2020 City PPO Full Formulary - EmblemHealth€¦ · PPO Preferred Plan Full Rx Formulary ii...

PPO Preferred Plan Full Rx Formulary2020 Formulary (List of Covered Drugs)

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

This formulary was updated on 10/01/2020. To reach member services, please call 212-501-4444 (TTY: 711). Our hours are Monday to Friday 8 am to 6 pm. Our agents will be happy to help.

EmblemHealth insurance plans are underwritten by Group Health Incorporated (GHI), HIP Health Plan of New York (HIP) and HIP Insurance Company of New York.

i

PPO Preferred Plan Full Rx Formulary2020 Comprehensive Formulary(List of Covered Drugs)

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

Thank you for being an EmblemHealth member. This guide tells you about the list of covered drugs in your plan. This list is called a formulary. It is up to date as of 10/01/2020. Please note: this list may change over time, such as when:

• We add a new, less costly drug.• We remove a drug that may no longer be as effective as other drugs.

Which drugs are included in the formulary?Our list of covered drugs includes both brand-name drugs and generic drugs. The brand name is the name the drug company gave the drug. For example, the brand name of acetaminophen is Tylenol. Generic drugs are the low-cost version of the brand-name drug.

How do I get the drugs listed in the formulary?We generally cover the drugs listed as long as that drug is “medically necessary.” Being “medically necessary” means that you have to take the drug to stay healthy. Your maintenance drugs must be filled at either Duane Reade/Walgreens, or by mail through our home delivery partner, Express-Scripts. Maintenance drugs are medicines you take regularly, for example if you have a chronic condition like high cholesterol or high blood pressure.

What if I don’t see the drug I need?

If your doctor orders you a drug that is not listed in this formulary, please call

PPO Preferred Plan Full Rx Formulary

ii

212-501-4444 (TTY: 711). We can review your doctor’s request and decide if we will cover your drug. Our hours are Monday to Friday 8 am to 6 pm. Our agents will be happy to help.

How do I use the formulary?This formulary lists drugs from A to Z.

• Generic drugs are italicized and spelled out in lowercase letters.• Brand-name drugs are not italicized and spelled out in all caps, or uppercase letters.

This formulary will also tell you which tier your drug belongs in. The chart below shows you what each tier means.

Tier Explanation ACA $0 cost-share preventive drugs

(there may be some limits on these drugs; see below)Tier 1 GenericTier 2 Preferred brandTier 3 Non-preferred brand

What are generic drugs?Generic drugs are the low-cost version of a brand-name drug. Generally, a pharmacist will fill the generic type of the drug your doctor ordered if it is available. This may happen even if your prescription is written for a brand-name drug.

If you want the brand-name drug, be sure your doctor tells the pharmacist to give you the brand-name drug. When this happens, you may have to pay the copay, or the set amount you pay, for the generic drug, plus the cost difference between the brand name drug and the generic one.

Are there any limitations on my coverage?A medicine listed in this guide does not mean we will pay for it. For example, some drugs may need prior authorization, or approval, for us to pay for them. In other cases, we may only pay for certain amounts or strengths. These drugs will have initials after their names.

Below is a list of abbreviations that explains what the initials mean.

PPO Preferred Plan Full Rx Formulary

iii

List of abbreviationsBelow is a list of abbreviations that may appear on the following pages in the Requirements/Limits column. They tell you if there are any special requirements for coverage of your drug.

Brand: Brand Drug

Generic: Generic Drug

PA: Prior Authorization. The plan requires you or your doctor to get approval before you fill your prescription. If you don’t get approval, we may not cover the drug.

QL: Quantity Limit. For certain drugs, the plan limits the amount of the drug that we will cover.

ST: Step Therapy. In some cases, the plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

ACA: There is no cost-sharing if this is the right drug for your age, condition and the way the drug is being used.

LA: Limited Availability. You may only be able to get this drug at some drug stores.

Can I get my drugs by mail order?Our pharmacy partner, Express Scripts, can help you get drugs sent to your home. Mail order may save you money if you refill the same drugs each month and think you will be on the same drug(s) for six months or longer. To learn more, visit emblemhealth.com/pharmacy.

To reach member services:

• Please call 212-501-4444 (TTY: 711). Our hours are Monday to Friday 8 am to 6 pm.Our agents will be happy to help.

(Continued)Group Health Incorporated (GHI), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies.

ATTENTION: Language assistance services, free of charge, are available to you. Call 1-877-411-3625 (TTY/TDD: 711). Español (Spanish) ATENCIÓN: Usted tiene a su disposición, gratis, servicios de ayuda para idiomas. Llame al 1-877-411-3625 (TTY/TDD: 711).

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(TTY/TDD: 711).

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(Arabic) العربية . (TTY/TDD: 711)أو 3625-411-877-1 الرقمعلى اتصل ،رجى االنتباه: تتوفر لك خدمات المساعدة اللغوية مجانا ي

Français (French) ATTENTION : une assistance d’interprétation gratuite est à votre disposition. Veuillez composer le 1-877-411-3625 (TTY/TDD : 711).

10-9127 6/18

(Urdu)اردو بان لیے کے آپ دیں: وجہ یں۔ کال پر (TTY/TDD: 711) 1-877- 411-3625 ہیں۔ دستیاب مفت ،خدمات کی اعانت متعلق سے ز کر

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Shqip (Albanian) VINI RE: Shërbime ndihmore për gjuhën, falas, janë në dispozicionin tuaj. Telefononi në 1-877-411-3625 (TTY/TDD: 711).

NOTICE OF NONDISCRIMINATION POLICY EmblemHealth complies with Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. EmblemHealth does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

EmblemHealth: Provides free aids and services to people with disabilities to

help– Qualified sign language interpreters– Written information in other formats (large print, audio,

accessible electronic formats, other formats) Provides free language services to people whose first

language is not English, such as:– Qualified interpreters– Information written in other languages

If you need these services, please call member services at 1-877-411-3625 (TTY/TDD: 711).If you believe that EmblemHealth has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with EmblemHealth Grievance and Appeals Department, PO Box 2844, New York, NY 10116, or call member services at 1-877-411-3625. (Dial 711 for TTY/TDD services.) You can file a grievance in person, by mail or by phone. If you need help filing a grievance, EmblemHealth’s Grievance and Appeals Department is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office of Civil Rights electronically through the Office of Civil Rights Complaint Portal, available at ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201; 1-800-368-1019, (dial 1-800-537-7697 for TTY services).

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

Table of Contents

ANTI - INFECTIVES........................................................................................................................................3

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS.....................................................................12

AUTONOMIC & CNS DRUGS, NEUROLOGY & PSYCH.......................................................................13

CARDIOVASCULAR, HYPERTENSION & LIPIDS.................................................................................32

DERMATOLOGICALS/TOPICAL THERAPY..........................................................................................41

DIAGNOSTICS & MISCELLANEOUS AGENTS......................................................................................53

EAR, NOSE & THROAT MEDICATIONS..................................................................................................55

ENDOCRINE/DIABETES..............................................................................................................................57

GASTROENTEROLOGY..............................................................................................................................65

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY..............................................................................72

MUSCULOSKELETAL & RHEUMATOLOGY.........................................................................................75

OBSTETRICS & GYNECOLOGY................................................................................................................76

OPHTHALMOLOGY.....................................................................................................................................85

RESPIRATORY, ALLERGY, COUGH & COLD.......................................................................................91

UROLOGICALS..............................................................................................................................................96

VITAMINS, HEMATINICS & ELECTROLYTES.....................................................................................98

Index................................................................................................................................................................105

List of Abbreviations

ACA: Affordable Care Act.

LA: Limited Availability. This prescription may be available only at certain pharmacies. For more information, please call Customer Service.

OTC: Over the Counter. An OTC drug is a non-prescription drug.

PA: Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval before you fill your prescriptions. If you don’t get approval, we may not cover the drug.

QL: Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.

ST: Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

2

Drug Name Tier Requirements / limits

ANTI - INFECTIVES

ANTIFUNGAL AGENTS

ANCOBON 3

clotrimazole mucous membrane 1

CRESEMBA ORAL 2 PA

DIFLUCAN ORAL SUSPENSION FOR RECONSTITUTION

3

DIFLUCAN ORAL TABLET 100 MG, 200 MG, 50 MG

3

DIFLUCAN ORAL TABLET 150 MG 3 QL

fluconazole oral suspension for reconstitution 1

fluconazole oral tablet 100 mg, 200 mg, 50 mg 1

fluconazole oral tablet 150 mg 1 QL

flucytosine 1

griseofulvin microsize 1

griseofulvin ultramicrosize 1

itraconazole oral capsule 1 QL

itraconazole oral solution 1

ketoconazole oral 1

NOXAFIL ORAL SUSPENSION 2 PA

nystatin oral suspension 1

nystatin oral tablet 1

ORAVIG 3

posaconazole oral tablet,delayed release (dr/ec) 1 PA

SPORANOX ORAL SOLUTION 3

SPORANOX PULSEPAK 3 QL

terbinafine hcl oral 1

VFEND 3 PA

voriconazole oral 1 PA

ANTIVIRALS

abacavir 1

abacavir-lamivudine 1

abacavir-lamivudine-zidovudine 1

You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table.

3


acyclovir oral capsule 1

acyclovir oral suspension 200 mg/5 ml 1

acyclovir oral tablet 1

adefovir 1

amantadine hcl 1

APTIVUS 2

APTIVUS (WITH VITAMIN E) 2

atazanavir 1

BARACLUDE ORAL SOLUTION 2

BIKTARVY 2

CIMDUO 2

COMBIVIR 3

CRIXIVAN ORAL CAPSULE 200 MG, 400 MG 2

DESCOVY 2

didanosine oral capsule,delayed release(dr/ec) 250 mg, 400 mg

1

DOVATO 2

EDURANT 2

efavirenz 1

EMTRIVA 2

entecavir 1

EPCLUSA 2 PA; LA; QL

EPIVIR 3

EPIVIR HBV ORAL SOLUTION 2

EPIVIR HBV ORAL TABLET 3

EPZICOM 3

EVOTAZ 3

famciclovir 1 QL

FLUMADINE ORAL TABLET 3

fosamprenavir 1

GENVOYA 2

HARVONI 2 PA; LA; QL

HEPSERA 3


4


INTELENCE 2

INVIRASE ORAL TABLET 2

ISENTRESS 2

ISENTRESS HD 2

JULUCA 2

KALETRA ORAL SOLUTION 3 QL

KALETRA ORAL TABLET 2 QL

lamivudine 1

lamivudine-zidovudine 1

LEXIVA ORAL SUSPENSION 2

LEXIVA ORAL TABLET 3

lopinavir-ritonavir 1 QL

nevirapine 1

NORVIR ORAL POWDER IN PACKET 2

NORVIR ORAL SOLUTION 2

NORVIR ORAL TABLET 3

ODEFSEY 2

oseltamivir 1 QL

PREVYMIS ORAL 2 QL

PREZISTA ORAL SUSPENSION 2

PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG

2

RELENZA DISKHALER 3 QL

RETROVIR ORAL CAPSULE 3

RETROVIR ORAL SYRUP 3

REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG

3

REYATAZ ORAL POWDER IN PACKET 2

ribavirin inhalation 1

rimantadine 1

ritonavir 1

SELZENTRY 2

stavudine oral capsule 1


5


SUSTIVA 3

SYMFI 2

SYMFI LO 2

SYMTUZA 2

TAMIFLU 3 QL

TEMIXYS 2

tenofovir disoproxil fumarate 1

TIVICAY 2

TIVICAY PD 2

TRIUMEQ 2

TRIZIVIR 3

TRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG

2

TRUVADA ORAL TABLET 200-300 MG 2 PA

TYBOST 3

valacyclovir 1 QL

VALCYTE 3

valganciclovir 1

VEMLIDY 2

VIEKIRA PAK 3 PA; LA; QL

VIRACEPT ORAL TABLET 2

VIRAMUNE 3

VIRAMUNE XR ORAL TABLET EXTENDED RELEASE 24 HR 400 MG

3

VIREAD ORAL POWDER 2

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG

2

VIREAD ORAL TABLET 300 MG 3

VOSEVI 2 PA; LA; QL

XOFLUZA 3 QL

ZEPATIER 2 PA; LA; QL

ZIAGEN 3

zidovudine 1

ZOVIRAX ORAL SUSPENSION 3


6


CEPHALOSPORINS

cefaclor oral capsule 1

cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml

1

cefaclor oral tablet extended release 12 hr 1

cefadroxil oral capsule 1

cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml

1

cefadroxil oral tablet 1

cefdinir 1

cefditoren pivoxil 1

cefixime 1

cefpodoxime 1

cefprozil 1

cefuroxime axetil oral tablet 1

cephalexin 1

KEFLEX ORAL CAPSULE 3

SPECTRACEF ORAL TABLET 400 MG 3

SUPRAX ORAL CAPSULE 3

SUPRAX ORAL SUSPENSION FOR RECONSTITUTION

3

SUPRAX ORAL TABLET,CHEWABLE 3

ERYTHROMYCINS & OTHER MACROLIDES

azithromycin oral 1 QL

clarithromycin 1

DIFICID 3 QL

e.e.s. 400 oral tablet 1

E.E.S. GRANULES 3

ERYPED 200 3

ERYPED 400 3

ery-tab oral tablet,delayed release (dr/ec) 250 mg, 333 mg

1

ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 500 MG

3


7


erythrocin (as stearate) oral tablet 250 mg 1

erythromycin ethylsuccinate oral suspension for reconstitution

1

erythromycin ethylsuccinate oral tablet 1

erythromycin oral 1

ZITHROMAX ORAL PACKET 3 QL

ZITHROMAX ORAL SUSPENSION FOR RECONSTITUTION

3 QL

ZITHROMAX ORAL TABLET 250 MG, 500 MG

3 QL

ZITHROMAX TRI-PAK 3 QL

ZITHROMAX Z-PAK 3 QL

MISCELLANEOUS ANTIINFECTIVES

AEMCOLO 3 QL

albendazole 1 QL

ALBENZA 3 QL

ALINIA 2 QL

ARAKODA 3 QL

ARIKAYCE 2 PA; LA

atovaquone 1

atovaquone-proguanil 1 QL

BENZNIDAZOLE 2 QL

BETHKIS 2 PA; LA; QL

BILTRICIDE 3

CAYSTON 2 LA; QL

chloroquine phosphate 1 QL

CLEOCIN HCL 3

CLEOCIN PEDIATRIC 3

clindamycin hcl 1

clindamycin palmitate hcl 1

clindamycin pediatric 1

COARTEM 2 QL

CYCLOSERINE 3

dapsone oral 1


8


DARAPRIM 3 PA

EMVERM 2 QL

ethambutol 1

FLAGYL 3

hydroxychloroquine 1 QL

IMPAVIDO 2 QL

isoniazid oral 1

ivermectin oral 1 QL

KITABIS PAK 2 PA; LA; QL

KRINTAFEL 3 QL

linezolid 1 PA

MALARONE 3 QL

MALARONE PEDIATRIC 3 QL

mefloquine 1 QL

MEPRON 3

metronidazole oral 1

MYAMBUTOL ORAL TABLET 400 MG 3

MYCOBUTIN 3

NEBUPENT 3 QL

neomycin 1

paromomycin 1

PASER 3

pentamidine inhalation 1 QL

praziquantel 1

PRETOMANID 3 PA

PRIFTIN 2

primaquine 1 QL

pyrazinamide 1

pyrimethamine 1 PA

QUALAQUIN 3 QL

quinine sulfate 1 QL

rifabutin 1

RIFADIN ORAL 3


9


RIFAMATE 3

rifampin oral 1

RIFATER 3

SIRTURO 2 PA; LA

SIVEXTRO ORAL 3 PA

SOLOSEC 2 QL

STROMECTOL 3 QL

tinidazole 1 QL

TOBI PODHALER INHALATION CAPSULE, W/INHALATION DEVICE

2 PA; LA; QL

tobramycin in 0.225 % nacl 1 PA; LA; QL

TOBRAMYCIN WITH NEBULIZER 3 PA; LA; QL

TRECATOR 3

XENLETA ORAL 3

XIFAXAN 2 QL

ZYVOX ORAL 3 PA

PENICILLINS

amoxicillin oral capsule 1

amoxicillin oral suspension for reconstitution 1

amoxicillin oral tablet 1

amoxicillin oral tablet,chewable 125 mg, 250 mg 1

amoxicillin-pot clavulanate 1

ampicillin oral capsule 500 mg 1

AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 125-31.25 MG/5 ML

2

AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 250-62.5 MG/5 ML

3

AUGMENTIN XR 3

dicloxacillin 1

MOXATAG 3

penicillin v potassium 1

QUINOLONES

BAXDELA ORAL 2 QL


10


CIPRO ORAL SUSPENSION,MICROCAPSULE RECON

3

CIPRO ORAL TABLET 250 MG, 500 MG 3

ciprofloxacin 1

ciprofloxacin hcl oral 1

FACTIVE 3

levofloxacin oral 1

moxifloxacin oral 1

ofloxacin oral tablet 300 mg, 400 mg 1

SULFA'S & RELATED AGENTS

BACTRIM 3

BACTRIM DS 3

sulfadiazine 1

sulfamethoxazole-trimethoprim 1

sulfatrim 1

TETRACYCLINES

ACTICLATE 3 ST

avidoxy 1

AVIDOXY DK 3 ST

coremino 1

demeclocycline 1

DORYX MPC 3 ST

DORYX ORAL TABLET,DELAYED RELEASE (DR/EC) 200 MG, 50 MG

3 ST

doxycycline hyclate oral capsule 1

doxycycline hyclate oral tablet 1

doxycycline hyclate oral tablet,delayed release (dr/ec) 100 mg, 150 mg, 200 mg, 50 mg, 75 mg

1

doxycycline monohydrate oral capsule 1

doxycycline monohydrate oral suspension for reconstitution

1

doxycycline monohydrate oral tablet 1

minocycline oral capsule 1

minocycline oral tablet 1


11


minocycline oral tablet extended release 24 hr 1 ST

MINOLIRA ER 3 ST

mondoxyne nl oral capsule 100 mg, 75 mg 1

MONODOX 3 ST

MORGIDOX 1X 50 3 ST

MORGIDOX 2X100 3 ST

morgidox oral capsule 100 mg 1

ORACEA 2 ST

SEYSARA 3 ST

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HR 105 MG, 115 MG, 55 MG, 65 MG, 80 MG

3 ST

TARGADOX 3 ST

tetracycline 1

VIBRAMYCIN ORAL CAPSULE 100 MG 3 ST

VIBRAMYCIN ORAL SUSPENSION FOR RECONSTITUTION

3

VIBRAMYCIN ORAL SYRUP 3

URINARY TRACT AGENTS

FURADANTIN 3

HIPREX 3

MACROBID 3

MACRODANTIN 3

methenamine hippurate 1

methenamine mandelate 1

MONUROL 3

nitrofurantoin 1

nitrofurantoin macrocrystal 1

nitrofurantoin monohyd/m-cryst 1

PRIMSOL 3

trimethoprim 1

VANCOMYCIN

FIRVANQ 3 QL

VANCOCIN 3 QL


12


vancomycin oral capsule 1 QL

vancomycin oral recon soln 1 QL

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS

ASTAGRAF XL 3 PA

AZASAN 3

azathioprine 1

CELLCEPT 3

cyclosporine modified 1

cyclosporine oral capsule 1

ENVARSUS XR 3 PA

everolimus (immunosuppressive) 1

gengraf oral capsule 100 mg, 25 mg 1

gengraf oral solution 1

GLIADEL WAFER 3

IMURAN 3

megestrol oral suspension 625 mg/5 ml (125 mg/ml)

1

mycophenolate mofetil 1

mycophenolate sodium 1

MYFORTIC 3

NEORAL 3

PROGRAF ORAL CAPSULE 3

PROGRAF ORAL GRANULES IN PACKET 2

RAPAMUNE 3

SANDIMMUNE ORAL CAPSULE 3

SANDIMMUNE ORAL SOLUTION 2

SANDOSTATIN INJECTION SOLUTION 100 MCG/ML, 50 MCG/ML, 500 MCG/ML

3 LA

SIGNIFOR 2 PA; LA

sirolimus 1

tacrolimus oral 1

UNITUXIN 2


13


ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG

3

ZORTRESS ORAL TABLET 1 MG 2

AUTONOMIC & CNS DRUGS, NEUROLOGY & PSYCH

ANTICONVULSANTS

APTIOM 3

BANZEL 2 PA

BRIVIACT ORAL 3 ST

carbamazepine oral capsule, er multiphase 12 hr 1

carbamazepine oral suspension 100 mg/5 ml 1

carbamazepine oral tablet 1

carbamazepine oral tablet extended release 12 hr 1

carbamazepine oral tablet,chewable 1

CARBATROL 3

CELONTIN ORAL CAPSULE 300 MG 2

clobazam 1 PA

clonazepam 1

DEPAKOTE 3 ST

DEPAKOTE ER 3 ST

DEPAKOTE SPRINKLES 3 ST

DIACOMIT 2 PA

DIASTAT 3

DIASTAT ACUDIAL 3

diazepam rectal 1

DILANTIN 2

DILANTIN EXTENDED 3

DILANTIN INFATABS 3

DILANTIN-125 3

divalproex 1

EPIDIOLEX 2 PA; LA

epitol 1

EQUETRO 3

ethosuximide 1


14


felbamate 1

FELBATOL 3

FYCOMPA ORAL SUSPENSION 2

FYCOMPA ORAL TABLET 2

gabapentin oral capsule 1

gabapentin oral solution 250 mg/5 ml 1

gabapentin oral tablet 600 mg, 800 mg 1

GABITRIL 3

GRALISE 3 ST

KLONOPIN 3

LAMICTAL XR STARTER ORAL TABLET EXTENDED REL,DOSE PACK 25 MG (21) -50 MG (7), 25MG (14)-50 MG (14)-100MG (7), 50 MG(14)-100MG (14)-200 MG (7)

