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2019 Prescription Drug List - Advantage Four-TierFlex Base 3-Tier Effective Jan. 1, 2021
This Prescription Drug List (PDL) is accurate as of Jan. 1, 2021 and is subject to change after this date. This PDL applies to members of our UnitedHealthcare and Oxford medical plans with a pharmacy benefit subject to the Flex Base 3-Tier PDL. Your estimated coverage and copayment/coinsurance may vary based on the benefit plan you choose and the effective date of the plan.
Table of contents Understanding your Prescription Drug List (PDL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Medication tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Reading your PDL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Analgesics
Drugs for Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Drugs for Pain and Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Anti-Addiction / Substance Abuse Treatment Agents . . . . . . . . . . . . . . . . . . . . . . . . . 9 Antibacterials
Drugs for Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Anticoagulants
Drugs to Treat or Prevent Blood Clots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Anticonvulsants
Drugs for Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Antidementia Agents
Drugs for Alzheimer’s Disease and Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Antidepressants
Drugs for Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Antiemetics
Drugs for Nausea and Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Antifungals
Drugs for Fungal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Antigout Agents
Drugs for Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Antimigraine Agents
Drugs for Migraines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Antineoplastics
Drugs for Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Antiparasitics
Drugs for Parasitic Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Antiparkinson Agents
Drugs for Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Antiplatelets
Drugs for Heart Attack and Stroke Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Antipsychotics
Drugs for Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Antivirals
Drugs for Viral Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Anxiolytics
Drugs for Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Bipolar Agents
Drugs for Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Cardiovascular Agents
Drugs for Heart and Circulation Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Central Nervous System Agents
Drugs for Attention Deficit Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Drugs for Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Dental and Oral Agents Drugs for Mouth and Throat Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
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Diabetes Glucose Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Non-Insulin Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Drugs for Blood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Drugs for Sexual Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Electrolytes / Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Gastrointestinal Agents Drugs for Acid Reflux and Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Drugs for Bowel, Intestine and Stomach Conditions . . . . . . . . . . . . . . . . . . . . . . . 22
Genetic or Enzyme Disorder Drugs for Replacement, Modification, Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 22
Genitourinary Agents Drugs for Bladder, Genital and Kidney Conditions. . . . . . . . . . . . . . . . . . . . . . . . . 23 Drugs for Prostate Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Hormonal Agents Hormone Replacement and Birth Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Oral Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Testosterone Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Immunological Agents Drugs for Immune System Stimulation or Suppression . . . . . . . . . . . . . . . . . . . . . 27
Infertility Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Metabolic Bone Disease Agents Drugs for Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Ophthalmic Agents Drugs for Eye Allergy, Infection and Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . 28 Drugs for Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Drugs for Miscellaneous Eye Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Otic Agents Drugs for Ear Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Respiratory Drugs for Anaphylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Respiratory Tract / Pulmonary Agents Drugs for Allergies, Cough, Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Drugs for Asthma and COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Drugs for Cystic Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Drugs for Pulmonary Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Skeletal Muscle Relaxants Drugs for Muscle Pain and Spasm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Sleep Disorder Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Understanding your Prescription Drug List (PDL)
What is a PDL? This document is a list of the most commonly prescribed medications. It includes About this PDL both brand-name and generic prescription medications approved by the Food and Where differences exist between Drug Administration (FDA). Medications are listed by common categories or classes this PDL and your benefit plan and placed in tiers that represent the cost you pay out-of-pocket. They are then documents, the benefit plan listed in alphabetical order. documents rule. This PDL is not
a complete list of medications, How do I use my PDL? and not all medications listed
may be covered by your plan. You and your doctor can consult the PDL to help you select the most cost-effective Please look at the benefit plan prescription medications. This guide tells you if a medication is generic or a brand documents provided by your name, and if there are coverage requirements or limits. Bring this list with you when employer or health plan to see you see your doctor. If your medication is not listed here, please visit your plan’s which medications are covered member website or call the toll-free member phone number on your health plan under your plan.ID card.
What are tiers? Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, set by your employer or benefit plan. This is how much you will pay when you fill a prescription. See page 6 for more information.
When does the PDL change? PDL changes typically occur 2-3 times per year. However, changes that have a positive impact for you — such as coverage for new medications or cost savings — may occur at any time. You can log in to the member website listed on your ID card at any time to check your medication coverage and lower-cost options.
Why are some medications excluded from coverage? We review medications based on their total value, including effectiveness and safety, how much they cost, and the availability of alternative medications to treat the same or similar medical conditions. Certain medications may be excluded from coverage or
1be subject to prior authorization (sometimes referred to as precertification) if similar alternatives are available at a lower cost. Examples include medications that work the same way, but one is much more expensive than the other, or options that are
2available without a prescription (also referred to as over-the-counter medications ). There are also some instances where the same product can be made by 2 or more manufacturers, but greatly vary in cost. In these instances, only the lower-cost product may be covered.
You should review your benefit plan documents to confirm if any medications are excluded from your plan. You can log in to the member website listed on your ID card at any time to check your medication coverage. Talk to your doctor to see if there are lower-cost options or over-the-counter medications available.
Who decides which medications are covered? Thousands of medications are already available and more come to the market regularly. Often, several medications are available to treat the same condition. The UnitedHealthcare® Pharmacy and Therapeutics Committee, which includes both internal and external doctors and pharmacists, meets regularly to provide clinical reviews of all medications. Using this information, the PDL Management Committee, which includes senior UnitedHealth Group® doctors and business leaders, meets to evaluate overall health care value. They also set coverage and tier status for all medications.
1. Depending on your benefit, you may have notification or medical necessity requirements for select medications.
2. For New York and New Jersey plans, a prescription drug product that is therapeutically equal to an over-the-counter drug may be covered if it is determined to be medically necessary.
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Medication tips
What is the difference between brand-name and Over-the-counter generic medications? (OTC) medicationsGeneric medications contain the same active ingredients (what makes the An OTC medication may be medication work) as brand-name medications, but they often cost less. Once the the right treatment option for patent for a brand-name medication ends, the FDA can approve a generic version some conditions. Talk to your with the same active ingredients. These types of medications are known as generic doctor about available OTC medications. Sometimes, the same company that makes a brand-name medication options. Even though these also makes the generic version. medications may not be covered by your pharmacy benefit, What if my doctor writes a brand-name prescription? they may cost less than a
If your doctor gives you a prescription for a brand-name medication, ask if a generic prescription medication. equivalent or lower-cost option is available and could be right for you. Generic medications are usually your lowest-cost option, but not always. For some benefit plans, if a brand-name drug is prescribed and a generic equal is available, your cost-share may be the copayment PLUS the cost difference between the brand- name drug and the generic equivalent.
What if I am taking a specialty medication? Specialty medications are high-cost and are used to treat rare or complex conditions that require additional care and support. For most plans, these medications are managed through the specialty pharmacy program. Take advantage of personalized support designed to help you get the most out of your treatment plan. Visit the member website listed on your ID card or call the toll-free phone number on your ID card to learn more.
Please note, not all specialty medications are listed here. If you’re taking a specialty medication that is on a higher tier, call the toll-free phone number on your ID card to talk with a pharmacist about finding lower-cost options.
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Reading your PDL The PDL gives you choices so you and your doctor can decide your best course of treatment. In this PDL, brand-name medications are shown in UPPERCASE and generic medications in lowercase.
Tier information Using lower-tier medications can help you pay your lowest out-of-pocket cost. Your plan may have multiple or no tiers. Please note: If you have a high deductible plan, the tier cost levels may apply once you hit your deductible.
In the chart below, overall value indicates medications’ effectiveness and safety, cost, and the availability of alternative medications to treat the same or similar medical condition(s).
Drug Tier Includes Helpful Tips
Tier 1 $ Lower-cost Use Tier 1 drugs for the Medications that provide the highest overall value. Mostly lowest out-of-pocket costs. generic drugs. Some brand-name drugs may also be included.
Tier 2 Use Tier 2 drugs, instead of $$ Mid-range cost Tier 3, to help reduce your Medications that provide good overall value. Mainly preferred out-of-pocket costs.brand-name drugs.
Tier 3 Ask your doctor if a Tier 1 or $$$ Highest-cost Tier 2 option could work for you.Medications that provide the lowest overall value.
Drug list information In this drug list, some medications are noted with letters next to them to help you see which ones may have coverage requirements or limits. Your benefit plan sets how these medications may be covered for you.
E May be excluded from coverage or subject to Prior Authorization in Connecticut, New Jersey and New York. (Referred to as First Start in New Jersey) — Lower-cost options are available and covered.
H Health Care Reform Preventive — This medication is part of a health care reform preventive benefit and may be available at no additional cost to you.
H-PA Health Care Reform Preventive with Prior Authorization — May be part of health care reform preventive and available at no additional cost to you if prior authorization criteria is met.
3PA Prior Authorization (sometimes referred to as precertification) — Requires your doctor to provide information about why you are taking a medication to determine how it may be covered by your plan.
QL Quantity Limits — Specifies the largest quantity of medication covered per copayment or in a defined period of time.
4RS Refill and Save Program — Save money on your copayment when you refill your prescription on time as prescribed. Program eligibility may vary.
SP Specialty Medication — Specialty medications treat complex or rare conditions and may require special storage and handling. You may be required to obtain these medications from a specialty pharmacy.
ST Step Therapy (referred to as First Start in New Jersey) — Requires prior authorization and may require you to try one or more other medications before the medication you are requesting may be covered.
3. Depending on your benefit, you may have notification or medical necessity requirements for select medications.
4. Not applicable to Oxford plans.
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Reading your PDL (continued)
Coverage details Some drug classes in this PDL have additional/important coverage details. Review this list to see if drug classes that apply to you are noted.
• Diabetes: blood glucose monitoring; insulin; non-insulin Diabetic supplies and prescription medications may be subject to different cost-share arrangements for Oxford plans. Please see your Summary of Benefits and Coverage (SBC) for specifics. Medications that require step therapy may require prior authorization (sometimes referred to as precertification) if covered under another benefit.
• Diabetes: continuous glucose monitors, sensors Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share. Diabetic self-management items, including continuous glucose monitors, may be covered under the consumer pharmacy and/or medical plan depending on the benefit.
• Endocrine: growth hormone Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share.
• Infertility Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share. Prior authorization (sometimes referred to as precertification) may be required for Oxford plans or where a state mandates infertility drug coverage.
• Medications for sexual dysfunction Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share.
Questions
For the most current list of covered medications or if you have questions:
Call the toll-free member phone number on your ID card.
And, if home delivery services are included in your pharmacy
Visit your plan’s member website listed on your ID card to: benefit, you can also:
• View your pharmacy benefit and coverage information, • Refill prescriptions including prescription history • Check the status of your order
• View medication interactions and side effects • Set up reminders for refills • Locate a participating retail pharmacy by ZIP code • Manage your account • Look up possible lower-cost medication alternatives
• Compare medication pricing and options
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Drug Name Drug Requirements Drug Name Drug Requirements Tier & Limits Tier & Limits
g morphine sulfate er oral tablet 1 PA, QLAnalgesics - Drugs for Pain extended releaseg acetaminophen-codeine 1
g morphine sulfate oral 1g acetaminophen-codeine #2 1 g morphine sulfate rectal 1g acetaminophen-codeine #3 1 B MS CONTIN 3 PA, ST, QLg acetaminophen-codeine #4 1 B NALOCET 3g apap-caff-dihydrocodeine oral 1 B NORCO 3capsule BB NUCYNTA 2 QLARYMO ER 3 PA, ST, QL BB NUCYNTA ER 3 PA, QLBELBUCA 3 PA, QL Bg OXAYDO E QLbutalbital-apap-caffeine 1 BB OXYCODONE HCL ER E PA, QLCONZIP 3 QL gB oxycodone hcl oral capsule 1DILAUDID ORAL 3 gB DVORAH E oxycodone hcl oral concentrate 1
100 mg/5mlg endocet 1 g oxycodone hcl oral solution 1B ESGIC 3 g oxycodone hcl oral tablet 1fentanyl 1 PA, QL g oxycodone-acetaminophen oral 1B FIORICET 3
tablet 10-325 mg, 2.5-325 mg, g hydrocodone-acetaminophen oral 1 5-325 mg, 7.5-325 mg
solution 10-325 mg/15ml, B OXYCONTIN E PA, QL7.5-325 mg/15ml g premium lidocaine 1g hydrocodone-acetaminophen oral 1 B PRIMLEV 3tablet Bg hydromorphone hcl er 1 PA, ST, QL ROXICODONE 3
g B SUBSYS 3 PA, QLhydromorphone hcl oral 1 gg tramadol hcl er (biphasic) 1 QLhydromorphone hcl rectal 1 BB HYSINGLA ER E PA, QL TRAMADOL HCL ER ORAL 3 QL
CAPSULE EXTENDED RELEASE B KADIAN ORAL CAPSULE 3 PA, ST, QL 24 HOUR 100 MG, 200 MG, EXTENDED RELEASE 24 HOUR 300 MG200 MG
g tramadol hcl er oral capsule 1 QLg lidocaine external ointment 1 extended release 24 hour 150 mg
g lidocaine external patch 5 % 1 g tramadol hcl er oral tablet extended 1 QL
g lidocaine-prilocaine external cream 1 release 24 hour g lorcet 1 g tramadol hcl oral tablet 50 mg 1 g lorcet hd 1 B TREZIX 1 g lorcet plus 1 B TYLENOL WITH CODEINE #3 3 B LORTAB 3 B ULTRAM 3 B MORPHABOND ER 3 PA, ST, QL B VANATOL LQ 2 g morphine sulfate (concentrate) oral 1 B VANATOL S 2
solution 100 mg/5ml, 20 mg/ml g vicodin hp oral tablet 10-300 mg 1
g morphine sulfate er oral capsule 1 PA, ST, QL B XTAMPZA ER 2 PA, QLextended release 24 hour
See page 7 for coverage details. Drugs listed as E or ST are subject to Prior Authorization in CT, NJ and NY.
