supplemental preferred drug list (pdl) - uhcprovider.com · 2021. 3. 2. · color, national origin,...

Supplemental Preferred Drug List (PDL)

Pennsylvania – UnitedHealthcare Community PlanEffective Date: 1/1/2021

© 2021 United HealthCare Services, Inc. All Rights Reserved.

UnitedHealthcare Community Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation.

UnitedHealthcare Community Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation.

UnitedHealthcare Community Plan provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters• Written information in other formats (large print, audio, accessible electronic formats,

other formats)

UnitedHealthcare Community Plan provides free language services to people whose primary language is not English, such as:

• Qualified interpreters• Information written in other languages

If you need these services, contact UnitedHealthcare Community Plan at 1-800-414-9025, TTY/PA RELAY 711.

If you believe that UnitedHealthcare Community Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation, you can file a complaint with:

UnitedHealthcare Community Plan P.O. Box 30608 Salt Lake City, UT 84131-0364

The Bureau of Equal Opportunity Room 223, Health and Welfare Building P.O. Box 2675 Harrisburg, PA 17105-2675 Phone: 717-787-1127, TTY/PA Relay 711 Fax: 717-772-4366, or Email: [email protected]

You can file a complaint in person or by mail, fax, or email. If you need help filing a complaint, UnitedHealthcare Community Plan and the Bureau of Equal Opportunity are available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 1-800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

CSPA15MC4049801_001

UnitedHealthcare Community Plan cumple con las leyes federales de derechos civiles aplicables y no discrimina por raza, color, nacionalidad, edad, discapacidad, creencias, afiliación religiosa, ascendencia, sexo, identificación de sexo, expresión sexual u orientación sexual.

UnitedHealthcare Community Plan no excluye a las personas ni las trata de manera diferente debido a su raza, color, nacionalidad, edad, discapacidad, creencias, afiliación religiosa, ascendencia, sexo, identificación de sexo, expresión sexual u orientación sexual.

UnitedHealthcare Community Plan proporciona ayuda y servicios gratuitos a personas con discapacidades para que puedan comunicarse con nosotros de manera efectiva, por ejemplo:

• Intérpretes de lenguaje de señas calificados• Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles

y demás formatos)

UnitedHealthcare Community Plan ofrece servicios de idioma gratuitos a las personas cuyo idioma principal no es el inglés, por ejemplo:

• Intérpretes calificados• Información escrita en otros idiomas

Si necesita estos servicios, comuníquese con UnitedHealthcare Community Plan al 1-800-414-9025, TTY/PA RELAY 711.

Si considera que UnitedHealthcare Community Plan no ha proporcionado estos servicios o ha discriminado de otro modo en función de la raza, el color, la nacionalidad, la edad, la discapacidad, las creencias, la afiliación religiosa, la ascendencia, el sexo, la identificación de sexo, la expresión sexual o la orientación sexual, puede presentar una queja con:

UnitedHealthcare Community Plan P.O. Box 30608 Salt Lake City, UT 84131-0364

The Bureau of Equal Opportunity Room 223, Health and Welfare Building P.O. Box 2675 Harrisburg, PA 17105-2675 Teléfono: 717-787-1127, TTY/PA Relay 711 Fax: 717-772-4366, o Correo electrónico: [email protected]

Usted puede presentar una queja en persona o por correo, fax o por correo electrónico. Si necesita ayuda para presentar una queja, UnitedHealthcare Community Plan y la Oficina de Igualdad de Oportunidades están disponibles para brindarle asistencia.

También puede presentar un reclamo de derechos civiles ante la Oficina de Derechos Civiles del Departamento de Salud y Servicios Humanos de los EE. UU. por vía electrónica a través del Portal de Quejas de la Oficina de Derechos Civiles disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o por correo postal o teléfono al:

U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, DC 20201 1-800-368-1019, 1-800-537-7697 (TDD)

Los formularios de reclamos están disponibles en http://www.hhs.gov/ocr/office/file/index.html.

ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call: 1-800-414-9025, TTY/PA RELAY: 711.ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-414-9025, TTY/PA RELAY: 711.

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주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-414-9025, TTY/PA RELAY: 711 번으로 전화해 주십시오.

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သတိျပဳရန္ - အကယ္၍ သင္သည္ ျမန္မာစကား ေျပာပါက၊ ဘာသာစကား အကူအညီ၊ အခမဲ့၊ သင့္အတြက္ စီစဥ္ေဆာင္ရြက္ေပးပါမည္။ ဖုန္းနံပါတ္ 1-800-414-9025, TTY/PA RELAY: 711 သုိ႔ ေခၚဆိုပါ။

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-414-9025, TTY/PA RELAY: 711.

ATENÇÃO: se fala português, encontram-se disponíveis serviços linguísticos gratuitos. Ligue para 1-800-414-9025, TTY/PA RELAY: 711.

লক্ষ্য করুন: আপনন যনি বাংলায় কথা বললন, তাহলল আপনার জনষ্য নবনা খরলে ভাষা সহায়তা পনরলষবা উপলব্ধ আলে। 1-800-414-9025, TTY/PA RELAY: 711 নম্বলর ফ�ান করুন।

KUJDES: Nëse flisni shqip, për ju ka në dispozicion shërbime falas të ndihmës gjuhësore. Telefononi në 1-800-414-9025, TTY/PA RELAY: 711.

સચૂના: જો તમે ગજુરાતી બોલતા હો, તો નન:શલુ્ક ભાષા સહાયતા સેવાઓ તમારા માટે ઉપલબ્ધ છે. ્કૉલ ્કરો 1-800-414-9025, TTY/PA RELAY: 711.

CSPA15MC3971164_000

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call: 1-800-414-9025, TTY/PA RELAY: 711.ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-414-9025, TTY/PA RELAY: 711.

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Table of Contents

Analgesics - Drugs to Treat Pain, Inflammation, and Muscle and Joint Conditions .......................... 3 Anesthetics - Drugs for Numbing ..................................................................................................................... 7 Anti-Addiction/Substance Abuse Treatment Agents - Drugs for Overdose or Deterrence .............. 7 Antibacterials ......................................................................................................................................................... 7 Antibacterials - Drugs to Treat Bacterial Infections .................................................................................... 7 Antimyasthenic Agents - Drugs to Treat Myasthenia Gravis .................................................................... 8 Antimycobacterials - Drugs to Treat Infections ............................................................................................ 8 Antineoplastics - Drugs to Treat Cancer......................................................................................................... 8 Antiparasitics - Drugs to Treat Parasitic Infections ................................................................................... 10 Antivirals - Drugs to Treat Viral Infections ................................................................................................... 10 Bipolar Agents - Drugs to Treat Mood Disorders ....................................................................................... 10 Blood Glucose Regulators - Drugs to Regulate Blood Sugar ................................................................. 10 Blood Products/Modifiers/Volume Expanders - Drugs to Treat Blood Disorders ............................. 11 Cardiovascular Agents - Drugs to Treat Heart and Circulation Conditions ........................................ 11 Central Nervous System Agents - Drugs to Treat Nerve Conditions .................................................... 13 Dental and Oral Agents - Drugs to Treat Mouth and Throat Conditions .............................................. 13 Dermatological Agents - Drugs to Treat Skin Conditions ........................................................................ 13 Electrolytes/Minerals/Metals/Vitamins .......................................................................................................... 16 Gastrointestinal Agents - Drugs to Treat Bowel, Intestine and Stomach Conditions ...................... 26 Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment ....................................................... 38 Genitourinary Agents - Drugs to Treat Bladder, Genital and Kidney Conditions .............................. 38 Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) - Drugs to Regulate Hormones 39 Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins) - Drugs to Regulate Hormones .............................................................................................................................................................. 39 Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) - Drugs to Regulate Hormones ............................................................................................................................................ 40 Hormonal Agents, Suppressant (Adrenal) - Drugs to Regulate Hormones......................................... 40 Hormonal Agents, Suppressant (Pituitary) - Drugs to Regulate Hormones ....................................... 40 Hormonal Agents, Suppressant (Thyroid) - Drugs to Suppress Thyroid Hormones ........................ 41 Immunological Agents - Drugs that Stimulate or Suppress the Immune System ............................. 41 Inflammatory Bowel Disease Agents - Drugs to Treat Inflammatory Bowel Disease ....................... 42 Metabolic Bone Disease Agents - Drugs to Treat Bone Conditions ..................................................... 42 Miscellaneous Therapeutic Agents ................................................................................................................ 43 Ophthalmic Agents - Drugs to Treat Eye Conditions ................................................................................ 45 Otic Agents - Drugs to Treat Ear Conditions ............................................................................................... 48 Respiratory Tract/Pulmonary Agents - Drugs to Treat Allergies, Cough, Cold and Lung Conditions ............................................................................................................................................................. 49

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Sleep Disorder Agents - Drugs for Sedation and Sleep ........................................................................... 59 Therapeutic Nutrients/Minerals/Electrolytes - Drugs to Treat Vitamin, Mineral and Body Fluid Deficiencies........................................................................................................................................................... 59

AL: Limited to members of a certain age; DX2RX: Diagnosis Required; GE: Gender Limit; PA: Prior Auth Required; QL: Quantity Limit; SP: Specialty Medication

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Drug Name Reference Brand-Generic Requirements & Limits

Analgesics - Drugs to Treat Pain, Inflammation, and Muscle and Joint Conditions

Analgesics - Miscellaneous Analgesics

8 hour arthritis pain reliever Tylenol 8 Hour Generic QL 8 hour arthritis relief Tylenol 8 Hour Generic QL 8 hour pain reliever Tylenol 8 Hour Generic QL 8 hr arthritis pain relief Tylenol 8 Hour Generic QL 8hr arthritis pain relief Tylenol 8 Hour Generic QL 8hr muscle aches & pain Tylenol 8 Hour Generic QL acetaminophen 8 hour Tylenol 8 Hour Generic QL acetaminophen childrens Generic QL acetaminophen er Tylenol 8 Hour Generic QL acetaminophen ex st oral liquid 500 mg/15ml