3 ST

lamotrigine 1

levetiracetam oral 1

MYSOLINE 3

NAYZILAM 2 PA; QL

ONFI ORAL SUSPENSION 3 PA

ONFI ORAL TABLET 10 MG, 20 MG 3 PA

oxcarbazepine 1

OXTELLAR XR 3 ST

PEGANONE 2

phenobarbital 1

PHENYTEK 3

phenytoin oral suspension 125 mg/5 ml 1

phenytoin oral tablet,chewable 1

phenytoin sodium extended 1

pregabalin 1

primidone 1

QUDEXY XR 2 ST

roweepra 1

SABRIL 3 PA; LA

SPRITAM 3 ST


15


subvenite 1

subvenite starter (blue) kit 1

subvenite starter (green) kit 1

subvenite starter (orange) kit 1

SYMPAZAN 3 PA

TEGRETOL ORAL SUSPENSION 3

TEGRETOL ORAL TABLET 3

TEGRETOL XR 3

tiagabine 1

topiramate oral capsule, sprinkle 1

topiramate oral tablet 1

TROKENDI XR 3 ST

valproic acid 1

valproic acid (as sodium salt) oral solution 250 mg/5 ml

1

VALTOCO 3 QL

vigabatrin 1 PA; LA

vigadrone 1 PA

VIMPAT ORAL SOLUTION 2

VIMPAT ORAL TABLET 2

XCOPRI 3 QL

XCOPRI MAINTENANCE PACK 3 QL

XCOPRI TITRATION PACK 3 QL

ZARONTIN 3

zonisamide 1

ANTIPARKINSONISM AGENTS

APOKYN 2 LA

AZILECT 3 ST

benztropine oral 1

bromocriptine 1

carbidopa 1

carbidopa-levodopa 1

carbidopa-levodopa-entacapone 1


16


COMTAN 3

DUOPA 3 LA

entacapone 1

INBRIJA INHALATION CAPSULE, W/INHALATION DEVICE

2 PA; LA

LODOSYN 3

MIRAPEX ER 3

NEUPRO 3

NOURIANZ 3 PA; LA; QL

OSMOLEX ER 3 PA; QL

PARLODEL 3

pramipexole 1

rasagiline 1

REQUIP XL ORAL TABLET EXTENDED RELEASE 24 HR 12 MG, 6 MG

3

ropinirole 1

RYTARY 3

selegiline hcl 1

SINEMET 3

STALEVO 100 3

STALEVO 125 3

STALEVO 150 3

STALEVO 200 3

STALEVO 50 3

STALEVO 75 3

TASMAR ORAL TABLET 100 MG 3

tolcapone 1

trihexyphenidyl 1

MIGRAINE & CLUSTER HEADACHE THERAPY

almotriptan malate 1 QL

AMERGE 3 QL

CAFERGOT 3

dihydroergotamine nasal 1 QL


17


eletriptan 1 QL

ERGOMAR 3

ergotamine-caffeine 1

FROVA 3 QL

frovatriptan 1 QL

migergot 1

MIGRANAL 3 QL

naratriptan 1 QL

NURTEC ODT 3 PA; QL

ONZETRA XSAIL 3 QL

RELPAX 3 QL

REYVOW 3 PA; QL

rizatriptan 1 QL

sumatriptan 1 QL

sumatriptan succinate oral 1 QL

sumatriptan-naproxen 1 QL

TOSYMRA 3 QL

UBRELVY 3 PA; QL

zolmitriptan 1 QL

ZOMIG NASAL 2 QL

MISCELLANEOUS NEUROLOGICAL THERAPY

ARICEPT 3 ST

AUSTEDO 2 PA; LA; QL

dalfampridine 1 PA; LA

donepezil oral tablet 10 mg, 5 mg 1

donepezil oral tablet 23 mg 1 ST

donepezil oral tablet,disintegrating 1

EVRYSDI 3 PA; LA

EXELON TRANSDERMAL 3 ST

FIRDAPSE 3 PA; LA

galantamine 1

HORIZANT 3 ST

KEVEYIS 3 PA


18


memantine oral capsule,sprinkle,er 24hr 1

memantine oral solution 1

memantine oral tablet 1

MEMANTINE ORAL TABLETS,DOSE PACK 3

NAMENDA ORAL TABLET 3 ST

NAMENDA TITRATION PAK 3

NAMENDA XR ORAL CAP,SPRINKLE,ER 24HR DOSE PACK

3

NAMZARIC 2 ST

NUEDEXTA 2 PA

RAZADYNE ER 3 ST

RAZADYNE ORAL TABLET 4 MG 3 ST

rivastigmine 1

rivastigmine tartrate 1

RUZURGI 2 PA

tetrabenazine 1 PA; LA; QL

MUSCLE RELAXANTS & ANTISPASMODIC THERAPY

baclofen oral tablet 10 mg, 20 mg 1

BACLOFEN ORAL TABLET 5 MG 3

carisoprodol 1

carisoprodol-aspirin 1

carisoprodol-aspirin-codeine 1

chlorzoxazone 1

cyclobenzaprine 1

DANTRIUM ORAL CAPSULE 25 MG, 50 MG 3

dantrolene oral 1

FEXMID 3 PA

LORZONE 3 PA

meprobamate 1

MESTINON ORAL 3

MESTINON TIMESPAN 3

metaxall 1

metaxalone 1


19


methocarbamol oral 1

NORGESIC FORTE 3

orphenadrine citrate oral 1

orphenadrine-asa-caffeine oral tablet 50-770-60 mg

1

orphengesic forte 1

pyridostigmine bromide oral syrup 1

PYRIDOSTIGMINE BROMIDE ORAL TABLET 30 MG

3

pyridostigmine bromide oral tablet 60 mg 1

pyridostigmine bromide oral tablet extended release

1

ROBAXIN-750 3

SKELAXIN 3

SOMA 3

tizanidine 1

vanadom 1

ZANAFLEX 3

NARCOTIC ANALGESICS

acetaminophen-caff-dihydrocod oral capsule 1

acetaminophen-codeine oral solution 120-12 mg/5 ml

1

acetaminophen-codeine oral tablet 1

ACTIQ 3 PA; QL

ALLZITAL 3 PA

ARYMO ER 3 PA; QL

ascomp with codeine 1

BELBUCA 2 PA; QL

buprenorphine 1 PA

buprenorphine hcl sublingual 1

butalbital compound w/codeine 1

butalbital-acetaminop-caf-cod 1

butalbital-acetaminophen 1

butalbital-acetaminophen-caff oral capsule 1


20


butalbital-acetaminophen-caff oral tablet 50-325-40 mg

1

butalbital-aspirin-caffeine 1

codeine sulfate oral tablet 1

codeine-butalbital-asa-caff 1

DILAUDID 3

diskets 1 PA

DOLOPHINE ORAL 3 PA

DURAGESIC 3 PA; QL

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

1

ESGIC 3 PA

fentanyl 1 PA; QL

fentanyl citrate buccal lozenge on a handle 1 PA; QL

FIORICET ORAL CAPSULE 3 PA

FIORICET WITH CODEINE ORAL CAPSULE 50-300-40-30 MG

3

FIORINAL 3 PA

FIORINAL-CODEINE #3 3

hydrocodone bitartrate 1 PA; QL

hydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml), 7.5-325 mg/15 ml

1

hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg

1

hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg

1

hydromorphone oral liquid 1

hydromorphone oral tablet 1

hydromorphone oral tablet extended release 24 hr 1 PA; QL

hydromorphone rectal 1

HYSINGLA ER 2 PA; QL

ibuprofen-oxycodone 1

KADIAN ORAL CAPSULE,EXTEND.RELEASE PELLETS 10 MG, 100 MG, 20 MG, 200 MG, 30 MG, 40 MG, 50 MG, 60 MG, 80 MG

3 PA; QL


21


levorphanol tartrate oral tablet 2 mg 1

LEVORPHANOL TARTRATE ORAL TABLET 3 MG

3

lorcet (hydrocodone) 1

lorcet hd 1

LORTAB ELIXIR ORAL SOLUTION 10-300 MG/15 ML

3

meperidine oral 1

methadone oral concentrate 1 PA

methadone oral solution 1 PA

methadone oral tablet 1 PA

methadone oral tablet,soluble 1 PA

methadose oral concentrate 1 PA

methadose oral tablet,soluble 1 PA

morphine concentrate oral solution 1

MORPHINE INTRAMUSCULAR 3

morphine oral capsule, er multiphase 24 hr 1 PA; QL

morphine oral capsule,extend.release pellets 1 PA; QL

morphine oral solution 1

morphine oral tablet 1

morphine oral tablet extended release 1 PA; QL

morphine rectal 1

MS CONTIN 3 PA; QL

NALOCET 3

OXAYDO 3

oxycodone oral capsule 1

oxycodone oral concentrate 1

oxycodone oral solution 1

oxycodone oral tablet 1

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-300 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1

oxycodone-aspirin 1

OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR

2 PA; QL


22


oxymorphone oral tablet 1

oxymorphone oral tablet extended release 12 hr 1 PA; QL

PROBUPHINE 3 LA

prolate 1

ROXICODONE 3

SUBLOCADE 2 LA

tencon oral tablet 50-325 mg 1

TREZIX ORAL CAPSULE 320.5-30-16 MG 3

VANATOL LQ 3 PA

VANATOL S 3 PA

vtol lq 1

zebutal oral capsule 50-325-40 mg 1

ZOHYDRO ER ORAL CAPSULE, ORAL ONLY, ER 12HR

3 PA; QL

NON-NARCOTIC ANALGESICS

adult aspirin regimen ACA ACA; OTC

ANAPROX DS 3 ST

ARTHROTEC 50 3 ST

ARTHROTEC 75 3 ST

aspirin low dose ACA ACA; OTC

aspirin oral tablet ACA ACA; OTC

aspirin oral tablet,chewable ACA ACA; OTC

aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg

ACA ACA; OTC

aspir-trin ACA ACA; OTC

bayer aspirin ACA ACA; OTC

BUNAVAIL BUCCAL FILM 2.1-0.3 MG, 4.2-0.7 MG

3 QL

BUNAVAIL BUCCAL FILM 6.3-1 MG 3

buprenorphine-naloxone sublingual film 12-3 mg 1

buprenorphine-naloxone sublingual film 2-0.5 mg, 4-1 mg, 8-2 mg

1 QL

buprenorphine-naloxone sublingual tablet 2-0.5 mg

1 QL


23


buprenorphine-naloxone sublingual tablet 8-2 mg 1

butorphanol nasal 1 QL

CAMBIA 3 ST; QL

celecoxib 1 ST

children's aspirin ACA ACA; OTC

choline,magnesium salicylate 1

CONZIP 3 ST; QL

DAYPRO 3 ST

diclofenac potassium 1

diclofenac sodium oral 1

diclofenac sodium topical drops 1 QL

diclofenac sodium topical gel 1 % 1 ST; QL

diclofenac-misoprostol 1

diflunisal 1

DISALCID 3

DUEXIS 3 ST

e.c. prin ACA ACA; OTC

EC-NAPROSYN 3 ST

ecotrin ACA ACA; OTC

ecotrin low strength ACA ACA; OTC

etodolac 1

FELDENE 3 ST

fenoprofen oral tablet 1 ST

FLECTOR 2 ST; QL

flurbiprofen oral tablet 100 mg 1

ibu 1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg 1

INDOCIN ORAL 3 ST

INDOCIN RECTAL 3

indomethacin oral 1

ketoprofen oral capsule 25 mg 1 ST

ketoprofen oral capsule 50 mg, 75 mg 1


24


ketoprofen oral capsule,ext rel. pellets 24 hr 200 mg

1 ST

ketorolac oral 1 QL

LICART 2 ST; QL

lite coat aspirin ACA ACA; OTC

LODINE ORAL TABLET 3 ST

meclofenamate 1

mefenamic acid 1

meloxicam oral tablet 15 mg 1

meloxicam oral tablet 7.5 mg 1 QL

MOBIC ORAL TABLET 15 MG 3 ST

MOBIC ORAL TABLET 7.5 MG 3 ST; QL

nabumetone 1

NALFON ORAL TABLET 3 ST

naloxone injection solution 1

naloxone injection syringe 1

naltrexone 1

NAPRELAN CR 3 ST

NAPROSYN ORAL SUSPENSION 3 ST

NAPROSYN ORAL TABLET 500 MG 3 ST

naproxen oral suspension 1 ST

naproxen oral tablet 1

naproxen oral tablet,delayed release (dr/ec) 1

naproxen sodium oral tablet 550 mg 1

naproxen sodium oral tablet, er multiphase 24 hr 1 ST

naproxen-esomeprazole 1 ST

NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION

2 QL

NUCYNTA 2 QL

NUCYNTA ER 2 PA; QL

oxaprozin 1

pentazocine-naloxone 1

piroxicam 1


25


READYSHARP KETOROLAC 3

salsalate 1

SPRIX 3 ST; QL

st joseph aspirin ACA ACA; OTC

st. joseph aspirin ACA ACA; OTC

SUBOXONE SUBLINGUAL FILM 12-3 MG 2

SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 4-1 MG, 8-2 MG

2 QL

sulindac 1

tolmetin oral capsule 1 ST

tolmetin oral tablet 200 mg 1

tolmetin oral tablet 600 mg 1 ST

TRAMADOL ORAL CAPSULE,ER BIPHASE 24 HR 17-83

3 ST; QL

TRAMADOL ORAL CAPSULE,ER BIPHASE 24 HR 25-75

3 ST; QL

TRAMADOL ORAL TABLET 100 MG 3

tramadol oral tablet 50 mg 1 QL

tramadol oral tablet extended release 24 hr 1 PA; QL

tramadol oral tablet, er multiphase 24 hr 1 ST; QL

tramadol-acetaminophen 1 QL

ULTRACET 3 QL

ULTRAM 3 QL

VIMOVO 3 ST

VIVITROL 2 LA

VOLTAREN TOPICAL 3 ST; QL

ZUBSOLV SUBLINGUAL TABLET 0.7-0.18 MG, 1.4-0.36 MG, 2.9-0.71 MG, 5.7-1.4 MG, 8.6-2.1 MG

2 QL

ZUBSOLV SUBLINGUAL TABLET 11.4-2.9 MG

2

PSYCHOTHERAPEUTIC DRUGS

ABILIFY MYCITE 3 QL

ADASUVE 3

ADDERALL XR 3 ST


26


ADDYI 3 PA

ADHANSIA XR 3 ST

ADZENYS ER 3 ST

ADZENYS XR-ODT 3 ST

alprazolam 1

alprazolam intensol 1

amitriptyline 1

amitriptyline-chlordiazepoxide 1

amoxapine 1

amphetamine sulfate 1

ANAFRANIL 3

APLENZIN 3 ST; QL

APTENSIO XR 3 ST

aripiprazole oral solution 1

aripiprazole oral tablet 1 QL

aripiprazole oral tablet,disintegrating 1 QL

armodafinil 1 PA; QL

ATIVAN ORAL 3

atomoxetine 1

BELSOMRA 3 ST; QL

bupropion hcl oral tablet 1

bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg

1 QL

BUPROPION HCL ORAL TABLET EXTENDED RELEASE 24 HR 450 MG

3 ST; QL

bupropion hcl oral tablet sustained-release 12 hr 1 QL

buspirone 1

chlordiazepoxide hcl 1

chlorpromazine oral 1

citalopram oral solution 1

citalopram oral tablet 1 QL

clomipramine 1

clonidine hcl oral tablet extended release 12 hr 1


27


clorazepate dipotassium 1

clozapine 1

CLOZARIL 3

CONCERTA 3 ST

COTEMPLA XR-ODT 3 ST

DAYTRANA 2 ST

DAYVIGO 3 ST; QL

desipramine 1

DESOXYN 3

DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24 HR

3 ST; QL

desvenlafaxine succinate 1 ST; QL

DEXEDRINE SPANSULE 3 ST

dexmethylphenidate 1

dextroamphetamine 1

dextroamphetamine-amphetamine oral tablet 1

diazepam intensol 1

diazepam oral solution 5 mg/5 ml (1 mg/ml) 1

diazepam oral tablet 1

doxepin oral capsule 1

doxepin oral concentrate 1

doxepin oral tablet 1 ST; QL

duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg

1 QL

duloxetine oral capsule,delayed release(dr/ec) 40 mg

1 ST; QL

DYANAVEL XR 2 ST

EDLUAR 3 ST; QL

EMSAM 3

ergoloid 1

escitalopram oxalate oral solution 1

escitalopram oxalate oral tablet 1 QL

estazolam 1 QL

eszopiclone 1 QL


28


EVEKEO 3

EVEKEO ODT 3

FANAPT 3 QL

FETZIMA 2 ST; QL

fluoxetine oral capsule 10 mg, 40 mg 1 QL

fluoxetine oral capsule 20 mg 1

fluoxetine oral capsule,delayed release(dr/ec) 1 QL

fluoxetine oral solution 1

fluoxetine oral tablet 10 mg 1 PA; QL

fluoxetine oral tablet 20 mg, 60 mg 1 PA

fluphenazine hcl oral 1

flurazepam 1 QL

fluvoxamine oral capsule,extended release 24hr 1 PA; QL

fluvoxamine oral tablet 1 QL

FORFIVO XL 3 ST; QL

GEODON ORAL 3 QL

guanfacine oral tablet extended release 24 hr 1

guanidine 1

HALCION ORAL TABLET 0.25 MG 3 QL

haloperidol 1

haloperidol lactate oral 1

HETLIOZ 3 PA; LA; QL

imipramine hcl 1

imipramine pamoate 1

INTERMEZZO 3 ST; QL

INVEGA 3 QL

JORNAY PM 3 ST

KAPVAY 3 ST

LATUDA 2 QL

lithium carbonate 1

lithium citrate oral solution 8 meq/5 ml 1

LITHOBID 3

lorazepam intensol 1


29


lorazepam oral concentrate 1

lorazepam oral tablet 1

loxapine succinate 1

maprotiline 1

MARPLAN 3

methamphetamine 1

METHYLIN ORAL SOLUTION 3

METHYLPHENIDATE HCL ORAL CAP,ER SPRINKLE,BIPHASIC 40-60

3 ST

methylphenidate hcl oral capsule, er biphasic 30-70

1

methylphenidate hcl oral capsule,er biphasic 50-50

1

methylphenidate hcl oral solution 1

methylphenidate hcl oral tablet 1

methylphenidate hcl oral tablet extended release 1

methylphenidate hcl oral tablet extended release 24hr 18 mg, 27 mg, 36 mg, 54 mg

1

METHYLPHENIDATE HCL ORAL TABLET EXTENDED RELEASE 24HR 72 MG

3 ST

methylphenidate hcl oral tablet,chewable 1

MIDAZOLAM IN NACL,ISO-OSMO(PF) 3

mirtazapine 1

modafinil 1 PA; QL

molindone 1

MYDAYIS 2 ST

NARDIL 3

nefazodone 1

NORPRAMIN ORAL TABLET 10 MG, 25 MG 3

nortriptyline 1

NUPLAZID ORAL CAPSULE 3 PA; LA; QL

NUPLAZID ORAL TABLET 10 MG 3 PA; LA; QL

olanzapine oral 1 QL

olanzapine-fluoxetine 1


30


oxazepam 1

paliperidone 1 QL

PAMELOR 3

PARNATE 3

paroxetine hcl oral tablet 1 QL

paroxetine hcl oral tablet extended release 24 hr 1 PA; QL

paroxetine mesylate(menop.sym) 1 PA; QL

PAXIL CR 3 ST; QL

PAXIL ORAL SUSPENSION 3 ST

PAXIL ORAL TABLET 3 ST; QL

perphenazine 1

perphenazine-amitriptyline 1

PEXEVA 3 ST; QL

phenelzine 1

pimozide 1

procentra 1

protriptyline 1

QUAZEPAM 3 QL

quetiapine 1 QL

QUILLICHEW ER 2 ST

QUILLIVANT XR 2 ST

ramelteon 1 ST; QL

RELEXXII 3 ST

REMERON ORAL TABLET 15 MG, 30 MG 3

REMERON SOLTAB 3

RESTORIL 3 QL

REXULTI 3 QL

RISPERDAL ORAL SOLUTION 3

RISPERDAL ORAL TABLET 0.5 MG, 1 MG, 2 MG, 3 MG, 4 MG

3 QL

risperidone oral solution 1

risperidone oral tablet 1 QL

risperidone oral tablet,disintegrating 1 QL


31


RITALIN 3

RITALIN LA ORAL CAPSULE,ER BIPHASIC 50-50 10 MG, 20 MG, 30 MG, 40 MG

3 ST

SAPHRIS 3 QL

SARAFEM ORAL TABLET 10 MG 3 ST; QL

SARAFEM ORAL TABLET 20 MG 3 ST

seconal sodium 1 QL

SECUADO 3 QL

sertraline oral concentrate 1

sertraline oral tablet 1 QL

SILENOR 3 ST; QL

SUNOSI 2 PA; QL

SYMBYAX ORAL CAPSULE 12-50 MG, 3-25 MG, 6-25 MG, 6-50 MG

3

temazepam 1 QL

thioridazine 1

thiothixene 1

TRANXENE T-TAB ORAL TABLET 7.5 MG 3

tranylcypromine 1

trazodone 1

triazolam 1 QL

trifluoperazine 1

trimipramine 1

TRINTELLIX 3 ST; QL

venlafaxine oral capsule,extended release 24hr 1 QL

venlafaxine oral tablet 1 QL

venlafaxine oral tablet extended release 24hr 1 ST; QL

VERSACLOZ 3

VIIBRYD ORAL TABLET 2 ST; QL

VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23)

2 ST; QL

VRAYLAR 3 QL

VYLEESI 3 PA; QL

VYVANSE 2 ST


32


WAKIX 3 PA; LA; QL

WELLBUTRIN XL 3 ST; QL

XYREM 2 PA; LA

zaleplon 1 QL

zenzedi oral tablet 10 mg, 5 mg 1

ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG

3

ziprasidone hcl 1 QL

zolpidem 1 QL

ZOLPIMIST 3 ST; QL

ZYPREXA ORAL 3 QL

ZYPREXA ZYDIS 3 QL

CARDIOVASCULAR, HYPERTENSION & LIPIDS

ANTIARRHYTHMIC AGENTS

amiodarone oral 1

BETAPACE 3 ST

BETAPACE AF 3 ST

disopyramide phosphate oral capsule 1

dofetilide 1

flecainide 1

mexiletine 1

MULTAQ 3

NORPACE 3

NORPACE CR 3

pacerone oral tablet 100 mg, 200 mg, 400 mg 1

propafenone 1

quinidine gluconate oral 1

quinidine sulfate oral tablet 1

RYTHMOL SR 3

sotalol af 1

sotalol oral 1

SOTYLIZE 2

ANTIHYPERTENSIVE THERAPY


33


ACCUPRIL 3

ACCURETIC 3

acebutolol 1

ADALAT CC 3 ST

ALDACTAZIDE 3

ALDACTONE 3

aliskiren 1

ALTACE 3

amiloride 1

amiloride-hydrochlorothiazide 1

amlodipine 1

amlodipine-benazepril 1

amlodipine-olmesartan 1

amlodipine-valsartan 1

amlodipine-valsartan-hcthiazid 1

atenolol 1

atenolol-chlorthalidone 1

benazepril 1

benazepril-hydrochlorothiazide 1

betaxolol oral 1

BIDIL 3

bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide 1

bumetanide oral 1

BYSTOLIC 2 ST

CALAN SR 3 ST

candesartan 1

candesartan-hydrochlorothiazid 1

captopril 1

captopril-hydrochlorothiazide 1

CARDIZEM CD 3

CARDIZEM LA 3


34


CARDIZEM ORAL TABLET 120 MG, 30 MG, 60 MG

3

CARDURA 3 ST; QL

CARDURA XL 3 ST; QL

cartia xt 1

carvedilol 1

carvedilol phosphate 1

CATAPRES 3

CATAPRES-TTS-1 3 QL

CATAPRES-TTS-2 3 QL

CATAPRES-TTS-3 3 QL

chlorothiazide oral tablet 500 mg 1

chlorthalidone oral tablet 25 mg, 50 mg 1

clonidine 1 QL

clonidine hcl oral tablet 1

CONSENSI 3

COREG CR 3 ST

CORGARD 3 ST

DEMSER 3 PA

DIBENZYLINE 3 PA

diltiazem hcl oral capsule,extended release 12 hr 1

diltiazem hcl oral capsule,extended release 24 hr 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

1

diltiazem hcl oral capsule,extended release 24hr 1

diltiazem hcl oral tablet 1

diltiazem hcl oral tablet extended release 24 hr 1

dilt-xr 1

DIURIL 3

doxazosin 1 QL

DYAZIDE 3

DYRENIUM 3

EDARBI 2

EDARBYCLOR 2


35


EDECRIN 3

enalapril maleate 1

enalapril-hydrochlorothiazide 1

eplerenone 1

eprosartan 1

ethacrynic acid 1

felodipine 1

fosinopril 1

fosinopril-hydrochlorothiazide 1

furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml)

1

furosemide oral tablet 1

guanfacine oral tablet 1

HEMANGEOL 3

hydralazine oral 1

hydrochlorothiazide 1

indapamide 1

INDERAL XL 3 ST

INNOPRAN XL 3 ST

INSPRA 3

irbesartan 1

irbesartan-hydrochlorothiazide 1

isradipine 1

labetalol oral 1

LASIX 3

lisinopril 1

lisinopril-hydrochlorothiazide 1

LOPRESSOR ORAL 3 ST

losartan 1

losartan-hydrochlorothiazide 1

LOTENSIN HCT 3

LOTENSIN ORAL TABLET 10 MG, 20 MG, 40 MG

3


36


matzim la 1

MAXZIDE 3

MAXZIDE-25MG 3

methyldopa 1

methyldopa-hydrochlorothiazide 1

metolazone 1

metoprolol succinate 1

metoprolol ta-hydrochlorothiaz 1

metoprolol tartrate oral 1

metyrosine 1 PA

MINIPRESS 3

minoxidil oral 1

moexipril 1

nadolol 1

nadolol-bendroflumethiazide oral tablet 80-5 mg 1

nicardipine oral 1

nifedipine 1

nimodipine 1

nisoldipine 1

olmesartan 1

olmesartan-amlodipin-hcthiazid 1

olmesartan-hydrochlorothiazide 1

ORENITRAM 3 PA; LA

perindopril erbumine 1

phenoxybenzamine 1 PA

pindolol 1

prazosin 1

PRESTALIA 3 ST

PRINIVIL ORAL TABLET 10 MG, 20 MG 3

PROCARDIA 3 ST

PROCARDIA XL 3 ST

propranolol oral 1

propranolol-hydrochlorothiazid 1


37


quinapril 1

quinapril-hydrochlorothiazide 1

ramipril 1

spironolactone 1

spironolacton-hydrochlorothiaz 1

SULAR ORAL TABLET EXTENDED RELEASE 24 HR 17 MG, 34 MG, 8.5 MG

3 ST

TARKA ORAL TABLET, IR - ER, BIPHASIC 24HR 2-180 MG, 2-240 MG, 4-240 MG

3

taztia xt 1

TEKTURNA 3

TEKTURNA HCT 2

telmisartan 1

telmisartan-amlodipine 1

telmisartan-hydrochlorothiazid 1

TENORETIC 100 3 ST

TENORETIC 50 3 ST

TENORMIN 3 ST

terazosin 1 QL

tiadylt er 1

TIAZAC 3

timolol maleate oral 1

torsemide oral 1

trandolapril 1

trandolapril-verapamil 1

triamterene 1

triamterene-hydrochlorothiazid oral capsule 37.5-25 mg

1

triamterene-hydrochlorothiazid oral tablet 1

UPTRAVI 2 PA; LA

valsartan 1

valsartan-hydrochlorothiazide 1

VASERETIC 3

VASOTEC 3


38


verapamil oral 1

VERELAN 3 ST

VERELAN PM 3 ST

ZESTORETIC 3

ZESTRIL 3

ZIAC 3 ST

CARDIAC GLYCOSIDES

digitek 1

digox 1

digoxin oral solution 50 mcg/ml (0.05 mg/ml) 1

digoxin oral tablet 1

LANOXIN ORAL TABLET 125 MCG (0.125 MG), 250 MCG (0.25 MG), 62.5 MCG (0.0625 MG)