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B BZEBUTAL 3 SPRIX 3 B BZOHYDRO ER E PA, QL VIVLODEX 3 B BZTLIDO 3 ZIPSOR 3
Analgesics - Drugs for Pain and Inflammation Anti-Addiction / Substance Abuse Treatment Agents g Bcelecoxib oral 1 BUNAVAIL E g gdiclofenac potassium 1 buprenorphine hcl sublingual 1 g gdiclofenac sodium er 1 buprenorphine hcl-naloxone hcl 1 g Bdiclofenac sodium oral 1 CHANTIX 2 PA, H g Bdiclofenac sodium transdermal E EVZIO 3
gel 1 % g naloxone hcl injection solution 1 g diclofenac sodium transdermal E g naloxone hcl injection solution 1
solution cartridge B EC-NAPROSYN 3 g naloxone hcl injection solution 1 g ec-naproxen 1 prefilled syringe g getodolac 1 naltrexone hcl oral 1 g Betodolac er 1 NARCAN 2 g Bibu 1 ZUBSOLV 1 g ibuprofen oral suspension E Antibacterials - Drugs for Infections g gibuprofen oral tablet 400 mg, 1 amoxicillin 1
600 mg, 800 mg g amoxicillin-potassium clavulanate er 1 B INDOCIN 3 g amoxicillin-potassium clavulanate 1 g indomethacin er 1 oral g Bindomethacin oral capsule 25 mg, 1 AUGMENTIN ORAL SUSPENSION 3
50 mg RECONSTITUTED 125-31.25 MG/5MLg ketorolac tromethamine oral 1
g avidoxy 1g meloxicam oral 1 g azithromycin oral 1B MOBIC 3 B BACTRIM 3g nabumetone oral 1 B BACTRIM DS 3B NAPRELAN ORAL TABLET E gEXTENDED RELEASE 24 HOUR cefadroxil 1
750 MG g cefdinir 1 B NAPROSYN ORAL SUSPENSION 3 g cefuroxime axetil 1 g naproxen dr 1 B CENTANY 3 g naproxen oral 1 B CENTANY AT 3 g naproxen sodium er 1 g cephalexin 1 g naproxen sodium oral tablet 1 B CIPRO ORAL TABLET 3
275 mg, 550 mg g ciprofloxacin hcl oral 1
B PENNSAID E g clarithromycin er 1
B QMIIZ ODT 3 g clarithromycin oral 1
B RELAFEN DS 3
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B BCLEOCIN ORAL CAPSULE 3 VIBRAMYCIN ORAL SUSPENSION 3 150 MG, 300 MG RECONSTITUTED
B BCLEOCIN ORAL CAPSULE 75 MG 2 XEPI 3 g Bclindamycin hcl oral 1 XIMINO 3 B BCLINDESSE 2 ZITHROMAX ORAL 3 g Bcoremino 1 ZITHROMAX TRI-PAK 3 B BDIFICID 3 ZITHROMAX Z-PAK 3 B DORYX MPC 3 Anticoagulants - Drugs to Treat or Prevent Blood Clots g Bdoxycycline hyclate oral 1 BEVYXXA 3 g Bdoxycycline monohydrate oral 1 COUMADIN 3 B BFLAGYL 3 ELIQUIS 2 B gKEFLEX 3 enoxaparin sodium 1 B gLEVAQUIN ORAL TABLET 500 MG, 3 jantoven 1
750 MG B PRADAXA 2 g levofloxacin oral 1 g warfarin sodium oral 1 B MACROBID 3 B XARELTO 2 B MACRODANTIN 3 Anticonvulsants - Drugs for Seizures g metronidazole oral 1 g carbamazepine er 1 g metronidazole vaginal 1 g carbamazepine oral 1 g minocycline hcl er oral tablet 1 B CARBATROL 3
extended release 24 hour B DEPAKOTE 3
g minocycline hcl oral 1 B DEPAKOTE ER 3
B MINOLIRA 3 B DEPAKOTE SPRINKLES 3
g mondoxyne nl 1 g divalproex sodium er 1
g morgidox oral 1 g divalproex sodium oral 1
g mupirocin calcium 1 g epitol 1
g mupirocin external 1 g gabapentin oral 1
g nitrofurantoin macrocrystal oral 1 B KEPPRA ORAL 3
g nitrofurantoin monohydrate 1 B KEPPRA XR 3macrocrystals B LAMICTAL 3B NUVESSA 3 B LAMICTAL ODT 3g okebo 1 B LAMICTAL STARTER 3g penicillin v potassium 1 B LAMICTAL XR 3B SOLODYN 3 g lamotrigine er 1g sulfamethoxazole-trimethoprim oral 1 g lamotrigine oral 1g sulfatrim pediatric 1 g lamotrigine starter kit-blue 1B TARGADOX 3 g lamotrigine starter kit-green 1g vandazole 1 g lamotrigine starter kit-orange 1B VIBRAMYCIN ORAL CAPSULE 3
1010
g Blevetiracetam er 1 BUPROPION HCL ER (XL) ORAL 3 TABLET EXTENDED RELEASE g levetiracetam oral 1 24 HOUR 450 MG
B NAYZILAM SPRAY 5 MG 3 g bupropion hcl oral 1
B NEURONTIN 3 g citalopram hydrobromide 1
g oxcarbazepine 1 g desvenlafaxine succinate er 1
B OXTELLAR XR 3 g doxepin hcl oral capsule 1
B QUDEXY XR 3 g doxepin hcl oral concentrate 1
g roweepra 1 B DRIZALMA SPRINKLE 3
g roweepra xr 1 g duloxetine hcl oral 1
B SPRITAM 3 g escitalopram oxalate 1
g subvenite 1 g fluoxetine hcl oral 1
g subvenite starter kit-blue 1 g fluvoxamine maleate 1
g subvenite starter kit-green 1 g fluvoxamine maleate er 1
g subvenite starter kit-orange 1 B FORFIVO XL 3
B TEGRETOL 3 g mirtazapine oral 1
B TEGRETOL-XR 3 g nortriptyline hcl oral 1
B TOPAMAX 3 B PAMELOR 3
B TOPAMAX SPRINKLE 3 g paroxetine hcl 1
g topiramate er 1 g paroxetine hcl er 1
g topiramate oral 1 B PAXIL 3
B TRILEPTAL 3 B PAXIL CR 3
B TROKENDI XR 3 B REMERON 3
B VALTOCO 3 B REMERON SOLTAB 3
B VIMPAT ORAL 2 g sertraline hcl oral 1
B XCOPRI PAK 3 g trazodone hcl oral 1
B XCOPRI TABLET 3 B TRINTELLIX 3
B ZONEGRAN 3 g venlafaxine hcl 1
g zonisamide oral 1 g venlafaxine hcl er 1
Antidementia Agents - Drugs for Alzheimer's Disease B VIIBRYD 2and Dementia
Antiemetics - Drugs for Nausea and VomitingB ARICEPT ORAL TABLET 10 MG, 3 B BONJESTA 25 MG gg doxylamine-pyridoxine 1donepezil hcl 1 g metoclopramide hcl oral solution 1Antidepressants - Drugs for Depression
5 mg/5mlg amitriptyline hcl oral 1 g metoclopramide hcl oral tablet 1g bupropion hcl er (sr) 1 g metoclopramide hcl oral tablet 1g bupropion hcl er (xl) oral tablet 1
dispersibleextended release 24 hour 150 mg, g300 mg ondansetron hcl oral 1
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g Bondansetron odt 1 MITIGARE 2 g Bphenadoz 1 ZYLOPRIM 3 g prochlorperazine maleate oral 1 Antimigraine Agents - Drugs for Migraines g Bpromethazine hcl oral tablet 1 AIMOVIG 2 g Bpromethazine hcl rectal 1 AMERGE 3 g gpromethegan 1 eletriptan hydrobromide 1 B BREGLAN 3 EMGALITY 2 g Bscopolamine 1 EMGALITY (300 MG DOSE) 2 B gTRANSDERM SCOP (1.5 MG) 3 naratriptan hcl 1 B BVARUBI (180 MG DOSE) 2 ONZETRA XSAIL 3 B BZOFRAN 3 REYVOW TABLET 2 B gZUPLENZ 3 rizatriptan benzoate 1
gAntifungals - Drugs for Fungal Infections sumatriptan succinate oral 1 g gciclodan 1 sumatriptan succinate refill 1 g gciclopirox 1 sumatriptan succinate 1
subcutaneousg ciclopirox treatment 1 B UBRELVY TABLET 2B CRESEMBA ORAL 3 B ZEMBRACE SYMTOUCH 3B DIFLUCAN 3
Antineoplastics - Drugs for CancerB EXTINA 3 g anastrozole oral 1g fluconazole oral 1 g bexarotene E SPB GYNAZOLE-1 3 g capecitabine E SPg ketoconazole external 1 B ERLEADA 2 PA, SPg ketodan external foam 1 B IBRANCE ORAL CAPSULE 2 PA, SPB NIZORAL 3 B IDHIFA 2 PA, SPg nyamyc 1 g imatinib mesylate 1 PA, SPg nystatin external 1 g letrozole oral 1g nystatin mouth/throat 1 B LYNPARZA 2 PA, SPg nystop 1 g mercaptopurine oral 1g terbinafine hcl oral 1 B NUBEQA 2 PA, SPg terconazole 1 B PURIXAN 3 PA, SPB XOLEGEL 3 B REVLIMID 2 PA, SPAntigout Agents - Drugs for Gout B SOLTAMOX 3g allopurinol oral 1 g tamoxifen citrate oral tablet 10 mg 1B COLCHICINE ORAL CAPSULE E g tamoxifen citrate oral tablet 20 mg 1 H-PAg colchicine oral tablet E B TARGRETIN EXTERNAL 3 SPB COLCRYS E B TARGRETIN ORAL 1 SPg febuxostat 1 B TASIGNA 2 PA, ST, SPB GLOPERBA 3
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B VERZENIO 2 PA, SP Antivirals - Drugs for Viral Infections B gXELODA 1 SP acyclovir oral 1 B BZEJULA 2 SP ATRIPLA E ST
BAntiparasitics - Drugs for Parasitic Infections BARACLUDE ORAL SOLUTION 2 SP B BARAKODA 3 CIMDUO 2 g Batovaquone-proguanil hcl 1 DESCOVY 3 PA, SP B BELIMITE 3 DOVATO 2 g ghydroxychloroquine sulfate oral 1 emtricitabine/tenofovir disoproxil 1 H
fumarateB KRINTAFEL 1 g entecavir 1 SPB MALARONE 3 B EPCLUSA 2 PA, SPg permethrin external 1 B GENVOYA 3Antiparkinson Agents - Drugs for Parkinson's Disease B HARVONI 2 PA, ST, SPg carbidopa-levodopa 1 B ISENTRESS 2g carbidopa-levodopa er 1 B ISENTRESS HD 2B DUOPA 3 B JULUCA 2B INBRIJA 3 PA, SP B LEDIPASVIR-SOFOSBUVIR 2 PA, ST, SPB MIRAPEX 3 B LEDIP-SOFOSB ORAL TABLET 2 PA, ST, SPB NOURIANZ ORAL TABLET 3
90-400MG g pramipexole dihydrochloride 1
B MAVYRET 2 PA, SP g pramipexole dihydrochloride er 1
B NORVIR ORAL PACKET 2 g ropinirole hcl 1
B NORVIR ORAL SOLUTION 2 g ropinirole hcl er 1
B ODEFSEY 3 B RYTARY 3
g oseltamivir phosphate oral 1 B SINEMET 3
B PREZCOBIX 2 Antiplatelets - Drugs for Heart Attack and Stroke
B PREZISTA 2Prevention g ritonavir 1 SPB BRILINTA 2 B SITAVIG 3g clopidogrel bisulfate oral 1 B SOFOS/VELPAT ORAL TABLET 2 PA, SPB ZONTIVITY 3
400-100 Antipsychotics - Drugs for Mood Disorders
B SOFOSBUVIR-VELPATASVIR 2 PA, SP B ABILIFY MYCITE E
B STRIBILD 3 g aripiprazole 1
B SYMFI 2 B LATUDA 2
B SYMFI LO 2 g olanzapine oral 1
B TEMIXYS 3 g quetiapine fumarate 1
g tenofovir disoproxil fumarate 1 SP g quetiapine fumarate er 1
B TIVICAY 3 g risperidone 1
B TRIUMEQ 2 B SAPHRIS 3
B TRUVADA E g ziprasidone hcl 1
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g Bvalacyclovir hcl oral 1 ALDACTONE 3 B gVEMLIDY 3 ST, SP aliskiren fumarate 1 B BVIREAD ORAL POWDER 3 ALTACE 3 B BVIREAD ORAL TABLET 150 MG, 2 ALTOPREV 3
200 MG, 250 MG g amiodarone hcl oral 1 B VOSEVI 2 PA, SP g amlodipine besylate oral 1 B XOFLUZA 3 g amlodipine besylate-benazepril hcl 1 B ZEPATIER 2 PA, SP g amlodipine besylate-valsartan 1 B ZOVIRAX ORAL SUSPENSION 3 g atenolol oral 1
Anxiolytics - Drugs for Anxiety g atenolol-chlorthalidone 1 g alprazolam er 1 g atorvastatin calcium oral tablet 1 H-PA g 10 mg, 20 mgalprazolam intensol 1
