your 2021 prescription drug list

Your 2021 Prescription Drug List

Advantage 4-Tier

This Prescription Drug List (PDL) is accurate as of May 1, 2021 and is subject to change after this date. This PDL applies to members of our UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers and Oxford medical plans with a pharmacy benefit subject to the Advantage 4-Tier PDL. Your estimated coverage and copayment/coinsurance may vary based on the benefit plan you choose and the effective date of the plan.

Effective May 1, 2021

Pharmacy | PDL

2

Understanding your Prescription Drug List (PDL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Medication tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Reading your PDL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Analgesics

Drugs for Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Drugs for Pain and Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Anti-Addiction / Substance Abuse Treatment Agents . . . . . . . . . . . . . . . . . . . . . . . . . 9Antibacterials

Drugs for Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Anticoagulants

Drugs to Treat or Prevent Blood Clots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Anticonvulsants

Drugs for Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Antidementia Agents

Drugs for Alzheimer’s Disease and Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Antidepressants

Drugs for Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Antiemetics

Drugs for Nausea and Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Antifungals

Drugs for Fungal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Antigout Agents

Drugs for Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antimigraine Agents

Drugs for Migraines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antineoplastics

Drugs for Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antiparasitics

Drugs for Parasitic Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Antiparkinson Agents

Drugs for Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Antiplatelets

Drugs for Heart Attack and Stroke Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Antipsychotics

Drugs for Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Antivirals

Drugs for Viral Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Anxiolytics

Drugs for Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Bipolar Agents

Drugs for Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Cardiovascular Agents

Drugs for Heart and Circulation Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Central Nervous System Agents

Drugs for Attention Deficit Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Drugs for Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Dental and Oral Agents Drugs for Mouth and Throat Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Table of contents

3

Dermatological Agents Drugs for Skin Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Diabetes Glucose Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Diabetes Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Diabetes Non-Insulin Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Drugs for Blood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Drugs for Sexual Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Electrolytes / Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Gastrointestinal Agents

Drugs for Acid Reflux and Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Drugs for Bowel, Intestine and Stomach Conditions . . . . . . . . . . . . . . . . . . . . . . . 24

Genetic or Enzyme Disorder Drugs for Replacement, Modification, Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 24

Genitourinary Agents Drugs for Bladder, Genital and Kidney Conditions. . . . . . . . . . . . . . . . . . . . . . . . . 24 Drugs for Prostate Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Hormonal Agents Hormone Replacement and Birth Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Oral Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Testosterone Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Immunological Agents Drugs for Immune System Stimulation or Suppression . . . . . . . . . . . . . . . . . . . . . 30

Infertility Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Inflammatory Bowel Disease Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Metabolic Bone Disease Agents

Drugs for Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Ophthalmic Agents Drugs for Eye Allergy, Infection and Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . 31 Drugs for Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Drugs for Miscellaneous Eye Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Otic Agents Drugs for Ear Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Respiratory Drugs for Anaphylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Respiratory Tract / Pulmonary Agents Drugs for Allergies, Cough, Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Drugs for Asthma and COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Drugs for Cystic Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Drugs for Pulmonary Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Skeletal Muscle Relaxants Drugs for Muscle Pain and Spasm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Sleep Disorder Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

4

Understanding your Prescription Drug List (PDL)

What is a PDL?This document is a list of the most commonly prescribed medications. It includes both brand-name and generic prescription medications approved by the Food and Drug Administration (FDA). Medications are listed by common categories or classes and placed in tiers that represent the cost you pay out-of-pocket. They are then listed in alphabetical order.

How do I use my PDL?You and your doctor can consult the PDL to help you select the most cost-effective prescription medications. This guide tells you if a medication is generic or a brand name, and if there are coverage requirements or limits. Bring this list with you when you see your doctor. If your medication is not listed here, please visit your plan’s member website or call the toll-free member phone number on your health 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 be subject to prior authorization (sometimes referred to as precertification)1 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 available without a prescription (also referred to as over-the-counter medications2). There are also some instances where the same product can be made by two 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.

About this PDLWhere differences exist between this PDL and your benefit plan documents, the benefit plan documents rule. This PDL is not a complete list of medications, and not all medications listed may be covered by your plan. Please look at the benefit plan documents provided by your employer or health plan to see which medications are covered under your plan.

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.

5

Medication tips

What is the difference between brand-name and generic medications?Generic medications contain the same active ingredients (what makes the medication work) as brand-name medications, but they often cost less. Once the patent for a brand-name medication ends, the FDA can approve a generic version with the same active ingredients. These types of medications are known as generic medications. Sometimes, the same company that makes a brand-name medication also makes the generic version.

What if my doctor writes a brand-name prescription?If your doctor gives you a prescription for a brand-name medication, ask if a generic 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.

Over-the-counter (OTC) medicationsAn OTC medication may be the right treatment option for some conditions. Talk to your doctor about available OTC options. Even though these medications may not be covered by your pharmacy benefit, they may cost less than a prescription medication.

6

Reading your PDLThe 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 informationUsing 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 Medications that provide the highest overall value. Mostly generic drugs. Some brand-name drugs may also be included.

Use Tier 1 drugs for the lowest out-of-pocket costs.

Tiers 2 and 3

$$ Mid-range cost Medications that provide good overall value. A mix of brand name and generic drugs.

Use Tier 2 or Tier 3 drugs, instead of Tier 4, to help reduce your out-of-pocket costs.

Tier 4 $$$ Highest-cost Medications that provide the lowest overall value. Mostly brand-name drugs, as well as some generics.

Many Tier 4 drugs have lower-cost options in Tiers 1, 2 or 3. Ask your doctor if they could work for you.

Drug list informationIn 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.

PA Prior Authorization (sometimes referred to as precertification)3 — 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.

RS Refill and Save Program4 — 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 Neighborhood Health Plan, Golden Rule, Oxford and UnitedHealthOne.

7

Reading your PDL (continued)

Coverage detailsSome drug classes in this PDL have additional/important coverage details. Review this list to see if drug classes that apply to you are noted.

• Central nervous system: sedatives/hypnotics Coverage is set by the consumer’s prescription drug benefit plan. Please consult plan documents regarding benefit coverage and cost-share.

• 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. This is not a covered benefit for Neighborhood Health Plan.

• 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.

And, if home delivery services are included in your pharmacy benefit, you can also:

• Refill prescriptions

• Check the status of your order

• Set up reminders for refills

• Manage your account

For the most current list of covered medications or if you have questions:

Call the toll-free member phone number on your ID card.

Visit your plan’s member website listed on your ID card to:

• View your pharmacy benefit and coverage information, including prescription history

• View medication interactions and side effects

• Locate a participating retail pharmacy by ZIP code

• Look up possible lower-cost medication alternatives

• Compare medication pricing and options

Questions

8

Drug Name Drug Tier

Requirements& Limits

Analgesics - Drugs for Paing acetaminophen-codeine 1g acetaminophen-codeine #2 1g acetaminophen-codeine #3 1g acetaminophen-codeine #4 1g apap-caff-dihydrocodeine oral

capsule4 QL

B ARYMO ER E PA, ST, QLB BELBUCA 3 PA, QLg butalbital-apap-caffeine oral

capsule 50-300-40 mg3 QL

g butalbital-apap-caffeine oral capsule 50-325-40 mg

1 QL

g butalbital-apap-caffeine oral tablet 1 QLB CONZIP E QLB DILAUDID ORAL 4B DVORAH E QLg endocet 1B ESGIC 4 QLg fentanyl transdermal patch 72 hour

100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr

2 PA, QL

g fentanyl transdermal patch 72 hour 37.5 mcg/hr, 62.5 mcg/hr, 87.5 mcg/hr

E PA, ST, QL

B FIORICET 4 QLg hydrocodone-acetaminophen oral

solution 10-325 mg/15ml1

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

2

g hydrocodone-acetaminophen oral tablet 10-300 mg, 5-300 mg, 7.5-300 mg

E

g hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg

1

g hydromorphone hcl er 4 PA, ST, QLg hydromorphone hcl oral 1g hydromorphone hcl rectal 1B HYSINGLA ER E PA, ST, QLB KADIAN ORAL CAPSULE

EXTENDED RELEASE 24 HOUR 200 MG

E PA, ST, QL

Drug Name Drug Tier


g lidocaine external ointment 2 QLg lidocaine external patch 5 % 3 PA, QLg lidocaine-prilocaine external cream 1g lorcet 1g lorcet hd 1g lorcet plus 1B LORTAB 4B MORPHABOND ER E PA, ST, QLg morphine sulfate (concentrate) oral

solution 100 mg/5ml, 20 mg/ml1

g morphine sulfate er oral capsule extended release 24 hour

E PA, ST, QL

g morphine sulfate er oral tablet extended release

1 PA, QL

g morphine sulfate oral 1g morphine sulfate rectal 1B MS CONTIN 3 PA, ST, QLB NALOCET E QLB NUCYNTA 4 QLB NUCYNTA ER 3 PA, QLB OXAYDO E QLB OXYCODONE HCL ER E PA, ST, QLg oxycodone hcl oral capsule 1g oxycodone hcl oral concentrate

100 mg/5ml1

g oxycodone hcl oral solution 1g oxycodone hcl oral tablet 1 PAg oxycodone-acetaminophen oral

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

1

B OXYCONTIN E PA, ST, QLg premium lidocaine 2 QLB PRIMLEV EB SUBSYS E PA, QLg tramadol hcl er (biphasic) E QLB TRAMADOL HCL ER ORAL

CAPSULE EXTENDED RELEASE 24 HOUR 100 MG, 200 MG, 300 MG

E QL

g tramadol hcl er oral capsule extended release 24 hour 150 mg

1 QL

9

Drug Name Drug Tier


g tramadol hcl er oral tablet extended release 24 hour

2 QL

g tramadol hcl oral tablet 50 mg 1B TREZIX 4 QLB TYLENOL WITH CODEINE #3 4B ULTRAM 4B VANATOL LQ 2 PA, QLB VANATOL S 2 PA, QLg vicodin hp oral tablet 10-300 mg EB XTAMPZA ER 2 PA, QLB ZEBUTAL 4 QLB ZOHYDRO ER E PA, ST, QLB ZTLIDO E PA, QL

Analgesics - Drugs for Pain and Inflammationg celecoxib oral 2 QLg diclofenac potassium 1g diclofenac sodium er 1g diclofenac sodium oral 1g diclofenac sodium transdermal

gel 1 %E

g diclofenac sodium transdermal solution

E

B EC-NAPROSYN 3g ec-naproxen 1g etodolac 1g etodolac er 1g ibu 1g ibuprofen oral suspension Eg ibuprofen oral tablet 400 mg,

600 mg, 800 mg1

B INDOCIN 3g indomethacin er 1g indomethacin oral capsule 25 mg,

50 mg1

g ketorolac tromethamine oral 1g meloxicam oral 1B MOBIC 4g nabumetone oral 1B NAPRELAN ORAL TABLET


E

Drug Name Drug Tier


B NAPROSYN ORAL SUSPENSION 4 PAg naproxen dr 1g naproxen oral suspension 1 PAg naproxen oral tablet 1g naproxen sodium er Eg naproxen sodium oral tablet

275 mg, 550 mg1

B PENNSAID EB QMIIZ ODT EB SPRIX 4 ST, QLB VIVLODEX E QLB VOLTAREN EB ZIPSOR E

Anti-Addiction / Substance Abuse Treatment AgentsB BUNAVAIL E PA, QLg buprenorphine hcl sublingual 1 QLg buprenorphine hcl-naloxone hcl 2 QLB CHANTIX 4 PA, HB CHANTIX CONTINUING MONTH

PAK4 PA, H

B CHANTIX STARTING MONTH PAK 4 PA, HB EVZIO E PA, QLg naloxone hcl injection solution 1g naloxone hcl injection solution

cartridge1

g naloxone hcl injection solution prefilled syringe

1

g naltrexone hcl oral 1B NARCAN 2 QLB ZUBSOLV 2 QL

Antibacterials - Drugs for InfectionsB AEMCOLO 3 QLg amoxicillin 1g amoxicillin-potassium clavulanate er Eg amoxicillin-potassium clavulanate

oral1

B AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

E

g avidoxy 1g azithromycin oral 1

10

Drug Name Drug Tier


B BACTRIM 4B BACTRIM DS 4g cefadroxil 1g cefdinir 1g cefuroxime axetil 1B CENTANY 4 QLB CENTANY AT Eg cephalexin 1B CIPRO ORAL TABLET 4g ciprofloxacin hcl oral 1g clarithromycin er 2g clarithromycin oral suspension

reconstituted2

g clarithromycin oral tablet 1B CLEOCIN ORAL CAPSULE

150 MG, 300 MG4

B CLEOCIN ORAL CAPSULE 75 MG 2g clindamycin hcl oral 1B CLINDESSE 2g coremino E PAB DIFICID 3 QLB DORYX MPC Eg doxycycline hyclate oral capsule 2g doxycycline hyclate oral tablet

100 mg2

g doxycycline hyclate oral tablet 150 mg, 50 mg, 75 mg

E

g doxycycline hyclate oral tablet 20 mg

1

g doxycycline hyclate oral tablet delayed release

E

g doxycycline monohydrate oral capsule 100 mg, 50 mg

1

g doxycycline monohydrate oral capsule 150 mg, 75 mg

E

g doxycycline monohydrate oral suspension reconstituted

3

g doxycycline monohydrate oral tablet

1

B FLAGYL 4B KEFLEX 4

Drug Name Drug Tier


B LEVAQUIN ORAL TABLET 500 MG, 750 MG

4

g levofloxacin oral 1B MACROBID 4B MACRODANTIN 4g metronidazole oral 1g metronidazole vaginal 2g minocycline hcl er oral tablet

extended release 24 hour 105 mg, 115 mg, 55 mg, 65 mg, 80 mg

E PA

g minocycline hcl er oral tablet extended release 24 hour 135 mg, 45 mg, 90 mg

E PA

g minocycline hcl oral capsule 1g minocycline hcl oral tablet EB MINOLIRA E PAg mondoxyne nl oral capsule 100 mg 1g mondoxyne nl oral capsule 75 mg Eg morgidox oral 2g mupirocin calcium 3 QLg mupirocin external 1 QLg nitrofurantoin macrocrystal oral 1g nitrofurantoin monohydrate

macrocrystals1

B NUVESSA EB NUZYRA 4 QLg okebo Eg penicillin v potassium 1g sulfamethoxazole-trimethoprim oral 1g sulfatrim pediatric 1g vandazole 2B VIBRAMYCIN ORAL CAPSULE 4B VIBRAMYCIN ORAL SUSPENSION

RECONSTITUTED4

B XENLETA 3B XEPI 3 QLB XIFAXAN 3 PAB XIMINO E PAB ZITHROMAX ORAL 4B ZITHROMAX TRI-PAK 4B ZITHROMAX Z-PAK 4

11

Drug Name Drug Tier


Anticoagulants - Drugs to Treat or Prevent Blood ClotsB BEVYXXA 3 QLB COUMADIN 3B ELIQUIS 2 QLB ELIQUIS DVT/PE STARTER PACK 2 QLg enoxaparin sodium 2 QLg jantoven 1B PRADAXA 2 QLg warfarin sodium oral 1B XARELTO 2 QLB XARELTO STARTER PACK 2 QL

Anticonvulsants - Drugs for Seizuresg carbamazepine er oral capsule

extended release 12 hour2

g carbamazepine er oral tablet extended release 12 hour

3

g carbamazepine oral 1B CARBATROL 4B DEPAKOTE 4 PAB DEPAKOTE ER 4 PA, STB DEPAKOTE SPRINKLES 4 PA, STg divalproex sodium er 2g divalproex sodium oral capsule

delayed release sprinkle2

g divalproex sodium oral tablet delayed release

1

g epitol 1g gabapentin oral 1B KEPPRA ORAL 4 PA, STB KEPPRA XR 4 PA, STB LAMICTAL 4 PA, STB LAMICTAL ODT ORAL KIT 4 PA, STB LAMICTAL ODT ORAL TABLET

DISPERSIBLE4 PA, ST

B LAMICTAL STARTER 4 PA, STB LAMICTAL XR 3 PA, STg lamotrigine er 3 PA, STg lamotrigine oral tablet 1g lamotrigine oral tablet chewable 1

Drug Name Drug Tier


g lamotrigine oral tablet dispersible 3 PA, STg lamotrigine starter kit-blue 1g lamotrigine starter kit-green 1g lamotrigine starter kit-orange 1g levetiracetam er 2g levetiracetam oral 1B NAYZILAM 3 PA, QL B NEURONTIN 4 PA, STg oxcarbazepine 1B OXTELLAR XR E PA, STg roweepra 1g roweepra xr 2B SPRITAM E PA, STg subvenite 1g subvenite starter kit-blue 1g subvenite starter kit-green 1g subvenite starter kit-orange 1B TEGRETOL 3B TEGRETOL-XR 4B TOPAMAX 4 PA, STB TOPAMAX SPRINKLE 4 PA, STg topiramate er E PA, STg topiramate oral 1B TRILEPTAL 4 PA, STB TROKENDI XR E PA, STB VALTOCO 3 PA, QL B VIMPAT ORAL 3 PAB XCOPRI 3 PAB ZONEGRAN 4 PA, STg zonisamide oral 1

Antidementia Agents - Drugs for Alzheimer’s Disease and Dementia

B ARICEPT ORAL TABLET 10 MG, 5 MG

3

g donepezil hcl oral tablet 10 mg, 5 mg

1

g donepezil hcl oral tablet 23 mg Eg donepezil hcl oral tablet dispersible 1

12

Drug Name Drug Tier


Antidepressants - Drugs for Depressiong amitriptyline hcl oral 1g bupropion hcl er (sr) 1g bupropion hcl er (xl) oral tablet

extended release 24 hour 150 mg, 300 mg

1

B BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG

E QL

g bupropion hcl oral 1g citalopram hydrobromide 1g desvenlafaxine succinate er 3 QLg doxepin hcl oral capsule 1g doxepin hcl oral concentrate 1B DRIZALMA SPRINKLE 4 PA, QLg duloxetine hcl oral capsule delayed

release particles 20 mg, 30 mg, 60 mg

2 QL

g duloxetine hcl oral capsule delayed release particles 40 mg

E

g escitalopram oxalate oral solution 3g escitalopram oxalate oral tablet 1g fluoxetine hcl oral capsule 1g fluoxetine hcl oral capsule delayed

release3 QL

g fluoxetine hcl oral solution 1g fluoxetine hcl oral tablet 10 mg 3 QLg fluoxetine hcl oral tablet 20 mg 3g fluoxetine hcl oral tablet 60 mg Eg fluvoxamine maleate 1g fluvoxamine maleate er 3 QLB FORFIVO XL E QLg mirtazapine oral 1g nortriptyline hcl oral 1B PAMELOR 4g paroxetine hcl 1g paroxetine hcl er 3 QLB PAXIL ORAL SUSPENSION 3B PAXIL ORAL TABLET 4B REMERON 4B REMERON SOLTAB 4

Drug Name Drug Tier


g sertraline hcl oral 1g trazodone hcl oral 1B TRINTELLIX 4 ST, QLg venlafaxine hcl 1g venlafaxine hcl er oral capsule


g venlafaxine hcl er oral tablet extended release 24 hour

E QL

B VIIBRYD 4 QLB VIIBRYD STARTER PACK 4

Antiemetics - Drugs for Nausea and VomitingB BONJESTA E PAg doxylamine-pyridoxine E PAg metoclopramide hcl oral solution

5 mg/5ml1

g metoclopramide hcl oral tablet 1g metoclopramide hcl oral tablet

dispersibleE

g ondansetron hcl oral 1g ondansetron odt 1g phenadoz 1g prochlorperazine maleate oral 1g promethazine hcl oral tablet 1g promethazine hcl rectal 1g promethegan 1B REGLAN 4g scopolamine 3B TRANSDERM-SCOP (1.5 MG) 4B VARUBI (180 MG DOSE) E QLB ZOFRAN 4B ZUPLENZ E QL

Antifungals - Drugs for Fungal Infectionsg ciclodan 1g ciclopirox external gel 1g ciclopirox external shampoo 2g ciclopirox external solution 1g ciclopirox treatment EB CRESEMBA ORAL 3B DIFLUCAN ORAL SUSPENSION

RECONSTITUTED4

13

Drug Name Drug Tier


B DIFLUCAN ORAL TABLET 100 MG, 150 MG, 200 MG

4

B DIFLUCAN ORAL TABLET 50 MG 3B EXTINA 4 ST, QLg fluconazole oral 1B GYNAZOLE-1 3g ketoconazole external cream 1 QLg ketoconazole external foam 3 ST, QLg ketoconazole external shampoo 1g ketodan external foam 3 ST, QLB NIZORAL 4g nyamyc 1 QLg nystatin external 1 QLg nystatin mouth/throat 1g nystop 1 QLg terbinafine hcl oral 1 QLg terconazole 1B XOLEGEL 3

Antigout Agents - Drugs for Goutg allopurinol oral 1B COLCHICINE ORAL CAPSULE Eg colchicine oral tablet EB COLCRYS Eg febuxostat 3 ST, QLB GLOPERBA 4 PAB MITIGARE 2B ZYLOPRIM 4

Antimigraine Agents - Drugs for MigrainesB AIMOVIG 2 PA, ST, QLB AIMOVIG SUBCUTANEOUS

SOLUTION AUTO-INJECTOR 140 MG/ML

2 PA, ST, QL

B AMERGE 4 QLg eletriptan hydrobromide 2 QLB EMGALITY 2 PA, ST, QLB EMGALITY (300 MG DOSE) 2 PA, ST, QLg naratriptan hcl 1 QLB ONZETRA XSAIL E QLB REYVOW 2 PA, ST, QLg rizatriptan benzoate 1 QL

Drug Name Drug Tier


g sumatriptan succinate oral 1 QLg sumatriptan succinate refill 1 QLg sumatriptan succinate

subcutaneous1 QL

B UBRELVY 2 PA, ST, QLB ZEMBRACE SYMTOUCH E QL

Antineoplastics - Drugs for CancerB ALECENSA 2 PA, QL, SPB ALUNBRIG 2 PA, QL, SPg anastrozole oral 1g bexarotene E SPB CALQUENCE 2 PA, QL, SPg capecitabine 1 QL, SPB ERLEADA 2 PA, QL, SPB IBRANCE ORAL CAPSULE 2 PA, QL, SPB IDHIFA 2 PA, QL, SPg imatinib mesylate 1 PA, QL, SPB KOSELUGO 2 PA, QL, SPg letrozole oral 1B LYNPARZA 2 PA, QL, SPg mercaptopurine oral 1B NUBEQA 2 PA, QL, SPB PURIXAN 4 PA, SPB REVLIMID 2 PA, QL, SPB ROZLYTREK 2 PA, QL, SPB SOLTAMOX Eg tamoxifen citrate oral tablet 10 mg 1g tamoxifen citrate oral tablet 20 mg 1 H-PAB TARGRETIN EXTERNAL 3 QL, SPB TARGRETIN ORAL 2 SPB TASIGNA 2 PA, ST, QL, SPB VERZENIO 2 PA, QL, SPB VITRAKVI 2 PA, QL, SPB ZEJULA 2 PA, QL, SP

Antiparasitics - Drugs for Parasitic InfectionsB ARAKODA 4 QLg atovaquone-proguanil hcl 2B ELIMITE 4g hydroxychloroquine sulfate oral 1 QL

14

Drug Name Drug Tier


B KRINTAFEL 1 QLB MALARONE 4g permethrin external 1

Antiparkinson Agents - Drugs for Parkinson’s Diseaseg carbidopa-levodopa 1g carbidopa-levodopa er 1B DUOPA 4 PAB INBRIJA 3 PA, QL, SPB KYNMOBI 3 PA, QL, SPB MIRAPEX 4B NOURIANZ 3 PA, QL g pramipexole dihydrochloride 1g pramipexole dihydrochloride er Eg ropinirole hcl 1g ropinirole hcl er EB RYTARY EB SINEMET 4

Antiplatelets - Drugs for Heart Attack and Stroke Prevention

B BRILINTA 4 QLg clopidogrel bisulfate oral 1B ZONTIVITY 4 QL

Antipsychotics - Drugs for Mood DisordersB ABILIFY MYCITE E PA, QLg aripiprazole oral solution 3g aripiprazole oral tablet 2 QLg aripiprazole oral tablet dispersible 2 QLB LATUDA 4 QLg olanzapine oral tablet 1 QLg olanzapine oral tablet dispersible 2 QLg quetiapine fumarate 1g quetiapine fumarate er 3 QLg risperidone 1B SAPHRIS 3 QLB VRAYLAR 4 ST, QLg ziprasidone hcl 2 QL

Antivirals - Drugs for Viral Infectionsg acyclovir oral 1B ATRIPLA E ST, QLB BARACLUDE ORAL SOLUTION 2 SP

Drug Name Drug Tier


B CIMDUO 2 QLB DESCOVY E PA, ST, QLB DOVATO 2 QLg emtricitabine-tenofovir df 1 QL, Hg entecavir 1 SPB EPCLUSA 2 PA, QL, SPB GENVOYA 4 QLB HARVONI 2 PA, ST, QL, SPB ISENTRESS 2B ISENTRESS HD 2B JULUCA 2 QLB LEDIPASVIR-SOFOSBUVIR 2 PA, ST, QL, SPB LEDIP-SOFOSB ORAL TABLET

90-400MG2 PA, ST, QL, SP

B MAVYRET 2 PA, QL, SPB NORVIR ORAL PACKET 2B NORVIR ORAL SOLUTION 2B ODEFSEY 4 QLg oseltamivir phosphate oral capsule 2g oseltamivir phosphate oral

suspension reconstituted2 QL

B PREZCOBIX 2B PREZISTA 2g ritonavir 2B RUKOBIA 4 PAB SITAVIG E QLB SOFOS/VELPAT ORAL TABLET

400-1002 PA, QL, SP

B SOFOSBUVIR-VELPATASVIR 2 PA, QL, SPB STRIBILD 4 QLB SYMFI 2 QLB SYMFI LO 2 QLB TEMIXYS E QLg tenofovir disoproxil fumarate 2B TIVICAY 3B TRIUMEQ 2 QLB TRUVADA E QLg valacyclovir hcl oral 1 QLB VEMLIDY 4 ST, SPB VIREAD ORAL POWDER 3

15

Drug Name Drug Tier


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

2

B VOSEVI 2 PA, QL, SPB XOFLUZA (40 MG DOSE) 3 QLB XOFLUZA (80 MG DOSE) 3 QLB ZEPATIER 2 PA, QL, SPB ZOVIRAX ORAL SUSPENSION 4

Anxiolytics - Drugs for Anxietyg alprazolam er 1g alprazolam intensol 1g alprazolam oral 1g alprazolam xr 1g buspirone hcl oral 1g clonazepam oral 1g diazepam intensol 1g diazepam oral 1B HALCION 4g hydroxyzine hcl oral 1g hydroxyzine pamoate oral 1g lorazepam intensol 1g lorazepam oral concentrate

2 mg/ml1

g lorazepam oral tablet 1g triazolam 1B VISTARIL 4

Bipolar Agents - Drugs for Mood Disordersg lithium carbonate er 1g lithium carbonate oral 1B LITHOBID 4

