGE

OTC; QL

BD INSULIN SYRINGE MICRO-FINE SYRINGE

OTC; QL

BD INSULIN SYRINGE SAFETY-LOK SYRINGE

OTC; QL

BD INSULIN SYRINGE SLIP TIP SYRINGE

OTC; QL

108


BD INSULIN SYRINGE SYRINGE OTC; QL

BD INSULIN SYRINGE U-500 SYRINGE QL

BD INSULIN SYRINGE ULTRA-FINE SYRINGE

OTC; QL

BD LO-DOSE MICRO-FINE IV SYRINGE OTC; QL

BD LO-DOSE ULTRA-FINE SYRINGE OTC; QL

BD LUER-LOK SYRINGE SYRINGE OTC

BD SAFETYGLIDE INSULIN SYRINGE SYRINGE

OTC; QL

BD ULTRA-FINE MICRO PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE MINI PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE NANO PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE ORIG PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE SHORT PEN NEEDLE NEEDLE

OTC; QL

BD VEO INSULIN SYR HALF UNIT SYRINGE

OTC; QL

BD VEO INSULIN SYRINGE UF SYRINGE

OTC; QL

RESPIRATORY AIDS, SPACERS, DEVICES AND EQUIPMENT

ACE AEROSOL CLOUD ENHANCER SPACER

QL

AEROTRACH PLUS SPACER QL

AEROVENT PLUS SPACER QL

BREATHERITE MDI SPACER SPACER QL

BREATHERITE SPACER-MASK, NEO. SPACER

QL

BREATHERITE SPACER-MASK,ADULT SPACER

QL

BREATHERITE SPACER-MASK,CHILD SPACER

QL

BREATHERITE SPACER-MASK,INFANT SPACER

QL

BREATHERITE SPACER-MASK,S.CHLD SPACER

QL

109


BREATHERITE VALVED MDI CHAMBER SPACER

QL

BREATHERITE VALVED MDI SPACER SPACER

QL

COMPACT SPACE CHAMBER SPACER QL

COMPACT SPACE CHAMBER-LRG MASK SPACER

QL

COMPACT SPACE CHAMBER-MED MASK SPACER

QL

COMPACT SPACE CHAMBER-SM MASK SPACER

QL

EASIVENT MASK LARGE DEVICE QL

EASIVENT MASK MEDIUM DEVICE QL

EASIVENT MASK SMALL DEVICE QL

LITEAIRE MDI CHAMBER SPACER QL

MICROCHAMBER SPACER QL

MICROSPACER SPACER QL

OPTICHAMBER ADULT MASK-LARGE DEVICE

QL

OPTICHAMBER DIAMOND LG MASK SPACER

QL

OPTICHAMBER DIAMOND VHC SPACER

QL

OPTICHAMBER DIAMOND-MED MSK SPACER

QL

OPTICHAMBER DIAMOND-SML MASK SPACER

QL

POCKET CHAMBER SPACER QL

PRIMEAIRE SPACER QL

PROCHAMBER SPACER QL

RITEFLO AEROCHAMBER SPACER QL

VORTEX HOLDING CHAMBER CHILD SPACER

QL

VORTEX HOLDING CHAMBER SPACER

QL

VORTEX HOLDING CHAMBER TODDLER SPACER

QL

VORTEX VHC FROG MASK-CHILD SPACER

QL

VORTEX VHC LADYBUG MASK-TODDLR SPACER

QL

110


URINE KETONE TEST AIDS

TRUEPLUS KETONE STRIP OTC; QL

METABOLIC MODIFIERS

METABOLIC DEFICIENCY AGENTS

calcitriol oral capsule Rocaltrol PA

calcitriol oral solution Rocaltrol PA

levocarnitine oral tablet Carnitor OTC

sodium phenylbutyrate oral powder Buphenyl PA; QL

sodium phenylbutyrate oral tablet Buphenyl PA; QL

PHARMACOENHANCER - CYTOCHROME P450 INHIBITORS

TYBOST ORAL TABLET

OPHTHALMIC AGENTS

ARTIFICIAL TEARS

advanced eye relief ophthalmic (eye) drops

OTC

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

artificial tears(glycerin-peg) ophthalmic (eye) drops

OTC

artificial tears(pg-hypm-glyc) ophthalmic (eye) drops

OTC

dry eye relief ophthalmic (eye) drops OTC

eye drop tears ophthalmic (eye) drops OTC

eye drops (with povidone) ophthalmic (eye) drops

OTC

eye drops advanced relief ophthalmic (eye) drops

OTC

for sty relief ophthalmic (eye) ointment OTC