gg alprazolam oral 1 atorvastatin calcium oral tablet 1 40 mg, 80 mgg alprazolam xr 1
B AVALIDE 3g buspirone hcl oral 1 B AVAPRO 3g clonazepam oral 1 g benazepril hcl oral 1g diazepam intensol 1 g benazepril-hydrochlorothiazide 1g diazepam oral 1 B BIDIL 2B HALCION 3 g bisoprolol fumarate 1g hydroxyzine hcl oral 1 g bisoprolol-hydrochlorothiazide 1g hydroxyzine pamoate oral 1 B BYSTOLIC 3g lorazepam intensol 1 B CALAN SR 3g lorazepam oral concentrate 1 B2 mg/ml CARDIZEM LA ORAL TABLET E
EXTENDED RELEASE 24 HOUR g lorazepam oral tablet 1 120 MG
g triazolam 1 B CARDURA 3
B VISTARIL 3 B CAROSPIR 3
Bipolar Agents - Drugs for Mood Disorders g cartia xt 1
g lithium carbonate er 1 g carvedilol 1
g lithium carbonate oral 1 B CATAPRES 3
B LITHOBID 3 g chlorthalidone 1
Cardiovascular Agents - Drugs for Heart and Circulation g clonidine hcl oral 1Conditions g colesevelam hcl EB ACCUPRIL 3 B COREG 3g acetazolamide er 1 B CORGARD 3g acetazolamide oral 1 B CORLANOR 3B ADALAT CC ORAL TABLET 3 B COZAAR 3EXTENDED RELEASE 24 HOUR
60 MG g diltiazem hcl er coated beads 1
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g gdiltiazem hcl er oral capsule 1 losartan potassium-hctz 1 extended release 12 hour B LOTENSIN 3
g diltiazem hcl oral 1 B LOTENSIN HCT 3 g dilt-xr 1 B LOTREL 3 g doxazosin mesylate oral 1 g lovastatin 1 H B DYAZIDE 3 g matzim la 1 B EDARBI 2 B MAXZIDE 3 B EDARBYCLOR 2 B MAXZIDE-25 3 g enalapril maleate oral 1 g metoprolol succinate er 1 B EPANED 3 g metoprolol tartrate oral 1 B EZALLOR SPRINKLE 3 B MINIPRESS 3 g ezetimibe 1 g minitran 1 g ezetimibe-simvastatin 1 B MULTAQ 3 g fenofibrate oral capsule 150 mg, 1 g nadolol oral 1
50 mg B NEXLETOL TABLET 2
g fenofibrate oral tablet 1 B NEXLIZET TABLET 2
g flecainide acetate 1 g niacin (antihyperlipidemic) 1
B FLOLIPID 3 g niacin er (antihyperlipidemic) 1
g furosemide oral 1 g niacor 1
g gemfibrozil oral 1 B NIASPAN 3
B GONITRO 3 g nifedipine er 1
g guanfacine hcl 1 g nifedipine er osmotic release 1
B HEMANGEOL 3 g nifedipine oral 1
g hydralazine hcl oral 1 B NITRO-BID 2
g hydrochlorothiazide oral 1 B NITRO-DUR 3
B HYZAAR 3 g nitroglycerin sublingual 1
g irbesartan 1 g nitroglycerin transdermal 1
g irbesartan-hydrochlorothiazide 1 g nitroglycerin translingual 1
g isosorbide mononitrate 1 B NITROMIST 3
g isosorbide mononitrate er 1 B NITROSTAT 3
B KAPSPARGO SPRINKLE 3 g nitro-time 1
g labetalol hcl oral 1 g olmesartan medoxomil oral 1
B LASIX 3 g olmesartan medoxomil-hctz 1
B LIPOFEN 3 g omega-3-acid ethyl esters 1
g lisinopril oral 1 B PACERONE ORAL TABLET 3
g lisinopril-hydrochlorothiazide 1 100 MG, 400 MG B LOPID 3 g pacerone oral tablet 200 mg 1 B LOPRESSOR 3 B PRALUENT 2 PA, ST g losartan potassium 1 B PRAVACHOL 3
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g pravastatin sodium 1 Central Nervous System Agents - Drugs for Attention Deficit Disorderg prazosin hcl oral 1
B ADDERALL XR 1B PRINIVIL 3 B ADHANSIA XR 3B PROCARDIA 3 g amphetamine-dextroamphetamine 1B PROCARDIA XL 3 g amphetamine-dextroamphetamine Eg propranolol hcl er 1
er g propranolol hcl oral 1
B APTENSIO XR 3 B QBRELIS 3
g atomoxetine hcl 1 g quinapril hcl 1
B CONCERTA 1 g ramipril 1
g dexmethylphenidate hcl 1 g ranolazine er 1
g dexmethylphenidate hcl er 1 B REPATHA 2 PA, ST
g dextroamphetamine sulfate 1 g rosuvastatin calcium 1
g dextroamphetamine sulfate er 1 g simvastatin oral tablet 10 mg, 1 H-PA
B FOCALIN 320 mg, 40 mg, 5 mg g guanfacine hcl er 1g simvastatin oral tablet 80 mg 1 B JORNAY PM 3g sotalol hcl oral 1 g metadate er 1B SOTYLIZE 3 B METHYLIN 3g spironolactone oral 1 g methylphenidate hcl er (cd) 1B TEKTURNA 3 g methylphenidate hcl er (la) 1B TEKTURNA HCT 3 g methylphenidate hcl er oral tablet 1g telmisartan 1
extended release 10 mg, 20 mg B TOPROL XL 3
g methylphenidate hcl er oral tablet E g torsemide 1 extended release 18 mg, 27 mg, g triamterene-hctz 1 36 mg, 54 mg, 72 mg g gvalsartan 1 methylphenidate hcl er oral tablet E
extended release 24 hourg valsartan-hydrochlorothiazide 1 g methylphenidate hcl oral 1B VASCEPA 2 B MYDAYIS 2g verapamil hcl er 1 B PROCENTRA 3g verapamil hcl oral 1 B QUILLICHEW ER 3B VERELAN 3 B QUILLIVANT XR 3B VERELAN PM 3 g relexxii EB WELCHOL 1 B RITALIN 3B ZIAC 3 B VYVANSE 3B ZOCOR ORAL TABLET 10 MG, 3 B20 MG, 40 MG, 80 MG ZENZEDI ORAL TABLET 15 MG, E
2.5 MG, 20 MG, 30 MG, 7.5 MG
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g lidocaine hcl mouth/throat 1Central Nervous System Agents - Drugs for Multiple Sclerosis g lidocaine viscous hcl 1
B AUBAGIO 3 PA, SP B NAFRINSE DAILY/NEUTRAL 2 B AVONEX 2 PA, SP B NAFRINSE WEEKLY 3 B BAFIERTAM CAPSULE 2 SP g neutral sodium fluoride 1 B BETASERON 2 PA, SP g paroex 1 g dalfampridine er 1 PA, SP B PERIDEX 3 B EXTAVIA E PA, ST, SP g periogard 1 B GILENYA ORAL CAPSULE 3 PA, SP B PREVIDENT 3 g glatiramer acetate 1 PA, SP B PREVIDENT 5000 BOOSTER PLUS 3 g glatopa 1 PA, SP B PREVIDENT 5000 DRY MOUTH 3 B MAVENCLAD 3 PA, ST, SP B PREVIDENT 5000 ORTHO 3 B MAYZENT 3 PA, SP DEFENSE B B PREVIDENT 5000 PLUS 3PLEGRIDY 3 PA, SP
gB sf 1REBIF 3 PA, ST, SP gB REBIF REBIDOSE 3 PA, ST, SP sf 5000 plus 1 gB sodium fluoride 5000 plus 1REBIF REBIDOSE TITRATION 3 PA, ST, SP
PACK g sodium fluoride dental 1 B REBIF TITRATION PACK 3 PA, ST, SP Dermatological Agents - Drugs for Skin Conditions B TECFIDERA E PA, SP B ABSORICA 3
Central Nervous System Agents - Miscellaneous B ACZONE EXTERNAL GEL 5 % 1 B AUSTEDO 2 PA, SP B ACZONE EXTERNAL GEL 7.5 % 2 B LYRICA 3 B ALA SCALP 3 B LYRICA CR 2 g ala-cort external cream 1 % E B NUEDEXTA 2 g ala-cort external cream 2.5 % 1 g pregabalin oral 1 B ALDARA 3 B RILUTEK 3 SP B ALTRENO 3 PA g riluzole 1 SP g amnesteem 1 B TIGLUTIK 3 PA B AMZEEQ AER 4% 3
Dental and Oral Agents - Drugs for Mouth and Throat g avar cleanser 1 Conditions
g azelaic acid external 1 g cavarest 1
g betamethasone dipropionate aug 1 g chlorhexidine gluconate mouth/ 1
g betamethasone dipropionate 1throat external
g clinpro 5000 1 g calcipotriene-betameth diprop 1
g denta 5000 plus 1 external ointment g dentagel 1 g calcitriol external 1 g fluoridex 1 B CAPEX 2 g fluoridex enhanced whitening 1 B CARAC 2
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g gclaravis 1 fluocinonide external 1 B BCLEOCIN-T 3 FLUOROPLEX 3 g Bclindacin etz external swab 1 FLUOROURACIL EXTERNAL 3
CREAM 0.5 %g clindacin-p 1 g fluorouracil external cream 5 % 1B CLINDAGEL 3 g fluorouracil external solution 1g clindamycin phos-benzoyl perox 1 gexternal gel 1.2-5 % hydrocortisone external cream 1 % E
g gclindamycin phosphate external 1 hydrocortisone external cream 1 foam 2.5 %
g gclindamycin phosphate external 1 hydrocortisone external lotion 2.5 % 1 lotion g hydrocortisone external ointment 1
g clindamycin phosphate external 1 1 %, 2.5 % solution g imiquimod external 1
g clindamycin phosphate external 1 B IMIQUIMOD PUMP 3 swab
B IMPOYZ 3 B CLINDAMYCIN PHOSPHATE GEL 3
g isotretinoin oral 11 % EXTERNAL B METROCREAM 3g clindamycin phosphate gel 1 % 1 B METROLOTION 3external gg metronidazole external 1clobetasol propionate external 1 Bg MIRVASO 3clodan external shampoo 1 gg mometasone furoate external 1clotrimazole-betamethasone 1 gg myorisan 1dapsone external gel 5 % E gB neuac external gel 1DERMA-SMOOTHE/FS BODY 3 BB NORITATE 3DERMA-SMOOTHE/FS SCALP 3 Bg PICATO 3desonide cream, lotion, ointment 1 Bg RHOFADE CREAM 1% 3desonide gel 1 gB rosadan external cream 1DESOWEN 3 gB rosadan external gel 1DIPROLENE 3 BB SERNIVO 3DIPROLENE AF 3 BB SOOLANTRA CREAM 1% 3DUPIXENT 3 PA, ST, SP gB sss 10-5 1EFUDEX 3 gB sulfacetamide sodium-sulfur 1ENSTILAR 3 gB sulfacleanse 8/4 1EUCRISA 3 ST gB sulfamez wash 1EVOCLIN 3 BB SYNALAR 3FINACEA EXTERNAL GEL 3 Bg TACLONEX EXTERNAL 1fluocinolone acetonide body 1
SUSPENSIONg fluocinolone acetonide external 1 g tazarotene external 1 PAg fluocinolone acetonide scalp 1
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B BTAZORAC EXTERNAL CREAM 3 PA DEXCOM G4 / G5 / G6 RECEIVER, 3 0.1 % TRANSMITTER, SENSOR
(INCLUDING PLATINUM, B TAZORAC EXTERNAL GEL 3 PA PLATINUM PEDIATRIC)
B TEMOVATE 3 B DEXCOM G4 / G5 / G6 RECEIVER, 3
B TEXACORT 2 TRANSMITTER, SENSOR B TOLAK 3 (INCLUDING PLATINUM,
PLATINUM PEDIATRIC) DEVICEg tretinoin external 1 B FREESTYLE LIBRE 14 DAY 3g triamcinolone acetonide external 1
READERg trianex 1 B FREESTYLE LIBRE 14 DAY 3g triderm 1 SENSOR
B TRIDESILON 1 B FREESTYLE LIBRE READER 3 B VERDESO 3 B FREESTYLE LIBRE SENSOR 3 g zenatane 1 SYSTEM B ZYCLARA 3 B FREESTYLE PRECISION NEO E B TESTZYCLARA PUMP 3
B GUARDIAN CONNECT 3Diabetes - Glucose Monitoring TRANSMITTERB ACCU-CHEK AVIVA CONNECT KIT E
B GUARDIAN LINK 3 TRANSMITTER 3W/DEVICE BB GUARDIAN SENSOR (3) 3ACCU-CHEK AVIVA DEVICE E BB INSULIN SYRINGES 2ACCU-CHEK AVIVA PLUS KIT E BW/DEVICE LANCETS 1
B ACCU-CHEK COMPACT PLUS E B NOVOFINE AUTOCOVER PEN 2 CARE KIT NEEDLE