Mapap Acetaminophen Extra Str Generic QL

acetaminophen ex st oral tablet 500 mg Medi-Tabs Extra Strength Generic QL acetaminophen extra strength Medi-Tabs Extra Strength Generic QL acetaminophen infants Panadol Childrens Generic QL

acetaminophen oral liquid 500 mg/15ml Mapap Acetaminophen Extra Str Generic QL

acetaminophen oral solution 160 mg/5ml, 325 mg/10.15ml, 650 mg/20.3ml Generic QL

acetaminophen oral suspension 160 mg/5ml, 650 mg/20.3ml Panadol Childrens Generic QL

acetaminophen oral tablet 325 mg Pharbetol Generic QL acetaminophen oral tablet 500 mg Medi-Tabs Extra Strength Generic QL acetaminophen oral tablet chewable 160 mg Mapap Childrens Generic QL

acetaminophen rectal suppository 120 mg FeverAll Childrens Generic QL acetaminophen rectal suppository 650 mg FeverAll Adults Generic QL added strength headache relief Excedrin Extra Strength Generic QL aminofen Pharbetol Generic QL apra Medi-Tabs Childrens Generic QL arthritis pain oral tablet extended release 650 mg Tylenol 8 Hour Generic QL

arthritis pain relief oral tablet extended release 650 mg Tylenol 8 Hour Generic QL

arthritis pain reliever oral Tylenol 8 Hour Generic QL


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aurophen childrens Panadol Childrens Generic QL betatemp childrens Panadol Childrens Generic QL CASTIVA WARMING Brand childrens acetaminophen oral suspension 160 mg/5ml Panadol Childrens Generic QL

childrens apap Childrens Medi-Tabs Generic QL childrens medi-tabs Childrens Medi-Tabs Generic QL childrens non-aspirin Childrens Medi-Tabs Generic QL childrens silapap Little Remedies for Fever Generic QL childrens tactinal Childrens Medi-Tabs Generic QL childs non-aspirin Childrens Medi-Tabs Generic QL ed-apap Little Remedies for Fever Generic QL EXCEDRIN EXTRA STRENGTH Brand QL EXCEDRIN MIGRAINE Brand QL fever reducer childrens FeverAll Childrens Generic QL fever reducing childrens FeverAll Childrens Generic QL feverall adults FeverAll Adults Generic QL feverall childrens FeverAll Childrens Generic QL FEVERALL INFANTS Brand QL feverall junior strength Generic QL headache formula Excedrin Extra Strength Generic QL headache relief Excedrin Extra Strength Generic QL headache relief extra str Excedrin Extra Strength Generic QL headrin ex strength pain rel Excedrin Extra Strength Generic QL infants pain & fever Panadol Childrens Generic QL infants pain relief drops Panadol Childrens Generic QL infants pain relief oral suspension 80 mg/0.8ml Generic QL

infants pain/fever Panadol Childrens Generic QL liquid acetaminophen Little Remedies for Fever Generic QL liquid pain relief Little Remedies for Fever Generic QL

mapap acetaminophen extra str Mapap Acetaminophen Extra Str Generic

mapap arthritis pain Tylenol 8 Hour Generic QL mapap childrens Mapap Childrens Generic QL mapap oral capsule Generic QL medi-tabs extra strength Medi-Tabs Extra Strength Generic QL


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migraine formula Excedrin Extra Strength Generic QL migraine relief Excedrin Extra Strength Generic QL mm arthritis pain Tylenol 8 Hour Generic QL m-pap Little Remedies for Fever Generic QL non-aspirin Pharbetol Generic QL non-aspirin childrens Panadol Childrens Generic QL non-aspirin extra strength Medi-Tabs Extra Strength Generic QL non-aspirin jr strength Mapap Childrens Generic QL non-aspirin pain relief Pharbetol Generic QL non-aspirin pain reliever oral tablet 325 mg Pharbetol Generic QL

pain & fever child Panadol Childrens Generic QL pain & fever childrens Panadol Childrens Generic QL pain & fever infants Panadol Childrens Generic QL pain relief childrens Panadol Childrens Generic QL pain relief extra st Medi-Tabs Extra Strength Generic QL pain relief extra strength oral capsule 500 mg Generic QL

pain relief extra strength oral liquid 500 mg/15ml

Mapap Acetaminophen Extra Str Generic

pain relief extra strength oral tablet 500 mg Medi-Tabs Extra Strength Generic QL

pain relief oral liquid 500 mg/15ml Mapap Acetaminophen Extra Str Generic

pain relief oral tablet 325 mg Pharbetol Generic QL pain relief oral tablet 500 mg Medi-Tabs Extra Strength Generic QL pain relief oral tablet extended release 650 mg Tylenol 8 Hour Generic QL

pain relief regular st Pharbetol Generic QL pain relief regular strength Pharbetol Generic QL pain reliever extra strength Excedrin Extra Strength Generic QL pain reliever oral tablet Pharbetol Generic QL pain reliever plus Excedrin Extra Strength Generic QL pain-off Excedrin Extra Strength Generic QL PANADOL CHILDRENS Brand QL PANADOL EXTRA STRENGTH Brand QL PANADOL INFANTS Brand QL pharbetol extra strength Medi-Tabs Extra Strength Generic QL


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pharbetol oral tablet 325 mg Pharbetol Generic QL tactinal Pharbetol Generic QL tactinal extra strength Medi-Tabs Extra Strength Generic QL TYLENOL 8 HOUR Brand QL TYLENOL 8 HOUR ARTHRITIS PAIN Brand QL TYLENOL CHILDRENS CHEWABLES Brand QL TYLENOL CHILDRENS ORAL SUSPENSION Brand QL

TYLENOL EXTRA STRENGTH Brand QL TYLENOL INFANTS Brand QL TYLENOL INFANTS PAIN+FEVER Brand QL TYLENOL ORAL TABLET Brand QL Nonsteroidal Anti-Inflammatory Drugs - Pain/Anti-Inflammatory Drugs

adult aspirin ec low strength oral tablet delayed release 81 mg Miniprin Low Dose Generic QL

adult aspirin low strength St Joseph Low Dose Generic QL adult aspirin regimen Miniprin Low Dose Generic QL aspirin 81 oral tablet delayed release Miniprin Low Dose Generic QL aspirin adult Bayer Aspirin Generic QL aspirin adult low dose St Joseph Low Dose Generic QL aspirin adult low st St Joseph Low Dose Generic QL aspirin adult low strength Miniprin Low Dose Generic QL aspirin childrens St Joseph Low Dose Generic QL aspirin ec EcPirin Generic QL aspirin ec low dose Miniprin Low Dose Generic QL aspirin ec low strength Miniprin Low Dose Generic QL aspirin low dose Miniprin Low Dose Generic QL aspirin low strength St Joseph Low Dose Generic QL aspirin oral St Joseph Low Dose Generic QL aspirin rectal Generic QL aspirtab EcPirin Generic QL

aspirtab maximum strength Bayer Advanced Aspirin Ex St Generic QL

BAYER ASPIRIN Brand QL BAYER ASPIRIN EC LOW DOSE Brand QL


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childrens aspirin St Joseph Low Dose Generic QL childrens aspirin low strength St Joseph Low Dose Generic QL ECOTRIN MAXIMUM STRENGTH Brand QL ecpirin EcPirin Generic QL miniprin low dose Miniprin Low Dose Generic QL salsalate oral Generic QL ST JOSEPH LOW DOSE Brand QL Anesthetics - Drugs for Numbing Local Anesthetics lidocaine hcl mouth/throat Generic Anti-Addiction/Substance Abuse Treatment Agents - Drugs for Overdose or Deterrence

Alcohol Deterrents/Anti-craving - Antidotes/Deterrents/Protectants

acamprosate calcium Generic disulfiram oral tablet 250 mg Generic disulfiram oral tablet 500 mg Generic Antibacterials Antibacterials, Other methenamine hippurate Hiprex Generic QL nitrofurantoin macrocrystal oral Macrodantin Generic QL nitrofurantoin monohydrate macrocrystals Macrobid Generic QL Antibacterials - Drugs to Treat Bacterial Infections

Antibacterials, Other - Antibiotics aplicare povidone-iodine external solution Aplicare Povidone-Iodine Generic BETADINE EXTERNAL SOLUTION 10 % Brand clindamycin hcl oral capsule 150 mg, 300 mg Cleocin Generic

clindamycin palmitate hcl Cleocin Generic linezolid oral suspension reconstituted Zyvox Generic PA linezolid oral tablet Zyvox Generic PA metronidazole external Rosadan Generic povidone-iodine external solution Aplicare Povidone-Iodine Generic pvp prep Aplicare Povidone-Iodine Generic


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rosadan external cream Rosadan Generic rosadan external gel Rosadan Generic SCRUB CARE POVIDONE-IODINE Brand trimethoprim oral Generic Sulfonamides - Antibiotics silver sulfadiazine external SSD Generic ssd SSD Generic sulfamethoxazole-trimethoprim oral Bactrim Generic sulfatrim pediatric Sulfatrim Pediatric Generic Antimyasthenic Agents - Drugs to Treat Myasthenia Gravis

Parasympathomimetics - Myasthenia Gravis Drugs

pyridostigmine bromide er Mestinon Generic pyridostigmine bromide oral solution Mestinon Generic pyridostigmine bromide oral tablet 60 mg Mestinon Generic Antimycobacterials - Drugs to Treat Infections

Antimycobacterials, Other - Miscellaneous Anti-Infectives

dapsone oral Generic rifabutin Mycobutin Generic Antituberculars - Tuberculosis Drugs

cycloserine oral Generic ethambutol hcl oral tablet 100 mg Generic ethambutol hcl oral tablet 400 mg Myambutol Generic isoniazid oral Generic PASER Brand PRIFTIN Brand pyrazinamide oral Generic rifampin oral Generic SIRTURO Brand QL TRECATOR Brand Antineoplastics - Drugs to Treat Cancer


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Alkylating Agents - Chemotherapy Agents

cyclophosphamide oral Generic GLEOSTINE Brand LEUKERAN Brand MATULANE Brand SP melphalan Alkeran Generic MYLERAN Brand Antiandrogens - Hormone Suppressants

flutamide Generic QL Antiestrogens/Modifiers - Chemotherapy Agents

EMCYT Brand Antimetabolites - Chemotherapy Agents

mercaptopurine oral Generic TABLOID Brand SP Antineoplastics, Other - Chemotherapy Agents

leucovorin calcium oral tablet 10 mg Generic leucovorin calcium oral tablet 15 mg, 25 mg, 5 mg Generic

