2020 Formulary - Kaiser Permanente - Community Providers

2020 FormularyKaiser Permanente a TRICARE® Prime Option

To search for a specific medication or condition:

• Press “Ctrl” or “CMD” and “F” on your keyboard at the same time.

• In the search window that pops up, enter the text that you wish to search for and press “Enter”.

• Press enter again to move to the next result.

• You can also find an alphabetic list of medication starting on page 86.

For questions about specific drug costs, call us at 1-877-904-0015.

Kaiser Permanente, a TRICARE Prime Option Formulary is for medications covered at Kaiser Permanente pharmacies and Network Pharmacies.

All drug product strengths and package sizes of a medication may not be included on the same tier on the formulary. Check with your Kaiser Permanente

pharmacist for clarification, if needed. TRICARE is a registered trademark of the Department of Defense, DHA. All rights reserved.

Kaiser Permanente, a TRICARE Prime Option Formulary 1

What is the Kaiser Permanente, a TRICARE®

Prime Option Formulary?

A formulary is a list of drugs determined to

be safe and effective for our members by

our Pharmacy and Therapeutics

committee. Use of the formulary enables

Kaiser Permanente to provide optimal

care to you and your family at

reasonable costs. Kaiser Permanente

continually updates the formulary

throughout the year based on new

medical evidence, considering the

recommendations of appropriate

physician experts. Our physicians and

pharmacists work closely together to

ensure that our formulary meets your

needs.

Does the formulary ever change?

Yes, Kaiser Permanente periodically

updates the formulary based on new

medical evidence, considering the

recommendations of appropriate

physician experts and notifies our doctors,

pharmacists, and other clinicians about

any changes. If a change in the

formulary affects any of your prescriptions,

your doctor or pharmacist will let you

know.

The enclosed formulary is effective as of

November 11, 2020 and represents the most

commonly prescribed medications.

How do I use the Formulary?

There is an easy way to find your drug

within the formulary:

To search for a specific medication or

condition, press the ‘CTRL’ key and the ‘F’

key on your keyboard at the same time.

In the search window that pops up, enter

the text you want to search for and press

‘Enter.’ Press ‘Enter’ again to move to the

next result.

Medical Condition

The drugs on this formulary are grouped

into categories depending on the type of

medical condition that they are used to

treat. For example, drugs used to treat a

heart condition are listed under the

category, “Cardiovascular Drugs.” If you

know what your drug is used for, simply

look for the category name in the list.

Then look under the category name for

your drug.

Alphabetical Listing

If you are not sure what category to look

under, you can look for the drug in the

Index. The Index provides an alphabetical

list of all the drugs included in this

document. Both brand-name drugs and

generic drugs are listed in the Index. Look

in the Index and find your drug. Next to

the drug, you will see the page number

where you can find coverage

information. Go to the page listed in the

Index and find the name of your drug on

the list.

What are generic drugs?

Kaiser Permanente covers both brand-

name drugs and generic drugs.

Generic drugs are produced and sold

under their chemical names after the

patent of the brand name drug expires.

Although the price is lower, the quality

and effectiveness of generic drugs is the

same as brand name drugs. The Federal





Food and Drug Administration (FDA)

requires that generic drugs contain the

same active ingredients in the same

amount as the brand name drug.

Generic drugs are listed in lower-case

italics (e.g., amoxicillin) within the

formulary. Brand-name drugs are

capitalized within the formulary (e.g.,

FLOVENT).

What are Formulary Brand name drugs?

Formulary Brand name drugs are drugs

that are produced and sold under the

original manufacturer’s name.

What are Non-Formulary Brand drugs?

Non-Formulary Brand drugs are drugs that

are not included on the plan's list

of preferred prescription drugs.

Because all drug product strengths and

package sizes of a formulary drug will be

included in your plan’s benefits, just note

the drug cost share coverage amount

will be based on the specific tier of the

formulary, check with your Kaiser

Permanente pharmacist for clarification, if

needed.

How much will I pay for Covered Drugs?

What you pay for covered drugs is

determined by the outpatient prescription

drug benefit outlined in your Evidence of

Coverage. Kaiser Permanente, a TRICARE

Prime Option plan has a three-tier open

formulary benefit.

Open formulary benefits have a generic

cost sharing requirement. This means that

if you choose to fill a brand name drug

when a generic is available, then in

addition to your standard cost share, you

will also pay the difference in cost

between the brand name and generic

drug.

Generics drugs are those covered at the

lowest cost share defined as Tier 1

coverage amount. Formulary brand

drugs are those brands which will be

covered at your formulary brand cost

share defined as Tier 2 coverage amount.

Non-formulary brands drugs are covered

at the non-formulary cost share defined

as Tier 3 coverage amount.

Coverage for prescription drugs is limited

to drugs for which a prescription is

required by law and those that are listed

on the Kaiser Permanente, a TRICARE

Prime Option drug formulary. Certain

diabetic supplies do not require a

prescription but must still be listed in our

formulary in order to be covered under

the benefit.

Each prescription refill is provided on the

same basis as the original prescription.

Cost shares are applied on a per

prescription basis, for up to the lesser of

the dispensing amount listed in the

“Schedule of Benefits” or the standard

prescription amount.

The standard prescription amount for the

following items is:

• Migraine medications ― the smallest

package size commercially available

• Ophthalmic and otic medications ―

the smallest package size

commercially available





• Oral and nasal inhalers ― the smallest

standard package size

Are there any other restrictions on coverage?

Some covered drugs may have

additional requirements or limits on

coverage. These requirements and limits

may include:

• Quantity Limits (QL): For certain drugs,

Kaiser Permanente limits the amount of

the drug that will be covered.

• Age Restriction (Age): For certain drugs,

Kaiser Permanente limits coverage

based on a designated age.

• Prior Authorization (PA): For certain drugs,

Kaiser Permanente requires review and

authorization prior to dispensing. Your

Provider must obtain this review and

authorization. The list of prescription

drugs requiring review and

authorization is subject to periodic

review and modification by our

Pharmacy and Therapeutics

Committee.

• Step Therapy (ST): For certain drugs,

Kaiser Permanente requires the use of

similar, alternative medications prior to

coverage.

You can find out if the drug has any

additional requirements or limits by

looking in the Restrictions Column on the

formulary list.

What if my drug is not on the Formulary?

Because all drug product strengths and

package sizes of a formulary drug may

not be included on the formulary, check

with your Kaiser Permanente pharmacist

for clarification, if needed.

For more information

For more detailed information about your

Kaiser Permanente, a TRICARE Prime

Option prescription drug coverage,

please review your Evidence of Coverage

and other plan materials.

If you have questions about Kaiser

Permanente, please call Member Services

at 1-833-642-5973 or 770-291-4430, Monday

through Friday 7:00 a.m. to 7 p.m. TTY/TDD

users should call 1-800-255-0056.

Or visit kp.org/tricare.

Kaiser Permanente, a TRICARE® Prime Option Formulary


Restrictions Mailable Tier Generic Name Brand Name Coverage Status

Antihistamine Drugs

Antihistamine Drugs

ST No 1 carbinoxamine maleate ARBINOXA Generic

No 1 cyproheptadine PERIACTIN Generic

No 1 chlorpheniramine, phenylephrine & pyrilamine

POLY HIST FORTE Generic

No 1 promethazine & phenylephrine PHENERGAN VC Generic

QL No 1 promethazine PHENERGAN Generic

Anti-infective Agents

Anthelmintics

No 2 albendazole ALBENZA Formulary Brand

No 1 ivermectin STROMECTOL Generic

PA, QL No 3 ivermectin (topical) SOOLANTRA Non-Formulary

Brand

ST Yes 1 praziquantel BILTRICIDE Generic

Anti-infectives, Miscellaneous

ST Yes 3 bismuth subcitrate & metronidazole

PYLERA Non-Formulary

Brand

Yes 3 metronidazole, tetracycline & bismuth subsalicylate

HELIDAC Non-Formulary

Brand

Yes 3 benznidazole benznidazole Non-Formulary

Brand

Antibacterials

PA No 3 amikacin liposomal inhalation ARIKAYCE Non-Formulary

Brand

No 1 amoxicillin AMOXIL Generic

No 1 amoxicillin & clavulanate potassium

AUGMENTIN Generic

No 1 amoxicillin & clavulanate potassium extended-release

AUGMENTIN XR Generic




No 1 ampicillin sodium AMPICILLIN Generic

Yes 1 azithromycin ZITHROMAX Generic

No 1 cefaclor CECLOR Generic

No 1 cefadroxil DURICEF Generic

No 1 cefdinir OMNICEF Generic

ST Yes 1 cefditoren SPECTRACEF Generic

No 3 cefixime SUPRAX Non-Formulary

Brand

No 1 cefixime solution SUPRAX Generic

No 1 cefpodoxime VANTIN Generic

No 1 cefprozil CEFZIL Generic

No 1 cefuroxime axetil CEFTIN Generic

No 1 cephalexin KEFLEX Generic

No 1 ciprofloxacin CIPRO Generic

No 1 clarithromycin BIAXIN Generic

No 1 clarithromycin extended-release BIAXIN XL Generic

No 1 clindamycin hcl CLEOCIN HCL Generic

No 1 clindamycin palmitate CLEOCIN PEDIATRIC Generic

ST Yes 3 delafloxacin BEXDELA Non-Formulary

Brand

No 1 demeclocycline DECLOMYCIN Generic

No 1 dicloxacillin DYNAPEN Generic

Yes 3 doxycycline ORACEA Non-Formulary

Brand

Yes 1 doxycycline hyclate PERIOSTAT Generic

ST Yes 3 doxycycline hyclate DORYX Non-Formulary

Brand

Yes 1 doxycycline monohydrate ADOXA Generic

Yes 1 doxycycline monohydrate MONODOX Generic

No 1 erythromycin & sulfisoxazole E.S.P Generic

No 1 erythromycin base ERYTHROMYCIN Generic




No 1 erythromycin base delayed-release

ERY-TAB Generic

No 1 erythromycin ethylsuccinate E.E.S. Generic

No 3 erythromycin ethylsuccinate ERYPED Non-Formulary

Brand

No 3 erythromycin sterate ERYTHROCIN Non-Formulary

Brand

ST Yes 3 fidaxomicin DIFICID Non-Formulary

Brand

No 1 gentamicin sulfate GARAMYCIN Generic

Yes 3 lefamulin XENLETA Non-Formulary

Brand

No 1 levofloxacin LEVAQUIN Generic

No 1 linezolid ZYVOX Generic

Yes 1 minocycline DYNACIN Generic

Yes 1 minocycline MINOCIN Generic

Yes 1 minocycline SOLODYN Generic

ST No 1 moxifloxacin AVELOX Generic

No 1 neomycin sulfate MYCIFRADIN Generic

Yes 3 norfloxacin NOROXIN Non-Formulary

Brand

No 1 penicillin v potassium PEN-VK Generic

ST Yes 3 omadacycline NUZYRA Non-Formulary

Brand

ST, QL (200 mg only)