liquitears ophthalmic (eye) drops OTC

lubricant (p-glycol-glycerin) ophthalmic (eye) drops

OTC

111


lubricant eye drops ophthalmic (eye) drops

OTC

lubricant eye ophthalmic (eye) ointment OTC

moisture drops ophthalmic (eye) drops OTC

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

tears again (pva) ophthalmic (eye) drops OTC

ultra fresh ophthalmic (eye) drops OTC

MIOTICS/OTHER INTRAOCULAR PRESSURE REDUCERS

apraclonidine ophthalmic (eye) drops

betaxolol ophthalmic (eye) drops

brimonidine ophthalmic (eye) drops QL

carteolol ophthalmic (eye) drops QL

dorzolamide ophthalmic (eye) drops Trusopt QL

latanoprost ophthalmic (eye) drops Xalatan QL

levobunolol ophthalmic (eye) drops

metipranolol ophthalmic (eye) drops QL

pilocarpine hcl ophthalmic (eye) drops Isopto Carpine

timolol maleate ophthalmic (eye) drops Timoptic QL

timolol maleate ophthalmic (eye) gel forming solution

Timoptic-XE QL

MYDRIATICS

atropine ophthalmic (eye) drops Isopto Atropine QL

OPHTHALMIC ANTIBIOTIC - CORTICOID COMBINATIONS

neomycin-bacitracin-poly-hc ophthalmic (eye) ointment

Neo-Polycin HC

neomycin-polymyxin b-dexameth ophthalmic (eye) drops,suspension

Maxitrol

neomycin-polymyxin b-dexameth ophthalmic (eye) ointment

Maxitrol

neomycin-polymyxin-hc ophthalmic (eye) drops,suspension

neo-polycin hc ophthalmic (eye) ointment

sulfacetamide-prednisolone ophthalmic (eye) drops

QL

tobramycin-dexamethasone ophthalmic (eye) drops,suspension

TobraDex QL

112


OPHTHALMIC ANTIBIOTICS

ak-poly-bac ophthalmic (eye) ointment

bacitracin ophthalmic (eye) ointment QL

bacitracin-polymyxin b ophthalmic (eye) ointment

AK-Poly-Bac

ciprofloxacin hcl ophthalmic (eye) drops Ciloxan

erythromycin ophthalmic (eye) ointment

gatifloxacin ophthalmic (eye) drops Zymaxid

gentak ophthalmic (eye) ointment QL

gentamicin ophthalmic (eye) drops QL

levofloxacin ophthalmic (eye) drops

moxifloxacin ophthalmic (eye) drops Vigamox QL

neomycin-bacitracin-polymyxin ophthalmic (eye) ointment

Neo-Polycin QL

neomycin-polymyxin-gramicidin ophthalmic (eye) drops

QL

neo-polycin ophthalmic (eye) ointment QL

ofloxacin ophthalmic (eye) drops Ocuflox QL

polycin ophthalmic (eye) ointment

polymyxin b sulf-trimethoprim ophthalmic (eye) drops

Polytrim QL

sulfacetamide sodium ophthalmic (eye) drops

Bleph-10 QL

sulfacetamide sodium ophthalmic (eye) ointment

QL

tobramycin ophthalmic (eye) drops Tobrex QL

OPHTHALMIC ANTIHISTAMINES

alaway ophthalmic (eye) drops OTC; QL

allergy eye (ketotifen) ophthalmic (eye) drops

OTC; QL

azelastine ophthalmic (eye) drops QL

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

epinastine ophthalmic (eye) drops QL

eye allergy relief ophthalmic (eye) drops 0.025-0.3 %

OTC; QL

eye allergy relief ophthalmic (eye) drops 0.02675-0.315 %

OTC

eye itch relief ophthalmic (eye) drops OTC; QL

itchy eye drops ophthalmic (eye) drops OTC; QL

113


ketotifen fumarate ophthalmic (eye) drops Alaway OTC; QL

redness reliever lubricant ophthalmic (eye) drops

OTC