Enzyme Inhibitors - Chemotherapy Agents

etoposide oral Generic HYCAMTIN ORAL Brand PA; SP Molecular Target Inhibitors - Chemotherapy Agents

FARYDAK ORAL CAPSULE 15 MG Brand PA; SP; QL Retinoids - Chemotherapy Agents bexarotene Targretin Generic PA; SP PANRETIN Brand PA TARGRETIN EXTERNAL Brand PA; SP tretinoin oral Generic SP Treatment Adjuncts - Supportive Chemotherapy Drugs


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MESNEX ORAL Brand SP Antiparasitics - Drugs to Treat Parasitic Infections

Anthelmintics - Worm Infection Drugs

albendazole oral Albenza Generic PA; QL ivermectin oral Stromectol Generic praziquantel oral Biltricide Generic DX2RX Antiprotozoals - Protozoal Infection Drugs

ALINIA ORAL TABLET Brand PA atovaquone oral Mepron Generic PA; QL BENZNIDAZOLE Brand PA IMPAVIDO Brand QL pentamidine isethionate inhalation Nebupent Generic pyrimethamine oral Daraprim Generic PA; SP; QL Antivirals - Drugs to Treat Viral Infections

Anti-hepatitis C (HCV) Agents, Other - Hepatitis C Drugs

INTRON A Brand PA; SP Antiherpetic Agents - Herpes Drugs trifluridine Generic Bipolar Agents - Drugs to Treat Mood Disorders

Mood Stabilizers - Mood Disorder Drugs

lithium Generic lithium carbonate er Lithobid Generic lithium carbonate oral Generic Blood Glucose Regulators - Drugs to Regulate Blood Sugar

Glycemic Agents - Diabetic Drugs

glucose oral tablet chewable 4 gm Dex4 Quick Dissolve Glucose Generic

soft glucose Dex4 Quick Dissolve Glucose Generic


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Blood Products/Modifiers/Volume Expanders - Drugs to Treat Blood Disorders

Anticoagulants - Blood Thinners heparin sodium (porcine) Generic heparin sodium (porcine) pf Generic Blood Formation Modifiers - Blood Formation Drugs

anagrelide hcl Agrylin Generic MOZOBIL Brand PA; SP; QL Hemostasis Agents - Drugs to Stop Bleeding

aminocaproic acid oral Amicar Generic tranexamic acid oral Lysteda Generic PA; QL Platelet Modifying Agents - Platelet Modifying Drugs

CABLIVI Brand PA; SP cilostazol Generic QL Cardiovascular Agents - Drugs to Treat Heart and Circulation Conditions

Alpha-adrenergic Agonists - Blood Pressure Drugs

midodrine hcl Generic Antiarrhythmics - Heart Regulation Drugs

amiodarone hcl oral tablet 200 mg, 400 mg Pacerone Generic

disopyramide phosphate Norpace Generic dofetilide Tikosyn Generic QL flecainide acetate Generic mexiletine hcl oral Generic NORPACE CR Brand pacerone oral tablet 200 mg Pacerone Generic propafenone hcl Generic quinidine gluconate er Generic quinidine sulfate Generic


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Cardiovascular Agents, Other - Miscellaneous Cardiac Drugs

amiloride-hydrochlorothiazide Generic digitek Digitek Generic digox Digitek Generic digoxin oral Digitek Generic pentoxifylline er Generic spironolactone-hctz Aldactazide Generic triamterene-hctz Maxzide-25 Generic VYNDAMAX Brand PA; SP; QL VYNDAQEL Brand PA; SP; QL Diuretics, Carbonic Anhydrase Inhibitors - Cardiac Drugs

methazolamide oral Generic Diuretics, Loop - Cardiac Drugs bumetanide oral Bumex Generic furosemide oral solution 10 mg/ml Generic furosemide oral tablet Lasix Generic torsemide Generic Diuretics, Potassium-sparing - Cardiac Drugs

amiloride hcl oral Generic spironolactone oral Aldactone Generic Diuretics, Thiazide - Cardiac Drugs chlorthalidone Generic DIURIL Brand hydrochlorothiazide oral Generic indapamide Generic metolazone Generic Vasodilators, Direct-acting Arterial - Chest Pain Drugs

hydralazine hcl oral Generic minoxidil oral Generic Vasodilators, Direct-acting Arterial/Venous - Chest Pain Drugs

RECTIV Brand DX2RX; QL


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Central Nervous System Agents - Drugs to Treat Nerve Conditions

Central Nervous System, Other - Miscellaneous Central Nervous System Drugs

caffeine citrate oral Generic QL; AL NUEDEXTA Brand DX2RX; QL riluzole Rilutek Generic QL Dental and Oral Agents - Drugs to Treat Mouth and Throat Conditions

cavarest Cavarest Generic chlorhexidine gluconate mouth/throat Paroex Generic denta 5000 plus Denta 5000 Plus Generic dentagel Cavarest Generic easygel Generic fluoridex daily renewal Generic oralone Oralone Generic paroex Paroex Generic periogard Paroex Generic pilocarpine hcl oral Salagen Generic PREVIDENT 5000 DRY MOUTH Brand PREVIDENT 5000 PLUS Brand PREVIDENT DENTAL Brand sf Cavarest Generic sf 5000 plus Denta 5000 Plus Generic sodium fluoride 5000 plus Denta 5000 Plus Generic sodium fluoride 5000 ppm dental cream Denta 5000 Plus Generic sodium fluoride dental cream Denta 5000 Plus Generic sodium fluoride dental gel Cavarest Generic triamcinolone acetonide mouth/throat Oralone Generic Dermatological Agents - Drugs to Treat Skin Conditions

acne Clearskin Generic acne control cleanser Clearskin Generic acne treatment external cream 10 % Clearskin Generic


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adv acne spot treatment Neutrogena Oil-Free Acne Wash Generic

advanced acne spot treat Clean & Clear Acne Scrub Generic

advanced healing DermaPhor Generic alum sulfate-ca acetate Domeboro Generic amcinonide external ointment Generic ammonium lactate external AL12 Generic AQUAPHILIC Brand AQUAPHOR Brand astringent solution Domeboro Generic azelaic acid external Finacea Generic beauty 360 pure glycerin Generic betasept surgical scrub Betasept Surgical Scrub Generic boro-packs Domeboro Generic BOUDREAUXS BABY BUTT SMOOTH Brand boudreauxs butt paste external ointment 40 % Boudreauxs Butt Paste Generic

bp wash external liquid 2.5 % PanOxyl Generic calamine external lotion Generic cerovel Cerovel Generic chlorhexidine gluconate external liquid 4 % Betasept Surgical Scrub Generic

clearskin Clearskin Generic corn & callus remover Compound W Generic

daily acne wash Neutrogena Oil-Free Acne Wash Generic

dermaphor DermaPhor Generic diaper rash creamy Dr Smiths Diaper Generic diaper rash external ointment Boudreauxs Butt Paste Generic DR SMITHS DIAPER Brand duofilm Duofilm Generic flanders buttocks DermaPhor Generic fluorouracil external cream 5 % Efudex Generic fluorouracil external solution Generic glycerin external Generic


15


glycerin external liquid 99.5 % Generic gormel Generic gormel 10 Nutraplus Generic HIBICLENS Brand hydrolatum DermaPhor Generic hydrophor DermaPhor Generic LAC-HYDRIN FIVE Brand lactic acid external Generic LANAPHILIC Brand

medicated spot Clean & Clear Acne Scrub Generic

NEUTROGENA OIL-FREE ACNE WASH Brand NUTRAPLUS EXTERNAL CREAM Brand nutraplus lotion 10 % external Nutraplus Generic NUTRAPLUS LOTION 10 % EXTERNAL Brand OINTMENT BASE Brand OVACE PLUS EXTERNAL CREAM Brand PANOXYL Brand podofilox external Generic REGRANEX Brand DX2RX SANTYL Brand scalp relief Psoriasin Generic selenium sulfide external lotion Generic

soothing bath treatment Aveeno Baby Bath Treatment Generic

sulfacetamide sodium-sulfur external lotion 10-5 % Generic

sulfacetamide sodium-sulfur external suspension 10-5 % Generic

urea 20 intensive hydrating Generic urea external lotion Cerovel Generic urea-c40 Cerovel Generic ureacin-10 Nutraplus Generic ureacin-20 Generic VANICREAM EXTERNAL OINTMENT Brand wart remover external liquid 17 % Compound W Generic


16


wart remover maximum strength external liquid Compound W Generic

zaclir cleansing Generic zinc oxide external ointment 40 % Boudreauxs Butt Paste Generic Electrolytes/Minerals/Metals/Vitamins

Electrolyte/Mineral Replacement - Vitamin, Mineral and Body Fluid Deficiency Drugs

cal mag zinc +d3 Advanced Calcium/D/Magnesium Generic

calcitrate oral tablet 950 mg Generic calcium 1200 Generic calcium 500/d RA Hi Cal Generic calcium 600 Generic calcium 600/d Generic calcium 600+d oral tablet 600-200 mg-unit Generic calcium 600+d oral tablet 600-400 mg-unit Generic calcium carb-cholecalciferol oral tablet Generic calcium carbonate oral tablet 600 mg Generic calcium carbonate oral tablet chewable 1250 (500 ca) mg Generic

calcium carbonate-vitamin d oral tablet 500-200 mg-unit RA Hi Cal Generic

calcium carbonate-vitamin d oral tablet 600-200 mg-unit Generic

calcium carbonate-vitamin d oral tablet 600-400 mg-unit Generic

calcium carbonate-vitamin d3 Generic calcium citrate + d oral tablet 315-250 mg-unit Calcitrate Generic

calcium citrate + d3 maximum Calcitrate Generic calcium citrate + oral tablet 315-200 mg-unit Generic

calcium citrate +d3 Calcitrate Generic calcium citrate+d maximum Calcitrate Generic calcium citrate+d3 Calcitrate Generic