Yes 3 rifaximin XIFAXAN Non-Formulary

Brand

No 1 sulfadiazine SULFADIAZINE Generic

Yes 1 sulfamethoxazole & trimethoprim BACTRIM DS Generic

Yes 1 sulfamethoxazole & trimethoprim SEPTRA Generic

No 1 sulfasalazine AZULFIDINE Generic

ST Yes 3 tedizolid SIVEXTRO Non-Formulary

Brand

ST Yes 3 telithromycin KETEK Non-Formulary

Brand

Yes 1 tetracycline TETRACYCLINE Generic




No 3 tobramycin inhalation powder TOBI PODHALER Non-Formulary

Brand

No 1 tobramycin inhalation solution TOBI Generic

No 1 Vancomycin capsule VANCOCIN Generic

Antifungals

PA, QL Yes 3 efinaconazole JUBLIA Non-Formulary

Brand

QL No 1 fluconazole DIFLUCAN Generic

No 1 flucytosine ANCOBON Generic

No 1 griseofulvin microsize GRIFULVIN V Generic

No 1 griseofulvin ultramicrosize GRIS-PEG Generic

Yes 3 isavuconazonium CRESEMBA Non-Formulary

Brand

No 1 itraconazole SPORANOX Generic

No 1 ketoconazole NIZORAL Generic

No 3 luliconazole LUZU Non-Formulary

Brand

No 1 nystatin MYCOSTATIN Generic

PA No 3 posaconazole NOXAFIL Non-Formulary

Brand

PA Yes 3 tavaborole KERYDIN Non-Formulary

Brand

No 1 terbinafine LAMISIL Generic

No 1 voriconazole tablet VFEND Generic

ST No 3 voriconazole suspension VFEND Non-Formulary

Brand

Antimycobacterials

Yes 1 cycloserine SEROMYCIN Generic

Yes 1 dapsone AVLOSULFON Generic

Yes 1 ethambutol MYAMBUTOL Generic

ST Yes 3 ethionamide TRECATOR Non-Formulary

Brand

Yes 1 isoniazid NYDRAZID Generic

ST Yes 1 pretomanid PRETOMANID Generic




Yes 1 pyrazinamide PYRAZINAMIDE Generic

Yes 1 rifabutin MYCOBUTIN Generic

Yes 1 rifampin RIFADIN Generic

Yes 3 rifapentine PRIFTIN Non-Formulary

Brand

Antiprotozoals

ST Yes 3 artemether & lumefantrine COARTEM Non-Formulary

Brand

No 1 atovaquone MEPRON Generic

ST No 1 atovaquone & proguanil MALARONE Generic

ST No 1 chloroquine phosphate ARALEN Generic

Yes 1 hydroxychloroquine sulfate PLAQUENIL Generic

ST No 1 mefloquine LARIAM Generic

No 1 metronidazole FLAGYL Generic

No 3 metronidazole extended-release FLAGYL ER Non-Formulary

Brand

PA Yes 3 miltefosine IMPAVIDO Non-Formulary

Brand

Yes 3 nitazoxanide ALINIA Non-Formulary

Brand

No 1 paromomycin sulfate HUMATIN Generic

ST No 3 pentamidine NEBUPENT Non-Formulary

Brand

No 2 primaquine phosphate PRIMAQUINE Formulary Brand

PA No 3 pyrimethamine DARAPRIM Non-Formulary

Brand

ST No 1 quinine sulfate QUALAQUIN Generic

ST Yes 3 secnidazole SOLOSEC Non-Formulary

Brand

Antiviral

QL Yes 1 abacavir sulfate & lamivudine EPZICOM Generic

QL No 2 abacavir sulfate solution ZIAGEN Formulary Brand




QL Yes 1 abacavir sulfate tablet ZIAGEN Generic

Yes 3 abacavir, dolutegravir & lamivudine

TRIUMEQ Non-Formulary

Brand

QL Yes 1 abacavir, lamivudine & zidovudine

TRIZIVIR Generic

Yes 1 acyclovir ZOVIRAX Generic

QL,ST No 1 adefovir dipivoxil HEPSERA Generic

Yes 3 atazanavir & cobicistat EVOTAZ Non-Formulary

Brand

QL Yes 2 atazanavir sulfate 150 mg REYATAZ Formulary Brand

QL Yes 1 atazanavir sulfate 200 mg, 300 mg

REYATAZ Generic

QL Yes 2 bictegravir & emtricitabine & tenofovir

BIKTARVY Formulary Brand

QL Yes 3 boceprevir VICTRELIS Non-Formulary

Brand

PA Yes 3 daclatasvir DAKLINZA Non-Formulary

Brand

Yes 2 darunavir & cobicistat PREZCOBIX Formulary Brand

QL Yes 2 darunavir ethanolate PREZISTA Formulary Brand

QL Yes 2 darunavir/cobicistat/FTC/tenofovir SYMTUZA Formulary Brand

QL Yes 2 delavirdine mesylate RESCRIPTOR Formulary Brand

QL Yes 1 didanosine VIDEX EC Generic

QL Yes 2 didanosine solution VIDEX Formulary Brand

Yes 2 dolutegravir TIVICAY Formulary Brand

QL Yes 3 dolutegravir & rilpivirine JULUCA Non-Formulary

Brand

QL Yes 2 dolutegravir & lamivudine DOVATO Formulary Brand




Yes 3 doravirine PIFELTRO Non-Formulary

Brand

QL Yes 3 doravirine, lamivudine, tenofovir DELSTRIGO Non-Formulary

Brand

QL Yes 1 efavirenz 600 mg SUSTIVA Generic

QL Yes 3 efavirenz, emtricitabine & tenofovir

ATRIPLA Non-Formulary

Brand

QL Yes 2 efavirenz 600 mg, lamivudine & tenofvir

SYMFI Formulary Brand

QL Yes 3 efavirenz 400 mg, lamivudine & tenofvir

SYMFI LO Non-Formulary

Brand

PA Yes 3 elbasvir & grazoprevir ZEPATIER Non-Formulary

Brand

QL Yes 3 elvitegravir, cobicistat, emtricitabine, & tenofovir

STRIBILD Non-Formulary

Brand

QL Yes 2 elvitegravir, cobicistat, emtricitabine, & tenofovir

GENVOYA Formulary Brand

QL Yes 2 emtricitabine EMTRIVA Formulary Brand

QL Yes 2 emtricitabine & tenofovir TRUVADA Formulary Brand

QL Yes 2 emtricitabine & tenofovir DESCOVY Formulary Brand

QL Yes 3 emtricitabine, rilpivirine, & tenofovir

COMPLERA Non-Formulary

Brand

QL Yes 2 emtricitabine, rilpivirine, & tenofovir

ODEFSEY Formulary Brand

QL Yes 2 enfuvirtide FUZEON Formulary Brand

QL Yes 1 entecavir BARACLUDE Generic

QL Yes 2 etravirine INTELENCE Formulary Brand

ST Yes 1 famciclovir FAMVIR Generic




QL Yes 2 fosamprenavir calcium LEXIVA Formulary Brand

Yes 1 ganciclovir CYTOVENE Generic

QL, PA Yes 3 glecaprevir & pibrentasvir MAVYRET Non-Formulary

Brand

QL Yes 2 indinavir sulfate CRIXIVAN Formulary Brand

Yes 3 interferon alfacon-1 INFERGEN Non-Formulary

Brand

QL, ST Yes 3 lamivudine EPIVIR HBV Non-Formulary

Brand

QL Yes 1 lamivudine EPIVIR Generic

QL Yes 2 Lamivudine & tenofovir CIMDUO Formulary Brand

QL Yes 1 lamivudine & zidovudine COMBIVIR Generic

ST Yes 3 letermovir PREVYMIS Non-Formulary

Brand

QL, PA No 3 ledipasvir & sofosbuvir HARVONI Non-Formulary

Brand

QL Yes 2 lopinavir & ritonavir KALETRA Formulary Brand

QL Yes 2 maraviroc SELZENTRY Formulary Brand

QL Yes 2 nelfinavir mesylate VIRACEPT Formulary Brand

QL Yes 1 nevirapine solution VIRAMUNE Generic

QL Yes 1 nevirapine tablet VIRAMUNE Generic

PA Yes 3 ombitasvir, paritaprevir & ritonavir TECHNIVIE Non-Formulary

Brand

QL, PA Yes 3 ombitasvir, paritaprevir, ritonavir, & dasabuvir

VIEKIRA Non-Formulary

Brand

QL, PA No 2 sofosbuvir, velpatasvir, voxilaprevir

VOSEVI Formulary Brand

QL Yes 1 oseltamivir phosphate TAMIFLU Generic




Yes 3 palivizumab SYNAGIS Non-Formulary

Brand

QL Yes 2 peginterferon alfa-2a PEGASYS Formulary Brand

Yes 2 peginterferon-alfa 2b PEG-INTRON Formulary Brand

QL Yes 2 raltegravir ISENTRESS Formulary Brand

QL Yes 2 raltegravir (600mg) ISENTRESS HD Formulary Brand

Yes 1 ribavirin REBETOL Generic

QL Yes 3 rilpivirine EDURANT Non-Formulary

Brand

QL Yes 1 rimantadine FLUMADINE Generic

QL Yes 1 ritonavir NORVIR Generic

QL Yes 2 saquinavir mesylate INVIRASE Formulary Brand

QL, PA Yes 3 simeprevir OLYSIO Non-Formulary

Brand

QL, PA No 3 sofosbuvir SOVALDI Non-Formulary

Brand

QL, PA No 2 sofosbuvir & velpatasvir EPCLUSA Formulary Brand

QL Yes 1 stavudine ZERIT Generic

QL Yes 3 telaprevir INCIVEK Non-Formulary

Brand

ST Yes 3 telbivudine TYZEKA Non-Formulary

Brand

QL Yes 3 tenofovir VIREAD Non-Formulary

Brand

QL Yes 1 tenofovir 300 mg VIREAD Generic

QL, PA Yes 3 tenofovir alafenamide VEMLIDY Non-Formulary

Brand

QL Yes 2 tipranavir APTIVUS Formulary Brand

ST Yes 1 valacyclovir VALTREX Generic

No 1 valganciclovir VALCYTE Generic

QL Yes 2 zanamivir RELENZA Formulary Brand

QL Yes 1 zidovudine RETROVIR Generic

Urinary Antiinfectives




ST Yes 3 fosfomycin MONUROL Non-Formulary

Brand

ST No 1 methenamine hippurate HIPREX Generic

No 3

methenamine, sodium biphosphate, phenyl salicylate, methylene blue, and hyoscyamine