visine-a ophthalmic (eye) drops OTC; QL

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

OPHTHALMIC ANTI-INFLAMMATORY AGENTS

dexamethasone sodium phosphate ophthalmic (eye) drops

diclofenac sodium ophthalmic (eye) drops

fluorometholone ophthalmic (eye) drops,suspension

FML Liquifilm

flurbiprofen sodium ophthalmic (eye) drops

prednisolone acetate ophthalmic (eye) drops,suspension

Pred Forte

prednisolone sodium phosphate ophthalmic (eye) drops

XIIDRA OPHTHALMIC (EYE) DROPPERETTE

PA; QL

OPHTHALMIC ANTIVIRALS

trifluridine ophthalmic (eye) drops QL

OPHTHALMIC BETA BLOCKERS

dorzolamide-timolol ophthalmic (eye) drops

Cosopt QL

OPHTHALMIC DECONGESTANT

altazine ophthalmic (eye) drops OTC; QL

eye drops (tetrahydrozoline) ophthalmic (eye) drops

OTC; QL

opti-clear ophthalmic (eye) drops OTC; QL

phenylephrine hcl ophthalmic (eye) drops

redness reliever eye drops ophthalmic (eye) drops

OTC; QL

redness reliever lubricant ophthalmic (eye) drops

OTC

sterile eye drops ophthalmic (eye) drops OTC; QL

OPHTHALMIC MAST CELL STABILIZERS

cromolyn ophthalmic (eye) drops QL

114


OPHTHALMIC, OTHER

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

OTC

OTIC

OTIC PREPARATIONS, MISCELLANEOUS ANTI-INFECTIVES

acetic acid otic (ear) solution

carbamoxide ear drops otic (ear) drops OTC

ciprofloxacin hcl otic (ear) dropperette Cetraxal QL

ear drops (carbamide peroxide) otic (ear) drops

OTC

ear drops otc otic (ear) drops OTC

ear wax removal drops otic (ear) drops OTC

ear wax removal kit otic (ear) drops OTC

murine ear wax removal system otic (ear) drops

OTC

neomycin-polymyxin-hc otic (ear) drops,suspension

neomycin-polymyxin-hc otic (ear) solution

ofloxacin otic (ear) drops QL



1ST TIER UNILET COMFORTOUCH OTC; QL

ACE AEROSOL CLOUD ENHANCER SPACER

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

AEROTRACH PLUS SPACER QL

AEROVENT PLUS SPACER QL

AIMSCO LATEX CONDOM DEVICE OTC

AIRZONE PEAK FLOW METER DEVICE OTC

ALTERNATE SITE LANCET OTC; QL

ALTERNATE SITE LANCING DEVICE OTC; QL

115


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

AUTO-LANCET MINI OTC; QL

AUTOLET IMPRESSION LANC DEV KIT OTC; QL

AUTOLET LANCING DEVICE OTC; QL

AUTOLET PLUS LANCING DEVICE OTC; QL

AZO TEST STRIPS STRIP OTC

BD AUTOSHIELD DUO PEN NEEDLE NEEDLE

OTC; QL

BD ECLIPSE LUER-LOK SYRINGE OTC; QL

BD INSULIN SYRINGE HALF UNIT SYRINGE

OTC; QL

BD INSULIN SYRINGE MICRO-FINE SYRINGE

OTC; QL

BD INSULIN SYRINGE SAFETY-LOK SYRINGE

OTC; QL

BD INSULIN SYRINGE SLIP TIP SYRINGE

OTC; QL

BD INSULIN SYRINGE SYRINGE OTC; QL

BD INSULIN SYRINGE U-500 SYRINGE QL

BD INSULIN SYRINGE ULTRA-FINE SYRINGE

OTC; QL

BD LO-DOSE MICRO-FINE IV SYRINGE OTC; QL

BD LO-DOSE ULTRA-FINE SYRINGE OTC; QL

BD LUER-LOK SYRINGE SYRINGE OTC

BD SAFETYGLIDE INSULIN SYRINGE SYRINGE

OTC; QL

BD ULTRA-FINE MICRO PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE MINI PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE NANO PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE ORIG PEN NEEDLE NEEDLE