Cardiovascular Agents - Drugs for Heart and Circulation Conditions

B ACCUPRIL 4g acetazolamide er 1g acetazolamide oral 1B ADALAT CC ORAL TABLET


4

B ALDACTONE 4g aliskiren fumarate 3B ALTACE 4B ALTOPREV E

Drug Name Drug Tier


g amiodarone hcl oral 1g amlodipine besylate oral 1g amlodipine besylate-benazepril hcl 1g amlodipine besylate-valsartan 2g atenolol oral 1g atenolol-chlorthalidone 1g atorvastatin calcium oral tablet

10 mg, 20 mg1 QL, H-PA

g atorvastatin calcium oral tablet 40 mg, 80 mg

1 QL

B AVALIDE 4g benazepril hcl oral 1g benazepril-hydrochlorothiazide 1B BIDIL 2g bisoprolol fumarate 1g bisoprolol-hydrochlorothiazide 1B BYSTOLIC EB CALAN SR 4B CARDIZEM LA ORAL TABLET


E

B CARDURA 4B CAROSPIR 4 PAg cartia xt 2g carvedilol 1B CATAPRES 4g chlorthalidone 1g clonidine hcl oral 1g colesevelam hcl EB COREG 4B CORGARD 4B CORLANOR 3 PA, QLg diltiazem hcl er coated beads 2g diltiazem hcl er oral capsule


g diltiazem hcl oral 1g dilt-xr 1g doxazosin mesylate oral 1B DYAZIDE 4B EDARBI 3B EDARBYCLOR 3

16

Drug Name Drug Tier


g enalapril maleate oral 1B EPANED 4 PAB EZALLOR SPRINKLE 3 PAg ezetimibe 2g ezetimibe-simvastatin 3g fenofibrate oral capsule 150 mg,

50 mgE

g fenofibrate oral tablet 120 mg, 40 mg, 48 mg

E

g fenofibrate oral tablet 160 mg, 145 mg, 54 mg

2

g flecainide acetate 1B FLOLIPID 4 PAg furosemide oral 1g gemfibrozil oral 1B GONITRO E QLg guanfacine hcl 1B HEMANGEOL Eg hydralazine hcl oral 1g hydrochlorothiazide oral 1B HYZAAR 4g icosapent ethyl E PAg irbesartan 1g irbesartan-hydrochlorothiazide 1g isosorbide mononitrate 1g isosorbide mononitrate er 1B KAPSPARGO SPRINKLE 4g labetalol hcl oral 1B LASIX 4B LIPOFEN Eg lisinopril oral 1g lisinopril-hydrochlorothiazide 1B LOPID 4B LOPRESSOR 4g losartan potassium 1g losartan potassium-hctz 1B LOTENSIN 4B LOTENSIN HCT 4g lovastatin 1 Hg matzim la 2

Drug Name Drug Tier


B MAXZIDE 4B MAXZIDE-25 4g metoprolol succinate er oral tablet

extended release 24 hour 100 mg, 200 mg, 50 mg

2

g metoprolol succinate er oral tablet extended release 24 hour 25 mg

1

g metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg

1

g metoprolol tartrate oral tablet 37.5 mg, 75 mg

E

B MINIPRESS 4g minitran 1B MULTAQ 4 PAg nadolol oral 1B NEXLETOL 2 PA, ST, QLB NEXLIZET 2 PA, ST, QLg niacin (antihyperlipidemic) Eg niacin er (antihyperlipidemic) 4g niacor EB NIASPAN 2g nifedipine er 1g nifedipine er osmotic release 1g nifedipine oral 1B NITRO-BID 2B NITRO-DUR 3g nitroglycerin sublingual 1g nitroglycerin transdermal 1g nitroglycerin translingual E QLB NITROMIST 4 QLB NITROSTAT 4g nitro-time 1g olmesartan medoxomil oral 2g olmesartan medoxomil-hctz 2g omega-3-acid ethyl esters 2B PACERONE ORAL TABLET

100 MG, 400 MG3

g pacerone oral tablet 200 mg 1B PRALUENT 2 PA, ST, QLB PRAVACHOL 4

17

Drug Name Drug Tier


g pravastatin sodium 1g prazosin hcl oral 1B PRINIVIL 4B PROCARDIA 4B PROCARDIA XL 4g propranolol hcl er 2g propranolol hcl oral 1B QBRELIS 4 PAg quinapril hcl 1g ramipril 1g ranolazine er 2B REPATHA 2 PA, ST, QLB REPATHA PUSHTRONEX SYSTEM 2 PA, ST, QLB REPATHA SURECLICK 2 PA, ST, QLg rosuvastatin calcium 2 QLg simvastatin oral tablet 10 mg,

20 mg, 40 mg, 5 mg1 H-PA

g simvastatin oral tablet 80 mg 1g sotalol hcl oral 1B SOTYLIZE 4 PAg spironolactone oral 1B TEKTURNA 3B TEKTURNA HCT 3g telmisartan 2B TOPROL XL 4g torsemide 1g triamterene-hctz 1g valsartan 2g valsartan-hydrochlorothiazide 1B VASCEPA ORAL CAPSULE 0.5 GM E PAB VASCEPA ORAL CAPSULE 1 GM E PAg verapamil hcl er oral capsule

extended release 24 hour 100 mg, 200 mg, 300 mg

3

g verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg

1

g verapamil hcl er oral tablet extended release

1

g verapamil hcl oral 1B VERELAN 4

Drug Name Drug Tier


B VERELAN PM 4B WELCHOL 2B ZIAC ORAL TABLET 10-6.25 MG,

2.5-6.25 MG3

B ZIAC ORAL TABLET 5-6.25 MG 4B ZOCOR ORAL TABLET 10 MG,

20 MG, 40 MG, 80 MG4

Central Nervous System Agents - Drugs for Attention Deficit Disorder

B ADDERALL XR 2 QLB ADHANSIA XR E PA, QLg amphetamine-dextroamphetamine 1 PAg amphetamine-dextroamphetamine

erE QL

B APTENSIO XR E PA, QLg atomoxetine hcl 3 QLB CONCERTA 2 PA, QLg dexmethylphenidate hcl 1 PAg dexmethylphenidate hcl er 3 PA, QLg dextroamphetamine sulfate er 3 PAg dextroamphetamine sulfate oral

solution1 PA

g dextroamphetamine sulfate oral tablet

3 PA

B FOCALIN 4 PAg guanfacine hcl er 2 QLB JORNAY PM E PA, QLg metadate er 4 PA, QLB METHYLIN 4 PAg methylphenidate hcl er (cd) 2 PA, QLg methylphenidate hcl er (la) oral

capsule extended release 24 hour 10 mg, 20 mg, 30 mg, 40 mg

2 PA, QL

g methylphenidate hcl er (la) oral capsule extended release 24 hour 60 mg

2 PA

g methylphenidate hcl er oral tablet extended release 10 mg, 20 mg

4 PA, QL

g methylphenidate hcl er oral tablet extended release 18 mg, 27 mg, 36 mg, 54 mg, 72 mg

E PA, QL

g methylphenidate hcl er oral tablet extended release 24 hour

E PA, QL

18

Drug Name Drug Tier


g methylphenidate hcl oral solution 1 PAg methylphenidate hcl oral tablet 1 PAg methylphenidate hcl oral tablet

chewable3 PA

B MYDAYIS E PA, QLB PROCENTRA 3 PAB QUILLICHEW ER E PA, QLB QUILLIVANT XR E PA, QLg relexxii E PA, QLB RITALIN 4 PAB VYVANSE 3 PA, QLB ZENZEDI ORAL TABLET 15 MG,

2.5 MG, 20 MG, 30 MG, 7.5 MGE PA

Central Nervous System Agents - Drugs for Multiple Sclerosis

B AUBAGIO 3 PA, QL, SPB AVONEX PEN 2 PA, QL, SPB AVONEX PREFILLED 2 PA, QL, SPB BAFIERTAM CAPSULE 2 PA, QL, SPB BETASERON 2 PA, QL, SPg dalfampridine er 2 PA, QL, SPg dimethyl fumarate 2 PA, QL, SPB EXTAVIA E PA, ST, QL, SPB GILENYA 3 PA, QL, SPg glatiramer acetate 2 PA, QL, SPg glatopa 2 PA, QL, SPB KESIMPTA 2 PA, QL, SPB MAVENCLAD (10 TABS) 3 PA, ST, QL, SPB MAVENCLAD (4 TABS) 3 PA, ST, QL, SPB MAVENCLAD (5 TABS) 3 PA, ST, QL, SPB MAVENCLAD (6 TABS) 3 PA, ST, QL, SPB MAVENCLAD (7 TABS) 3 PA, ST, QL, SPB MAVENCLAD (8 TABS) 3 PA, ST, QL, SPB MAVENCLAD (9 TABS) 3 PA, ST, QL, SPB MAYZENT 3 PA, QL, SPB MAYZENT STARTER PACK 3 PA, QL, SPB PLEGRIDY 3 PA, QL, SPB PLEGRIDY STARTER PACK 3 PA, QL, SPB REBIF 4 PA, ST, QL, SPB REBIF REBIDOSE 4 PA, ST, QL, SP

Drug Name Drug Tier


B REBIF REBIDOSE TITRATION PACK

4 PA, ST, QL, SP

B REBIF TITRATION PACK 4 PA, ST, QL, SPB TECFIDERA E PA, QL, SPB ZEPOSIA 3 PA, QL, SP

Central Nervous System Agents - MiscellaneousB AUSTEDO 2 PA, QL, SPB LYRICA 4 PA, ST, QLB LYRICA CR E ST, QLB NUEDEXTA 2 PAg pregabalin oral capsule 2 QLg pregabalin oral solution 3 QLB RILUTEK 4 SPg riluzole 1 SPB TIGLUTIK 4 PA

Dental and Oral Agents - Drugs for Mouth and Throat Conditions

g cavarest 1g chlorhexidine gluconate mouth/

throat1

g clinpro 5000 1g denta 5000 plus 1g dentagel 1g fluoridex 1g fluoridex enhanced whitening 1g lidocaine hcl mouth/throat 1g lidocaine viscous hcl 1B NAFRINSE DAILY/NEUTRAL 2B NAFRINSE WEEKLY 4g neutral sodium fluoride 1g paroex 1B PERIDEX 4g periogard 1B PREVIDENT 5000 BOOSTER PLUS 3B PREVIDENT 5000 DRY MOUTH 4B PREVIDENT 5000 ORTHO

DEFENSE3

B PREVIDENT 5000 PLUS 4B PREVIDENT DENTAL 4B PREVIDENT MOUTH/THROAT 3g sf 1

19

Drug Name Drug Tier


g sf 5000 plus 1g sodium fluoride 5000 plus 1g sodium fluoride dental 1

Dermatological Agents - Drugs for Skin ConditionsB ABSORICA E PAB ACZONE EXTERNAL GEL 5 % 4 QLB ACZONE EXTERNAL GEL 7.5 % 3 QLB ALA SCALP 4g ala-cort external cream 1 % Eg ala-cort external cream 2.5 % 1B ALDARA 4 QLB ALTRENO E PA, QLg amnesteem 2B AMZEEQ 4 PA, QL g avar cleanser 1B AVAR LS CLEANSER EB AVAR-E EMOLLIENT 3B AVAR-E GREEN 3B AVAR-E LS 3g avita E PA, QLg azelaic acid external 3g betamethasone dipropionate aug

external cream1

g betamethasone dipropionate aug external gel

1

g betamethasone dipropionate aug external lotion

3

g betamethasone dipropionate aug external ointment

3

g betamethasone dipropionate external cream

2

g betamethasone dipropionate external lotion

1

g betamethasone dipropionate external ointment

2

g bp 10-1 1g calcipotriene-betameth diprop

external ointment3 QL

g calcitriol external 1 QLB CAPEX 2B CARAC 2

Drug Name Drug Tier


g claravis 2B CLEOCIN-T EXTERNAL GEL 4 QLB CLEOCIN-T EXTERNAL LOTION 4g clindacin etz external swab 1g clindacin-p 1B CLINDAGEL E QLg clindamycin phos-benzoyl perox

external gel 1.2-5 %3 QL

g clindamycin phosphate external foam

3

g clindamycin phosphate external lotion

3

g clindamycin phosphate external solution

1 QL

g clindamycin phosphate external swab

1

B CLINDAMYCIN PHOSPHATE GEL 1 % EXTERNAL

E

g clindamycin phosphate gel 1 % external

3 QL

g clobetasol propionate external cream

2 QL

g clobetasol propionate external foam E QLg clobetasol propionate external gel 2 QLg clobetasol propionate external

liquid1 QL

g clobetasol propionate external lotion

E QL

g clobetasol propionate external ointment

2 QL

g clobetasol propionate external shampoo

E QL

g clobetasol propionate external solution

1 QL

g clodan external shampoo E QLg clotrimazole-betamethasone

external cream1 QL

g clotrimazole-betamethasone external lotion

1

g dapsone external gel 5 % E QLB DERMA-SMOOTHE/FS BODY 4 QLB DERMA-SMOOTHE/FS SCALP 4B DESONATE 4 ST, QL

20

Drug Name Drug Tier


g desonide external 3 QLB DESOWEN 3 QLB DIPROLENE 4B DIPROLENE AF 4B DUPIXENT 4 PA, ST, QL, SPB EFUDEX 4B ENSTILAR 4 QLB EUCRISA 3 ST, QLB EVOCLIN 4B FINACEA 4g fluocinolone acetonide body 3 QLg fluocinolone acetonide external

cream3 QL

g fluocinolone acetonide external ointment

2 QL

g fluocinolone acetonide external solution

3 QL

g fluocinolone acetonide scalp 3g fluocinonide external cream 0.05 % 1g fluocinonide external cream 0.1 % E QLg fluocinonide external gel 1g fluocinonide external ointment 1g fluocinonide external solution 1B FLUOROPLEX 4B FLUOROURACIL EXTERNAL

CREAM 0.5 %4

g fluorouracil external cream 5 % 1g fluorouracil external solution 1g hydrocortisone external cream 1 % Eg hydrocortisone external cream

2.5 %1

g hydrocortisone external lotion 2.5 % 1g hydrocortisone external ointment

1 %, 2.5 %1

g imiquimod external 1 QLB IMIQUIMOD PUMP E QLB IMPOYZ E QLg isotretinoin oral 2B METROCREAM 4B METROLOTION 4g metronidazole external cream 1

Drug Name Drug Tier


g metronidazole external gel 0.75 % 1g metronidazole external gel 1 % Eg metronidazole external lotion 1B MIRVASO 4 PA, QLg mometasone furoate external 1g myorisan 2g neuac external gel 3 QLB NORITATE EB PICATO 3 QLB PLEXION EB PLEXION CLEANSER EB PLEXION CLEANSING CLOTH EB RHOFADE 4 PA, QLg rosadan external cream 1g rosadan external gel 1B SERNIVO E QLB SOOLANTRA 4 QLg sss 10-5 1g sulfacetamide sodium-sulfur

external cream 10-2 %, 10-5 %1

g sulfacetamide sodium-sulfur external cream 9.8-4.8 %

E

g sulfacetamide sodium-sulfur external emulsion

1

g sulfacetamide sodium-sulfur external liquid 10-2 %, 9.8-4.8 %

E

g sulfacetamide sodium-sulfur external liquid 9-4 %, 9-4.5 %

1

g sulfacetamide sodium-sulfur external lotion 10-5 %

1

g sulfacetamide sodium-sulfur external lotion 9.8-4.8 %

E

g sulfacetamide sodium-sulfur external pad

1

g sulfacetamide sodium-sulfur external suspension 10-5 %

1

g sulfacetamide sodium-sulfur external suspension 8-4 %

E

g sulfacleanse 8/4 Eg sulfamez wash 1B SUMADAN WASH EB SUMAXIN 4

21

Drug Name Drug Tier


B SUMAXIN WASH 3B TACLONEX EXTERNAL

SUSPENSION3 QL

g tazarotene external 3 PA, QLB TAZORAC 4 PA, QLB TEMOVATE 4 QLB TEXACORT 2B TOLAK Eg tretinoin external cream 3 QLg tretinoin external gel 0.01 %, 0.05 % E QLg tretinoin external gel 0.025 % Eg triamcinolone acetonide external

aerosol solution2 QL

g triamcinolone acetonide external cream 0.025 %, 0.1 %

1

g triamcinolone acetonide external cream 0.5 %

1 QL

g triamcinolone acetonide external lotion

1

g triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 %

1

g triamcinolone acetonide external ointment 0.05 %

E

g trianex Eg triderm external cream 0.1 % 1g triderm external cream 0.5 % 1 QLB TRIDESILON 3 QLB VERDESO E QLg zenatane 2B ZILXI 4 PA, ST, QLB ZYCLARA E QLB ZYCLARA PUMP E QL

Diabetes - Glucose MonitoringB ACCU-CHEK AVIVA CONNECT KIT

W/DEVICEE

B ACCU-CHEK AVIVA DEVICE EB ACCU-CHEK AVIVA PLUS KIT

W/DEVICEE

B ACCU-CHEK AVIVA PLUS TEST STRIPS

E QL

B ACCU-CHEK COMPACT PLUS CARE KIT

E

Drug Name Drug Tier


B ACCU-CHEK COMPACT PLUS TEST STRIPS

E QL

B ACCU-CHEK GUIDE KIT W/DEVICE 3B ACCU-CHEK GUIDE ME KIT

W/DEVICE3

B ACCU-CHEK GUIDE TEST STRIPS 3 QLB ACCU-CHEK NANO SMARTVIEW

KIT W/DEVICEE

B ACCU-CHEK SMARTVIEW TEST STRIPS

E QL

B ACCU-CHEK SOFTCLIX LANCET DEVICE KIT

1

B BD AUTOSHIELD DUO PEN NEEDLES

2

B BD ULTRA-FINE INSULIN SYRINGES

2

B BD ULTRA-FINE PEN NEEDLES 2B CONTOUR NEXT EZ MONITOR 2B CONTOUR NEXT LNK MONITOR EB CONTOUR NEXT MONITOR 2B CONTOUR NEXT ONE MONITOR 2B CONTOUR NEXT TEST STRIP 2 QLB CONTOUR TEST STRIP E QLB DEXCOM G4 / G5 / G6 RECEIVER,

TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC)

3 PA, QL

B DEXCOM G4 / G5 / G6 RECEIVER, TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC) DEVICE

3 PA, QL

B EASYPLUS BLOOD GLUCOSE TEST

E QL

B FREESTYLE LIBRE 14 DAY READER

3 PA, QL

B FREESTYLE LIBRE 14 DAY SENSOR

3 PA, QL

B FREESTYLE LIBRE READER 3 PA, QLB FREESTYLE LIBRE SENSOR

SYSTEM3 PA, QL

B FREESTYLE PRECISION NEO TEST

E QL

B GUARDIAN CONNECT TRANSMITTER

3 PA, QL

22

Drug Name Drug Tier


B GUARDIAN LINK 3 TRANSMITTER 3B GUARDIAN SENSOR (3) 3 PAB INSULIN SYRINGES 2B LANCETS 1B NOVOFINE AUTOCOVER PEN

NEEDLE2

B NOVOFINE PEN NEEDLE 2B NOVOFINE PLUS PEN NEEDLE 2B ONETOUCH ULTRA 2 KIT

W/DEVICE1

B ONETOUCH ULTRA BLUE TEST STRIPS IN VITRO STRIP

1 QL

B ONETOUCH ULTRA MINI KIT W/DEVICE

1

B ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE

1

B ONETOUCH VERIO IQ SYSTEM 1B ONETOUCH VERIO KIT W/DEVICE 1B ONETOUCH VERIO SYNC SYSTEM

KIT W/DEVICE1

B ONETOUCH VERIO TEST STRIPS 1 QLB PRECISION LINK EB PRECISION PCX PLUS TEST E QLB PRECISION QID MONITOR EB PRECISION QID TEST E QLB PRECISION SOF-TACT MONITOR EB PRECISION SOF-TACT TEST E QLB PRECISION XTRA BLOOD

GLUCOSEE QL

B PRECISION XTRA DEVICE EB PRECISION XTRA KIT EB PRECISION XTRA MONITOR EB RELION BLOOD GLUCOSE TEST E QLB RELION ULTIMA TEST E QLB SOFTCLIX 1B TRUE METRIX BLOOD GLUCOSE

TESTE QL

B TRUETRACK TEST E QL

Diabetes - InsulinB ADMELOG E QLB ADMELOG SOLOSTAR E QL

Drug Name Drug Tier


B AFREZZA INHALATION POWDER 12 UNIT, 4 UNIT

E PA, QL

B AFREZZA INHALATION POWDER 4 & 8 & 12 UNIT, 8 UNIT, 90 X 4 UNIT & 90X8 UNIT, 90 X 8 UNIT & 90X12 UNIT

E PA, QL

B BASAGLAR KWIKPEN E QLB HUMALOG KWIKPEN 2 QLB HUMALOG MIX 50/50 KWIKPEN 2 QLB HUMALOG MIX 50/50 VIAL 1 QLB HUMALOG MIX 75/25 KWIKPEN 2 QLB HUMALOG MIX 75/25 VIAL 1 QLB HUMALOG SUBCUTANEOUS

SOLUTION1 QL

B HUMALOG SUBCUTANEOUS SOLUTION CARTRIDGE

2 QL

B HUMALOG U-100 JUNIOR KWIKPEN

2 QL

B HUMULIN 70/30 KWIKPEN 2 QLB HUMULIN 70/30 VIAL 1 QLB HUMULIN N KWIKPEN 2 QLB HUMULIN N VIAL 1 QLB HUMULIN R U-500 KWIKPEN 2 QLB HUMULIN R U-500 VIAL

(CONCENTRATED)1 QL

B HUMULIN R VIAL 1 QLB INSULIN ASPART E ST, QLB INSULIN ASPART FLEXPEN E ST, QLB INSULIN ASPART PENFILL E ST, QLB INSULIN LISPRO E QLB INSULIN LISPRO (1 UNIT DIAL) E QLB LANTUS SOLOSTAR 1 QLB LANTUS U-100 VIAL 1 QLB LEVEMIR U-100 FLEXTOUCH E QLB LEVEMIR U-100 VIAL E QLB LYUMJEV KWIKPEN 2 QLB LYUMJEV VIAL 1 QLB NOVOLIN 70/30 FLEXPEN E ST, QLB NOVOLIN 70/30 FLEXPEN RELION E ST, QLB NOVOLIN 70/30 RELION E ST, QLB NOVOLIN 70/30 VIAL E ST, QL

23

Drug Name Drug Tier


B NOVOLIN N FLEXPEN E ST, QLB NOVOLIN N FLEXPEN RELION E ST, QLB NOVOLIN N RELION E ST, QLB NOVOLIN N VIAL E ST, QLB NOVOLIN R FLEXPEN E ST, QLB NOVOLIN R FLEXPEN RELION E ST, QLB NOVOLIN R RELION E ST, QLB NOVOLIN R VIAL E ST, QLB NOVOLOG FLEXPEN E ST, QLB NOVOLOG PENFILL E ST, QLB NOVOLOG U-100 VIAL E ST, QLB TOUJEO MAX SOLOSTAR 2 QLB TOUJEO SOLOSTAR 2 QLB TRESIBA E QLB TRESIBA FLEXTOUCH E QL

Diabetes - Non-Insulin AgentsB ADLYXIN 4 PA, ST, QLB ADLYXIN STARTER PACK 4 PA, ST, QLB ALOGLIPTIN BENZOATE E QLB ALOGLIPTIN-METFORMIN HCL E QLB ALOGLIPTIN-PIOGLITAZONE E QLB AMARYL 4B BAQSIMI ONE PACK 2 QLB BAQSIMI TWO PACK 2 QLB BYDUREON 2 PA, ST, QLB BYDUREON BCISE

AUTOINJECTOR2 PA, ST, QL

B BYETTA 10 MCG PEN 2 PA, ST, QLB BYETTA 5 MCG PEN 2 PA, ST, QLB FARXIGA E ST, QLg glimepiride 1g glipizide er 1g glipizide ir 1g glipizide xl 1B GLUCAGON EMERGENCY KIT

INJECTION KIT2 QL

B GLUCOTROL 4B GLUCOTROL XL 4B GLUCOVANCE ORAL TABLET

5-500 MG4

Drug Name Drug Tier


g glyburide oral 1g glyburide-metformin 1B GLYXAMBI 2 ST, QLB GVOKE HYPOPEN, PFS 2 QLB JANUVIA E ST, QLB JARDIANCE 2 ST, QLB JENTADUETO 2 QLB JENTADUETO XR 2 QLB KAZANO 2 QLB KOMBIGLYZE XR 2 QLg metformin hcl er 1g metformin hcl er (mod) E PAg metformin hcl er (osm) E PAB METFORMIN HCL ORAL

SOLUTION3

g metformin hcl oral tablet 1B NESINA 2 QLB ONGLYZA 2 QLB OSENI 2 QLB OZEMPIC 2 PA, ST, QLg pioglitazone hcl 1 QLB RYBELSUS 2 PA, ST, QLB SOLIQUA 2 QLB SYMLINPEN 60 3 QLB SYMLNPEN 120 3 QLB SYNJARDY 2 QLB SYNJARDY XR 2 QLB TRADJENTA 2 QLB TRIJARDY XR 2 QLB TRULICITY 2 PA, ST, QLB VICTOZA SOLUTION PEN-

INJECTOR 18 MG/3ML SUBCUTANEOUS (2 Pak)

2 PA, ST, QL

B VICTOZA SOLUTION PEN-INJECTOR 18 MG/3ML SUBCUTANEOUS (3 Pak)

3 PA, ST, QL

Drugs for Blood DisordersB ADVATE 2 SPB ADYNOVATE 4 PA, SPB AFSTYLA INTRAVENOUS KIT 1000

UNIT, 2000 UNIT, 250 UNIT, 3000 UNIT, 500 UNIT

4 PA, SP

24

Drug Name Drug Tier


B AFSTYLA INTRAVENOUS KIT 1500 UNIT, 2500 UNIT

4 PA, SP

B ARANESP (ALBUMIN FREE) 2 QL, SPB ELOCTATE 4 PA, SPB JIVI 4 PA, SPB KOGENATE FS 2 SPB KOVALTRY 2 SPB MULPLETA 2 PA, QL, SPB NOVOEIGHT 2 SPB NEULASTA 3 SPB NUWIQ 2 SPB RECOMBINATE 2 SPB RETACRIT 2 QL, SPB ZARXIO 2 SPB ZIEXTENZO 3 PA, QL

Drugs for Sexual DysfunctionB ADDYI 4 PA, QLB IMVEXXY MAINTENANCE PACK 3 QLB IMVEXXY STARTER PACK 3 QLB INTRAROSA 3 QLB OSPHENA 3 PA, QLg sildenafil citrate oral tablet 100 mg,

25 mg, 50 mg2 QL

B STENDRA 4 PA, QLg tadalafil oral tablet 10 mg, 20 mg 2 QLg tadalafil oral tablet 2.5 mg, 5 mg 2 ST, QLB VYLEESI 4 PA, QL