URELLE Non-Formulary

Brand

No 2 nitrofurantoin FURADANTIN Formulary Brand

No 1 nitrofurantoin macrocrystal MACRODANTIN Generic

No 1 nitrofurantoin monohydrate MACROBID Generic

Yes 1 trimethoprim PROLOPRIM Generic

Antineoplastic Agents

Antineoplastic Agents

Yes 3 abemaciclib VERZENIO Non-Formulary

Brand

No 2 abiraterone ZYTIGA Formulary Brand

Yes 3 acalabrutinib CALQUENCE Non-Formulary

Brand

QL, PA Yes 2 alpelisib PIQRAY Formulary Brand

No 1 anastrozole ARIMIDEX Generic

QL No 3 avapritinib AYVAKIT Non-Formulary

Brand

Yes 3 axitinib INLYTA Non-Formulary

Brand

No 2 bexarotene TARGRETIN Formulary Brand

No 1 bicalutamide CASODEX Generic

Yes 3 binimetinib MEKTOVI Non-Formulary

Brand

Yes 3 bosutinib BOSULIF Non-Formulary

Brand

Yes 2 busulfan MYLERAN Formulary Brand

Yes 1 capecitabine XELODA Generic

Yes 3 ceritinib ZYKADIA Non-Formulary

Brand

Yes 2 chlorambucil LEUKERAN Formulary Brand




Yes 2 cobimetinib COTELLIC Formulary Brand

Yes 2 crizotinib XALKORI Formulary Brand

No 1 cyclophosphamide CYTOXAN Generic

Yes 3 dacomitinib VIZIMPRO Non-Formulary

Brand

QL Yes 2 dasatinib SPRYCEL Formulary Brand

QL, PA Yes 3 darolutamide NUBEQA Non-Formulary

Brand

Yes 3 enasidenib IDHIFA Non-Formulary Brand

Yes 3 encorafenib BRAFTOVI Non-Formulary

Brand

PA Yes 3 entrectinib ROZLYTREK Non-Formulary

Brand

Yes 2 enzalutamide XTANDI Formulary Brand

No 2 erlotinib TARCEVA Formulary Brand

Yes 2 estramustine EMCYT Formulary Brand

QL No 2 everolimus AFINITOR Formulary Brand

No 1 exemestane AROMASIN Generic

Yes 3 gilteritinib XOSPATA Non-Formulary

Brand

Yes 3 glasdegib DAURISMO Non-Formulary

Brand

No 1 flutamide EULEXIN Generic

No 1 hydroxyurea HYDREA Generic

No 2 hydroxyurea DROXIA Formulary Brand

QL Yes 2 ibrutinib IMBRUVICA Formulary Brand

QL Yes 3 Ibrutinib 140 mg, 280 mg IMBRUVICA Non-Formulary

Brand

Yes 2 idelalisib ZYDELIG Formulary Brand

No 1 imatinib mesylate GLEEVEC Generic

Yes 3 ivosidenib TIBSOVO Non-Formulary

Brand

Yes 2 ixazomib NINLARO Formulary Brand

Yes 2 lapatinib TYKERB Formulary Brand

PA Yes 3 larotrectinib VITRAKVI Non-Formulary

Brand




QL Yes 2 lenalidomide REVLIMID Formulary Brand

Yes 2 lenvatinib LENVIMA Formulary Brand

No 1 letrozole FEMARA Generic

No 1 leuprolide acetate LUPRON Generic

ST Yes 1 lomustine GLEOSTINE Generic

Yes 3 lorlatinib LORBRENA Non-Formulary

Brand

Yes 3 mechlorethamine VALCHLOR Non-Formulary

Brand

Yes 2 melphalan ALKERAN Formulary Brand

No 1 mercaptopurine PURINETHOL Generic

No 3 methotrexate RASUVO Non-Formulary

Brand

No 3 methotrexate OTREXUP Non-Formulary

Brand

ST No 1 methotrexate sodium RHEUMATREX Generic

No 3 methotrexate sodium TREXALL Non-Formulary

Brand

Yes 2 mitotane LYSODREN Formulary Brand

Yes 2 nilotinib TASIGNA Formulary Brand

ST No 3 nilutamide NILANDRON Non-Formulary

Brand

QL Yes 2 niraparib ZEJULA Formulary Brand

QL Yes 2 palbociclib IBRANCE Formulary Brand

Yes 2 pazopanib VOTRIENT Formulary Brand

No 3 pemigatinib PEMAZYRE Non-Formulary

Brand

QL Yes 2 pomalidomide POMALYST Formulary Brand

Yes 3 ponatinib ICLUSIG Non-Formulary

Brand

Yes 2 procarbazine MATULANE Formulary Brand

Yes 2 regorafenib STIVARGA Formulary Brand

No 3 ripritinib QINLOCK Non-Formulary

Brand

Yes 3 ruxolitinib JAKAFI Non-Formulary

Brand

PA Yes 3 selinexor XPOVIO Non-Formulary

Brand




PA No 3 selumetinib KOSELUGO Non-Formulary

Brand

Yes 2 sorafenib tosylate NEXAVAR Formulary Brand

Yes 2 sunitinib malate SUTENT Formulary Brand

Yes 3 talazoparib TALZENNA Non-Formulary

Brand

No 1 tamoxifen citrate NOLVADEX Generic

No 3 tazemetostat TAZVERIK Non-Formulary

Brand

Yes 1 temozolomide TEMODAR Generic

Yes 2 thioguanine TABLOID Formulary Brand

Yes 2 topotecan HYCAMTIN Formulary Brand

ST No 1 toremifene FARESTON Generic

No 1 tretinoin VESANOID Generic

Yes 2 trifluidine/tipiracil LONSURF Formulary Brand

PA No 3 tucatinib TUKYSA Non-Formulary

Brand

PA, QL Yes 3 pexidartinib TURALIO Non-Formulary

Brand

Yes 2 vandetanib CAPRELSA Formulary Brand

Yes 2 vemurafenib ZELBORAF Formulary Brand

Yes 2 vorinostat ZOLINZA Formulary Brand

PA, QL Yes 3 zanubrutinib BRUKINSA Non-Formulary

Brand

Autonomic Drugs

Anticholinergic Agents

Yes 1 atropine sulfate ATROPINE SULFATE Generic

Yes 1 dicyclomine BENTYL Generic

Yes 1 glycopyrrolate ROBINUL Generic

Yes 1 glycopyrrolate ROBINULFORTE Generic

Yes 3 glycopyrrolate inhalation pow SEEBRI NEOHALER Non-Formulary

Brand

ST Yes 3 glycopyrrolate nebulizer soln LONHALA MAGNAIR Non-Formulary

Brand

Yes 1 hyoscyamine sulfate LEVBID Generic

Yes 1 hyoscyamine sulfate LEVSIN Generic




Yes 1 hyoscyamine sulfate SYMAX Generic

Yes 3 hyoscyamine sulfate SYMAX DUOTAB Non-Formulary

Brand

Yes 1 ipratropium bromide ATROVENT Generic

Yes 2 ipratropium bromide ATROVENT HFA Formulary Brand

ST Yes 1 methscopolamine PAMINE Generic

Yes 1 propantheline bromide PRO-BANTHINE Generic

ST Yes 3 revefenacin YUPELRI Non-Formulary

Brand

Yes 3 tiotropium SPIRIVA Non-Formulary

Brand

Yes 2 tiotropium 2.5 mcg SPIRIVA RESPIMAT Formulary Brand

Yes 3 tiotropium 1.25 mcg SPIRIVA RESPIMAT Non-Formulary

Brand

Yes 3 umeclidinium INCRUSE ELLIPTA Non-Formulary

Brand

Smoking Cessation Agents

Yes 1 nicotine gum NICORETTE Generic

QL, ST Yes 3 nicotine inhalation NICOTROL Non-Formulary

Brand

Yes 1 nicotine lozenge NICORETTE Generic

QL, ST Yes 3 nicotine nasal spray NICOTROL Non-Formulary

Brand

Yes 1 nicotine patch NICODERM Generic

ST Yes 3 varenicline CHANTIX Non-Formulary

Brand

Parasympathomimetic (Cholinergic) Agents

Yes 1 bethanechol chloride URECHOLINE Generic

Yes 1 cevimeline hcl EVOXAC Generic

Yes 1 donepezil ARICEPT Generic

Yes 1 donepezil ARICEPT ODT Generic

Yes 1 galantamine hydrobromide RAZADYNE Generic




Yes 1 galantamine hydrobromide ER RAZADYNE ER Generic

Yes 1 neostigmine bromide PROSTIGMIN Generic

ST Yes 1 pilocarpine SALAGEN Generic

Yes 1 pyridostigmine MESTION TIMESPAN Generic

Yes 1 pyridostigmine MESTION Generic

Yes 1 rivastigmine tartrate EXELON Generic

Yes 2 rivastigmine tartrate (solution) EXELON Formulary Brand

Skeletal Muscle Relaxants

Yes 1 baclofen LIORESAL Generic

ST No 1 carisoprodol SOMA Generic

ST No 1 carisoprodol & aspirin SOMA COMPOUND Generic

No 1 chlorzoxazone PARAFON FORTE DSC

Generic

No 1 cyclobenzaprine FLEXERIL Generic

No 3 cyclobenzaprine extended-release

AMRIX Non-Formulary

Brand

No 1 dantrolene sodium DANTRIUM Generic

ST No 1 metaxalone SKELAXIN Generic

No 1 methocarbamol ROBAXIN Generic

No 1 orphenadrine citrate NORFLEX Generic

Yes 1 orphenadrine, aspirin, & caffeine NORGESIC Generic

No 1 tizanidine ZANAFLEX Generic

Sympatholytic (Adrenergic Blocking) Agents

Yes 1 alfuzosin UROXATRAL Generic

No 1 dihydroergotamine mesylate D.H.E.45 Generic

No 2 dihydroergotamine mesylate MIGRANAL Formulary Brand

Yes 1 ergoloid mesylates HYDERGINE Generic




No 1 ergotamine & caffeine CAFERGOT Generic

ST No 1 phenoxybenzamine DIBENZYLINE Generic

ST Yes 3 silodosin RAPAFLO Non-Formulary

Brand

Yes 1 tamsulosin hcl FLOMAX Generic

Sympathomimetic (Adrenergic) Agents

Yes 1 albuterol nebulizer solution ACCUNEB Generic

Yes 3 albuterol sulfate PROAIR HFA Non-Formulary

Brand

Yes 3 albuterol sulfate PROVENTIL HFA Non-Formulary

Brand

Yes 2 albuterol sulfate VENTOLIN HFA Formulary Brand

Yes 3 albuterol sulfate & ipratropium COMBIVENT RESPIMAT

Non-Formulary Brand

Yes 1 albuterol sulfate & ipratropium DUONEB Generic

Yes 1 albuterol sulfate tablet VOSPIRE ER Generic

Yes 3 arformoterol BROVANA Non-Formulary

Brand

PA Yes 3 droxidopa NORTHERA Non-Formulary

Brand

No 1 epinephrine ADRENACLICK Generic

PA No 3 epinephrine AUVI-Q Non-Formulary

Brand

No 3 epinephrine EPIPEN Non-Formulary

Brand

No 3 epinephrine EPIPEN JR Non-Formulary

Brand

No 3 epinephrine TWINJECT Non-Formulary

Brand

Yes 3 formoterol fumarate FORADIL Non-Formulary

Brand

ST Yes 1 levalbuterol nebulizer solution XOPENEX NEBULIZER

Generic

ST Yes 1 levalbuterol tartrate XOPENEX HFA Generic




Yes 1 midodrine hcl PROAMATINE Generic

Yes 2 olodaterol STRIVERDI RESPIMAT

Formulary Brand

ST Yes 3 pirbuterol acetate MAXAIR AUTOHALER

Non-Formulary Brand

Yes 1 terbutaline sulfate BRETHINE Generic

Yes 3 umeclidinium & vilanterol ANORO ELLIPTA Non-Formulary

Brand

Blood Formation, Coagulation, and Thrombosis

Coagulants and Anticoagulants

Yes 2 aminocaproic acid AMICAR Formulary Brand

Yes 1 anagrelide AGRYLIN Generic

ST Yes 3 apixaban ELIQUIS Non-Formulary

Brand

Yes 1 aspirin & dipyridamole AGGRENOX Generic

ST Yes 3 betrixaban BEVYXXA Non-Formulary

Brand

Yes 1 cilostazol PLETAL Generic

Yes 1, 3 clopidogrel PLAVIX Generic;