OTC; QL

BD ULTRA-FINE SHORT PEN NEEDLE NEEDLE

OTC; QL

116


BD VEO INSULIN SYR HALF UNIT SYRINGE

OTC; QL

BD VEO INSULIN SYRINGE UF SYRINGE

OTC; QL

BREATHERITE MDI SPACER SPACER QL

BREATHERITE SPACER-MASK, NEO. SPACER

QL

BREATHERITE SPACER-MASK,ADULT SPACER

QL

BREATHERITE SPACER-MASK,CHILD SPACER

QL

BREATHERITE SPACER-MASK,INFANT SPACER

QL

BREATHERITE SPACER-MASK,S.CHLD SPACER

QL

BREATHERITE VALVED MDI CHAMBER SPACER

QL

BREATHERITE VALVED MDI SPACER SPACER

QL

CAREONE LANCING DEVICE OTC; QL

CAREONE ULTRA THIN LANCET OTC; QL

CARETOUCH TWIST LANCET OTC; QL

CHEMSTRIP 10 MD STRIP OTC

COLOR LANCETS OTC; QL

COMFORT LANCETS OTC; QL

COMPACT SPACE CHAMBER SPACER QL

COMPACT SPACE CHAMBER-LRG MASK SPACER

QL

COMPACT SPACE CHAMBER-MED MASK SPACER

QL

COMPACT SPACE CHAMBER-SM MASK SPACER

QL

CONDOMS-PREM LUBRICATED DEVICE

OTC

CUT N CRUSH OTC

DROPLET LANCING DEVICE OTC; QL

EASIVENT MASK LARGE DEVICE QL

EASIVENT MASK MEDIUM DEVICE QL

EASIVENT MASK SMALL DEVICE QL

EASY TOUCH LANCETS OTC; QL

117


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

FANTASY CONDOM DEVICE OTC

FC2 FEMALE CONDOM OTC

FINE 30 UNIVERSAL LANCETS OTC; QL

FORA LANCING DEVICE OTC; QL

FORACARE LANCETS OTC; QL

GLUCOCOM LANCETS OTC; QL

HEALTHY ACCENTS AUTOLET 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 SUPER THIN LANCETS OTC; QL

INCONTROL ULTRA THIN LANCETS 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