3

COAGULATION THERAPY

AMICAR 3

aminocaproic acid oral 1

aspirin-dipyridamole 1

BEVYXXA 3 QL

BRILINTA 2

cilostazol 1

clopidogrel 1

DEFITELIO 3

dipyridamole oral 1

DOPTELET (15 TAB PACK) 2 PA; LA; QL

EFFIENT 3

ELIQUIS 2 PA

ELIQUIS DVT-PE TREAT 30D START 2 PA

jantoven 1

MEPHYTON 3 QL

pentoxifylline 1

phytonadione (vitamin k1) oral tablet 5 mg 1 QL

prasugrel 1


39


PROMACTA 2 PA; LA

warfarin 1

XARELTO DVT-PE TREAT 30D START 2 PA

XARELTO, XARELTO STARTER PACK 2 PA

ZONTIVITY 3 PA

LIPID/CHOLESTEROL LOWERING AGENTS

amlodipine-atorvastatin 1 QL

ANTARA ORAL CAPSULE 30 MG, 90 MG 3 ST

atorvastatin oral tablet 10 mg, 20 mg ACA ACA; QL

atorvastatin oral tablet 40 mg, 80 mg 1 QL

CADUET ORAL TABLET 10-10 MG, 10-20 MG, 10-40 MG, 10-80 MG, 5-10 MG, 5-20 MG, 5-40 MG, 5-80 MG

3 ST; QL

cholestyramine (with sugar) 1

cholestyramine light 1

colesevelam oral powder in packet 1

COLESTID 3 ST

COLESTID FLAVORED ORAL PACKET 3 ST

colestipol 1

ezetimibe 1 ST

ezetimibe-simvastatin 1 QL

fenofibrate micronized 1

fenofibrate nanocrystallized oral tablet 145 mg, 48 mg

1

FENOFIBRATE ORAL CAPSULE 3 ST

fenofibrate oral tablet 1

fenofibric acid 1

fenofibric acid (choline) 1

FENOGLIDE 3 ST

FIBRICOR 3 ST

fluvastatin ACA ACA; QL

gemfibrozil 1

JUXTAPID 2 PA; LA

LESCOL XL 3 ST; QL


40


LIPOFEN 2

LIVALO 2 ST; QL

LOPID 3

lovastatin ACA ACA; QL

LOVAZA 3 PA

NEXLETOL 2 PA

NEXLIZET 2 PA

niacin oral tablet extended release 24 hr 1

NIASPAN EXTENDED-RELEASE 3

omega-3 acid ethyl esters 1 PA

pravastatin ACA ACA; QL

prevalite 1

QUESTRAN 3 ST

QUESTRAN LIGHT ORAL POWDER 3 ST

rosuvastatin oral tablet 10 mg, 5 mg ACA ACA; QL

rosuvastatin oral tablet 20 mg, 40 mg 1 QL

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg ACA ACA; QL

simvastatin oral tablet 80 mg 1 QL

TRIGLIDE ORAL TABLET 160 MG 3 ST

TRILIPIX 3 ST

VASCEPA 2 PA

WELCHOL 3 ST

ZYPITAMAG ORAL TABLET 2 MG, 4 MG 3 ST; QL

MISCELLANEOUS CARDIOVASCULAR AGENTS

CORLANOR 2 PA

ENTRESTO 2 QL

ranolazine 1

VECAMYL 3

VYNDAMAX 2 PA; LA

VYNDAQEL 2 PA; LA

NITRATES

DILATRATE-SR 2

GONITRO 3


41


ISORDIL 3

ISORDIL TITRADOSE ORAL TABLET 5 MG 3

isosorbide dinitrate oral tablet 1

isosorbide mononitrate 1

MINITRAN 3

nitro-bid 1

NITRO-DUR 3

nitroglycerin oral 1

nitroglycerin sublingual 1

nitroglycerin transdermal patch 24 hour 1

nitroglycerin translingual spray,non-aerosol 1

NITROLINGUAL 3

NITROMIST 3

NITROSTAT 3

nitro-time 1

DERMATOLOGICALS/TOPICAL THERAPY

ANTIPSORIATIC / ANTISEBORRHEIC

acitretin 1

ANALPRAM-HC TOPICAL 3 ST

calcipotriene scalp 1 QL

calcipotriene topical cream 1 QL

calcipotriene topical ointment 1 QL

calcipotriene-betamethasone topical ointment 1 QL

calcitriol topical 1

DOVONEX TOPICAL 3 QL

ENSTILAR 2 QL

EPIFOAM 3 ST

hydrocortisone-pramoxine topical 1 ST

OVACE 3

OVACE PLUS SHAMPOO 3

OVACE PLUS TOPICAL CLEANSER 3

OVACE PLUS TOPICAL CREAM 3

OVACE PLUS TOPICAL FOAM 3


42


OVACE PLUS TOPICAL LOTION 3

OVACE PLUS WASH 3

PRAMOSONE 3 ST

selenium sulfide topical lotion 1

selenium sulfide topical shampoo 2.25 %, 2.3 % 1

SELRX 3

SORIATANE ORAL CAPSULE 10 MG, 25 MG 3

SORILUX 3 QL

sulfacetamide sodium topical 1

TACLONEX 3 QL

TERSI FOAM 3

VECTICAL 3

BURN THERAPY

SILVADENE 3

silver sulfadiazine 1

ssd 1

KERATOLYTICS

INOVA 4-1 3 ST

INOVA 8-2 3 ST

MISCELLANEOUS DERMATOLOGICALS

CONDYLOX TOPICAL GEL 3

CORTANE-B TOPICAL 3

doxepin topical 1 ST; QL

DUPIXENT PEN 2 PA; LA; QL

DUPIXENT SYRINGE 2 PA; LA; QL

EUCRISA 3 ST; QL

iodine-sodium iodide topical tincture 2 % 1

IODOFLEX 3

IODOSORB 3

methoxsalen 1

methyl salicylate 1

methyl salicylate topical liquid 1

OXSORALEN ULTRA 3


43


pimecrolimus 1 ST; QL

podofilox 1

PROTOPIC 3 ST; QL

prudoxin 1 ST; QL

QBREXZA 2 PA

REGRANEX 2 QL

SCENESSE 3 PA

tacrolimus topical 1 ST; QL

VEREGEN 3 PA

wintergreen oil 1

ZONALON 3 ST; QL

THERAPY FOR ACNE

ABSORICA 3 ST

ABSORICA LD 3 ST

ACZONE 3 ST

adapalene topical cream 1

adapalene topical gel 1

adapalene topical gel with pump 1

ADAPALENE TOPICAL LOTION 3 ST

adapalene topical solution 1

adapalene topical swab 1

adapalene-benzoyl peroxide 1

AKLIEF 3 ST

ALTRENO 3 PA

amnesteem 1

AMZEEQ 2 ST

ARAZLO 3 PA

AVAR LS 3 ST

avar topical cleanser 1

AVAR TOPICAL PADS, MEDICATED 3 ST

AVAR-E GREEN 3 ST

AVAR-E LS 3 ST

avita topical cream 1 PA


44


AVITA TOPICAL GEL 3 PA

azelaic acid 1

AZELEX 3 ST

BENZACLIN 3 ST

BENZACLIN PUMP 3 ST

BENZAMYCIN 3 ST

BENZEPRO (MICROSPHERES) 3 ST

benzoyl peroxide topical cleanser 7 % 1

benzoyl peroxide topical foam 9.8 % 1

bp 10-1 1 ST

claravis 1

CLEOCIN T TOPICAL GEL 3 ST; QL

CLEOCIN T TOPICAL LOTION 3 ST; QL

CLINDACIN ETZ TOPICAL KIT 3 ST

clindacin p 1

CLINDACIN PAC 3 ST

clindamycin phosphate topical foam 1 QL

clindamycin phosphate topical gel 1 QL

clindamycin phosphate topical lotion 1 QL

clindamycin phosphate topical solution 1 QL

clindamycin phosphate topical swab 1

clindamycin-benzoyl peroxide 1

clindamycin-tretinoin 1 PA

dapsone topical 1

DIFFERIN TOPICAL CREAM 3 ST

DIFFERIN TOPICAL GEL WITH PUMP 3 ST

DIFFERIN TOPICAL LOTION 3 ST

ENZOCLEAR 3 ST

ery pads 1

erygel 1

erythromycin with ethanol topical gel 1

erythromycin with ethanol topical solution 1

erythromycin-benzoyl peroxide 1


45


EVOCLIN 3 ST; QL

FABIOR 3 PA

FINACEA TOPICAL FOAM 2 ST

FINACEA TOPICAL GEL 3 ST

INOVA 3 ST

isotretinoin 1

METROCREAM 3 ST

METROGEL TOPICAL GEL 1 % 3 ST

metronidazole topical 1

MIRVASO TOPICAL GEL WITH PUMP 2 PA

myorisan 1

neuac 1

NEUAC KIT 3 ST

NORITATE 3 ST

ONEXTON TOPICAL GEL WITH PUMP 2 ST

PACNEX 3 ST

PLEXION 3 ST

PLEXION CLEANSING CLOTHS 3 ST

PR BENZOYL PEROXIDE 3 ST

RETIN-A 3 PA

RETIN-A MICRO 3 PA

RETIN-A MICRO PUMP 3 PA

RHOFADE 3 PA

rosadan topical cream 1

rosadan topical gel 1

ROSADAN TOPICAL KIT, CLEANSER AND GEL

3 ST

ROSADAN TOPICAL KIT,CLEANSER AND CREAM

3 ST

ROSANIL 3 ST

ROSULA 3 ST

rosula cleansing cloths 1

SOOLANTRA 3 ST; QL


46


sss 10-5 1

sulfacetamide sodium-sulfur topical cleanser 1

sulfacetamide sodium-sulfur topical cream 1

sulfacetamide sodium-sulfur topical lotion 1

sulfacetamide sodium-sulfur topical pads, medicated 10-4 %

1

sulfacetamide sodium-sulfur topical suspension 1

sulfacetamide-sulfur-cleansr23 1

sulfacleanse 8-4 1 ST

SUMADAN 3 ST

SUMADAN XLT 3 ST

SUMAXIN 3 ST

SUMAXIN CP 3 ST

SUMAXIN TS 3 ST

tazarotene 1 PA

TAZORAC TOPICAL CREAM 0.05 % 2 PA

TAZORAC TOPICAL CREAM 0.1 % 3 PA

TAZORAC TOPICAL GEL 2 PA

tretinoin 1 PA

tretinoin microspheres 1 PA

TRETIN-X CREAM KIT 3 PA

TRETIN-X TOPICAL CREAM 0.075 % 3 PA

VANOXIDE-HC 3 ST

zenatane 1

ZIANA 3 PA

TOPICAL ANESTHETICS

glydo 1 QL

lidocaine hcl laryngotracheal 1

lidocaine hcl mucous membrane jelly 1 QL

lidocaine hcl mucous membrane jelly in applicator 1 QL

lidocaine hcl mucous membrane solution 4 % (40 mg/ml)

1

lidocaine hcl-hydrocortison ac topical 1


47


lidocaine topical adhesive patch,medicated 5 % 1 PA

lidocaine topical ointment 1 QL

lidocaine viscous 1

lidocaine-prilocaine topical cream 1 QL

lidocaine-prilocaine topical kit 1

lta pre-attached 1

PLIAGLIS 3 PA; QL

SYNERA 3

ZTLIDO 2 PA

TOPICAL ANTIBACTERIALS

ALTABAX 3 ST; QL

CENTANY 3 ST; QL

CENTANY AT 3 ST; QL

CORTISPORIN TOPICAL 3

gentamicin topical 1

KLARON 3 ST

lugols topical 1

mafenide acetate 1

mupirocin 1 QL

mupirocin calcium 1 ST; QL

NEO-SYNALAR 3

NEO-SYNALAR KIT 3

strong iodine topical 1

sulfacetamide sodium (acne) 1

SULFAMYLON TOPICAL CREAM 2

SULFAMYLON TOPICAL PACKET 3

XEPI 3 ST; QL

TOPICAL ANTIFUNGALS

CICLODAN KIT TOPICAL COMBO PACK 3

CICLODAN KIT TOPICAL SOLUTION 3 ST

ciclodan topical cream 1 QL

ciclodan topical solution 1

ciclopirox topical cream 1 QL


48


ciclopirox topical gel 1 QL

ciclopirox topical shampoo 1 QL

ciclopirox topical solution 1

ciclopirox topical suspension 1 QL

ciclopirox-ure-camph-menth-euc 1

clotrimazole-betamethasone 1 QL

econazole 1 QL

ECOZA 3 QL

ERTACZO 3 QL

EXELDERM 3 QL

EXTINA 3 QL

JUBLIA 3 ST

KERYDIN 3 ST

ketoconazole topical 1 QL

ketodan 1 QL

ketodan kit 1

LOPROX (AS OLAMINE) 3 QL

LOPROX KIT 3 QL

LOPROX TOPICAL SHAMPOO 3 QL

LUZU 3 QL

MICONAZOLE NITRATE-ZINC OX-PET 3 QL

naftifine 1 QL

NAFTIN TOPICAL CREAM 2 % 3 QL

NAFTIN TOPICAL GEL 3 QL

nyamyc 1

nystatin topical cream 1 QL

nystatin topical ointment 1 QL

nystatin topical powder 1

nystatin-triamcinolone 1 QL

nystop 1

oxiconazole 1 QL

OXISTAT 3 QL

VUSION 3 QL


49


XOLEGEL 3 QL

TOPICAL ANTIVIRALS

acyclovir topical 1 PA; QL

DENAVIR 3

XERESE 3

ZOVIRAX TOPICAL CREAM 3 PA; QL

TOPICAL CORTICOSTEROIDS

ALA-SCALP 3 ST

alclometasone 1

amcinonide topical cream 1 ST

amcinonide topical lotion 1 ST

apexicon e 1 ST

beser 1 ST

betamethasone dipropionate 1

betamethasone valerate topical cream 1

betamethasone valerate topical foam 1 ST

betamethasone valerate topical lotion 1

betamethasone valerate topical ointment 1

betamethasone, augmented 1

BRYHALI 3 ST

CAPEX 3 ST

clobetasol scalp 1 QL

clobetasol topical cream 1 QL

clobetasol topical foam 1 ST; QL

clobetasol topical gel 1 QL

clobetasol topical lotion 1 ST; QL

clobetasol topical ointment 1 QL

clobetasol topical shampoo 1 ST; QL

clobetasol topical spray,non-aerosol 1 ST; QL

clobetasol-emollient topical cream 1 QL

clobetasol-emollient topical foam 1 ST; QL

CLOBEX 3 ST; QL

clodan 1 ST; QL


50


CLODAN KIT 3 ST

CLODERM 3 ST

CORDRAN TAPE LARGE ROLL 3 ST

CORDRAN TOPICAL CREAM 3 ST; QL

CORDRAN TOPICAL LOTION 3 ST; QL

CORDRAN TOPICAL OINTMENT 3 ST; QL

CUTIVATE TOPICAL CREAM 3 ST

CUTIVATE TOPICAL LOTION 3 ST

DERMA-SMOOTHE/FS BODY OIL 3 ST

DERMA-SMOOTHE/FS SCALP OIL 3 ST

DESONATE 3 ST

desonide topical cream 1

desonide topical gel 1 ST

desonide topical lotion 1 ST

desonide topical ointment 1

DESOWEN TOPICAL LOTION 3 ST

desoximetasone 1 ST

diflorasone 1 ST; QL

DIPROLENE TOPICAL OINTMENT 3 ST

DUOBRII 3 ST; QL

fluocinolone 1

fluocinolone and shower cap 1

fluocinonide topical cream 0.05 % 1 QL

fluocinonide topical cream 0.1 % 1 ST; QL

fluocinonide topical gel 1 QL

fluocinonide topical ointment 1 QL

fluocinonide topical solution 1 QL

fluocinonide-e 1 QL

flurandrenolide 1 ST; QL

fluticasone propionate topical cream 1

fluticasone propionate topical lotion 1 ST

fluticasone propionate topical ointment 1

halcinonide 1 ST


51


halobetasol propionate topical cream 1

HALOBETASOL PROPIONATE TOPICAL FOAM

3 ST

halobetasol propionate topical ointment 1

HALOG 3 ST

hydrocortisone butyrate topical cream 1 QL

hydrocortisone butyrate topical lotion 1 ST; QL

hydrocortisone butyrate topical ointment 1 ST

hydrocortisone butyrate topical solution 1 ST; QL

hydrocortisone butyr-emollient 1 QL

hydrocortisone topical cream 2.5 % 1

hydrocortisone topical lotion 2.5 % 1

hydrocortisone topical ointment 2.5 % 1

hydrocortisone valerate 1

IMPOYZ 3 ST; QL

KENALOG TOPICAL 3 ST; QL

LEXETTE 3 ST

LUXIQ 3 ST

mometasone topical 1

nolix 1 ST; QL

NUCORT 3 ST

OLUX 3 ST; QL

OLUX-E 3 ST; QL

PANDEL 3 ST

prednicarbate 1

PSORCON 3 ST; QL

scalacort 1

SCALACORT DK 3 ST

SERNIVO 3 ST

SYNALAR 3 ST

SYNALAR CREAM KIT 3 ST

SYNALAR OINTMENT KIT 3 ST

SYNALAR TS 3 ST


52


TEMOVATE TOPICAL CREAM 3 ST; QL

TEMOVATE TOPICAL OINTMENT 3 ST; QL

TEXACORT 3 ST

TOPICORT TOPICAL CREAM 3 ST

TOPICORT TOPICAL GEL 3 ST

TOPICORT TOPICAL OINTMENT 3 ST

tovet emollient 1 ST; QL

triamcinolone acetonide topical aerosol 1 ST; QL

triamcinolone acetonide topical cream 1

triamcinolone acetonide topical lotion 1

triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 %

1

triamcinolone acetonide topical ointment 0.05 % 1 ST

trianex 1 ST

triderm topical cream 0.1 % 1

triderm topical cream 0.5 % 1 ST

TRIDESILON 3 ST

ULTRAVATE TOPICAL LOTION 3 ST

TOPICAL ENZYMES

SANTYL 2 QL

TOPICAL SCABICIDES / PEDICULICIDES

crotan 1

ELIMITE 3

EURAX 3

lindane topical shampoo 1

malathion 1

NATROBA 3

OVIDE 3

permethrin topical cream 1

SKLICE 3

spinosad 1

ULESFIA 3

DIAGNOSTICS & MISCELLANEOUS AGENTS


53


ANOREXIANTS

ADIPEX-P 3 PA

benzphetamine oral tablet 50 mg 1 PA

CONTRAVE 3 PA

diethylpropion 1 PA

LOMAIRA 3 PA

phendimetrazine tartrate 1 PA

phentermine 1 PA

QSYMIA 3 PA

XENICAL 3 PA

ANTIDOTES

DUODOTE 3

IRRIGATING SOLUTIONS

SORBITOL IRRIGATION SOLUTION 3 % 3

SORBITOL-MANNITOL 3

tis-u-sol pentalyte 1

MISCELLANEOUS AGENTS

acamprosate 1

AGRYLIN 3

anagrelide 1

ANTABUSE 3

BUPHENYL 3

caffeine citrate oral 1

CARBAGLU 2 LA

CARNITOR (SUGAR-FREE) 3

CARNITOR ORAL 3

cevimeline 1

CHEMET 2 PA

clovique 1 PA

deferasirox 1 PA; LA

disulfiram 1

ENDARI 3 PA

EVOXAC 3


54


FERRIPROX 2 PA

INFASURF 3

levocarnitine (with sugar) 1

levocarnitine oral solution 100 mg/ml 1

levocarnitine oral tablet 1

LITHOSTAT 3

METOPIRONE 3

midodrine 1

MYOVIEW KIT 3

nitisinone 1 PA; LA

NITYR 2 PA; LA

NORTHERA 3 PA; LA

ORFADIN 3 PA; LA

pilocarpine hcl oral tablet 5 mg 1

RADIOGARDASE 3

RAVICTI 2 LA

RILUTEK 3 PA

riluzole 1 PA

risedronate oral tablet 30 mg 1 QL

SALAGEN (PILOCARPINE) ORAL TABLET 5 MG

3

SINOGRAFIN 3

sodium chloride 0.9 % (flush) injection syringe 1

sodium phenylbutyrate 1

SURVANTA 3

SYPRINE 3 PA

THIOLA 3

THIOLA EC 3

TIGLUTIK 3 PA

trientine 1 PA

XURIDEN 2

SMOKING DETERRENTS

bupropion hcl (smoking deter) ACA ACA


55


CHANTIX ACA ACA

CHANTIX CONTINUING MONTH BOX ACA ACA

CHANTIX STARTING MONTH BOX ACA ACA

NICODERM CQ ACA ACA; OTC

NICORETTE BUCCAL GUM 2 MG ACA ACA; OTC

nicorette buccal gum 4 mg ACA ACA; OTC

NICORETTE BUCCAL LOZENGE ACA ACA; OTC

NICORETTE BUCCAL MINI LOZENGE ACA ACA; OTC

nicotine (polacrilex) ACA ACA; OTC

nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr

ACA ACA; OTC

nicotine transdermal patch, td daily, sequential ACA ACA; OTC

NICOTROL ACA ACA

NICOTROL NS ACA ACA

quit 2 ACA ACA; OTC

quit 4 ACA ACA; OTC

stop smoking aid ACA ACA; OTC

EAR, NOSE & THROAT MEDICATIONS

MISCELLANEOUS AGENTS

azelastine nasal aerosol,spray 1 QL

azelastine nasal spray,non-aerosol 1

chlorhexidine gluconate mucous membrane 1

CLINPRO 5000 3

denta 5000 plus 1

dentagel 1

fluoride (sodium) dental cream 1

fluoride (sodium) dental gel 1

fluoride (sodium) dental paste 1

FLUORIDEX DAILY DEFENSE DENTAL PASTE

3

FLUORIDEX SENSITIVITY RELIEF DENTAL PASTE

3

ipratropium bromide nasal 1 QL

olopatadine nasal 1 QL


56


oralone 1

paroex oral rinse 1

PATANASE 3 QL

PERIDEX 3

periogard 1

pilocarpine hcl oral tablet 7.5 mg 1

PREVIDENT 3

PREVIDENT 5000 BOOSTER PLUS 3

PREVIDENT 5000 DRY MOUTH 3

PREVIDENT 5000 ENAMEL PROTECT 3

PREVIDENT 5000 ORTHO DEFENSE 3

PREVIDENT 5000 PLUS 3

PREVIDENT 5000 SENSITIVE 3

Q-CARE RX Q4 3

SALAGEN (PILOCARPINE) ORAL TABLET 7.5 MG

3

sf 1

sf 5000 plus 1

sodium fluoride 5000 plus 1

sodium fluoride-pot nitrate 1

triamcinolone acetonide dental 1

MISCELLANEOUS OTIC PREPARATIONS

acetic acid otic (ear) 1

ciprofloxacin hcl otic (ear) 1

DERMOTIC OIL 3

flac otic oil 1

fluocinolone acetonide oil 1

hydrocortisone-acetic acid 1

ofloxacin otic (ear) 1

OTIPRIO 3 QL

OTIC STEROID / ANTIBIOTIC

CIPRO HC 3

CIPRODEX 2


57


ciprofloxacin-dexamethasone 1

CORTISPORIN-TC 3

neomycin-polymyxin-hc otic (ear) 1

OTOVEL 2

ENDOCRINE/DIABETES

ADRENAL HORMONES

CORTEF 3

cortisone 1

decadron oral tablet 1

dexabliss 1 PA

dexamethasone intensol 1

dexamethasone oral elixir 1

dexamethasone oral solution 1

dexamethasone oral tablet 1

dexamethasone oral tablets,dose pack 1 PA

DXEVO 3 PA

fludrocortisone 1

hidex 1 PA

hydrocortisone oral 1

LIDOCIDEX-I 3

LIDOCILONE I 3

MEDROL 3

MEDROL (PAK) 3

methylprednisolone 1

millipred dp 1

millipred oral tablet 1

ORAPRED ODT 3

P-CARE K40 3

P-CARE K80 3

POD-CARE 100K 3

prednisolone oral solution 15 mg/5 ml 1


58


prednisolone sodium phosphate oral solution 10 mg/5 ml, 15 mg/5 ml (3 mg/ml), 20 mg/5 ml (4 mg/ml), 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml)

1

prednisolone sodium phosphate oral tablet,disintegrating

1

prednisone 1

prednisone intensol 1

PRO-C-DURE 5 3

PRO-C-DURE 6 3

RAYOS 3 PA

READYSHARP DEXAMETHASONE 3

TAPERDEX 3 PA

ZCORT 3 PA

ANTITHYROID AGENTS

methimazole oral tablet 10 mg, 5 mg 1

propylthiouracil 1

SSKI 3

TAPAZOLE 3

BLOOD GLUCOSE MONITORING DEVICES & SUPPLIES

FREESTYLE INSULINX STRIP 2 OTC

FREESTYLE INSULINX TEST STRIPS 2 OTC

FREESTYLE LITE STRIPS 2 OTC

FREESTYLE TEST 2 OTC

ONETOUCH ULTRA BLUE TEST STRIP 2 OTC

ONETOUCH VERIO TEST STRIPS 2 OTC

PRECISION XTRA TEST 2 OTC

DIABETES, SUPPLIES, & DURABLE MEDICAL EQUIPMENT

ACE AEROSOL CLOUD ENHANCER 2

AEROVENT PLUS 2

COMPACT SPACE CHAMBER 2

FLEXICHAMBER 2

INSPIRACHAMBER 2

MICROSPACER 2


59


GLUCOSE ELEVATING AGENTS

BAQSIMI 2 QL

diazoxide 1

GLUCAGEN HYPOKIT 2 QL

GLUCAGON (HCL) EMERGENCY KIT 2 QL

GLUCAGON EMERGENCY KIT (HUMAN) 2 QL

GVOKE HYPOPEN 2-PACK 2 QL

GVOKE PFS 2-PACK SYRINGE 2 QL

PROGLYCEM 2

INSULIN SYRINGES/MISCELLANEOUS DURABLE MEDICAL EQU

BD MICROTAINER LANCET 30 GAUGE 2 OTC

BD ULTRA FINE LANCETS 2 OTC

BD ULTRA-FINE NANO PEN NEEDLE 2 OTC

CEQUR SIMPLICITY 3

DEXCOM G4 RECEIVER 2



DEXCOM RECEIVER 2

FREESTYLE FREEDOM 2 OTC

FREESTYLE FREEDOM LITE 2 OTC

FREESTYLE INSULINX 2 OTC

FREESTYLE LITE METER 2 OTC

LANCETS 33 GAUGE 2 OTC

OMNIPOD DASH 5 PACK POD 2

ONETOUCH ULTRA2 METER 2 OTC

ONETOUCH ULTRAMINI 2 OTC

ONETOUCH VERIO FLEX METER 2 OTC

ONETOUCH VERIO IQ METER 2 OTC

ONETOUCH VERIO METER 2 OTC

PRECISION XTRA MONITOR 2 OTC

V-GO 20 2

V-GO 30 2

V-GO 40 2


60


INSULIN THERAPY

AFREZZA INHALATION CARTRIDGE WITH INHALER 12 UNIT, 4 UNIT, 4 UNIT (90)/ 8 UNIT (90), 4 UNIT/8 UNIT/ 12 UNIT (60), 8 UNIT, 8 UNIT (90)/ 12 UNIT (90)

3

BASAGLAR KWIKPEN U-100 INSULIN 3

HUMALOG JUNIOR KWIKPEN U-100 2

HUMALOG KWIKPEN INSULIN 2

HUMALOG MIX 50-50 INSULN U-100 2

HUMALOG MIX 50-50 KWIKPEN 2

HUMALOG MIX 75-25 KWIKPEN 2

HUMALOG MIX 75-25(U-100)INSULN 2

HUMALOG U-100 INSULIN 2

HUMULIN 70/30 U-100 INSULIN 2

HUMULIN 70/30 U-100 KWIKPEN 2

HUMULIN N NPH INSULIN KWIKPEN 2

HUMULIN N NPH U-100 INSULIN 2

HUMULIN R REGULAR U-100 INSULN 2

HUMULIN R U-500 (CONC) INSULIN 2

HUMULIN R U-500 (CONC) KWIKPEN 2

LANTUS SOLOSTAR U-100 INSULIN 2

LANTUS U-100 INSULIN 2

LEVEMIR FLEXTOUCH U-100 INSULN 2

LEVEMIR U-100 INSULIN 2

LYUMJEV KWIKPEN U-100 INSULIN 2

LYUMJEV KWIKPEN U-200 INSULIN 2

LYUMJEV U-100 INSULIN 2

MYXREDLIN 3

SOLIQUA 100/33 2 QL

TOUJEO MAX U-300 SOLOSTAR 2

TOUJEO SOLOSTAR U-300 INSULIN 2

TRESIBA FLEXTOUCH U-100 2

TRESIBA FLEXTOUCH U-200 2

TRESIBA U-100 INSULIN 2


61


XULTOPHY 100/3.6 2 QL

MISCELLANEOUS HORMONES

ANDRODERM 2 PA; QL

ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP 20.25 MG/1.25 GRAM (1.62 %)

3 PA; QL

ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (20.25 MG/1.25 GRAM), 1.62 % (40.5 MG/2.5 GRAM)