17


calcium citrate+d3 w/magne Advanced Calcium/D/Magnesium Generic

calcium citrate-vitamin d oral tablet 315-200 mg-unit Generic

calcium high potency Generic calcium high potency/vitamin d Generic calcium oral tablet 600 mg Generic calcium oyster shell oral tablet 1250 (500 ca) mg Generic

calcium plus 600 +d Generic calcium plus vitamin d oral tablet Oysco 500+D Generic calcium/vitamin d/minerals Generic calcium-magnesium-zinc oral tablet 333-133-5 mg, 333.33-133.33-5 mg Generic

calcium-vitamin d oral tablet 600-200 mg-unit, 600-400 mg-unit Generic

calcium-vitamin d3 oral tablet 600-400 mg-unit Generic

CARBAGLU Brand PA; SP cytra-2 Generic effer-k oral tablet effervescent 25 meq Generic electrolyte solution Oralyte Freezer Pops Generic ENFAMIL ENFALYTE Brand ezfe 200 Generic fa-8 oral tablet FA-8 Generic ferretts Generic ferrous gluconate oral tablet 324 (37.5 fe) mg Generic

fluoritab Generic FLURA-DROPS Brand folic acid oral tablet 1 mg Generic folic acid oral tablet 400 mcg Generic folic acid oral tablet 800 mcg FA-8 Generic klor-con Klor-Con Generic klor-con 10 Klor-Con 10 Generic klor-con m10 Klor-Con M10 Generic klor-con m20 Klor-Con M20 Generic


18


klor-con sprinkle oral capsule extended release 10 meq Klor-Con Sprinkle Generic

klor-con/ef Generic kp calcium 600+d oral tablet 600-400 mg-unit Generic

kp calcium citrate+d Calcitrate Generic kp calcium-magnesium-zinc Generic kp ferrous gluconate Generic kp folic acid oral tablet 1 mg Generic kp folic acid oral tablet 800 mcg FA-8 Generic K-PHOS Brand K-PHOS-NEUTRAL Brand k-prime Generic magnesium oral tablet 500 mg Generic magnesium oxide oral tablet 400 (241.3 mg) mg MAGnesium-Oxide Generic

magnesium oxide oral tablet 500 mg Generic magnesium-oxide MAGnesium-Oxide Generic nafrinse NaFrinse Generic nafrinse drops NaFrinse Drops Generic oralyte freezer pops Oralyte Freezer Pops Generic oscal 500/200 d-3 RA Hi Cal Generic OS-CAL CALCIUM + D3 Brand oysco 500+d oral tablet Oysco 500+D Generic oyster calcium + d Generic oyster shell calcium RA Hi-Cal Generic oyster shell calcium 500 + d Generic oyster shell calcium plus d oral tablet 500-200 mg-unit Oysco 500+D Generic

oyster shell calcium/d oral tablet 250-125 mg-unit Generic

oyster shell calcium/d oral tablet 250-250 mg-unit, 500-400 mg-unit Generic

oyster shell calcium/d oral tablet 500-200 mg-unit RA Hi Cal Generic

oyster shell calcium/vitamin d oral tablet Oysco 500+D Generic oyster shell/vitamin d Generic


19


pa calcium/vitamin d Generic pa oyster shell calcium RA Hi Cal Generic ped electrolyte freeze pop Oralyte Freezer Pops Generic ped electrolyte freezer pops Oralyte Freezer Pops Generic PEDIALYTE FREEZER POPS Brand PEDIALYTE ORAL SOLUTION Brand PEDIALYTE SINGLES Brand pediatric electrolyte oral solution Oralyte Freezer Pops Generic phospha 250 neutral Phospha 250 Neutral Generic phosphorous Phospha 250 Neutral Generic phospho-trin 250 neutral Phospha 250 Neutral Generic potassium chloride crys er Klor-Con M10 Generic potassium chloride er oral capsule extended release 10 meq Klor-Con Sprinkle Generic

potassium chloride er oral tablet extended release Klor-Con 10 Generic

potassium chloride oral Klor-Con Generic potassium citrate er oral tablet extended release 10 meq (1080 mg) Urocit-K 10 Generic

potassium citrate er oral tablet extended release 15 meq (1620 mg) Urocit-K 15 Generic

potassium citrate er oral tablet extended release 5 meq (540 mg) Urocit-K 5 Generic

PREVIDENT MOUTH/THROAT Brand rehydralyte Oralyte Freezer Pops Generic sod citrate-citric acid Generic sodium fluoride oral solution Generic sodium fluoride oral tablet 1.1 (0.5 f) mg Generic sodium fluoride oral tablet chewable Generic virt-phos 250 neutral Phospha 250 Neutral Generic zinc chelated oral tablet 50 mg IS-ZC 50 Generic AL zinc oral tablet 50 mg IS-ZC 50 Generic AL Electrolyte/Mineral/Metal Modifiers CHEMET Brand kionex Kionex Generic sodium polystyrene sulfonate oral suspension Kionex Generic


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sodium polystyrene sulfonate rectal Generic sps Kionex Generic Vitamins a-25 Generic AL adc/f (0.5mg/ml) Generic AL alph-e Ester-E Generic AL alph-e-mixed oral capsule 400 unit Ester-E Generic AL animal shapes Animal Shapes Generic AL animal shapes plus extra c Dino-Life w/Extra C Generic AL

animal shapes plus iron Land Before Time Multivitamin Generic AL

animal shapes/iron Cerovite Jr Generic AL AQUADEKS Brand AL aqueous vitamin d BProtected Pedia D-Vite Generic AL ascorbic acid oral tablet 500 mg PureWay-C Generic AL asco-tabs-1000 Generic AL ATABEX OB Brand GE; AL b complex oral capsule Generic AL b complex vitamins Generic AL b-1 Generic AL b6 Generic AL BACMIN Brand AL biocel Lysiplex Plus Generic AL b-plex plus Lysiplex Plus Generic AL bprotected pedia d-vite BProtected Pedia D-Vite Generic AL

bprotected pedia poly-vite BProtected Pedia Poly-Vite Generic AL

bprotected pedia poly-vite/fe Generic AL bprotected vitamin c BProtected Vitamin C Generic AL c 250 oral tablet Generic AL c 500/rose hips PureWay-C Generic AL c-1000/rose hips Generic AL calcidol Calcidol Generic AL calciferol Calcidol Generic AL CENTRUM FLAVOR BURST KIDS Brand AL CENTRUM KIDS Brand AL


21


cerovite jr Cerovite Jr Generic AL chewable c with rose hips Sunkist Vitamin C Generic AL chewable childrens vitamin Cerovite Jr Generic AL chew-c Sunkist Vitamin C Generic AL

child chewable vitamins/iron Land Before Time Multivitamin Generic AL

childrens animal shapes Cerovite Jr Generic AL childrens chewable vitamins Animal Shapes Generic AL childrens chewables/ex c Dino-Life w/Extra C Generic AL

childrens chewables/iron Land Before Time Multivitamin Generic AL

childrens complete Centrum Flavor Burst Kids Generic AL

childrens vitamins/iron Land Before Time Multivitamin Generic AL

classic prenatal Generic AL cyanocobalamin injection solution 1000 mcg/ml Generic AL

d 1000 oral tablet Vitamin D-1000 Max St Generic AL d 10000 Decara Generic AL d 400 oral tablet Generic AL d 400 oral tablet chewable Healthy Kids Vitamin D3 Generic AL

d 5000 oral tablet Radiance Platinum Vitamin D3 Generic AL

d3 high potency oral capsule 25 mcg (1000 ut) Pronutrients Vitamin D3 Generic AL

d3 oral capsule 10 mcg (400 unit), 50 mcg (2000 ut) Generic AL

d3 oral capsule 125 mcg (5000 ut) Dialyvite Vitamin D 5000 Generic AL d3 oral capsule 25 mcg (1000 ut) Pronutrients Vitamin D3 Generic AL d3 super strength Generic AL d-3-5 Dialyvite Vitamin D 5000 Generic AL d3-50 D3-50 Generic AL

daily prenatal One-A-Day Womens Prenatal Generic GE; AL

daily vitamin formula+iron Generic AL decara oral capsule 1.25 mg (50000 ut) D3-50 Generic AL decara oral capsule 250 mcg (10000 ut) Decara Generic AL


22


DECARA ORAL CAPSULE 625 MCG (25000 UT) Brand AL

DIALYVITE 800 ORAL TABLET Brand AL DIALYVITE VITAMIN D 5000 Brand AL dino-life Animal Shapes Generic AL dino-life w/extra c Dino-Life w/Extra C Generic AL D-VI-SOL Brand AL d-vite pediatric BProtected Pedia D-Vite Generic AL e-400-clear Ester-E Generic AL e-400-mixed Ester-E Generic AL ENFAMIL EXPECTA Brand GE; AL ergocalciferol oral Drisdol Generic AL fruity c Generic AL full spectrum b/vitamin c Dialyvite 800 Generic AL

gummy dinos Centrum Flavor Burst Kids Generic AL

gummy multivitamin kids Centrum Flavor Burst Kids Generic AL

HYLAZINC Brand AL little ones childrens Animal Shapes Generic AL lysiplex plus oral tablet Lysiplex Plus Generic AL multiple vitamins/iron Generic AL

multiple vitamins-iron oral tablet chewable Land Before Time Multivitamin Generic AL

multi-vit/iron/fluoride Generic AL multi-vitamin/fluoride Floriva Plus Generic AL multivitamin/fluoride oral solution Floriva Plus Generic AL multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg Quflora Pediatric Generic AL

multi-vitamin/fluoride/iron Generic AL multi-vitamin/iron Generic AL multivitamins/fluoride Quflora Pediatric Generic AL mynephrocaps Mynephron Generic AL mynephron Mynephron Generic AL NASCOBAL Brand AL NEONATAL VITAMIN Brand GE; AL NEOVITE Brand AL