KIMONO MICROTHIN CONDOMS DEVICE

OTC

KIMONO MICROTHIN LARGE CONDOMS DEVICE

OTC

KIMONO TEXTURED CONDOMS DEVICE

OTC

LANZO LANCING DEVICE KIT OTC; QL

LITE TOUCH LANCING DEVICE OTC; QL

118


LITEAIRE MDI CHAMBER SPACER QL

MEDLANCE PLUS LANCETS OTC; QL

MICRO THIN LANCETS OTC; QL

MICROCHAMBER SPACER QL

MICROLET NEXT LANCING DEVICE KIT

OTC; QL

MICROLIFE PEAK FLOW METER DEVICE

OTC

MICROSPACER SPACER QL

MINI LANCING DEVICE OTC; QL

MINI WRIGHT PEAK FLOW METER DEVICE

MONOLET LANCETS OTC; QL

MONOLET THIN LANCETS OTC; QL

MULTI-LANCET DEVICE 2 KIT OTC; QL

MULTISTIX 9 SG STRIP OTC

MULTISTIX 9 STRIP OTC

MYGLUCOHEALTH LANCETS OTC; QL

ON CALL LANCING DEVICE OTC; QL

ON CALL PLUS LANCING DEVICE OTC; QL

ON-THE-GO LANCETS OTC; QL

OPTICHAMBER ADULT MASK-LARGE DEVICE

QL

OPTICHAMBER DIAMOND LG MASK SPACER

QL

OPTICHAMBER DIAMOND VHC SPACER

QL

OPTICHAMBER DIAMOND-MED MSK SPACER

QL

OPTICHAMBER DIAMOND-SML MASK SPACER

QL

PEAK AIR PEAK FLOW METER DEVICE

OTC

PERSONAL BEST FULL RANGE DEVICE

OTC

PERSONAL BEST LOW RANGE DEVICE

OTC

PIKO 1 DEVICE OTC

POCKET CHAMBER SPACER QL

POCKET PEAK FLOW METER DEVICE OTC

119


PRIMEAIRE SPACER QL

PROCHAMBER SPACER 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

RITEFLO AEROCHAMBER SPACER QL

SAFETY LANCETS OTC; QL

SMART SENSE LANCETS OTC; QL

SMARTDIABETES VANTAGE OTC; QL

STERILANCE TL OTC; QL

SUPER THIN LANCETS OTC; QL

SURE COMFORT LANCING PEN OTC; QL

SUREFLEX LANCING DEVICE OTC; QL

SURE-PEN LANCING DEVICE OTC; QL

TABLET CUTTER OTC

TECHLITE LANCETS OTC; QL

THIN LANCETS OTC; QL

TOPCARE UNIVERSAL1 LANCET OTC; QL

TRUE METRIX AIR GLUCOSE METER OTC

TRUE METRIX GLUCOSE TEST STRIP STRIP

OTC; QL




TRUEDRAW LANCING DEVICE OTC; QL

TRUEPLUS KETONE STRIP OTC; QL

TRUEPLUS LANCETS OTC; QL

TRUERESULT BLOOD GLUCOSE SYSTM KIT

OTC

TRUETEST TEST STRIPS STRIP OTC; QL

TRUSTEX LATEX CONDOM DEVICE OTC

TRUSTEX LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX NON-LUB CONDOMS DEVICE

OTC

120


TRUSTEX-RIA LUB/SPERMICIDE DEVICE

OTC

TRUSTEX-RIA LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX-RIA NON-LUB CONDOMS DEVICE

OTC

TRUZONE PEAK FLOW METER DEVICE

TWIST LANCETS OTC; QL

ULTI-LANCE OTC; QL

ULTRA THIN LANCETS OTC; QL

ULTRA THIN PLUS LANCETS OTC; QL

ULTRA-CARE 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 PRO LANCET OTC; QL

UNISTIK SAFETY OTC; QL

UNISTIK TOUCH LANCETS OTC; QL

UNIVERSAL 1 LANCETS OTC; QL

URINARY TRACT INF.TEST (WBCS) STRIP

OTC

121


VORTEX HOLDING CHAMBER CHILD SPACER

QL

VORTEX HOLDING CHAMBER SPACER

QL

VORTEX HOLDING CHAMBER TODDLER SPACER

QL

VORTEX VHC FROG MASK-CHILD SPACER

QL

VORTEX VHC LADYBUG MASK-TODDLR SPACER

QL









RESPIRATORY THERAPY AGENTS

ALPHA/BETA ADRENERGIC AGENTS

epinephrine injection solution Adrenalin

epinephrine injection syringe

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

122


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-24hr 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; QL

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

OTC; QL

aprodine oral tablet OTC

ed a-hist pse oral tablet OTC

fexofenadine-pseudoephedrine oral tablet extended release 12 hr

Allegra-D 12 Hour OTC; QL

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

promethazine vc oral syrup AL; QL

promethazine-phenylephrine oral syrup Promethazine VC AL; QL

ritifed oral syrup OTC

rynex pse oral liquid OTC

wal-act d cold and allergy oral tablet OTC

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

OTC; QL

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

OTC; QL

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

OTC; QL

wal-itin d oral tablet extended release 24 hr

OTC; QL

123


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 PA; OTC; QL

aller-fex oral tablet PA; OTC; QL

aller-g-time 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 tablet OTC; QL