Non-Formulary Brand

QL Yes 2 dabigatran PRADAXA Formulary Brand

ST Yes 3 dalteparin FRAGMIN Non-Formulary

Brand

Yes 1 dipyridamole PERSANTINE Generic

ST Yes 3 edoxaban SAVAYSA Non-Formulary

Brand

No 1 enoxaparin LOVENOX Generic

ST No 1 fondaparinux ARIXTRA Generic

No 1 heparin HEPARIN SODIUM Generic

Yes 1 pentoxifylline TRENTAL Generic

Yes 1 prasugrel EFFIENT Generic

QL, ST Yes 3 rivaroxaban XARELTO Non-Formulary

Brand

Yes 2 ticagrelor BRILINTA Formulary Brand

ST Yes 1 tranexamic acid LYSTEDA Generic




Yes 3 vorapaxar ZONTIVITY Non-Formulary

Brand

No 1 warfarin COUMADIN Generic

Hematopoietic Agents

Yes 2 darbepoetin alfa ARANESP Formulary Brand

Yes 2 eltrombopag PROMACTA Formulary Brand

Yes 2 epoetin alfa PROCRIT Formulary Brand

Yes 3 epoetin alfa EPOGEN Non-Formulary

Brand

Yes 3 filgrastim NEUPOGEN Non-Formulary

Brand

Yes 2 filgrastim ZARXIO Formulary Brand

Yes 2 oprelvekin NEUMEGA Formulary Brand

Yes 3 pegfilgrastim NEULASTA Non-Formulary

Brand

Yes 3 pegfilgrastim-jmdb FULPHILA Non-Formulary

Brand

Yes 2 sargramostim LEUKINE Formulary Brand

Cardiovascular Drugs

α-Adrenergic Blocking Agents

Yes 1 doxazosin CARDURA Generic

Yes 1 prazosin MINIPRESS Generic

Yes 1 terazosin HYTRIN Generic

Antilipemic Agents

PA Yes 3 alirocumab PRALUENT Non-Formulary

Brand

Yes 1 atorvastatin LIPITOR Generic

PA Yes 3 bempedoic acid NEXLETOL Non-Formulary

Brand

PA Yes 3 bempedoic acid & ezetimibe NEXLIZET Non-Formulary

Brand

Yes 1 cholestyramine light QUESTRAN LIGHT Generic

Yes 1 cholestyramine QUESTRAN Generic

ST Yes 1 colesevelam WELCHOL Generic

Yes 1 colestipol COLESTID Generic

Yes 3 evolocumab REPATHA Non-Formulary

Brand




PA No 3

Yes 1 ezetimibe ZETIA Generic

Yes 3 ezetimibe & simvastatin VYTORIN Non-Formulary

Brand

Yes 1 fenofibrate LOFIBRA TAB Generic

Yes 1 fenofibrate TRICOR Generic

Yes 1 fenofibrate, micronized LOFIBRA CAP Generic

Yes 1 fenofibric acid TRILIPIX Generic

ST Yes 1 fluvastatin extended-release LESCOL XL Generic

ST Yes 1 fluvastatin LESCOL Generic

Yes 1 gemfibrozil LOPID Generic

PA Yes 3 icosapent VASCEPA Non-Formulary

Brand

PA Yes 3 lomitapide JUXTAPID Non-Formulary

Brand

Yes 1 lovastatin MEVACOR Generic

Yes 3 lovastatine extended-release ALTOPREV Non-Formulary

Brand

PA Yes 3 mipomersen sodium KYNAMRO Non-Formulary

Brand

ST Yes 1 niacin NIASPAN Generic

Yes 3 niacin & lovastatin ADVICOR Non-Formulary

Brand

Yes 1 omega-3 acid ethyl esters LOVAZA Generic

Yes 3 omega-3-carboxylic acid EPANOVA Non-Formulary

Brand

ST Yes 3 pitavastatin LIVALO Non-Formulary

Brand

Yes 1 pravastatin PRAVACHOL Generic

Yes 1 rosuvastatin CRESTOR Generic

Yes 1 simvastatin ZOCOR Generic

Calcium Channel Blocking Agents

Yes 1 amlodipine NORVASC Generic

Yes 1 amlodipine & benazepril LOTREL Generic




Yes 1 amlodipine & atorvastatin CADUET Generic

Yes 3 amlodipine & olmesartan AZOR Non-Formulary

Brand

ST Yes 1 amlodipine & telmisartan TWYNSTA Generic

ST Yes 1 amlodipine & valsartan EXFORGE Generic

ST Yes 1 amlodipine, valsartan & hydrochlorothiazide

EXFORGE HCT Generic

Yes 1 amlodipine, olmesartan & hydrochlorothiazide

TRIBENZOR Generic

Yes 1 diltiazem extended-release CARDIZEM CD Generic

Yes 1 diltiazem extended-release TIAZAC Generic

Yes 1 diltiazem extended-release CARTIA XT Generic

Yes 1 diltiazem extended-release CARDIZEM LA Generic

Yes 1 diltiazem CARDIZEM Generic

Yes 1 felodipine PLENDIL Generic

ST Yes 1 isradipine DYNACIRC Generic

Yes 1 nicardipine CARDENE Generic

Yes 1 nifedipine PROCARDIA Generic

Yes 1 nifedipine extended-release ADALAT CC Generic

Yes 1 nifedipine extended-release PROCARDIA XL Generic

Yes 1 nimodipine NIMOTOP Generic

ST Yes 1 nisoldipine SULAR Generic

Yes 1 trandolapril & verapamil TARKA Generic

Yes 1 verapamil sustained-release cap VERELAN Generic




Yes 3 verapamil COVERA-HS Non-Formulary

Brand

Yes 1 verapamil extended-release cap VERELAN PM Generic

Yes 1 verapamil sustained-release cap CALAN SR Generic

Yes 1 verapamil sustained-release tab ISOPTIN SR Generic

Cardiac Drugs

Yes 1 amiodarone PACERONE Generic

Yes 1 digoxin LANOXIN Generic

Yes 1 disopyramide NORPACE Generic

Yes 2 disopyramide controlled-release NORPACE CR Formulary Brand

Yes 1 dofetilide TIKOSYN Generic

ST Yes 3 dronedarone MULTAQ Non-Formulary

Brand

Yes 1 flecainide TAMBOCOR Generic

Yes 3 Ivabradine CORLANOR Non-Formulary

Brand

Yes 1 mexiletine MEXITIL Generic

Yes 1 propafenone RYTHMOL Generic

Yes 3 propafenone RYTHMOL SR Non-Formulary

Brand

Yes 1 quinidine gluconate QUINAGLUTE Generic

Yes 1 quinidine QUINIDINE SULFATE Generic

QL Yes 1 ranolazine RANEXA Generic

Yes 3 sacubitril & valsartan ENTRESTO Non-Formulary

Brand

Hypotensive Agents

ST Yes 1 clonidine extended-release KAPVAY Generic

Yes 1 clonidine CATAPRES Generic




Yes 1 clonidine transdermal CATAPRES-TTS Generic

Yes 1 guanfacine TENEX Generic

Yes 1 hydralazine APRESOLINE Generic

Yes 1 methyldopa ALDOMET Generic

Yes 1 methyldopa & hydrochlorothiazide

ALDORIL-25 Generic

Yes 1 minoxidil LONITEN Generic

Yes 3 reserpine SERPASIL Non-Formulary

Brand

Renin-Angiotensin-Aldosterone System Inhibitors

ST Yes 3 aliskiren TEKTURNA Non-Formulary

Brand

ST Yes 3 aliskiren, amlodipine & hydrochlorothiazide

AMTURNIDE Non-Formulary

Brand

Yes 3 aliskiren & amlodipine TEKAMLO Non-Formulary

Brand

ST Yes 3 aliskiren & hydrochlorothiazide TEKTURNA HCT Non-Formulary

Brand

Yes 3 aliskiren & valsartan VALTURNA Non-Formulary

Brand

ST Yes 3 azilsartan EDARBI Non-Formulary

Brand

Yes 1 benazepril LOTENSIN Generic

Yes 1 benazepril & hydrochlorothiazide LOTENSIN HCT Generic

ST Yes 1 candesartan ATACAND Generic

ST Yes 1 candesartan & hydrochlorothiazide

ATACAND HCT Generic

Yes 1 captopril CAPOTEN Generic

Yes 1 captopril & hydrochlorothiazide CAPOZIDE Generic

Yes 1 enalapril VASOTEC Generic




Yes 1 enalapril & hydrochlorothiazide VASERETIC Generic

ST Yes 1 eplerenone INSPRA Generic

ST Yes 3 eprosartan TEVETEN Non-Formulary

Brand

Yes 3 eprosartan & hydrochlorothiazide TEVETEN PLUS Non-Formulary

Brand

ST Yes 1 fosinopril MONOPRIL Generic

ST Yes 1 fosinopril & hydrochlorothiazide MONOPRIL HCT Generic

ST Yes 1 irbesartan AVAPRO Generic

ST Yes 1 irbesartan & hydrochlorothiazide AVALIDE Generic

Yes 1 lisinopril ZESTRIL Generic

Yes 1 lisinopril & hydrochlorothiazide ZESTORETIC Generic

Yes 1 losartan COZAAR Generic

Yes 1 losartan & hydrochlorothiazide HYZAAR Generic

ST Yes 1 moexipril UNIVASC Generic

ST Yes 1 moexipril & hydrochlorothiazide UNIRETIC Generic

ST Yes 1 olmesartan BENICAR Generic

ST Yes 1 olmesartan & hydrochlorothiazide BENICAR HCT Generic

ST Yes 1 perindopril ACEON Generic

ST Yes 1 quinapril hcl ACCUPRIL Generic

ST Yes 1 quinapril & hydrochlorothiazide ACCURETIC Generic

Yes 1 ramipril ALTACE Generic