B ACCU-CHEK COMPACT PLUS E B NOVOFINE PEN NEEDLE 2 TEST STRIPS B NOVOFINE PLUS PEN NEEDLE 2
B ACCU-CHEK GUIDE/GUIDE ME KIT 3 B ONETOUCH ULTRA 2 KIT 1 W/DEVICE W/DEVICE
B ACCU-CHEK NANO SMARTVIEW E B ONETOUCH ULTRA BLUE TEST 1 KIT W/DEVICE STRIPS IN VITRO STRIP
B ACCU-CHEK SMARTVIEW TEST E B ONETOUCH ULTRA MINI KIT 1 STRIPS W/DEVICE
B ACCU-CHEK SOFTCLIX LANCET 1 B ONETOUCH VERIO FLEX SYSTEM 1DEVICE KIT KIT W/DEVICE B BD AUTOSHIELD DUO PEN 2 B ONETOUCH VERIO IQ SYSTEM 1
NEEDLES B ONETOUCH VERIO KIT W/DEVICE 1
B BD ULTRA-FINE INSULIN 2 B ONETOUCH VERIO SYNC SYSTEM 1SYRINGES
KIT W/DEVICEB BD ULTRA-FINE PEN NEEDLES 2 B ONETOUCH VERIO TEST STRIPS 1B CONTOUR NEXT MONITOR 2 B SOFTCLIX 1
B CONTOUR NEXT TEST 2 B CONTOUR TEST E
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Diabetes - Insulin Diabetes - Non-Insulin Agents B BADMELOG E ADLYXIN 3 B BAFREZZA 3 ALOGLIPTIN BENZOATE E B BBASAGLAR KWIKPEN E ALOGLIPTIN-METFORMIN HCL E B BHUMALOG KWIKPEN 2 ALOGLIPTIN-PIOGLITAZONE E B BHUMALOG MIX 50/50 KWIKPEN 2 AMARYL 3 B BHUMALOG MIX 50/50 VIAL 1 BAQSIMI ONE PACK 2 B BHUMALOG MIX 75/25 KWIKPEN 2 BAQSIMI TWO PACK 2 B BHUMALOG MIX 75/25 VIAL 1 BYDUREON 2 B BHUMALOG SUBCUTANEOUS 1 BYDUREON BCISE 2
SOLUTION AUTOINJECTOR B BHUMALOG SUBCUTANEOUS 2 BYETTA 2
SOLUTION CARTRIDGE B FARXIGA E ST B HUMALOG U-100 JUNIOR 2 g glimepiride 1
KWIKPEN g glipizide er 1
B HUMULIN 70/30 KWIKPEN 2 g glipizide ir 1
B HUMULIN 70/30 VIAL 1 g glipizide xl 1
B HUMULIN N KWIKPEN 2 B GLUCAGON EMERGENCY KIT 2
B HUMULIN N VIAL 1 INJECTION KIT B HUMULIN R U-500 KWIKPEN 2 B GLUCOTROL 3 B HUMULIN R U-500 VIAL 1 B GLUCOTROL XL 3
(CONCENTRATED) B GLUCOVANCE ORAL TABLET 3
B HUMULIN R VIAL 1 5-500 MG B INSULIN ASPART E B GLUMETZA 3 B INSULIN LISPRO E g glyburide oral 1 B LANTUS SOLOSTAR 1 g glyburide-metformin 1 B LANTUS U-100 VIAL 1 B GLYXAMBI 2 ST B LEVEMIR U-100 FLEXTOUCH E B GVOKE PFS 2 B LEVEMIR U-100 VIAL E B INVOKANA E B NOVOLIN 70/30 E B JANUVIA E ST B NOVOLIN N E B JARDIANCE 2 B NOVOLIN R E B JENTADUETO 2 B NOVOLOG E B JENTADUETO XR 2 B TOUJEO MAX SOLOSTAR 2 B KAZANO 2 B TOUJEO SOLOSTAR 2 B KOMBIGLYZE XR 2 B TRESIBA E g metformin hcl er 1 B TRESIBA FLEXTOUCH E g metformin hcl er (mod) 1
g metformin hcl er (osm) 1
2020
B METFORMIN HCL ORAL 1 Drugs for Sexual Dysfunction SOLUTION B ADDYI 3
g metformin hcl oral tablet 1 B IMVEXXY 3 B NESINA 2 B INTRAROSA 2 B ONGLYZA 2 B OSPHENA 2 B OSENI 2 g sildenafil citrate oral tablet 100 mg, 1 QL B OZEMPIC 2 25 mg, 50 mg g Bpioglitazone hcl 1 STENDRA 2 QL B gRIOMET 3 tadalafil oral 1 QL B BRYBELSUS 2 VYLEESI 3 B SOLIQUA 2 Electrolytes / Vitamins B BSYNJARDY 2 DRISDOL 3 B BSYNJARDY XR 2 ERGOCAL 3 B gTRADJENTA 2 ergocalciferol oral capsule 1 B BTRIJARDY XR 2 FLORIVA PLUS 3 B gTRULICITY 2 folic acid oral tablet 1 mg 1 B gVICTOZA SOLUTION PEN- 2 klor-con 1
INJECTOR 18 MG/3ML g klor-con 10 1 SUBCUTANEOUS (2 PACK)
g klor-con m10 1 B VICTOZA SOLUTION PEN- 3
B KLOR-CON M15 3INJECTOR 18 MG/3ML g klor-con m20 1SUBCUTANEOUS (3 PACK) g klor-con sprinkle 1Drugs for Blood Disorders BB K-TAB 3ADVATE 2 SP BB LOKELMA 3ADYNOVATE 3 PA, SP gB multi-vitamin/fluoride 1AFSTYLA INTRAVENOUS KIT 3 PA, SP gB multivitamin/fluoride oral solution 1ARANESP (ALBUMIN FREE) 2 SP gB multivitamin/fluoride oral tablet 1ELOCTATE 3 PA, SP
chewable 0.25 mg, 0.5 mg, 1 mgB JIVI 3 PA, SP g multivitamins/fluoride 1B KOGENATE FS 2 SP g mvc-fluoride 1B KOVALTRY 2 PA, ST, SP B NASCOBAL 3B MULPLETA 2 PA, SP B POLY-VI-FLOR 3B NEULASTA 3 SP g potassium chloride crys er 1B NOVOEIGHT 2 SP g potassium chloride er 1B NUWIQ 2 SP g potassium chloride oral 1B RECOMBINATE 2 SP g potassium citrate er 1B RETACRIT 2 SP B QUFLORA PEDIATRIC 3B ZARXIO 2 SP B UROCIT-K 10 3B ZIEXTENZO 3 SP
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B gUROCIT-K 15 3 hyoscyamine sulfate er 1 B gUROCIT-K 5 3 hyoscyamine sulfate oral 1 B gVELTASSA 3 hyoscyamine sulfate sl 1 g gvitamin d (ergocalciferol) oral 1 hyoscyamine sulfate sublingual 1
capsule 1.25 mg (50000 ut) g hyosyne 1 Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer B LEVBID 3
B ACIPHEX SPRINKLE 3 B LEVSIN ORAL 3 B CARAFATE 3 B LEVSIN/SL 3 B CYTOTEC 3 B LINZESS 2 B DEXILANT 2 B LOMOTIL 3 g misoprostol oral 1 B MOTEGRITY 3 PA B OMECLAMOX-PAK 3 B MOVIPREP 2 g omeprazole oral capsule delayed 1 B NULEV 3
release g oscimin 1
g pantoprazole sodium tablet delayed 1 g oscimin sr 1release 20 mg oral g peg-3350/electrolytes 1 Hg pantoprazole sodium tablet delayed 1 B PLENVU 2release 40 mg oral BB PREPOPIK 2PROTONIX ORAL PACKET 3 BB SUPREP BOWEL PREP KIT 2PYLERA 3 BB SYMAX DUOTAB 3RABEPRAZOLE SODIUM ORAL 3
CAPSULE SPRINKLE g symax-sl 1 g rabeprazole sodium oral tablet 1 g symax-sr 1
delayed release B SYMPROIC 2 PA g sucralfate oral 1 B URSO 250 3
Gastrointestinal Agents - Drugs for Bowel, Intestine and B URSO FORTE 3Stomach Conditions g ursodiol oral 1B ACTIGALL 3 B VIBERZI 3B AEMCOLO 3 B XIFAXAN 3B ANASPAZ 2 B ZELNORM 3B CLENPIQ 2
Genetic or Enzyme Disorder - Drugs for Replacement, g dicyclomine hcl oral 1 Modification, Treatment
g diphenoxylate-atropine 1 B CERDELGA 2 PA, SP g ed-spaz 1 g clovique E PA, SP g gavilyte-c 1 H B CREON 2 g gavilyte-g 1 H B CUPRIMINE E SP B GOLYTELY ORAL SOLUTION 2 B DEPEN TITRATABS 2 SPRECONSTITUTED 227.1 GM
B ENDARI 3B GOLYTELY ORAL SOLUTION 3 B KUVAN 2 PA, SPRECONSTITUTED 236 GM
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g gnitisinone E PA, SP altavera 1 H B gNITYR 2 PA, SP alyacen 1/35 1 H B gORFADIN ORAL CAPSULE 20 MG E PA, SP amethia 1 H B gORFADIN ORAL SUSPENSION E PA, SP amethia lo 1 H B gPANCREAZE 3 ST apri 1 H g gpenicillamine oral capsule 1 SP ashlyna 1 H B gPERTZYE 3 ST aubra 1 H B gSTRENSIQ 2 PA, SP aubra eq 1 H B gSYPRINE 1 PA, SP aurovela 1.5/30 1 H B gTEGSEDI 2 PA, SP aurovela 1/20 1 H g gtrientine hcl E PA, SP aurovela 24 fe 1 H B gVIOKACE 3 ST aurovela fe 1.5/30 1 H B gZENPEP 2 aurovela fe 1/20 1 H
gGenitourinary Agents - Drugs for Bladder, Genital and aviane 1 H Kidney Conditions B AYGESTIN 3
B AURYXIA 3 g ayuna 1 H B DITROPAN XL 3 g azurette 1 H B GELNIQUE 3 g balziva 1 H g oxybutynin chloride er 1 g bekyree 1 H g oxybutynin chloride oral 1 B BIJUVA 3 g phenazo oral tablet 200 mg 1 g blisovi 24 fe 1 H g phenazopyridine hcl oral tablet 1 g blisovi fe 1.5/30 1 H
100 mg, 200 mg g blisovi fe 1/20 1 H
B PYRIDIUM 3 g briellyn 1 H
B TOVIAZ 2 g camila 1 H
B VELPHORO 2 g camrese 1 H
Genitourinary Agents - Drugs for Prostate Conditions g camrese lo 1 H
g alfuzosin hcl er 1 g chateal 1 H
g finasteride oral tablet 5 mg 1 g chateal eq 1 H
B PROSCAR 3 B CLIMARA PRO 2
g tamsulosin hcl 1 g cryselle-28 1 H
g terazosin hcl 1 g cyclafem 1/35 1 H
B UROXATRAL 3 g cyred 1 H
Hormonal Agents - Hormone Replacement and Birth g cyred eq 1 HControl g dasetta 1/35 1 Hg afirmelle 1 H g daysee 1 HB ALORA TRANSDERMAL PATCH 3 g deblitane 1 HTWICE WEEKLY 0.025 MG/24HR,
0.075 MG/24HR, 0.1 MG/24HR
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g gdelyla 1 H hailey 1.5/30 1 H B gDEPO-PROVERA 3 hailey 24 fe 1 H
INTRAMUSCULAR SUSPENSION g heather 1 H 150 MG/ML
g incassia 1 H B DEPO-PROVERA 3
g introvale 1 HINTRAMUSCULAR SUSPENSION g isibloom 1 HPREFILLED SYRINGE gB jasmiel 1 HDEPO-SUBQ PROVERA 104 2 g jencycla 1 Hdesogestrel-ethinyl estradiol 1 H gB jolessa 1 HDIVIGEL TRANSDERMAL GEL 2 gg juleber 1 Hdotti E gg junel 1.5/30 1 Hdrospiren-eth estrad-levomefol 1 gg junel 1/20 1 Hdrospirenone-ethinyl estradiol 1 H gB junel fe 1.5/30 1 HDUAVEE 3 gB junel fe 1/20 1 HELESTRIN 3 gg junel fe 24 1 Helinest 1 H gg kalliga 1 Heluryng E gg kariva 1 Hemoquette 1 H gg kurvelo 1 Henskyce 1 H gg larin 1.5/30 1 Herrin 1 H gg larin 1/20 1 Hestarylla 1 H gB larin 24 fe 1 HESTRACE ORAL 3 gB larin fe 1.5/30 1 HESTRACE VAGINAL 1 gg larin fe 1/20 1 Hestradiol oral 1 gg larissia 1 Hestradiol patch twice weekly 1
transdermal (generic MINIVELLE) g lessina 1 H g estradiol patch twice weekly E g levonorgest-eth est & eth est 1
transdermal (generic VIVELLE-DOT) g levonorgest-eth estrad 91-day 1 H g estradiol transdermal patch weekly 1 g levonorgestrel-ethinyl estrad oral 1 H(generic CLIMARA) tablet 0.1-20 mg-mcg, g estradiol vaginal cream E 0.15-30 mg-mcg g estradiol vaginal tablet 1 g levora 0.15/30 (28) 1 H B ESTRING 2 g lillow 1 H B ESTROGEL 3 B LO LOESTRIN FE 2 g etonogestrel-ethinyl estradiol E B LOESTRIN 1.5/30 (21) 3 B EVAMIST 2 B LOESTRIN 1/20 (21) 3 g falmina 1 H B LOESTRIN FE 1.5/30 3 g fayosim 1 B LOESTRIN FE 1/20 3 g femynor 1 H g loryna 1 H g gianvi 1 H B LOSEASONIQUE 3
2424
g glow-ogestrel 1 H ogestrel 1 H g glo-zumandimine 1 H orsythia 1 H g Blutera 1 H ORTHO MICRONOR 3 g glyza 1 H philith 1 H g gmarlissa 1 H pimtrea 1 H g gmedroxyprogesterone acetate 1 H pirmella 1/35 1 H