allergy relief (clemastine) oral tablet OTC

allergy relief (fexofenadine) oral tablet PA; OTC; QL

allergy relief (loratadine) oral solution OTC; QL

allergy relief (loratadine) oral tablet OTC; QL

allergy relief (loratadine) oral tablet,disintegrating

OTC; QL

allergy relief(chlorpheniramn) oral tablet OTC

allergy relief(chlorpheniramn) oral tablet extended release

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

banophen oral capsule 25 mg OTC; QL

banophen oral capsule 50 mg OTC

banophen oral tablet OTC; QL

carbinoxamine maleate oral liquid

carbinoxamine maleate oral tablet

child allergy relief (diphen) oral tablet,disintegrating

OTC

children's allegra allergy oral suspension OTC; QL

124


children's allegra allergy oral tablet,disintegrating

PA; OTC

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

children's allergy relief(fex) oral suspension

OTC; QL

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

CHILDREN'S WAL-FEX ORAL SUSPENSION

OTC; QL

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

clemastine oral tablet

complete allergy medicine oral capsule OTC; QL

complete allergy medicine oral tablet OTC; QL

complete allergy oral capsule OTC; QL

complete allergy oral tablet OTC; QL

cyproheptadine oral tablet

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

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

diphenhydramine hcl oral capsule 50 mg Banophen OTC

diphenhydramine hcl oral elixir OTC; QL

diphenhydramine hcl oral liquid Allergy (diphenhydramine) OTC; QL

diphenhydramine hcl oral syrup OTC

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

ed chlorped jr oral syrup OTC

125


fexofenadine oral suspension Children's Allegra Allergy OTC; QL

fexofenadine oral tablet 180 mg Allegra Allergy PA; OTC; QL

fexofenadine oral tablet 60 mg Allegra Allergy OTC; QL

loradamed oral tablet OTC; QL

loratadine oral capsule Claritin Liqui-Gel OTC

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

non-drowsy allergy oral tablet OTC; QL

pharbechlor oral tablet OTC

pharbedryl oral capsule 25 mg OTC; QL

pharbedryl oral capsule 50 mg OTC

promethazine oral syrup AL

promethazine oral tablet 12.5 mg, 50 mg AL

promethazine oral tablet 25 mg AL; QL

siladryl sa oral liquid OTC; QL

simply sleep oral tablet OTC

sleep aid (diphenhydramine) oral capsule OTC

sleep aid (diphenhydramine) oral tablet OTC

sleep aid max str (diphenhydr) oral capsule

OTC

sleep ii oral tablet OTC

sleep tablet (diphenhydramine) oral tablet OTC

sleep-tabs oral tablet OTC

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 PA; OTC; QL

wal-finate oral tablet OTC

wal-itin oral solution OTC; QL

wal-itin oral tablet OTC; QL

wal-som (diphenhydramine) oral capsule OTC

126


ANTITUSSIVES - NONNARCOTIC

cough drops mucous membrane lozenge OTC

ASTHMA THERAPY AGENTS

ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE

QL

budesonide inhalation suspension for nebulization

Pulmicort PA; AL; QL

cromolyn inhalation solution for nebulization

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE

QL

FLOVENT HFA INHALATION HFA AEROSOL INHALER

QL

montelukast oral granules in packet Singulair QL

montelukast oral tablet Singulair

montelukast oral tablet,chewable Singulair

zafirlukast oral tablet Accolate QL

BETA-ADRENERGIC AGENTS

ALBUTEROL SULFATE INHALATION HFA AEROSOL INHALER

ProAir HFA QL

albuterol sulfate inhalation solution for nebulization