Yes 1 spironolactone & hydrochlorothiazide

ALDACTAZIDE Generic

Yes 1 spironolactone ALDACTONE Generic

ST Yes 1 telmisartan MICARDIS Generic

ST Yes 1 telmisartan & hydrochlorothiazide MICARDIS HCT Generic

ST Yes 1 trandolapril MAVIK Generic

ST Yes 1 valsartan DIOVAN Generic

ST Yes 1 valsartan & hydrochlorothiazide DIOVAN HCT Generic

Vasodilating Agents

No 2 ambrisentan LETAIRIS Formulary Brand

No 2 bosentan TRACLEER Formulary Brand

Yes 3 isosorbide dinitrate & hydralazine BIDIL Non-Formulary

Brand

Yes 1 isosorbide dinitrate ISORDIL Generic

Yes 1 isosorbide mononitrate IMDUR Generic

Yes 2 macitentan OPSUMIT Formulary Brand

Yes 3 nitroglycerin aerosol NITROMIST Non-Formulary

Brand

Yes 1 nitroglycerin solution NITROLINGUAL Generic

Yes 1 nitroglycerin sublingual NITROSTAT Generic

Yes 2 nitroglycerin topical ointment NITRO-BID Formulary Brand

Yes 1 nitroglycerin transdermal patch NITRO-DUR Generic

Yes 2 nitroglycerin transdermal patch 0.8 mg strength

NITRO-DUR Formulary Brand

ST Yes 3 nitroglycerin (intra-anal) RECTIV Non-Formulary

Brand

Yes 1 papaverine PAVABID Generic




Yes 3 riociguat ADEMPAS Non-Formulary

Brand

Yes 1 sildenafil REVATIO Generic

No 3 tadalafil ADCIRCA Non-Formulary

Brand

No 3 treprostinil ORENITRAM Non-Formulary

Brand

No 2 treprostinil REMODULIN Formulary Brand

β-Adrenergic Blocking Agents

Yes 1 acebutolol SECTRAL Generic

Yes 1 atenolol TENORMIN Generic

Yes 1 atenolol & chlorthalidone TENORETIC Generic

ST Yes 1 betaxolol KERLONE Generic

Yes 1 bisoprolol & hydrochlorothiazide ZIAC Generic

Yes 1 bisoprolol ZEBETA Generic

Yes 1 carvedilol COREG Generic

Yes 3 carvedilol phosphate COREG CR Non-Formulary

Brand

Yes 1 labetalol TRANDATE Generic

Yes 1 metoprolol & hydrochlorothiazide LOPRESSOR HCT Generic

Yes 1 metoprolol succinate TOPROL XL Generic

Yes 1 metoprolol tartrate LOPRESSOR Generic

Yes 1 nadolol CORGARD Generic

Yes 1 nadolol & bendroflumethiazide CORZIDE Generic

ST Yes 3 nebivolol BYSTOLIC Non-Formulary

Brand

ST Yes 3 penbutolol LEVATOL Non-Formulary

Brand

ST Yes 1 pindolol VISKEN Generic




Yes 1 propranolol & hydrochlorothiazide INDERIDE Generic

Yes 3 propranolol extended-release INNOPRAN XL Non-Formulary

Brand

Yes 1 propranolol INDERAL Generic

Yes 1 propranolol sustained-release INDERAL LA Generic

Yes 1 sotalol BETAPACE Generic

Yes 1 sotalol BETAPACE AF Generic

Yes 1 timolol BLOCADREN Generic

Central Nervous System Agents

Analgesics and Antipyretics

No 1 acetaminophen & codeine TYLENOL W/ CODEINE

Generic

No 1 acetaminophen, caffeine, & dihydrocodeine

TREZIX Generic

No 1 buprenorphine SUBUTEX Generic

QL No 1 buprenorphine& naloxone tablet SUBOXONE Generic

QL No 3 buprenorphine & naloxone film SUBOXONE Non-Formulary

Brand

QL, ST No 1 buprenorphine transdermal BUTRANS Generic

No 1 butalbital & acetaminophen PHRENILIN Generic

No 3 butalbital & acetaminophen PHRENILIN FORTE Non-Formulary

Brand

No 1 butalbital, acetaminophen, & caffeine

FIORICET Generic

No 1 butalbital, acetaminophen, caffeine, & codeine

FIORICET W/ CODEINE

Generic

No 1 butalbital, aspirin, & caffeine FIORINAL Generic




No 1 butalbital, aspirin, caffeine, & codeine

FIORINAL W/ CODEINE

Generic

No 1 butorphanol tartrate STADOL Generic

ST No 1 carisoprodol, aspirin, & codeine SOMA COMPOUND W/ CODEINE

Generic

ST No 1 celecoxib CELEBREX Generic

ST No 1 codeine CODEINE SULF Generic

No 1 diclofenac potassium CATAFLAM Generic

No 1 diclofenac sodium VOLTAREN Generic

No 1 diclofenac sodium PENNSAID Generic

No 1 diclofenac sodium & misoprostol ARTHROTEC Generic

No 1 diclofenac sodium extended release

VOLTAREN XR Generic

ST No 1 diflunisal DIFLUNISAL Generic

No 1 etodolac LODINE Generic

ST No 3 fenoprofen calcium NALFON Non-Formulary

Brand

No 3 fentanyl film ONSOLIS Non-Formulary

Brand

No 3 fentanyl intranasal LAZANDA Non-Formulary

Brand

No 1 fentanyl lozenge ACTIQ Generic

No 3 fentanyl sublingual ABSTRAL Non-Formulary

Brand

No 3 fentanyl tablet FENTORA Non-Formulary

Brand

QL No 1 fentanyl transdermal DURAGESIC Generic

ST No 1 flurbiprofen ANSAID Generic

ST No 3 hydrocodone ZOHYDRO ER Non-Formulary

Brand

No 3 hydrocodone er HYSINGLA ER Non-Formulary

Brand

No 1 hydrocodone & acetaminophen NORCO Generic




No 1 hydrocodone & ibuprofen VICOPROFEN Generic

No 3 hydromorphone oral suspension DILAUDID Non-Formulary

Brand

No 1 hydromorphone tablet DILAUDID Generic

ST No 3 hydromorphone tablet EXALGO Non-Formulary

Brand

No 1 ibuprofen MOTRIN Generic

No 1 indomethacin INDOCIN Generic

No 1 ketoprofen KETOPROFEN Generic

QL No 1 ketorolac tablet TORADOL Generic

ST No 1 levorphanol LEVO-DROMORAN Generic

ST No 1 meclofenamate MECLOMEN Generic

QL, ST No 1 mefenamic acid PONSTEL Generic

No 1 meloxicam MOBIC Generic

No 1 meperidine tablet DEMEROL Generic

No 1 methadone DOLOPHINE Generic

No 2 morphine MORPHINE SULFATE

Formulary Brand

No 1 morphine MSIR Generic

No 3 morphine beads AVINZA Non-Formulary

Brand

No 3 morphine extended-release capsule

KADIAN Non-Formulary

Brand

No 1 morphine extended-release tablet MS CONTIN Generic

ST No 3 morphine & naltrexone EMBEDA Non-Formulary

Brand

No 1 nabumetone RELAFEN Generic

Yes 1 nalbuphine NUBAIN Generic

No 1 naproxen NAPROSYN Generic

No 1 naproxen sodium ANAPROX Generic

No 3 naproxen sodium NAPRELAN Non-Formulary

Brand




Yes 1 opium & belladonna alkaloids B & O SUPPRETTES Generic

Yes 3 opium tincture OPIUM Non-Formulary

Brand

ST No 1 oxaprozin DAYPRO Generic

ST No 1 oxycodone ROXICODONE Generic

No 1 oxycodone & acetaminophen PERCOCET Generic

No 2 oxycodone & acetaminophen ROXICET Formulary Brand

No 3 oxycodone & acetaminophen er XARTEMIS XR Non-Formulary

Brand

No 1 oxycodone & aspirin PERCODAN Generic

QL No 3 oxycodone & ibuprofen COMBUNOX Non-Formulary

Brand

QL, ST No 1 oxycodone controlled-release OXYCONTIN Generic

ST No 1 oxymorphone OPANA Generic

ST No 1 oxymorphone extended-release OPANA ER Generic

No 1 pentazocine & naloxone TALWIN NX Generic

ST No 1 piroxicam FELDENE Generic

Yes 1 salsalate DISALCID Generic

No 1 sulindac CLINORIL Generic

QL, ST Yes 3 tapentadol NUCYNTA Non-Formulary

Brand

No 1 tolmetin sodium TOLECTIN 600 Generic

No 1 tramadol ULTRAM Generic

No 1 tramadol & acetaminophen ULTRACET Generic

ST No 1 tramadol extended-release ULTRAM ER Generic

Anorexigenic Agents and Respiratory and Cerebral Stimulants

ST No 3 amphetamine sulfate EVEKEO Non-Formulary

Brand




ST No 3 amphetamine extended-release ADZENYS ER Non-Formulary

Brand

No 1 amphetamine & dextroamphetamine

ADDERALL Generic

No 1 amphetamine & dextroamphetamine extended-release

ADDERALL XR Generic

ST No 3 amphetamine & dextroamphetamine extended-release

MYDAYIS Non-Formulary

Brand

QL, ST

No 1 armodafinil NUVIGIL Generic (ST-Brand only)