intramuscular g portia-28 1 H g medroxyprogesterone acetate oral 1 B PREMARIN ORAL 2 g melodetta 24 fe 1 B PREMARIN VAGINAL 3 B MENOSTAR 3 B PREMPHASE 2 g mibelas 24 fe 1 B PREMPRO 2 g microgestin 1.5/30 1 H g previfem 1 H g microgestin 1/20 1 H g progesterone micronized oral 1 g microgestin fe 1.5/30 1 H B PROVERA 3 g microgestin fe 1/20 1 H g reclipsen 1 H g mili 1 H g rivelsa 1 B MIRCETTE 3 B SEASONIQUE 3 g mono-linyah 1 H g setlakin 1 H B NATAZIA 2 g sharobel 1 H g necon 0.5/35 (28) 1 H g simliya 1 H g nikki 1 H g simpesse 1 H g nora-be 1 H g sprintec 28 1 H g norethin ace-eth estrad-fe oral 1 H g sronyx 1 H
tablet g syeda 1 H
g norethin ace-eth estrad-fe oral 1 g tarina 24 fe 1 Htablet chewable g tarina fe 1/20 1 Hg norethindrone acetate oral 1 g tarina fe 1/20 eq 1 Hg norethindrone acet-ethinyl est 1 H B TAYTULLA 3g norethindrone oral 1 H g tri femynor 1 Hg norgestimate-eth estradiol 1 H g tri-estarylla 1 Hg norgestimate-ethinyl estradiol 1 H g tri-linyah 1 Htriphasic gg tri-lo-estarylla 1 Hnorlyda 1 H gg tri-lo-mili 1 Hnorlyroc 1 H gg tri-lo-sprintec 1 Hnortrel 0.5/35 (28) 1 H gg tri-mili 1 Hnortrel 1/35 (21) 1 H gg tri-previfem 1 Hnortrel 1/35 (28) 1 H gB tri-sprintec 1 HNUVARING 1 H gg tri-vylibra 1 Hocella 1 H
2525
g tri-vylibra lo 1 H Hormonal Agents - Other g gtulana 1 H cabergoline 1 g Btydemy 1 DDAVP INJECTION 3 g Bvienva 1 H DDAVP ORAL 3 g gviorele 1 H desmopressin acetate injection 1 B gVIVELLE-DOT 1 desmopressin acetate oral 1 g Bvyfemla 1 H GENOTROPIN E PA, SP g Bvylibra 1 H GENOTROPIN MINIQUICK E PA, SP g Bwera 1 H HUMATROPE E PA, SP g Bxulane 1 H NOCDURNA 3 B BYASMIN 28 3 NORDITROPIN FLEXPRO E PA, SP B BYAZ 3 NUTROPIN AQ NUSPIN 10 2 PA, SP g Byuvafem 1 NUTROPIN AQ NUSPIN 20 2 PA, SP g Bzarah 1 H NUTROPIN AQ NUSPIN 5 2 PA, SP g Bzumandimine 1 H OMNITROPE E PA, SP
BHormonal Agents - Oral Steroids ORILISSA 3 B BCORTEF 3 STIMATE 3 B BDECADRON 3 ZOMACTON E PA, SP g dexamethasone intensol 1 Hormonal Agents - Testosterone Replacement g Bdexamethasone oral 1 ANDRODERM 2 B BDEXPAK 3 DEPO-TESTOSTERONE 3 B BDXEVO 11-DAY 3 NATESTO E B BHIDEX 6-DAY 3 STRIANT 3 g Bhydrocortisone oral 1 TESTIM 1 B BMEDROL ORAL TABLET 16 MG, 3 TESTOSTERONE CYPIONATE 3
32 MG, 4 MG, 8 MG INJECTION B gMEDROL ORAL TABLET 2 MG 2 testosterone cypionate 1
intramuscularB MEDROL ORAL TABLET THERAPY 3 gPACK testosterone enanthate 1
intramuscularg methylprednisolone oral 1 g testosterone transdermal EB MILLIPRED 2 B XYOSTED 3B ORAPRED ODT 3
Hormonal Agents - ThyroidB PEDIAPRED 2 B ARMOUR THYROID 2g prednisolone oral solution 1 g euthyrox 1g prednisolone sodium phosphate 1 goral levo-t 1
g gprednisone intensol 1 levothyroxine sodium oral 1 g gprednisone oral 1 levoxyl 1 B gRAYOS 3 liothyronine sodium oral 1 B TAPERDEX 3
2626
g Bmethimazole oral 1 OLUMIANT 2 PA, ST, SP B BNATURE-THROID ORAL TABLET 2 OTEZLA 2 PA, SP
113.75 MG, 130 MG, 146.25 MG, B OTREXUP SUBCUTANEOUS 3 16.25 MG, 162.5 MG, 195 MG, SOLUTION AUTO-INJECTOR 260 MG, 32.5 MG, 325 MG, 10 MG/0.4ML, 12.5 MG/0.4ML, 48.75 MG, 65 MG, 81.25 MG 15 MG/0.4ML, 17.5 MG/0.4ML,
B NATURE-THROID TABLET 97.5 MG 3 22.5 MG/0.4ML, 25 MG/0.4ML ORAL B OTREXUP SUBCUTANEOUS E
B NATURE-THROID TABLET 97.5 MG 2 SOLUTION AUTO-INJECTOR ORAL 20 MG/0.4ML
g Bnp thyroid 1 PROGRAF ORAL PACKET 3 SP B BSYNTHROID E RAPAMUNE ORAL SOLUTION 3 SP B BTAPAZOLE 3 RASUVO 2 g Bthyroid oral tablet 120 mg, 15 mg, 1 RINVOQ 2 PA, SP
30 mg, 60 mg, 90 mg B RUCONEST 3 PA, SP B TIROSINT 3 B SIMPONI 2 PA, SP B TIROSINT-SOL 3 g sirolimus oral 1 SP g unithroid 1 B SKYRIZI (150 MG DOSE) 2 PA, SP B WESTHROID 3 B STELARA 2 PA, SP B WP THYROID 3 g tacrolimus oral 1 SP
Immunological Agents - Drugs for Immune System B TAKHZYRO 2 PA, SP Stimulation or Suppression
B TREMFYA 2 PA, SP B ACTEMRA 3 PA, ST, SP
B TREXALL 2 B ASTAGRAF XL 3 SP
B XELJANZ 2 PA, ST, SP B AZASAN 3
B XELJANZ XR ORAL TABLET 2 PA, ST, SP g azathioprine oral 1 EXTENDED RELEASE 24 HOUR B CIMZIA 2 PA, SP 11 MG B Infertility AgentsCOSENTYX 3 PA, ST, SP
gg cyclosporine modified 1 SP chorionic gonadotropin 1 SP intramuscularB ENBREL 3 PA, ST, SP
B CRINONE VAGINAL GEL 4 % 3 PA, STB ENVARSUS XR 3 SP B CRINONE VAGINAL GEL 8 % 3 PA, STB FIRAZYR 1 PA, SP B ENDOMETRIN 2 PAg gengraf 1 SP B FOLLISTIM AQ 2 SPB HAEGARDA 2 PA, SP g ganirelix acetate solution 4 SPB HUMIRA 2 PA, SP
prefilled syringe 250 mcg/0.5ml g icatibant acetate E PA, SP subcutaneous (Ferring) g methotrexate oral 1 g ganirelix acetate solution 2 SP g methotrexate sodium oral 1 prefilled syringe 250 mcg/0.5ml
subcutaneous (Merck/Organon)g mycophenolate mofetil 1 SP g novarel intramuscular solution 3 SPg mycophenolate sodium 1 SP
reconstituted 10000 unit
2727
B NOVAREL INTRAMUSCULAR 3 SP Ophthalmic Agents - Drugs for Eye Allergy, Infection and SOLUTION RECONSTITUTED Inflammation 5000 UNIT B ACULAR 3
g pregnyl 1 SP B ACULAR LS 3 Inflammatory Bowel Disease Agents B ACUVAIL 3
B APRISO 1 B ALREX 3 B AZULFIDINE 3 B AZASITE 3 B AZULFIDINE EN-TABS 3 g azelastine hcl ophthalmic 1 g budesonide er E B BESIVANCE 3 g budesonide oral 1 B CILOXAN 3 B CANASA E g ciprofloxacin hcl ophthalmic 1 B CORTIFOAM 2 g erythromycin ophthalmic 1 B DIPENTUM 3 B ILEVRO 3 g hydrocortisone ace-pramoxine 1 B INVELTYS 3
external cream 1-1 % g ketorolac tromethamine ophthalmic 1
g hydrocort-pramoxine (perianal) 1 B LASTACAFT 3
B LIALDA 1 B LOTEMAX 3
g mesalamine er E B LOTEMAX SM 3
g mesalamine oral E g loteprednol etabonate 1
g mesalamine rectal 1 B MAXITROL 3
B PENTASA E B MOXEZA 3
B PROCORT 3 g moxifloxacin hcl ophthalmic 1
B PROCTOFOAM HC 2 g neomycin-polymyxin-dexameth 1
B SFROWASA 3 ophthalmic ointment g sulfasalazine oral tablet 1 g neomycin-polymyxin-dexameth 1 B UCERIS ORAL 1 ophthalmic suspension
3.5-10000-0.1B UCERIS RECTAL 2 B NEVANAC 3Metabolic Bone Disease Agents - Drugs for Osteoporosis B OCUFLOX 3g alendronate sodium 1 g ofloxacin ophthalmic 1B BONIVA ORAL 3 g olopatadine hcl ophthalmic solution 1B FORTEO E PA, ST, SP
0.1% B FOSAMAX 3
g olopatadine hcl ophthalmic solution E g ibandronate sodium oral 1 0.2 % B TERIPARATIDE 3 PA, SP g polymyxin b-trimethoprim 1 B TYMLOS 3 SP B POLYTRIM 3
Metabolic Bone Disease Agents - Other B PRED FORTE 3 g calcitriol oral 1 B PRED MILD 3 B ROCALTROL 3 g prednisolone acetate ophthalmic 1
2828
B TOBRADEX 3 Respiratory - Drugs for Anaphylaxis B BTOBRADEX ST 3 AUVI-Q 3 g gtobramycin ophthalmic 1 epinephrine solution auto-injector 1
0.15 mg/0.3ml injection (generic g tobramycin-dexamethasone 1 EPIPEN JR., 2 pack)
B TOBREX 3 g epinephrine solution auto-injector 1
Ophthalmic Agents - Drugs for Glaucoma 0.3 mg/0.3ml injection (generic B ALPHAGAN P OPHTHALMIC 2 EPIPEN, 2 pack)
SOLUTION 0.1 % B SYMJEPI 2 B ALPHAGAN P OPHTHALMIC 3 Respiratory Tract / Pulmonary Agents - Drugs for
SOLUTION 0.15 % Allergies, Cough, Cold B AZOPT 2 g azelastine hcl nasal 1 B BETIMOL 2 g benzonatate 1 g bimatoprost ophthalmic 1 g bromfed dm 1 g brimonidine tartrate ophthalmic 1 g cyproheptadine hcl oral 1 B COMBIGAN 2 g fluticasone propionate nasal 1 B COSOPT 3 g hydrocodone polst-cpm polst er 1 PA g dorzolamide hcl-timolol mal 1 g ipratropium bromide nasal 1 g dorzolamide hcl-timolol mal pf 1 g levocetirizine dihydrochloride oral 1 B ISTALOL 3 B OMNARIS 3 g latanoprost ophthalmic 1 g promethazine hcl oral solution 1 B LUMIGAN 2 g promethazine hcl oral syrup 1 B RHOPRESSA 3 g promethazine-codeine 1 PA B ROCKLATAN 3 g promethazine-dm 1 g timolol maleate ophthalmic 1 g pseudoephedrine-bromphen-dm 1 B TIMOPTIC 3 B TESSALON PERLES 3 B TIMOPTIC OCUDOSE 2 B TUSSICAPS 3 B TIMOPTIC-XE 3 B XHANCE 3 B TRAVATAN Z 3 B ZETONNA 3 g travoprost (bak free) 1 Respiratory Tract / Pulmonary Agents - Drugs for B VYZULTA 3 Asthma and COPD B BXELPROS 3 ADVAIR DISKUS 1
BOphthalmic Agents - Drugs for Miscellaneous Eye ADVAIR HFA 2 RS Conditions B AIRDUO RESPICLICK 113/14 E
B CEQUA E B AIRDUO RESPICLICK 232/14 E B RESTASIS 2 B AIRDUO RESPICLICK 55/14 E B RESTASIS MULTIDOSE 3 g albuterol sulfate er 1 B XIIDRA 2 g albuterol sulfate hfa aerosol solution 1
Otic Agents - Drugs for Ear Conditions 108 (90 base) mcg/act inhalation (generic PROAIR HFA, PROVENTIL B CIPRODEX 3 HFA)g neomycin-polymyxin-hc otic 1
g ofloxacin otic 1
2929
B BALBUTEROL SULFATE HFA 3 PULMICORT FLEXHALER 1 AEROSOL SOLUTION 108 (90 B QVAR REDIHALER E BASE) MCG/ACT INHALATION
B SEREVENT DISKUS 2(generic VENTOLIN HFA) B SINGULAIR ORAL PACKET 3g albuterol sulfate inhalation 1 B SPIRIVA HANDIHALER 2g albuterol sulfate oral 1 B SPIRIVA RESPIMAT 2B ALVESCO E B STRIVERDI RESPIMAT 2B ANORO ELLIPTA 3 B SYMBICORT 2 RSB ARNUITY ELLIPTA 1 B TRELEGY ELLIPTA 3 RSB ASMANEX E B VENTOLIN HFA 2B ASMANEX HFA INHALATION E g wixela inhub EAEROSOL 100 MCG/ACT,
200 MCG/ACT B XOPENEX HFA 3 B ATROVENT HFA 2 B YUPELRI 3 B BEVESPI AEROSPHERE 2 Respiratory Tract / Pulmonary Agents - Drugs for Cystic B FibrosisBREO ELLIPTA 2 RS
Bg BETHKIS 1 PA, SPbudesonide inhalation 1 BB KITABIS PAK E PA, SPCOMBIVENT RESPIMAT 2 BB PULMOZYME 2 PA, SPEASIVENT 2 BB TOBI PODHALER 3 PA, SPFASENRA PEN 3 PA gB tobramycin nebulization solution 1 PA, SPFLOVENT DISKUS 1