QL

albuterol sulfate oral syrup

albuterol sulfate oral tablet

albuterol sulfate oral tablet extended release 12 hr

metaproterenol oral syrup

metaproterenol oral tablet

SEREVENT DISKUS INHALATION BLISTER WITH DEVICE

QL

terbutaline oral tablet

VENTOLIN HFA INHALATION HFA AEROSOL INHALER

QL

BETA-ADRENERGIC COMBINATION AGENTS

ANORO ELLIPTA INHALATION BLISTER WITH DEVICE

COMBIVENT RESPIMAT INHALATION MIST

127


ipratropium-albuterol inhalation solution for nebulization

STIOLTO RESPIMAT INHALATION MIST

QL

BETA-ADRENERGICS AND GLUCOCORTICOIDS COMBINATIONS

BREO ELLIPTA INHALATION BLISTER WITH DEVICE

QL

fluticasone propion-salmeterol inhalation aerosol powdr breath activated

AirDuo RespiClick QL

fluticasone propion-salmeterol inhalation blister with device

Advair Diskus QL

wixela inhub inhalation blister with device

CYSTIC FIBROSIS THERAPY AGENTS

tobramycin in 0.225 % nacl inhalation solution for nebulization

Tobi QL

EXPECTORANTS

adult tussin chest congestion oral liquid OTC

adult wal-tussin oral liquid OTC

chest congestion relief oral tablet OTC

child mucus relief expectorant oral liquid OTC

children's chest congestion oral liquid OTC

cough syrup oral liquid OTC

diabetic siltussin das-na oral liquid OTC

diabetic tussin ex oral liquid OTC

expectorant cough syrup oral liquid OTC

expectorant oral liquid OTC

fenesin ir oral tablet OTC

geri-tussin oral liquid OTC

guaifenesin oral liquidAdult Tussin Chest Congestion

OTC

guaifenesin oral tablet Expectorant OTC

mucosa oral tablet OTC

mucus relief chest oral tablet OTC

mucus relief oral tablet OTC

ri-tussin oral liquid OTC

robafen oral liquid OTC

128


scot-tussin expectorant oral liquid OTC

siltussin sa oral liquid OTC

tussin chest congestion oral liquid OTC

tussin expectorant oral liquid OTC

tussin honey oral liquid OTC

tussin mucus-chest congestion oral liquid OTC

tussin oral liquid OTC

tussin oral tablet OTC

GENERAL BRONCHODILATOR AGENTS

ATROVENT HFA INHALATION HFA AEROSOL INHALER

QL

ipratropium bromide inhalation solution QL

SPIRIVA RESPIMAT INHALATION MIST QL

IMMUNOGLOBULIN ANTIBODIES

XOLAIR SUBCUTANEOUS RECON SOLN

PA

XOLAIR SUBCUTANEOUS SYRINGE PA

MAST CELL STABILIZERS

cromolyn nasal spray,non-aerosolNasal Allergy Symptom Control

OTC

nasal allergy symptom control nasal spray,non-aerosol

OTC

MUCOLYTICS

acetylcysteine solution

PULMOZYME INHALATION SOLUTION PA; QL

NARCOTIC ANTITUSSIVE COMBINATIONS

cheratussin ac oral liquid AL; OTC; QL

guaiatussin ac oral liquid AL; OTC; QL

guaifenesin ac oral liquid AL; OTC; QL

guaifenesin dac oral syrup AL; OTC

hydrocodone-homatropine oral syrup Hydrocodone Compound AL

hydrocodone-homatropine oral tablet AL

hydromet oral syrup AL

m-clear wc oral liquid AL; OTC

promethazine-codeine oral syrup AL; QL

129


promethazine-phenyleph-codeine oral syrup

AL; QL

tusnel c oral syrup AL; OTC

virtussin ac oral liquid AL; OTC; QL

NASAL ANTICHOLINERGICS

ipratropium bromide nasal spray,non-aerosol

NASAL ANTIHISTAMINES

azelastine nasal aerosol,spray QL

azelastine nasal spray,non-aerosol Astepro QL

NASAL CORTICOSTEROIDS

24 hour allergy relief nasal spray,suspension

OTC; QL

24 HOUR NASAL ALLERGY NASAL AEROSOL,SPRAY

OTC; QL

aller-flo nasal spray,suspension OTC; QL

allergy relief (fluticasone) nasal spray,suspension 50 mcg/actuation

OTC; QL

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 propionate nasal spray,suspension