23


nephro vitamins Dialyvite 800 Generic AL NEPHRO-VITE Brand AL NEURO-K-250 T.D. Brand AL neuro-k-250 vitamin b6 Generic AL neuro-k-50 Generic AL neuro-k-500 Generic AL NICADAN Brand AL NICAZEL Brand AL NICAZEL FORTE Brand AL novamv pediatric multi-vitamin Generic AL NUTRICAP Brand AL nutrifac zx Lysiplex Plus Generic AL once daily/iron Generic AL one daily plus iron Generic AL ONE VITE WOMENS Brand GE; AL one-daily multi-vitamin/iron Generic AL one-daily/iron Generic AL pa vitamin d-3 gummy Healthy Kids Vitamin D3 Generic AL pa vitamin d-3 oral capsule 125 mcg (5000 ut) Dialyvite Vitamin D 5000 Generic AL

pa vitamin d-3 oral capsule 50 mcg (2000 ut) Generic AL

pa vitamin d-3 oral tablet Vitamin D-1000 Max St Generic AL pa vitamin e Ester-E Generic AL pediavit Generic AL phytonadione oral Mephyton Generic AL

poly-vite pediatric BProtected Pedia Poly-Vite Generic AL

prenatal low iron NeoNatal Vitamin Generic GE; AL prenatal multi+dha Generic GE; AL prenatal oral tablet 27-0.8 mg NeoNatal Vitamin Generic GE; AL prenatal oral tablet 28-0.8 mg Generic GE; AL prenatal vitamins Generic GE; AL prenatal/iron Generic GE; AL PRENATAL-U Brand GE; AL PRENATVITE RX Brand GE; AL


24


pronutrients vitamin d3 Pronutrients Vitamin D3 Generic AL pyridoxine hcl oral Generic AL QUFLORA PEDIATRIC ORAL SOLUTION 0.5 MG/ML Brand AL

QUFLORA PEDIATRIC ORAL TABLET CHEWABLE Brand AL

radiance platinum vitamin d3 Radiance Platinum Vitamin D3 Generic AL

renal Mynephron Generic AL RENAL MULTIVITAMIN FORMULA Brand AL renal-vite Dialyvite 800 Generic AL rena-vite Dialyvite 800 Generic AL REQ 49+ Brand AL RIGHT STEP PRENATAL Brand GE; AL SIDEROL Brand AL stress formula/iron Generic AL STROVITE FORTE ORAL TABLET Brand PA; AL STROVITE ONE Brand PA; AL support Alive Multi-Vitamin Generic AL tab-a-vite/iron Generic AL thiamine hcl oral Generic AL thiamine mononitrate oral Generic AL triphrocaps Mynephron Generic AL tri-vite pediatric BProtected Pedia Tri-Vite Generic AL tri-vite/fluoride Generic AL vinate ii Generic GE; AL virt-caps Mynephron Generic AL vita s forte Lysiplex Plus Generic AL vitacel Lysiplex Plus Generic AL

vitachew multiple vitamin Centrum Flavor Burst Kids Generic AL

VITAMAX Brand AL vitamin a oral capsule 2400 mcg (8000 ut), 3 mg (10000 ut) Generic AL

vitamin b1 Generic AL vitamin b-1 Generic AL


25


vitamin b-12 er oral tablet extended release 1000 mcg Generic AL

vitamin b12 oral tablet extended release Generic AL vitamin b-12 tr Generic AL vitamin b-6 Generic AL vitamin b-6 er Generic AL vitamin c cr Endur-C Generic AL vitamin c er oral tablet extended release 1500 mg Generic AL

vitamin c oral liquid 500 mg/5ml BProtected Vitamin C Generic AL vitamin c oral tablet 1000 mg, 250 mg Generic AL vitamin c oral tablet 500 mg PureWay-C Generic AL vitamin c oral tablet chewable 100 mg, 250 mg Generic AL

vitamin c oral tablet chewable 500 mg Sunkist Vitamin C Generic AL vitamin c w/rose hips oral tablet 500 mg PureWay-C Generic AL vitamin c/rose hips tr Endur-C Generic AL vitamin c-rose hips oral tablet PureWay-C Generic AL vitamin d (cholecalciferol) oral tablet Generic AL vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut) Drisdol Generic AL

vitamin d oral capsule 400 unit Generic AL vitamin d oral liquid 10 mcg/ml BProtected Pedia D-Vite Generic AL vitamin d oral tablet 25 mcg (1000 ut) Vitamin D-1000 Max St Generic AL vitamin d oral tablet 50 mcg (2000 ut) Thera-D 2000 Generic AL vitamin d3 oral capsule 1.25 mg (50000 ut) D3-50 Generic AL

vitamin d3 oral capsule 125 mcg (5000 ut) Dialyvite Vitamin D 5000 Generic AL vitamin d3 oral capsule 25 mcg (1000 ut) Pronutrients Vitamin D3 Generic AL vitamin d3 oral capsule 250 mcg (10000 ut) Decara Generic AL

vitamin d3 oral capsule 50 mcg (2000 ut) Generic AL vitamin d3 oral liquid 10 mcg/ml BProtected Pedia D-Vite Generic AL vitamin d3 oral tablet 10 mcg (400 unit) Generic AL

vitamin d3 oral tablet 125 mcg (5000 ut) Radiance Platinum Vitamin D3 Generic AL

vitamin d3 oral tablet 25 mcg (1000 ut) Vitamin D-1000 Max St Generic AL vitamin d3 oral tablet 50 mcg (2000 ut) Thera-D 2000 Generic AL


26


vitamin d3 oral tablet chewable 10 mcg (400 unit) Healthy Kids Vitamin D3 Generic AL

vitamin d3 super strength oral tablet Thera-D 2000 Generic AL vitamin d-400 Generic AL vitamin e oral capsule 400 unit Ester-E Generic AL vitamins acd-fluoride Generic AL VITAROCA PLUS Brand AL VITREXYL Brand PA; AL VITREXYL + IRON Brand PA; AL weekly-d D3-50 Generic AL WEST-VITE W/FOLIC ACID Brand AL womens prenatal+dha Generic GE; AL

zoo friends Centrum Flavor Burst Kids Generic AL

zoo friends complete Centrum Flavor Burst Kids Generic AL

zoo friends gummies Centrum Flavor Burst Kids Generic AL

zoo friends plus extra c Dino-Life w/Extra C Generic AL

zoo friends plus iron Land Before Time Multivitamin Generic AL

zoochews gummies Centrum Flavor Burst Kids Generic AL

Gastrointestinal Agents - Drugs to Treat Bowel, Intestine and Stomach Conditions

Antispasmodics, Gastrointestinal - Stomach and Intestine Drugs

dicyclomine hcl oral capsule Generic dicyclomine hcl oral solution Generic dicyclomine hcl oral tablet Generic glycopyrrolate oral tablet 1 mg, 2 mg Generic propantheline bromide oral Generic Gastrointestinal Agents, Other - Miscellaneous Gastrointestinal Drugs

abatinex Abatinex Generic acid gone Acid Gone Generic


27


acidophilus lactobacillus oral Abatinex Generic acidophilus oral capsule Abatinex Generic acidophilus probiotic Floranex Generic acidophilus probiotic oral capsule 10 mg Abatinex Generic acidophilus/l-sporogenes Floranex Generic

adult 50+ probiotic Digestive Adv Lactose Defense Generic

adult probiotic Digestive Adv Lactose Defense Generic

almacone double strength Almacone Double Strength Generic

alum & mag hydroxide-simeth Mi-Acid Generic alumina-magnesia-simethicone Mi-Acid Generic antacid & anti-gas oral suspension 200-200-20 mg/5ml Mi-Acid Generic

antacid & anti-gas oral suspension 400-400-40 mg/5ml

Almacone Double Strength Generic

antacid advanced Almacone Double Strength Generic

antacid anti-gas Mi-Acid Generic

antacid anti-gas max strength Almacone Double Strength Generic

antacid anti-gas reg strength Mi-Acid Generic antacid calcium Cal-Gest Antacid Generic

antacid calcium extra strength CVS Chewy Not Chalky Flavor Generic

antacid calcium rich Cal-Gest Antacid Generic

antacid extra CVS Chewy Not Chalky Flavor Generic

antacid extra strength oral suspension Almacone Double Strength Generic

antacid extra strength oral tablet chewable 160-105 mg Acid Gone Generic

antacid extra strength oral tablet chewable 750 mg

CVS Chewy Not Chalky Flavor Generic

antacid fast relief Mi-Acid Generic antacid i Mi-Acid Generic

antacid iii Almacone Double Strength Generic


28


antacid kids CVS Chewy Not Chalky Flavor Generic

antacid liquid Mi-Acid Generic antacid m Mi-Acid Generic antacid maximum Tums Ultra 1000 Generic

antacid maximum strength Almacone Double Strength Generic

antacid maximum strength oral tablet chewable 1000 mg Tums Ultra 1000 Generic

antacid oral suspension Mi-Acid Generic antacid oral tablet chewable 1000 mg Tums Ultra 1000 Generic antacid oral tablet chewable 500 mg Cal-Gest Antacid Generic

antacid oral tablet chewable 750 mg CVS Chewy Not Chalky Flavor Generic

antacid plus antigas Almacone Double Strength Generic

antacid plus anti-gas fast act Mi-Acid Generic

antacid plus anti-gas relief Almacone Double Strength Generic

antacid regular strength oral suspension Mi-Acid Generic antacid regular strength oral tablet chewable Cal-Gest Antacid Generic

antacid supreme Generic antacid ultra strength oral tablet chewable 1000 mg Tums Ultra 1000 Generic

antacid/anti-gas Almacone Double Strength Generic

antacid/simethicone ds Almacone Double Strength Generic

anti-diarr/ant-gas Imodium Multi-Symptom Relief Generic

anti-diarrheal oral liquid 1 mg/5ml Generic anti-diarrheal oral suspension 262 mg/15ml Soothe Generic

anti-diarrheal oral tablet 2 mg Imodium A-D Generic anti-gas Gas-X Ultra Strength Generic biotinex Abatinex Generic

bismatrol maximum strength Soothe Maximum Strength Generic


29


bismatrol oral suspension Soothe Generic bismatrol oral tablet chewable Soothe Generic bismuth Soothe Generic bismuth subsalicylate oral suspension Soothe Generic bismuth subsalicylate oral tablet chewable Soothe Generic calcium antacid Cal-Gest Antacid Generic

calcium antacid extra strength CVS Chewy Not Chalky Flavor Generic

calcium antacid ultra max st Tums Ultra 1000 Generic calcium antacid ultra strength Tums Ultra 1000 Generic calcium carbonate antacid oral suspension Generic

calcium carbonate antacid oral tablet Generic calcium carbonate antacid oral tablet chewable Cal-Gest Antacid Generic

calcium carbonate oral tablet chewable 500 mg Cal-Gest Antacid Generic

cal-gest antacid Cal-Gest Antacid Generic

chewy not chalky flavor CVS Chewy Not Chalky Flavor Generic

childrens soothe Childrens Soothe Generic comfort gel Mi-Acid Generic comfort gel antacid anti-gas oral suspension 400-400-40 mg/5ml