Electrolytes / VitaminsB DRISDOL 4B ERGOCAL 3g ergocalciferol oral capsule 1B FLORIVA PLUS 3g folic acid oral tablet 1 mg 1g klor-con 1g klor-con 10 1g klor-con m10 1B KLOR-CON M15 3g klor-con m20 1g klor-con sprinkle 1B K-TAB 3

Drug Name Drug Tier


B LOKELMA 3 PA, QLg multi-vitamin/fluoride 1g multivitamin/fluoride oral solution 1g multivitamin/fluoride oral tablet

chewable 0.25 mg, 0.5 mg, 1 mg1

g multivitamins/fluoride 1g mvc-fluoride 1B NASCOBAL 3B POLY-VI-FLOR 3g potassium chloride crys er 1g potassium chloride er 1g potassium chloride oral 1g potassium citrate er 1B QUFLORA PEDIATRIC 3B UROCIT-K 10 4B UROCIT-K 15 4B UROCIT-K 5 4B VELTASSA 3 PA, QLg vitamin d (ergocalciferol) oral

capsule 1.25 mg (50000 ut)1

Gastrointestinal Agents - Drugs for Acid Reflux and UlcerB ACIPHEX SPRINKLE E QLB CYTOTEC 4B DEXILANT 3 QLg misoprostol oral 1B OMECLAMOX-PAK 3 QLg omeprazole oral capsule delayed

release1

g pantoprazole sodium tablet delayed release 20 mg oral

1


E


1


E

B PROTONIX ORAL PACKET EB PYLERA 3 QLB RABEPRAZOLE SODIUM ORAL

CAPSULE SPRINKLEE QL

g rabeprazole sodium oral tablet delayed release

2 QL

25

Drug Name Drug Tier


g sucralfate oral suspension 3g sucralfate oral tablet 1

Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions

B ACTIGALL 4B ANASPAZ 2B CLENPIQ 3g dicyclomine hcl oral 1g diphenoxylate-atropine 1g ed-spaz 1g gavilyte-c 1 Hg gavilyte-g 1 QL, HB GOLYTELY ORAL SOLUTION

RECONSTITUTED 227.1 GM2 QL

B GOLYTELY ORAL SOLUTION RECONSTITUTED 236 GM

4 QL

g hyoscyamine sulfate er 1g hyoscyamine sulfate oral 1g hyoscyamine sulfate sl 1g hyoscyamine sulfate sublingual 1g hyosyne 1B LEVBID 4B LEVSIN ORAL 4B LEVSIN/SL 4B LINZESS 2 PA, QLB LOMOTIL 4B MOTEGRITY 3 PA, QLB MOVIPREP 3 QLB NULEV 4g oscimin 1g oscimin sr 1g peg-3350/electrolytes 1 QL, HB PLENVU 3 QLB PREPOPIK 3 QLB SUPREP BOWEL PREP KIT 3 QLB SYMAX DUOTAB 3g symax-sl 1g symax-sr 1B SYMPROIC 2 PA, QLB TRULANCE 4 PA, ST, QL

Drug Name Drug Tier


B URSO 250 4B URSO FORTE 4g ursodiol oral 1B VIBERZI 4 PA, QLB ZELNORM 3 PA, ST, QL

Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment

B CERDELGA 2 PA, SPg clovique E PA, SPB CREON 2B CUPRIMINE E SPB DEPEN TITRATABS 2 SPB ENDARI 4 PA, QLg nitisinone E PA, SPB NITYR E PA, SPB ORFADIN ORAL CAPSULE 2 PA, SPB ORFADIN ORAL SUSPENSION 2 PA, SPB PANCREAZE 3 STg penicillamine oral capsule 4 SPB PERTZYE 4 STB STRENSIQ 2 PA, QL, SPB TEGSEDI 2 PA, QL, SPg trientine hcl 3 PA, SPB VIOKACE 4 STB ZENPEP 2

Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions

B AURYXIA 3B DITROPAN XL 3B GELNIQUE Eg oxybutynin chloride er 2g oxybutynin chloride oral 1g phenazo oral tablet 200 mg 1g phenazopyridine hcl oral tablet

100 mg, 200 mg1

B PYRIDIUM 3g solifenacin 3B TOVIAZ 3B VELPHORO 2

26

Drug Name Drug Tier


Genitourinary Agents - Drugs for Prostate Conditionsg alfuzosin hcl er 1g finasteride oral tablet 5 mg 1B PROSCAR 4g tamsulosin hcl 1g terazosin hcl 1

Hormonal Agents - Hormone Replacement and Birth Control

g afirmelle 1 HB ALORA TRANSDERMAL PATCH

TWICE WEEKLY 0.025 MG/24HR, 0.075 MG/24HR, 0.1 MG/24HR

3 QL

g altavera 1 Hg alyacen 1/35 1 Hg amethia 3g amethia lo 3g apri 1 Hg ashlyna 3g aubra 1 Hg aubra eq 1 Hg aurovela 1.5/30 2g aurovela 1/20 2g aurovela 24 fe 3g aurovela fe 1.5/30 1 Hg aurovela fe 1/20 1 Hg aviane 1 HB AYGESTIN 4g ayuna 1 Hg azurette 2g balziva 2g bekyree 2B BIJUVA 3g blisovi 24 fe 3g blisovi fe 1.5/30 1 Hg blisovi fe 1/20 1 Hg briellyn 2g camila 1 Hg camrese 3g camrese lo 3g chateal 1 H

Drug Name Drug Tier


g chateal eq 1 HB CLIMARA PRO 3 QLg cryselle-28 1 Hg cyclafem 1/35 1 Hg cyred 1 Hg cyred eq 1 Hg dasetta 1/35 1 Hg daysee 3g deblitane 1 Hg delyla 1 HB DEPO-PROVERA

INTRAMUSCULAR SUSPENSION 150 MG/ML

4 QL

B DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

4

B DEPO-SUBQ PROVERA 104 2 QLg desogestrel-ethinyl estradiol oral

tablet 0.15-0.02/0.01 mg (21/5)2

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

1 H

B DIVIGEL TRANSDERMAL GEL 0.25 MG/0.25GM, 0.5 MG/0.5GM, 0.75 MG/0.75GM, 1 MG/GM

3

g dotti E QLg drospiren-eth estrad-levomefol Eg drospirenone-ethinyl estradiol 3B DUAVEE 3 QLB ELESTRIN 3g elinest 1 Hg eluryng Eg emoquette 1 Hg enskyce 1 Hg errin 1 Hg estarylla 1 HB ESTRACE ORAL 4g estradiol oral 1g estradiol patch twice weekly

transdermal (generic for Minivelle)2 QL

g estradiol patch twice weekly transdermal (generic for Vivelle-Dot)

E QL

27

Drug Name Drug Tier


g estradiol transdermal patch weekly (generic for Climara)

1 QL

g estradiol vaginal cream 3g estradiol vaginal tablet 2B ESTRING 2 QLB ESTROGEL 3 QLg etonogestrel-ethinyl estradiol EB EVAMIST 2g falmina 1 Hg fayosim Eg femynor 1 Hg gianvi 3g hailey 1.5/30 2g hailey 24 fe 3g heather 1 Hg incassia 1 Hg introvale 2 Hg isibloom 1 Hg jasmiel 3g jencycla 1 Hg jolessa 2 Hg juleber 1 Hg junel 1.5/30 2g junel 1/20 2g junel fe 1.5/30 1 Hg junel fe 1/20 1 Hg junel fe 24 3g kalliga 1 Hg kariva 2g kurvelo 1 Hg larin 1.5/30 2g larin 1/20 2g larin 24 fe 3g larin fe 1.5/30 1 Hg larin fe 1/20 1 Hg larissia 1 Hg lessina 1 Hg levonorgest-eth est & eth est E

Drug Name Drug Tier


g levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 &0.01 mg

3

g levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg

2 H

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

1 H

g levora 0.15/30 (28) 1 Hg lillow 1 HB LO LOESTRIN FE 3B LOESTRIN 1.5/30 (21) 4B LOESTRIN 1/20 (21) 4B LOESTRIN FE 1.5/30 4B LOESTRIN FE 1/20 4g loryna 3B LOSEASONIQUE 4g low-ogestrel 1 Hg lo-zumandimine 3g lutera 1 Hg lyza 1 Hg marlissa 1 Hg medroxyprogesterone acetate

intramuscular suspension1 QL, H

g medroxyprogesterone acetate intramuscular suspension prefilled syringe

1 H

g medroxyprogesterone acetate oral 1g melodetta 24 fe EB MENOSTAR 3 QLg mibelas 24 fe Eg microgestin 1.5/30 2g microgestin 1/20 2g microgestin fe 1.5/30 1 Hg microgestin fe 1/20 1 Hg mili 1 HB MIRCETTE 4g mono-linyah 1 HB NATAZIA 2g necon 0.5/35 (28) 1 Hg nikki 3

28

Drug Name Drug Tier


g nora-be 1 Hg norethin ace-eth estrad-fe oral

tablet 1-20 mg-mcg(24)3

g norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg

1 H

g norethin ace-eth estrad-fe oral tablet chewable

E

g norethindrone acetate oral 1g norethindrone acet-ethinyl est 2g norethindrone oral 1 Hg norgestimate-eth estradiol 1 Hg norgestimate-ethinyl estradiol

triphasic oral tablet 0.18/0.215/ 0.25 mg-25 mcg

2

g norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/ 0.25 mg-35 mcg

1 H

g norlyda 1 Hg norlyroc 1 Hg nortrel 0.5/35 (28) 1 Hg nortrel 1/35 (21) 1 Hg nortrel 1/35 (28) 1 HB NUVARING 1 Hg ocella 3g ogestrel 2g orsythia 1 HB ORTHO MICRONOR 4g philith 2g pimtrea 2g pirmella 1/35 1 Hg portia-28 1 HB PREMARIN ORAL 3B PREMARIN VAGINAL 3B PREMPHASE 3B PREMPRO 3g previfem 1 Hg progesterone micronized oral 2B PROVERA 4g reclipsen 1 Hg rivelsa Eg setlakin 2 H

Drug Name Drug Tier


g sharobel 1 Hg simliya 2g simpesse 3g sprintec 28 1 Hg sronyx 1 Hg syeda 3g tarina 24 fe 3g tarina fe 1/20 1 Hg tarina fe 1/20 eq 1 HB TAYTULLA Eg tri femynor 1 Hg tri-estarylla 1 Hg tri-linyah 1 Hg tri-lo-estarylla 2g tri-lo-mili 2g tri-lo-sprintec 2g tri-mili 1 Hg tri-previfem 1 Hg tri-sprintec 1 Hg tri-vylibra 1 Hg tri-vylibra lo 2g tulana 1 Hg tydemy Eg vienva 1 Hg viorele 2B VIVELLE-DOT 2 QLg vyfemla 2g vylibra 1 Hg wera 1 Hg xulane 3 HB YASMIN 28 2B YAZ 2g yuvafem 2g zarah 3g zumandimine 3

Hormonal Agents - Oral SteroidsB CORTEF 4B DECADRON Eg dexamethasone intensol 1g dexamethasone oral elixir 1

29

Drug Name Drug Tier


g dexamethasone oral solution 1g dexamethasone oral tablet 1g dexamethasone oral tablet therapy

pack3

B DEXPAK 10 DAY 4B DEXPAK 13 DAY 4B DEXPAK 6 DAY 4B DXEVO 11-DAY EB HIDEX 6-DAY Eg hydrocortisone oral 1B MEDROL ORAL TABLET 16 MG,

4 MG, 8 MG4

B MEDROL ORAL TABLET 2 MG 2B MEDROL ORAL TABLET 32 MG 3B MEDROL ORAL TABLET THERAPY

PACK4

g methylprednisolone oral 1B MILLIPRED 2B MILLIPRED DP 2B MILLIPRED DP 12-DAY 2B ORAPRED ODT 4B PEDIAPRED 2g prednisolone oral solution 1g prednisolone sodium phosphate

oral1

g prednisone intensol 1g prednisone oral 1B RAYOS EB TAPERDEX 12-DAY 3B TAPERDEX 6-DAY ORAL TABLET

THERAPY PACK 1.5 MG (21)3

B TAPERDEX 7-DAY 3

Hormonal Agents - Otherg cabergoline 2B DDAVP INJECTION 4B DDAVP ORAL 4g desmopressin acetate injection 1g desmopressin acetate oral 1B GENOTROPIN E PA, QL, SPB GENOTROPIN MINIQUICK E PA, QL, SP

Drug Name Drug Tier


B HUMATROPE E PA, QL, SPB NOCDURNA 3 PA, QLB NORDITROPIN FLEXPRO E PA, QL, SPB NUTROPIN AQ NUSPIN 10 2 PA, QL, SPB NUTROPIN AQ NUSPIN 20 2 PA, QL, SPB NUTROPIN AQ NUSPIN 5 2 PA, QL, SPg octreotide 1 PA, SPB OMNITROPE E PA, QL, SPB ORIAHNN 4 PA, QLB ORILISSA 4 PA, QLB SOMATULINE DEPOT 4 SPB STIMATE 3B ZOMACTON E PA, QL, SP

Hormonal Agents - Testosterone ReplacementB ANDRODERM 2 PA, QLB DEPO-TESTOSTERONE

INTRAMUSCULAR SOLUTION 100 MG/ML

E

B DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 200 MG/ML

E

B NATESTO E PA, QLB STRIANT 3 PA, QLB TESTIM 2 PA, QLB TESTOSTERONE CYPIONATE

INJECTIONE

g testosterone cypionate intramuscular

E

g testosterone enanthate intramuscular

1

g testosterone transdermal E PA, QLB XYOSTED E PA

Hormonal Agents - ThyroidB ARMOUR THYROID 3g euthyrox 1g levo-t 1g levothyroxine sodium oral 1g levoxyl 2g liothyronine sodium oral 2g methimazole oral 1B NATURE-THROID 3

30

Drug Name Drug Tier


g np thyroid 1B SYNTHROID EB TAPAZOLE 4g thyroid oral tablet 120 mg, 15 mg,

30 mg, 60 mg, 90 mg1

B TIROSINT EB TIROSINT-SOL 4 PAg unithroid 1B WESTHROID 3B WP THYROID 3

Immunological Agents - Drugs for Immune System Stimulation or Suppression

B ACTEMRA ACTPEN 3 PA, ST, QL, SPB ACTEMRA SUBCUTANEOUS 3 PA, ST, QL, SPB ASTAGRAF XL E SPB AZASAN 3 SPg azathioprine oral 1 SPB CIMZIA PREFILLED KIT 2 PA, QL, SPB CIMZIA STARTER KIT 2 PA, QL, SPB COSENTYX (300 MG DOSE) 3 PA, ST, QL, SPB COSENTYX 150 MG/ML 3 PA, ST, QL, SPB COSENTYX SENSOREADY

(300 MG)3 PA, ST, QL, SP

B COSENTYX SENSOREADY PEN 3 PA, ST, QL, SPg cyclosporine modified 1 SPB ENBREL 4 PA, ST, QL, SPB ENBREL MINI 4 PA, ST, QL, SPB ENBREL SURECLICK 4 PA, ST, QL, SPB ENVARSUS XR E SPB FIRAZYR 2 PA, QL, SPg gengraf 1 SPB HAEGARDA 2 PA, QL, SPB HUMIRA 2 PA, QL, SPB HUMIRA PEDIATRIC CROHNS

START2 PA, QL, SP

B HUMIRA PEN 2 PA, QL, SPB HUMIRA PEN-CD/UC/HS STARTER 2 PA, QL, SPB HUMIRA PEN-PS/UV/ADOL HS

START2 PA, QL, SP

g icatibant acetate E PA, QL, SP

Drug Name Drug Tier


g methotrexate oral 1g methotrexate sodium oral 1g mycophenolate mofetil 1 SPg mycophenolate sodium 2 SPB OLUMIANT 2 PA, QL, SPB ORENCIA 4 PA, ST, QL, SPB ORENCIA CLICKJET 4 PA, ST, QL, SPB OTEZLA 2 PA, QL, SPB OTREXUP E QLB PROGRAF ORAL PACKET 4 PA, SPB RAPAMUNE ORAL SOLUTION 4 SPB RASUVO 2 QLB RINVOQ 2 PA, QL, SPB RUCONEST 4 PA, QL, SPB SIMPONI 2 PA, QL, SPg sirolimus oral solution 2 SPg sirolimus oral tablet 1 SPB SKYRIZI (150 MG DOSE) 2 PA, QL, SPB STELARA SUBCUTANEOUS

SOLUTION2 PA, QL, SP

B STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

2 PA, QL, SP

g tacrolimus oral 1 SPB TAKHZYRO 2 PA, QL, SPB TREMFYA 2 PA, QL, SPB TREXALL 2B XELJANZ 2 PA, ST, QL, SPB XELJANZ XR ORAL TABLET


2 PA, ST, QL, SP

Infertility Agentsg chorionic gonadotropin

intramuscular4 SP

B CRINONE VAGINAL GEL 4 % 4 STB CRINONE VAGINAL GEL 8 % 4 STB ENDOMETRIN 2B FOLLISTIM AQ 2 SPg ganirelix acetate solution

prefilled syringe 250 mcg/0.5ml subcutaneous (Ferring)

4 QL, SP

31

Drug Name Drug Tier


g ganirelix acetate solution prefilled syringe 250 mcg/0.5ml subcutaneous (Merck/Organon)

2 QL, SP

g novarel intramuscular solution reconstituted 10000 unit

3 SP

B NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT

3 SP

B OVIDREL 4 SPg pregnyl 1 SP

Inflammatory Bowel Disease AgentsB ANALPRAM HC 4B ANALPRAM HC SINGLES 4B ANALPRAM-HC EXTERNAL

CREAM4

B ANALPRAM-HC EXTERNAL LOTION

3

B APRISO 2B AZULFIDINE 4B AZULFIDINE EN-TABS 4g budesonide er Eg budesonide oral 2B CORTIFOAM 2B DIPENTUM 3g hydrocortisone ace-pramoxine

external cream 1-1 %1

g hydrocort-pramoxine (perianal) 1B LIALDA 2g mesalamine er Eg mesalamine oral Eg mesalamine rectal enema 1g mesalamine rectal suppository 2 QLB PENTASA EB PROCORT EB PROCTOFOAM HC 2B SFROWASA 4g sulfasalazine oral tablet 1B UCERIS ORAL 3B UCERIS RECTAL 2

Metabolic Bone Disease Agents - Drugs for Osteoporosisg alendronate sodium 1B BONIVA ORAL 4

Drug Name Drug Tier


B FORTEO E PA, SPB FOSAMAX 4g ibandronate sodium oral 2B TERIPARATIDE (RECOMBINANT) 3 PA, SPB TYMLOS 3 PA, SP

Metabolic Bone Disease Agents - Otherg calcitriol oral 1B ROCALTROL 4

Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation

B ACULAR 4B ACULAR LS 4B ACUVAIL EB ALREX 4 QLB AZASITE 3g azelastine hcl ophthalmic 1B BESIVANCE 3B CILOXAN OPHTHALMIC

OINTMENT3

B CILOXAN OPHTHALMIC SOLUTION

4

g ciprofloxacin hcl ophthalmic 1g erythromycin ophthalmic 1B FLAREX 2B ILEVRO EB INVELTYS 3g ketorolac tromethamine ophthalmic 1B LASTACAFT 3 QLB LOTEMAX OPHTHALMIC GEL EB LOTEMAX OPHTHALMIC

OINTMENT3

B LOTEMAX OPHTHALMIC SUSPENSION

4 QL

B LOTEMAX SM 3 QLg loteprednol etabonate 3 QLB MAXITROL 4B MOXEZA 4g moxifloxacin hcl ophthalmic 3g neomycin-polymyxin-dexameth

ophthalmic ointment1

32

Drug Name Drug Tier


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

1

B NEVANAC 4B OCUFLOX 4g ofloxacin ophthalmic 1g olopatadine hcl ophthalmic solution

0.1 %3 QL

g olopatadine hcl ophthalmic solution 0.2 %

E QL

B PAZEO E QLg polymyxin b-trimethoprim 1B POLYTRIM 4B PRED FORTE 4B PRED MILD 3g prednisolone acetate ophthalmic 1B TOBRADEX OPHTHALMIC

OINTMENT3

B TOBRADEX OPHTHALMIC SUSPENSION

4

B TOBRADEX ST Eg tobramycin ophthalmic 1g tobramycin-dexamethasone 2B TOBREX OPHTHALMIC OINTMENT 3 QLB TOBREX OPHTHALMIC SOLUTION 4 QL

Ophthalmic Agents - Drugs for GlaucomaB ALPHAGAN P OPHTHALMIC

SOLUTION 0.1 %2 QL

B ALPHAGAN P OPHTHALMIC SOLUTION 0.15 %

4 QL

B AZOPT 2 QLB BETIMOL 2 QLg bimatoprost ophthalmic E QLg brimonidine tartrate ophthalmic

solution 0.15 %2 QL

g brimonidine tartrate ophthalmic solution 0.2 %

1

B COMBIGAN 2 QLB COSOPT 4g dorzolamide hcl-timolol mal 2g dorzolamide hcl-timolol mal pf E QLB ISTALOL 4

Drug Name Drug Tier


g latanoprost ophthalmic 1B LUMIGAN 2B RHOPRESSA 3 QLB ROCKLATAN 3 QLg timolol maleate ophthalmic gel

forming solution1

g timolol maleate ophthalmic solution 0.25 %, 0.5 %

1

g timolol maleate ophthalmic solution 0.5 % (daily)

2

B TIMOPTIC 4B TIMOPTIC OCUDOSE 0.25 % 2B TIMOPTIC-XE 4g travoprost (bak free) 2 QLB VYZULTA E ST, QLB XELPROS 3 QL

Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions

B CEQUA E PA, QLB RESTASIS 4 PA, QLB RESTASIS MULTIDOSE E PA, QLB XIIDRA 4 PA, QL

Otic Agents - Drugs for Ear ConditionsB CIPRODEX 3g neomycin-polymyxin-hc otic 1g ofloxacin otic 2

Respiratory - Drugs for AnaphylaxisB AUVI-Q E QLg epinephrine solution auto-injector

0.15 mg/0.3ml injection (generic EpiPen Jr)

2 QL

g epinephrine solution auto-injector 0.3 mg/0.3ml injection (generic EpiPen)

2 QL

B SYMJEPI 2 QL

Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold

g azelastine hcl nasal solution 0.1 %, 137 mcg/spray

3

g azelastine hcl nasal solution 0.15 % Eg benzonatate oral capsule 100 mg,

200 mg1

33

Drug Name Drug Tier


g benzonatate oral capsule 150 mg Eg bromfed dm 1g cyproheptadine hcl oral 1g fluticasone propionate nasal 2 QLg hydrocodone polst-cpm polst er 3 PA, QLg ipratropium bromide nasal 1g levocetirizine dihydrochloride oral

solution3

g levocetirizine dihydrochloride oral tablet

1

B OMNARIS E QLg promethazine hcl oral solution 1g promethazine hcl oral syrup 1g promethazine-codeine 1 PA, QLg promethazine-dm 1g pseudoephedrine-bromphen-dm 1B TESSALON PERLES 4B TUSSICAPS 3 PA, QLB XHANCE E QLB ZETONNA 3 QL

Respiratory Tract / Pulmonary Agents - Drugs for Asthma and COPD

B ADVAIR DISKUS 3 QL, RSB ADVAIR HFA 3 QL, RSB AIRDUO RESPICLICK 113/14 E QLB AIRDUO RESPICLICK 232/14 E QLB AIRDUO RESPICLICK 55/14 E QLg albuterol sulfate er 1g albuterol sulfate hfa aerosol solution

108 (90 base) mcg/act inhalation (ProAir HFA or Proventil HFA)

2 QL

B ALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) MCG/ACT INHALATION (Ventolin HFA)

E QL

g albuterol sulfate inhalation 1g albuterol sulfate oral 3 PAB ALVESCO E QLB ANORO ELLIPTA 3 QLB ARNUITY ELLIPTA 1 QLB ASMANEX (120 METERED DOSES) E QL

Drug Name Drug Tier


B ASMANEX (14 METERED DOSES) E QLB ASMANEX (30 METERED DOSES) E QLB ASMANEX (60 METERED DOSES) E QLB ASMANEX (7 METERED DOSES) E QLB ASMANEX HFA INHALATION

AEROSOL 100 MCG/ACT, 200 MCG/ACT

E QL

B ATROVENT HFA 3 QLB BEVESPI AEROSPHERE 2 QLB BREO ELLIPTA 3 QL, RSB BREZTRI AEROSPHERE 3 QL, RSg budesonide inhalation 2 QLB COMBIVENT RESPIMAT 3 QLB EASIVENT 3B FASENRA PEN 4 PA, QL, SPB FLOVENT DISKUS 1 QLB FLOVENT HFA 1 QLg fluticasone-salmeterol inhalation

aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

E QL, RS

B FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT

2 QL

B INCRUSE ELLIPTA E QLg ipratropium-albuterol 2B LEVALBUTEROL HFA INHALATION

AEROSOL 45 MCG/ACT3 QL

g montelukast sodium oral packet 2g montelukast sodium oral tablet 1g montelukast sodium oral tablet

chewable1

B NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR

4 PA, QL, SP

B NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

4 PA, QL, SP

B PERFOROMIST 3 QLB PROAIR DIGIHALER E QLB PROAIR HFA E QLB PROAIR RESPICLICK E QL

34

Drug Name Drug Tier


B PROVENTIL HFA E QLB PULMICORT FLEXHALER 1 QLB QVAR REDIHALER E QLB SEREVENT DISKUS 2 QLB SINGULAIR ORAL PACKET 3B SPIRIVA HANDIHALER 2 QLB SPIRIVA RESPIMAT 2 QLB STRIVERDI RESPIMAT 2 QLB SYMBICORT 3 QL, RSB TRELEGY ELLIPTA 3 QL, RSB VENTOLIN HFA E QLg wixela inhub E QL, RSB XOPENEX HFA 3 QLB YUPELRI 4 PA, QL

Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis

B KITABIS PAK E PA, QL, SPB PULMOZYME 2 PA, QL, SPB TOBI PODHALER 3 PA, QL, SPg tobramycin nebulization solution

300 mg/4ml inhalation2 PA, QL, SP

g tobramycin nebulization solution 300 mg/5ml inhalation

E PA, QL, SP

B TOBRAMYCIN NEBULIZATION SOLUTION 300 MG/5ML INHALATION

E PA, QL, SP

Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension

B ADEMPAS 2 PA, QL, SPg ambrisentan 2 PA, QL, SPg bosentan 2 PA, QL, SPB OPSUMIT 2 PA, QL, SPB ORENITRAM 4 PA, QL, SPg sildenafil oral tablets 1 QLB TRACLEER 2 PA, QL, SPB TYVASO 2 PA, SPB TYVASO REFILL 2 PA, SPB TYVASO STARTER 2 PA, SP

Drug Name Drug Tier


Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm

g baclofen oral 1g carisoprodol oral tablet 250 mg Eg carisoprodol oral tablet 350 mg 1g cyclobenzaprine hcl er Eg cyclobenzaprine hcl oral tablet