24 Hour Allergy Relief OTC; QL

NASACORT NASAL AEROSOL,SPRAY OTC; QL

nasal allergy nasal aerosol,spray OTC; QL

QC ALLERGY RELIEF 50 MCG SPRAY OTC; QL

triamcinolone acetonide nasal aerosol,spray

24 Hour Nasal Allergy OTC; QL

NASAL, OTHER

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

children's saline nasal spray nasal aerosol,spray

OTC

130


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

benzonatate oral capsule

biocotron oral liquid OTC; QL

biogil oral liquid OTC

brotapp dm oral elixir OTC

child chest congestion-cough oral liquid OTC

child mucus relief cough oral liquid OTC

children's cough oral liquid OTC

CHILDREN'S MUCINEX COUGH ORAL LIQUID

OTC

cough dm er oral suspension,extended rel 12 hr

OTC

cough relief oral liquid OTC; QL

cough syrup dm oral syrup OTC; QL

day-time cough oral syrup OTC

despec eda cough-cold drops oral drops OTC

dextromethorphan polistirex oral suspension,extended rel 12 hr

12-Hour Cough Relief OTC

dextromethorphan-guaifenesin oral syrup Adult Tussin DM OTC; QL

diabetic siltussin-dm oral liquid OTC; QL

diabetic tussin dm oral liquid OTC; QL

131


g-tron oral liquid OTC; QL

MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HR

OTC

MUCINEX FAST-MAX DM MAX ORAL LIQUID

OTC

mucus relief cough oral liquid OTC

mucus relief dm max oral liquid OTC

neo-tuss oral liquid OTC

non-aspirin flu oral tablet OTC

pediatric cough and cold oral liquid OTC

promethazine-dm oral syrup AL; QL

ri-tussin dm oral syrup OTC; QL

robafen dm cough oral liquid OTC; QL

robafen dm cough-chest congest oral syrup

OTC; QL

siltussin dm das oral liquid OTC; QL

siltussin-dm oral syrup OTC; QL

supress dx oral drops OTC

tusnel diabetic oral liquid OTC; QL

tussin cough (dm only) oral liquid OTC; QL

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 oral liquid OTC; QL

tussin dm oral syrup OTC; QL

tussin maximum strength cough oral syrup OTC; QL

vicks dayquil cough oral syrup OTC

wal-tussin cough oral liquid OTC; QL

wal-tussin dm oral syrup OTC; QL

wal-tussin max strength cough oral syrup OTC; QL

SYSTEMIC SYMPATHOMIMETIC DECONGESTANTS

12 hour decongestant oral tablet extended release

OTC

12 hour nasal decongest (pse) oral tablet extended release

AL; OTC

children's silfedrine oral liquid OTC

nasal decongestant (pseudoeph) oral tablet

OTC

132


nasal decongestant (pseudoeph) oral tablet extended release

OTC

pedia relief infant nasal oral drops OTC

pseudoephedrine hcl oral tabletNasal Decongestant (pseudoeph)

AL; OTC

pseudoephedrine hcl oral tablet extended release

12 Hour Decongestant OTC

sinus 12 hour oral tablet extended release OTC

sudogest 12-hour oral tablet extended release

OTC

sudogest oral tablet OTC

suphedrin oral liquid OTC

suphedrin oral tablet OTC

suphedrine 12 hour oral tablet extended release

OTC

suphedrine oral tablet OTC

wal-phed 12 hour oral tablet extended release

OTC

wal-phed d oral tablet extended release OTC

wal-phed oral tablet OTC

XANTHINES

theochron oral tablet extended release 12 hr

theophylline oral elixir Elixophyllin

theophylline oral solution

theophylline oral tablet extended release 12 hr

Theochron

theophylline oral tablet extended release 24 hr

VAGINAL PRODUCTS

VAGINAL ANTIBIOTICS

CLEOCIN VAGINAL SUPPOSITORY

clindamycin phosphate vaginal cream Cleocin

metronidazole vaginal gel Metrogel Vaginal

vandazole vaginal gel

VAGINAL ANTIFUNGALS

3 day vaginal vaginal cream OTC

3-day vaginal vaginal cream OTC

clotrimazole 3 day vaginal cream OTC

133


clotrimazole vaginal cream Clotrimazole-7 OTC; QL

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-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-3 vaginal suppository PA

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

OTC; QL

terconazole vaginal cream QL

terconazole vaginal suppository QL

tioconazole vaginal ointment 1-Day OTC

tioconazole-1 vaginal ointment OTC

VAGINAL ESTROGEN PREPARATIONS

estradiol vaginal tablet Vagifem

yuvafem vaginal tablet

134

medicaid-approved preferred drug list · 2019. 9. 14. · new jersey medicaid-approved preferred...

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