300 mg/5ml inhalationB FLOVENT HFA 1 g tobramycin nebulization solution E PA, SPg fluticasone-salmeterol inhalation E
300 mg/5ml inhalationaerosol powder breath activated B TOBRAMYCIN NEBULIZATION E PA, SP100-50 mcg/dose, 250-50 mcg/
SOLUTION 300 MG/5ML dose, 500-50 mcg/dose INHALATIONB FLUTICASONE-SALMETEROL 1 Respiratory Tract / Pulmonary Agents - Drugs for INHALATION AEROSOL POWDER Pulmonary HypertensionBREATH ACTIVATED 113-14 MCG/
ACT, 232-14 MCG/ACT, 55-14 MCG/ B ADEMPAS 2 PA, SP ACT
g bosentan 1 PA, SP B INCRUSE ELLIPTA E
B OPSUMIT 2 PA, SP g ipratropium-albuterol 1
B ORENITRAM 3 PA, SP B LEVALBUTEROL HFA INHALATION 3
B TRACLEER 2 PA, SPAEROSOL 45 MCG/ACT B TYVASO 2 PA, SPg montelukast sodium oral 1
Skeletal Muscle Relaxants - Drugs for Muscle Pain and B NUCALA 3 PA, SP Spasm
B PERFOROMIST 3 B AMRIX 3
B PROAIR HFA 2 g baclofen oral 1
B PROAIR RESPICLICK 2 g carisoprodol oral 1
B PROVENTIL HFA 3 g cyclobenzaprine hcl er 1
3030
Drug Name Drug Requirements Tier & Limits
g cyclobenzaprine hcl oral 1 g metaxalone 1 g methocarbamol oral 1 B OZOBAX 3 B ROBAXIN-750 3 B SOMA ORAL TABLET 350 MG 3 g tizanidine hcl oral 1 B ZANAFLEX ORAL CAPSULE 3
Sleep Disorder Agents B EDLUAR 3 g eszopiclone 1 g modafinil 1 B RESTORIL 3 B SUNOSI 3 PA g temazepam 1 B WAKIX 3 PA, SP B XYREM 3 PA, SP g zolpidem tartrate 1 g zolpidem tartrate er 1
3131
Index ADLYXIN . . . . . . . . . . . . . . . . . . . . . . . . 20 alprazolam xr . . . . . . . . . . . . . . . . . . . . 14A
ADMELOG . . . . . . . . . . . . . . . . . . . . . . 20 ALREX . . . . . . . . . . . . . . . . . . . . . . . . . 28ABILIFY MYCITE . . . . . . . . . . . . . . . . . 13 ADVAIR DISKUS . . . . . . . . . . . . . . . . . 29 ALTACE . . . . . . . . . . . . . . . . . . . . . . . . . 14ABSORICA . . . . . . . . . . . . . . . . . . . . . . 17 ADVAIR HFA . . . . . . . . . . . . . . . . . . . . . 29 altavera . . . . . . . . . . . . . . . . . . . . . . . . . 23ACCU-CHEK AVIVA CONNECT KIT ADVATE . . . . . . . . . . . . . . . . . . . . . . . . 21 ALTOPREV . . . . . . . . . . . . . . . . . . . . . . 14W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 19 ADYNOVATE . . . . . . . . . . . . . . . . . . . . 21 ALTRENO . . . . . . . . . . . . . . . . . . . . . . . 17ACCU-CHEK AVIVA DEVICE . . . . . . . 19 AEMCOLO . . . . . . . . . . . . . . . . . . . . . . 22 ALVESCO . . . . . . . . . . . . . . . . . . . . . . . 30ACCU-CHEK AVIVA PLUS KIT
W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 19 afirmelle . . . . . . . . . . . . . . . . . . . . . . . . 23 alyacen 1/35 . . . . . . . . . . . . . . . . . . . . . 23 ACCU-CHEK COMPACT PLUS AFREZZA . . . . . . . . . . . . . . . . . . . . . . . 20 AMARYL . . . . . . . . . . . . . . . . . . . . . . . . 20 CARE KIT . . . . . . . . . . . . . . . . . . . . . . . 19
AFSTYLA INTRAVENOUS KIT . . . . . . 21 AMERGE . . . . . . . . . . . . . . . . . . . . . . . 12 ACCU-CHEK COMPACT PLUS
AIMOVIG. . . . . . . . . . . . . . . . . . . . . . . . 12 amethia . . . . . . . . . . . . . . . . . . . . . . . . . 23TEST STRIPS . . . . . . . . . . . . . . . . . . . . 19 AIRDUO RESPICLICK 113/14 . . . . . . 29 amethia lo . . . . . . . . . . . . . . . . . . . . . . . 23ACCU-CHEK GUIDE/GUIDE ME
KIT W/DEVICE . . . . . . . . . . . . . . . . . . . 19 AIRDUO RESPICLICK 232/14 . . . . . . 29 amiodarone hcl oral . . . . . . . . . . . . . . 14
ACCU-CHEK NANO SMARTVIEW AIRDUO RESPICLICK 55/14 . . . . . . . 29 amitriptyline hcl oral . . . . . . . . . . . . . . 11 KIT W/DEVICE . . . . . . . . . . . . . . . . . . . 19 ALA SCALP . . . . . . . . . . . . . . . . . . . . . 17 amlodipine besylate oral . . . . . . . . . . . 14 ACCU-CHEK SMARTVIEW TEST ala-cort external cream 1 % . . . . . . . . 17 amlodipine besylate-benazepril hcl . . 14 STRIPS . . . . . . . . . . . . . . . . . . . . . . . . . 19
ala-cort external cream 2.5 % . . . . . . 17 amlodipine besylate-valsartan . . . . . . 14 ACCU-CHEK SOFTCLIX LANCET
albuterol sulfate er . . . . . . . . . . . . . . . . 29 amnesteem . . . . . . . . . . . . . . . . . . . . . 17DEVICE KIT . . . . . . . . . . . . . . . . . . . . . 19 albuterol sulfate hfa aerosol amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . 9ACCUPRIL . . . . . . . . . . . . . . . . . . . . . . 14 solution 108 (90 base) mcg/act amoxicillin-potassium clavulanate er . . 9acetaminophen-codeine . . . . . . . . . . . . 8 inhalation . . . . . . . . . . . . . . . . . . . . 29, 30
amoxicillin-potassium clavulanate acetaminophen-codeine #2 . . . . . . . . . 8 albuterol sulfate inhalation . . . . . . . . . 30 oral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 acetaminophen-codeine #3 . . . . . . . . . 8 albuterol sulfate oral . . . . . . . . . . . . . . 30 amphetamine-dextroamphetamine . . 16 acetaminophen-codeine #4 . . . . . . . . . 8 ALDACTONE . . . . . . . . . . . . . . . . . . . . 14 amphetamine-dextroamphetamine acetazolamide er . . . . . . . . . . . . . . . . . 14 ALDARA . . . . . . . . . . . . . . . . . . . . . . . . 17 er . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 acetazolamide oral . . . . . . . . . . . . . . . 14 alendronate sodium . . . . . . . . . . . . . . 28 AMRIX . . . . . . . . . . . . . . . . . . . . . . . . . . 30 ACIPHEX SPRINKLE . . . . . . . . . . . . . . 22 alfuzosin hcl er . . . . . . . . . . . . . . . . . . . 23 AMZEEQ AER 4% . . . . . . . . . . . . . . . . 17 ACTEMRA . . . . . . . . . . . . . . . . . . . . . . 27 aliskiren fumarate . . . . . . . . . . . . . . . . 14 ANASPAZ . . . . . . . . . . . . . . . . . . . . . . . 22 ACTIGALL . . . . . . . . . . . . . . . . . . . . . . 22 allopurinol oral . . . . . . . . . . . . . . . . . . . 12 anastrozole oral . . . . . . . . . . . . . . . . . . 12 ACULAR . . . . . . . . . . . . . . . . . . . . . . . . 28 ALOGLIPTIN BENZOATE . . . . . . . . . . 20 ANDRODERM . . . . . . . . . . . . . . . . . . . 26 ACULAR LS . . . . . . . . . . . . . . . . . . . . . 28 ALOGLIPTIN-METFORMIN HCL . . . . 20 ANORO ELLIPTA . . . . . . . . . . . . . . . . . 30 ACUVAIL . . . . . . . . . . . . . . . . . . . . . . . . 28 ALOGLIPTIN-PIOGLITAZONE . . . . . . 20 apap-caff-dihydrocodeine oral acyclovir oral . . . . . . . . . . . . . . . . . . . . 13 capsule . . . . . . . . . . . . . . . . . . . . . . . . . . 8ALORA TRANSDERMAL PATCH ACZONE EXTERNAL GEL 5 % . . . . . . 17 TWICE WEEKLY 0.025 MG/24HR, apri . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
0.075 MG/24HR, 0.1 MG/24HR . . . . . 23ACZONE EXTERNAL GEL 7.5 % . . . . 17 APRISO . . . . . . . . . . . . . . . . . . . . . . . . 28 ALPHAGAN P OPHTHALMIC ADALAT CC ORAL TABLET APTENSIO XR . . . . . . . . . . . . . . . . . . . 16 SOLUTION 0.1 % . . . . . . . . . . . . . . . . . 29EXTENDED RELEASE 24 HOUR ARAKODA . . . . . . . . . . . . . . . . . . . . . . 13
60 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 14 ALPHAGAN P OPHTHALMIC ARANESP (ALBUMIN FREE) . . . . . . . 21SOLUTION 0.15 % . . . . . . . . . . . . . . . . 29ADDERALL XR . . . . . . . . . . . . . . . . . . 16 ARICEPT ORAL TABLET 10 MG, alprazolam er . . . . . . . . . . . . . . . . . . . . 14ADDYI . . . . . . . . . . . . . . . . . . . . . . . . . . 21 5 MG . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
alprazolam intensol . . . . . . . . . . . . . . . 14ADEMPAS . . . . . . . . . . . . . . . . . . . . . . 30 aripiprazole . . . . . . . . . . . . . . . . . . . . . 13 alprazolam oral . . . . . . . . . . . . . . . . . . 14ADHANSIA XR . . . . . . . . . . . . . . . . . . . 16 ARMOUR THYROID . . . . . . . . . . . . . . 26
32
ARNUITY ELLIPTA . . . . . . . . . . . . . . . 30 azelastine hcl nasal . . . . . . . . . . . . . . . 29 blisovi 24 fe . . . . . . . . . . . . . . . . . . . . . 23
ARYMO ER . . . . . . . . . . . . . . . . . . . . . . . 8 azelastine hcl ophthalmic . . . . . . . . . . 28 blisovi fe 1/20 . . . . . . . . . . . . . . . . . . . . 23
ashlyna . . . . . . . . . . . . . . . . . . . . . . . . . 23 azithromycin oral . . . . . . . . . . . . . . . . . . 9 blisovi fe 1.5/30 . . . . . . . . . . . . . . . . . . 23
ASMANEX . . . . . . . . . . . . . . . . . . . . . . 30 AZOPT . . . . . . . . . . . . . . . . . . . . . . . . . 29 BONIVA ORAL . . . . . . . . . . . . . . . . . . . 28
ASMANEX HFA INHALATION AZULFIDINE . . . . . . . . . . . . . . . . . . . . . 28 BONJESTA . . . . . . . . . . . . . . . . . . . . . . 11 AEROSOL 100 MCG/ACT, AZULFIDINE EN-TABS . . . . . . . . . . . . 28 bosentan . . . . . . . . . . . . . . . . . . . . . . . 30 200 MCG/ACT . . . . . . . . . . . . . . . . . . . 30
azurette . . . . . . . . . . . . . . . . . . . . . . . . . 23 BREO ELLIPTA . . . . . . . . . . . . . . . . . . 30 ASTAGRAF XL . . . . . . . . . . . . . . . . . . . 27
briellyn . . . . . . . . . . . . . . . . . . . . . . . . . 23 atenolol oral . . . . . . . . . . . . . . . . . . . . . 14