10 mg, 5 mg1

g cyclobenzaprine hcl oral 7.5 mg EB FEXMID Eg metaxalone 3g methocarbamol oral 1B OZOBAX 4 PAB ROBAXIN-750 4B SOMA ORAL TABLET 350 MG 3g tizanidine hcl oral capsule 3g tizanidine hcl oral tablet 1B ZANAFLEX ORAL CAPSULE 4

Sleep Disorder AgentsB BELSOMRA 4 ST, QLB DAYVIGO 4 ST, QLB EDLUAR E QLg eszopiclone 2 QLg modafinil 2 PA, QLB RESTORIL 4B SUNOSI 3 PA, QLg temazepam 1B WAKIX 4 PA, QL, SPB XYREM 4 PA, QL, SPg zolpidem tartrate er 3 QLg zolpidem tartrate oral 1 QLg zolpidem tartrate sublingual E QL

35

A

ABILIFY MYCITE . . . . . . . . . . . . . . . . . 14ABSORICA . . . . . . . . . . . . . . . . . . . . . . 19ACCU-CHEK AVIVA CONNECT KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 21ACCU-CHEK AVIVA DEVICE . . . . . . . 21ACCU-CHEK AVIVA PLUS KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 21ACCU-CHEK AVIVA PLUS TEST STRIPS . . . . . . . . . . . . . . . . . . . . . . . . . 21ACCU-CHEK COMPACT PLUS CARE KIT . . . . . . . . . . . . . . . . . . . . . . . 21ACCU-CHEK COMPACT PLUS TEST STRIPS . . . . . . . . . . . . . . . . . . . . 21ACCU-CHEK GUIDE KIT W/DEVICE . 21ACCU-CHEK GUIDE ME KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 21ACCU-CHEK GUIDE TEST STRIPS . . 21ACCU-CHEK NANO SMARTVIEW KIT W/DEVICE . . . . . . . . . . . . . . . . . . . 21ACCU-CHEK SMARTVIEW TEST STRIPS . . . . . . . . . . . . . . . . . . . . . . . . . 21ACCU-CHEK SOFTCLIX LANCET DEVICE KIT . . . . . . . . . . . . . . . . . . . . . 21ACCUPRIL . . . . . . . . . . . . . . . . . . . . . . 15acetaminophen-codeine . . . . . . . . . . . . 8acetaminophen-codeine #2 . . . . . . . . . 8acetaminophen-codeine #3 . . . . . . . . . 8acetaminophen-codeine #4 . . . . . . . . . 8acetazolamide er . . . . . . . . . . . . . . . . . 15acetazolamide oral . . . . . . . . . . . . . . . 15ACIPHEX SPRINKLE . . . . . . . . . . . . . . 24ACTEMRA ACTPEN . . . . . . . . . . . . . . 30ACTEMRA SUBCUTANEOUS . . . . . . 30ACTIGALL . . . . . . . . . . . . . . . . . . . . . . 25ACULAR . . . . . . . . . . . . . . . . . . . . . . . . 31ACULAR LS . . . . . . . . . . . . . . . . . . . . . 31ACUVAIL . . . . . . . . . . . . . . . . . . . . . . . . 31acyclovir oral . . . . . . . . . . . . . . . . . . . . 14ACZONE EXTERNAL GEL 5 % . . . . . . 19ACZONE EXTERNAL GEL 7.5 % . . . . 19ADALAT CC ORAL TABLET EXTENDED RELEASE 24 HOUR 60 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 15ADDERALL XR . . . . . . . . . . . . . . . . . . 17ADDYI . . . . . . . . . . . . . . . . . . . . . . . . . . 24ADEMPAS . . . . . . . . . . . . . . . . . . . . . . 34ADHANSIA XR . . . . . . . . . . . . . . . . . . . 17ADLYXIN . . . . . . . . . . . . . . . . . . . . . . . . 23

ADLYXIN STARTER PACK . . . . . . . . . 23ADMELOG . . . . . . . . . . . . . . . . . . . . . . 22ADMELOG SOLOSTAR . . . . . . . . . . . . 22ADVAIR DISKUS . . . . . . . . . . . . . . . . . 33ADVAIR HFA . . . . . . . . . . . . . . . . . . . . . 33ADVATE . . . . . . . . . . . . . . . . . . . . . . . . 23ADYNOVATE . . . . . . . . . . . . . . . . . . . . 23AEMCOLO . . . . . . . . . . . . . . . . . . . . . . . 9afirmelle . . . . . . . . . . . . . . . . . . . . . . . . 26AFREZZA INHALATION POWDER 12 UNIT, 4 UNIT . . . . . . . . . . . . . . . . . . 22AFREZZA INHALATION POWDER 4 & 8 & 12 UNIT, 8 UNIT, 90 X 4 UNIT & 90X8 UNIT, 90 X 8 UNIT & 90X12 UNIT . . . . . . . . . . . . . . . . . . . . . 22AFSTYLA INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 3000 UNIT, 500 UNIT . . . . . . . . . . . . . . . . . . 23AFSTYLA INTRAVENOUS KIT 1500 UNIT, 2500 UNIT . . . . . . . . . . . . . . . . . 24AIMOVIG. . . . . . . . . . . . . . . . . . . . . . . . 13AIMOVIG SUBCUTANEOUS SOLUTION AUTO-INJECTOR 140 MG/ML . . . . . . . . . . . . . . . . . . . . . . . . . 13AIRDUO RESPICLICK 113/14 . . . . . . 33AIRDUO RESPICLICK 232/14 . . . . . . 33AIRDUO RESPICLICK 55/14 . . . . . . . 33ALA SCALP . . . . . . . . . . . . . . . . . . . . . 19ala-cort external cream 1 % . . . . . . . . 19ala-cort external cream 2.5 % . . . . . . 19albuterol sulfate er . . . . . . . . . . . . . . . . 33albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation . . . . . . . . . . . . . . . . . . . . . . . 33albuterol sulfate inhalation . . . . . . . . . 33albuterol sulfate oral . . . . . . . . . . . . . . 33ALDACTONE . . . . . . . . . . . . . . . . . . . . 15ALDARA . . . . . . . . . . . . . . . . . . . . . . . . 19ALECENSA . . . . . . . . . . . . . . . . . . . . . . 13alendronate sodium . . . . . . . . . . . . . . 31alfuzosin hcl er . . . . . . . . . . . . . . . . . . . 26aliskiren fumarate . . . . . . . . . . . . . . . . 15allopurinol oral . . . . . . . . . . . . . . . . . . . 13ALOGLIPTIN BENZOATE . . . . . . . . . . 23ALOGLIPTIN-METFORMIN HCL . . . . 23ALOGLIPTIN-PIOGLITAZONE . . . . . . 23ALORA TRANSDERMAL PATCH TWICE WEEKLY 0.025 MG/24HR, 0.075 MG/24HR, 0.1 MG/24HR . . . . . 26

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % . . . . . . . . . . . . . . . . . 32ALPHAGAN P OPHTHALMIC SOLUTION 0.15 % . . . . . . . . . . . . . . . . 32alprazolam er . . . . . . . . . . . . . . . . . . . . 15alprazolam intensol . . . . . . . . . . . . . . . 15alprazolam oral . . . . . . . . . . . . . . . . . . 15alprazolam xr . . . . . . . . . . . . . . . . . . . . 15ALREX . . . . . . . . . . . . . . . . . . . . . . . . . 31ALTACE . . . . . . . . . . . . . . . . . . . . . . . . . 15altavera . . . . . . . . . . . . . . . . . . . . . . . . . 26ALTOPREV . . . . . . . . . . . . . . . . . . . . . . 15ALTRENO . . . . . . . . . . . . . . . . . . . . . . . 19ALUNBRIG . . . . . . . . . . . . . . . . . . . . . . 13ALVESCO . . . . . . . . . . . . . . . . . . . . . . . 33alyacen 1/35 . . . . . . . . . . . . . . . . . . . . . 26AMARYL . . . . . . . . . . . . . . . . . . . . . . . . 23ambrisentan . . . . . . . . . . . . . . . . . . . . . 34AMERGE . . . . . . . . . . . . . . . . . . . . . . . 13amethia . . . . . . . . . . . . . . . . . . . . . . . . . 26amethia lo . . . . . . . . . . . . . . . . . . . . . . . 26amiodarone hcl oral . . . . . . . . . . . . . . 15amitriptyline hcl oral . . . . . . . . . . . . . . 12amlodipine besylate oral . . . . . . . . . . . 15amlodipine besylate-benazepril hcl . . 15amlodipine besylate-valsartan . . . . . . 15amnesteem . . . . . . . . . . . . . . . . . . . . . 19amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . 9amoxicillin-potassium clavulanate er . . 9amoxicillin-potassium clavulanate oral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9amphetamine-dextroamphetamine . . 17amphetamine-dextroamphetamine er . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17AMZEEQ . . . . . . . . . . . . . . . . . . . . . . . . 19ANALPRAM HC . . . . . . . . . . . . . . . . . . 31ANALPRAM HC SINGLES . . . . . . . . . 31ANALPRAM-HC EXTERNAL CREAM . . . . . . . . . . . . . . . . . . . . . . . . . 31ANALPRAM-HC EXTERNAL LOTION . . . . . . . . . . . . . . . . . . . . . . . . . 31ANASPAZ . . . . . . . . . . . . . . . . . . . . . . . 25anastrozole oral . . . . . . . . . . . . . . . . . . 13ANDRODERM . . . . . . . . . . . . . . . . . . . 29ANORO ELLIPTA . . . . . . . . . . . . . . . . . 33apap-caff-dihydrocodeine oral capsule . . . . . . . . . . . . . . . . . . . . . . . . . . 8apri . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26APRISO . . . . . . . . . . . . . . . . . . . . . . . . 31

Index

36

APTENSIO XR . . . . . . . . . . . . . . . . . . . 17ARAKODA . . . . . . . . . . . . . . . . . . . . . . 13ARANESP (ALBUMIN FREE) . . . . . . . 24ARICEPT ORAL TABLET 10 MG, 5 MG . . . . . . . . . . . . . . . . . . . . . . . . . . . 11aripiprazole oral solution . . . . . . . . . . 14aripiprazole oral tablet . . . . . . . . . . . . 14aripiprazole oral tablet dispersible . . 14ARMOUR THYROID . . . . . . . . . . . . . . 29ARNUITY ELLIPTA . . . . . . . . . . . . . . . 33ARYMO ER . . . . . . . . . . . . . . . . . . . . . . . 8ashlyna . . . . . . . . . . . . . . . . . . . . . . . . . 26ASMANEX (120 METERED DOSES) . 33ASMANEX (14 METERED DOSES) . . 33ASMANEX (30 METERED DOSES) . . 33ASMANEX (60 METERED DOSES) . . 33ASMANEX (7 METERED DOSES) . . . 33ASMANEX HFA INHALATION AEROSOL 100 MCG/ACT, 200 MCG/ACT . . . . . . . . . . . . . . . . . . . 33ASTAGRAF XL . . . . . . . . . . . . . . . . . . . 30atenolol oral . . . . . . . . . . . . . . . . . . . . . 15atenolol-chlorthalidone . . . . . . . . . . . . 15atomoxetine hcl . . . . . . . . . . . . . . . . . . 17atorvastatin calcium oral tablet 10 mg, 20 mg . . . . . . . . . . . . . . . . . . . . 15atorvastatin calcium oral tablet 40 mg, 80 mg . . . . . . . . . . . . . . . . . . . . 15atovaquone-proguanil hcl . . . . . . . . . . 13ATRIPLA . . . . . . . . . . . . . . . . . . . . . . . . 14ATROVENT HFA . . . . . . . . . . . . . . . . . 33AUBAGIO . . . . . . . . . . . . . . . . . . . . . . . 18aubra . . . . . . . . . . . . . . . . . . . . . . . . . . . 26aubra eq . . . . . . . . . . . . . . . . . . . . . . . . 26AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/ 5ML . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9aurovela 1/20 . . . . . . . . . . . . . . . . . . . . 26aurovela 1.5/30 . . . . . . . . . . . . . . . . . . 26aurovela 24 fe . . . . . . . . . . . . . . . . . . . . 26aurovela fe 1/20 . . . . . . . . . . . . . . . . . . 26aurovela fe 1.5/30 . . . . . . . . . . . . . . . . 26AURYXIA . . . . . . . . . . . . . . . . . . . . . . . 25AUSTEDO . . . . . . . . . . . . . . . . . . . . . . . 18AUVI-Q . . . . . . . . . . . . . . . . . . . . . . . . . 32AVALIDE . . . . . . . . . . . . . . . . . . . . . . . . 15avar cleanser . . . . . . . . . . . . . . . . . . . . 19AVAR LS CLEANSER . . . . . . . . . . . . . 19AVAR-E EMOLLIENT . . . . . . . . . . . . . . 19AVAR-E GREEN . . . . . . . . . . . . . . . . . . 19AVAR-E LS . . . . . . . . . . . . . . . . . . . . . . 19

aviane . . . . . . . . . . . . . . . . . . . . . . . . . . 26avidoxy . . . . . . . . . . . . . . . . . . . . . . . . . . 9avita . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19AVONEX PEN . . . . . . . . . . . . . . . . . . . . 18AVONEX PREFILLED . . . . . . . . . . . . . 18AYGESTIN . . . . . . . . . . . . . . . . . . . . . . 26ayuna . . . . . . . . . . . . . . . . . . . . . . . . . . 26AZASAN . . . . . . . . . . . . . . . . . . . . . . . . 30AZASITE . . . . . . . . . . . . . . . . . . . . . . . . 31azathioprine oral . . . . . . . . . . . . . . . . . 30azelaic acid external . . . . . . . . . . . . . . 19azelastine hcl nasal solution 0.1 %, 137 mcg/spray . . . . . . . . . . . . . . . . . . . 32azelastine hcl nasal solution 0.15 % . . 32azelastine hcl ophthalmic . . . . . . . . . . 31azithromycin oral . . . . . . . . . . . . . . . . . . 9AZOPT . . . . . . . . . . . . . . . . . . . . . . . . . 32AZULFIDINE . . . . . . . . . . . . . . . . . . . . . 31AZULFIDINE EN-TABS . . . . . . . . . . . . 31azurette . . . . . . . . . . . . . . . . . . . . . . . . . 26

B

baclofen oral . . . . . . . . . . . . . . . . . . . . 34BACTRIM . . . . . . . . . . . . . . . . . . . . . . . 10BACTRIM DS . . . . . . . . . . . . . . . . . . . . 10BAFIERTAM CAPSULE . . . . . . . . . . . . 18balziva . . . . . . . . . . . . . . . . . . . . . . . . . . 26BAQSIMI ONE PACK . . . . . . . . . . . . . . 23BAQSIMI TWO PACK . . . . . . . . . . . . . 23BARACLUDE ORAL SOLUTION . . . . 14BASAGLAR KWIKPEN . . . . . . . . . . . . 22BD AUTOSHIELD DUO PEN NEEDLES . . . . . . . . . . . . . . . . . . . . . . . 21BD ULTRA-FINE INSULIN SYRINGES . . . . . . . . . . . . . . . . . . . . . . 21BD ULTRA-FINE PEN NEEDLES . . . . 21bekyree . . . . . . . . . . . . . . . . . . . . . . . . . 26BELBUCA . . . . . . . . . . . . . . . . . . . . . . . . 8BELSOMRA . . . . . . . . . . . . . . . . . . . . . 34benazepril hcl oral . . . . . . . . . . . . . . . . 15benazepril-hydrochlorothiazide . . . . . 15benzonatate oral capsule 100 mg, 200 mg . . . . . . . . . . . . . . . . . . . . . . . . . 32benzonatate oral capsule 150 mg . . . 33BESIVANCE . . . . . . . . . . . . . . . . . . . . . 31betamethasone dipropionate aug external cream . . . . . . . . . . . . . . . . . . . 19betamethasone dipropionate aug external gel . . . . . . . . . . . . . . . . . . . . . . 19betamethasone dipropionate aug external lotion . . . . . . . . . . . . . . . . . . . 19

betamethasone dipropionate aug external ointment . . . . . . . . . . . . . . . . . 19betamethasone dipropionate external cream . . . . . . . . . . . . . . . . . . . 19betamethasone dipropionate external lotion . . . . . . . . . . . . . . . . . . . 19betamethasone dipropionate external ointment . . . . . . . . . . . . . . . . . 19BETASERON . . . . . . . . . . . . . . . . . . . . 18BETIMOL . . . . . . . . . . . . . . . . . . . . . . . 32BEVESPI AEROSPHERE . . . . . . . . . . 33BEVYXXA . . . . . . . . . . . . . . . . . . . . . . . 11bexarotene . . . . . . . . . . . . . . . . . . . . . . 13BIDIL . . . . . . . . . . . . . . . . . . . . . . . . . . . 15BIJUVA . . . . . . . . . . . . . . . . . . . . . . . . . 26bimatoprost ophthalmic . . . . . . . . . . . 32bisoprolol fumarate . . . . . . . . . . . . . . . 15bisoprolol-hydrochlorothiazide . . . . . 15blisovi 24 fe . . . . . . . . . . . . . . . . . . . . . 26blisovi fe 1/20 . . . . . . . . . . . . . . . . . . . . 26blisovi fe 1.5/30 . . . . . . . . . . . . . . . . . . 26BONIVA ORAL . . . . . . . . . . . . . . . . . . . 31BONJESTA . . . . . . . . . . . . . . . . . . . . . . 12bosentan . . . . . . . . . . . . . . . . . . . . . . . 34bp 10-1 . . . . . . . . . . . . . . . . . . . . . . . . . 19BREO ELLIPTA . . . . . . . . . . . . . . . . . . 33BREZTRI AEROSPHERE . . . . . . . . . . 33briellyn . . . . . . . . . . . . . . . . . . . . . . . . . 26BRILINTA . . . . . . . . . . . . . . . . . . . . . . . 14brimonidine tartrate ophthalmic solution 0.15 % . . . . . . . . . . . . . . . . . . . 32brimonidine tartrate ophthalmic solution 0.2 % . . . . . . . . . . . . . . . . . . . . 32bromfed dm . . . . . . . . . . . . . . . . . . . . . 33budesonide er . . . . . . . . . . . . . . . . . . . 31budesonide inhalation. . . . . . . . . . . . . 33budesonide oral . . . . . . . . . . . . . . . . . . 31BUNAVAIL . . . . . . . . . . . . . . . . . . . . . . . 9buprenorphine hcl sublingual . . . . . . . 9buprenorphine hcl-naloxone hcl . . . . . 9bupropion hcl er (sr) . . . . . . . . . . . . . . 12bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg . . . . . . . . . . . . . . . . . . . . . . . . . 12BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG . . . . . . . . . . . . . . . . 12bupropion hcl oral . . . . . . . . . . . . . . . . 12buspirone hcl oral . . . . . . . . . . . . . . . . 15butalbital-apap-caffeine oral capsule 50-300-40 mg . . . . . . . . . . . . . 8

37

butalbital-apap-caffeine oral capsule 50-325-40 mg . . . . . . . . . . . . . 8butalbital-apap-caffeine oral tablet . . . 8BYDUREON . . . . . . . . . . . . . . . . . . . . . 23BYDUREON BCISE AUTOINJECTOR . . . . . . . . . . . . . . . . . 23BYETTA 10 MCG PEN . . . . . . . . . . . . . 23BYETTA 5 MCG PEN . . . . . . . . . . . . . . 23BYSTOLIC . . . . . . . . . . . . . . . . . . . . . . 15

C

cabergoline . . . . . . . . . . . . . . . . . . . . . 29CALAN SR . . . . . . . . . . . . . . . . . . . . . . 15calcipotriene-betameth diprop external ointment . . . . . . . . . . . . . . . . . 19calcitriol external . . . . . . . . . . . . . . . . . 19calcitriol oral . . . . . . . . . . . . . . . . . . . . . 31CALQUENCE . . . . . . . . . . . . . . . . . . . . 13camila . . . . . . . . . . . . . . . . . . . . . . . . . . 26camrese . . . . . . . . . . . . . . . . . . . . . . . . 26camrese lo . . . . . . . . . . . . . . . . . . . . . . 26capecitabine . . . . . . . . . . . . . . . . . . . . 13CAPEX . . . . . . . . . . . . . . . . . . . . . . . . . 19CARAC . . . . . . . . . . . . . . . . . . . . . . . . . 19carbamazepine er oral capsule extended release 12 hour . . . . . . . . . . 11carbamazepine er oral tablet extended release 12 hour . . . . . . . . . . 11carbamazepine oral . . . . . . . . . . . . . . 11CARBATROL . . . . . . . . . . . . . . . . . . . . 11carbidopa-levodopa . . . . . . . . . . . . . . 14carbidopa-levodopa er . . . . . . . . . . . . 14CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG . . . . . . . . . . . . . . . . . . . . . . . . . 15CARDURA . . . . . . . . . . . . . . . . . . . . . . 15carisoprodol oral tablet 250 mg . . . . . 34carisoprodol oral tablet 350 mg . . . . . 34CAROSPIR . . . . . . . . . . . . . . . . . . . . . . 15cartia xt . . . . . . . . . . . . . . . . . . . . . . . . . 15carvedilol . . . . . . . . . . . . . . . . . . . . . . . 15CATAPRES . . . . . . . . . . . . . . . . . . . . . . 15cavarest . . . . . . . . . . . . . . . . . . . . . . . . 18cefadroxil . . . . . . . . . . . . . . . . . . . . . . . 10cefdinir . . . . . . . . . . . . . . . . . . . . . . . . . 10cefuroxime axetil . . . . . . . . . . . . . . . . . 10celecoxib oral. . . . . . . . . . . . . . . . . . . . . 9CENTANY . . . . . . . . . . . . . . . . . . . . . . . 10CENTANY AT . . . . . . . . . . . . . . . . . . . . 10cephalexin . . . . . . . . . . . . . . . . . . . . . . 10CEQUA . . . . . . . . . . . . . . . . . . . . . . . . . 32

CERDELGA . . . . . . . . . . . . . . . . . . . . . 25CHANTIX . . . . . . . . . . . . . . . . . . . . . . . . 9CHANTIX CONTINUING MONTH PAK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9CHANTIX STARTING MONTH PAK . . . 9chateal . . . . . . . . . . . . . . . . . . . . . . . . . 26chateal eq . . . . . . . . . . . . . . . . . . . . . . . 26chlorhexidine gluconate mouth/throat. . . . . . . . . . . . . . . . . . . . . . . . . . . 18chlorthalidone . . . . . . . . . . . . . . . . . . . 15chorionic gonadotropin intramuscular . . . . . . . . . . . . . . . . . . . . 30ciclodan . . . . . . . . . . . . . . . . . . . . . . . . 12ciclopirox external gel . . . . . . . . . . . . . 12ciclopirox external shampoo . . . . . . . 12ciclopirox external solution . . . . . . . . . 12ciclopirox treatment . . . . . . . . . . . . . . 12CILOXAN OPHTHALMIC OINTMENT . . . . . . . . . . . . . . . . . . . . . . 31CILOXAN OPHTHALMIC SOLUTION . . . . . . . . . . . . . . . . . . . . . . 31CIMDUO . . . . . . . . . . . . . . . . . . . . . . . . 14CIMZIA PREFILLED KIT . . . . . . . . . . . 30CIMZIA STARTER KIT . . . . . . . . . . . . . 30CIPRO ORAL TABLET . . . . . . . . . . . . 10CIPRODEX . . . . . . . . . . . . . . . . . . . . . . 32ciprofloxacin hcl ophthalmic . . . . . . . 31ciprofloxacin hcl oral . . . . . . . . . . . . . . 10citalopram hydrobromide . . . . . . . . . . 12claravis . . . . . . . . . . . . . . . . . . . . . . . . . 19clarithromycin er . . . . . . . . . . . . . . . . . 10clarithromycin oral suspension reconstituted . . . . . . . . . . . . . . . . . . . . 10clarithromycin oral tablet . . . . . . . . . . 10CLENPIQ . . . . . . . . . . . . . . . . . . . . . . . 25CLEOCIN ORAL CAPSULE 150 MG, 300 MG . . . . . . . . . . . . . . . . . 10CLEOCIN ORAL CAPSULE 75 MG . . 10CLEOCIN-T EXTERNAL GEL . . . . . . . 19CLEOCIN-T EXTERNAL LOTION . . . . 19Climara . . . . . . . . . . . . . . . . . . . . . . 26, 27CLIMARA PRO . . . . . . . . . . . . . . . . . . 26clindacin etz external swab . . . . . . . . 19clindacin-p . . . . . . . . . . . . . . . . . . . . . . 19CLINDAGEL . . . . . . . . . . . . . . . . . . . . . 19clindamycin hcl oral . . . . . . . . . . . . . . 10clindamycin phos-benzoyl perox external gel 1.2-5 % . . . . . . . . . . . . . . . 19clindamycin phosphate external foam . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

clindamycin phosphate external lotion . . . . . . . . . . . . . . . . . . . . . . . . . . . 19clindamycin phosphate external solution . . . . . . . . . . . . . . . . . . . . . . . . . 19clindamycin phosphate external swab . . . . . . . . . . . . . . . . . . . . . . . . . . . 19CLINDAMYCIN PHOSPHATE GEL 1 % EXTERNAL . . . . . . . . . . . . . . . . . . 19CLINDESSE . . . . . . . . . . . . . . . . . . . . . 10clinpro 5000 . . . . . . . . . . . . . . . . . . . . . 18clobetasol propionate external cream . . . . . . . . . . . . . . . . . . . . . . . . . . 19clobetasol propionate external foam . . . . . . . . . . . . . . . . . . . . . . . . . . . 19clobetasol propionate external gel . . 19clobetasol propionate external liquid . . . . . . . . . . . . . . . . . . . . . . . . . . . 19clobetasol propionate external lotion . . . . . . . . . . . . . . . . . . . . . . . . . . . 19clobetasol propionate external ointment . . . . . . . . . . . . . . . . . . . . . . . . 19clobetasol propionate external shampoo . . . . . . . . . . . . . . . . . . . . . . . 19clobetasol propionate external solution . . . . . . . . . . . . . . . . . . . . . . . . . 19clodan external shampoo . . . . . . . . . . 19clonazepam oral . . . . . . . . . . . . . . . . . 15clonidine hcl oral . . . . . . . . . . . . . . . . . 15clopidogrel bisulfate oral . . . . . . . . . . 14clotrimazole-betamethasone external cream . . . . . . . . . . . . . . . . . . . 19clotrimazole-betamethasone external lotion . . . . . . . . . . . . . . . . . . . 19clovique . . . . . . . . . . . . . . . . . . . . . . . . 25COLCHICINE ORAL CAPSULE . . . . . 13colchicine oral tablet . . . . . . . . . . . . . . 13COLCRYS . . . . . . . . . . . . . . . . . . . . . . . 13colesevelam hcl . . . . . . . . . . . . . . . . . . 15COMBIGAN . . . . . . . . . . . . . . . . . . . . . 32COMBIVENT RESPIMAT . . . . . . . . . . 33CONCERTA . . . . . . . . . . . . . . . . . . . . . 17CONTOUR NEXT EZ MONITOR . . . . 21CONTOUR NEXT LNK MONITOR . . . 21CONTOUR NEXT MONITOR . . . . . . . 21CONTOUR NEXT ONE MONITOR . . . 21CONTOUR NEXT TEST STRIP . . . . . 21CONTOUR TEST STRIP . . . . . . . . . . . 21CONZIP . . . . . . . . . . . . . . . . . . . . . . . . . 8COREG . . . . . . . . . . . . . . . . . . . . . . . . . 15coremino . . . . . . . . . . . . . . . . . . . . . . . 10CORGARD . . . . . . . . . . . . . . . . . . . . . . 15CORLANOR . . . . . . . . . . . . . . . . . . . . . 15