3 PA; QL

cabergoline 1 QL

calcitonin (salmon) 1

calcitriol oral 1

CERDELGA 2 PA; LA

cinacalcet 1 PA

clomiphene citrate 1

danazol 1

DDAVP NASAL SOLUTION 2

DDAVP ORAL 3

desmopressin nasal spray,non-aerosol 1

desmopressin oral 1

doxercalciferol oral 1 ST

GALAFOLD 3 PA; LA; QL

JYNARQUE 3 PA; LA; QL

KUVAN 2 PA; LA

miglustat 1 PA; LA

NOCDURNA (MEN) 3 PA; QL

NOCDURNA (WOMEN) 3 PA; QL

ORILISSA 2 PA; QL

paricalcitol oral 1 ST

RAYALDEE 3 ST

ROCALTROL 3 ST

SAMSCA ORAL TABLET 15 MG 2 PA; LA; QL

SAMSCA ORAL TABLET 30 MG 3 PA; LA; QL

SYNAREL 2


62


testosterone transdermal gel 1 PA; QL

testosterone transdermal gel in metered-dose pump 12.5 mg/ 1.25 gram (1 %), 20.25 mg/1.25 gram (1.62 %)

1 PA; QL

testosterone transdermal gel in packet 1 PA; QL

tolvaptan 1 PA; LA; QL

VAPRISOL IN 5 % DEXTROSE 3

VOGELXO TRANSDERMAL GEL 3 PA; QL

VOGELXO TRANSDERMAL GEL IN PACKET 3 PA; QL

ZEMPLAR ORAL CAPSULE 1 MCG, 2 MCG 3 ST

NON-INSULIN HYPOGLYCEMIC AGENTS

acarbose 1

ACTOPLUS MET 3 ST; QL

ACTOPLUS MET XR ORAL TABLET, ER MULTIPHASE 24 HR 15-1,000 MG

3 ST; QL

ACTOS 3 ST; QL

AMARYL 3

AVANDIA ORAL TABLET 2 MG, 4 MG 3 ST; QL

BYDUREON BCISE 2 PA; QL

BYDUREON SUBCUTANEOUS PEN INJECTOR

2 PA; QL

BYETTA 2 PA; QL

CYCLOSET 3

DUETACT 3 ST; QL

FARXIGA 2 ST; QL

FORTAMET 3 PA; QL

glimepiride 1

glipizide 1

glipizide-metformin 1

GLUCOTROL 3

GLUCOTROL XL 3

glyburide 1

glyburide micronized 1

glyburide-metformin 1


63


GLYNASE 3

GLYSET 3

GLYXAMBI 2 ST; QL

INVOKAMET 2 ST; QL

INVOKAMET XR 2 ST; QL

INVOKANA 2 ST; QL

JANUMET 2 PA; QL

JANUMET XR 2 PA; QL

JANUVIA 2 PA; QL

JARDIANCE 2 ST; QL

JENTADUETO 2 PA; QL

JENTADUETO XR 2 PA; QL

metformin oral solution 1

metformin oral tablet 1

metformin oral tablet extended release 24 hr 1 QL

metformin oral tablet extended release 24hr 1 PA; QL

metformin oral tablet,er gast.retention 24 hr 1 PA; QL

miglitol 1

nateglinide 1

OSENI 3 ST; QL

OZEMPIC 2 PA; QL

pioglitazone 1 QL

pioglitazone-glimepiride 1 QL

pioglitazone-metformin 1 QL

PRANDIN ORAL TABLET 1 MG, 2 MG 3

PRECOSE 3

QTERN 3 ST

repaglinide 1

repaglinide-metformin 1 QL

RIOMET 3 ST

RIOMET ER 3 ST

RYBELSUS 2 PA; QL

SEGLUROMET 2 ST; QL


64


STARLIX 3

STEGLATRO 2 ST; QL

STEGLUJAN 3 ST; QL

SYMLINPEN 120 2 PA; QL

SYMLINPEN 60 2 PA; QL

SYNJARDY 2 ST; QL

SYNJARDY XR 2 ST; QL

TRADJENTA 2 PA; QL

TRIJARDY XR 2 ST

TRULICITY SUBCUTANEOUS PEN INJECTOR 0.75 MG/0.5 ML, 1.5 MG/0.5 ML

2 PA; QL

XIGDUO XR 2 ST; QL

THYROID HORMONES

ARMOUR THYROID 2

euthyrox 2

levo-t 2

levothyroxine oral 1

levoxyl oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg

1

liothyronine oral 1

nature-throid 1

np thyroid 1

SYNTHROID 3

thyroid (pork) 1

THYROLAR-1 3

THYROLAR-1/2 3

THYROLAR-1/4 3

THYROLAR-2 3

THYROLAR-3 3

TIROSINT 3

TIROSINT-SOL 3

unithroid 1


65


westhroid oral tablet 130 mg, 195 mg, 32.5 mg, 65 mg, 97.5 mg

1

WP THYROID 3

GASTROENTEROLOGY

ANTIDIARRHEALS & ANTISPASMODICS

anaspaz 1

belladonna alkaloids-opium 1

chlordiazepoxide-clidinium 1

CUVPOSA 3

dicyclomine oral capsule 1

dicyclomine oral solution 1

dicyclomine oral tablet 1

diphenoxylate-atropine 1

DONNATAL ORAL ELIXIR 16.2-0.1037 -0.0194 MG/5 ML

3

DONNATAL ORAL TABLET 3

ed-spaz 1

GLYCATE 3

glycopyrrolate oral 1

hyoscyamine sulfate oral 1

hyoscyamine sulfate sublingual 1

hyosyne 1

LEVBID 3

LEVSIN ORAL 3

LEVSIN/SL 3

LOMOTIL 3

methscopolamine 1

MOTOFEN 3

MYTESI 3

NULEV 3

opium tincture 1

oscimin oral tablet 1

oscimin sl 1


66


oscimin sr 1

phenobarb-hyoscy-atropine-scop oral elixir 16.2-0.1037 -0.0194 mg/5 ml

1

phenobarb-hyoscy-atropine-scop oral tablet 1

phenohytro oral elixir 16.2-0.1037 -0.0194 mg/5 ml

1

phenohytro oral tablet 1

propantheline 1

SYMAX DUOTAB 3

symax fastabs 1

symax-sl 1

symax-sr 1

MISCELLANEOUS GASTROINTESTINAL AGENTS

ACTIGALL 3

alophen (bisacodyl) ACA ACA; OTC

alosetron 1

AMITIZA 3 QL

ANA-LEX KIT 3

ANALPRAM-HC RECTAL CREAM 1-1 % 3

ANALPRAM-HC RECTAL CREAM 2.5-1 % 3 ST

ANALPRAM-HC SINGLES RECTAL CREAM 2.5-1 % (4G)

3

anucort-hc 1

APRISO 3

AURYXIA 3

AZULFIDINE 3

AZULFIDINE EN-TABS 3

balsalazide 1

bisacodyl oral ACA ACA; OTC

bisa-lax (bisacodyl) ACA ACA; OTC

BONJESTA 3 QL

budesonide oral capsule,delayed,extend.release 1

calcium acetate(phosphat bind) 1

CANASA 3


67


CHENODAL 2 PA; LA

CHOLBAM ORAL CAPSULE 250 MG 2 PA

CHOLBAM ORAL CAPSULE 50 MG 2 PA; QL

CINVANTI 2

citrate of magnesia ACA ACA; OTC

citroma ACA ACA; OTC

clearlax ACA ACA; OTC

CLENPIQ 2

COLAZAL 3

constulose 1

CORTENEMA 3

CREON 2

cromolyn oral 1

CYSTADANE 2

DICLEGIS 3 QL

ducodyl (bisacodyl) ACA ACA; OTC

ENTOCORT EC 3

enulose 1

fleet laxative (bisacodyl) ACA ACA; OTC

fosaprepitant 1

GASTROCROM 3

GATTEX 30-VIAL 3 LA

gavilax oral powder ACA ACA; OTC

gavilyte-c ACA ACA

gavilyte-g ACA ACA

gavilyte-n ACA ACA

generlac 1

gentle laxative (bisacodyl) oral ACA ACA; OTC

gentlelax ACA ACA; OTC

glycolax oral powder ACA ACA; OTC

GOLYTELY 3

healthylax ACA ACA; OTC

hemmorex-hc rectal suppository 25 mg 1


68


hydrocortisone acetate rectal 1

hydrocortisone rectal 1

hydrocortisone topical cream with perineal applicator

1

hydrocortisone-pramoxine rectal 1

kionex (with sorbitol) 1

KRISTALOSE 3

lactulose oral packet 1

lactulose oral solution 10 gram/15 ml 1

lanthanum 1

laxaclear ACA ACA; OTC

laxative (bisacodyl) oral ACA ACA; OTC

laxative peg 3350 oral powder ACA ACA; OTC

LIALDA 3

lidocaine hcl-hydrocortison ac rectal cream 3-0.5 %

1

LIDOCAINE HCL-HYDROCORTISON AC RECTAL GEL

3

lidocaine hcl-hydrocortison ac rectal kit 1

lidocaine-hydrocortisone-aloe rectal gel 1

lidocaine-hydrocortisone-aloe rectal kit 3-2.5 % (7 gram)

1

LINZESS 2 QL

LOKELMA 2 QL

LOTRONEX 3

magnesium citrate oral solution ACA ACA; OTC

mesalamine oral capsule (with del rel tablets) 1

mesalamine oral tablet,delayed release (dr/ec) 1

mesalamine rectal 1

mesalamine with cleansing wipe 1

milk of magnesia ACA ACA; OTC

milk of magnesia concentrated ACA ACA; OTC

miralax oral powder in packet ACA ACA; OTC

MOTEGRITY 3 QL


69


MOVANTIK 2 QL

MOVIPREP 3

natura-lax ACA ACA; OTC

NULYTELY LEMON-LIME 3

NULYTELY WITH FLAVOR PACKS 3

OCALIVA 2 PA; LA; QL

oral saline laxative oral liquid ACA ACA; OTC

peg 3350-electrolytes oral recon soln 236-22.74-6.74 -5.86 gram

ACA ACA

peg-electrolyte soln ACA ACA

peg-prep ACA ACA

PENTASA 2

PHOSLYRA 2

phosphate laxative oral liquid ACA ACA; OTC

PLENVU 3

polyethylene glycol 3350 ACA ACA; OTC

powderlax ACA ACA; OTC

PREPOPIK 2

PROCORT 3

PROCTOCORT RECTAL 3 ST

PROCTOFOAM HC 3 ST

procto-med hc 1

procto-pak 1

proctosol hc topical 1

proctozone-hc 1

purelax ACA ACA; OTC

RECTIV 2

RELISTOR ORAL 2 ST

RENVELA 3

ROWASA RECTAL ENEMA KIT 3

scopolamine base 1

sevelamer carbonate 1

sevelamer hcl 1


70


SFROWASA 3

smoothlax ACA ACA; OTC

sodium polystyrene (sorb free) 1

sodium polystyrene sulfonate oral powder 1

sps (with sorbitol) 1

SUCRAID 2

sulfasalazine 1

SUPREP BOWEL PREP KIT 2

SYMPROIC 2

trilyte with flavor packets ACA ACA

TRULANCE 2

UCERIS ORAL 3

UCERIS RECTAL 2

URSO 250 3

URSO FORTE 3

ursodiol 1

VELPHORO 2

VIBERZI 2

VIOKACE 2

women's gentle laxative(bisac) ACA ACA; OTC

women's laxative (bisacodyl) ACA ACA; OTC

ZELNORM 3

ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,000-32,000 -42,000 UNIT, 15,000-47,000 -63,000 UNIT, 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 3,000-10,000 -14,000-UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT

2

ULCER THERAPY

amoxicil-clarithromy-lansopraz 1 QL

CARAFATE 3

cimetidine hcl oral 1

cimetidine oral tablet 300 mg, 400 mg, 800 mg 1

CYTOTEC 3


71


DEXILANT ORAL CAPSULE,BIPHASE DELAYED RELEAS 30 MG

3 ST; QL

DEXILANT ORAL CAPSULE,BIPHASE DELAYED RELEAS 60 MG

3 ST

esomeprazole magnesium oral capsule,delayed release(dr/ec) 20 mg

1 QL

esomeprazole magnesium oral capsule,delayed release(dr/ec) 40 mg

1

esomeprazole magnesium oral granules dr for susp in packet 10 mg, 20 mg

1 ST; QL

esomeprazole magnesium oral granules dr for susp in packet 40 mg

1 ST

famotidine oral suspension 1

famotidine oral tablet 20 mg, 40 mg 1

lansoprazole oral capsule,delayed release(dr/ec) 15 mg

1 QL

lansoprazole oral capsule,delayed release(dr/ec) 30 mg

1

lansoprazole oral tablet,disintegrat, delay rel 15 mg

1 QL

lansoprazole oral tablet,disintegrat, delay rel 30 mg

1

misoprostol 1

NEXIUM ORAL CAPSULE,DELAYED RELEASE(DR/EC) 20 MG

3 ST; QL

NEXIUM ORAL CAPSULE,DELAYED RELEASE(DR/EC) 40 MG

3 ST

NEXIUM PACKET ORAL GRANULES DR FOR SUSP IN PACKET 10 MG, 20 MG

3 ST; QL

NEXIUM PACKET ORAL GRANULES DR FOR SUSP IN PACKET 2.5 MG, 5 MG

2 ST; QL

NEXIUM PACKET ORAL GRANULES DR FOR SUSP IN PACKET 40 MG

3 ST

nizatidine 1

OMECLAMOX-PAK 3 QL

omeprazole oral capsule,delayed release(dr/ec) 10 mg

1 QL


72


omeprazole oral capsule,delayed release(dr/ec) 20 mg, 40 mg

1

omeprazole-sodium bicarbonate oral capsule 20-1.1 mg-gram

1 PA; QL

omeprazole-sodium bicarbonate oral capsule 40-1.1 mg-gram

1 PA

omeprazole-sodium bicarbonate oral packet 20-1,680 mg

1 PA; QL

omeprazole-sodium bicarbonate oral packet 40-1,680 mg

1 PA

pantoprazole oral granules dr for susp in packet 1

pantoprazole oral tablet,delayed release (dr/ec) 20 mg

1 QL

pantoprazole oral tablet,delayed release (dr/ec) 40 mg

1

PEPCID ORAL TABLET 3

rabeprazole oral tablet,delayed release (dr/ec) 1

ranitidine hcl oral syrup 1

ranitidine hcl oral tablet 150 mg, 300 mg 1

sucralfate oral tablet 1

TALICIA 2 QL

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY

INTERFERONS

AUBAGIO 3 PA; LA

dimethyl fumarate 1 PA

GILENYA ORAL CAPSULE 0.5 MG 2 PA; LA

MAYZENT 2 PA; LA; QL

ribavirin oral capsule 1 PA; LA

ribavirin oral tablet 200 mg 1 PA; LA

TECFIDERA 2 PA; LA

VUMERITY 2 PA; LA

ZEPOSIA 2 PA; LA

ZEPOSIA STARTER KIT 2 PA; LA

ZEPOSIA STARTER PACK 2 PA; LA

INTERLEUKINS


73


PROLEUKIN 2 PA; LA

VACCINES & MISCELLANEOUS IMMUNOLOGICALS

ACTHIB (PF) ACA ACA

ADACEL(TDAP ADOLESN/ADULT)(PF) ACA ACA

AFLURIA QD 2020-21(3YR UP)(PF) ACA ACA

AFLURIA QD 2020-21(6-35MO)(PF) ACA ACA

AFLURIA QUAD 2020-2021(6MO UP) ACA ACA

BCG VACCINE, LIVE (PF) ACA ACA

BEXSERO ACA ACA

BIOTHRAX ACA ACA

BOOSTRIX TDAP ACA ACA

DAPTACEL (DTAP PEDIATRIC) (PF) ACA ACA

ENGERIX-B (PF) ACA ACA

ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE

ACA ACA

FLUAD 2020-2021 (65 YR UP)(PF) ACA ACA

FLUAD QUAD 2020-21(65Y UP)(PF) ACA ACA

FLUARIX QUAD 2020-2021 (PF) ACA ACA

FLUBLOK QUAD 2020-2021 (PF) ACA ACA

FLUCELVAX QUAD 2020-2021 ACA ACA

FLUCELVAX QUAD 2020-2021 (PF) ACA ACA

FLULAVAL QUAD 2020-2021 (PF) ACA ACA

FLUMIST QUAD 2020-2021 ACA ACA

FLUZONE HIGHDOSE QUAD 20-21 PF ACA ACA

FLUZONE QUAD 2020-2021 ACA ACA

FLUZONE QUAD 2020-2021 (PF) ACA ACA

GARDASIL 9 (PF) ACA ACA

HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML

ACA ACA

HAVRIX (PF) INTRAMUSCULAR SYRINGE ACA ACA

HEPLISAV-B (PF) INTRAMUSCULAR SYRINGE

ACA ACA

HIBERIX (PF) ACA ACA

IMOVAX RABIES VACCINE (PF) ACA ACA


74


INFANRIX (DTAP) (PF) ACA ACA

IPOL ACA ACA

IXIARO (PF) ACA ACA

KINRIX (PF) ACA ACA

MENACTRA (PF) INTRAMUSCULAR SOLUTION

ACA ACA

MENVEO A-C-Y-W-135-DIP (PF) ACA ACA

M-M-R II (PF) ACA ACA

PEDIARIX (PF) ACA ACA

PEDVAX HIB (PF) ACA ACA

PENTACEL (PF) ACA ACA

PENTACEL ACTHIB COMPONENT (PF) ACA ACA

PNEUMOVAX-23 ACA ACA

PREVNAR 13 (PF) ACA ACA

PROQUAD (PF) ACA ACA

QUADRACEL (PF) ACA ACA

RABAVERT (PF) ACA ACA

RECOMBIVAX HB (PF) ACA ACA

ROTARIX ACA ACA

ROTATEQ VACCINE ACA ACA

SHINGRIX (PF) ACA ACA

STAMARIL (PF) ACA ACA

TDVAX ACA ACA

TENIVAC (PF) ACA ACA

TETANUS,DIPHTHERIA TOX PED(PF) ACA ACA

TRUMENBA ACA ACA

TWINRIX (PF) INTRAMUSCULAR SYRINGE ACA ACA

TYPHIM VI ACA ACA

VAQTA (PF) ACA ACA

VARIVAX (PF) ACA ACA

VARIZIG INTRAMUSCULAR SOLUTION ACA ACA

VAXCHORA VACCINE ACA ACA

VIVOTIF ACA ACA


75


YF-VAX (PF) ACA ACA

ZOSTAVAX (PF) ACA ACA

MUSCULOSKELETAL & RHEUMATOLOGY

GOUT THERAPY

allopurinol 1

COLCRYS 3 ST

febuxostat 1 ST

GLOPERBA 3

MITIGARE 2

probenecid 1

probenecid-colchicine 1

ZYLOPRIM 3

OSTEOPOROSIS THERAPY

ACTONEL ORAL TABLET 150 MG, 35 MG, 5 MG

3 ST; QL

alendronate oral solution 1 QL

alendronate oral tablet 10 mg, 35 mg, 5 mg, 70 mg 1 QL

ATELVIA 3 ST; QL

BINOSTO 3 ST; QL

BONIVA ORAL 3 ST; QL

EVISTA 3

FOSAMAX ORAL TABLET 70 MG 3 ST; QL

FOSAMAX PLUS D 3 ST; QL

ibandronate oral 1 QL

raloxifene 1

risedronate oral tablet 150 mg, 35 mg, 5 mg 1 QL

risedronate oral tablet,delayed release (dr/ec) 1 QL

OTHER RHEUMATOLOGICALS

ARAVA 3 QL

DEPEN TITRATABS 3 PA

leflunomide 1 QL

OTEZLA 2 PA; LA; QL


76


OTEZLA STARTER ORAL TABLETS,DOSE PACK 10 MG (4)-20 MG (4)-30 MG (47)

2 PA; LA; QL

penicillamine 1 PA

RIDAURA 2

RINVOQ 2 PA; LA; QL

SAVELLA 2 ST; QL

SIMPONI SUBCUTANEOUS PEN INJECTOR 100 MG/ML

2 PA; LA; QL

SIMPONI SUBCUTANEOUS SYRINGE 100 MG/ML

2 PA; LA; QL

XELJANZ 2 PA; LA; QL

XELJANZ XR 2 PA; LA; QL

OBSTETRICS & GYNECOLOGY

DIAPHRAGMS AND OTHER NON-ORAL CONTRACEPTIVES

CAYA CONTOURED ACA ACA

FC2 FEMALE CONDOM ACA ACA; OTC

FEMCAP VAGINAL DEVICE 22 MM ACA ACA

KYLEENA ACA ACA

LILETTA ACA ACA; LA

MIRENA ACA ACA

PARAGARD T 380A ACA ACA

SKYLA ACA ACA

WIDE-SEAL DIAPHRAGM ACA ACA

ESTROGENS & PROGESTINS

ACTIVELLA ORAL TABLET 1-0.5 MG 3

ALORA 3 QL

amabelz 1

ANGELIQ 3

AYGESTIN 3

BIJUVA 3

camila 1 ACA

CLIMARA 3 QL

COMBIPATCH 2


77


covaryx 1

covaryx h.s. 1

deblitane ACA ACA

DIVIGEL TRANSDERMAL GEL IN PACKET 0.25 MG/0.25 GRAM (0.1 %), 0.5 MG/0.5 GRAM (0.1 %), 0.75 MG/0.75 GRAM (0.1%), 1 MG/GRAM (0.1 %)

2 QL

DIVIGEL TRANSDERMAL GEL IN PACKET 1.25 MG/1.25 GRAM (0.1 %)

2

dotti 1 QL

DUAVEE 2

eemt 1

eemt hs 1

ELESTRIN 3 QL

errin 1 ACA

ESTRACE 3

estradiol oral 1

estradiol transdermal 1 QL

estradiol vaginal 1

estradiol-norethindrone acet 1

ESTRING 2

estrogens-methyltestosterone 1

EVAMIST 3 QL

FEMHRT LOW DOSE 3

fyavolv 1

heather ACA ACA

IMVEXXY MAINTENANCE PACK 3 QL

IMVEXXY STARTER PACK 3 QL

incassia ACA ACA

jencycla ACA ACA

jinteli 1

lopreeza oral tablet 1-0.5 mg 1

lyza ACA ACA

medroxyprogesterone oral 1


78


MENEST 3

MENOSTAR 3 QL

mimvey 1

MINIVELLE 3 QL

nora-be ACA ACA

norethindrone (contraceptive) ACA ACA

norethindrone acetate 1

norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg, 1-5 mg-mcg

1

norlyda ACA ACA

PREFEST 3

PREMARIN ORAL 2

PREMARIN VAGINAL 2

PREMPHASE 2

PREMPRO 2

progesterone micronized 1

PROMETRIUM 3

PROVERA 3

sharobel ACA ACA

tulana ACA ACA

yuvafem 1

MISCELLANEOUS OB/GYN

ANNOVERA ACA ACA; QL

CERVIDIL 3

CLEOCIN VAGINAL 3

clindamycin phosphate vaginal 1

CLINDESSE 3

eluryng ACA ACA

etonogestrel-ethinyl estradiol ACA ACA

fem ph 1

GYNAZOLE-1 3

gynol ii ACA ACA; OTC

INTRAROSA 3


79


isoxsuprine 1

LYSTEDA 3

METROGEL VAGINAL 3

metronidazole vaginal 1

NEXPLANON ACA ACA; LA

NUVARING ACA ACA

NUVESSA 3

OSPHENA 3

PREPIDIL 3

PROSTIN E2 3

RELAGARD 3

terconazole 1

TODAY CONTRACEPTIVE SPONGE ACA ACA; OTC

tranexamic acid oral 1

TRIMO-SAN JELLY 2

vaginal contraceptive foam ACA ACA; OTC

vandazole 1

VCF CONTRACEPTIVE FILM ACA ACA; OTC

VCF CONTRACEPTIVE GEL ACA ACA; OTC

xulane ACA ACA

ORAL CONTRACEPTIVES & RELATED AGENTS

afirmelle ACA ACA

AFTERA ACA ACA; OTC; QL

altavera (28) ACA ACA

alyacen 1/35 (28) ACA ACA

alyacen 7/7/7 (28) ACA ACA

amethia ACA ACA

amethia lo ACA ACA

amethyst (28) ACA ACA

apri ACA ACA

aranelle (28) ACA ACA

ashlyna ACA ACA

aubra ACA ACA


80


aubra eq ACA ACA

aurovela 1.5/30 (21) ACA ACA

aurovela 1/20 (21) ACA ACA

aurovela 24 fe ACA ACA

aurovela fe 1.5/30 (28) ACA ACA

aurovela fe 1-20 (28) ACA ACA

aviane ACA ACA

ayuna ACA ACA

azurette (28) ACA ACA

BALCOLTRA ACA ST; ACA

balziva (28) ACA ACA

bekyree (28) ACA ACA

BEYAZ ACA ST; ACA

blisovi 24 fe ACA ACA

blisovi fe 1.5/30 (28) ACA ACA

blisovi fe 1/20 (28) ACA ACA

briellyn ACA ACA

camrese ACA ACA

camrese lo ACA ACA

caziant (28) ACA ACA

charlotte 24 fe 1 ACA

chateal (28) ACA ACA

chateal eq (28) ACA ACA

cryselle (28) ACA ACA

cyclafem 1/35 (28) ACA ACA

cyclafem 7/7/7 (28) ACA ACA

cyred ACA ACA

cyred eq ACA ACA

dasetta 1/35 (28) ACA ACA

dasetta 7/7/7 (28) ACA ACA

daysee ACA ACA

desog-e.estradiol/e.estradiol ACA ACA

desogestrel-ethinyl estradiol ACA ACA


81


drospirenone-e.estradiol-lm.fa ACA ACA

drospirenone-ethinyl estradiol ACA ACA

econtra ez ACA ACA; OTC; QL

econtra one-step ACA ACA; OTC; QL

elinest ACA ACA

ELLA ACA ACA; QL

emoquette ACA ACA

enpresse ACA ACA

enskyce ACA ACA

estarylla ACA ACA

ESTROSTEP FE-28 ACA ST; ACA

ethynodiol diac-eth estradiol ACA ACA

falmina (28) ACA ACA

fayosim ACA ACA

femynor ACA ACA

GENERESS FE ACA ST; ACA

gianvi (28) ACA ACA

hailey ACA ACA

hailey 24 fe ACA ACA

hailey fe 1.5/30 (28) 1 ACA

hailey fe 1/20 (28) 1 ACA

introvale ACA ACA

isibloom ACA ACA

jaimiess ACA ACA

jasmiel (28) ACA ACA

jolessa ACA ACA

juleber ACA ACA

junel 1.5/30 (21) ACA ACA

junel 1/20 (21) ACA ACA

junel fe 1.5/30 (28) ACA ACA

junel fe 1/20 (28) ACA ACA

junel fe 24 ACA ACA

kaitlib fe ACA ACA


82


kalliga ACA ACA

kariva (28) ACA ACA

kelnor 1/35 (28) ACA ACA

kelnor 1-50 ACA ACA

kurvelo (28) 1 ACA

l norgest/e.estradiol-e.estrad ACA ACA

larin 1.5/30 (21) ACA ACA

larin 1/20 (21) ACA ACA

larin 24 fe ACA ACA

larin fe 1.5/30 (28) ACA ACA

larin fe 1/20 (28) ACA ACA

larissia ACA ACA

layolis fe ACA ACA

leena 28 ACA ACA

lessina ACA ACA

levonest (28) ACA ACA

levonorgestrel oral tablet 1.5 mg ACA ACA; OTC; QL

levonorgestrel-ethinyl estrad ACA ACA

levonorg-eth estrad triphasic ACA ACA

levora-28 ACA ACA

lillow (28) ACA ACA

LO LOESTRIN FE ACA ST; ACA

lojaimiess ACA ACA

loryna (28) ACA ACA

LOSEASONIQUE ACA ST; ACA

low-ogestrel (28) ACA ACA

lo-zumandimine (28) ACA ACA

lutera (28) ACA ACA

marlissa (28) ACA ACA

melodetta 24 fe ACA ACA

mibelas 24 fe 1 ACA

microgestin 1.5/30 (21) ACA ACA

microgestin 1/20 (21) ACA ACA


83


microgestin fe 1.5/30 (28) ACA ACA

microgestin fe 1/20 (28) ACA ACA

mili ACA ACA

MIRCETTE (28) ACA ST; ACA

mono-linyah ACA ACA

my choice ACA ACA; OTC; QL

my way ACA ACA; OTC; QL

NATAZIA ACA ST; ACA

necon 0.5/35 (28) ACA ACA

new day ACA ACA; OTC; QL

nikki (28) ACA ACA

noreth-ethinyl estradiol-iron ACA ACA

norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg

ACA ACA

norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (21)/75 mg (7), 1.5 mg-30 mcg (21)/75 mg (7)