Almacone Double Strength Generic

diamode Imodium A-D Generic diarrhea Soothe Generic DIGESTIVE ADV LACTOSE DEFENSE Brand

digestive probiotic oral capsule Digestive Adv Lactose Defense Generic

digestive probiotic oral capsule 250 mg Florastor Generic diotame instydose Soothe Generic diphenoxylate-atropine Generic

fast acting antacid/anti-gas Almacone Double Strength Generic

FLORA VANCE Brand floranex oral tablet Floranex Generic foaming antacid Acid Gone Generic


30


freeze dried acidophilus Abatinex Generic gas relief drops infants Little Tummys Gas Relief Generic gas relief extra strength Gas-X Extra Strength Generic gas relief infants Little Tummys Gas Relief Generic gas relief max st Gas-X Extra Strength Generic gas relief oral capsule 125 mg Gas-X Extra Strength Generic gas relief oral capsule 180 mg Gas-X Ultra Strength Generic gas relief oral suspension Little Tummys Gas Relief Generic gas relief oral tablet chewable Generic gas relief ultra strength Gas-X Ultra Strength Generic GAS-X EXTRA STRENGTH ORAL CAPSULE Brand

GAS-X EXTRA STRENGTH ORAL TABLET CHEWABLE Brand

GAS-X ULTRA STRENGTH Brand GATTEX Brand PA; SP gavis-care Acid Gone Generic GAVISCON EXTRA RELIEF FORMULA Brand GAVISCON EXTRA STRENGTH Brand GAVISCON ORAL SUSPENSION Brand GELUSIL Brand geri-lanta Mi-Acid Generic geri-lanta supreme Generic geri-mox Mi-Acid Generic geri-pectate Soothe Generic heartburn antacid ex st Acid Gone Generic

heartburn relief ex st Gaviscon Extra Relief Formula Generic

heartburn relief oral tablet chewable 160-105 mg Acid Gone Generic

high potency probiotic Digestive Adv Lactose Defense Generic

IMODIUM A-D ORAL TABLET Brand IMODIUM MULTI-SYMPTOM RELIEF Brand infant gas relief Little Tummys Gas Relief Generic infants gas relief Little Tummys Gas Relief Generic


31


infants simethicone Little Tummys Gas Relief Generic intestinex Abatinex Generic k-pec Soothe Generic lactobacillus oral tablet Floranex Generic LACTOJEN Brand lacto-key-100 Abatinex Generic lacto-key-600 Abatinex Generic

lacto-pectin Digestive Adv Lactose Defense Generic

little tummys gas relief Little Tummys Gas Relief Generic long lasting antacid Cal-Gest Antacid Generic loperamide hcl oral capsule Imodium A-D Generic QL loperamide hcl oral tablet Imodium A-D Generic MAALOX Brand MAALOX CHILDRENS Brand MAALOX MAX ORAL SUSPENSION Brand MAALOX MULTI SYMPTOM MAX ST Brand mag-al plus Mi-Acid Generic

mag-al plus xs Almacone Double Strength Generic

magnesium oxide oral tablet 400 mg Generic magnesium oxide oral tablet 420 mg Maox Generic AL MAOX Brand AL medi-bismuth Soothe Generic

mega probiotic Digestive Adv Lactose Defense Generic

meijer antacid Almacone Double Strength Generic

meijer anti-diarrheal Imodium A-D Generic mi-acid Mi-Acid Generic mi-acid gas relief Generic

mi-acid maximum strength Almacone Double Strength Generic

milantex Mi-Acid Generic

milantex extra strength Almacone Double Strength Generic


32


mintox maximum strength Almacone Double Strength Generic

mintox plus Generic

mood support probiotic Digestive Adv Lactose Defense Generic

MYTESI Brand DX2RX; QL peptic relief Soothe Generic PEPTO-BISMOL ORAL SUSPENSION 524 MG/30ML Brand

PHAZYME Brand PHAZYME ULTRA STRENGTH Brand

pink bismuth maximum strength Soothe Maximum Strength Generic

pink bismuth oral suspension 262 mg/15ml Soothe Generic

pink bismuth oral tablet 262 mg Soothe Generic pink bismuth oral tablet chewable 262 mg Soothe Generic

pro-biotic blend Digestive Adv Lactose Defense Generic

probiotic maximum strength Digestive Adv Lactose Defense Generic

probiotic oral capsule Digestive Adv Lactose Defense Generic

probiotic oral capsule 250 mg Florastor Generic

probiotic pearls ex st Digestive Adv Lactose Defense Generic

RESTORA Brand RESTORA RX Brand RISAQUAD Brand RISAQUAD-2 Brand saccharomyces boulardii Florastor Generic

senior probiotic Digestive Adv Lactose Defense Generic

simeped Little Tummys Gas Relief Generic simethicone oral Gas-X Extra Strength Generic

smooth antacid extra st CVS Chewy Not Chalky Flavor Generic

sodium bicarbonate oral tablet Generic


33


soothe maximum strength Soothe Maximum Strength Generic

soothe oral suspension Soothe Generic soothe oral tablet Soothe Generic soothe oral tablet chewable Soothe Generic

stomach relief extra strength Soothe Maximum Strength Generic

stomach relief max st Soothe Maximum Strength Generic

stomach relief oral suspension 1050 mg/30ml, 525 mg/15ml

Soothe Maximum Strength Generic

stomach relief oral suspension 262 mg/15ml, 525 mg/30ml, 527 mg/30ml Soothe Generic

stomach relief oral tablet 262 mg Soothe Generic stomach relief oral tablet chewable 262 mg Soothe Generic

stomach relief plus Soothe Maximum Strength Generic

stomach relief ultra Soothe Maximum Strength Generic

TUMS Brand TUMS CHEWY BITES Brand TUMS E-X 750 Brand TUMS EXTRA STRENGTH 750 Brand TUMS LASTING EFFECTS Brand TUMS SMOOTHIES Brand TUMS ULTRA 1000 Brand VISBIOME HIGH POTENCY ORAL CAPSULE Brand

ZELAC Brand Laxatives - Drugs to treat Constipation

bisacodyl ec GNP Bisa-Lax Generic bisacodyl laxative The Magic Bullet Generic bisacodyl rectal The Magic Bullet Generic bisa-lax GNP Bisa-Lax Generic calcium polycarbophil FiberCon Generic citrate of magnesia Citroma Generic


34


citroma Citroma Generic CITRUCEL Brand c-lax laxative GNP Bisa-Lax Generic clearlax oral powder 17 gm/scoop ClearLax Generic COLACE Brand constulose Generic correct GNP Bisa-Lax Generic daily fiber Medi-Mucil Generic diocto Generic docu Generic docusate calcium Surfak Generic docusate mini DocuSol Mini Generic docusate sodium oral capsule Docusil Generic docusate sodium oral liquid 50 mg/5ml Generic docusate sodium oral syrup Generic docusate sodium-casanthranol oral capsule 100-30 mg Generic

docusil Docusil Generic DOCUSOL MINI Brand docuzen Senexon-S Generic dok oral capsule Docusil Generic dss Docusil Generic ducodyl GNP Bisa-Lax Generic easy-lax plus Senexon-S Generic enema Pure & Gentle Enema Generic enema disposable Pure & Gentle Enema Generic enema mineral oil Fleet Oil Generic enema ready-to-use Pure & Gentle Enema Generic ENEMEEZ MINI Brand enulose Generic EVAC Brand EX-LAX ULTRA Brand fiber laxative FiberCon Generic fiber oral powder Wal-Mucil Generic fiber oral tablet FiberCon Generic


35


fiber therapy Citrucel Generic fiber-caps FiberCon Generic FIBERCON Brand fiber-lax FiberCon Generic FLEET BISACODYL Brand FLEET ENEMA Brand FLEET OIL Brand FLEET PEDIATRIC Brand gavilax oral powder ClearLax Generic gavilyte-c Generic

gavilyte-n with flavor pack GaviLyte-N with Flavor Pack Generic

generlac Generic gentle laxative GNP Bisa-Lax Generic gentle laxative womens GNP Bisa-Lax Generic gentlelax ClearLax Generic geri-kot Senno Generic geri-mucil Generic glycerin (adult) rectal suppository 2 gm Generic glycerin (infant) Generic glycerin (infants & children) rectal suppository 1 gm Pedia-Lax Generic

glycerin (pediatric) rectal suppository 1 gm Pedia-Lax Generic

glycerin adult rectal suppository 2 gm Generic glycerin child Generic glycerin childrens Pedia-Lax Generic glycolax ClearLax Generic kao-tin oral capsule 240 mg Surfak Generic KONSYL DAILY FIBER ORAL POWDER 100 % Brand

konsyl daily fiber oral powder 28.3 % Wal-Mucil Generic ks stool softener Docusil Generic lactulose encephalopathy Generic lactulose oral solution Generic laxa basic Docusil Generic


36


laxacin Senexon-S Generic laxative GNP Bisa-Lax Generic laxative max str Generic laxative pills Generic laxative regular strength Senna Smooth Generic magnesium citrate oral solution Citroma Generic medi-mucil Medi-Mucil Generic medi-natural Senno Generic milk of magnesia Phillips Milk of Magnesia Generic mineral oil enema Fleet Oil Generic mineral oil heavy oral Generic mineral oil oral Generic MIRALAX ORAL POWDER Brand mm stool softener laxative Docusil Generic natural daily fiber Wal-Mucil Generic natural fiber laxative oral powder 28.3 % Wal-Mucil Generic natural fiber laxative oral powder 30.9 % Generic natural fiber laxative oral powder 58.6 % Wal-Mucil Generic natural fiber oral capsule 0.52 gm Medi-Mucil Generic natural fiber oral powder 28.3 % Wal-Mucil Generic natural fiber oral powder 48.57 %, 58.6 % Wal-Mucil Generic natural fiber supplement oral powder Wal-Mucil Generic natural senna laxative Senno Generic natural vegetable fiber Wal-Mucil Generic PEDIA-LAX ORAL LIQUID Brand PEDIA-LAX RECTAL SUPPOSITORY 1 GM Brand

peg 3350 oral powder ClearLax Generic

peg 3350-kcl-na bicarb-nacl GaviLyte-N with Flavor Pack Generic

PERDIEM OVERNIGHT RELIEF Brand PHILLIPS MILK OF MAGNESIA ORAL SUSPENSION 400 MG/5ML Brand

polyethylene glycol 3350 oral powder ClearLax Generic polyethylene glycol 3350-grx oral powder ClearLax Generic psyldex Generic