38

CORTEF . . . . . . . . . . . . . . . . . . . . . . . . 28CORTIFOAM . . . . . . . . . . . . . . . . . . . . 31COSENTYX (300 MG DOSE) . . . . . . . 30COSENTYX 150 MG/ML . . . . . . . . . . 30COSENTYX SENSOREADY (300 MG) . . . . . . . . . . . . . . . . . . . . . . . . 30COSENTYX SENSOREADY PEN . . . . 30COSOPT . . . . . . . . . . . . . . . . . . . . . . . . 32COUMADIN . . . . . . . . . . . . . . . . . . . . . 11CREON . . . . . . . . . . . . . . . . . . . . . . . . . 25CRESEMBA ORAL . . . . . . . . . . . . . . . 12CRINONE VAGINAL GEL 4 % . . . . . . 30CRINONE VAGINAL GEL 8 % . . . . . . 30cryselle-28 . . . . . . . . . . . . . . . . . . . . . . 26CUPRIMINE . . . . . . . . . . . . . . . . . . . . . 25cyclafem 1/35 . . . . . . . . . . . . . . . . . . . 26cyclobenzaprine hcl er . . . . . . . . . . . . 34cyclobenzaprine hcl oral 7.5 mg . . . . 34cyclobenzaprine hcl oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . 34cyclosporine modified . . . . . . . . . . . . 30cyproheptadine hcl oral . . . . . . . . . . . 33cyred . . . . . . . . . . . . . . . . . . . . . . . . . . . 26cyred eq . . . . . . . . . . . . . . . . . . . . . . . . 26CYTOTEC . . . . . . . . . . . . . . . . . . . . . . . 24

D

dalfampridine er. . . . . . . . . . . . . . . . . . 18dapsone external gel 5 % . . . . . . . . . . 19dasetta 1/35 . . . . . . . . . . . . . . . . . . . . . 26daysee . . . . . . . . . . . . . . . . . . . . . . . . . 26DAYVIGO . . . . . . . . . . . . . . . . . . . . . . . 34DDAVP INJECTION . . . . . . . . . . . . . . . 29DDAVP ORAL. . . . . . . . . . . . . . . . . . . . 29deblitane . . . . . . . . . . . . . . . . . . . . . . . . 26DECADRON . . . . . . . . . . . . . . . . . . . . . 28delyla . . . . . . . . . . . . . . . . . . . . . . . . . . 26denta 5000 plus . . . . . . . . . . . . . . . . . . 18dentagel . . . . . . . . . . . . . . . . . . . . . . . . 18DEPAKOTE . . . . . . . . . . . . . . . . . . . . . . 11DEPAKOTE ER . . . . . . . . . . . . . . . . . . . 11DEPAKOTE SPRINKLES . . . . . . . . . . . 11DEPEN TITRATABS . . . . . . . . . . . . . . . 25DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 MG/ML . . . . . . . . . . . . . . . . . . . . . 26DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE . . . . . . . . . . . . . 26DEPO-SUBQ PROVERA 104 . . . . . . . 26

DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 100 MG/ML . . . . . . . . . . . . . . . . . . . . . 29DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 200 MG/ML . . . . . . . . . . . . . . . . . . . . . 29DERMA-SMOOTHE/FS BODY . . . . . . 19DERMA-SMOOTHE/FS SCALP . . . . . 19DESCOVY. . . . . . . . . . . . . . . . . . . . . . . 14desmopressin acetate injection . . . . . 29desmopressin acetate oral . . . . . . . . . 29desogestrel-ethinyl estradiol oral tablet 0.15-0.02/0.01 mg (21/5) . . . . . 26desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg . . . . . . . . . . . . 26DESONATE . . . . . . . . . . . . . . . . . . . . . 19desonide external . . . . . . . . . . . . . . . . 20DESOWEN . . . . . . . . . . . . . . . . . . . . . . 20desvenlafaxine succinate er . . . . . . . . 12dexamethasone intensol . . . . . . . . . . . 28dexamethasone oral elixir . . . . . . . . . . 28dexamethasone oral solution . . . . . . . 29dexamethasone oral tablet . . . . . . . . . 29dexamethasone oral tablet therapy pack . . . . . . . . . . . . . . . . . . . . . . . . . . . 29DEXCOM G4 / G5 / G6 RECEIVER, TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC) . . . . . . . . . . . 21DEXCOM G4 / G5 / G6 RECEIVER, TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC) DEVICE . . . . 21DEXILANT . . . . . . . . . . . . . . . . . . . . . . 24dexmethylphenidate hcl . . . . . . . . . . . 17dexmethylphenidate hcl er . . . . . . . . . 17DEXPAK 10 DAY . . . . . . . . . . . . . . . . . 29DEXPAK 13 DAY . . . . . . . . . . . . . . . . . 29DEXPAK 6 DAY . . . . . . . . . . . . . . . . . . 29dextroamphetamine sulfate er . . . . . . 17dextroamphetamine sulfate oral solution . . . . . . . . . . . . . . . . . . . . . . . . . 17dextroamphetamine sulfate oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . . 17diazepam intensol . . . . . . . . . . . . . . . . 15diazepam oral . . . . . . . . . . . . . . . . . . . 15diclofenac potassium . . . . . . . . . . . . . . 9diclofenac sodium er . . . . . . . . . . . . . . . 9diclofenac sodium oral . . . . . . . . . . . . . 9diclofenac sodium transdermal gel 1 % . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9diclofenac sodium transdermal solution . . . . . . . . . . . . . . . . . . . . . . . . . . 9

dicyclomine hcl oral . . . . . . . . . . . . . . 25DIFICID . . . . . . . . . . . . . . . . . . . . . . . . . 10DIFLUCAN ORAL SUSPENSION RECONSTITUTED . . . . . . . . . . . . . . . . 12DIFLUCAN ORAL TABLET 100 MG, 150 MG, 200 MG . . . . . . . . . . . . . . . . . 13DIFLUCAN ORAL TABLET 50 MG . . . 13DILAUDID ORAL . . . . . . . . . . . . . . . . . . 8dilt-xr . . . . . . . . . . . . . . . . . . . . . . . . . . . 15diltiazem hcl er coated beads . . . . . . 15diltiazem hcl er oral capsule extended release 12 hour . . . . . . . . . . 15diltiazem hcl oral . . . . . . . . . . . . . . . . . 15dimethyl fumarate . . . . . . . . . . . . . . . . 18DIPENTUM . . . . . . . . . . . . . . . . . . . . . . 31diphenoxylate-atropine . . . . . . . . . . . . 25DIPROLENE . . . . . . . . . . . . . . . . . . . . . 20DIPROLENE AF . . . . . . . . . . . . . . . . . . 20DITROPAN XL . . . . . . . . . . . . . . . . . . . 25divalproex sodium er . . . . . . . . . . . . . . 11divalproex sodium oral capsule delayed release sprinkle . . . . . . . . . . . 11divalproex sodium oral tablet delayed release . . . . . . . . . . . . . . . . . . 11DIVIGEL TRANSDERMAL GEL 0.25 MG/0.25GM, 0.5 MG/0.5GM, 0.75 MG/0.75GM, 1 MG/GM . . . . . . . 26donepezil hcl oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . . . . . . . 11donepezil hcl oral tablet 23 mg . . . . . 11donepezil hcl oral tablet dispersible . 11DORYX MPC . . . . . . . . . . . . . . . . . . . . 10dorzolamide hcl-timolol mal . . . . . . . . 32dorzolamide hcl-timolol mal pf . . . . . . 32dotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26DOVATO . . . . . . . . . . . . . . . . . . . . . . . . 14doxazosin mesylate oral . . . . . . . . . . . 15doxepin hcl oral capsule . . . . . . . . . . . 12doxepin hcl oral concentrate . . . . . . . 12doxycycline hyclate oral capsule . . . . 10doxycycline hyclate oral tablet 100 mg . . . . . . . . . . . . . . . . . . . . . . . . . 10doxycycline hyclate oral tablet 150 mg, 50 mg, 75 mg . . . . . . . . . . . . 10doxycycline hyclate oral tablet 20 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 10doxycycline hyclate oral tablet delayed release . . . . . . . . . . . . . . . . . . 10doxycycline monohydrate oral capsule 100 mg, 50 mg . . . . . . . . . . . 10doxycycline monohydrate oral capsule 150 mg, 75 mg . . . . . . . . . . . . 10

39

doxycycline monohydrate oral suspension reconstituted . . . . . . . . . . 10doxycycline monohydrate oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . . 10doxylamine-pyridoxine . . . . . . . . . . . . 12DRISDOL . . . . . . . . . . . . . . . . . . . . . . . 24DRIZALMA SPRINKLE . . . . . . . . . . . . 12drospiren-eth estrad-levomefol . . . . . 26drospirenone-ethinyl estradiol . . . . . . 26DUAVEE . . . . . . . . . . . . . . . . . . . . . . . . 26duloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 60 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 12duloxetine hcl oral capsule delayed release particles 40 mg . . . . . . . . . . . 12DUOPA . . . . . . . . . . . . . . . . . . . . . . . . . 14DUPIXENT . . . . . . . . . . . . . . . . . . . . . . 20DVORAH . . . . . . . . . . . . . . . . . . . . . . . . . 8DXEVO 11-DAY . . . . . . . . . . . . . . . . . . . 29DYAZIDE . . . . . . . . . . . . . . . . . . . . . . . . 15

E

EASIVENT . . . . . . . . . . . . . . . . . . . . . . 33EASYPLUS BLOOD GLUCOSE TEST . . . . . . . . . . . . . . . . . . . . . . . . . . . 21EC-NAPROSYN . . . . . . . . . . . . . . . . . . . 9ec-naproxen . . . . . . . . . . . . . . . . . . . . . . 9ed-spaz . . . . . . . . . . . . . . . . . . . . . . . . . 25EDARBI . . . . . . . . . . . . . . . . . . . . . . . . . 15EDARBYCLOR . . . . . . . . . . . . . . . . . . . 15EDLUAR . . . . . . . . . . . . . . . . . . . . . . . . 34EFUDEX . . . . . . . . . . . . . . . . . . . . . . . . 20ELESTRIN . . . . . . . . . . . . . . . . . . . . . . . 26eletriptan hydrobromide . . . . . . . . . . . 13ELIMITE . . . . . . . . . . . . . . . . . . . . . . . . 13elinest . . . . . . . . . . . . . . . . . . . . . . . . . . 26ELIQUIS . . . . . . . . . . . . . . . . . . . . . . . . 11ELIQUIS DVT/PE STARTER PACK. . . 11ELOCTATE . . . . . . . . . . . . . . . . . . . . . . 24eluryng . . . . . . . . . . . . . . . . . . . . . . . . . 26EMGALITY . . . . . . . . . . . . . . . . . . . . . . 13EMGALITY (300 MG DOSE) . . . . . . . . 13emoquette . . . . . . . . . . . . . . . . . . . . . . 26emtricitabine-tenofovir df . . . . . . . . . . 14enalapril maleate oral . . . . . . . . . . . . . 16ENBREL . . . . . . . . . . . . . . . . . . . . . . . . 30ENBREL MINI. . . . . . . . . . . . . . . . . . . . 30ENBREL SURECLICK . . . . . . . . . . . . . 30ENDARI . . . . . . . . . . . . . . . . . . . . . . . . . 25endocet . . . . . . . . . . . . . . . . . . . . . . . . . 8ENDOMETRIN . . . . . . . . . . . . . . . . . . . 30

enoxaparin sodium . . . . . . . . . . . . . . . 11enskyce . . . . . . . . . . . . . . . . . . . . . . . . 26ENSTILAR . . . . . . . . . . . . . . . . . . . . . . 20entecavir . . . . . . . . . . . . . . . . . . . . . . . . 14ENVARSUS XR . . . . . . . . . . . . . . . . . . 30EPANED . . . . . . . . . . . . . . . . . . . . . . . . 16EPCLUSA . . . . . . . . . . . . . . . . . . . . . . . 14epinephrine solution auto-injector 0.15 mg/0.3ml injection . . . . . . . . . . . . 32epinephrine solution auto-injector 0.3 mg/0.3ml injection . . . . . . . . . . . . 32EpiPen . . . . . . . . . . . . . . . . . . . . . . . . . 32EpiPen Jr . . . . . . . . . . . . . . . . . . . . . . . 32epitol . . . . . . . . . . . . . . . . . . . . . . . . . . . 11ERGOCAL . . . . . . . . . . . . . . . . . . . . . . 24ergocalciferol oral capsule . . . . . . . . . 24ERLEADA . . . . . . . . . . . . . . . . . . . . . . . 13errin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26erythromycin ophthalmic . . . . . . . . . . 31escitalopram oxalate oral solution . . . 12escitalopram oxalate oral tablet . . . . . 12ESGIC . . . . . . . . . . . . . . . . . . . . . . . . . . . 8estarylla . . . . . . . . . . . . . . . . . . . . . . . . 26ESTRACE ORAL . . . . . . . . . . . . . . . . . 26estradiol oral . . . . . . . . . . . . . . . . . . . . 26estradiol patch twice weekly transdermal . . . . . . . . . . . . . . . . . . . . . 26estradiol transdermal patch weekly . . 27estradiol vaginal cream . . . . . . . . . . . . 27estradiol vaginal tablet . . . . . . . . . . . . 27ESTRING . . . . . . . . . . . . . . . . . . . . . . . 27ESTROGEL . . . . . . . . . . . . . . . . . . . . . 27eszopiclone . . . . . . . . . . . . . . . . . . . . . 34etodolac . . . . . . . . . . . . . . . . . . . . . . . . . 9etodolac er . . . . . . . . . . . . . . . . . . . . . . . 9etonogestrel-ethinyl estradiol . . . . . . . 27EUCRISA . . . . . . . . . . . . . . . . . . . . . . . 20euthyrox . . . . . . . . . . . . . . . . . . . . . . . . 29EVAMIST . . . . . . . . . . . . . . . . . . . . . . . 27EVOCLIN . . . . . . . . . . . . . . . . . . . . . . . 20EVZIO . . . . . . . . . . . . . . . . . . . . . . . . . . . 9EXTAVIA . . . . . . . . . . . . . . . . . . . . . . . . 18EXTINA . . . . . . . . . . . . . . . . . . . . . . . . . 13EZALLOR SPRINKLE . . . . . . . . . . . . . 16ezetimibe . . . . . . . . . . . . . . . . . . . . . . . 16ezetimibe-simvastatin . . . . . . . . . . . . . 16

F

falmina . . . . . . . . . . . . . . . . . . . . . . . . . 27FARXIGA . . . . . . . . . . . . . . . . . . . . . . . 23

FASENRA PEN . . . . . . . . . . . . . . . . . . . 33fayosim . . . . . . . . . . . . . . . . . . . . . . . . . 27febuxostat . . . . . . . . . . . . . . . . . . . . . . 13femynor . . . . . . . . . . . . . . . . . . . . . . 27, 28fenofibrate oral capsule 150 mg, 50 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 16fenofibrate oral tablet 120 mg, 40 mg, 48 mg . . . . . . . . . . . . . . . . . . . . 16fenofibrate oral tablet 160 mg, 145 mg, 54 mg . . . . . . . . . . . . . . . . . . . 16fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr . . . . . . . . . . . . . . 8fentanyl transdermal patch 72 hour 37.5 mcg/hr, 62.5 mcg/hr, 87.5 mcg/hr . . . . . . . . . . . . . . . . . . . . . . 8FEXMID . . . . . . . . . . . . . . . . . . . . . . . . . 34FINACEA . . . . . . . . . . . . . . . . . . . . . . . 20finasteride oral tablet 5 mg . . . . . . . . . 26FIORICET . . . . . . . . . . . . . . . . . . . . . . . . 8FIRAZYR . . . . . . . . . . . . . . . . . . . . . . . 30FLAGYL . . . . . . . . . . . . . . . . . . . . . . . . 10FLAREX . . . . . . . . . . . . . . . . . . . . . . . . 31flecainide acetate . . . . . . . . . . . . . . . . 16FLOLIPID . . . . . . . . . . . . . . . . . . . . . . . 16FLORIVA PLUS . . . . . . . . . . . . . . . . . . 24FLOVENT DISKUS . . . . . . . . . . . . . . . . 33FLOVENT HFA . . . . . . . . . . . . . . . . . . . 33fluconazole oral . . . . . . . . . . . . . . . . . . 13fluocinolone acetonide body . . . . . . . 20fluocinolone acetonide external cream . . . . . . . . . . . . . . . . . . . . . . . . . . 20fluocinolone acetonide external ointment . . . . . . . . . . . . . . . . . . . . . . . . 20fluocinolone acetonide external solution . . . . . . . . . . . . . . . . . . . . . . . . . 20fluocinolone acetonide scalp . . . . . . . 20fluocinonide external cream 0.05 % . 20fluocinonide external cream 0.1 % . . . 20fluocinonide external gel . . . . . . . . . . 20fluocinonide external ointment . . . . . . 20fluocinonide external solution . . . . . . 20fluoridex . . . . . . . . . . . . . . . . . . . . . . . . 18fluoridex enhanced whitening . . . . . . 18FLUOROPLEX . . . . . . . . . . . . . . . . . . . 20FLUOROURACIL EXTERNAL CREAM 0.5 % . . . . . . . . . . . . . . . . . . . 20fluorouracil external cream 5 % . . . . . 20fluorouracil external solution . . . . . . . 20fluoxetine hcl oral capsule . . . . . . . . . 12fluoxetine hcl oral capsule delayed release . . . . . . . . . . . . . . . . . . . . . . . . . 12

40

fluoxetine hcl oral solution . . . . . . . . . 12fluoxetine hcl oral tablet 10 mg . . . . . 12fluoxetine hcl oral tablet 20 mg . . . . . 12fluoxetine hcl oral tablet 60 mg . . . . . 12fluticasone propionate nasal . . . . . . . 33fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose . . . . . . . . . . . 33FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT . . . . . . . . . . . . . . . . . . . . . . . 33fluvoxamine maleate . . . . . . . . . . . . . . 12fluvoxamine maleate er . . . . . . . . . . . . 12FOCALIN . . . . . . . . . . . . . . . . . . . . . . . 17folic acid oral tablet 1 mg . . . . . . . . . . 24FOLLISTIM AQ . . . . . . . . . . . . . . . . . . . 30FORFIVO XL . . . . . . . . . . . . . . . . . . . . . 12FORTEO . . . . . . . . . . . . . . . . . . . . . . . . 31FOSAMAX . . . . . . . . . . . . . . . . . . . . . . 31FREESTYLE LIBRE 14 DAY READER . . . . . . . . . . . . . . . . . . . . . . . . 21FREESTYLE LIBRE 14 DAY SENSOR . . . . . . . . . . . . . . . . . . . . . . . . 21FREESTYLE LIBRE READER . . . . . . . 21FREESTYLE LIBRE SENSOR SYSTEM . . . . . . . . . . . . . . . . . . . . . . . . 21FREESTYLE PRECISION NEO TEST . . . . . . . . . . . . . . . . . . . . . . . . . . . 21furosemide oral . . . . . . . . . . . . . . . . . . 16

G

gabapentin oral . . . . . . . . . . . . . . . . . . 11ganirelix acetate solution prefilled syringe 250 mcg/0.5ml subcutaneous . . . . . . . . . . . . . . . . . . . 30ganirelix acetate solution prefilled syringe 250 mcg/0.5ml subcutaneous . . . . . . . . . . . . . . . . . . . 31gavilyte-c . . . . . . . . . . . . . . . . . . . . . . . 25gavilyte-g . . . . . . . . . . . . . . . . . . . . . . . 25GELNIQUE . . . . . . . . . . . . . . . . . . . . . . 25gemfibrozil oral . . . . . . . . . . . . . . . . . . 16gengraf . . . . . . . . . . . . . . . . . . . . . . . . . 30GENOTROPIN . . . . . . . . . . . . . . . . . . . 29GENOTROPIN MINIQUICK. . . . . . . . . 29GENVOYA . . . . . . . . . . . . . . . . . . . . . . . 14gianvi. . . . . . . . . . . . . . . . . . . . . . . . . . . 27GILENYA . . . . . . . . . . . . . . . . . . . . . . . . 18glatiramer acetate . . . . . . . . . . . . . . . . 18glatopa . . . . . . . . . . . . . . . . . . . . . . . . . 18

glimepiride . . . . . . . . . . . . . . . . . . . . . . 23glipizide er . . . . . . . . . . . . . . . . . . . . . . 23glipizide ir . . . . . . . . . . . . . . . . . . . . . . . 23glipizide xl . . . . . . . . . . . . . . . . . . . . . . . 23GLOPERBA . . . . . . . . . . . . . . . . . . . . . 13GLUCAGON EMERGENCY KIT INJECTION KIT . . . . . . . . . . . . . . . . . . 23GLUCOTROL . . . . . . . . . . . . . . . . . . . . 23GLUCOTROL XL . . . . . . . . . . . . . . . . . 23GLUCOVANCE ORAL TABLET 5-500 MG . . . . . . . . . . . . . . . . . . . . . . . 23glyburide oral . . . . . . . . . . . . . . . . . . . . 23glyburide-metformin . . . . . . . . . . . . . . 23GLYXAMBI . . . . . . . . . . . . . . . . . . . . . . 23GOLYTELY ORAL SOLUTION RECONSTITUTED 227.1 GM . . . . . . . 25GOLYTELY ORAL SOLUTION RECONSTITUTED 236 GM . . . . . . . . 25GONITRO . . . . . . . . . . . . . . . . . . . . . . . 16guanfacine hcl . . . . . . . . . . . . . . . . 16, 17guanfacine hcl er . . . . . . . . . . . . . . . . . 17GUARDIAN CONNECT TRANSMITTER . . . . . . . . . . . . . . . . . . 21GUARDIAN LINK 3 TRANSMITTER . 22GUARDIAN SENSOR (3) . . . . . . . . . . . 22GVOKE HYPOPEN, PFS . . . . . . . . . . . 23GYNAZOLE-1 . . . . . . . . . . . . . . . . . . . . 13

H

HAEGARDA . . . . . . . . . . . . . . . . . . . . . 30hailey 1.5/30 . . . . . . . . . . . . . . . . . . . . . 27hailey 24 fe . . . . . . . . . . . . . . . . . . . . . . 27HALCION . . . . . . . . . . . . . . . . . . . . . . . 15HARVONI . . . . . . . . . . . . . . . . . . . . . . . 14heather . . . . . . . . . . . . . . . . . . . . . . . . . 27HEMANGEOL . . . . . . . . . . . . . . . . . . . 16HIDEX 6-DAY . . . . . . . . . . . . . . . . . . . . 29HUMALOG KWIKPEN . . . . . . . . . . . . . 22HUMALOG MIX 50/50 KWIKPEN . . . 22HUMALOG MIX 50/50 VIAL . . . . . . . . 22HUMALOG MIX 75/25 KWIKPEN . . . 22HUMALOG MIX 75/25 VIAL . . . . . . . . 22HUMALOG SUBCUTANEOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . . 22HUMALOG SUBCUTANEOUS SOLUTION CARTRIDGE . . . . . . . . . . 22HUMALOG U-100 JUNIOR KWIKPEN . . . . . . . . . . . . . . . . . . . . . . . 22HUMATROPE . . . . . . . . . . . . . . . . . . . . 29HUMIRA . . . . . . . . . . . . . . . . . . . . . . . . 30HUMIRA PEDIATRIC CROHNS START . . . . . . . . . . . . . . . . . . . . . . . . . . 30

HUMIRA PEN . . . . . . . . . . . . . . . . . . . . 30HUMIRA PEN-CD/UC/HS STARTER . . . . . . . . . . . . . . . . . . . . . . . 30HUMIRA PEN-PS/UV/ADOL HS START . . . . . . . . . . . . . . . . . . . . . . . . . . 30HUMULIN 70/30 KWIKPEN . . . . . . . . 22HUMULIN 70/30 VIAL . . . . . . . . . . . . . 22HUMULIN N KWIKPEN . . . . . . . . . . . . 22HUMULIN N VIAL . . . . . . . . . . . . . . . . 22HUMULIN R U-500 KWIKPEN . . . . . . 22HUMULIN R U-500 VIAL (CONCENTRATED) . . . . . . . . . . . . . . . 22HUMULIN R VIAL . . . . . . . . . . . . . . . . 22hydralazine hcl oral . . . . . . . . . . . . . . . 16hydrochlorothiazide oral . . . . . . . . . . . 16hydrocodone polst-cpm polst er . . . . 33hydrocodone-acetaminophen oral solution 10-325 mg/15ml . . . . . . . . . . . 8hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml . . . . . . . . . . . 8hydrocodone-acetaminophen oral tablet 10-300 mg, 5-300 mg, 7.5-300 mg . . . . . . . . . . . . . . . . . . . . . . . 8hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg . . . . . . . . . . . . . . . . . . . . . . . 8hydrocort-pramoxine (perianal) . . . . . 31hydrocortisone ace-pramoxine external cream 1-1 % . . . . . . . . . . . . . . 31hydrocortisone external cream 1 % . . 20hydrocortisone external cream 2.5 % . . . . . . . . . . . . . . . . . . . . . . . . . . . 20hydrocortisone external lotion 2.5 % . . . . . . . . . . . . . . . . . . . . . . . . . . . 20hydrocortisone external ointment 1 %, 2.5 % . . . . . . . . . . . . . . . . . . . . . . . 20hydrocortisone oral . . . . . . . . . . . . . . . 29hydromorphone hcl er . . . . . . . . . . . . . 8hydromorphone hcl oral . . . . . . . . . . . . 8hydromorphone hcl rectal . . . . . . . . . . 8hydroxychloroquine sulfate oral . . . . . 13hydroxyzine hcl oral . . . . . . . . . . . . . . 15hydroxyzine pamoate oral . . . . . . . . . 15hyoscyamine sulfate er . . . . . . . . . . . . 25hyoscyamine sulfate oral . . . . . . . . . . 25hyoscyamine sulfate sl . . . . . . . . . . . . 25hyoscyamine sulfate sublingual . . . . . 25hyosyne . . . . . . . . . . . . . . . . . . . . . . . . 25HYSINGLA ER . . . . . . . . . . . . . . . . . . . . 8HYZAAR . . . . . . . . . . . . . . . . . . . . . . . . 16