ACA ACA

norethindrone-e.estradiol-iron oral tablet,chewable

ACA ACA

norgestimate-ethinyl estradiol ACA ACA

nortrel 0.5/35 (28) ACA ACA

nortrel 1/35 (21) ACA ACA

nortrel 1/35 (28) ACA ACA

nortrel 7/7/7 (28) ACA ACA

ocella ACA ACA

opcicon one-step ACA ACA; OTC; QL

option-2 ACA ACA; OTC; QL

orsythia ACA ACA

philith ACA ACA

pimtrea (28) ACA ACA

pirmella ACA ACA

PLAN B ONE-STEP ACA ACA; OTC; QL

portia 28 ACA ACA

previfem ACA ACA

QUARTETTE ACA ST; ACA


84


reclipsen (28) ACA ACA

rivelsa ACA ACA

SAFYRAL ACA ST; ACA

SEASONIQUE ACA ST; ACA

setlakin ACA ACA

simliya (28) ACA ACA

simpesse ACA ACA

SLYND ACA ST; ACA

sprintec (28) ACA ACA

sronyx ACA ACA

syeda ACA ACA

TAKE ACTION ACA ACA; OTC; QL

tarina 24 fe ACA ACA

tarina fe 1/20 (28) ACA ACA

TAYTULLA ACA ST; ACA

tilia fe ACA ACA

tri femynor ACA ACA

tri-estarylla ACA ACA

tri-legest fe ACA ACA

tri-linyah ACA ACA

tri-lo-estarylla ACA ACA

tri-lo-marzia ACA ACA

tri-lo-mili ACA ACA

tri-lo-sprintec ACA ACA

tri-mili ACA ACA

tri-previfem (28) ACA ACA

tri-sprintec (28) ACA ACA

trivora (28) ACA ACA

tri-vylibra ACA ACA

tri-vylibra lo ACA ACA

tydemy ACA ACA

velivet triphasic regimen (28) ACA ACA

vienva ACA ACA


85


viorele (28) ACA ACA

volnea (28) ACA ACA

vyfemla (28) ACA ACA

vylibra ACA ACA

wera (28) ACA ACA

wymzya fe ACA ACA

YAZ (28) ACA ST; ACA

zarah ACA ACA

zovia 1/35e (28) ACA ACA

zumandimine (28) ACA ACA

OXYTOCICS

methergine 1 QL

methylergonovine oral 1 QL

OPHTHALMOLOGY

ANTIBIOTICS

ak-poly-bac 1

AZASITE 2

BACIGUENT 3

bacitracin ophthalmic (eye) 1

bacitracin-polymyxin b ophthalmic (eye) 1

BESIVANCE 3

BETADINE OPHTHALMIC PREP 3

CILOXAN 3

ciprofloxacin hcl ophthalmic (eye) 1

erythromycin ophthalmic (eye) 1

gatifloxacin 1

gentak ophthalmic (eye) ointment 1

gentamicin ophthalmic (eye) drops 1

levofloxacin ophthalmic (eye) 1

MOXEZA 3

moxifloxacin ophthalmic (eye) 1

NATACYN 2

neomycin-bacitracin-polymyxin 1


86


neomycin-polymyxin-gramicidin 1

neo-polycin 1

OCUFLOX 3

ofloxacin ophthalmic (eye) 1

polycin 1

polymyxin b sulf-trimethoprim 1

POLYTRIM 3

tobramycin ophthalmic (eye) 1

TOBREX 3

VIGAMOX 3

ZYMAXID 3

ANTIVIRALS

trifluridine 1

ZIRGAN 3

BETA-BLOCKERS

betaxolol ophthalmic (eye) 1

BETIMOL 3

BETOPTIC S 3

carteolol 1

levobunolol ophthalmic (eye) drops 0.5 % 1

timolol maleate ophthalmic (eye) 1

TIMOPTIC 3

TIMOPTIC-XE 3

CHOLINESTERASE INHIBITOR MIOTICS

PHOSPHOLINE IODIDE 2

CYCLOPLEGIC MYDRIATICS

atropine ophthalmic (eye) drops 1

ATROPINE OPHTHALMIC (EYE) DROPS, EMULSION

3

atropine ophthalmic (eye) ointment 1

CYCLOGYL 3

cyclopentolate 1

homatropaire 1


87


ISOPTO ATROPINE 3

MYDRIACYL 3

PAREMYD 3

tropicamide 1

DIRECT ACTING MIOTICS

ISOPTO CARPINE 3

pilocarpine hcl ophthalmic (eye) drops 1 %, 2 %, 4 %

1

MISCELLANEOUS OPHTHALMOLOGICS

AKTEN (PF) 3

ALCAINE 3

altacaine 1

azelastine ophthalmic (eye) 1

BEPREVE 2 ST

CEQUA 3 PA

cromolyn ophthalmic (eye) 1

CYCLOSPORINE IN KLARITY 3

CYSTARAN 2

DEXAMET-MOXIFL-KETORO-NACL(PF) 3

epinastine 1

fluorescein-proparacaine 1

KLARITY-A (AZITHRO-CHONDR)(PF) 3

KLARITY-B (BETAMETH-CHOND)(PF) 3

KLARITY-L (LOTEPRED-CHOND)(PF) 3

LACRISERT 3

LASTACAFT 3 ST

olopatadine ophthalmic (eye) 1

OXERVATE 2 PA; LA

PAZEO 2 ST

PREDNISOL ACE-GATIFLOX-BROMFEN 3

PREDNISOLN SP-GATIFLOX-BROMFEN 3

PREDNISOLN SP-MOXIFLOX-BROMFEN 3

PREDNISOLONE ACETATE-NEPAFENAC 3


88


PREDNISOLONE SOD PH-BROMFENAC 3

PREDNISOLONE-MOXIFLO-NEPAFENAC 3

PREDNISOLONE-MOXIFLOX-BROMFEN 3

proparacaine 1

RESTASIS 2 PA; QL

RESTASIS MULTIDOSE 2 PA; QL

tetracaine hcl 1

TETRACAINE HCL (PF) OPHTHALMIC (EYE) 3

XIIDRA 2 PA; QL

ZERVIATE 3 ST

NON-STEROIDAL ANTI-INFLAMMATORY AGENTS

ACULAR 3

ACULAR LS 3

bromfenac 1

BROMSITE 3

diclofenac sodium ophthalmic (eye) 1

flurbiprofen sodium 1

ILEVRO 2

ketorolac ophthalmic (eye) 1

PROLENSA 2

ORAL DRUGS FOR GLAUCOMA

acetazolamide 1

methazolamide 1

OTHER GLAUCOMA DRUGS

AZOPT 3

bimatoprost ophthalmic (eye) 1 PA

BRIMONIDINE-DORZOLAMIDE (PF) 3

COMBIGAN 2

COSOPT (PF) 3

dorzolamide 1

DORZOLAMIDE (PF) 3

dorzolamide-timolol 1


89


dorzolamide-timolol (pf) ophthalmic (eye) dropperette

1

DORZOLAMIDE-TIMOLOL (PF) OPHTHALMIC (EYE) DROPS

3

latanoprost 1 PA

LATANOPROST (PF) 3

LUMIGAN OPHTHALMIC (EYE) DROPS 0.01 %

2 PA

MITOSOL 3

RHOPRESSA 2

ROCKLATAN 3 PA

SIMBRINZA 3

TIMOL-BRIMON-DORZO-LATANOP(PF) 3

TIMOLOL-BRIMONIDI-DORZOLAM(PF) 3

TIMOLOL-DORZOLAMID-LATANOP(PF) 3

TIMOLOL-LATANOPROST(PF) 3

TRAVATAN Z 3 PA

travoprost 1 ST

TRUSOPT 3

VYZULTA 3 PA

ZIOPTAN (PF) 2 PA

STEROID-ANTIBIOTIC COMBINATIONS

DEXAMETH-MOXIFLOX(PF)-NACL,ISO 3

MAXITROL 3

neomycin-bacitracin-poly-hc 1

neomycin-polymyxin b-dexameth 1

neomycin-polymyxin-hc ophthalmic (eye) 1

neo-polycin hc 1

PRED-G 3

PRED-G S.O.P. 3

PREDNISOLONE ACET-GATIFLOXACIN 3

PREDNISOLONE SOD PH-MOXIFLOX 3

PREDNISOLONE-MOXIFLOXACIN HCL 3


90


TOBRADEX OPHTHALMIC (EYE) DROPS,SUSPENSION

3

TOBRADEX OPHTHALMIC (EYE) OINTMENT

2

TOBRADEX ST 2

tobramycin-dexamethasone 1

TRIAMCINOLON-MOXIFLOX-WATR(PF) 3

ZYLET 2

STEROIDS

ALREX 2 ST

dexamethasone sodium phosphate ophthalmic (eye)

1

DUREZOL 3

FLAREX 3

fluorometholone 1

FML LIQUIFILM 3

INVELTYS 2

LOTEMAX OPHTHALMIC (EYE) DROPS,GEL 2

LOTEMAX OPHTHALMIC (EYE) DROPS,SUSPENSION

3

LOTEMAX OPHTHALMIC (EYE) OINTMENT 2

LOTEMAX SM 2

loteprednol etabonate 1

PRED FORTE 3

prednisolone acetate 1

PREDNISOLONE ACETATE (PF) 3

prednisolone sodium phosphate ophthalmic (eye) 1

STEROID-SULFONAMIDE COMBINATIONS

BLEPHAMIDE 3

BLEPHAMIDE S.O.P. 3

sulfacetamide-prednisolone 1

SULFONAMIDES

BLEPH-10 3

sulfacetamide sodium ophthalmic (eye) 1


91


SYMPATHOMIMETICS

ALPHAGAN P OPHTHALMIC (EYE) DROPS 0.1 %

2

ALPHAGAN P OPHTHALMIC (EYE) DROPS 0.15 %

3

apraclonidine 1

brimonidine 1

IOPIDINE OPHTHALMIC (EYE) DROPPERETTE

3

VASOCONSTRICTOR DECONGESTANTS

CYCLOMYDRIL 3

phenylephrine hcl ophthalmic (eye) 1

RESPIRATORY, ALLERGY, COUGH & COLD

ANTIHISTAMINE & ANTIALLERGENIC AGENTS

ADYPHREN 3

ADYPHREN AMP 3

ADYPHREN AMP II 3

ADYPHREN II 3

carbinoxamine maleate oral liquid 1

carbinoxamine maleate oral tablet 4 mg 1

carbinoxamine maleate oral tablet 6 mg 1 ST

cetirizine oral solution 1 mg/ml 1

CLARINEX ORAL TABLET 3 QL

cyproheptadine 1

desloratadine 1 QL

dexchlorpheniramine maleate oral solution 1

EPINEPHINE PROFESSIONAL EMS 3

EPINEPHRINE PROFESSIONAL 3

EPINEPHRINESNAP-EMS 3

EPINEPHRINESNAP-V 3

EPIPEN 2-PAK 2 PA; QL

EPIPEN JR 2-PAK 2 PA; QL

hydroxyzine hcl oral solution 10 mg/5 ml 1


92


hydroxyzine hcl oral tablet 1

hydroxyzine pamoate 1

KARBINAL ER 3 ST

levocetirizine oral solution 1

levocetirizine oral tablet 1 QL

promethazine oral 1

promethazine rectal suppository 12.5 mg, 25 mg 1

promethegan 1

RYCLORA 3

RYVENT 3 ST

VISTARIL 3

COUGH & COLD THERAPY

benzonatate 1

BROMFED DM 3

brompheniramine-pseudoeph-dm oral syrup 1

CAPCOF 3

CLARINEX-D 12 HOUR 3 QL

codeine-guaifenesin 1

CODITUSSIN AC 3

CODITUSSIN DAC 3

g tussin ac 1

guaiatussin ac 1

HISTEX-AC 3

hydrocodone-chlorpheniramine 1

hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml

1

hydrocodone-homatropine oral tablet 1

hydromet 1

MAR-COF CG 3

maxi-tuss ac 1

MAXI-TUSS CD 3

m-clear wc 1

M-END PE 3


93


NINJACOF-XG 3

OBREDON 3 PA

POLY-TUSSIN AC ORAL LIQUID 4-10-10 MG/5 ML

3

promethazine-codeine 1

promethazine-dm 1

promethazine-phenyleph-codeine 1

promethazine-phenylephrine 1

RESPA-AR 3

SEMPREX-D 3

TESSALON PERLES 3

TUSSICAPS ORAL CAPSULE,EXTENDED RELEASE 12 HR 10-8 MG

3 PA

TUXARIN ER 3

TUZISTRA XR 3 PA

virtussin ac 1

virtussin dac 1

Z-TUSS AC 3

PULMONARY AGENTS

ACCOLATE 3

ADEMPAS 2 PA; LA

ADRENALIN NASAL 3

ADVAIR DISKUS 3 PA; QL

ADVAIR HFA 2 PA; QL

AIRDUO RESPICLICK 3 PA; QL

albuterol sulfate inhalation hfa aerosol inhaler 1 QL

albuterol sulfate inhalation solution for nebulization

1

albuterol sulfate oral 1

ALVESCO 3 QL

alyq 1 PA; QL

ambrisentan 1 PA; LA

ANORO ELLIPTA 2 QL

ARCAPTA NEOHALER 3 QL


94


ARNUITY ELLIPTA 2 QL

ASMANEX HFA 2 QL

ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 110 MCG/ ACTUATION (30), 220 MCG/ ACTUATION (120), 220 MCG/ ACTUATION (14), 220 MCG/ ACTUATION (30), 220 MCG/ ACTUATION (60)

2 QL

ATROVENT HFA 3 QL

azelastine-fluticasone 1 QL

BEVESPI AEROSPHERE 2 QL

bosentan 1 PA; LA

BREO ELLIPTA 2 PA; QL

BROVANA 3 QL

budesonide inhalation 1 QL

COMBIVENT RESPIMAT 2 QL

cromolyn inhalation 1

CUROSURF 3

DALIRESP ORAL TABLET 250 MCG 2 PA; QL

DALIRESP ORAL TABLET 500 MCG 2 PA

DULERA 2 PA; QL

DYMISTA 2 QL

ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML 3

ESBRIET ORAL CAPSULE 2 PA; LA; QL

ESBRIET ORAL TABLET 267 MG 2 PA; LA; QL

ESBRIET ORAL TABLET 801 MG 2 PA; LA

FASENRA PEN 2 PA; LA

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL

flunisolide nasal spray,non-aerosol 25 mcg (0.025 %)

1 QL

fluticasone propionate nasal 1 QL

FLUTICASONE PROPION-SALMETEROL INHALATION AEROSOL POWDR BREATH ACTIVATED

2 PA; QL


95


INCRUSE ELLIPTA 2 QL

ipratropium bromide inhalation 1

ipratropium-albuterol 1 QL

KALYDECO ORAL GRANULES IN PACKET 25 MG

2 PA; LA

KALYDECO ORAL GRANULES IN PACKET 50 MG, 75 MG

2 PA; LA; QL

KALYDECO ORAL TABLET 2 PA; LA; QL

levalbuterol hcl 1

LONHALA MAGNAIR REFILL 3 QL

LONHALA MAGNAIR STARTER 3 QL

metaproterenol oral syrup 1

mometasone nasal 1 QL

montelukast 1

OFEV 2 PA; LA; QL

OPSUMIT 2 PA; LA

ORKAMBI ORAL TABLET 2 PA; LA; QL

PERFOROMIST 2 QL

PROAIR HFA 2 QL

PROAIR RESPICLICK 2 QL

PULMICORT FLEXHALER 2 QL

PULMOZYME 2 LA

QNASL 2 QL

QVAR REDIHALER 2 QL

REVATIO ORAL 3 PA; LA; QL

SEEBRI NEOHALER 3 QL

SEREVENT DISKUS 2 QL

sildenafil (pulm.hypertension) oral 1 PA; LA; QL

SPIRIVA RESPIMAT 2 QL

SPIRIVA WITH HANDIHALER 2 QL

STIOLTO RESPIMAT 2 QL

SYMBICORT 2 PA; QL

SYMDEKO 2 PA; LA; QL


96


tadalafil (pulm. hypertension) 1 PA; LA; QL

terbutaline oral 1

THEO-24 3

theophylline oral elixir 1

theophylline oral solution 1

theophylline oral tablet extended release 12 hr 300 mg, 450 mg

1

theophylline oral tablet extended release 24 hr 1

TRACLEER ORAL TABLET 3 PA; LA

TRACLEER ORAL TABLET FOR SUSPENSION

2 PA; LA

TRELEGY ELLIPTA 2 QL

TRIKAFTA 2 PA; LA

TYVASO 2 PA; LA

TYVASO REFILL KIT 2 PA; LA

TYVASO STARTER KIT 2 PA; LA

UTIBRON NEOHALER 3 QL

VENTAVIS 3 PA; LA

VENTOLIN HFA 2 QL

XHANCE 3 QL

XOPENEX 3

XOPENEX CONCENTRATE 3

YUPELRI 2 QL

zafirlukast 1

zileuton 1 PA

ZYFLO 3 PA

UROLOGICALS

ANTICHOLINERGICS & ANTISPASMODICS

darifenacin 1

DITROPAN XL ORAL TABLET EXTENDED RELEASE 24HR 10 MG, 5 MG

3 ST

flavoxate 1

GELNIQUE TRANSDERMAL GEL IN PACKET 2 QL

MYRBETRIQ 2


97


oxybutynin chloride 1

OXYTROL 3 ST; QL

solifenacin 1

tolterodine 1

TOVIAZ 2

trospium 1

BENIGN PROSTATIC HYPERPLASIA (BPH) THERAPY

alfuzosin 1

dutasteride 1 ST

dutasteride-tamsulosin 1 ST

finasteride oral tablet 5 mg 1

FLOMAX 3 ST

JALYN 3 ST

PROSCAR 3 ST

silodosin 1

tadalafil oral tablet 2.5 mg, 5 mg 1 QL

tamsulosin 1

CHOLINERGIC STIMULANTS

bethanechol chloride 1

MISCELLANEOUS UROLOGICALS

CYSTAGON 2 LA

ELMIRON 2

hyophen 1

K-PHOS NO 2 3

K-PHOS ORIGINAL 2

LEVITRA ORAL TABLET 10 MG, 20 MG 3 QL

methen-sod phos-meth blue-hyos 1

MUSE 2 QL

ORACIT 3

phosphasal 1

potassium citrate 1

SHOHL'S MODIFIED 3

sildenafil 1 QL


98


STAXYN 3 QL

STENDRA 3 QL

tadalafil oral tablet 10 mg, 20 mg 1 QL

URELLE 3

uretron d-s oral tablet 81.6-10.8-40.8 mg 1

URIBEL 3

urimar-t 1

urin ds 1

uro-458 1

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3

urogesic-blue 1

uro-mp 1

UROQID-ACID NO.2 3

uryl 1

ustell 1

utira-c 1

vardenafil 1 QL

vilamit mb 1

vilevev mb 1

URINARY ANESTHETICS

phenazopyridine oral tablet 100 mg, 200 mg 1

PYRIDIUM 3

VITAMINS, HEMATINICS & ELECTROLYTES

ELECTROLYTES

EFFER-K ORAL TABLET, EFFERVESCENT 10 MEQ, 20 MEQ

3

effer-k oral tablet, effervescent 25 meq 1

GALZIN 3

klor-con oral packet 20 meq 1

klor-con oral tablet extended release 10 meq, 8 meq

1


99


klor-con oral tablet,er particles/crystals 10 meq, 15 meq, 20 meq

1

klor-con/ef 1

K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ, 20 MEQ

3

k-tab oral tablet extended release 8 meq 1

lugols oral 1

POTABA ORAL CAPSULE 3

potassium chloride oral 1

strong iodine oral 1

VITAMINS & HEMATINICS

ASCOR 3

b complex 1 (with folic acid) ACA ACA; OTC

b complex-vitamin b12 ACA ACA; OTC

b complex-vitamin c-folic acid oral tablet ACA ACA; OTC

B-12 COMPLIANCE 3

balanced b-100 complex oral tablet extended release 100 mg

ACA ACA; OTC

balanced b-100 oral tablet 0.4 mg ACA ACA; OTC

balanced b-50 oral tablet ACA ACA; OTC

bal-care dha 1

BAL-CARE DHA ESSENTIAL 3

b-complex with vitamin c oral tablet ACA ACA; OTC

CITRANATAL (DUAL-IRON) 3

CITRANATAL 90 DHA (ALGAL OIL) 3

CITRANATAL ASSURE ORAL COMBO PACK 35 MG IRON-1 MG -50 MG-300 MG

3

CITRANATAL B-CALM (FE GLUC) 3

CITRANATAL BLOOM 3

CITRANATAL DHA (ALGAL OIL) 3

CITRANATAL HARMONY (IRON FUM) 3

classic prenatal ACA ACA; OTC

c-nate dha 1

complete natal dha 1


100


complex b-100 oral tablet extended release ACA ACA; OTC

CONCEPT DHA 3

CONCEPT OB 3

dialyvite 800 oral tablet ACA ACA; OTC

DRISDOL ORAL CAPSULE 3

DUET DHA BALANCED ORAL COMBO PACK 25 MG IRON-1 MG -267 MG-233 MG

3

DUET DHA WITH OMEGA-3 ORAL COMBO PACK 25 MG IRON-1 MG -400 MG

3

ENBRACE HR 3

ergocalciferol (vitamin d2) oral capsule 1,250 mcg (50,000 unit)

1

fluoride (sodium) oral drops ACA ACA; OTC

fluoride (sodium) oral tablet,chewable ACA ACA; OTC

fluoritab oral tablet,chewable ACA ACA; OTC

FOLET ONE 3

folic acid oral tablet 1 mg 1

folic acid oral tablet 400 mcg, 800 mcg ACA ACA; OTC

folivane-ob 1

foltabs 800 ACA ACA; OTC

full spectrum b-vitamin c ACA ACA; OTC

kobee ACA ACA; OTC

KOSHER PRENATAL PLUS IRON 3

kpn oral tablet ACA ACA; OTC

ludent fluoride ACA ACA; OTC

MARNATAL-F 3

m-natal plus 1

multi-vitamin with fluoride ACA ACA; OTC

multivitamins with fluoride ACA ACA; OTC

mvc-fluoride ACA ACA; OTC

mynatal 1

mynatal advance 1

mynatal plus 1

mynatal-z 1


101


mynate 90 plus 1

NASCOBAL 2

NATACHEW (FE BIS-GLYCINATE) 3

natural b-100 complex ACA ACA; OTC

NEEVODHA (WITH ALGAL OIL) 3

NESTABS 3

NESTABS ABC 3

NESTABS DHA 3

NESTABS ONE 3

newgen 1

OB COMPLETE ONE 3

OB COMPLETE PETITE 3

OB COMPLETE PREMIER 3

OB COMPLETE WITH DHA 3

obstetrix dha 1

OBSTETRIX EC 3

OBSTETRIX ONE 3

OBTREX DHA 3

one daily prenatal oral combo pack 28-800-440 mg-mcg-mg

ACA ACA; OTC

perry prenatal ACA ACA; OTC

PHYSICIANS EZ USE B-12 3

pnv 29-1 1

pnv-dha 1

pnv-dha + docusate 1

pnv-omega 1

pnv-select 1

pr natal 400 1

pr natal 400 ec 1

pr natal 430 1

pr natal 430 ec 1

PREGENNA 3

prena1 chew 1


102


prena1 pearl 1

prena1 true 1

prenaissance 1

prenaissance plus 1

PRENATA 3

prenatabs fa 1

prenatabs rx 1

prenatal complete ACA ACA; OTC

prenatal formula oral tablet 28 mg iron- 800 mcg ACA ACA; OTC

prenatal multi-dha (algal oil) ACA ACA; OTC

prenatal one daily ACA ACA; OTC

prenatal oral tablet 28 mg iron- 800 mcg ACA ACA; OTC

prenatal plus 1

prenatal plus (calcium carb) 1

PRENATAL PLUS DHA ORAL COMBO PACK 3

prenatal vitamin oral tablet 27 mg iron- 0.8 mg ACA ACA; OTC

prenatal vitamin plus low iron 1

prenatal vitamin with minerals ACA ACA; OTC

prenatal vits96-iron fum-folic ACA ACA; OTC

prenatal-u 1

PRENATE AM 3

PRENATE CHEWABLE 3

PRENATE DHA (FERR ASP GLYCIN) 3

PRENATE ELITE (IRON ASP GLYC) 3

PRENATE ENHANCE 3

PRENATE ESSENTIAL(IRON-ASP-GL) 3

PRENATE MINI (FERR ASP GLYCIN) 3

PRENATE PIXIE 3

PRENATE RESTORE 3

PRENATE STAR 3

preplus 1

pretab 1

PRIMACARE 3


103


PROVIDA OB 3

PUREFE OB PLUS 3

rena-vite ACA ACA; OTC

R-NATAL OB 3

SELECT-OB 3

SELECT-OB (FOLIC ACID) 3

SELECT-OB + DHA 3

se-natal 19 chewable 1

se-natal-19 1

stress formula ACA ACA; OTC

stress formula with iron ACA ACA; OTC

stress formula with iron(sulf) ACA ACA; OTC

super b complex-vitamin c ACA ACA; OTC

super b maxi complex ACA ACA; OTC

super quints ACA ACA; OTC

super quints b-50 ACA ACA; OTC

taron-c dha 1

taron-prex prenatal-dha 1

THRIVITE RX 3

TRICARE 3

TRIFERIC 3

trinatal rx 1 1

trinate 1

TRINAZ 3

TRISTART DHA 3

triveen-duo dha 1

tri-vitamin with fluoride ACA ACA; OTC

VENOFER 2 PA

VINATE DHA RF 3

virt-c dha 1

virt-nate dha 1

virt-pn dha 1

virt-pn plus 1


104


VITAFOL FE PLUS 3

VITAFOL FE+ (WITH DOCUSATE) 3

VITAFOL GUMMIES 3

VITAFOL NANO 3

VITAFOL ULTRA 3

VITAFOL-OB 3

VITAFOL-OB+DHA 3

VITAFOL-ONE 3

VITAMED MD ONE RX 3

VITAMEDMD REDICHEW RX 3

vitamin b complex oral tablet ACA ACA; OTC

vitamin b complex-folic acid oral tablet ACA ACA; OTC

vitamins a,c,d and fluoride ACA ACA; OTC

VITAPEARL 3

VITATRUE 3

vp-ch-pnv 1

VP-PNV-DHA 3

zatean-pn dha 1

zatean-pn plus 1

zingiber 1

IndexAabacavir...................................3abacavir-lamivudine...............3abacavir-lamivudine-

zidovudine..........................3ABILIFY MYCITE..............26ABSORICA..........................43ABSORICA LD....................43acamprosate..........................53acarbose................................62ACCOLATE.........................93ACCUPRIL..........................33ACCURETIC........................33ACE AEROSOL CLOUD