QL No 1 dexmethylphenidate FOCALIN Generic

No 1 dexmethylphenidate extended-release

FOCALIN XR Generic

QL No 1 dextroamphetamine sulfate DEXTROSTAT Generic

QL No 1 dextroamphetamine sulfate extended-release

DEXEDRINE Generic

QL, ST Yes 3 lisdexamfetamine VYVANSE Non-Formulary

Brand

ST No 1 methamphetamine DESOXYN Generic

No 1 methylphenidate METHYLIN Generic

No 1 methylphenidate RITALIN Generic

QL No 1 methylphenidate extended-release

METADATE ER Generic

QL No 1 methylphenidate extended-release

CONCERTA Generic

No 1 methylphenidate extended-release

METADATE CD Generic

QL, ST No 1 methylphenidate extended-release

RITALIN LA Generic




QL No 1 methylphenidate sustained release

RITALIN SR Generic

QL, ST No 3 methylphenidate transdermal patch

DAYTRANA Non-Formulary

Brand

ST No 3 Methylphenidate extended-release disintegrating tablet

COTEMPLA XR-ODT Non-Formulary

Brand

QL No 1 modafinil PROVIGIL Generic

Anticonvulsants

Yes 1 carbamazepine TEGRETOL Generic

Yes 1 carbamazepine extended-release cap

CARBATROL Generic

Yes 3 carbamazepine extended-release cap

EQUETRO Non-Formulary

Brand

Yes 1 carbamazepine extended-release tab

TEGRETOL XR Generic

Yes 3 clobazam ONFI Non-Formulary

Brand

No 1 clonazepam KLONOPIN Generic

No 1 diazepam DIASTAT Generic

No 2 diazepam DIASTAT ACUDIAL Formulary Brand

Yes 1 divalproex sodium DEPAKOTE Generic

Yes 1 divalproex sodium capsule DEPAKOTE SPRINKLE

Generic

Yes 1 divalproex sodium extended release

DEPAKOTE ER Generic

Yes 3 eslicarbazepine APTIOM Non-Formulary

Brand

ST Yes 3 ethontoin PEGANONE Non-Formulary

Brand

Yes 1 ethosuximide ZARONTIN Generic

ST Yes 3 ezogaine POTIGA Non-Formulary

Brand

ST Yes 1 felbamate FELBATOL Generic

No 1 gabapentin NEURONTIN Generic




ST No 3 gabapentin HORIZANT Non-Formulary

Brand

QL, ST Yes 3 lacosamide VIMPAT Non-Formulary

Brand

Yes 1 lamotrigine LAMICTAL Generic

Yes 1 lamotrigine extended-release LAMICTAL XR Generic

Yes 1 levetiracetam KEPPRA Generic

Yes 1 levetiracetam extended-release KEPPRA XR Generic

Yes 2 methsuximide CELONTIN Formulary Brand

Yes 1 oxcarbazepine TRILEPTAL Generic

Yes 3 perampanel FYCOMPA Non-Formulary

Brand

Yes 1 phenytoin sodium extended-release

DILANTIN Generic

Yes 1 phenytoin sodium extended-release

PHENYTEK Generic

Yes 1 phenytoin suspension DILANTIN Generic

Yes 1 pregabalin LYRICA Generic

Yes 1 primidone MYSOLINE Generic

ST Yes 3 rufinamide BANZEL Non-Formulary

Brand

PA Yes 3 stiripentol DIACOMIT Non-Formulary

Brand

ST Yes 1 tiagabine GABITRIL Generic

Yes 1 topiramate capsule TOPAMAX SPRINKLE Generic

Yes 1 topiramate tablet TOPAMAX Generic

Yes 1 valproate sodium DEPAKENE Generic

Yes 1 valproic acid DEPAKENE Generic

PA No 3 vigabatrin SABRIL Non-Formulary

Brand

Yes 1 zonisamide ZONEGRAN Generic

Antimigraine Agents

ST No 1 almotriptan AXERT Generic

No 1 ergotamine & caffeine MIGERGOT Generic




ST No 1 eletriptan RELPAX Generic

ST No 1 frovatriptan FROVA Generic

QL, ST No 3 lasmitidan REYVOW Non-Formulary

Brand

No 1 naratriptan AMERGE Generic

QL, ST No 3 rimegepant NURTEC ODT Non-Formulary

Brand

No 1 rizatriptan MAXALT Generic

No 1 rizatriptan orally disintegrating MAXALT MLT Generic

No 1 sumatriptan IMITREX Generic

QL, ST Yes 3 ubrogepant UBRELVY Non-Formulary

Brand

ST No 1 zolmitriptan ZOMIG Generic

No 1 zolmitriptan orally disintegrating ZOMIG ZMT Generic

Antiparkinsonian Agents

Yes 1 amantadine SYMMETREL Generic

ST Yes 3 amantadine ER GOCOVRI Non-Formulary

Brand

ST Yes 3 apomorphine APOKYN Non-Formulary

Brand

Yes 1 benztropine COGENTIN Generic

Yes 1 bromocriptine PARLODEL Generic

ST Yes 3 bromocriptine CYCLOSET Non-Formulary

Brand

Yes 1 cabergoline DOSTINEX Generic

ST Yes 3 carbidopa LODOSYN Non-Formulary

Brand

Yes 1 carbidopa & levodopa SINEMET Generic

Yes 3 carbidopa & levodopa PARCOPA Non-Formulary

Brand

Yes 1 carbidopa & levodopa extended release

SINEMET CR Generic

Yes 2 carbidopa, levodopa, & entacapone

STALEVO Formulary Brand

Yes 1 entacapone COMTAN Generic




PA Yes 3 levophed (oral inhalation) INBRIJA Non-Formulary

Brand

Yes 1 pramipexole MIRAPEX Generic

Yes 1 pramipexole extended-release MIRAPEX ER Generic

ST Yes 3 rasagiline AZILECT Non-Formulary

Brand

Yes 1 ropinirole REQUIP Generic

ST Yes 1 ropinirole extended-release REQUIP XL Generic

ST Yes 3 rotigotine NEUPRO Non-Formulary

Brand

Yes 1 selegiline ELDEPRYL Generic

ST Yes 3 selegiline ZELAPAR Non-Formulary

Brand

ST Yes 3 selegiline transdermal EMSAM Non-Formulary

Brand

Yes 2 tolcapone TASMAR Formulary Brand

Yes 1 trihexyphenidyl ARTANE Generic

Anxiolytics, Sedatives, and Hypnotics

No 1 alprazolam XANAX Generic

No 1 alprazolam extended-release XANAX XR Generic

No 3 alprazolam orally disintegrating NIRAVAM Non-Formulary

Brand

No 1 buspirone BUSPAR Generic

No 1 chlordiazepoxide LIBRIUM Generic

No 1 clorazepate TRANXENE Generic

No 1 diazepam VALIUM Generic

ST Yes 3 doxepin (sleep) SILENOR Non-Formulary

Brand

No 1 estazolam PROSOM Generic

ST No 1 eszopiclone LUNESTA Generic

No 1 flurazepam DALMANE Generic

No 1 hydroxyzine hcl ATARAX Generic

ST No 1 hydroxyzine pamoate VISTARIL Generic

No 1 lorazepam ATIVAN Generic




No 1 meprobamate MILTOWN Generic

No 1 oxazepam SERAX Generic

No 1 phenobarbital PHENOBARBITAL Generic

ST No 1 ramelteon ROZEREM Generic

Yes 3 suvorexant BELSOMRA Non-Formulary

Brand

PA Yes 3 tasimelteon HETLIOZ Non-Formulary

Brand

No 1 temazepam RESTORIL Generic

No 1 triazolam HALCION Generic

No 1 zaleplon SONATA Generic

Yes 3 zolipdem sublingual EDLUAR Non-Formulary

Brand

No 1 zolpidem AMBIEN Generic

No 3 zolpidem extended-release AMBIEN CR Non-Formulary

Brand

No 3 zolpidem oral spray ZOLPIMIST Non-Formulary

Brand

Central Nervous System Agents Miscellaneous

ST Yes 1 acamprosate CAMPRAL Generic

ST Yes 3 atomoxetine STRATTERA Non-Formulary

Brand

PA Yes 3 cannabidiol EPIDIOLEX Non-Formulary

Brand

PA Yes 3 deutetrabenazine AUSTEDO Non-Formulary

Brand

PA Yes 3 dextromethorphan & quinidine NUEDEXTA Non-Formulary

Brand

Yes 1 guanfacine extended-release INTUNIV Generic

ST Yes 3 lofexidine LUCEMYRA Non-Formulary

Brand

No 1 memantine NAMENDA Generic

No 3 memantine er & donepezil NAMZARIC Non-Formulary

Brand

QL, ST Yes 3 milnacipran SAVELLA Non-Formulary

Brand

PA Yes 3 pitolisant WAKIX Non-Formulary

Brand




Yes 1 riluzole RILUTEK Generic

PA Yes 3 solriamfetol SUNOSI Non-Formulary

Brand

PA Yes 3 sodium oxybate XYREM Non-Formulary

Brand

PA No 3 tetrabenazine XENAZINE Non-Formulary

Brand

PA Yes 3 valbenazine INGREZZA Non-Formulary

Brand

Opioid Antagonists

No 1 naloxone NARCAN Generic

QL No 2 naloxone nasal spray NARCAN Formulary Brand

No 1 naltrexone REVIA Generic

Psychotherapeutic Agents

Yes 1 amitriptyline ELAVIL Generic

Yes 1 amitriptyline & perphenazine TRIAVIL Generic

Yes 1 amoxapine ASENDIN Generic

Yes 1 aripiprazole tablet ABILIFY Generic

ST Yes 3 aripiprazole solution ABILIFY Non-Formulary

Brand

ST Yes 3 aripiprazole ABILIFY DISCMELT Non-Formulary

Brand

ST Yes 3 asenapine SAPHRIS Non-Formulary

Brand

QL, ST Yes 3 brexpiprazole REXULTI Non-Formulary

Brand

Yes 1 bupropion WELLBUTRIN Generic

Yes 1 bupropion extended-release WELLBUTRIN XL Generic

ST Yes 3 bupropion hydrobromide APLENZIN Non-Formulary

Brand

Yes 1 bupropion sustained-release WELLBUTRIN SR Generic

ST Yes 3 bupropion (smoking deterrent) ZYBAN Non-Formulary

Brand




QL, ST Yes 3 cariprazine VRAYLAR Non-Formulary

Brand

No 1 chlordiazepoxide & amitriptyline LIMBITROL DS Generic

Yes 1 chlorpromazine THORAZINE Generic

Yes 1 citalopram CELEXA Generic

Yes 1 clomipramine ANAFRANIL Generic

No 1 clozapine CLOZARIL Generic

No 1 clozapine FAZACLO Generic

Yes 1 desipramine NORPRAMIN Generic

ST Yes 1 desvenlafaxine succinate extended release

PRISTIQ Generic

ST Yes 1 desvenlafaxine extended release KHEDEZLA Generic

Yes 1 doxepin SINEQUAN Generic

Yes 1 duloxetine CYMBALTA Generic

Yes 1 escitalopram LEXAPRO Generic

Yes 1 fluoxetine PROZAC Generic

Yes 3 fluoxetine PROZAC WEEKLY Non-Formulary

Brand

Yes 3 fluoxetine SARAFEM Non-Formulary

Brand

Yes 1 fluphenazine PROLIXIN Generic

Yes 1 fluvoxamine LUVOX Generic