41

I

ibandronate sodium oral . . . . . . . . . . . 31IBRANCE ORAL CAPSULE . . . . . . . . 13ibu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9ibuprofen oral suspension . . . . . . . . . . 9ibuprofen oral tablet 400 mg, 600 mg, 800 mg . . . . . . . . . . . . . . . . . . 9icatibant acetate . . . . . . . . . . . . . . . . . 30icosapent ethyl. . . . . . . . . . . . . . . . . . . 16IDHIFA. . . . . . . . . . . . . . . . . . . . . . . . . . 13ILEVRO . . . . . . . . . . . . . . . . . . . . . . . . . 31imatinib mesylate . . . . . . . . . . . . . . . . . 13imiquimod external . . . . . . . . . . . . . . . 20IMIQUIMOD PUMP . . . . . . . . . . . . . . . 20IMPOYZ . . . . . . . . . . . . . . . . . . . . . . . . 20IMVEXXY MAINTENANCE PACK . . . 24IMVEXXY STARTER PACK . . . . . . . . . 24INBRIJA . . . . . . . . . . . . . . . . . . . . . . . . 14incassia . . . . . . . . . . . . . . . . . . . . . . . . . 27INCRUSE ELLIPTA . . . . . . . . . . . . . . . 33INDOCIN . . . . . . . . . . . . . . . . . . . . . . . . . 9indomethacin er . . . . . . . . . . . . . . . . . . . 9indomethacin oral capsule 25 mg, 50 mg . . . . . . . . . . . . . . . . . . . . . . . . . . . 9INSULIN ASPART . . . . . . . . . . . . . . . . 22INSULIN ASPART FLEXPEN . . . . . . . 22INSULIN ASPART PENFILL . . . . . . . . 22INSULIN LISPRO . . . . . . . . . . . . . . . . . 22INSULIN LISPRO (1 UNIT DIAL) . . . . . 22INSULIN SYRINGES . . . . . . . . . . . 21, 22INTRAROSA. . . . . . . . . . . . . . . . . . . . . 24introvale . . . . . . . . . . . . . . . . . . . . . . . . 27INVELTYS . . . . . . . . . . . . . . . . . . . . . . . 31ipratropium bromide nasal . . . . . . . . . 33ipratropium-albuterol . . . . . . . . . . . . . 33irbesartan . . . . . . . . . . . . . . . . . . . . . . . 16irbesartan-hydrochlorothiazide . . . . . 16ISENTRESS . . . . . . . . . . . . . . . . . . . . . 14ISENTRESS HD . . . . . . . . . . . . . . . . . . 14isibloom . . . . . . . . . . . . . . . . . . . . . . . . 27isosorbide mononitrate . . . . . . . . . . . . 16isosorbide mononitrate er . . . . . . . . . 16isotretinoin oral . . . . . . . . . . . . . . . . . . 20ISTALOL . . . . . . . . . . . . . . . . . . . . . . . . 32

J

jantoven . . . . . . . . . . . . . . . . . . . . . . . . 11JANUVIA . . . . . . . . . . . . . . . . . . . . . . . . 23JARDIANCE . . . . . . . . . . . . . . . . . . . . . 23jasmiel. . . . . . . . . . . . . . . . . . . . . . . . . . 27

jencycla. . . . . . . . . . . . . . . . . . . . . . . . . 27JENTADUETO . . . . . . . . . . . . . . . . . . . 23JENTADUETO XR . . . . . . . . . . . . . . . . 23JIVI . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24jolessa. . . . . . . . . . . . . . . . . . . . . . . . . . 27JORNAY PM . . . . . . . . . . . . . . . . . . . . . 17juleber . . . . . . . . . . . . . . . . . . . . . . . . . . 27JULUCA . . . . . . . . . . . . . . . . . . . . . . . . 14junel 1/20 . . . . . . . . . . . . . . . . . . . . . . . 27junel 1.5/30 . . . . . . . . . . . . . . . . . . . . . 27junel fe 1/20 . . . . . . . . . . . . . . . . . . . . . 27junel fe 1.5/30 . . . . . . . . . . . . . . . . . . . 27junel fe 24 . . . . . . . . . . . . . . . . . . . . . . . 27

K

K-TAB . . . . . . . . . . . . . . . . . . . . . . . . . . 24KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 200 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 8kalliga . . . . . . . . . . . . . . . . . . . . . . . . . . 27KAPSPARGO SPRINKLE . . . . . . . . . . 16kariva . . . . . . . . . . . . . . . . . . . . . . . . . . 27KAZANO . . . . . . . . . . . . . . . . . . . . . . . 23KEFLEX. . . . . . . . . . . . . . . . . . . . . . . . . 10KEPPRA ORAL . . . . . . . . . . . . . . . . . . 11KEPPRA XR . . . . . . . . . . . . . . . . . . . . . 11KESIMPTA . . . . . . . . . . . . . . . . . . . . . . 18ketoconazole external cream . . . . . . . 13ketoconazole external foam . . . . . . . . 13ketoconazole external shampoo . . . . 13ketodan external foam . . . . . . . . . . . . 13ketorolac tromethamine ophthalmic . 31ketorolac tromethamine oral . . . . . . . . 9KITABIS PAK . . . . . . . . . . . . . . . . . . . . 34klor-con . . . . . . . . . . . . . . . . . . . . . . . . . 24klor-con 10 . . . . . . . . . . . . . . . . . . . . . . 24klor-con m10 . . . . . . . . . . . . . . . . . . . . 24KLOR-CON M15 . . . . . . . . . . . . . . . . . 24klor-con m20 . . . . . . . . . . . . . . . . . . . . 24klor-con sprinkle . . . . . . . . . . . . . . . . . 24KOGENATE FS . . . . . . . . . . . . . . . . . . . 24KOMBIGLYZE XR . . . . . . . . . . . . . . . . 23KOSELUGO . . . . . . . . . . . . . . . . . . . . . 13KOVALTRY . . . . . . . . . . . . . . . . . . . . . . 24KRINTAFEL . . . . . . . . . . . . . . . . . . . . . 14kurvelo . . . . . . . . . . . . . . . . . . . . . . . . . 27KYNMOBI . . . . . . . . . . . . . . . . . . . . . . . 14

L

labetalol hcl oral . . . . . . . . . . . . . . . . . 16

LAMICTAL . . . . . . . . . . . . . . . . . . . . . . 11LAMICTAL ODT ORAL KIT . . . . . . . . . 11LAMICTAL ODT ORAL TABLET DISPERSIBLE . . . . . . . . . . . . . . . . . . . 11LAMICTAL STARTER . . . . . . . . . . . . . 11LAMICTAL XR . . . . . . . . . . . . . . . . . . . 11lamotrigine er . . . . . . . . . . . . . . . . . . . . 11lamotrigine oral tablet . . . . . . . . . . . . . 11lamotrigine oral tablet chewable . . . . 11lamotrigine oral tablet dispersible . . . 11lamotrigine starter kit-blue . . . . . . . . . 11lamotrigine starter kit-green . . . . . . . . 11lamotrigine starter kit-orange . . . . . . . 11LANCETS . . . . . . . . . . . . . . . . . . . . . . . 22LANTUS SOLOSTAR . . . . . . . . . . . . . 22LANTUS U-100 VIAL . . . . . . . . . . . . . . 22larin 1/20 . . . . . . . . . . . . . . . . . . . . . . . 27larin 1.5/30 . . . . . . . . . . . . . . . . . . . . . . 27larin 24 fe . . . . . . . . . . . . . . . . . . . . . . . 27larin fe 1/20 . . . . . . . . . . . . . . . . . . . . . 27larin fe 1.5/30 . . . . . . . . . . . . . . . . . . . . 27larissia . . . . . . . . . . . . . . . . . . . . . . . . . . 27LASIX . . . . . . . . . . . . . . . . . . . . . . . . . . 16LASTACAFT . . . . . . . . . . . . . . . . . . . . . 31latanoprost ophthalmic . . . . . . . . . . . . 32LATUDA . . . . . . . . . . . . . . . . . . . . . . . . 14LEDIP-SOFOSB ORAL TABLET 90-400MG . . . . . . . . . . . . . . . . . . . . . . 14LEDIPASVIR-SOFOSBUVIR . . . . . . . . 14lessina . . . . . . . . . . . . . . . . . . . . . . . . . . 27letrozole oral . . . . . . . . . . . . . . . . . . . . 13LEVALBUTEROL HFA INHALATION AEROSOL 45 MCG/ACT . . . . . . . . . . 33LEVAQUIN ORAL TABLET 500 MG, 750 MG . . . . . . . . . . . . . . . . . . . . . . . . . 10LEVBID . . . . . . . . . . . . . . . . . . . . . . . . . 25LEVEMIR U-100 FLEXTOUCH . . . . . . 22LEVEMIR U-100 VIAL . . . . . . . . . . . . . 22levetiracetam er . . . . . . . . . . . . . . . . . . 11levetiracetam oral . . . . . . . . . . . . . . . . 11levo-t . . . . . . . . . . . . . . . . . . . . . . . . . . . 29levocetirizine dihydrochloride oral solution . . . . . . . . . . . . . . . . . . . . . . . . . 33levocetirizine dihydrochloride oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . . 33levofloxacin oral . . . . . . . . . . . . . . . . . . 10levonorgest-eth est & eth est . . . . . . . 27levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg, 0.15-0.03 &0.01 mg . . . . . . . . . . . . . . . 27

42

levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg . . . . . . . . . . . . . . . 27levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg . . . . . . . . . . . . . . . . . . 27levora 0.15/30 (28) . . . . . . . . . . . . . . . . 27levothyroxine sodium oral . . . . . . . . . . 29levoxyl . . . . . . . . . . . . . . . . . . . . . . . . . . 29LEVSIN ORAL . . . . . . . . . . . . . . . . . . . 25LEVSIN/SL . . . . . . . . . . . . . . . . . . . . . . 25LIALDA . . . . . . . . . . . . . . . . . . . . . . . . . 31lidocaine external ointment . . . . . . . . . 8lidocaine external patch 5 % . . . . . . . . 8lidocaine hcl mouth/throat . . . . . . . . . 18lidocaine viscous hcl . . . . . . . . . . . . . . 18lidocaine-prilocaine external cream . . 8lillow . . . . . . . . . . . . . . . . . . . . . . . . . . . 27LINZESS . . . . . . . . . . . . . . . . . . . . . . . . 25liothyronine sodium oral . . . . . . . . . . . 29LIPOFEN . . . . . . . . . . . . . . . . . . . . . . . . 16lisinopril oral . . . . . . . . . . . . . . . . . . . . . 16lisinopril-hydrochlorothiazide . . . . . . . 16lithium carbonate er . . . . . . . . . . . . . . 15lithium carbonate oral . . . . . . . . . . . . . 15LITHOBID . . . . . . . . . . . . . . . . . . . . . . . 15LO LOESTRIN FE. . . . . . . . . . . . . . . . . 27lo-zumandimine . . . . . . . . . . . . . . . . . . 27LOESTRIN 1/20 (21) . . . . . . . . . . . . . . 27LOESTRIN 1.5/30 (21) . . . . . . . . . . . . . 27LOESTRIN FE 1/20 . . . . . . . . . . . . . . . 27LOESTRIN FE 1.5/30 . . . . . . . . . . . . . . 27LOKELMA . . . . . . . . . . . . . . . . . . . . . . . 24LOMOTIL . . . . . . . . . . . . . . . . . . . . . . . 25LOPID . . . . . . . . . . . . . . . . . . . . . . . . . . 16LOPRESSOR . . . . . . . . . . . . . . . . . . . . 16lorazepam intensol . . . . . . . . . . . . . . . 15lorazepam oral concentrate 2 mg/ml . . . . . . . . . . . . . . . . . . . . . . . . 15lorazepam oral tablet . . . . . . . . . . . . . 15lorcet . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8lorcet hd . . . . . . . . . . . . . . . . . . . . . . . . . 8lorcet plus . . . . . . . . . . . . . . . . . . . . . . . . 8LORTAB . . . . . . . . . . . . . . . . . . . . . . . . . 8loryna . . . . . . . . . . . . . . . . . . . . . . . . . . 27losartan potassium . . . . . . . . . . . . . . . 16losartan potassium-hctz . . . . . . . . . . . 16LOSEASONIQUE . . . . . . . . . . . . . . . . . 27LOTEMAX OPHTHALMIC GEL . . . . . 31LOTEMAX OPHTHALMIC OINTMENT . . . . . . . . . . . . . . . . . . . . . . 31

LOTEMAX OPHTHALMIC SUSPENSION . . . . . . . . . . . . . . . . . . . 31LOTEMAX SM . . . . . . . . . . . . . . . . . . . 31LOTENSIN . . . . . . . . . . . . . . . . . . . . . . 16LOTENSIN HCT . . . . . . . . . . . . . . . . . . 16loteprednol etabonate . . . . . . . . . . . . . 31lovastatin . . . . . . . . . . . . . . . . . . . . . . . 16low-ogestrel . . . . . . . . . . . . . . . . . . . . . 27LUMIGAN . . . . . . . . . . . . . . . . . . . . . . . 32lutera . . . . . . . . . . . . . . . . . . . . . . . . . . . 27LYNPARZA . . . . . . . . . . . . . . . . . . . . . . 13LYRICA . . . . . . . . . . . . . . . . . . . . . . . . . 18LYRICA CR . . . . . . . . . . . . . . . . . . . . . . 18LYUMJEV KWIKPEN . . . . . . . . . . . . . . 22LYUMJEV VIAL . . . . . . . . . . . . . . . . . . 22lyza . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

M

MACROBID . . . . . . . . . . . . . . . . . . . . . 10MACRODANTIN . . . . . . . . . . . . . . . . . 10MALARONE . . . . . . . . . . . . . . . . . . . . . 14marlissa . . . . . . . . . . . . . . . . . . . . . . . . 27matzim la . . . . . . . . . . . . . . . . . . . . . . . 16MAVENCLAD (10 TABS) . . . . . . . . . . . 18MAVENCLAD (4 TABS) . . . . . . . . . . . . 18MAVENCLAD (5 TABS) . . . . . . . . . . . . 18MAVENCLAD (6 TABS) . . . . . . . . . . . . 18MAVENCLAD (7 TABS) . . . . . . . . . . . . 18MAVENCLAD (8 TABS) . . . . . . . . . . . . 18MAVENCLAD (9 TABS) . . . . . . . . . . . . 18MAVYRET . . . . . . . . . . . . . . . . . . . . . . 14MAXITROL . . . . . . . . . . . . . . . . . . . . . . 31MAXZIDE . . . . . . . . . . . . . . . . . . . . . . . 16MAXZIDE-25 . . . . . . . . . . . . . . . . . . . . 16MAYZENT . . . . . . . . . . . . . . . . . . . . . . . 18MAYZENT STARTER PACK . . . . . . . . 18MEDROL ORAL TABLET 16 MG, 4 MG, 8 MG . . . . . . . . . . . . . . . . . . . . . 29MEDROL ORAL TABLET 2 MG . . . . . 29MEDROL ORAL TABLET 32 MG . . . . 29MEDROL ORAL TABLET THERAPY PACK . . . . . . . . . . . . . . . . . . . . . . . . . . . 29medroxyprogesterone acetate intramuscular suspension . . . . . . . . . 27medroxyprogesterone acetate intramuscular suspension prefilled syringe . . . . . . . . . . . . . . . . . . . . . . . . . 27medroxyprogesterone acetate oral . . 27melodetta 24 fe . . . . . . . . . . . . . . . . . . 27meloxicam oral . . . . . . . . . . . . . . . . . . . 9MENOSTAR . . . . . . . . . . . . . . . . . . . . . 27

mercaptopurine oral . . . . . . . . . . . . . . 13mesalamine er . . . . . . . . . . . . . . . . . . . 31mesalamine oral . . . . . . . . . . . . . . . . . 31mesalamine rectal enema . . . . . . . . . 31mesalamine rectal suppository . . . . . 31metadate er . . . . . . . . . . . . . . . . . . . . . 17metaxalone . . . . . . . . . . . . . . . . . . . . . 34metformin hcl er . . . . . . . . . . . . . . . . . 23metformin hcl er (mod) . . . . . . . . . . . . 23metformin hcl er (osm) . . . . . . . . . . . . 23METFORMIN HCL ORAL SOLUTION . . . . . . . . . . . . . . . . . . . . . . 23metformin hcl oral tablet . . . . . . . . . . . 23methimazole oral . . . . . . . . . . . . . . . . . 29methocarbamol oral . . . . . . . . . . . . . . 34methotrexate oral . . . . . . . . . . . . . . . . 30methotrexate sodium oral . . . . . . . . . . 30METHYLIN . . . . . . . . . . . . . . . . . . . . . . 17methylphenidate hcl er (cd) . . . . . . . . 17methylphenidate hcl er (la) oral capsule extended release 24 hour 10 mg, 20 mg, 30 mg, 40 mg . . . . . . . 17methylphenidate hcl er (la) oral capsule extended release 24 hour 60 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 17methylphenidate hcl er oral tablet extended release 10 mg, 20 mg . . . . 17methylphenidate hcl er oral tablet extended release 18 mg, 27 mg, 36 mg, 54 mg, 72 mg . . . . . . . . . . . . . 17methylphenidate hcl er oral tablet extended release 24 hour . . . . . . . . . . 17methylphenidate hcl oral solution . . . 18methylphenidate hcl oral tablet . . . . . 18methylphenidate hcl oral tablet chewable . . . . . . . . . . . . . . . . . . . . . . . 18methylprednisolone oral . . . . . . . . . . . 29metoclopramide hcl oral solution 5 mg/5ml . . . . . . . . . . . . . . . . . . . . . . . . . 12metoclopramide hcl oral tablet . . . . . 12metoclopramide hcl oral tablet dispersible . . . . . . . . . . . . . . . . . . . . . . 12metoprolol succinate er oral tablet extended release 24 hour 100 mg, 200 mg, 50 mg . . . . . . . . . . . . . . . . . . . 16metoprolol succinate er oral tablet extended release 24 hour 25 mg . . . . 16metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg . . . . . . . . . . . . 16metoprolol tartrate oral tablet 37.5 mg, 75 mg . . . . . . . . . . . . . . . . . . 16METROCREAM . . . . . . . . . . . . . . . . . . 20METROLOTION . . . . . . . . . . . . . . . . . . 20

43

metronidazole external cream . . . . . . 20metronidazole external gel 0.75 % . . . 20metronidazole external gel 1 % . . . . . 20metronidazole external lotion . . . . . . . 20metronidazole oral . . . . . . . . . . . . . . . . 10metronidazole vaginal . . . . . . . . . . . . . 10mibelas 24 fe . . . . . . . . . . . . . . . . . . . . 27microgestin 1/20 . . . . . . . . . . . . . . . . . 27microgestin 1.5/30 . . . . . . . . . . . . . . . 27microgestin fe 1/20 . . . . . . . . . . . . . . . 27microgestin fe 1.5/30 . . . . . . . . . . . . . 27mili . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27MILLIPRED . . . . . . . . . . . . . . . . . . . . . . 29MILLIPRED DP . . . . . . . . . . . . . . . . . . . 29MILLIPRED DP 12-DAY . . . . . . . . . . . . 29MINIPRESS . . . . . . . . . . . . . . . . . . . . . 16minitran . . . . . . . . . . . . . . . . . . . . . . . . . 16Minivelle . . . . . . . . . . . . . . . . . . . . . . . . 26minocycline hcl er oral tablet extended release 24 hour 105 mg, 115 mg, 55 mg, 65 mg, 80 mg . . . . . . 10minocycline hcl er oral tablet extended release 24 hour 135 mg, 45 mg, 90 mg . . . . . . . . . . . . . . . . . . . . 10minocycline hcl oral capsule . . . . . . . 10minocycline hcl oral tablet . . . . . . . . . 10MINOLIRA . . . . . . . . . . . . . . . . . . . . . . 10MIRAPEX . . . . . . . . . . . . . . . . . . . . . . . 14MIRCETTE . . . . . . . . . . . . . . . . . . . . . . 27mirtazapine oral . . . . . . . . . . . . . . . . . . 12MIRVASO . . . . . . . . . . . . . . . . . . . . . . . 20misoprostol oral . . . . . . . . . . . . . . . . . . 24MITIGARE . . . . . . . . . . . . . . . . . . . . . . 13MOBIC . . . . . . . . . . . . . . . . . . . . . . . . . . 9modafinil . . . . . . . . . . . . . . . . . . . . . . . . 34mometasone furoate external . . . . . . 20mondoxyne nl oral capsule 100 mg . 10mondoxyne nl oral capsule 75 mg . . . 10mono-linyah . . . . . . . . . . . . . . . . . . . . . 27montelukast sodium oral packet . . . . 33montelukast sodium oral tablet . . . . . 33montelukast sodium oral tablet chewable . . . . . . . . . . . . . . . . . . . . . . . 33morgidox oral . . . . . . . . . . . . . . . . . . . . 10MORPHABOND ER . . . . . . . . . . . . . . . . 8morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml . . . . . . 8morphine sulfate er oral capsule extended release 24 hour . . . . . . . . . . . 8morphine sulfate er oral tablet extended release . . . . . . . . . . . . . . . . . . 8

morphine sulfate oral . . . . . . . . . . . . . . 8morphine sulfate rectal . . . . . . . . . . . . . 8MOTEGRITY . . . . . . . . . . . . . . . . . . . . 25MOVIPREP . . . . . . . . . . . . . . . . . . . . . . 25MOXEZA . . . . . . . . . . . . . . . . . . . . . . . . 31moxifloxacin hcl ophthalmic . . . . . . . . 31MS CONTIN . . . . . . . . . . . . . . . . . . . . . . 8MULPLETA . . . . . . . . . . . . . . . . . . . . . . 24MULTAQ . . . . . . . . . . . . . . . . . . . . . . . . 16multi-vitamin/fluoride . . . . . . . . . . . . . 24multivitamin/fluoride oral solution . . . 24multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg . . . . 24multivitamins/fluoride . . . . . . . . . . . . . 24mupirocin calcium . . . . . . . . . . . . . . . . 10mupirocin external . . . . . . . . . . . . . . . . 10mvc-fluoride . . . . . . . . . . . . . . . . . . . . . 24mycophenolate mofetil . . . . . . . . . . . . 30mycophenolate sodium . . . . . . . . . . . 30MYDAYIS . . . . . . . . . . . . . . . . . . . . . . . 18myorisan . . . . . . . . . . . . . . . . . . . . . . . . 20

N

nabumetone oral . . . . . . . . . . . . . . . . . . 9nadolol oral . . . . . . . . . . . . . . . . . . . . . 16NAFRINSE DAILY/NEUTRAL . . . . . . . 18NAFRINSE WEEKLY . . . . . . . . . . . . . . 18NALOCET . . . . . . . . . . . . . . . . . . . . . . . . 8naloxone hcl injection solution . . . . . . . 9naloxone hcl injection solution cartridge . . . . . . . . . . . . . . . . . . . . . . . . . 9naloxone hcl injection solution prefilled syringe . . . . . . . . . . . . . . . . . . . 9naltrexone hcl oral . . . . . . . . . . . . . . . . . 9NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 750 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 9NAPROSYN ORAL SUSPENSION . . . . 9naproxen dr . . . . . . . . . . . . . . . . . . . . . . 9naproxen oral suspension . . . . . . . . . . 9naproxen oral tablet . . . . . . . . . . . . . . . 9naproxen sodium er . . . . . . . . . . . . . . . 9naproxen sodium oral tablet 275 mg, 550 mg . . . . . . . . . . . . . . . . . . . 9naratriptan hcl . . . . . . . . . . . . . . . . . . . 13NARCAN . . . . . . . . . . . . . . . . . . . . . . . . 9NASCOBAL . . . . . . . . . . . . . . . . . . . . . 24NATAZIA . . . . . . . . . . . . . . . . . . . . . . . . 27NATESTO . . . . . . . . . . . . . . . . . . . . . . . 29NATURE-THROID . . . . . . . . . . . . . . . . 29NAYZILAM . . . . . . . . . . . . . . . . . . . . . . 11

necon 0.5/35 (28) . . . . . . . . . . . . . . . . 27neomycin-polymyxin-dexameth ophthalmic ointment . . . . . . . . . . . . . . 31neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1 . . . . . . . . . . . . . . . . . . . . 32neomycin-polymyxin-hc otic . . . . . . . . 32NESINA . . . . . . . . . . . . . . . . . . . . . . . . . 23neuac external gel . . . . . . . . . . . . . . . . 20NEULASTA . . . . . . . . . . . . . . . . . . . . . . 24NEURONTIN . . . . . . . . . . . . . . . . . . . . 11neutral sodium fluoride . . . . . . . . . . . . 18NEVANAC . . . . . . . . . . . . . . . . . . . . . . . 32NEXLETOL . . . . . . . . . . . . . . . . . . . . . . 16NEXLIZET . . . . . . . . . . . . . . . . . . . . . . . 16niacin (antihyperlipidemic) . . . . . . . . . 16niacin er (antihyperlipidemic) . . . . . . . 16niacor . . . . . . . . . . . . . . . . . . . . . . . . . . 16NIASPAN . . . . . . . . . . . . . . . . . . . . . . . 16nifedipine er . . . . . . . . . . . . . . . . . . . . . 16nifedipine er osmotic release . . . . . . . 16nifedipine oral . . . . . . . . . . . . . . . . . . . 16nikki . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27nitisinone . . . . . . . . . . . . . . . . . . . . . . . 25NITRO-BID . . . . . . . . . . . . . . . . . . . . . . 16NITRO-DUR . . . . . . . . . . . . . . . . . . . . . 16nitro-time . . . . . . . . . . . . . . . . . . . . . . . 16nitrofurantoin macrocrystal oral . . . . . 10nitrofurantoin monohydrate macrocrystals . . . . . . . . . . . . . . . . . . . 10nitroglycerin sublingual . . . . . . . . . . . . 16nitroglycerin transdermal . . . . . . . . . . 16nitroglycerin translingual . . . . . . . . . . 16NITROMIST . . . . . . . . . . . . . . . . . . . . . 16NITROSTAT . . . . . . . . . . . . . . . . . . . . . 16NITYR . . . . . . . . . . . . . . . . . . . . . . . . . . 25NIZORAL . . . . . . . . . . . . . . . . . . . . . . . 13NOCDURNA . . . . . . . . . . . . . . . . . . . . . 29nora-be . . . . . . . . . . . . . . . . . . . . . . . . . 28NORDITROPIN FLEXPRO . . . . . . . . . 29norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg(24) . . . . . . . . . . . . 28norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg . 28norethin ace-eth estrad-fe oral tablet chewable . . . . . . . . . . . . . . . . . . 28norethindrone acet-ethinyl est . . . . . . 28norethindrone acetate oral . . . . . . . . . 28norethindrone oral . . . . . . . . . . . . . . . . 28norgestimate-eth estradiol . . . . . . . . . 28