ENHANCER....................59acebutolol..............................33

acetaminophen-caff-dihydrocod........................20

acetaminophen-codeine........20acetazolamide.......................88acetic acid.............................56acitretin.................................41ACTHIB (PF).......................73ACTICLATE........................11ACTIGALL..........................66ACTIQ..................................20ACTIVELLA........................76ACTONEL............................75ACTOPLUS MET................62ACTOPLUS MET XR..........62ACTOS.................................62ACULAR..............................88ACULAR LS........................88

acyclovir.......................3, 4, 49ACZONE..............................43ADACEL(TDAP ADOLESN/

ADULT)(PF)....................73ADALAT CC.......................33adapalene..............................43ADAPALENE......................43adapalene-benzoyl peroxide. 44ADASUVE...........................26ADDERALL XR..................26ADDYI.................................26adefovir...................................4ADEMPAS...........................93ADHANSIA XR...................26ADIPEX-P............................53ADRENALIN.......................93adult aspirin regimen............23


105

ADVAIR DISKUS...............93ADVAIR HFA......................93ADYPHREN........................91ADYPHREN AMP...............91ADYPHREN AMP II...........91ADYPHREN II.....................91ADZENYS ER.....................26ADZENYS XR-ODT...........26AEMCOLO............................8AEROVENT PLUS..............59afirmelle................................79AFLURIA QD 2020-21(3YR

UP)(PF).............................73AFLURIA QD 2020-21(6-

35MO)(PF).......................73AFLURIA QUAD 2020-

2021(6MO UP).................73AFREZZA............................60AFTERA...............................79AGRYLIN............................53AIRDUO RESPICLICK.......93AKLIEF................................44ak-poly-bac...........................85AKTEN (PF).........................87ALA-SCALP........................49albendazole.............................8ALBENZA..............................8albuterol sulfate....................93ALCAINE.............................87alclometasone.......................49ALDACTAZIDE..................33ALDACTONE......................33alendronate............................75alfuzosin................................96ALINIA..................................8aliskiren................................33allopurinol.............................75ALLZITAL...........................20almotriptan malate................17alophen (bisacodyl)...............66ALORA................................76alosetron................................66ALPHAGAN P.....................90alprazolam............................26alprazolam intensol...............26ALREX.................................90ALTABAX...........................47altacaine................................87ALTACE..............................33altavera (28)..........................79

ALTRENO............................44ALVESCO............................93alyacen 1/35 (28)..................79alyacen 7/7/7 (28).................79alyq.......................................93amabelz.................................76amantadine hcl........................4AMARYL.............................62ambrisentan...........................93amcinonide............................49AMERGE.............................17amethia..................................79amethia lo.............................79amethyst (28)........................79AMICAR..............................38amiloride...............................33amiloride-hydrochlorothiazide

..........................................33aminocaproic acid.................38amiodarone...........................32AMITIZA.............................66amitriptyline..........................26amitriptyline-chlordiazepoxide

..........................................26amlodipine............................33amlodipine-atorvastatin........39amlodipine-benazepril..........33amlodipine-olmesartan.........33amlodipine-valsartan............33amlodipine-valsartan-hcthiazid

..........................................33amnesteem............................44amoxapine.............................26amoxicil-clarithromy-lansopraz

..........................................70amoxicillin............................10amoxicillin-pot clavulanate. .10amphetamine sulfate.............26ampicillin..............................10AMZEEQ..............................44ANAFRANIL.......................26anagrelide..............................53ANA-LEX KIT.....................66ANALPRAM-HC...........41, 66ANALPRAM-HC SINGLES66ANAPROX DS.....................23anaspaz..................................65ANCOBON............................3ANDRODERM....................61ANDROGEL........................61

ANGELIQ............................76ANNOVERA........................78ANORO ELLIPTA...............93ANTABUSE.........................53ANTARA..............................39anucort-hc.............................66apexicon e.............................49APLENZIN...........................26APOKYN..............................16apraclonidine........................90apri........................................79APRISO................................66APTENSIO XR....................27APTIOM...............................14APTIVUS...............................4APTIVUS (WITH VITAMIN

E)........................................4ARAKODA............................8aranelle (28)..........................79ARAVA................................75ARAZLO..............................44ARCAPTA NEOHALER.....93ARICEPT..............................18ARIKAYCE............................8aripiprazole...........................27armodafinil............................27ARMOUR THYROID..........64ARNUITY ELLIPTA...........93ARTHROTEC 50.................23ARTHROTEC 75.................23ARYMO ER.........................20ascomp with codeine............20ASCOR.................................98ashlyna..................................79ASMANEX HFA.................93ASMANEX TWISTHALER93aspirin...................................23aspirin low dose....................23aspirin-dipyridamole.............38aspir-trin................................23ASTAGRAF XL...................13atazanavir................................4ATELVIA.............................75atenolol.................................34atenolol-chlorthalidone.........34ATIVAN...............................27atomoxetine..........................27atorvastatin............................39atovaquone..............................8atovaquone-proguanil.............8


106

atropine.................................86ATROPINE..........................86ATROVENT HFA................93AUBAGIO............................72aubra.....................................79aubra eq.................................79AUGMENTIN......................10AUGMENTIN XR...............10aurovela 1.5/30 (21)..............79aurovela 1/20 (21).................79aurovela 24 fe.......................79aurovela fe 1.5/30 (28)..........79aurovela fe 1-20 (28)............80AURYXIA............................66AUSTEDO............................18AVANDIA............................62avar.......................................44AVAR...................................44AVAR LS.............................44AVAR-E GREEN.................44AVAR-E LS.........................44aviane....................................80avidoxy.................................11AVIDOXY DK.....................11avita......................................44AVITA..................................44AYGESTIN..........................76ayuna.....................................80AZASAN..............................13AZASITE..............................85azathioprine..........................13azelaic acid...........................44azelastine........................55, 87azelastine-fluticasone............93AZELEX...............................44AZILECT..............................16azithromycin...........................7AZOPT.................................88AZULFIDINE......................66AZULFIDINE EN-TABS.....66azurette (28)..........................80Bb complex 1 (with folic acid)98b complex-vitamin b12.........99b complex-vitamin c-folic acid

..........................................99B-12 COMPLIANCE...........99BACIGUENT.......................85bacitracin..............................85bacitracin-polymyxin b.........85

baclofen................................19BACLOFEN.........................19BACTRIM............................11BACTRIM DS......................11balanced b-100......................99balanced b-100 complex.......99balanced b-50........................99bal-care dha...........................99BAL-CARE DHA

ESSENTIAL.....................99BALCOLTRA......................80balsalazide............................66balziva (28)...........................80BANZEL..............................14BAQSIMI.............................59BARACLUDE........................4BASAGLAR KWIKPEN U-

100 INSULIN...................60BAXDELA...........................10bayer aspirin.........................23BCG VACCINE, LIVE (PF) 73b-complex with vitamin c.....99BD MICROTAINER

LANCET..........................59BD ULTRA FINE LANCETS

..........................................59BD ULTRA-FINE NANO

PEN NEEDLE..................59bekyree (28)..........................80BELBUCA............................20belladonna alkaloids-opium..65BELSOMRA........................27benazepril..............................34benazepril-hydrochlorothiazide

..........................................34BENZACLIN........................44BENZACLIN PUMP............44BENZAMYCIN....................44BENZEPRO

(MICROSPHERES).........44BENZNIDAZOLE..................8benzonatate...........................92benzoyl peroxide...................44benzphetamine......................53benztropine...........................16BEPREVE............................87beser......................................49BESIVANCE........................85BETADINE OPHTHALMIC

PREP.................................85

betamethasone dipropionate. 49betamethasone valerate.........49betamethasone, augmented...49BETAPACE..........................33BETAPACE AF...................33betaxolol.........................34, 86bethanechol chloride.............97BETHKIS...............................8BETIMOL............................86BETOPTIC S........................86BEVESPI AEROSPHERE.. .93BEVYXXA...........................38BEXSERO............................73BEYAZ.................................80BIDIL....................................34BIJUVA................................76BIKTARVY............................4BILTRICIDE..........................8bimatoprost...........................88BINOSTO.............................75BIOTHRAX..........................73bisacodyl...............................66bisa-lax (bisacodyl)...............67bisoprolol fumarate...............34bisoprolol-hydrochlorothiazide

..........................................34BLEPH-10............................90BLEPHAMIDE....................90BLEPHAMIDE S.O.P..........90blisovi 24 fe..........................80blisovi fe 1.5/30 (28)............80blisovi fe 1/20 (28)...............80BONIVA...............................75BONJESTA..........................67BOOSTRIX TDAP...............73bosentan................................93bp 10-1..................................44BREO ELLIPTA..................94briellyn..................................80BRILINTA............................38brimonidine...........................90BRIMONIDINE-

DORZOLAMIDE (PF).....88BRIVIACT...........................14BROMFED DM...................92bromfenac.............................88bromocriptine........................16brompheniramine-pseudoeph-

dm.....................................92BROMSITE..........................88


107

BROVANA..........................94BRYHALI............................49budesonide......................67, 94bumetanide............................34BUNAVAIL.........................23BUPHENYL.........................53buprenorphine.......................20buprenorphine hcl.................20buprenorphine-naloxone.......23bupropion hcl........................27BUPROPION HCL...............27bupropion hcl (smoking deter)

..........................................55buspirone..............................27butalbital compound w/codeine

..........................................20butalbital-acetaminop-caf-cod

..........................................20butalbital-acetaminophen......20butalbital-acetaminophen-caff

..........................................20butalbital-aspirin-caffeine.....20butorphanol...........................23BYDUREON........................62BYDUREON BCISE............62BYETTA..............................62BYSTOLIC...........................34Ccabergoline............................61CADUET..............................39CAFERGOT.........................17caffeine citrate......................53CALAN SR...........................34calcipotriene....................41, 42calcipotriene-betamethasone 42calcitonin (salmon)...............61calcitriol..........................42, 61calcium acetate(phosphat bind)

..........................................67CAMBIA..............................23camila....................................76camrese.................................80camrese lo.............................80CANASA..............................67candesartan...........................34candesartan-hydrochlorothiazid

..........................................34CAPCOF...............................92CAPEX.................................49captopril................................34

captopril-hydrochlorothiazide..........................................34

CARAFATE.........................70CARBAGLU........................54carbamazepine......................14CARBATROL......................14carbidopa..............................16carbidopa-levodopa..............16carbidopa-levodopa-

entacapone........................16carbinoxamine maleate.........91CARDIZEM.........................34CARDIZEM CD...................34CARDIZEM LA...................34CARDURA...........................34CARDURA XL....................34carisoprodol..........................19carisoprodol-aspirin..............19carisoprodol-aspirin-codeine 19CARNITOR..........................54CARNITOR (SUGAR-FREE)

..........................................54carteolol................................86cartia xt.................................34carvedilol..............................34carvedilol phosphate.............34CATAPRES..........................34CATAPRES-TTS-1..............34CATAPRES-TTS-2..............34CATAPRES-TTS-3..............34CAYA CONTOURED.........76CAYSTON.............................8caziant (28)...........................80cefaclor...............................6, 7cefadroxil................................7cefdinir....................................7cefditoren pivoxil....................7cefixime..................................7cefpodoxime...........................7cefprozil..................................7cefuroxime axetil....................7celecoxib...............................23CELLCEPT..........................13CELONTIN..........................14CENTANY...........................47CENTANY AT.....................47cephalexin...............................7CEQUA................................87CEQUR SIMPLICITY.........59CERDELGA.........................61

CERVIDIL............................78cetirizine...............................91cevimeline.............................54CHANTIX............................55CHANTIX CONTINUING

MONTH BOX..................55CHANTIX STARTING

MONTH BOX..................55charlotte 24 fe.......................80chateal (28)...........................80chateal eq (28)......................80CHEMET..............................54CHENODAL........................67children's aspirin...................23chlordiazepoxide hcl.............27chlordiazepoxide-clidinium. .65chlorhexidine gluconate........55chloroquine phosphate............8chlorothiazide.......................34chlorpromazine.....................27chlorthalidone.......................34chlorzoxazone.......................19CHOLBAM..........................67cholestyramine (with sugar). 39cholestyramine light.............39choline,magnesium salicylate

..........................................23ciclodan.................................48CICLODAN KIT..................48ciclopirox..............................48ciclopirox-ure-camph-menth-

euc.....................................48cilostazol...............................39CILOXAN............................85CIMDUO................................4cimetidine.............................71cimetidine hcl.......................70cinacalcet..............................61CINVANTI...........................67CIPRO..................................10CIPRO HC............................57CIPRODEX..........................57ciprofloxacin.........................10ciprofloxacin hcl.......11, 56, 85ciprofloxacin-dexamethasone

..........................................57citalopram.............................27CITRANATAL (DUAL-

IRON)...............................99


108

CITRANATAL 90 DHA (ALGAL OIL)..................99

CITRANATAL ASSURE....99CITRANATAL B-CALM (FE

GLUC)..............................99CITRANATAL BLOOM.....99CITRANATAL DHA

(ALGAL OIL)..................99CITRANATAL HARMONY

(IRON FUM)....................99citrate of magnesia................67citroma..................................67claravis..................................44CLARINEX..........................91CLARINEX-D 12 HOUR....92clarithromycin.........................7classic prenatal......................99clearlax..................................67CLENPIQ.............................67CLEOCIN.............................78CLEOCIN HCL......................8CLEOCIN PEDIATRIC.........8CLEOCIN T.........................44CLIMARA............................76CLINDACIN ETZ................44clindacin p.............................44CLINDACIN PAC...............44clindamycin hcl.......................8clindamycin palmitate hcl.......8clindamycin pediatric.............8clindamycin phosphate. . .44, 78clindamycin-benzoyl peroxide

..........................................45clindamycin-tretinoin............45CLINDESSE.........................78CLINPRO 5000....................55clobazam...............................14clobetasol........................49, 50clobetasol-emollient..............50CLOBEX..............................50clodan....................................50CLODAN KIT......................50CLODERM...........................50clomiphene citrate.................61clomipramine........................27clonazepam...........................14clonidine...............................34clonidine hcl...................27, 34clopidogrel............................39clorazepate dipotassium........27

clotrimazole............................3clotrimazole-betamethasone. 48clovique................................54clozapine...............................27CLOZARIL..........................27c-nate dha..............................99COARTEM.............................8codeine sulfate......................20codeine-butalbital-asa-caff. . .20codeine-guaifenesin..............92CODITUSSIN AC................92CODITUSSIN DAC.............92COLAZAL............................67COLCRYS............................75colesevelam..........................39COLESTID...........................39COLESTID FLAVORED.....39colestipol...............................39COMBIGAN........................88COMBIPATCH....................76COMBIVENT RESPIMAT..94COMBIVIR............................4COMPACT SPACE

CHAMBER......................59complete natal dha................99complex b-100......................99COMTAN.............................16CONCEPT DHA..................99CONCEPT OB.....................99CONCERTA.........................27CONDYLOX........................42CONSENSI...........................34constulose.............................67CONTRAVE........................53CONZIP................................23CORDRAN...........................50CORDRAN TAPE LARGE

ROLL................................50COREG CR..........................34coremino...............................11CORGARD...........................35CORLANOR........................41CORTANE-B.......................43CORTEF...............................57CORTENEMA.....................67cortisone................................57CORTISPORIN....................47CORTISPORIN-TC..............57COSOPT (PF).......................88COTEMPLA XR-ODT.........27

covaryx.................................76covaryx h.s............................76CREON.................................67CRESEMBA...........................3CRIXIVAN.............................4cromolyn...................67, 87, 94crotan....................................52cryselle (28)..........................80CUROSURF.........................94CUTIVATE..........................50CUVPOSA............................65cyclafem 1/35 (28)................80cyclafem 7/7/7 (28)...............80cyclobenzaprine....................19CYCLOGYL........................86CYCLOMYDRIL.................91cyclopentolate.......................86CYCLOSERINE.....................8CYCLOSET..........................62cyclosporine..........................13CYCLOSPORINE IN

KLARITY.........................87cyclosporine modified..........13cyproheptadine......................91cyred.....................................80cyred eq.................................80CYSTADANE......................67CYSTAGON........................97CYSTARAN.........................87CYTOTEC............................71Ddalfampridine........................18DALIRESP...........................94danazol..................................61DANTRIUM.........................19dantrolene.............................19dapsone.............................8, 45DAPTACEL (DTAP

PEDIATRIC) (PF)............73DARAPRIM...........................8darifenacin............................96dasetta 1/35 (28)...................80dasetta 7/7/7 (28)..................80DAYPRO..............................23daysee...................................80DAYTRANA........................27DAYVIGO............................27DDAVP................................61deblitane................................76decadron................................57


109

deferasirox............................54DEFITELIO..........................39demeclocycline.....................11DEMSER..............................35DENAVIR............................49denta 5000 plus.....................55dentagel.................................56DEPAKOTE.........................14DEPAKOTE ER...................14DEPAKOTE SPRINKLES...14DEPEN TITRATABS..........75DERMA-SMOOTHE/FS

BODY OIL.......................50DERMA-SMOOTHE/FS

SCALP OIL......................50DERMOTIC OIL..................57DESCOVY.............................4desipramine...........................27desloratadine.........................91desmopressin........................61desog-e.estradiol/e.estradiol. 80desogestrel-ethinyl estradiol. 80DESONATE.........................50desonide................................50DESOWEN...........................50desoximetasone.....................50DESOXYN...........................27DESVENLAFAXINE..........27desvenlafaxine succinate......27dexabliss...............................57dexamethasone......................57dexamethasone intensol........57dexamethasone sodium

phosphate..........................90DEXAMETH-

MOXIFLOX(PF)-NACL,ISO........................89

DEXAMET-MOXIFL-KETORO-NACL(PF).......87

dexchlorpheniramine maleate..........................................91

DEXCOM G4 RECEIVER. .59DEXCOM G5 RECEIVER. .59DEXCOM G6 RECEIVER. .59DEXCOM RECEIVER........59DEXEDRINE SPANSULE. .27DEXILANT..........................71dexmethylphenidate..............28dextroamphetamine..............28

dextroamphetamine-amphetamine.....................28

DIACOMIT..........................14dialyvite 800.........................99DIASTAT.............................14DIASTAT ACUDIAL..........14diazepam.........................14, 28diazepam intensol.................28diazoxide...............................59DIBENZYLINE....................35DICLEGIS............................67diclofenac potassium............23diclofenac sodium.....23, 24, 88diclofenac-misoprostol.........24dicloxacillin..........................10dicyclomine..........................65didanosine...............................4diethylpropion.......................53DIFFERIN............................45DIFICID..................................7diflorasone............................50DIFLUCAN............................3diflunisal...............................24digitek...................................38digox.....................................38digoxin..................................38dihydroergotamine................17DILANTIN...........................14DILANTIN EXTENDED.....14DILANTIN INFATABS.......14DILANTIN-125....................14DILATRATE-SR..................41DILAUDID...........................20diltiazem...............................35dilt-xr....................................35dimethyl fumarate.................72diphenoxylate-atropine.........65DIPROLENE........................50dipyridamole.........................39DISALCID............................24diskets...................................20disopyramide phosphate.......33disulfiram..............................54DITROPAN XL....................96DIURIL.................................35divalproex.............................14DIVIGEL..............................77dofetilide...............................33DOLOPHINE.......................20donepezil...............................18

DONNATAL........................65DOPTELET (15 TAB PACK)

..........................................39DORYX................................11DORYX MPC.......................11dorzolamide..........................88DORZOLAMIDE (PF).........88dorzolamide-timolol.............88dorzolamide-timolol (pf)......88DORZOLAMIDE-TIMOLOL

(PF)...................................88dotti.......................................77DOVATO...............................4DOVONEX..........................42doxazosin..............................35doxepin...........................28, 43doxercalciferol......................61doxycycline hyclate..............11doxycycline monohydrate.....11DRISDOL.............................99drospirenone-e.estradiol-lm.fa

..........................................80drospirenone-ethinyl estradiol

..........................................80DUAVEE..............................77ducodyl (bisacodyl)..............67DUET DHA BALANCED...99DUET DHA WITH OMEGA-3

..........................................99DUETACT............................62DUEXIS................................24DULERA..............................94duloxetine.............................28DUOBRII..............................50DUODOTE...........................53DUOPA................................16DUPIXENT PEN..................43DUPIXENT SYRINGE........43DURAGESIC.......................20DUREZOL............................90dutasteride.............................96dutasteride-tamsulosin..........96DXEVO................................57DYANAVEL XR.................28DYAZIDE............................35DYMISTA............................94DYRENIUM.........................35Ee.c. prin.................................24e.e.s. 400.................................7


110

E.E.S. GRANULES................7EC-NAPROSYN..................24econazole..............................48econtra ez..............................80econtra one-step....................80ecotrin...................................24ecotrin low strength..............24ECOZA.................................48EDARBI...............................35EDARBYCLOR...................35EDECRIN.............................35EDLUAR..............................28ed-spaz..................................65EDURANT.............................4eemt......................................77eemt hs..................................77efavirenz.................................4effer-k...................................98EFFER-K..............................98EFFIENT..............................39ELESTRIN...........................77eletriptan...............................17ELIMITE..............................52elinest....................................80ELIQUIS...............................39ELIQUIS DVT-PE TREAT

30D START......................39ELIXOPHYLLIN.................94ELLA....................................81ELMIRON............................97eluryng..................................78emoquette..............................81EMSAM................................28EMTRIVA..............................4EMVERM...............................8enalapril maleate...................35enalapril-hydrochlorothiazide

..........................................35ENBRACE HR.....................99ENDARI...............................54endocet..................................21ENGERIX-B (PF).................73ENGERIX-B PEDIATRIC

(PF)...................................73enpresse................................81enskyce.................................81ENSTILAR...........................42entacapone............................16entecavir..................................4ENTOCORT EC...................67

ENTRESTO..........................41enulose..................................67ENVARSUS XR...................13ENZOCLEAR......................45EPCLUSA..............................4EPIDIOLEX.........................14EPIFOAM.............................42epinastine..............................87EPINEPHINE

PROFESSIONAL EMS....91EPINEPHRINE

PROFESSIONAL.............91EPINEPHRINESNAP-EMS.91EPINEPHRINESNAP-V......91EPIPEN 2-PAK....................91EPIPEN JR 2-PAK...............91epitol.....................................14EPIVIR...................................4EPIVIR HBV..........................4eplerenone.............................35eprosartan..............................35EPZICOM...............................4EQUETRO............................14ergocalciferol (vitamin d2)...99ergoloid.................................28ERGOMAR..........................17ergotamine-caffeine..............17errin.......................................77ERTACZO............................48ery pads.................................45erygel....................................45ERYPED 200..........................7ERYPED 400..........................7ery-tab.....................................7ERY-TAB...............................7erythrocin (as stearate)............7erythromycin.....................8, 85erythromycin ethylsuccinate.7,

8erythromycin with ethanol....45erythromycin-benzoyl peroxide

..........................................45ESBRIET..............................94escitalopram oxalate.............28ESGIC...................................21esomeprazole magnesium.....71estarylla.................................81estazolam..............................28ESTRACE............................77estradiol................................77

estradiol-norethindrone acet. 77ESTRING.............................77estrogens-methyltestosterone77ESTROSTEP FE-28.............81eszopiclone...........................28ethacrynic acid......................35ethambutol..............................8ethosuximide.........................14ethynodiol diac-eth estradiol 81etodolac.................................24etonogestrel-ethinyl estradiol78EUCRISA.............................43EURAX................................53euthyrox................................64EVAMIST............................77EVEKEO..............................28EVEKEO ODT.....................28everolimus