Yes 1 haloperidol HALDOL Generic

ST Yes 3 iloperidone FANAPT Non-Formulary

Brand

Yes 1 imipramine TOFRANIL Generic

Yes 1 imipramine pamoate TOFRANIL-PM Generic

ST Yes 3 isocarboxazid MARPLAN Non-Formulary

Brand

QL Yes 3 levomilnacipran FETZIMA Non-Formulary

Brand

Yes 1 lithium carbonate capsule LITHIUM CARBONATE

Generic

Yes 1 lithium carbonate extended release

LITHOBID Generic




Yes 1 lithium citrate CIBALITH-S Generic

ST Yes 1 loxapine LOXITANE Generic

QL, ST Yes 3 lurasidone LATUDA Non-Formulary

Brand

ST Yes 1 maprotiline LUDIOMIL Generic

Yes 1 mirtazapine REMERON Generic

Yes 1 nefazodone SERZONE Generic

Yes 1 nortriptyline PAMELOR Generic

Yes 1 olanzapine ZYPREXA Generic

Yes 1 olanzapine & fluoxetine hcl SYMBYAX Generic

Yes 1 olanzapine orally disintegrating ZYPREXA ZYDIS Generic

ST Yes 1 paliperidone INVEGA Generic

Yes 1 paroxetine PAXIL Generic

Yes 3 paroxetine extended-release PAXIL CR Non-Formulary

Brand

Yes 3 paroxetine mesylate PEXEVA Non-Formulary

Brand

Yes 1 perphenazine TRILAFON Generic

Yes 1 phenelzine NARDIL Generic

PA Yes 3 pimavanserin NUPLAZID Non-Formulary

Brand

ST Yes 1 pimozide ORAP Generic

ST Yes 1 protriptyline VIVACTIL Generic

Yes 1 quetiapine SEROQUEL Generic

Yes 1 quetiapine extended-release SEROQUEL XR Generic

Yes 1 risperidone RISPERDAL Generic

Yes 3 risperidone orally disintegrating RISPERDALM-TAB Non-Formulary

Brand

Yes 1 sertraline ZOLOFT Generic

Yes 1 thioridazine MELLARIL Generic

Yes 1 thiothixene NAVANE Generic

Yes 1 tranylcypromine sulfate PARNATE Generic

Yes 1 trazodone DESYREL Generic




Yes 3 trazodone extended-release OLEPTRO Non-Formulary

Brand

Yes 1 trifluoperazine STELAZINE Generic

ST Yes 1 trimipramine SURMONTIL Generic

Yes 1 venlafaxine EFFEXOR Generic

Yes 1 venlafaxine extended-release EFFEXOR XR Generic

QL, ST Yes 3 vilazodone VIIBRYD Non-Formulary

Brand

QL, ST Yes 3 vortioxetine TRINTELLIX Non-Formulary

Brand

Yes 1 ziprasidone GEODON Generic

Diabetic Supplies

Diabetic Supplies

QL Yes 2 blood sugar diagnostic ONE TOUCH ULTRA TEST STRIPS

Formulary Brand

QL Yes 2 blood sugar diagnostic ONE TOUCH VERIO TEST STRIPS

Formulary Brand

QL Yes 2 blood sugar diagnostic ACCU-CHEK TEST STRIPS

Formulary Brand

QL Yes 2 blood sugar diagnostic ASCENSIA TEST STRIPS

Formulary Brand

QL Yes 2 blood sugar diagnostic FREESTYLE TEST STRIPS

Formulary Brand

QL Yes 2 blood sugar diagnostic PRODIGY TEST STRIPS

Formulary Brand

QL Yes 2 blood-glucose meter ONE TOUCH ULTRA 2

Formulary Brand

QL Yes 2 blood-glucose meter ONE TOUCH VERIO FLEX

Formulary Brand

QL Yes 2 blood-glucose meter ACCU-CHEK Formulary Brand

QL Yes 2 blood-glucose meter ASCENSIA BREEZE Formulary Brand

QL Yes 2 blood-glucose meter FREESTYLE SYSTEM

Formulary Brand

QL Yes 2 blood-glucose meter ONE TOUCH ULTRA SMART

Formulary Brand




QL Yes 2 blood-glucose meter ONE TOUCH ULTRAMINI

Formulary Brand

QL Yes 2 blood-glucose meter PRODIGY Formulary Brand

ST Yes 2 Insulin delivery system OMNIPOD DASHTM SYSTEM KIT AND PODs

Formulary Brand

QL Yes 2 syringe with needle,disposable BD INSULIN SYRINGE

Formulary Brand

Electrolytic, Caloric and Water Balance

Acidifying and Alkalinizing Agents

Yes 3 citric acid, sodium citrate, & potassium citrate

CYTRA-3 Non-Formulary

Brand

Yes 1 potassium citrate UROCIT-K Generic

Yes 2 potassium citrate & citric acid POLYCITRA-K Formulary Brand

Yes 3 sodium citrate & citric acid BICITRA Non-Formulary

Brand

Ammonia Detoxicants

ST Yes 3 carglumic acid CARBAGLU Non-Formulary

Brand

PA Yes 3 glycerol phenylbutyrate RAVICTI Non-Formulary

Brand

No 3 sodium phenylbutyrate BUPHENYL Non-Formulary

Brand

Yes 3 lactulose CHRONULAC Non-Formulary

Brand

Yes 1 lactulose ENULOSE Generic

Yes 3 lactulose KRISTALOSE Non-Formulary

Brand

Diuretics

ST Yes 1 amiloride MIDAMOR Generic

Yes 1 amiloride & hydrochlorothiazide MODURETIC Generic

Yes 1 bumetanide BUMEX Generic

ST Yes 1 chlorothiazide DIURIL Generic

Yes 1 chlorthalidone HYGROTON Generic




ST Yes 3 ethacrynic acid EDECRIN Non-Formulary

Brand

Yes 1 furosemide LASIX Generic

Yes 1 hydrochlorothiazide MICROZIDE Generic

Yes 1 indapamide LOZOL Generic

ST Yes 1 methyclothiazide METHYCLOTHIAZIDE Generic

Yes 1 metolazone ZAROXOLYN Generic

PA No 3 tolvaptan JYNARQUE Non-Formulary

Brand

QL No 3 tolvaptan SAMSCA Non-Formulary

Brand

Yes 1 torsemide DEMADEX Generic

ST Yes 3 triamterene DYRENIUM Non-Formulary

Brand

Yes 1 triamterene & hydrochlorothiazide DYAZIDE Generic

Yes 1 triamterene & hydrochlorothiazide MAXZIDE Generic

Ion-Removing Agnets

ST Yes 1 sevelamer carbonate RENVELA Generic

No 1 sodium polystyrene sulfonate SPS Generic

Yes 3 sucroferric oxyhydroxide VELPHORO Non-Formulary

Brand

ST Yes 3 lanthanum carbonate FOSRENOL Non-Formulary

Brand

Yes 3 patiromer VELTASSA Non-Formulary

Brand

Yes 1 sevelamer hcl RENAGEL Generic

ST Yes 3 sodium zirconium cyclosilicate LOKELMA Non-Formulary

Brand

Replacement Products

Yes 2 calcium acetate ELIPHOS Formulary Brand

Yes 1 calcium acetate PHOSLO Generic




Yes 2 calcium acetate PHOSLYRA Formulary Brand

Yes 1 potassium bicarbonate & potassium chloride

K-LYTE/CL Generic

Yes 1 potassium chloride K-DUR Generic

Yes 1 potassium chloride K-TAB 10, KLOR-CON 20 MEQ

Generic

Yes 3 potassium chloride powder KLOR-CON 20 MEQ Non-Formulary

Brand

Yes 1 potassium gluconate KAON Generic

Yes 2 potassium phosphate PHOSPHA Formulary Brand

Yes 3 potassium phosphate, monobasic K-PHOS NEUTRAL Non-Formulary

Brand

Yes 2 potassium phosphate, monobasic K-PHOS ORIGINAL Formulary Brand

Uricosuric Agents

Yes 1 colchicine & probenecid COL-BENEMID Generic

Yes 1 probenecid BENEMID Generic

Enzymes

Enzymes

Yes 2 dornase alfa PULMOZYME Formulary Brand

Eye, Ear, Nose and Throat (EENT)

Anti-infectives

Yes 3 azithromycin (ophth) AZASITE Non-Formulary

Brand

No 1 bacitracin & polmyxin B (ophth) POLYSPORIN Generic

No 1 bacitracin (ophth) AK-TRACIN Generic

ST Yes 3 besilfoxacin BESIVANCE Non-Formulary

Brand

No 1 chlorhexidine (mouth-throat) PERIDEX Generic




No 3 ciprofloxacin (ophth) ointment CILOXAN Non-Formulary

Brand

No 1 ciprofloxacin (ophth) solution CILOXAN Generic

No 1 erythromycin (ophth) ROMYCIN Generic

ST Yes 3 ganciclovir (ophth) ZIRGAN Non-Formulary

Brand

ST No 1 gatifloxacin (ophth) ZYMAXID Generic

No 1 gentamicin (ophth) GENTAK Generic

No 1 levofloxacin (ophth) QUIXIN Generic

No 1 moxifloxacin (ophth) VIGAMOX Generic

Yes 2 natamycin NATACYN Formulary Brand

No 1 neomycin, bacitracin & polymyxin b (ophth)

NEO-POLYCIN Generic

No 1 neomycin, polymycin b & gramicidin (ophth)

NEOSPORIN Generic

No 1 ofloxacin (ophth) OCUFLOX Generic

No 1 ofloxacin (otic) FLOXIN Generic

No 1 polymyxin b & trimethoprim (ophth)

POLYTRIM Generic

No 1 sulfacetamide sodium (ophth) ointment

SULFAC Generic

No 1 sulfacetamide sodium (ophth) solution

BLEPH-10 Generic

No 2 tobramycin sulfate (ophth) ointment

TOBREX Formulary Brand

No 1 tobramycin sulfate (ophth) solution

TOBREX Generic

No 1 trifluridine VIROPTIC Generic




Anti-Inflammatory Agents

No 1 bacitracin, neomycin, polymyxin B & hydrocortisone (ophth)

NEO-POLYCIN HC Generic

ST Yes 3 bromfenac (ophth) XIBROM Non-Formulary

Brand

No 2 ciprofloxacin & dexamethasone (ophth)

CIPRODEX Formulary Brand

ST No 3 ciprofloxacin & hydrocortisone (otic)

CIPRO HC Non-Formulary

Brand

QL, ST Yes 3 cyclosporine (ophth) CEQUA Non-Formulary

Brand

QL, ST Yes 3 cyclosporine (ophth) RESTASIS Non-Formulary

Brand

Yes 1 dexamethasone (ophth) solution DECADRON Generic

Yes 2 dexamethasone (ophth) suspension

MAXIDEX Formulary Brand

No 1 diclofenac sodium (ophth) VOLTAREN Generic

ST Yes 3 difluprednate DUREZOL Non-Formulary

Brand

ST Yes 3 fluocinolone acetonide (otic) DERMOTIC Non-Formulary

Brand

Yes 1 fluorometholone (ophth) FML Generic

Yes 3 fluorometholone (ophth) FML FORTE Non-Formulary

Brand

ST Yes 3 fluorometholone (ophth oint) FML OINT Non-Formulary

Brand

Yes 2 fluorometholone acetate FLAREX Formulary Brand

ST No 1 flurbiprofen (ophth) OCUFEN Generic

No 2 gentamicin & prednisolone PRED-G Formulary Brand




Yes 1 hydrocortisone & acetic acid (otic)