44

norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/0.25 mg-25 mcg . . . . . . . . . . . . . . . . . . . . . . 28norgestimate-ethinyl estradiol triphasic oral tablet 0.18/0.215/ 0.25 mg-35 mcg. . . . . . . . . . . . . . . . . . 28NORITATE . . . . . . . . . . . . . . . . . . . . . . 20norlyda . . . . . . . . . . . . . . . . . . . . . . . . . 28norlyroc . . . . . . . . . . . . . . . . . . . . . . . . 28nortrel 0.5/35 (28) . . . . . . . . . . . . . . . . 28nortrel 1/35 (21) . . . . . . . . . . . . . . . . . . 28nortrel 1/35 (28) . . . . . . . . . . . . . . . . . . 28nortriptyline hcl oral . . . . . . . . . . . . . . 12NORVIR ORAL PACKET . . . . . . . . . . . 14NORVIR ORAL SOLUTION . . . . . . . . 14NOURIANZ . . . . . . . . . . . . . . . . . . . . . . 14novarel intramuscular solution reconstituted 10000 unit . . . . . . . . . . . 31NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT . . . . . . . . . . . . . . . . . . . . . . 31NOVOEIGHT . . . . . . . . . . . . . . . . . . . . 24NOVOFINE AUTOCOVER PEN NEEDLE . . . . . . . . . . . . . . . . . . . . . . . . 22NOVOFINE PEN NEEDLE . . . . . . . . . . 22NOVOFINE PLUS PEN NEEDLE . . . . 22NOVOLIN 70/30 FLEXPEN . . . . . . . . . 22NOVOLIN 70/30 FLEXPEN RELION . 22NOVOLIN 70/30 RELION . . . . . . . . . . 22NOVOLIN 70/30 VIAL . . . . . . . . . . . . . 22NOVOLIN N FLEXPEN . . . . . . . . . . . . 23NOVOLIN N FLEXPEN RELION . . . . . 23NOVOLIN N RELION . . . . . . . . . . . . . . 23NOVOLIN N VIAL . . . . . . . . . . . . . . . . . 23NOVOLIN R FLEXPEN . . . . . . . . . . . . 23NOVOLIN R FLEXPEN RELION . . . . . 23NOVOLIN R RELION . . . . . . . . . . . . . . 23NOVOLIN R VIAL . . . . . . . . . . . . . . . . . 23NOVOLOG FLEXPEN . . . . . . . . . . . . . 23NOVOLOG PENFILL . . . . . . . . . . . . . . 23NOVOLOG U-100 VIAL . . . . . . . . . . . . 23np thyroid . . . . . . . . . . . . . . . . . . . . . . . 30NUBEQA. . . . . . . . . . . . . . . . . . . . . . . . 13NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR . . . . . . 33NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE . . . 33NUCYNTA . . . . . . . . . . . . . . . . . . . . . . . . 8NUCYNTA ER . . . . . . . . . . . . . . . . . . . . . 8NUEDEXTA . . . . . . . . . . . . . . . . . . . . . 18NULEV . . . . . . . . . . . . . . . . . . . . . . . . . 25

NUTROPIN AQ NUSPIN 10 . . . . . . . . 29NUTROPIN AQ NUSPIN 20 . . . . . . . . 29NUTROPIN AQ NUSPIN 5 . . . . . . . . . 29NUVARING . . . . . . . . . . . . . . . . . . . . . . 28NUVESSA . . . . . . . . . . . . . . . . . . . . . . . 10NUWIQ . . . . . . . . . . . . . . . . . . . . . . . . . 24NUZYRA . . . . . . . . . . . . . . . . . . . . . . . . 10nyamyc . . . . . . . . . . . . . . . . . . . . . . . . . 13nystatin external . . . . . . . . . . . . . . . . . 13nystatin mouth/throat . . . . . . . . . . . . . 13nystop . . . . . . . . . . . . . . . . . . . . . . . . . . 13

O

ocella . . . . . . . . . . . . . . . . . . . . . . . . . . 28octreotide . . . . . . . . . . . . . . . . . . . . . . . 29OCUFLOX . . . . . . . . . . . . . . . . . . . . . . . 32ODEFSEY . . . . . . . . . . . . . . . . . . . . . . . 14ofloxacin ophthalmic . . . . . . . . . . . . . . 32ofloxacin otic . . . . . . . . . . . . . . . . . . . . 32ogestrel . . . . . . . . . . . . . . . . . . . . . . . . . 28okebo . . . . . . . . . . . . . . . . . . . . . . . . . . 10olanzapine oral tablet . . . . . . . . . . . . . 14olanzapine oral tablet dispersible . . . 14olmesartan medoxomil oral . . . . . . . . 16olmesartan medoxomil-hctz . . . . . . . . 16olopatadine hcl ophthalmic solution 0.1 % . . . . . . . . . . . . . . . . . . . . . . . . . . . 32olopatadine hcl ophthalmic solution 0.2 % . . . . . . . . . . . . . . . . . . . . . . . . . . . 32OLUMIANT . . . . . . . . . . . . . . . . . . . . . . 30OMECLAMOX-PAK . . . . . . . . . . . . . . . 24omega-3-acid ethyl esters . . . . . . . . . 16omeprazole oral capsule delayed release . . . . . . . . . . . . . . . . . . . . . . . . . 24OMNARIS . . . . . . . . . . . . . . . . . . . . . . . 33OMNITROPE . . . . . . . . . . . . . . . . . . . . 29ondansetron hcl oral . . . . . . . . . . . . . . 12ondansetron odt . . . . . . . . . . . . . . . . . 12ONETOUCH ULTRA 2 KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 22ONETOUCH ULTRA BLUE TEST STRIPS IN VITRO STRIP . . . . . . . . . . 22ONETOUCH ULTRA MINI KIT W/DEVICE . . . . . . . . . . . . . . . . . . . . . . 22ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE . . . . . . . . . . . . . . . . . . . 22ONETOUCH VERIO IQ SYSTEM . . . . 22ONETOUCH VERIO KIT W/DEVICE . 22ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE . . . . . . . . . . . . . . . . . . . 22ONETOUCH VERIO TEST STRIPS . . 22

ONGLYZA . . . . . . . . . . . . . . . . . . . . . . . 23ONZETRA XSAIL . . . . . . . . . . . . . . . . . 13OPSUMIT . . . . . . . . . . . . . . . . . . . . . . . 34ORAPRED ODT . . . . . . . . . . . . . . . . . . 29ORENCIA . . . . . . . . . . . . . . . . . . . . . . . 30ORENCIA CLICKJET . . . . . . . . . . . . . . 30ORENITRAM . . . . . . . . . . . . . . . . . . . . 34ORFADIN ORAL CAPSULE . . . . . . . . 25ORFADIN ORAL SUSPENSION . . . . . 25ORIAHNN . . . . . . . . . . . . . . . . . . . . . . . 29ORILISSA . . . . . . . . . . . . . . . . . . . . . . . 29orsythia . . . . . . . . . . . . . . . . . . . . . . . . . 28ORTHO MICRONOR . . . . . . . . . . . . . . 28oscimin . . . . . . . . . . . . . . . . . . . . . . . . . 25oscimin sr . . . . . . . . . . . . . . . . . . . . . . . 25oseltamivir phosphate oral capsule . . 14oseltamivir phosphate oral suspension reconstituted . . . . . . . . . . 14OSENI . . . . . . . . . . . . . . . . . . . . . . . . . . 23OSPHENA . . . . . . . . . . . . . . . . . . . . . . 24OTEZLA . . . . . . . . . . . . . . . . . . . . . . . . 30OTREXUP . . . . . . . . . . . . . . . . . . . . . . . 30OVIDREL . . . . . . . . . . . . . . . . . . . . . . . 31OXAYDO . . . . . . . . . . . . . . . . . . . . . . . . . 8oxcarbazepine . . . . . . . . . . . . . . . . . . . 11OXTELLAR XR . . . . . . . . . . . . . . . . . . . 11oxybutynin chloride er . . . . . . . . . . . . 25oxybutynin chloride oral . . . . . . . . . . . 25OXYCODONE HCL ER . . . . . . . . . . . . . 8oxycodone hcl oral capsule . . . . . . . . . 8oxycodone hcl oral concentrate 100 mg/5ml . . . . . . . . . . . . . . . . . . . . . . 8oxycodone hcl oral solution . . . . . . . . . 8oxycodone hcl oral tablet . . . . . . . . . . . 8oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg . . . . . . . . . . . . . . 8OXYCONTIN . . . . . . . . . . . . . . . . . . . . . 8OZEMPIC . . . . . . . . . . . . . . . . . . . . . . . 23OZOBAX . . . . . . . . . . . . . . . . . . . . . . . . 34

P

PACERONE ORAL TABLET 100 MG, 400 MG . . . . . . . . . . . . . . . . . 16pacerone oral tablet 200 mg . . . . . . . 16PAMELOR . . . . . . . . . . . . . . . . . . . . . . 12PANCREAZE . . . . . . . . . . . . . . . . . . . . 25pantoprazole sodium tablet delayed release 20 mg oral . . . . . . . . . . . . . . . . 24pantoprazole sodium tablet delayed release 40 mg oral . . . . . . . . . . . . . . . . 24

45

paroex . . . . . . . . . . . . . . . . . . . . . . . . . . 18paroxetine hcl . . . . . . . . . . . . . . . . . . . 12paroxetine hcl er . . . . . . . . . . . . . . . . . 12PAXIL ORAL SUSPENSION . . . . . . . . 12PAXIL ORAL TABLET . . . . . . . . . . . . . 12PAZEO . . . . . . . . . . . . . . . . . . . . . . . . . 32PEDIAPRED . . . . . . . . . . . . . . . . . . . . . 29peg-3350/electrolytes . . . . . . . . . . . . . 25penicillamine oral capsule . . . . . . . . . 25penicillin v potassium . . . . . . . . . . . . . 10PENNSAID . . . . . . . . . . . . . . . . . . . . . . . 9PENTASA . . . . . . . . . . . . . . . . . . . . . . . 31PERFOROMIST . . . . . . . . . . . . . . . . . . 33PERIDEX . . . . . . . . . . . . . . . . . . . . . . . . 18periogard . . . . . . . . . . . . . . . . . . . . . . . 18permethrin external . . . . . . . . . . . . . . . 14PERTZYE . . . . . . . . . . . . . . . . . . . . . . . 25phenadoz . . . . . . . . . . . . . . . . . . . . . . . 12phenazo oral tablet 200 mg . . . . . . . . 25phenazopyridine hcl oral tablet 100 mg, 200 mg . . . . . . . . . . . . . . . . . . 25philith . . . . . . . . . . . . . . . . . . . . . . . . . . 28PICATO . . . . . . . . . . . . . . . . . . . . . . . . . 20pimtrea . . . . . . . . . . . . . . . . . . . . . . . . . 28pioglitazone hcl . . . . . . . . . . . . . . . . . . 23pirmella 1/35 . . . . . . . . . . . . . . . . . . . . 28PLEGRIDY . . . . . . . . . . . . . . . . . . . . . . 18PLEGRIDY STARTER PACK . . . . . . . . 18PLENVU . . . . . . . . . . . . . . . . . . . . . . . . 25PLEXION . . . . . . . . . . . . . . . . . . . . . . . 20PLEXION CLEANSER . . . . . . . . . . . . . 20PLEXION CLEANSING CLOTH . . . . . 20POLY-VI-FLOR . . . . . . . . . . . . . . . . . . . 24polymyxin b-trimethoprim . . . . . . . . . . 32POLYTRIM . . . . . . . . . . . . . . . . . . . . . . 32portia-28 . . . . . . . . . . . . . . . . . . . . . . . . 28potassium chloride crys er . . . . . . . . . 24potassium chloride er . . . . . . . . . . . . . 24potassium chloride oral . . . . . . . . . . . 24potassium citrate er. . . . . . . . . . . . . . . 24PRADAXA . . . . . . . . . . . . . . . . . . . . . . 11PRALUENT. . . . . . . . . . . . . . . . . . . . . . 16pramipexole dihydrochloride . . . . . . . 14pramipexole dihydrochloride er . . . . . 14PRAVACHOL . . . . . . . . . . . . . . . . . . . . 16pravastatin sodium . . . . . . . . . . . . . . . 17prazosin hcl oral . . . . . . . . . . . . . . . . . 17PRECISION LINK . . . . . . . . . . . . . . . . . 22PRECISION PCX PLUS TEST . . . . . . . 22PRECISION QID MONITOR . . . . . . . . 22

PRECISION QID TEST . . . . . . . . . . . . 22PRECISION SOF-TACT MONITOR . . 22PRECISION SOF-TACT TEST . . . . . . . 22PRECISION XTRA BLOOD GLUCOSE . . . . . . . . . . . . . . . . . . . . . . 22PRECISION XTRA DEVICE . . . . . . . . 22PRECISION XTRA KIT . . . . . . . . . . . . 22PRECISION XTRA MONITOR . . . . . . 22PRED FORTE . . . . . . . . . . . . . . . . . . . . 32PRED MILD . . . . . . . . . . . . . . . . . . . . . 32prednisolone acetate ophthalmic . . . 32prednisolone oral solution . . . . . . . . . 29prednisolone sodium phosphate oral . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29prednisone intensol . . . . . . . . . . . . . . . 29prednisone oral . . . . . . . . . . . . . . . . . . 29pregabalin oral capsule . . . . . . . . . . . 18pregabalin oral solution . . . . . . . . . . . 18pregnyl . . . . . . . . . . . . . . . . . . . . . . . . . 31PREMARIN ORAL . . . . . . . . . . . . . . . . 28PREMARIN VAGINAL . . . . . . . . . . . . . 28premium lidocaine . . . . . . . . . . . . . . . . . 8PREMPHASE . . . . . . . . . . . . . . . . . . . . 28PREMPRO . . . . . . . . . . . . . . . . . . . . . . 28PREPOPIK . . . . . . . . . . . . . . . . . . . . . . 25PREVIDENT 5000 BOOSTER PLUS . 18PREVIDENT 5000 DRY MOUTH . . . . 18PREVIDENT 5000 ORTHO DEFENSE . . . . . . . . . . . . . . . . . . . . . . . 18PREVIDENT 5000 PLUS . . . . . . . . . . . 18PREVIDENT DENTAL . . . . . . . . . . . . . 18PREVIDENT MOUTH/THROAT . . . . . 18previfem . . . . . . . . . . . . . . . . . . . . . . . . 28PREZCOBIX . . . . . . . . . . . . . . . . . . . . . 14PREZISTA . . . . . . . . . . . . . . . . . . . . . . . 14PRIMLEV . . . . . . . . . . . . . . . . . . . . . . . . 8PRINIVIL . . . . . . . . . . . . . . . . . . . . . . . . 17PROAIR DIGIHALER . . . . . . . . . . . . . . 33ProAir HFA . . . . . . . . . . . . . . . . . . . . . . 33PROAIR RESPICLICK . . . . . . . . . . . . . 33PROCARDIA . . . . . . . . . . . . . . . . . . . . 17PROCARDIA XL . . . . . . . . . . . . . . . . . . 17PROCENTRA . . . . . . . . . . . . . . . . . . . . 18prochlorperazine maleate oral . . . . . . 12PROCORT . . . . . . . . . . . . . . . . . . . . . . 31PROCTOFOAM HC . . . . . . . . . . . . . . . 31progesterone micronized oral . . . . . . 28PROGRAF ORAL PACKET . . . . . . . . . 30promethazine hcl oral solution . . . . . . 33promethazine hcl oral syrup . . . . . . . . 33

promethazine hcl oral tablet . . . . . . . . 12promethazine hcl rectal . . . . . . . . . . . 12promethazine-codeine . . . . . . . . . . . . 33promethazine-dm . . . . . . . . . . . . . . . . 33promethegan . . . . . . . . . . . . . . . . . . . . 12propranolol hcl er . . . . . . . . . . . . . . . . 17propranolol hcl oral . . . . . . . . . . . . . . . 17PROSCAR . . . . . . . . . . . . . . . . . . . . . . 26PROTONIX ORAL PACKET . . . . . . . . 24PROVENTIL HFA . . . . . . . . . . . . . . 33, 34Proventil HFA) . . . . . . . . . . . . . . . . 33, 34PROVERA . . . . . . . . . . . . . . . . . . . . 26, 28pseudoephedrine-bromphen-dm . . . 33PULMICORT FLEXHALER . . . . . . . . . 34PULMOZYME . . . . . . . . . . . . . . . . . . . 34PURIXAN . . . . . . . . . . . . . . . . . . . . . . . 13PYLERA . . . . . . . . . . . . . . . . . . . . . . . . 24PYRIDIUM . . . . . . . . . . . . . . . . . . . . . . 25

Q

QBRELIS . . . . . . . . . . . . . . . . . . . . . . . 17QMIIZ ODT . . . . . . . . . . . . . . . . . . . . . . . 9quetiapine fumarate . . . . . . . . . . . . . . 14quetiapine fumarate er . . . . . . . . . . . . 14QUFLORA PEDIATRIC . . . . . . . . . . . . 24QUILLICHEW ER . . . . . . . . . . . . . . . . . 18QUILLIVANT XR . . . . . . . . . . . . . . . . . . 18quinapril hcl . . . . . . . . . . . . . . . . . . . . . 17QVAR REDIHALER . . . . . . . . . . . . . . . 34

R

RABEPRAZOLE SODIUM ORAL CAPSULE SPRINKLE . . . . . . . . . . . . . 24rabeprazole sodium oral tablet delayed release . . . . . . . . . . . . . . . . . . 24ramipril . . . . . . . . . . . . . . . . . . . . . . . . . 17ranolazine er . . . . . . . . . . . . . . . . . . . . 17RAPAMUNE ORAL SOLUTION . . . . . 30RASUVO . . . . . . . . . . . . . . . . . . . . . . . . 30RAYOS . . . . . . . . . . . . . . . . . . . . . . . . . 29REBIF . . . . . . . . . . . . . . . . . . . . . . . . . . 18REBIF REBIDOSE . . . . . . . . . . . . . . . . 18REBIF REBIDOSE TITRATION PACK . . . . . . . . . . . . . . . . . . . . . . . . . . . 18REBIF TITRATION PACK . . . . . . . . . . 18reclipsen . . . . . . . . . . . . . . . . . . . . . . . . 28RECOMBINATE . . . . . . . . . . . . . . . . . . 24REGLAN . . . . . . . . . . . . . . . . . . . . . . . . 12relexxii . . . . . . . . . . . . . . . . . . . . . . . . . 18RELION BLOOD GLUCOSE TEST . . . 22

46

RELION ULTIMA TEST . . . . . . . . . . . . 22REMERON . . . . . . . . . . . . . . . . . . . . . . 12REMERON SOLTAB . . . . . . . . . . . . . . 12REPATHA . . . . . . . . . . . . . . . . . . . . . . . 17REPATHA PUSHTRONEX SYSTEM. . 17REPATHA SURECLICK . . . . . . . . . . . . 17RESTASIS . . . . . . . . . . . . . . . . . . . . . . . 32RESTASIS MULTIDOSE . . . . . . . . . . . 32RESTORIL . . . . . . . . . . . . . . . . . . . . . . 34RETACRIT . . . . . . . . . . . . . . . . . . . . . . 24REVLIMID . . . . . . . . . . . . . . . . . . . . . . . 13REYVOW . . . . . . . . . . . . . . . . . . . . . . . 13RHOFADE. . . . . . . . . . . . . . . . . . . . . . . 20RHOPRESSA . . . . . . . . . . . . . . . . . . . . 32RILUTEK . . . . . . . . . . . . . . . . . . . . . . . . 18riluzole . . . . . . . . . . . . . . . . . . . . . . . . . 18RINVOQ . . . . . . . . . . . . . . . . . . . . . . . . 30risperidone . . . . . . . . . . . . . . . . . . . . . . 14RITALIN . . . . . . . . . . . . . . . . . . . . . . . . 18ritonavir . . . . . . . . . . . . . . . . . . . . . . . . . 14rivelsa . . . . . . . . . . . . . . . . . . . . . . . . . . 28rizatriptan benzoate . . . . . . . . . . . . . . . 13ROBAXIN-750 . . . . . . . . . . . . . . . . . . . 34ROCALTROL . . . . . . . . . . . . . . . . . . . . 31ROCKLATAN . . . . . . . . . . . . . . . . . . . . 32ropinirole hcl . . . . . . . . . . . . . . . . . . . . 14ropinirole hcl er . . . . . . . . . . . . . . . . . . 14rosadan external cream . . . . . . . . . . . 20rosadan external gel . . . . . . . . . . . . . . 20rosuvastatin calcium . . . . . . . . . . . . . . 17roweepra . . . . . . . . . . . . . . . . . . . . . . . 11roweepra xr . . . . . . . . . . . . . . . . . . . . . 11ROZLYTREK. . . . . . . . . . . . . . . . . . . . . 13RUCONEST . . . . . . . . . . . . . . . . . . . . . 30RUKOBIA . . . . . . . . . . . . . . . . . . . . . . . 14RYBELSUS . . . . . . . . . . . . . . . . . . . . . . 23RYTARY . . . . . . . . . . . . . . . . . . . . . . . . 14

S

SAPHRIS . . . . . . . . . . . . . . . . . . . . . . . 14scopolamine . . . . . . . . . . . . . . . . . . . . 12SEREVENT DISKUS . . . . . . . . . . . . . . 34SERNIVO . . . . . . . . . . . . . . . . . . . . . . . 20sertraline hcl oral . . . . . . . . . . . . . . . . . 12setlakin . . . . . . . . . . . . . . . . . . . . . . . . . 28sf . . . . . . . . . . . . . . . . . . . . . . . . . . . 18, 19sf 5000 plus . . . . . . . . . . . . . . . . . . . . . 19SFROWASA . . . . . . . . . . . . . . . . . . . . . 31sharobel . . . . . . . . . . . . . . . . . . . . . . . . 28

sildenafil citrate oral tablet 100 mg, 25 mg, 50 mg . . . . . . . . . . . . . . . . . . . . 24sildenafil oral tablets . . . . . . . . . . . . . . 34simliya . . . . . . . . . . . . . . . . . . . . . . . . . . 28simpesse . . . . . . . . . . . . . . . . . . . . . . . 28SIMPONI . . . . . . . . . . . . . . . . . . . . . . . . 30simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg . . . . . . . . . . . . . . 17simvastatin oral tablet 80 mg . . . . . . . 17SINEMET . . . . . . . . . . . . . . . . . . . . . . . 14SINGULAIR ORAL PACKET . . . . . . . . 34sirolimus oral solution . . . . . . . . . . . . . 30sirolimus oral tablet . . . . . . . . . . . . . . . 30SITAVIG . . . . . . . . . . . . . . . . . . . . . . . . 14SKYRIZI (150 MG DOSE) . . . . . . . . . . 30sodium fluoride 5000 plus . . . . . . . . . 19sodium fluoride dental . . . . . . . . . . . . 19SOFOS/VELPAT ORAL TABLET 400-100 . . . . . . . . . . . . . . . . . . . . . . . . . 14SOFOSBUVIR-VELPATASVIR . . . . . . . 14SOFTCLIX . . . . . . . . . . . . . . . . . . . 21, 22solifenacin . . . . . . . . . . . . . . . . . . . . . . 25SOLIQUA . . . . . . . . . . . . . . . . . . . . . . . 23SOLTAMOX . . . . . . . . . . . . . . . . . . . . . 13SOMA ORAL TABLET 350 MG . . . . . 34SOMATULINE DEPOT . . . . . . . . . . . . . 29SOOLANTRA . . . . . . . . . . . . . . . . . . . . 20sotalol hcl oral . . . . . . . . . . . . . . . . . . . 17SOTYLIZE . . . . . . . . . . . . . . . . . . . . . . . 17SPIRIVA HANDIHALER . . . . . . . . . . . . 34SPIRIVA RESPIMAT . . . . . . . . . . . . . . 34spironolactone oral . . . . . . . . . . . . . . . 17sprintec 28 . . . . . . . . . . . . . . . . . . . . . . 28SPRITAM . . . . . . . . . . . . . . . . . . . . . . . 11SPRIX . . . . . . . . . . . . . . . . . . . . . . . . . . . 9sronyx . . . . . . . . . . . . . . . . . . . . . . . . . . 28sss 10-5 . . . . . . . . . . . . . . . . . . . . . . . . 20STELARA SUBCUTANEOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . . 30STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE . . . 30STENDRA . . . . . . . . . . . . . . . . . . . . . . . 24STIMATE . . . . . . . . . . . . . . . . . . . . . . . . 29STRENSIQ . . . . . . . . . . . . . . . . . . . . . . 25STRIANT. . . . . . . . . . . . . . . . . . . . . . . . 29STRIBILD . . . . . . . . . . . . . . . . . . . . . . . 14STRIVERDI RESPIMAT . . . . . . . . . . . . 34SUBSYS . . . . . . . . . . . . . . . . . . . . . . . . . 8subvenite . . . . . . . . . . . . . . . . . . . . . . . 11subvenite starter kit-blue . . . . . . . . . . 11

subvenite starter kit-green . . . . . . . . . 11subvenite starter kit-orange . . . . . . . . 11sucralfate oral suspension . . . . . . . . . 25sucralfate oral tablet . . . . . . . . . . . . . . 25sulfacetamide sodium-sulfur external cream 10-2 %, 10-5 % . . . . . . 20sulfacetamide sodium-sulfur external cream 9.8-4.8 % . . . . . . . . . . 20sulfacetamide sodium-sulfur external emulsion . . . . . . . . . . . . . . . . 20sulfacetamide sodium-sulfur external liquid 10-2 %, 9.8-4.8 % . . . . 20sulfacetamide sodium-sulfur external liquid 9-4 %, 9-4.5 % . . . . . . . 20sulfacetamide sodium-sulfur external lotion 10-5 % . . . . . . . . . . . . . 20sulfacetamide sodium-sulfur external lotion 9.8-4.8 % . . . . . . . . . . . 20sulfacetamide sodium-sulfur external pad . . . . . . . . . . . . . . . . . . . . . 20sulfacetamide sodium-sulfur external suspension 10-5 % . . . . . . . . 20sulfacetamide sodium-sulfur external suspension 8-4 % . . . . . . . . . 20sulfacleanse 8/4 . . . . . . . . . . . . . . . . . . 20sulfamethoxazole-trimethoprim oral . 10sulfamez wash . . . . . . . . . . . . . . . . . . . 20sulfasalazine oral tablet . . . . . . . . . . . 31sulfatrim pediatric . . . . . . . . . . . . . . . . 10SUMADAN WASH . . . . . . . . . . . . . . . . 20sumatriptan succinate oral . . . . . . . . . 13sumatriptan succinate refill . . . . . . . . 13sumatriptan succinate subcutaneous . . . . . . . . . . . . . . . . . . . 13SUMAXIN . . . . . . . . . . . . . . . . . . . . 20, 21SUMAXIN WASH . . . . . . . . . . . . . . . . . 21SUNOSI . . . . . . . . . . . . . . . . . . . . . . . . 34SUPREP BOWEL PREP KIT . . . . . . . . 25syeda . . . . . . . . . . . . . . . . . . . . . . . . . . 28SYMAX DUOTAB . . . . . . . . . . . . . . . . . 25symax-sl . . . . . . . . . . . . . . . . . . . . . . . . 25symax-sr . . . . . . . . . . . . . . . . . . . . . . . . 25SYMBICORT . . . . . . . . . . . . . . . . . . . . 34SYMFI . . . . . . . . . . . . . . . . . . . . . . . . . . 14SYMFI LO . . . . . . . . . . . . . . . . . . . . . . . 14SYMJEPI . . . . . . . . . . . . . . . . . . . . . . . . 32SYMLINPEN 60 . . . . . . . . . . . . . . . . . . 23SYMLNPEN 120 . . . . . . . . . . . . . . . . . . 23SYMPROIC . . . . . . . . . . . . . . . . . . . . . . 25SYNJARDY . . . . . . . . . . . . . . . . . . . . . . 23SYNJARDY XR . . . . . . . . . . . . . . . . . . . 23SYNTHROID . . . . . . . . . . . . . . . . . . . . . 30