37


pure & gentle enema Pure & Gentle Enema Generic purelax oral powder ClearLax Generic sb docusate sodium/senna Senexon-S Generic senexon-s Senexon-S Generic senna lax Senno Generic senna laxative Senno Generic senna oral liquid Generic senna oral syrup Generic senna oral tablet Senno Generic senna plus oral tablet Senexon-S Generic senna s Senexon-S Generic senna smooth Senna Smooth Generic senna-docusate sodium Senexon-S Generic senna-lax Senno Generic senna-plus Senexon-S Generic senna-s Senexon-S Generic senna-tabs Senno Generic senna-time Senno Generic senna-time s Senexon-S Generic sennazon Generic senno Senno Generic sennosides-docusate sodium Senexon-S Generic SENOKOT Brand SENOKOT S Brand silace oral liquid Generic silace oral syrup Generic smooth lax oral powder ClearLax Generic soluble fiber therapy Generic sorbitol oral Generic stimulant laxative Senexon-S Generic stool softener laxative oral capsule Docusil Generic stool softener laxative oral tablet Senexon-S Generic stool softener oral capsule 100 mg Docusil Generic stool softener oral capsule 240 mg Surfak Generic


38


stool softener oral capsule 250 mg Generic stool softener oral capsule 50 mg Colace Clear Generic stool softener oral liquid 50 mg/5ml Generic stool softener oral syrup 60 mg/15ml Generic stool softener plus laxative Senexon-S Generic stool softener/laxative Senexon-S Generic the magic bullet The Magic Bullet Generic

trilyte GaviLyte-N with Flavor Pack Generic

vegetable lax+stool softener Senexon-S Generic veracolate GNP Bisa-Lax Generic womans laxative GNP Bisa-Lax Generic womens gentle laxative GNP Bisa-Lax Generic womens laxative GNP Bisa-Lax Generic Protectants - Ulcer and Stomach Acid Drugs

CARAFATE ORAL SUSPENSION Brand misoprostol oral Cytotec Generic sucralfate oral tablet Carafate Generic Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment

CYSTAGON Brand SP NITYR Brand DX2RX; SP sapropterin dihydrochloride Kuvan Generic DX2RX; SP STRENSIQ Brand PA; SP TEGSEDI Brand PA; SP Genitourinary Agents - Drugs to Treat Bladder, Genital and Kidney Conditions

Genitourinary Agents, Other - Miscellaneous Bladder, Genital, and Kidney Conditions Drugs

azo tabs Phenazo Generic bethanechol chloride oral Generic ELMIRON Brand DX2RX; QL penicillamine oral tablet Depen Titratabs Generic DX2RX; SP


39


phenazo oral tablet 200 mg Phenazo Generic phenazo oral tablet 95 mg Phenazo Generic phenazopyridine hcl oral tablet 100 mg Pyridium Generic phenazopyridine hcl oral tablet 200 mg Phenazo Generic PYRIDIUM Brand SHUR-SEAL CONTRACEPTIVE Brand urinary pain relief oral tablet 95 mg Phenazo Generic VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM Brand

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) - Drugs to Regulate Hormones

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) - Hormone Replacement/Modifying Drugs

chorionic gonadotropin intramuscular Novarel Generic DX2RX DDAVP RHINAL TUBE Brand desmopressin ace spray refrig Generic QL desmopressin acetate oral DDAVP Generic desmopressin acetate spray DDAVP Generic QL INCRELEX Brand PA; SP NOCDURNA Brand PA; QL NORDITROPIN FLEXPRO Brand PA; SP novarel intramuscular solution reconstituted 10000 unit Novarel Generic DX2RX

NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT

Brand DX2RX

OMNITROPE SUBCUTANEOUS SOLUTION CARTRIDGE Brand PA; SP

OVIDREL Brand DX2RX pregnyl Novarel Generic DX2RX Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins) - Drugs to Regulate Hormones


40


Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins) - Hormone Replacement/Modifying Drugs

KORLYM Brand PA; SP; QL Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) - Drugs to Regulate Hormones

Androgens - Hormone Replacement/Modifying Drugs

danazol oral Generic Progestins - Hormone Replacement/Modifying Drugs

aftera Aftera Generic econtra ez Aftera Generic econtra one-step Aftera Generic levonorgestrel Aftera Generic megestrol acetate oral suspension 40 mg/ml Generic

megestrol acetate oral tablet Generic my choice Aftera Generic my way Aftera Generic new day Aftera Generic opcicon one-step Aftera Generic option 2 Aftera Generic PLAN B ONE-STEP Brand react Aftera Generic take action Aftera Generic Hormonal Agents, Suppressant (Adrenal) - Drugs to Regulate Hormones

Hormonal Agents, Suppressant (Adrenal) - Hormone Suppressants

LYSODREN Brand Hormonal Agents, Suppressant (Pituitary) - Drugs to Regulate Hormones


41


Hormonal Agents, Suppressant (Pituitary) - Hormone Suppressants

cabergoline Generic QL EGRIFTA SV Brand DX2RX; SP octreotide acetate SandoSTATIN Generic SP SIGNIFOR Brand PA; SP; QL SOMAVERT Brand PA; SP; QL Hormonal Agents, Suppressant (Thyroid) - Drugs to Suppress Thyroid Hormones

Antithyroid Agents - Thyroid Suppressing Drugs

methimazole oral Tapazole Generic propylthiouracil oral Generic Immunological Agents - Drugs that Stimulate or Suppress the Immune System

Immunomodulators - Immune System Drugs

ACTIMMUNE Brand PA; SP leflunomide oral Arava Generic RIDAURA Brand SYNAGIS Brand PA; SP Vaccines ADACEL Brand QL AFLURIA QUADRIVALENT Brand QL BEXSERO Brand QL BOOSTRIX Brand QL DAPTACEL Brand QL DIPHTHERIA-TETANUS TOXOIDS DT Brand QL ENGERIX-B Brand QL FLUAD Brand QL FLUAD QUADRIVALENT Brand QL FLUARIX QUADRIVALENT Brand QL FLUCELVAX QUADRIVALENT Brand QL FLULAVAL QUADRIVALENT Brand QL


42


FLUMIST QUADRIVALENT Brand QL FLUZONE QUADRIVALENT Brand QL GARDASIL 9 Brand QL HAVRIX Brand QL HEPLISAV-B Brand QL HYPERTET S/D Brand QL INFANRIX Brand QL MENACTRA Brand QL MENQUADFI Brand QL MENVEO Brand QL M-M-R II Brand QL PNEUMOVAX 23 Brand QL PREVNAR 13 Brand QL RECOMBIVAX HB Brand QL SHINGRIX Brand QL; AL TDVAX Brand QL TENIVAC Brand QL TETANUS-DIPHTHERIA TOXOIDS TD Brand QL TRUMENBA Brand QL TWINRIX Brand QL VAQTA Brand QL VARIVAX Brand QL Inflammatory Bowel Disease Agents - Drugs to Treat Inflammatory Bowel Disease

Glucocorticoids - Drugs to Treat Inflammation

hydrocortisone (perianal) Procto-Pak Generic hydrocortisone rectal Cortenema Generic procto-med hc Procto-Med HC Generic procto-pak Procto-Pak Generic proctozone-hc Procto-Med HC Generic Metabolic Bone Disease Agents - Drugs to Treat Bone Conditions

Metabolic Bone Disease Agents - Osteoporosis (Bone Loss) Drugs


43


cinacalcet hcl Sensipar Generic PA; QL Miscellaneous Therapeutic Agents ACCU-CHEK AVIVA IN VITRO Brand ACCU-CHEK COMPACT PLUS CONTROL Brand

ACCU-CHEK GUIDE CONTROL Brand ACCU-CHEK SMARTVIEW CONTROL Brand ACCUTREND GLUCOSE CONTROL Brand AIRZONE PEAK FLOW METER Brand ALCOHOL PREP PADS PAD Brand ALCOHOL PREP PADS PAD 70 % Brand ASSESS FULL RANGE PEAK METER Brand ASSESS LOW RANGE PEAK METER Brand BD AUTOSHIELD DUO PEN NEEDLES Brand BD ULTRA-FINE INSULIN SYRINGES Brand BD ULTRA-FINE PEN NEEDLES Brand BREATHE EASE HUMIDIFIER Brand CARETOUCH CONTROL SOL LEVEL 2 Brand CAYA Brand CHEMSTRIP 10 MD Brand CHEMSTRIP 10/SG Brand CHEMSTRIP 2 GP Brand CHEMSTRIP 5 OB Brand CHEMSTRIP 7 Brand CHEMSTRIP 9 Brand CHEMSTRIP K Brand CHEMSTRIP UGK Brand CONDOMS Brand COOL MIST HUMIDIFER Brand EASIVENT Brand EASIVENT MASK LARGE Brand EASIVENT MASK MEDIUM Brand EASIVENT MASK SMALL Brand EASYMAX 15 LEVEL 2 CONTROL Brand EASYMAX 15 LEVEL 2-3 CONTROL Brand


44


EASYMAX CONTROL NORMAL/HIGH Brand GLUCOSE CONTROL SOLUTION IN VITRO SOLUTION Brand

INSPIREASE Brand INSPIREASE RESERVOIR BAGS Brand KETO-DIASTIX Brand KETONE CARE Brand KETONE TEST Brand KETOSTIX Brand LANCETS Brand MASK VORTEX Brand MEDISENSE GLUCOSE KETONE CONTR Brand