(immunosuppressive)........13EVISTA................................75EVOCLIN.............................45EVOTAZ................................4EVOXAC..............................54EVRYSDI.............................18EXELDERM........................48EXELON..............................18EXTINA...............................48ezetimibe...............................39ezetimibe-simvastatin...........39FFABIOR................................45FACTIVE.............................11falmina (28)..........................81famciclovir..............................4famotidine.............................71FANAPT...............................28FARXIGA............................62FASENRA PEN...................94fayosim.................................81FC2 FEMALE CONDOM....76febuxostat..............................75felbamate..............................14FELBATOL..........................14FELDENE............................24felodipine..............................35fem ph...................................78FEMCAP..............................76FEMHRT LOW DOSE........77femynor.................................81fenofibrate.............................40


111

FENOFIBRATE...................40fenofibrate micronized..........40fenofibrate nanocrystallized. 40fenofibric acid.......................40fenofibric acid (choline).......40FENOGLIDE........................40fenoprofen.............................24fentanyl.................................21fentanyl citrate......................21FERRIPROX........................54FETZIMA.............................28FEXMID...............................19FIBRICOR............................40FINACEA.............................45finasteride.............................96FIORICET............................21FIORICET WITH CODEINE

..........................................21FIORINAL............................21FIORINAL-CODEINE #3....21FIRDAPSE...........................18FIRVANQ............................12flac otic oil............................57FLAGYL................................9FLAREX...............................90flavoxate...............................96flecainide..............................33FLECTOR............................24fleet laxative (bisacodyl)......67FLEXICHAMBER...............59FLOMAX.............................96FLOVENT DISKUS.............94FLOVENT HFA...................94FLUAD 2020-2021 (65 YR

UP)(PF).............................73FLUAD QUAD 2020-21(65Y

UP)(PF).............................73FLUARIX QUAD 2020-2021

(PF)...................................73FLUBLOK QUAD 2020-2021

(PF)...................................73FLUCELVAX QUAD 2020-

2021..................................73FLUCELVAX QUAD 2020-

2021 (PF)..........................73fluconazole..............................3flucytosine..............................3fludrocortisone......................57FLULAVAL QUAD 2020-

2021 (PF)..........................73

FLUMADINE.........................4FLUMIST QUAD 2020-2021

..........................................73flunisolide.............................94fluocinolone..........................50fluocinolone acetonide oil... .57fluocinolone and shower cap 50fluocinonide..........................51fluocinonide-e.......................51fluorescein-proparacaine......87fluoride (sodium)............56, 99FLUORIDEX DAILY

DEFENSE.........................56FLUORIDEX SENSITIVITY

RELIEF.............................56fluoritab..............................100fluorometholone....................90fluoxetine..............................28fluphenazine hcl....................28flurandrenolide......................51flurazepam............................28flurbiprofen...........................24flurbiprofen sodium..............88fluticasone propionate.....51, 94FLUTICASONE PROPION-

SALMETEROL................94fluvastatin.............................40fluvoxamine....................28, 29FLUZONE HIGHDOSE

QUAD 20-21 PF...............73FLUZONE QUAD 2020-2021

..........................................73FLUZONE QUAD 2020-2021

(PF)...................................73FML LIQUIFILM.................90FOLET ONE.......................100folic acid.............................100folivane-ob..........................100foltabs 800..........................100FORFIVO XL.......................29FORTAMET.........................62FOSAMAX...........................75FOSAMAX PLUS D............75fosamprenavir.........................4fosaprepitant.........................67fosinopril...............................35fosinopril-hydrochlorothiazide

..........................................35FREESTYLE FREEDOM....59

FREESTYLE FREEDOM LITE..................................59

FREESTYLE INSULINX. .58, 59

FREESTYLE INSULINX TEST STRIPS...................58

FREESTYLE LITE METER59FREESTYLE LITE STRIPS 58FREESTYLE TEST.............58FROVA.................................17frovatriptan...........................17full spectrum b-vitamin c....100FURADANTIN....................12furosemide............................35fyavolv..................................77FYCOMPA...........................14Gg tussin ac.............................92gabapentin.......................14, 15GABITRIL............................15GALAFOLD.........................61galantamine...........................18GALZIN...............................98GARDASIL 9 (PF)...............73GASTROCROM..................67gatifloxacin...........................85GATTEX 30-VIAL..............67gavilax..................................67gavilyte-c..............................67gavilyte-g..............................67gavilyte-n..............................67GELNIQUE..........................96gemfibrozil............................40GENERESS FE....................81generlac.................................67gengraf..................................13gentak....................................85gentamicin......................47, 85gentle laxative (bisacodyl)....67gentlelax................................68GENVOYA............................4GEODON.............................29gianvi (28).............................81GILENYA............................72GLIADEL WAFER..............13glimepiride............................62glipizide................................63glipizide-metformin..............63GLOPERBA.........................75GLUCAGEN HYPOKIT......59


112

GLUCAGON (HCL) EMERGENCY KIT..........59

GLUCAGON EMERGENCY KIT (HUMAN).................59

GLUCOTROL......................63GLUCOTROL XL................63glyburide...............................63glyburide micronized............63glyburide-metformin.............63GLYCATE............................65glycolax................................68glycopyrrolate.......................65glydo.....................................47GLYNASE............................63GLYSET...............................63GLYXAMBI.........................63GOLYTELY.........................68GONITRO............................41GRALISE.............................15griseofulvin microsize............3griseofulvin ultramicrosize.....3guaiatussin ac........................92guanfacine.......................29, 35guanidine..............................29GVOKE HYPOPEN 2-PACK

..........................................59GVOKE PFS 2-PACK

SYRINGE.........................59GYNAZOLE-1.....................78gynol ii..................................78Hhailey....................................81hailey 24 fe...........................81hailey fe 1.5/30 (28)..............81hailey fe 1/20 (28).................81halcinonide............................51HALCION............................29halobetasol propionate..........51HALOBETASOL

PROPIONATE.................51HALOG................................51haloperidol............................29haloperidol lactate.................29HARVONI..............................4HAVRIX (PF).......................73healthylax..............................68heather..................................77HEMANGEOL.....................35hemmorex-hc........................68HEPLISAV-B (PF)...............73

HEPSERA..............................4HETLIOZ.............................29HIBERIX (PF)......................73hidex.....................................57HIPREX................................12HISTEX-AC.........................92homatropaire.........................86HORIZANT..........................18HUMALOG JUNIOR

KWIKPEN U-100.............60HUMALOG KWIKPEN

INSULIN..........................60HUMALOG MIX 50-50

INSULN U-100................60HUMALOG MIX 50-50

KWIKPEN........................60HUMALOG MIX 75-25

KWIKPEN........................60HUMALOG MIX 75-25(U-

100)INSULN....................60HUMALOG U-100 INSULIN

..........................................60HUMULIN 70/30 U-100

INSULIN..........................60HUMULIN 70/30 U-100

KWIKPEN........................60HUMULIN N NPH INSULIN

KWIKPEN........................60HUMULIN N NPH U-100

INSULIN..........................60HUMULIN R REGULAR U-

100 INSULN.....................60HUMULIN R U-500 (CONC)

INSULIN..........................60HUMULIN R U-500 (CONC)

KWIKPEN........................60hydralazine............................35hydrochlorothiazide..............35hydrocodone bitartrate..........21hydrocodone-acetaminophen21hydrocodone-chlorpheniramine

..........................................92hydrocodone-homatropine....92hydrocodone-ibuprofen........21hydrocortisone..........51, 57, 68hydrocortisone acetate..........68hydrocortisone butyrate........51hydrocortisone butyr-emollient

..........................................51hydrocortisone valerate.........51

hydrocortisone-acetic acid....57hydrocortisone-pramoxine..42,

68hydromet...............................92hydromorphone.....................21hydroxychloroquine................9hydroxyzine hcl....................91hydroxyzine pamoate............91hyophen................................97hyoscyamine sulfate.............65hyosyne.................................65HYSINGLA ER....................21Iibandronate...........................75ibu.........................................24ibuprofen...............................24ibuprofen-oxycodone............21ILEVRO................................88imipramine hcl......................29imipramine pamoate.............29IMOVAX RABIES VACCINE

(PF)...................................74IMPAVIDO............................9IMPOYZ...............................51IMURAN..............................13IMVEXXY MAINTENANCE

PACK................................77IMVEXXY STARTER PACK

..........................................77INBRIJA...............................16incassia..................................77INCRUSE ELLIPTA............94indapamide............................35INDERAL XL......................35INDOCIN.............................24indomethacin........................24INFANRIX (DTAP) (PF).....74INFASURF...........................54INNOPRAN XL...................36INOVA.................................45INOVA 4-1...........................42INOVA 8-2...........................42INSPIRACHAMBER...........59INSPRA................................36INTELENCE..........................4INTERMEZZO.....................29INTRAROSA.......................78introvale................................81INVEGA...............................29INVELTYS...........................90


113

INVIRASE..............................4INVOKAMET......................63INVOKAMET XR...............63INVOKANA.........................63iodine-sodium iodide............43IODOFLEX..........................43IODOSORB..........................43IOPIDINE.............................90IPOL.....................................74ipratropium bromide.......56, 94ipratropium-albuterol............94irbesartan..............................36irbesartan-hydrochlorothiazide

..........................................36ISENTRESS...........................5ISENTRESS HD.....................5isibloom................................81isoniazid..................................9ISOPTO ATROPINE...........86ISOPTO CARPINE..............87ISORDIL..............................41ISORDIL TITRADOSE.......41isosorbide dinitrate...............41isosorbide mononitrate.........41isotretinoin............................45isoxsuprine............................78isradipine..............................36itraconazole.............................3ivermectin...............................9IXIARO (PF)........................74Jjaimiess.................................81JALYN..................................97jantoven................................39JANUMET............................63JANUMET XR.....................63JANUVIA.............................63JARDIANCE........................63jasmiel (28)...........................81jencycla.................................77JENTADUETO....................63JENTADUETO XR..............63jinteli.....................................77jolessa...................................81JORNAY PM........................29JUBLIA................................48juleber...................................81JULUCA.................................5junel 1.5/30 (21)...................81junel 1/20 (21)......................81

junel fe 1.5/30 (28)...............81junel fe 1/20 (28)..................81junel fe 24.............................81JUXTAPID...........................40JYNARQUE.........................61KKADIAN..............................21kaitlib fe................................81KALETRA..............................5kalliga...................................81KALYDECO........................94KAPVAY..............................29KARBINAL ER...................91kariva (28).............................81KEFLEX.................................7kelnor 1/35 (28)....................81kelnor 1-50............................81KENALOG...........................51KERYDIN............................48ketoconazole.....................3, 48ketodan..................................48ketodan kit............................48ketoprofen.............................24ketorolac.........................24, 88KEVEYIS.............................18KINRIX (PF)........................74kionex (with sorbitol)...........68KITABIS PAK.......................9KLARITY-A (AZITHRO-

CHONDR)(PF).................87KLARITY-B (BETAMETH-

CHOND)(PF)....................87KLARITY-L (LOTEPRED-

CHOND)(PF)....................87KLARON..............................47KLONOPIN..........................15klor-con.................................98klor-con/ef............................98kobee...................................100KOSHER PRENATAL PLUS

IRON..............................100K-PHOS NO 2......................97K-PHOS ORIGINAL...........97kpn......................................100KRINTAFEL..........................9KRISTALOSE......................68k-tab......................................98K-TAB..................................98kurvelo (28)..........................81KUVAN................................61

KYLEENA...........................76Ll norgest/e.estradiol-e.estrad. 82labetalol................................36LACRISERT........................87lactulose................................68LAMICTAL XR STARTER 15lamivudine..............................5lamivudine-zidovudine...........5lamotrigine............................15LANCETS............................59LANOXIN............................38lansoprazole..........................71lanthanum.............................68LANTUS SOLOSTAR U-100

INSULIN..........................60LANTUS U-100 INSULIN. .60larin 1.5/30 (21)....................82larin 1/20 (21).......................82larin 24 fe..............................82larin fe 1.5/30 (28)................82larin fe 1/20 (28)...................82larissia...................................82LASIX..................................36LASTACAFT.......................87latanoprost............................88LATANOPROST (PF).........88LATUDA..............................29laxaclear................................68laxative (bisacodyl)...............68laxative peg 3350..................68layolis fe...............................82leena 28.................................82leflunomide...........................75LESCOL XL.........................40lessina...................................82levalbuterol hcl.....................94LEVBID................................65LEVEMIR FLEXTOUCH U-

100 INSULN.....................60LEVEMIR U-100 INSULIN 60levetiracetam.........................15LEVITRA.............................97levobunolol...........................86levocarnitine.........................54levocarnitine (with sugar).....54levocetirizine........................91levofloxacin....................11, 85levonest (28).........................82levonorgestrel.......................82


114

levonorgestrel-ethinyl estrad 82levonorg-eth estrad triphasic 82levora-28...............................82levorphanol tartrate...............21LEVORPHANOL

TARTRATE.....................21levo-t.....................................64levothyroxine........................64levoxyl..................................64LEVSIN................................65LEVSIN/SL..........................65LEXETTE.............................51LEXIVA.................................5LIALDA...............................68LICART................................24lidocaine................................47lidocaine hcl..........................47lidocaine hcl-hydrocortison ac

....................................47, 68LIDOCAINE HCL-

HYDROCORTISON AC. 68lidocaine viscous...................47lidocaine-hydrocortisone-aloe

..........................................68lidocaine-prilocaine..............47LIDOCIDEX-I......................57LIDOCILONE I....................57LILETTA..............................76lillow (28).............................82lindane..................................53linezolid..................................9LINZESS..............................68liothyronine...........................64LIPOFEN..............................40lisinopril................................36lisinopril-hydrochlorothiazide

..........................................36lite coat aspirin......................24lithium carbonate..................29lithium citrate........................29LITHOBID...........................29LITHOSTAT........................54LIVALO...............................40LO LOESTRIN FE...............82LODINE...............................24LODOSYN...........................16lojaimiess..............................82LOKELMA...........................68LOMAIRA............................53LOMOTIL............................65

LONHALA MAGNAIR REFILL.............................94

LONHALA MAGNAIR STARTER........................94

LOPID..................................40lopinavir-ritonavir...................5lopreeza.................................77LOPRESSOR........................36LOPROX..............................48LOPROX (AS OLAMINE). .48LOPROX KIT.......................48lorazepam..............................29lorazepam intensol................29lorcet (hydrocodone).............21lorcet hd................................21LORTAB ELIXIR................21loryna (28)............................82LORZONE............................19losartan..................................36losartan-hydrochlorothiazide 36LOSEASONIQUE................82LOTEMAX...........................90LOTEMAX SM....................90LOTENSIN...........................36LOTENSIN HCT..................36loteprednol etabonate............90LOTRONEX.........................68lovastatin...............................40LOVAZA..............................40low-ogestrel (28)...................82loxapine succinate.................29lo-zumandimine (28)............82lta pre-attached.....................47ludent fluoride.....................100lugols..............................47, 98LUMIGAN...........................88lutera (28).............................82LUXIQ..................................51LUZU....................................48LYSTEDA............................78LYUMJEV KWIKPEN U-100

INSULIN..........................60LYUMJEV KWIKPEN U-200

INSULIN..........................60LYUMJEV U-100 INSULIN

..........................................60lyza........................................77MMACROBID.........................12MACRODANTIN................12

mafenide acetate...................47magnesium citrate.................68MALARONE..........................9MALARONE PEDIATRIC....9malathion..............................53maprotiline............................29MAR-COF CG.....................92marlissa (28).........................82MARNATAL-F..................100MARPLAN...........................29matzim la..............................36MAXITROL.........................89maxi-tuss ac..........................92MAXI-TUSS CD..................92MAXZIDE............................36MAXZIDE-25MG................36MAYZENT...........................72m-clear wc............................92meclofenamate......................24MEDROL.............................57MEDROL (PAK)..................57medroxyprogesterone...........77mefenamic acid.....................24mefloquine..............................9megestrol..............................13melodetta 24 fe.....................82meloxicam............................24memantine............................18MEMANTINE......................18MENACTRA (PF)................74M-END PE...........................92MENEST..............................77MENOSTAR........................77MENVEO A-C-Y-W-135-DIP

(PF)...................................74meperidine............................21MEPHYTON........................39meprobamate........................19MEPRON................................9mesalamine...........................68mesalamine with cleansing

wipe..................................68MESTINON..........................19MESTINON TIMESPAN.....19metaproterenol......................94metaxall................................19metaxalone............................19metformin.............................63methadone.......................21, 22methadose.............................22


115

methamphetamine.................29methazolamide......................88methenamine hippurate.........12methenamine mandelate.......12methen-sod phos-meth blue-

hyos...................................97methergine............................85methimazole..........................58methocarbamol.....................19methoxsalen..........................43methscopolamine..................65methyl salicylate...................43methyldopa...........................36methyldopa-

hydrochlorothiazide..........36methylergonovine.................85METHYLIN.........................29methylphenidate hcl........29, 30METHYLPHENIDATE HCL

....................................29, 30methylprednisolone..............57metolazone............................36METOPIRONE....................54metoprolol succinate.............36metoprolol ta-hydrochlorothiaz

..........................................36metoprolol tartrate................36METROCREAM..................45METROGEL........................45METROGEL VAGINAL.....78metronidazole.............9, 45, 78metyrosine............................36mexiletine.............................33mibelas 24 fe.........................82MICONAZOLE NITRATE-

ZINC OX-PET..................48microgestin 1.5/30 (21).........82microgestin 1/20 (21)............82microgestin fe 1.5/30 (28)... .82microgestin fe 1/20 (28).......82MICROSPACER..................59MIDAZOLAM IN NACL,ISO-

OSMO(PF)........................30midodrine..............................54migergot................................17miglitol..................................63miglustat...............................61MIGRANAL.........................17mili........................................82milk of magnesia..................69

milk of magnesia concentrated..........................................69

millipred................................58millipred dp...........................58mimvey.................................77MINIPRESS.........................36MINITRAN..........................41MINIVELLE........................77minocycline..........................11MINOLIRA ER....................11minoxidil...............................36miralax..................................69MIRAPEX ER......................17MIRCETTE (28)...................82MIRENA..............................76mirtazapine...........................30MIRVASO............................45misoprostol...........................71MITIGARE...........................75MITOSOL............................89M-M-R II (PF)......................74m-natal plus........................100MOBIC.................................24modafinil...............................30moexipril...............................36molindone.............................30mometasone....................51, 95mondoxyne nl.......................11MONODOX.........................11mono-linyah..........................82montelukast...........................95MONUROL..........................12morgidox...............................12MORGIDOX 1X 50.............12MORGIDOX 2X100............12morphine...............................22MORPHINE.........................22morphine concentrate...........22MOTEGRITY.......................69MOTOFEN...........................65MOVANTIK........................69MOVIPREP..........................69MOXATAG..........................10MOXEZA.............................85moxifloxacin...................11, 85MS CONTIN........................22MULTAQ.............................33multi-vitamin with fluoride 100multivitamins with fluoride 100mupirocin..............................47

mupirocin calcium................47MUSE...................................97mvc-fluoride.......................100my choice..............................83my way.................................83MYAMBUTOL......................9MYCOBUTIN........................9mycophenolate mofetil.........13mycophenolate sodium.........13MYDAYIS............................30MYDRIACYL......................86MYFORTIC..........................13mynatal...............................100mynatal advance.................100mynatal plus........................100mynatal-z............................100mynate 90 plus....................100myorisan...............................45MYOVIEW KIT...................54MYRBETRIQ.......................96MYSOLINE..........................15MYTESI...............................66MYXREDLIN......................61Nnabumetone...........................25nadolol..................................36nadolol-bendroflumethiazide36naftifine.................................48NAFTIN................................49NALFON..............................25NALOCET............................22naloxone................................25naltrexone.............................25NAMENDA..........................18NAMENDA TITRATION

PAK..................................18NAMENDA XR...................18NAMZARIC.........................19NAPRELAN CR...................25NAPROSYN.........................25naproxen...............................25naproxen sodium...................25naproxen-esomeprazole........25naratriptan.............................18NARCAN.............................25NARDIL...............................30NASCOBAL.......................100NATACHEW (FE BIS-

GLYCINATE)................100NATACYN...........................85


116

NATAZIA............................83nateglinide............................63NATROBA...........................53natural b-100 complex........100natura-lax..............................69nature-throid.........................64NAYZILAM.........................15NEBUPENT...........................9necon 0.5/35 (28)..................83NEEVODHA (WITH ALGAL

OIL)................................100nefazodone............................30neomycin................................9neomycin-bacitracin-poly-hc89neomycin-bacitracin-

polymyxin.........................85neomycin-polymyxin b-

dexameth...........................89neomycin-polymyxin-

gramicidin.........................85neomycin-polymyxin-hc.57, 89neo-polycin...........................85neo-polycin hc......................89NEORAL..............................13NEO-SYNALAR..................47NEO-SYNALAR KIT..........47NESTABS..........................100NESTABS ABC.................100NESTABS DHA.................100NESTABS ONE.................100neuac.....................................45NEUAC KIT.........................45NEUPRO..............................17nevirapine...............................5new day.................................83newgen................................100NEXIUM..............................71NEXIUM PACKET..............71NEXLETOL.........................40NEXLIZET...........................40NEXPLANON......................78niacin....................................40NIASPAN EXTENDED-

RELEASE.........................40nicardipine............................36NICODERM CQ..................55nicorette................................55NICORETTE........................55nicotine.................................55nicotine (polacrilex)..............55

NICOTROL..........................55NICOTROL NS....................55nifedipine..............................36nikki (28)..............................83nimodipine............................36NINJACOF-XG....................92nisoldipine............................36nitisinone..............................54nitro-bid................................41NITRO-DUR........................41nitrofurantoin........................12nitrofurantoin macrocrystal. .12nitrofurantoin monohyd/m-

cryst..................................12nitroglycerin..........................41NITROLINGUAL................41NITROMIST........................41NITROSTAT........................41nitro-time..............................41NITYR..................................54nizatidine..............................71NOCDURNA (MEN)...........61NOCDURNA (WOMEN)....61nolix......................................51nora-be..................................78noreth-ethinyl estradiol-iron. 83norethindrone (contraceptive)

..........................................78norethindrone acetate............78norethindrone ac-eth estradiol

....................................78, 83norethindrone-e.estradiol-iron

..........................................83NORGESIC FORTE.............19norgestimate-ethinyl estradiol

..........................................83NORITATE..........................45norlyda..................................78NORPACE............................33NORPACE CR.....................33NORPRAMIN......................30NORTHERA........................54nortrel 0.5/35 (28).................83nortrel 1/35 (21)....................83nortrel 1/35 (28)....................83nortrel 7/7/7 (28)...................83nortriptyline..........................30NORVIR.................................5NOURIANZ.........................17NOXAFIL...............................3

np thyroid..............................64NUCORT..............................51NUCYNTA...........................25NUCYNTA ER.....................25NUEDEXTA........................19NULEV.................................66NULYTELY LEMON-LIME

..........................................69NULYTELY WITH FLAVOR

PACKS.............................69NUPLAZID..........................30NURTEC ODT.....................18NUVARING.........................79NUVESSA............................79nyamyc..................................49nystatin..............................3, 49nystatin-triamcinolone..........49nystop....................................49OOB COMPLETE ONE.......100OB COMPLETE PETITE. .100OB COMPLETE PREMIER

........................................100OB COMPLETE WITH DHA

........................................101OBREDON...........................92obstetrix dha.......................101OBSTETRIX EC................101OBSTETRIX ONE.............101OBTREX DHA...................101OCALIVA............................69ocella.....................................83OCUFLOX...........................85ODEFSEY..............................5OFEV....................................95ofloxacin...................11, 57, 85olanzapine.............................30olanzapine-fluoxetine...........30olmesartan.............................37olmesartan-amlodipin-

hcthiazid............................37olmesartan-

hydrochlorothiazide..........37olopatadine......................56, 87OLUX...................................51OLUX-E...............................51OMECLAMOX-PAK...........71omega-3 acid ethyl esters.....40omeprazole............................72


117

omeprazole-sodium bicarbonate........................72

OMNIPOD DASH 5 PACK POD..................................59

one daily prenatal................101ONETOUCH ULTRA BLUE

TEST STRIP.....................58ONETOUCH ULTRA2

METER.............................59ONETOUCH ULTRAMINI.59ONETOUCH VERIO FLEX

METER.............................60ONETOUCH VERIO IQ

METER.............................60ONETOUCH VERIO METER

..........................................60ONETOUCH VERIO TEST

STRIPS.............................58ONEXTON...........................45ONFI.....................................15ONZETRA XSAIL...............18opcicon one-step...................83opium tincture.......................66OPSUMIT.............................95option-2.................................83ORACEA..............................12ORACIT...............................97oral saline laxative................69oralone..................................56ORAPRED ODT..................58ORAVIG.................................3ORENITRAM......................37ORFADIN............................54ORILISSA............................62ORKAMBI...........................95orphenadrine citrate..............19orphenadrine-asa-caffeine.. . .19orphengesic forte..................19orsythia.................................83oscimin..................................66oscimin sl..............................66oscimin sr..............................66oseltamivir..............................5OSENI..................................63OSMOLEX ER.....................17OSPHENA............................79OTEZLA...............................75OTEZLA STARTER............75OTIPRIO..............................57OTOVEL..............................57

OVACE................................42OVACE PLUS......................42OVACE PLUS SHAMPOO. 42OVACE PLUS WASH.........42OVIDE..................................53oxaprozin..............................25OXAYDO.............................22oxazepam..............................30oxcarbazepine.......................15OXERVATE.........................87oxiconazole...........................49OXISTAT.............................49OXSORALEN ULTRA........43OXTELLAR XR...................15oxybutynin chloride..............96oxycodone.............................22oxycodone-acetaminophen...22oxycodone-aspirin................22OXYCONTIN......................22oxymorphone........................22OXYTROL...........................96OZEMPIC.............................63Ppacerone................................33PACNEX..............................45paliperidone..........................30PAMELOR...........................30PANDEL..............................52pantoprazole..........................72PARAGARD T 380A...........76PAREMYD...........................86paricalcitol............................62PARLODEL.........................17PARNATE............................30paroex oral rinse...................56paromomycin..........................9paroxetine hcl.......................30paroxetine

mesylate(menop.sym).......30PASER....................................9PATANASE.........................56PAXIL..................................30PAXIL CR............................30PAZEO.................................87P-CARE K40........................58P-CARE K80........................58PEDIARIX (PF)...................74PEDVAX HIB (PF)..............74peg 3350-electrolytes............69PEGANONE.........................15

peg-electrolyte soln...............69peg-prep................................69penicillamine........................76penicillin v potassium...........10PENTACEL (PF)..................74PENTACEL ACTHIB