BRILINTA . . . . . . . . . . . . . . . . . . . . . . . 13B atenolol-chlorthalidone . . . . . . . . . . . . 14
brimonidine tartrate ophthalmic. . . . . 29baclofen oral . . . . . . . . . . . . . . . . . . . . 30atomoxetine hcl . . . . . . . . . . . . . . . . . . 16 bromfed dm . . . . . . . . . . . . . . . . . . . . . 29BACTRIM . . . . . . . . . . . . . . . . . . . . . . . . 9atorvastatin calcium oral tablet budesonide er . . . . . . . . . . . . . . . . . . . 2810 mg, 20 mg . . . . . . . . . . . . . . . . . . . . 14 BACTRIM DS . . . . . . . . . . . . . . . . . . . . . 9 budesonide inhalation. . . . . . . . . . . . . 30atorvastatin calcium oral tablet BAFIERTAM CAPSULE . . . . . . . . . . . . 17
40 mg, 80 mg . . . . . . . . . . . . . . . . . . . . 14 budesonide oral . . . . . . . . . . . . . . . . . . 28balziva . . . . . . . . . . . . . . . . . . . . . . . . . . 23 atovaquone-proguanil hcl . . . . . . . . . . 13 BUNAVAIL . . . . . . . . . . . . . . . . . . . . . . . 9BAQSIMI ONE PACK . . . . . . . . . . . . . . 20 ATRIPLA . . . . . . . . . . . . . . . . . . . . . . . . 13 buprenorphine hcl sublingual . . . . . . . 9BAQSIMI TWO PACK . . . . . . . . . . . . . 20 ATROVENT HFA . . . . . . . . . . . . . . . . . 30 buprenorphine hcl-naloxone hcl . . . . . 9BARACLUDE ORAL SOLUTION . . . . 13 AUBAGIO . . . . . . . . . . . . . . . . . . . . . . . 17 bupropion hcl er (sr) . . . . . . . . . . . . . . 11BASAGLAR KWIKPEN . . . . . . . . . . . . 20 aubra . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 bupropion hcl er (xl) oral tablet BD AUTOSHIELD DUO PEN extended release 24 hour 150 mg, aubra eq . . . . . . . . . . . . . . . . . . . . . . . . 23 NEEDLES . . . . . . . . . . . . . . . . . . . . . . . 19 300 mg . . . . . . . . . . . . . . . . . . . . . . . . . 11 AUGMENTIN ORAL SUSPENSION BD ULTRA-FINE INSULIN BUPROPION HCL ER (XL) ORAL RECONSTITUTED SYRINGES . . . . . . . . . . . . . . . . . . . . . . 19 TABLET EXTENDED RELEASE 125-31.25 MG/5ML . . . . . . . . . . . . . . . . 9
BD ULTRA-FINE PEN NEEDLES . . . . 19 24 HOUR 450 MG . . . . . . . . . . . . . . . . 11 aurovela 1/20 . . . . . . . . . . . . . . . . . . . . 23
bekyree . . . . . . . . . . . . . . . . . . . . . . . . . 23 bupropion hcl oral . . . . . . . . . . . . . . . . 11 aurovela 1.5/30 . . . . . . . . . . . . . . . . . . 23
BELBUCA . . . . . . . . . . . . . . . . . . . . . . . . 8 buspirone hcl oral . . . . . . . . . . . . . . . . 14 aurovela 24 fe . . . . . . . . . . . . . . . . . . . . 23
benazepril hcl oral . . . . . . . . . . . . . . . . 14 butalbital-apap-caffeine . . . . . . . . . . . . 8 aurovela fe 1/20 . . . . . . . . . . . . . . . . . . 23
benazepril-hydrochlorothiazide . . . . . 14 BYDUREON . . . . . . . . . . . . . . . . . . . . . 20 aurovela fe 1.5/30 . . . . . . . . . . . . . . . . 23
benzonatate . . . . . . . . . . . . . . . . . . . . . 29 BYDUREON BCISE AURYXIA . . . . . . . . . . . . . . . . . . . . . . . 23 AUTOINJECTOR . . . . . . . . . . . . . . . . . 20BESIVANCE . . . . . . . . . . . . . . . . . . . . . 28 AUSTEDO . . . . . . . . . . . . . . . . . . . . . . . 17 BYETTA . . . . . . . . . . . . . . . . . . . . . . . . 20betamethasone dipropionate aug . . . 17 AUVI-Q . . . . . . . . . . . . . . . . . . . . . . . . . 29 BYSTOLIC . . . . . . . . . . . . . . . . . . . . . . 14betamethasone dipropionate AVALIDE . . . . . . . . . . . . . . . . . . . . . . . . 14 external . . . . . . . . . . . . . . . . . . . . . . . . . 17 AVAPRO . . . . . . . . . . . . . . . . . . . . . . . . 14 BETASERON . . . . . . . . . . . . . . . . . . . . 17 C avar cleanser . . . . . . . . . . . . . . . . . . . . 17 BETHKIS . . . . . . . . . . . . . . . . . . . . . . . 30
cabergoline . . . . . . . . . . . . . . . . . . . . . 26aviane . . . . . . . . . . . . . . . . . . . . . . . . . . 23 BETIMOL . . . . . . . . . . . . . . . . . . . . . . . 29 CALAN SR . . . . . . . . . . . . . . . . . . . . . . 14avidoxy . . . . . . . . . . . . . . . . . . . . . . . . . . 9 BEVESPI AEROSPHERE . . . . . . . . . . 30 calcipotriene-betameth diprop AVONEX . . . . . . . . . . . . . . . . . . . . . . . . 17 BEVYXXA . . . . . . . . . . . . . . . . . . . . . . . 10 external ointment . . . . . . . . . . . . . . . . . 17
AYGESTIN . . . . . . . . . . . . . . . . . . . . . . 23 bexarotene . . . . . . . . . . . . . . . . . . . . . . 12 calcitriol external . . . . . . . . . . . . . . . . . 17 ayuna . . . . . . . . . . . . . . . . . . . . . . . . . . 23 BIDIL . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 calcitriol oral . . . . . . . . . . . . . . . . . . . . . 28 AZASAN . . . . . . . . . . . . . . . . . . . . . . . . 27 BIJUVA . . . . . . . . . . . . . . . . . . . . . . . . . 23 camila . . . . . . . . . . . . . . . . . . . . . . . . . . 23 AZASITE . . . . . . . . . . . . . . . . . . . . . . . . 28 bimatoprost ophthalmic . . . . . . . . . . . 29 camrese . . . . . . . . . . . . . . . . . . . . . . . . 23 azathioprine oral . . . . . . . . . . . . . . . . . 27 bisoprolol fumarate . . . . . . . . . . . . . . . 14 camrese lo . . . . . . . . . . . . . . . . . . . . . . 23 azelaic acid external . . . . . . . . . . . . . . 17 bisoprolol-hydrochlorothiazide . . . . . 14 CANASA . . . . . . . . . . . . . . . . . . . . . . . . 28
33
capecitabine . . . . . . . . . . . . . . . . . . . . 12 ciprofloxacin hcl ophthalmic . . . . . . . 28 CONTOUR NEXT MONITOR . . . . . . . 19
CAPEX . . . . . . . . . . . . . . . . . . . . . . . . . 17 ciprofloxacin hcl oral . . . . . . . . . . . . . . . 9 CONTOUR NEXT TEST . . . . . . . . . . . 19
CARAC . . . . . . . . . . . . . . . . . . . . . . . . . 17 citalopram hydrobromide . . . . . . . . . . 11 CONTOUR TEST . . . . . . . . . . . . . . . . . 19
CARAFATE . . . . . . . . . . . . . . . . . . . . . . 22 claravis . . . . . . . . . . . . . . . . . . . . . . . . . 18 CONZIP . . . . . . . . . . . . . . . . . . . . . . . . . 8
carbamazepine er . . . . . . . . . . . . . . . . 10 clarithromycin er . . . . . . . . . . . . . . . . . . 9 COREG . . . . . . . . . . . . . . . . . . . . . . . . . 14
carbamazepine oral . . . . . . . . . . . . . . 10 clarithromycin oral . . . . . . . . . . . . . . . . . 9 coremino . . . . . . . . . . . . . . . . . . . . . . . 10
CARBATROL . . . . . . . . . . . . . . . . . . . . 10 CLENPIQ . . . . . . . . . . . . . . . . . . . . . . . 22 CORGARD . . . . . . . . . . . . . . . . . . . . . . 14
carbidopa-levodopa . . . . . . . . . . . . . . 13 CLEOCIN ORAL CAPSULE CORLANOR . . . . . . . . . . . . . . . . . . . . . 14 150 MG, 300 MG . . . . . . . . . . . . . . . . . 10carbidopa-levodopa er . . . . . . . . . . . . 13 CORTEF . . . . . . . . . . . . . . . . . . . . . . . . 26 CLEOCIN ORAL CAPSULE 75 MG . . 10CARDIZEM LA ORAL TABLET CORTIFOAM . . . . . . . . . . . . . . . . . . . . 28
EXTENDED RELEASE 24 HOUR CLEOCIN-T . . . . . . . . . . . . . . . . . . . . . . 18 COSENTYX . . . . . . . . . . . . . . . . . . . . . 27 120 MG . . . . . . . . . . . . . . . . . . . . . . . . . 14 CLIMARA . . . . . . . . . . . . . . . . . . . . 23, 24 COSOPT . . . . . . . . . . . . . . . . . . . . . . . . 29 CARDURA . . . . . . . . . . . . . . . . . . . . . . 14 CLIMARA PRO . . . . . . . . . . . . . . . . . . 23 COUMADIN . . . . . . . . . . . . . . . . . . . . . 10 carisoprodol oral . . . . . . . . . . . . . . . . . 30 clindacin etz external swab . . . . . . . . 18 COZAAR . . . . . . . . . . . . . . . . . . . . . . . 14 CAROSPIR . . . . . . . . . . . . . . . . . . . . . . 14 clindacin-p . . . . . . . . . . . . . . . . . . . . . . 18 CREON . . . . . . . . . . . . . . . . . . . . . . . . . 22 cartia xt . . . . . . . . . . . . . . . . . . . . . . . . . 14 CLINDAGEL . . . . . . . . . . . . . . . . . . . . . 18 CRESEMBA ORAL . . . . . . . . . . . . . . . 12 carvedilol . . . . . . . . . . . . . . . . . . . . . . . 14 clindamycin hcl oral . . . . . . . . . . . . . . 10 CRINONE VAGINAL GEL 4 % . . . . . . 27 CATAPRES . . . . . . . . . . . . . . . . . . . . . . 14 clindamycin phos-benzoyl perox CRINONE VAGINAL GEL 8 % . . . . . . 27 cavarest . . . . . . . . . . . . . . . . . . . . . . . . 17 external gel 1.2-5 % . . . . . . . . . . . . . . . 18
cryselle-28 . . . . . . . . . . . . . . . . . . . . . . 23 cefadroxil . . . . . . . . . . . . . . . . . . . . . . . . 9 clindamycin phosphate external
CUPRIMINE . . . . . . . . . . . . . . . . . . . . . 22foam . . . . . . . . . . . . . . . . . . . . . . . . . . . 18cefdinir . . . . . . . . . . . . . . . . . . . . . . . . . . 9 cyclafem 1/35 . . . . . . . . . . . . . . . . . . . 23clindamycin phosphate external cefuroxime axetil . . . . . . . . . . . . . . . . . . 9
lotion . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 cyclobenzaprine hcl er . . . . . . . . . . . . 30 celecoxib oral. . . . . . . . . . . . . . . . . . . . . 9