MEDISENSE HI/MID/LOW CONTROL Brand MEDISENSE HIGH/LOW CONTROL Brand MEDISENSE MID CONTROL Brand methergine Methergine Generic methylergonovine maleate oral Methergine Generic MINI WRIGHT PEAK FLOW METER Brand NEODOT THERMOMETER Brand NEUTEK 2TEK CONTROL Brand OMNIFLEX DIAPHRAGM Brand ONETOUCH ULTRA CONTROL Brand ONETOUCH VERIO IN VITRO SOLUTION Brand

OPTICHAMBER ADVANTAGE-LG MASK Brand OPTICHAMBER ADVANTAGE-MED MASK Brand

OPTICHAMBER ADVANTAGE-SM MASK Brand OPTICHAMBER FACE MASK-LARGE Brand OPTICHAMBER FACE MASK-MEDIUM Brand OPTICHAMBER FACE MASK-SMALL Brand OPTIHALER DEVICE Brand PRECISION GLUCOSE CONTROL Brand PRECISION GLUCOSE CONTROL SOLN Brand


45


PRECISION GLUCOSE KETONE CONTR Brand

PRECISION GLUCOSE/KETONE CONTR Brand

PREMIUM CONDOMS LUBRICATED Brand QUINTET CONTROL HIGH/NORMAL Brand RELION KETONE Brand SOLARTEK GLUCOSE CONTROL Brand SSKI Brand SUPREME II HIGH/LOW CONTROL Brand TRUECONTROL GLUCOSE CONT LEV 0 Brand

TRUECONTROL GLUCOSE CONT LEV 1 Brand

VAPORIZER WARM STEAM Brand VISTOGARD Brand VORTEX HOLDING CHAMBER/MASK Brand VORTEX VALVED HOLDING CHAMBER Brand WIDE-SEAL DIAPHRAGM 60 Brand WIDE-SEAL DIAPHRAGM 65 Brand WIDE-SEAL DIAPHRAGM 70 Brand WIDE-SEAL DIAPHRAGM 75 Brand WIDE-SEAL DIAPHRAGM 80 Brand WIDE-SEAL DIAPHRAGM 85 Brand WIDE-SEAL DIAPHRAGM 90 Brand WIDE-SEAL DIAPHRAGM 95 Brand Ophthalmic Agents - Drugs to Treat Eye Conditions

Ophthalmic Agents, Other - Miscellaneous Eye Drugs

altachlore ophthalmic ointment Altachlore Generic altachlore ophthalmic solution Altachlore Generic altafrin Altafrin Generic altalube Altalube Generic artificial tears ophthalmic solution 1.4 % Generic astringent eye drops Visine-AC Generic


46


atropine sulfate ophthalmic ointment Generic atropine sulfate ophthalmic solution 1 % Isopto Atropine Generic biolle tears Biolle Tears Generic bion tears pf Bion Tears PF Generic cyclopentolate hcl ophthalmic solution 1 % Cyclogyl Generic

CYSTARAN Brand DX2RX; SP dry-eye relief nighttime Altalube Generic eye drops advanced relief Visine Advanced Relief Generic eye drops allergy relief Visine-AC Generic eye drops ar Visine-AC Generic eye drops long lasting Systane Generic eye drops ophthalmic solution 0.05-0.1-1-1 % Visine Advanced Relief Generic

eye drops ophthalmic solution 0.4-0.3 % Systane Generic eye drops ophthalmic solution 0.5 % Ultra Fresh Generic eye lubricant Altalube Generic for sty relief Altalube Generic GENTEAL SEVERE Brand GENTEAL TEARS Brand GENTEAL TEARS MODERATE PF Brand GENTEAL TEARS NIGHT-TIME Brand GENTEAL TEARS PF Brand HYPOTEARS Brand ISOPTO ATROPINE Brand lubricant drops fast act Systane Generic lubricant drops long last Systane Generic lubricant drops ophthalmic gel 0.25-0.3 % Generic lubricant drops ophthalmic solution Systane Complete Generic lubricant eye drops (pf) ophthalmic solution 0.4-0.3 % Systane Hydration PF Generic

lubricant eye drops (pf) ophthalmic solution 0.5 % Biolle Tears Generic

lubricant eye drops ophthalmic solution 0.4-0.3 % Systane Generic

lubricant eye drops ophthalmic solution 0.5 % Ultra Fresh Generic


47


lubricant eye drops ophthalmic solution 0.6 % Systane Complete Generic

lubricant eye drops pf Biolle Tears Generic lubricant eye nighttime Altalube Generic lubricant eye pm Altalube Generic lubricant pm Altalube Generic lubricating eye drop Biolle Tears Generic lubricating eye drops ophthalmic solution 0.4-0.3 % Systane Generic

lubricating eye/overnight Altalube Generic lubricating plus eye drops Biolle Tears Generic lubrifresh p.m. Altalube Generic MURO 128 OPHTHALMIC OINTMENT Brand MURO 128 OPHTHALMIC SOLUTION 5 % Brand

natural tears pf Bion Tears PF Generic nighttime dry-eye relief Altalube Generic phenylephrine hcl ophthalmic Altafrin Generic polyvinyl alcohol ophthalmic Generic puralube Altalube Generic pure & gentle lubricant Generic REFRESH LACRI-LUBE Brand REFRESH P.M. Brand REFRESH PLUS Brand REFRESH TEARS Brand relief eye drops Visine-AC Generic sodium chloride (hypertonic) ophthalmic ointment Altachlore Generic

sodium chloride (hypertonic) ophthalmic solution Altachlore Generic

sodium chloride ophthalmic ointment 5 % Altachlore Generic sodium chloride ophthalmic solution 5 % Altachlore Generic SYSTANE Brand SYSTANE COMPLETE Brand SYSTANE CONTACTS Brand SYSTANE HYDRATION PF Brand


48


SYSTANE NIGHTTIME Brand SYSTANE OVERNIGHT THERAPY Brand SYSTANE PRESERVATIVE FREE Brand SYSTANE ULTRA Brand SYSTANE ULTRA PF Brand tears again Altalube Generic TEARS AGAIN ADVANCED EYELID OPHTHALMIC Brand

tears pure GenTeal Tears Generic ultra fresh Ultra Fresh Generic ultra fresh pm Altalube Generic ultra lubricant drop Systane Generic ultra lubricating eye drops Systane Generic VISINE ADVANCED RELIEF Brand Ophthalmic Anti-allergy Agents - Allergy, Infection and Inflammation Drugs

CLEAR EYES REDNESS RELIEF Brand eye drops ophthalmic solution 0.05 % Visine Red Eye Comfort Generic VASOCLEAR-A Brand Ophthalmic Antiglaucoma Agents - Glaucoma Drugs

acetazolamide er Generic acetazolamide oral Generic BETIMOL Brand Otic Agents - Drugs to Treat Ear Conditions

Otic Agents - Drugs for the Ear acetic acid otic Generic

auraphene-b Clearcanal Earwax Softener Generic

clearcanal earwax softener Clearcanal Earwax Softener Generic

ear drops Clearcanal Earwax Softener Generic

ear drops earwax aid Clearcanal Earwax Softener Generic


49


ear systems Clearcanal Earwax Softener Generic

ear wax kit Clearcanal Earwax Softener Generic

ear wax removal Clearcanal Earwax Softener Generic

ear wax removal drops Clearcanal Earwax Softener Generic

ear wax removal kit Clearcanal Earwax Softener Generic

ear wax removal system Clearcanal Earwax Softener Generic

earwax removal Clearcanal Earwax Softener Generic

earwax removal drops Clearcanal Earwax Softener Generic

earwax removal kit Clearcanal Earwax Softener Generic

hydrocortisone-acetic acid Acetasol HC Generic Respiratory Tract/Pulmonary Agents - Drugs to Treat Allergies, Cough, Cold and Lung Conditions

Antihistamines - Allergy Drugs allergy oral tablet extended release Chlor-Trimeton Allergy Generic allergy relief oral tablet extended release 12 mg Chlor-Trimeton Allergy Generic

chlorpheniramine maleate er Chlor-Trimeton Allergy Generic CHLOR-TRIMETON ALLERGY Brand CHLOR-TRIMETON ORAL SYRUP Brand ed chlorped jr Chlor-Trimeton Generic Antihistamines - Drugs to Treat Allergies

aler-dryl Generic aller-chlor Wal-finate Generic allergy antihistamine Naramin Generic allergy childrens oral liquid Naramin Generic allergy oral capsule Banophen Generic allergy oral tablet Wal-finate Generic allergy relief adult Naramin Generic


50


allergy relief childrens oral liquid 12.5 mg/5ml Naramin Generic

allergy relief oral capsule 25 mg Banophen Generic allergy relief oral liquid 25 mg/10ml Naramin Generic allergy relief oral tablet 25 mg Banophen Generic allergy relief oral tablet 4 mg Wal-finate Generic

allergy relief oral tablet chewable 12.5 mg Benadryl Allergy Childrens Generic

allergy-time Wal-finate Generic anti-hist allergy Banophen Generic aurodryl allergy childrens Naramin Generic banophen oral capsule 25 mg Banophen Generic banophen oral tablet Banophen Generic BENADRYL ALLERGY CHILDRENS ORAL LIQUID Brand

BENADRYL ALLERGY CHILDRENS ORAL TABLET CHEWABLE Brand

BENADRYL ALLERGY ORAL TABLET Brand childrens allergy Naramin Generic chlorpheniramine maleate oral Wal-finate Generic CHLOR-TRIMETON ORAL TABLET Brand clemastine fumarate oral tablet 2.68 mg Generic complete allergy medicine oral capsule Banophen Generic complete allergy relief Banophen Generic cyproheptadine hcl oral Generic

dayhist allergy 12 hour relief Dayhist Allergy 12 Hour Relief Generic

diphen Generic DI-PHEN Brand diphenhist Banophen Generic diphenhydramine hcl oral capsule Banophen Generic diphenhydramine hcl oral elixir Generic diphenhydramine hcl oral liquid 12.5 mg/5ml Naramin Generic

diphenhydramine hcl oral tablet Banophen Generic dye-free allergy relief Naramin Generic geri-dryl Banophen Generic

AL: Limited to members of a certain age; DX2RX: Diagnosis Required; GE: Gender Limit; PA: Prior Auth Required; QL: Quantity Lim

supplemental preferred drug list (pdl) - uhcprovider.com · 2021. 3. 2. · color, national origin,...

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