COMPONENT (PF).........74pentamidine............................9PENTASA............................69pentazocine-naloxone...........25pentoxifylline........................39PEPCID................................72PERFOROMIST...................95PERIDEX.............................56perindopril erbumine............37periogard...............................56permethrin.............................53perphenazine.........................30perphenazine-amitriptyline...30perry prenatal......................101PEXEVA..............................30phenazopyridine....................98phendimetrazine tartrate.......53phenelzine.............................30phenobarb-hyoscy-atropine-

scop...................................66phenobarbital........................15phenohytro............................66phenoxybenzamine...............37phentermine..........................53phenylephrine hcl.................91PHENYTEK.........................15phenytoin..............................15phenytoin sodium extended. .15philith....................................83PHOSLYRA.........................69phosphasal............................97phosphate laxative................69PHOSPHOLINE IODIDE....86PHYSICIANS EZ USE B-12

........................................101phytonadione (vitamin k1)....39pilocarpine hcl..........54, 56, 87pimecrolimus........................43pimozide...............................31pimtrea (28)..........................83pindolol.................................37pioglitazone..........................63pioglitazone-glimepiride.......63pioglitazone-metformin........63


118

pirmella.................................83piroxicam..............................25PLAN B ONE-STEP............83PLENVU..............................69PLEXION.............................45PLEXION CLEANSING

CLOTHS...........................45PLIAGLIS............................47PNEUMOVAX-23...............74pnv 29-1..............................101pnv-dha...............................101pnv-dha + docusate.............101pnv-omega..........................101pnv-select............................101POD-CARE 100K................58podofilox...............................43polycin..................................85polyethylene glycol 3350......69polymyxin b sulf-trimethoprim

..........................................86POLYTRIM..........................86POLY-TUSSIN AC..............92portia 28................................83posaconazole...........................3POTABA..............................98potassium chloride................98potassium citrate...................97powderlax.............................69PR BENZOYL PEROXIDE.45pr natal 400.........................101pr natal 400 ec.....................101pr natal 430.........................101pr natal 430 ec.....................101pramipexole..........................17PRAMOSONE......................42PRANDIN............................63prasugrel...............................39pravastatin.............................40praziquantel............................9prazosin.................................37PRECISION XTRA

MONITOR........................60PRECISION XTRA TEST...58PRECOSE.............................63PRED FORTE......................90PRED-G................................89PRED-G S.O.P.....................89prednicarbate........................52PREDNISOL ACE-

GATIFLOX-BROMFEN..87

PREDNISOLN SP-GATIFLOX-BROMFEN..87

PREDNISOLN SP-MOXIFLOX-BROMFEN 87

prednisolone..........................58prednisolone acetate.............90PREDNISOLONE ACETATE

(PF)...................................90PREDNISOLONE ACETATE-

NEPAFENAC...................87PREDNISOLONE ACET-

GATIFLOXACIN............89PREDNISOLONE SOD PH-

BROMFENAC.................87PREDNISOLONE SOD PH-

MOXIFLOX.....................89prednisolone sodium phosphate

....................................58, 90PREDNISOLONE-

MOXIFLO-NEPAFENAC..........................................87

PREDNISOLONE-MOXIFLOXACIN HCL. .89

PREDNISOLONE-MOXIFLOX-BROMFEN 87

prednisone.............................58prednisone intensol...............58PREFEST..............................78pregabalin.............................15PREGENNA.......................101PREMARIN..........................78PREMPHASE.......................78PREMPRO............................78prena1 chew........................101prena1 pearl........................101prena1 true..........................101prenaissance........................101prenaissance plus................101PRENATA..........................101prenatabs fa.........................101prenatabs rx.........................101prenatal...............................101prenatal complete................101prenatal formula..................101prenatal multi-dha (algal oil)

........................................101prenatal one daily................101prenatal plus........................101prenatal plus (calcium carb)101PRENATAL PLUS DHA...102

prenatal vitamin..................102prenatal vitamin plus low iron

........................................102prenatal vitamin with minerals

........................................102prenatal vits96-iron fum-folic

........................................102prenatal-u............................102PRENATE AM...................102PRENATE CHEWABLE...102PRENATE DHA (FERR ASP

GLYCIN)........................102PRENATE ELITE (IRON ASP

GLYC)............................102PRENATE ENHANCE......102PRENATE

ESSENTIAL(IRON-ASP-GL)..................................102

PRENATE MINI (FERR ASP GLYCIN)........................102

PRENATE PIXIE...............102PRENATE RESTORE.......102PRENATE STAR...............102PREPIDIL.............................79preplus................................102PREPOPIK...........................69PRESTALIA.........................37pretab..................................102PRETOMANID......................9prevalite................................40PREVIDENT........................56PREVIDENT 5000 BOOSTER

PLUS................................56PREVIDENT 5000 DRY

MOUTH............................56PREVIDENT 5000 ENAMEL

PROTECT........................56PREVIDENT 5000 ORTHO

DEFENSE.........................56PREVIDENT 5000 PLUS....56PREVIDENT 5000

SENSITIVE......................56previfem................................83PREVNAR 13 (PF)..............74PREVYMIS............................5PREZISTA..............................5PRIFTIN.................................9PRIMACARE.....................102primaquine..............................9primidone..............................15


119

PRIMSOL.............................12PRINIVIL.............................37PROAIR HFA.......................95PROAIR RESPICLICK........95probenecid............................75probenecid-colchicine...........75PROBUPHINE.....................22PROCARDIA.......................37PROCARDIA XL.................37PRO-C-DURE 5...................58PRO-C-DURE 6...................58procentra...............................31PROCORT............................69PROCTOCORT....................69PROCTOFOAM HC............69procto-med hc.......................69procto-pak.............................69proctosol hc...........................69proctozone-hc.......................69progesterone micronized.......78PROGLYCEM......................59PROGRAF............................13prolate...................................22PROLENSA..........................88PROLEUKIN........................73PROMACTA........................39promethazine........................91promethazine-codeine...........92promethazine-dm..................92promethazine-phenyleph-

codeine..............................92promethazine-phenylephrine 92promethegan.........................91PROMETRIUM....................78propafenone..........................33propantheline........................66proparacaine..........................87propranolol............................37propranolol-hydrochlorothiazid

..........................................37propylthiouracil....................58PROQUAD (PF)...................74PROSCAR............................97PROSTIN E2........................79PROTOPIC...........................43protriptyline..........................31PROVERA............................78PROVIDA OB....................102prudoxin................................43PSORCON............................52

PULMICORT FLEXHALER..........................................95

PULMOZYME.....................95PUREFE OB PLUS............102purelax..................................69pyrazinamide..........................9PYRIDIUM..........................98pyridostigmine bromide..19, 20PYRIDOSTIGMINE

BROMIDE........................19pyrimethamine........................9QQBREXZA...........................43Q-CARE RX Q4...................56QNASL.................................95QSYMIA..............................53QTERN.................................64QUADRACEL (PF).............74QUALAQUIN........................9QUARTETTE.......................83QUAZEPAM........................31QUDEXY XR.......................15QUESTRAN.........................40QUESTRAN LIGHT............40quetiapine..............................31QUILLICHEW ER...............31QUILLIVANT XR...............31quinapril................................37quinapril-hydrochlorothiazide

..........................................37quinidine gluconate...............33quinidine sulfate...................33quinine sulfate.........................9quit 2.....................................55quit 4.....................................55QVAR REDIHALER...........95RRABAVERT (PF).................74rabeprazole............................72RADIOGARDASE...............54raloxifene..............................75ramelteon..............................31ramipril.................................37ranitidine hcl.........................72ranolazine..............................41RAPAMUNE........................13rasagiline...............................17RAVICTI..............................54RAYALDEE.........................62RAYOS.................................58

RAZADYNE........................19RAZADYNE ER..................19READYSHARP

DEXAMETHASONE......58READYSHARP

KETOROLAC..................25reclipsen (28)........................83RECOMBIVAX HB (PF).....74RECTIV................................69REGRANEX........................43RELAGARD........................79RELENZA DISKHALER......5RELEXXII............................31RELISTOR...........................69RELPAX...............................18REMERON...........................31REMERON SOLTAB..........31rena-vite..............................102RENVELA............................69repaglinide............................64repaglinide-metformin..........64REQUIP XL.........................17RESPA-AR...........................92RESTASIS............................87RESTASIS MULTIDOSE....87RESTORIL...........................31RETIN-A..............................45RETIN-A MICRO................45RETIN-A MICRO PUMP....46RETROVIR............................5REVATIO.............................95REXULTI.............................31REYATAZ..............................5REYVOW.............................18RHOFADE...........................46RHOPRESSA.......................89ribavirin............................5, 72RIDAURA............................76rifabutin..................................9RIFADIN................................9RIFAMATE............................9rifampin..................................9RIFATER................................9RILUTEK.............................54riluzole..................................54rimantadine.............................5RINVOQ...............................76RIOMET...............................64RIOMET ER.........................64risedronate......................54, 75


120

RISPERDAL........................31risperidone............................31RITALIN..............................31RITALIN LA........................31ritonavir..................................5rivastigmine..........................19rivastigmine tartrate..............19rivelsa....................................83rizatriptan..............................18R-NATAL OB....................102ROBAXIN-750.....................20ROCALTROL......................62ROCKLATAN......................89ropinirole..............................17rosadan..................................46ROSADAN...........................46ROSANIL.............................46ROSULA..............................46rosula cleansing cloths..........46rosuvastatin...........................40ROTARIX............................74ROTATEQ VACCINE.........74ROWASA.............................69roweepra...............................15ROXICODONE....................22RUZURGI............................19RYBELSUS..........................64RYCLORA...........................91RYTARY..............................17RYTHMOL SR.....................33RYVENT..............................91SSABRIL................................15SAFYRAL............................83SALAGEN (PILOCARPINE)

....................................54, 56salsalate.................................25SAMSCA..............................62SANDIMMUNE...................13SANDOSTATIN..................13SANTYL..............................52SAPHRIS..............................31SARAFEM...........................31SAVELLA............................76scalacort................................52SCALACORT DK................52SCENESSE...........................43scopolamine base..................70SEASONIQUE.....................83seconal sodium.....................31

SECUADO...........................31SEEBRI NEOHALER..........95SEGLUROMET...................64SELECT-OB.......................102SELECT-OB (FOLIC ACID)

........................................102SELECT-OB + DHA..........102selegiline hcl.........................17selenium sulfide....................42SELRX..................................42SELZENTRY.........................5SEMPREX-D........................92se-natal 19 chewable...........102se-natal-19..........................102SEREVENT DISKUS..........95SERNIVO.............................52sertraline...............................31setlakin..................................83sevelamer carbonate.............70sevelamer hcl........................70SEYSARA............................12sf 56sf 5000 plus...........................56SFROWASA........................70sharobel.................................78SHINGRIX (PF)...................74SHOHL'S MODIFIED.........97SIGNIFOR............................13sildenafil...............................97sildenafil (pulm.hypertension)

..........................................95SILENOR.............................31silodosin................................97SILVADENE........................42silver sulfadiazine.................42SIMBRINZA........................89simliya (28)...........................84simpesse................................84SIMPONI..............................76simvastatin............................40SINEMET.............................17SINOGRAFIN......................54sirolimus...............................13SIRTURO.............................10SIVEXTRO..........................10SKELAXIN..........................20SKLICE................................53SKYLA.................................76SLYND.................................84smoothlax..............................70

sodium chloride 0.9 % (flush)..........................................54

sodium fluoride 5000 plus....56sodium fluoride-pot nitrate...56sodium phenylbutyrate.........54sodium polystyrene (sorb free)

..........................................70sodium polystyrene sulfonate

..........................................70solifenacin.............................96SOLIQUA 100/33.................61SOLODYN...........................12SOLOSEC............................10SOMA...................................20SOOLANTRA......................46SORBITOL...........................53SORBITOL-MANNITOL....53SORIATANE........................42SORILUX.............................42sotalol....................................33sotalol af...............................33SOTYLIZE...........................33SPECTRACEF.......................7spinosad................................53SPIRIVA RESPIMAT..........95SPIRIVA WITH

HANDIHALER................95spironolactone.......................37spironolacton-hydrochlorothiaz

..........................................37SPORANOX...........................3SPORANOX PULSEPAK.....3sprintec (28)..........................84SPRITAM.............................15SPRIX...................................25sps (with sorbitol).................70sronyx...................................84ssd.........................................42SSKI......................................58sss 10-5.................................46st joseph aspirin....................25st. joseph aspirin...................25STALEVO 100.....................17STALEVO 125.....................17STALEVO 150.....................17STALEVO 200.....................17STALEVO 50.......................17STALEVO 75.......................17STAMARIL (PF)..................74STARLIX.............................64


121

stavudine.................................5STAXYN..............................97STEGLATRO.......................64STEGLUJAN........................64STENDRA............................97STIOLTO RESPIMAT.........95stop smoking aid...................55stress formula......................102stress formula with iron......102stress formula with iron(sulf)

........................................102STROMECTOL....................10strong iodine...................48, 98SUBLOCADE......................22SUBOXONE........................25subvenite...............................15subvenite starter (blue) kit....15subvenite starter (green) kit. .15subvenite starter (orange) kit 15SUCRAID.............................70sucralfate...............................72SULAR.................................37sulfacetamide sodium.....42, 90sulfacetamide sodium (acne) 48sulfacetamide sodium-sulfur.46sulfacetamide-prednisolone. .90sulfacetamide-sulfur-cleansr23

..........................................46sulfacleanse 8-4....................46sulfadiazine...........................11sulfamethoxazole-trimethoprim

..........................................11SULFAMYLON...................48sulfasalazine..........................70sulfatrim................................11sulindac.................................25SUMADAN..........................46SUMADAN XLT.................46sumatriptan...........................18sumatriptan succinate...........18sumatriptan-naproxen...........18SUMAXIN............................46SUMAXIN CP......................46SUMAXIN TS......................46SUNOSI................................31super b complex-vitamin c. 102super b maxi complex.........102super quints.........................103super quints b-50................103SUPRAX................................7

SUPREP BOWEL PREP KIT..........................................70

SURVANTA........................55SUSTIVA...............................5syeda.....................................84SYMAX DUOTAB..............66symax fastabs........................66symax-sl................................66symax-sr................................66SYMBICORT.......................95SYMBYAX..........................31SYMDEKO..........................95SYMFI....................................5SYMFI LO..............................5SYMLINPEN 120................64SYMLINPEN 60..................64SYMPAZAN........................15SYMPROIC..........................70SYMTUZA.............................6SYNALAR...........................52SYNALAR CREAM KIT... .52SYNALAR OINTMENT KIT

..........................................52SYNALAR TS......................52SYNAREL............................62SYNERA..............................47SYNJARDY.........................64SYNJARDY XR...................64SYNTHROID.......................64SYPRINE..............................55TTACLONEX.........................42tacrolimus.......................13, 43tadalafil.................................97tadalafil (pulm. hypertension)

..........................................95TAKE ACTION...................84TALICIA..............................72TAMIFLU..............................6tamsulosin.............................97TAPAZOLE..........................58TAPERDEX.........................58TARGADOX........................12tarina 24 fe............................84tarina fe 1/20 (28).................84TARKA................................37taron-c dha..........................103taron-prex prenatal-dha.......103TASMAR..............................17TAYTULLA.........................84

tazarotene..............................46TAZORAC...........................46taztia xt.................................37TDVAX................................74TECFIDERA........................72TEGRETOL..........................16TEGRETOL XR...................16TEKTURNA.........................37TEKTURNA HCT................37telmisartan............................37telmisartan-amlodipine.........37telmisartan-hydrochlorothiazid

..........................................37temazepam............................31TEMIXYS..............................6TEMOVATE........................52tencon....................................22TENIVAC (PF).....................74tenofovir disoproxil fumarate. 6TENORETIC 100.................37TENORETIC 50...................37TENORMIN.........................37terazosin................................37terbinafine hcl.........................3terbutaline.............................95terconazole............................79TERSI FOAM.......................42TESSALON PERLES..........92testosterone...........................62TETANUS,DIPHTHERIA

TOX PED(PF)..................74tetrabenazine.........................19tetracaine hcl.........................88TETRACAINE HCL (PF)....88tetracycline............................12TEXACORT.........................52THEO-24..............................95theophylline..........................95THIOLA...............................55THIOLA EC.........................55thioridazine...........................32thiothixene............................32THRIVITE RX...................103thyroid (pork)........................64THYROLAR-1.....................64THYROLAR-1/2..................64THYROLAR-1/4..................65THYROLAR-2.....................65THYROLAR-3.....................65tiadylt er................................37


122

tiagabine................................16TIAZAC................................38TIGLUTIK............................55tilia fe....................................84TIMOL-BRIMON-DORZO-

LATANOP(PF)................89timolol maleate...............38, 86TIMOLOL-BRIMONIDI-

DORZOLAM(PF)............89TIMOLOL-DORZOLAMID-

LATANOP(PF)................89TIMOLOL-

LATANOPROST(PF)......89TIMOPTIC...........................86TIMOPTIC-XE.....................86tinidazole..............................10TIROSINT............................65TIROSINT-SOL...................65tis-u-sol pentalyte.................53TIVICAY................................6TIVICAY PD..........................6tizanidine..............................20TOBI PODHALER...............10TOBRADEX........................89TOBRADEX ST...................89tobramycin............................86tobramycin in 0.225 % nacl. .10TOBRAMYCIN WITH

NEBULIZER....................10tobramycin-dexamethasone. .89TOBREX..............................86TODAY CONTRACEPTIVE

SPONGE...........................79tolcapone...............................17tolmetin.................................25tolterodine.............................96tolvaptan...............................62TOPICORT...........................52topiramate.............................16torsemide..............................38TOSYMRA...........................18TOUJEO MAX U-300

SOLOSTAR......................61TOUJEO SOLOSTAR U-300

INSULIN..........................61tovet emollient......................52TOVIAZ...............................96TRACLEER..........................95TRADJENTA.......................64tramadol................................26

TRAMADOL........................26tramadol-acetaminophen......26trandolapril............................38trandolapril-verapamil..........38tranexamic acid.....................79TRANXENE T-TAB............32tranylcypromine....................32TRAVATAN Z.....................89travoprost..............................89trazodone..............................32TRECATOR.........................10TRELEGY ELLIPTA...........95TRESIBA FLEXTOUCH U-

100....................................61TRESIBA FLEXTOUCH U-

200....................................61TRESIBA U-100 INSULIN. 61tretinoin.................................46tretinoin microspheres..........46TRETIN-X............................46TRETIN-X CREAM KIT.....46TREZIX................................22tri femynor............................84triamcinolone acetonide..52, 56TRIAMCINOLON-

MOXIFLOX-WATR(PF).89triamterene............................38triamterene-hydrochlorothiazid

..........................................38trianex...................................52triazolam...............................32TRICARE...........................103triderm..................................52TRIDESILON.......................52trientine.................................55tri-estarylla............................84TRIFERIC..........................103trifluoperazine.......................32trifluridine.............................86TRIGLIDE............................40trihexyphenidyl.....................17TRIJARDY XR....................64TRIKAFTA..........................95tri-legest fe............................84tri-linyah...............................84TRILIPIX..............................40tri-lo-estarylla.......................84tri-lo-marzia..........................84tri-lo-mili..............................84tri-lo-sprintec........................84

trilyte with flavor packets.....70trimethoprim.........................12tri-mili...................................84trimipramine.........................32TRIMO-SAN JELLY...........79trinatal rx 1..........................103trinate..................................103TRINAZ..............................103TRINTELLIX.......................32tri-previfem (28)...................84tri-sprintec (28).....................84TRISTART DHA...............103TRIUMEQ..............................6triveen-duo dha...................103tri-vitamin with fluoride.....103trivora (28)............................84tri-vylibra..............................84tri-vylibra lo..........................84TRIZIVIR...............................6TROKENDI XR...................16tropicamide...........................86trospium................................96TRULANCE.........................70TRULICITY.........................64TRUMENBA........................74TRUSOPT............................89TRUVADA.............................6tulana....................................78TUSSICAPS.........................93TUXARIN ER......................93TUZISTRA XR....................93TWINRIX (PF).....................74TYBOST.................................6tydemy..................................84TYPHIM VI..........................74TYVASO..............................96TYVASO REFILL KIT........96TYVASO STARTER KIT....96UUBRELVY...........................18UCERIS................................70ULESFIA..............................53ULTRACET.........................26ULTRAM.............................26ULTRAVATE......................52unithroid................................65UNITUXIN...........................13UPTRAVI.............................38URELLE...............................97uretron d-s.............................97


123

URIBEL................................97urimar-t.................................97urin ds...................................97uro-458..................................97UROCIT-K 10......................97UROCIT-K 15......................97UROCIT-K 5........................97urogesic-blue........................98uro-mp..................................98UROQID-ACID NO.2..........98URSO 250.............................70URSO FORTE......................70ursodiol.................................70uryl........................................98ustell......................................98UTIBRON NEOHALER......96utira-c....................................98Vvaginal contraceptive foam...79valacyclovir............................6VALCYTE..............................6valganciclovir.........................6valproic acid.........................16valproic acid (as sodium salt)

..........................................16valsartan................................38valsartan-hydrochlorothiazide

..........................................38VALTOCO...........................16vanadom................................20VANATOL LQ.....................22VANATOL S........................23VANCOCIN.........................12vancomycin...........................12vandazole..............................79VANOXIDE-HC..................47VAPRISOL IN 5 %

DEXTROSE.....................62VAQTA (PF)........................74vardenafil..............................98VARIVAX (PF)....................74VARIZIG..............................74VASCEPA............................40VASERETIC........................38VASOTEC............................38VAXCHORA VACCINE.....74VCF CONTRACEPTIVE

FILM.................................79VCF CONTRACEPTIVE GEL

..........................................79

VECAMYL..........................41VECTICAL..........................42velivet triphasic regimen (28)

..........................................84VELPHORO.........................70VEMLIDY..............................6venlafaxine............................32VENOFER..........................103VENTAVIS..........................96VENTOLIN HFA.................96verapamil..............................38VEREGEN............................43VERELAN............................38VERELAN PM.....................38VERSACLOZ.......................32VFEND...................................3V-GO 20...............................60V-GO 30...............................60V-GO 40...............................60VIBERZI..............................70VIBRAMYCIN....................12VIEKIRA PAK.......................6vienva....................................84vigabatrin..............................16vigadrone..............................16VIGAMOX...........................86VIIBRYD..............................32vilamit mb.............................98vilevev mb............................98VIMOVO..............................26VIMPAT...............................16VINATE DHA RF..............103VIOKACE............................70viorele (28)...........................84VIRACEPT.............................6VIRAMUNE...........................6VIRAMUNE XR....................6VIREAD.................................6virt-c dha.............................103virt-nate dha........................103virt-pn dha...........................103virt-pn plus..........................103virtussin ac............................93virtussin dac..........................93VISTARIL............................92VITAFOL FE PLUS...........103VITAFOL FE+ (WITH

DOCUSATE)..................103VITAFOL GUMMIES.......103VITAFOL NANO...............103

VITAFOL ULTRA.............103VITAFOL-OB....................103VITAFOL-OB+DHA.........103VITAFOL-ONE..................103VITAMED MD ONE RX...103VITAMEDMD REDICHEW

RX...................................103vitamin b complex..............103vitamin b complex-folic acid

........................................103vitamins a,c,d and fluoride. 103VITAPEARL......................103VITATRUE........................104VIVITROL...........................26VIVOTIF..............................74VOGELXO...........................62volnea (28)............................84VOLTAREN.........................26voriconazole............................3VOSEVI..................................6vp-ch-pnv............................104VP-PNV-DHA....................104VRAYLAR...........................32vtol lq....................................23VUMERITY.........................72VUSION...............................49vyfemla (28).........................84VYLEESI..............................32vylibra...................................84VYNDAMAX......................41VYNDAQEL........................41VYVANSE...........................32VYZULTA...........................89WWAKIX................................32warfarin.................................39WELCHOL...........................41WELLBUTRIN XL..............32wera (28)...............................84westhroid..............................65WIDE-SEAL DIAPHRAGM

..........................................76wintergreen oil......................43women's gentle laxative(bisac)

..........................................70women's laxative (bisacodyl)70WP THYROID.....................65wymzya fe.............................85


124

XXARELTO DVT-PE TREAT

30D START......................39XARELTO, XARELTO

STARTER PACK.............39XCOPRI................................16XCOPRI MAINTENANCE

PACK................................16XCOPRI TITRATION PACK

..........................................16XELJANZ.............................76XELJANZ XR......................76XENICAL.............................53XENLETA............................10XEPI.....................................48XERESE...............................49XHANCE..............................96XIFAXAN............................10XIGDUO XR........................64XIIDRA................................88XOFLUZA..............................6XOLEGEL............................49XOPENEX............................96XOPENEX CONCENTRATE

..........................................96xulane....................................79XULTOPHY 100/3.6............61XURIDEN............................55XYREM................................32YYAZ (28)..............................85YF-VAX (PF).......................75

YUPELRI.............................96yuvafem................................78Zzafirlukast.............................96zaleplon.................................32ZANAFLEX.........................20zarah......................................85ZARONTIN..........................16zatean-pn dha......................104zatean-pn plus.....................104ZCORT.................................58zebutal...................................23ZELNORM...........................70ZEMPLAR............................62zenatane................................47ZENPEP................................70zenzedi..................................32ZENZEDI.............................32ZEPATIER.............................6ZEPOSIA..............................72ZEPOSIA STARTER KIT. . .72ZEPOSIA STARTER PACK

..........................................72ZERVIATE...........................88ZESTORETIC......................38ZESTRIL..............................38ZIAC.....................................38ZIAGEN.................................6ZIANA..................................47zidovudine..............................6zileuton.................................96zingiber...............................104

ZIOPTAN (PF).....................89ziprasidone hcl......................32ZIRGAN...............................86ZITHROMAX........................8ZITHROMAX TRI-PAK.......8ZITHROMAX Z-PAK...........8ZOHYDRO ER.....................23zolmitriptan...........................18zolpidem...............................32ZOLPIMIST.........................32ZOMIG.................................18ZONALON...........................43zonisamide............................16ZONTIVITY.........................39ZORTRESS..........................13ZOSTAVAX (PF).................75zovia 1/35e (28)....................85ZOVIRAX........................6, 49ZTLIDO................................47Z-TUSS AC..........................93ZUBSOLV............................26zumandimine (28).................85ZYFLO.................................96ZYLET..................................89ZYLOPRIM..........................75ZYMAXID...........................86ZYPITAMAG.......................41ZYPREXA............................32ZYPREXA ZYDIS...............32ZYVOX................................10


125

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EMB_MB_48013_City_PPO_Full_Formulary 10/20

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