clindamycin phosphate external cyclobenzaprine hcl oral . . . . . . . . . . . 31 CENTANY . . . . . . . . . . . . . . . . . . . . . . . . 9 solution . . . . . . . . . . . . . . . . . . . . . . . . . 18 cyclosporine modified . . . . . . . . . . . . 27 CENTANY AT . . . . . . . . . . . . . . . . . . . . . 9 clindamycin phosphate external cyproheptadine hcl oral . . . . . . . . . . . 29swab . . . . . . . . . . . . . . . . . . . . . . . . . . . 18cephalexin . . . . . . . . . . . . . . . . . . . . . . . 9
cyred . . . . . . . . . . . . . . . . . . . . . . . . . . . 23CLINDAMYCIN PHOSPHATE GEL CEQUA . . . . . . . . . . . . . . . . . . . . . . . . . 29 cyred eq . . . . . . . . . . . . . . . . . . . . . . . . 231 % EXTERNAL . . . . . . . . . . . . . . . . . . 18CERDELGA . . . . . . . . . . . . . . . . . . . . . 22 CYTOTEC . . . . . . . . . . . . . . . . . . . . . . . 22CLINDESSE . . . . . . . . . . . . . . . . . . . . . 10CHANTIX . . . . . . . . . . . . . . . . . . . . . . . . 9
clinpro 5000 . . . . . . . . . . . . . . . . . . . . . 17chateal . . . . . . . . . . . . . . . . . . . . . . . . . 23 Dclobetasol propionate external . . . . . 18chateal eq . . . . . . . . . . . . . . . . . . . . . . . 23
clodan external shampoo . . . . . . . . . . 18 dalfampridine er. . . . . . . . . . . . . . . . . . 17chlorhexidine gluconate mouth/ clonazepam oral . . . . . . . . . . . . . . . . . 14throat. . . . . . . . . . . . . . . . . . . . . . . . . . . 17 dapsone external gel 5 % . . . . . . . . . . 18 clonidine hcl oral . . . . . . . . . . . . . . . . . 14chlorthalidone . . . . . . . . . . . . . . . . . . . 14 dasetta 1/35 . . . . . . . . . . . . . . . . . . . . . 23 clopidogrel bisulfate oral . . . . . . . . . . 13chorionic gonadotropin daysee . . . . . . . . . . . . . . . . . . . . . . . . . 23
intramuscular . . . . . . . . . . . . . . . . . . . . 27 clotrimazole-betamethasone . . . . . . . 18 DDAVP INJECTION . . . . . . . . . . . . . . . 26 ciclodan . . . . . . . . . . . . . . . . . . . . . . . . 12 clovique . . . . . . . . . . . . . . . . . . . . . . . . 22 DDAVP ORAL. . . . . . . . . . . . . . . . . . . . 26 ciclopirox . . . . . . . . . . . . . . . . . . . . . . . 12 COLCHICINE ORAL CAPSULE . . . . . 12 deblitane . . . . . . . . . . . . . . . . . . . . . . . . 23 ciclopirox treatment . . . . . . . . . . . . . . 12 colchicine oral tablet . . . . . . . . . . . . . . 12 DECADRON . . . . . . . . . . . . . . . . . . . . . 26 CILOXAN . . . . . . . . . . . . . . . . . . . . . . . 28 COLCRYS . . . . . . . . . . . . . . . . . . . . . . . 12 delyla . . . . . . . . . . . . . . . . . . . . . . . . . . 24 CIMDUO . . . . . . . . . . . . . . . . . . . . . . . . 13 colesevelam hcl . . . . . . . . . . . . . . . . . . 14 denta 5000 plus . . . . . . . . . . . . . . . . . . 17 CIMZIA . . . . . . . . . . . . . . . . . . . . . . . . . 27 COMBIGAN . . . . . . . . . . . . . . . . . . . . . 29 dentagel . . . . . . . . . . . . . . . . . . . . . . . . 17 CIPRO ORAL TABLET . . . . . . . . . . . . . 9 COMBIVENT RESPIMAT . . . . . . . . . . 30 DEPAKOTE . . . . . . . . . . . . . . . . . . . . . . 10 CIPRODEX . . . . . . . . . . . . . . . . . . . . . . 29 CONCERTA . . . . . . . . . . . . . . . . . . . . . 16
34
DEPAKOTE SPRINKLES . . . . . . . . . . . 10 DIFICID . . . . . . . . . . . . . . . . . . . . . . . . . 10 ec-naproxen . . . . . . . . . . . . . . . . . . . . . . 9
DEPEN TITRATABS . . . . . . . . . . . . . . . 22 DIFLUCAN . . . . . . . . . . . . . . . . . . . . . . 12 ed-spaz . . . . . . . . . . . . . . . . . . . . . . . . . 22
DEPO-PROVERA DILAUDID ORAL . . . . . . . . . . . . . . . . . . 8 EDARBI . . . . . . . . . . . . . . . . . . . . . . . . . 15 INTRAMUSCULAR SUSPENSION dilt-xr . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 EDARBYCLOR . . . . . . . . . . . . . . . . . . . 15 150 MG/ML . . . . . . . . . . . . . . . . . . . . . 24
diltiazem hcl er coated beads . . . . . . 14 EDLUAR . . . . . . . . . . . . . . . . . . . . . . . . 31 DEPO-PROVERA
diltiazem hcl er oral capsule EFUDEX . . . . . . . . . . . . . . . . . . . . . . . . 18INTRAMUSCULAR SUSPENSION extended release 12 hour . . . . . . . . . . 15PREFILLED SYRINGE . . . . . . . . . . . . . 24 ELESTRIN . . . . . . . . . . . . . . . . . . . . . . . 24 diltiazem hcl oral . . . . . . . . . . . . . . . . . 15DEPO-SUBQ PROVERA 104 . . . . . . . 24 eletriptan hydrobromide . . . . . . . . . . . 12 DIPENTUM . . . . . . . . . . . . . . . . . . . . . . 28DEPO-TESTOSTERONE . . . . . . . . . . . 26 ELIMITE . . . . . . . . . . . . . . . . . . . . . . . . 13 diphenoxylate-atropine . . . . . . . . . . . . 22DERMA-SMOOTHE/FS BODY . . . . . . 18 elinest . . . . . . . . . . . . . . . . . . . . . . . . . . 24 DIPROLENE . . . . . . . . . . . . . . . . . . . . . 18DERMA-SMOOTHE/FS SCALP . . . . . 18 ELIQUIS . . . . . . . . . . . . . . . . . . . . . . . . 10 DIPROLENE AF . . . . . . . . . . . . . . . . . . 18DESCOVY. . . . . . . . . . . . . . . . . . . . . . . 13 ELOCTATE . . . . . . . . . . . . . . . . . . . . . . 21 DITROPAN XL . . . . . . . . . . . . . . . . . . . 23desmopressin acetate injection . . . . . 26 eluryng . . . . . . . . . . . . . . . . . . . . . . . . . 24 divalproex sodium er . . . . . . . . . . . . . . 10desmopressin acetate oral . . . . . . . . . 26 EMGALITY . . . . . . . . . . . . . . . . . . . . . . 12 divalproex sodium oral . . . . . . . . . . . . 10desogestrel-ethinyl estradiol . . . . . . . 24 EMGALITY (300 MG DOSE) . . . . . . . . 12 DIVIGEL TRANSDERMAL GEL . . . . . 24desonide cream, lotion, ointment . . . 18 emoquette . . . . . . . . . . . . . . . . . . . . . . 24 donepezil hcl . . . . . . . . . . . . . . . . . . . . 11desonide gel . . . . . . . . . . . . . . . . . . . . 18 emtricitabine/tenofovir disoproxil DORYX MPC . . . . . . . . . . . . . . . . . . . . 10 fumarate . . . . . . . . . . . . . . . . . . . . . . . . 13DESOWEN . . . . . . . . . . . . . . . . . . . . . . 18 dorzolamide hcl-timolol mal . . . . . . . . 29 enalapril maleate oral . . . . . . . . . . . . . 15desvenlafaxine succinate er . . . . . . . . 11 dorzolamide hcl-timolol mal pf . . . . . . 29 ENBREL . . . . . . . . . . . . . . . . . . . . . . . . 27dexamethasone intensol . . . . . . . . . . . 26 dotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 ENDARI . . . . . . . . . . . . . . . . . . . . . . . . . 22dexamethasone oral . . . . . . . . . . . . . . 26 DOVATO . . . . . . . . . . . . . . . . . . . . . . . . 13 endocet . . . . . . . . . . . . . . . . . . . . . . . . . 8DEXCOM G4 / G5 / G6 RECEIVER,
TRANSMITTER, SENSOR doxazosin mesylate oral . . . . . . . . . . . 15 ENDOMETRIN . . . . . . . . . . . . . . . . . . . 27 (INCLUDING PLATINUM, doxepin hcl oral capsule . . . . . . . . . . . 11 enoxaparin sodium . . . . . . . . . . . . . . . 10PLATINUM PEDIATRIC) . . . . . . . . . . . 19
doxepin hcl oral concentrate . . . . . . . 11 enskyce . . . . . . . . . . . . . . . . . . . . . . . . 24DEXCOM G4 / G5 / G6 RECEIVER, doxycycline hyclate oral . . . . . . . . . . . 10 ENSTILAR . . . . . . . . . . . . . . . . . . . . . . 18TRANSMITTER, SENSOR
(INCLUDING PLATINUM, doxycycline monohydrate oral . . . . . . 10 entecavir . . . . . . . . . . . . . . . . . . . . . . . . 13 PLATINUM PEDIATRIC) DEVICE . . . . 19
doxylamine-pyridoxine . . . . . . . . . . . . 11 ENVARSUS XR . . . . . . . . . . . . . . . . . . 27 DEXILANT . . . . . . . . . . . . . . . . . . . . . . 22
DRISDOL . . . . . . . . . . . . . . . . . . . . . . . 21 EPANED . . . . . . . . . . . . . . . . . . . . . . . . 15 dexmethylphenidate hcl . . . . . . . . . . . 16
DRIZALMA SPRINKLE . . . . . . . . . . . . 11 EPCLUSA . . . . . . . . . . . . . . . . . . . . . . . 13 dexmethylphenidate hcl er . . . . . . . . . 16
drospiren-eth estrad-levomefol . . . . . 24 epinephrine solution auto-injector DEXPAK . . . . . . . . . . . . . . . . . . . . . . . . 26 0.15 mg/0.3ml injection . . . . . . . . . . . . 29drospirenone-ethinyl estradiol . . . . . . 24 dextroamphetamine sulfate . . . . . . . . 16 epinephrine solution auto-injector DUAVEE . . . . . . . . . . . . . . . . . . . . . . . . 24
0.3 mg/0.3ml injection . . . . . . . . . . . . 29dextroamphetamine sulfate er . . . . . . 16 duloxetine hcl oral . . . . . . . . . . . . . . . . 11
EPIPEN . . . . . . . . . . . . . . . . . . . . . . . . . 29diazepam intensol . . . . . . . . . . . . . . . . 14 DUOPA . . . . . . . . . . . . . . . . . . . . . . . . . 13
EPIPEN JR. . . . . . . . . . . . . . . . . . . . . . . 29diazepam oral . . . . . . . . . . . . . . . . . . . 14 DUPIXENT . . . . . . . . . . . . . . . . . . . . . . 18
epitol . . . . . . . . . . . . . . . . . . . . . . . . . . . 10diclofenac potassium . . . . . . . . . . . . . . 9 DVORAH . . . . . . . . . . . . . . . . . . . . . . . . . 8
ERGOCAL . . . . . . . . .

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