47

T

TACLONEX EXTERNAL SUSPENSION . . . . . . . . . . . . . . . . . . . 21tacrolimus oral . . . . . . . . . . . . . . . . . . . 30tadalafil oral tablet 10 mg, 20 mg . . . 24tadalafil oral tablet 2.5 mg, 5 mg . . . . 24TAKHZYRO . . . . . . . . . . . . . . . . . . . . . 30tamoxifen citrate oral tablet 10 mg . . 13tamoxifen citrate oral tablet 20 mg . . 13tamsulosin hcl . . . . . . . . . . . . . . . . . . . 26TAPAZOLE . . . . . . . . . . . . . . . . . . . . . . 30TAPERDEX 12-DAY . . . . . . . . . . . . . . . 29TAPERDEX 6-DAY ORAL TABLET THERAPY PACK 1.5 MG (21) . . . . . . . 29TAPERDEX 7-DAY . . . . . . . . . . . . . . . . 29TARGRETIN EXTERNAL . . . . . . . . . . 13TARGRETIN ORAL . . . . . . . . . . . . . . . 13tarina 24 fe . . . . . . . . . . . . . . . . . . . . . . 28tarina fe 1/20 . . . . . . . . . . . . . . . . . . . . 28tarina fe 1/20 eq . . . . . . . . . . . . . . . . . . 28TASIGNA . . . . . . . . . . . . . . . . . . . . . . . 13TAYTULLA . . . . . . . . . . . . . . . . . . . . . . 28tazarotene external . . . . . . . . . . . . . . . 21TAZORAC . . . . . . . . . . . . . . . . . . . . . . . 21TECFIDERA . . . . . . . . . . . . . . . . . . . . . 18TEGRETOL . . . . . . . . . . . . . . . . . . . . . . 11TEGRETOL-XR . . . . . . . . . . . . . . . . . . . 11TEGSEDI. . . . . . . . . . . . . . . . . . . . . . . . 25TEKTURNA . . . . . . . . . . . . . . . . . . . . . 17TEKTURNA HCT . . . . . . . . . . . . . . . . . 17telmisartan . . . . . . . . . . . . . . . . . . . . . . 17temazepam . . . . . . . . . . . . . . . . . . . . . 34TEMIXYS . . . . . . . . . . . . . . . . . . . . . . . 14TEMOVATE . . . . . . . . . . . . . . . . . . . . . . 21tenofovir disoproxil fumarate . . . . . . . 14terazosin hcl . . . . . . . . . . . . . . . . . . . . . 26terbinafine hcl oral . . . . . . . . . . . . . . . . 13terconazole . . . . . . . . . . . . . . . . . . . . . 13TERIPARATIDE (RECOMBINANT). . . 31TESSALON PERLES . . . . . . . . . . . . . . 33TESTIM . . . . . . . . . . . . . . . . . . . . . . . . . 29TESTOSTERONE CYPIONATE INJECTION . . . . . . . . . . . . . . . . . . . . . . 29testosterone cypionate intramuscular . . . . . . . . . . . . . . . . . . . . 29testosterone enanthate intramuscular . . . . . . . . . . . . . . . . . . . . 29testosterone transdermal . . . . . . . . . . 29TEXACORT . . . . . . . . . . . . . . . . . . . . . 21

thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg . . . . . . . . . . . . . 30TIGLUTIK . . . . . . . . . . . . . . . . . . . . . . . 18timolol maleate ophthalmic gel forming solution . . . . . . . . . . . . . . . . . . 32timolol maleate ophthalmic solution 0.25 %, 0.5 % . . . . . . . . . . . . . . . . . . . . 32timolol maleate ophthalmic solution 0.5 % (daily) . . . . . . . . . . . . . . . . . . . . . 32TIMOPTIC . . . . . . . . . . . . . . . . . . . . . . 32TIMOPTIC OCUDOSE 0.25 % . . . . . . 32TIMOPTIC-XE . . . . . . . . . . . . . . . . . . . . 32TIROSINT . . . . . . . . . . . . . . . . . . . . . . . 30TIROSINT-SOL . . . . . . . . . . . . . . . . . . . 30TIVICAY. . . . . . . . . . . . . . . . . . . . . . . . . 14tizanidine hcl oral capsule . . . . . . . . . 34tizanidine hcl oral tablet . . . . . . . . . . . 34TOBI PODHALER . . . . . . . . . . . . . . . . 34TOBRADEX OPHTHALMIC OINTMENT . . . . . . . . . . . . . . . . . . . . . . 32TOBRADEX OPHTHALMIC SUSPENSION . . . . . . . . . . . . . . . . . . . 32TOBRADEX ST . . . . . . . . . . . . . . . . . . 32tobramycin nebulization solution 300 mg/4ml inhalation . . . . . . . . . . . . 34tobramycin nebulization solution 300 mg/5ml inhalation . . . . . . . . . . . . 34tobramycin ophthalmic . . . . . . . . . . . . 32tobramycin-dexamethasone . . . . . . . . 32TOBREX OPHTHALMIC OINTMENT . 32TOBREX OPHTHALMIC SOLUTION . 32TOLAK . . . . . . . . . . . . . . . . . . . . . . . . . 21TOPAMAX . . . . . . . . . . . . . . . . . . . . . . 11TOPAMAX SPRINKLE . . . . . . . . . . . . . 11topiramate er . . . . . . . . . . . . . . . . . . . . 11topiramate oral . . . . . . . . . . . . . . . . . . . 11TOPROL XL . . . . . . . . . . . . . . . . . . . . . 17torsemide . . . . . . . . . . . . . . . . . . . . . . . 17TOUJEO MAX SOLOSTAR . . . . . . . . . 23TOUJEO SOLOSTAR . . . . . . . . . . . . . 23TOVIAZ . . . . . . . . . . . . . . . . . . . . . . . . . 25TRACLEER . . . . . . . . . . . . . . . . . . . . . . 34TRADJENTA . . . . . . . . . . . . . . . . . . . . . 23tramadol hcl er (biphasic) . . . . . . . . . . . 8TRAMADOL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG, 200 MG, 300 MG . 8tramadol hcl er oral capsule extended release 24 hour 150 mg . . . . 8tramadol hcl er oral tablet extended release 24 hour . . . . . . . . . . . . . . . . . . . 9tramadol hcl oral tablet 50 mg . . . . . . . 9

TRANSDERM-SCOP (1.5 MG) . . . . . . 12travoprost (bak free) . . . . . . . . . . . . . . 32trazodone hcl oral . . . . . . . . . . . . . . . . 12TRELEGY ELLIPTA . . . . . . . . . . . . . . . 34TREMFYA . . . . . . . . . . . . . . . . . . . . . . . 30TRESIBA . . . . . . . . . . . . . . . . . . . . . . . . 23TRESIBA FLEXTOUCH . . . . . . . . . . . . 23tretinoin external cream . . . . . . . . . . . 21tretinoin external gel 0.01 %, 0.05 % . 21tretinoin external gel 0.025 % . . . . . . . 21TREXALL . . . . . . . . . . . . . . . . . . . . . . . 30TREZIX . . . . . . . . . . . . . . . . . . . . . . . . . . 9tri femynor . . . . . . . . . . . . . . . . . . . . . . 28tri-estarylla . . . . . . . . . . . . . . . . . . . . . . 28tri-linyah . . . . . . . . . . . . . . . . . . . . . . . . 28tri-lo-estarylla . . . . . . . . . . . . . . . . . . . . 28tri-lo-mili . . . . . . . . . . . . . . . . . . . . . . . . 28tri-lo-sprintec . . . . . . . . . . . . . . . . . . . . 28tri-mili . . . . . . . . . . . . . . . . . . . . . . . . . . 28tri-previfem . . . . . . . . . . . . . . . . . . . . . . 28tri-sprintec . . . . . . . . . . . . . . . . . . . . . . 28tri-vylibra . . . . . . . . . . . . . . . . . . . . . . . . 28tri-vylibra lo . . . . . . . . . . . . . . . . . . . . . . 28triamcinolone acetonide external aerosol solution . . . . . . . . . . . . . . . . . . 21triamcinolone acetonide external cream 0.025 %, 0.1 % . . . . . . . . . . . . . 21triamcinolone acetonide external cream 0.5 % . . . . . . . . . . . . . . . . . . . . . 21triamcinolone acetonide external lotion . . . . . . . . . . . . . . . . . . . . . . . . . . . 21triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 % . . . . . 21triamcinolone acetonide external ointment 0.05 % . . . . . . . . . . . . . . . . . . 21triamterene-hctz . . . . . . . . . . . . . . . . . 17trianex . . . . . . . . . . . . . . . . . . . . . . . . . . 21triazolam . . . . . . . . . . . . . . . . . . . . . . . . 15triderm external cream 0.1 % . . . . . . . 21triderm external cream 0.5 % . . . . . . . 21TRIDESILON . . . . . . . . . . . . . . . . . . . . 21trientine hcl. . . . . . . . . . . . . . . . . . . . . . 25TRIJARDY XR . . . . . . . . . . . . . . . . . . . 23TRILEPTAL . . . . . . . . . . . . . . . . . . . . . . 11TRINTELLIX . . . . . . . . . . . . . . . . . . . . . 12TRIUMEQ . . . . . . . . . . . . . . . . . . . . . . . 14TROKENDI XR . . . . . . . . . . . . . . . . . . . 11TRUE METRIX BLOOD GLUCOSE TEST . . . . . . . . . . . . . . . . . . . . . . . . . . . 22TRUETRACK TEST . . . . . . . . . . . . . . . 22TRULANCE . . . . . . . . . . . . . . . . . . . . . 25

48

TRULICITY . . . . . . . . . . . . . . . . . . . . . . 23TRUVADA . . . . . . . . . . . . . . . . . . . . . . . 14tulana . . . . . . . . . . . . . . . . . . . . . . . . . . 28TUSSICAPS . . . . . . . . . . . . . . . . . . . . . 33tydemy . . . . . . . . . . . . . . . . . . . . . . . . . 28TYLENOL WITH CODEINE #3 . . . . . . . 9TYMLOS . . . . . . . . . . . . . . . . . . . . . . . . 31TYVASO . . . . . . . . . . . . . . . . . . . . . . . . 34TYVASO REFILL . . . . . . . . . . . . . . . . . 34TYVASO STARTER . . . . . . . . . . . . . . . 34

U

UBRELVY . . . . . . . . . . . . . . . . . . . . . . . 13UCERIS ORAL . . . . . . . . . . . . . . . . . . . 31UCERIS RECTAL . . . . . . . . . . . . . . . . . 31ULTRAM . . . . . . . . . . . . . . . . . . . . . . . . . 9unithroid . . . . . . . . . . . . . . . . . . . . . . . . 30UROCIT-K 10 . . . . . . . . . . . . . . . . . . . . 24UROCIT-K 15 . . . . . . . . . . . . . . . . . . . . 24UROCIT-K 5 . . . . . . . . . . . . . . . . . . . . . 24URSO 250 . . . . . . . . . . . . . . . . . . . . . . 25URSO FORTE . . . . . . . . . . . . . . . . . . . 25ursodiol oral . . . . . . . . . . . . . . . . . . . . . 25

V

valacyclovir hcl oral . . . . . . . . . . . . . . . 14valsartan . . . . . . . . . . . . . . . . . . . . . . . . 17valsartan-hydrochlorothiazide . . . . . . 17VALTOCO . . . . . . . . . . . . . . . . . . . . . . . 11VANATOL LQ . . . . . . . . . . . . . . . . . . . . . 9VANATOL S . . . . . . . . . . . . . . . . . . . . . . 9vandazole . . . . . . . . . . . . . . . . . . . . . . . 10VARUBI (180 MG DOSE) . . . . . . . . . . . 12VASCEPA ORAL CAPSULE 0.5 GM . 17VASCEPA ORAL CAPSULE 1 GM . . . 17VELPHORO . . . . . . . . . . . . . . . . . . . . . 25VELTASSA . . . . . . . . . . . . . . . . . . . . . . 24VEMLIDY . . . . . . . . . . . . . . . . . . . . . . . 14venlafaxine hcl . . . . . . . . . . . . . . . . . . . 12venlafaxine hcl er oral capsule extended release 24 hour . . . . . . . . . . 12venlafaxine hcl er oral tablet extended release 24 hour . . . . . . . . . . 12Ventolin HFA. . . . . . . . . . . . . . . . . . 33, 34verapamil hcl er oral capsule extended release 24 hour 100 mg, 200 mg, 300 mg . . . . . . . . . . . . . . . . . 17verapamil hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 360 mg . . . . . . . . . . 17

verapamil hcl er oral tablet extended release . . . . . . . . . . . . . . . . . 17verapamil hcl oral . . . . . . . . . . . . . . . . 17VERDESO . . . . . . . . . . . . . . . . . . . . . . . 21VERELAN . . . . . . . . . . . . . . . . . . . . . . . 17VERELAN PM . . . . . . . . . . . . . . . . . . . 17VERZENIO . . . . . . . . . . . . . . . . . . . . . . 13VIBERZI . . . . . . . . . . . . . . . . . . . . . . . . 25VIBRAMYCIN ORAL CAPSULE . . . . . 10VIBRAMYCIN ORAL SUSPENSION RECONSTITUTED . . . . . . . . . . . . . . . . 10vicodin hp oral tablet 10-300 mg . . . . . 9VICTOZA SOLUTION PEN-INJECTOR 18 MG/3ML SUBCUTANEOUS (2 Pak) . . . . . . . . . . 23VICTOZA SOLUTION PEN-INJECTOR 18 MG/3ML SUBCUTANEOUS (3 Pak) . . . . . . . . . . 23vienva . . . . . . . . . . . . . . . . . . . . . . . . . . 28VIIBRYD . . . . . . . . . . . . . . . . . . . . . . . . 12VIIBRYD STARTER PACK . . . . . . . . . . 12VIMPAT ORAL . . . . . . . . . . . . . . . . . . . 11VIOKACE . . . . . . . . . . . . . . . . . . . . . . . 25viorele . . . . . . . . . . . . . . . . . . . . . . . . . . 28VIREAD ORAL POWDER . . . . . . . . . . 14VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG . . . . . . . . . . . . . . . . . 15VISTARIL . . . . . . . . . . . . . . . . . . . . . . . 15vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut) . . . . . . . . 24VITRAKVI . . . . . . . . . . . . . . . . . . . . . . . 13Vivelle-Dot . . . . . . . . . . . . . . . . . . . 26, 28VIVLODEX . . . . . . . . . . . . . . . . . . . . . . . 9VOLTAREN . . . . . . . . . . . . . . . . . . . . . . . 9VOSEVI . . . . . . . . . . . . . . . . . . . . . . . . . 15VRAYLAR . . . . . . . . . . . . . . . . . . . . . . . 14vyfemla . . . . . . . . . . . . . . . . . . . . . . . . . 28VYLEESI . . . . . . . . . . . . . . . . . . . . . . . . 24vylibra . . . . . . . . . . . . . . . . . . . . . . . . . . 28VYVANSE . . . . . . . . . . . . . . . . . . . . . . . 18VYZULTA . . . . . . . . . . . . . . . . . . . . . . . 32

W

WAKIX . . . . . . . . . . . . . . . . . . . . . . . . . . 34warfarin sodium oral . . . . . . . . . . . . . . 11WELCHOL . . . . . . . . . . . . . . . . . . . . . . 17wera . . . . . . . . . . . . . . . . . . . . . . . . . . . 28WESTHROID . . . . . . . . . . . . . . . . . . . . 30wixela inhub . . . . . . . . . . . . . . . . . . . . . 34WP THYROID . . . . . . . . . . . . . . . . . . . . 30

X

XARELTO . . . . . . . . . . . . . . . . . . . . . . . 11XARELTO STARTER PACK. . . . . . . . . 11XCOPRI. . . . . . . . . . . . . . . . . . . . . . . . . 11XELJANZ . . . . . . . . . . . . . . . . . . . . . . . 30XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 11 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 30XELPROS . . . . . . . . . . . . . . . . . . . . . . . 32XENLETA . . . . . . . . . . . . . . . . . . . . . . . 10XEPI . . . . . . . . . . . . . . . . . . . . . . . . . . . 10XHANCE . . . . . . . . . . . . . . . . . . . . . . . . 33XIFAXAN . . . . . . . . . . . . . . . . . . . . . . . . 10XIIDRA . . . . . . . . . . . . . . . . . . . . . . . . . 32XIMINO . . . . . . . . . . . . . . . . . . . . . . . . . 10XOFLUZA (40 MG DOSE) . . . . . . . . . . 15XOFLUZA (80 MG DOSE) . . . . . . . . . . 15XOLEGEL . . . . . . . . . . . . . . . . . . . . . . . 13XOPENEX HFA . . . . . . . . . . . . . . . . . . . 34XTAMPZA ER . . . . . . . . . . . . . . . . . . . . . 9xulane . . . . . . . . . . . . . . . . . . . . . . . . . . 28XYOSTED . . . . . . . . . . . . . . . . . . . . . . . 29XYREM . . . . . . . . . . . . . . . . . . . . . . . . . 34

Y

YASMIN 28 . . . . . . . . . . . . . . . . . . . . . . 28YAZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28YUPELRI . . . . . . . . . . . . . . . . . . . . . . . . 34yuvafem . . . . . . . . . . . . . . . . . . . . . . . . 28

Z

ZANAFLEX ORAL CAPSULE . . . . . . . 34zarah . . . . . . . . . . . . . . . . . . . . . . . . . . . 28ZARXIO . . . . . . . . . . . . . . . . . . . . . . . . 24ZEBUTAL . . . . . . . . . . . . . . . . . . . . . . . . 9ZEJULA . . . . . . . . . . . . . . . . . . . . . . . . 13ZELNORM . . . . . . . . . . . . . . . . . . . . . . 25ZEMBRACE SYMTOUCH . . . . . . . . . . 13zenatane . . . . . . . . . . . . . . . . . . . . . . . . 21ZENPEP . . . . . . . . . . . . . . . . . . . . . . . . 25ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG . . . . . 18ZEPATIER . . . . . . . . . . . . . . . . . . . . . . . 15ZEPOSIA . . . . . . . . . . . . . . . . . . . . . . . 18ZETONNA. . . . . . . . . . . . . . . . . . . . . . . 33ZIAC ORAL TABLET 10-6.25 MG, 2.5-6.25 MG . . . . . . . . . . . . . . . . . . . . . 17ZIAC ORAL TABLET 5-6.25 MG . . . . 17ZIEXTENZO . . . . . . . . . . . . . . . . . . . . . 24ZILXI . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

49

ziprasidone hcl. . . . . . . . . . . . . . . . . . . 14ZIPSOR . . . . . . . . . . . . . . . . . . . . . . . . . . 9ZITHROMAX ORAL . . . . . . . . . . . . . . . 10ZITHROMAX TRI-PAK . . . . . . . . . . . . . 10ZITHROMAX Z-PAK . . . . . . . . . . . . . . . 10ZOCOR ORAL TABLET 10 MG, 20 MG, 40 MG, 80 MG . . . . . . . . . . . . 17ZOFRAN . . . . . . . . . . . . . . . . . . . . . . . . 12ZOHYDRO ER . . . . . . . . . . . . . . . . . . . . 9zolpidem tartrate er . . . . . . . . . . . . . . . 34zolpidem tartrate oral . . . . . . . . . . . . . 34zolpidem tartrate sublingual . . . . . . . . 34ZOMACTON . . . . . . . . . . . . . . . . . . . . . 29ZONEGRAN . . . . . . . . . . . . . . . . . . . . . 11zonisamide oral . . . . . . . . . . . . . . . . . . 11ZONTIVITY . . . . . . . . . . . . . . . . . . . . . . 14ZOVIRAX ORAL SUSPENSION . . . . . 15ZTLIDO . . . . . . . . . . . . . . . . . . . . . . . . . . 9ZUBSOLV . . . . . . . . . . . . . . . . . . . . . . . . 9zumandimine . . . . . . . . . . . . . . . . . . . . 28ZUPLENZ . . . . . . . . . . . . . . . . . . . . . . . 12ZYCLARA . . . . . . . . . . . . . . . . . . . . . . . 21ZYCLARA PUMP . . . . . . . . . . . . . . . . . 21ZYLOPRIM . . . . . . . . . . . . . . . . . . . . . . 13

50

Nondiscrimination notice and access to communication services UnitedHealthcare® and its subsidiaries do not discriminate on the basis of race, color, national origin, age, disability or sex in their health programs or activities.

If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator.

Online: [email protected]

Mail: Civil Rights Coordinator UnitedHealthcare Civil Rights Grievance P.O. Box 30608 Salt Lake City, UT 84130

You must send the complaint within 60 days of your experience. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll-free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m., or at the times listed in your health plan documents.

You can also file a complaint with the U.S. Dept. of Health and Human Services.

Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

Phone: Toll-free 1-800-368-1019, 800-537-7697 (TDD)

Mail: U.S. Dept. of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, D.C. 20201

We provide free services to help you communicate with us, including letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll-free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m., or at the times listed in your health plan documents.

51

Multi-language interpreter servicesMulti-language interpreter services

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Please call the toll-free phone number listed on your identification card.

ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al número de teléfono gratuito que aparece en su tarjeta de identificación.

請注意：如果您說中文 (Chinese)，我們免費為您提供語言協助服務。請撥打會員卡所列的免付費會員電話號碼。

XIN LƯU Ý: Nếu quý vị nói tiếng Việt (Vietnamese), quý vị sẽ được cung cấp dịch vụ trợ giúp về ngôn ngữ miễn phí. Vui lòng gọi số điện thoại miễn phí ở mặt sau thẻ hội viên của quý vị.

알림: 한국어(Korean)를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다. 귀하의 신분증 카드에 기재된 무료 회원 전화번호로 문의하십시오.

PAALALA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Pakitawagan ang toll-free na numero ng telepono na nasa iyong identification card.

ВНИМАНИЕ: бесплатные услуги перевода доступны для людей, чей родной язык является русском (Russian). Позвоните по бесплатному номеру телефона, указанному на вашей идентификационной карте.

تنبيه: إذا كنت تتحدث العربية (Arabic)، فإن خدمات المساعدة اللغوية المجانية متاحة لك. الرجاء الاتصال على رقم الهاتف المجاني الموجود على معرّف العضوية.

ATANSYON: Si w pale Kreyòl ayisyen (Haitian Creole), ou kapab benefisye sèvis ki gratis pou ede w nan lang pa w. Tanpri rele nimewo gratis ki sou kat idantifikasyon w.

ATTENTION : Si vous parlez français (French), des services d’aide linguistique vous sont proposés gratuitement. Veuillez appeler le numéro de téléphone gratuit figurant sur votre carte d’identification.

UWAGA: Jeżeli mówisz po polsku (Polish), udostępniliśmy darmowe usługi tłumacza. Prosimy zadzwonić pod bezpłatny numer telefonu podany na karcie identyfikacyjnej.

ATENÇÃO: Se você fala português (Portuguese), contate o serviço de assistência de idiomas gratuito. Ligue gratuitamente para o número encontrado no seu cartão de identificação.

ATTENZIONE: in caso la lingua parlata sia l’italiano (Italian), sono disponibili servizi di assistenza linguistica gratuiti. Per favore chiamate il numero di telefono verde indicato sulla vostra tessera identificativa.

ACHTUNG: Falls Sie Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Bitte rufen Sie die gebührenfreie Rufnummer auf der Rückseite Ihres Mitgliedsausweises an.

注意事項：日本語(Japanese)を話される場合、無料の言語支援サービスをご利用いただけます。健康保険証に記載されているフリーダイヤルにお電話ください。

توجه: اگر زبان شما فارسی (Farsi) است، خدمات امداد زبانی به طور رايگان در اختيار شما می باشد. لطفا با شماره تلفن رايگانی که روی کارت شناسايی شما قيد شده تماس بگيريد.

ध्यान दें: यदि आप हिंदी (Hindi) बोलते है, आपको भाषा सहायता सेबाए,ं नि:शुल्क उपलब्ध हैं। कृपया अपने पहचान पत्र पर सूचीबद्ध टोल-फ्री फोन नंबर पर कॉल करें।CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu deb dawb uas teev muaj nyob rau ntawm koj daim yuaj cim qhia tus kheej.

ចំណាប់អារម្មណ៍ៈ បើសិនអ្នកនិយាយភាសាខ្មែរ(Khmer)សេវាជំនួយភាសាដោយឥតគិតថ្លៃ គឺមានសំរាប់អ្នក។ សូមទូរស័ព្ទទៅលេខឥតគិតថ្លៃ ដែលមាននៅលើអត្ដសញ្ញាណប័ណ្ណរបស់អ្នក។PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti toll-free a numero ti telepono nga nakalista ayan iti identification card mo.

DÍÍ BAA’ÁKONÍNÍZIN: Diné (Navajo) bizaad bee yániłti’go, saad bee áka›anída›awo›ígíí, t’áá jíík’eh, bee ná’ahóót’i’. T’áá shǫǫdí ninaaltsoos nitł’izí bee nééhozinígíí bine’dę́ę́› t’áá jíík’ehgo béésh bee hane’í biká’ígíí bee hodíilnih.

OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wac lambarka telefonka khadka bilaashka ee ku yaalla kaarkaaga aqoonsiga.

This document applies to members of UnitedHealthcare and UnitedHealthOne plans.

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates and Stop-loss insurance is underwritten by All Savers Insurance Company (except CA, MA, MN, NJ and NY), UnitedHealthcare Insurance Company in MA and MN, UnitedHealthcare Life Insurance Company in NJ, UnitedHealthcare Insurance Company of New York in NY, and All Savers Life Insurance Company of California in CA. Administrative services provided by UnitedHealthcare Insurance Company, UnitedHealthcare Services, Inc., Oxford Health Plans LLC or their affiliates, and UnitedHealthcare Service LLC in NY. Health Plan coverage provided by or through a UnitedHealthcare company. OptumRx is an affiliate of UnitedHealthcare Insurance Company. UnitedHealthOne plans provided by or through Oxford Health Plans (NJ), Inc.

UnitedHealthcare® is a registered trademark owned by UnitedHealth Group Incorporated. All other trademarks are the property of their respective owners.

12/20 ©2021 United HealthCare Services, Inc. WF3888362-B 2021 Prescription Drug List — Advantage 4-Tier

your 2021 prescription drug list

Documents