ACETASOL HC Generic

No 1 ketorolac (ophth) ACULAR Generic

No 1 ketorolac (ophth) ACULAR LS Generic

QL, ST Yes 3 lifitegrast XIIDRA Non-Formulary

Brand

Yes 3 loteprednol ALREX Non-Formulary

Brand

ST Yes 3 loteprednol LOTEMAX Non-Formulary

Brand

Yes 3 loteprednol & tobramycin ZYLET Non-Formulary

Brand

No 3 neomycin, colistin, hydrocortisone & thonzonium (otic)

CORTISPORIN-TC Non-Formulary

Brand

No 1 neomycin, polymyxin B & dexamethasone (ophth)

MAXITROL Generic

No 3 neomycin, polymyxin B & hydrocortisone (ophth)

CORTISPORIN Non-Formulary

Brand

No 1 neomycin, polymyxin B & hydrocortisone (otic)

CORTISPORIN Generic

ST Yes 3 nepafenac NEVANAC Non-Formulary

Brand

Yes 1 prednisolone acetate (ophth) OMNIPRED Generic

Yes 1 prednisolone acetate (ophth) PRED FORTE Generic

Yes 2 prednisolone acetate (ophth) PRED MILD Formulary Brand

Yes 3 prednisolone sodium phosphate (ophth)

INFLAMASE FORTE Non-Formulary

Brand




Yes 1 prednisolone sodium phosphate (ophth)

PREDNISOL Generic

ST Yes 3 rimexolone VEXOL Non-Formulary

Brand

No 1 sulfacetamide sodium & prednisolone

BLEPHAMIDE Generic

No 2 tobramycin & dexamethasone ointment

TOBRADEX Formulary Brand

No 1 tobramycin & dexamethasone suspension

TOBRADEX Generic

Antiallergic Agents

ST Yes 3 aflcaftadine LASTACAFT Non-Formulary

Brand

Yes 1 azelastine ASTELIN Generic

Yes 1 azelastine ASTEPRO Generic

Yes 3 azelastine & fluticasone DYMISTA Non-Formulary

Brand

ST Yes 1 azelastine (ophth) OPTIVAR Generic

ST Yes 3 bepotastine BEPREVE Non-Formulary

Brand

Yes 1 cromolyn sodium (ophth) OPTICROM Generic

ST Yes 3 emedastine EMADINE Non-Formulary

Brand

ST Yes 1 epinastine (ophth) ELESTAT Generic

Yes 3 grass pollen allergen extract (5 glass extract)

ORALAIR Non-Formulary

Brand

ST Yes 3 lodoxamide tromethamine ALOMIDE Non-Formulary

Brand

Yes 3 house dust mite allergen extract ODACTRA Non-Formulary

Brand

ST Yes 3 nedocromil sodium (ophth) ALOCRIL Non-Formulary

Brand

ST Yes 3 olopatadine PATADAY Non-Formulary

Brand




ST Yes 3 olopatadine (nasal) PATANASE Non-Formulary

Brand

ST Yes 1 olopatadine (ophth) PATANOL Generic

Yes 3 short ragweed pollen allergen extract

RAGWITEK Non-Formulary

Brand

Yes 3 timothy grass pollen allergen extract

GRASTEK Non-Formulary

Brand

Antiglaucoma Agents

Yes 1 acetazolamide DIAMOX Generic

Yes 1 acetazolamide DIAMOX SEQUELS Generic

Yes 1 betaxolol hcl BETOPTIC Generic

Yes 2 betaxolol hcl BETOPTIC S Formulary Brand

ST Yes 3 bimatoprost LUMIGAN Non-Formulary

Brand

Yes 1 brimonidine ALPHAGAN Generic

Yes 1 brimonidine tartrate ALPHAGAN P Generic

ST Yes 3 brimonidine & timolol COMBIGAN Non-Formulary

Brand

ST Yes 3 brinzolamide AZOPT Non-Formulary

Brand

Yes 2 carbachol ISOPTO CARBACHOL

Formulary Brand

ST Yes 1 carteolol (ophth) OCUPRESS Generic

Yes 1 dorzolamide TRUSOPT Generic

Yes 1 dorzolamide & timolol COSOPT Generic

Yes 2 ecothiophate PHOSPHOLINE IODIDE

Formulary Brand

Yes 1 latanoprost XALATAN Generic

PA Yes 3 latanoprostene bunod VYZULTA Non-Formulary

Brand

Yes 1 levobunolol BETAGAN Generic

Yes 1 methazolamide NEPTAZANE Generic

Yes 1 metipranolol OPTIPRANOLOL Generic




PA Yes 3 netarsudil RHOPRESSA Non-Formulary

Brand

Yes 1 pilocarpine ISOPTO CARPINE Generic

Yes 3 pilocarpine gel PILOPINE HS Non-Formulary

Brand

Yes 3 timolol BETIMOL Non-Formulary

Brand

Yes 3 timolol ISTALOL Non-Formulary

Brand

Yes 1 timolol TIMOPTIC Generic

Yes 3 timolol TIMOPTIC-XE Non-Formulary

Brand

ST Yes 3 travoprost TRAVATAN Z Non-Formulary

Brand

Yes 3 unoprostone isopropyl RESCULA Non-Formulary

Brand

EENT Drugs, Miscellaneous

Yes 1 acetic acid VOSOL Generic

Yes 2 apraclonidine IOPIDINE Formulary Brand

ST Yes 3 artificial tear insert LACRISERT Non-Formulary

Brand

PA Yes 3 cenegermin-bkbj OXERVATE Non-Formulary

Brand

Local Anesthetics

Yes 1 antipyrine & benzocaine AURODEX Generic

No 1 lidocaine (mouth-throat) XYLOCAINE VISCOUS

Generic

Yes 1 proparacaine OPTHETIC Generic

Mydriatics

Yes 1 atropine ISOPTO ATROPINE Generic

Yes 2 homatropine ISOPTO HOMATROPINE

Formulary Brand

Yes 2 scopolamine (ophth) ISOPTO HYOSCINE Formulary Brand

Vasoconstrictors

ST Yes 1 tetrahydrozoline TYZINE Generic

Gastrointestinal Drugs




Anti-inflammatory Agents

No 1 alosetron LOTRONEX Generic

Yes 1 balsalazide COLAZAL Generic

Yes 3 balsalazide GIAZO Non-Formulary

Brand

PA Yes 3 eluxadoline VIBERZI Non-Formulary

Brand

Yes 2 mesalamine controlled-release PENTASA Formulary Brand

Yes 2 mesalamine suppository CANASA Formulary Brand

Yes 1 mesalamine suspension ROWASA Generic

Yes 2 mesalamine tablet LIALDA Formulary Brand

ST Yes 3 olsalazine DIPENTUM Non-Formulary

Brand

Antidiarrhea Agents

ST Yes 3 difenoxin & atropine MOTOFEN Non-Formulary

Brand

No 1 diphenoxylate & atropine LOMOTIL Generic

Yes 3 paregoric PAREGORIC Non-Formulary

Brand

Antiemetics

No 2 aprepitant EMEND Formulary Brand

ST Yes 3 dolasetron ANZEMET Non-Formulary

Brand

No 1 dronabinol MARINOL Generic

ST No 3 granisetron KYTRIL Non-Formulary

Brand

No 3 granisetron SANCUSO Non-Formulary

Brand

ST Yes 3 nabilone CESAMET Non-Formulary

Brand

Yes 2 netupitant & palonosetron AKYNZEO Formulary Brand

No 1 ondansetron ZOFRAN Generic




No 1 ondansetron (orally disintegrating)

ZOFRAN ODT Generic

QL No 1 prochlorperazine COMPAZINE Generic

Yes 3 rolapitant VARUBI Non-Formulary

Brand

ST Yes 1 scopolamine hydrobromide TRANSDERM-SCOP Generic

ST No 1 trimethobenzamide TIGAN Generic

Antiulcer Agents and Acid Suppressants

No 3 amoxicillin, clarithromycin, & lansoprazole

PREVPAC Non-Formulary

Brand

Yes 1 cimetidine TAGAMET Generic

ST Yes 3 dexlansoprazole DEXILANT Non-Formulary

Brand

ST No 1 esomeprazole NEXIUM Generic

Yes 1 famotidine PEPCID Generic

Yes 1 lansoprazole PREVACID Generic

Yes 1 misoprostol CYTOTEC Generic

ST Yes 1 nizatidine AXID Generic

Yes 1 omeprazole PRILOSEC Generic

Yes 1 pantoprazole PROTONIX Generic

ST Yes 1 rabeprazole ACIPHEX Generic

Yes 1 sucralfate tablets CARAFATE Generic

Yes 3 sucralfate suspension CARAFATE Non-Formulary

Brand

Cathartics and Laxatives

Yes 3 polyethylene glycol-electrolyte solution

HALFLYTELY Non-Formulary

Brand

ST Yes 3 polyethylene glycol-electrolyte solution

MOVIPREP Non-Formulary

Brand


COLYTE Generic





GOLYTELY Generic


GAVILYTE-C Generic


NULYTELY Generic

ST Yes 3 sodium phosphates OSMOPREP Non-Formulary

Brand

No 3 sodium phosphates VISICOL Non-Formulary

Brand

ST No 3 sodium picosulfate-mag ox-anhydrous citric acid

PREPOPIK Non-Formulary

Brand

Digestants

Yes 2 pancrelipase (lipase-protease-amylase)

CREON Formulary Brand


ZENPEP Formulary Brand


PANCREAZE Formulary Brand


VIOKACE Non-Formulary

Brand


PERTZYE Non-Formulary

Brand

GI Drugs, Miscellaneous

Yes 1 clidinium & chlordiazepoxide LIBRAX Generic

QL, ST Yes 3 linaclotide LINZESS Non-Formulary

Brand

ST Yes 3 lubiprostone AMITIZA Non-Formulary

Brand




ST Yes 3 mepenzolate CANTIL Non-Formulary

Brand

Yes 1 metoclopramide REGLAN Generic

ST Yes 3 methylnaltrexone RELISTOR Non-Formulary

Brand

No 3 phenobarbital and belladonna alkaloids

DONNATAL Non-Formulary

Brand

Yes 3 teduglutide GATTEX Non-Formulary

Brand

Yes 1 ursodiol ACTIGALL Generic

Yes 1 ursodiol URSO Generic

Yes 1 ursodiol URSO FORTE Generic

Gold Compounds

Gold Compounds

Yes 2 auranofin RIDAURA Formulary Brand

Heavy Metal Antagonists

Heavy Metal Antagonists

No 2 deferasirox EXJADE Formulary Brand

Yes 3 deferiprone FERRIPROX Non-Formulary

Brand

No 2 penicillamine CUPRIMINE Formulary Brand

No 2 penicillamine DEPEN Formulary Brand

ST Yes 3 succimer CHEMET Non-Formulary

Brand

ST No 3 trientine SYPRINE Non-Formulary

Brand

Hormones and Synthetic Substitutes

Adrenals

ST No 1 budesonide ENTOCORT EC Generic

No 3 budesonide UCERIS Non-Formulary

Brand

ST Yes 1 cortisone acetate CORTONE ACETATE Generic

Yes 1 dexamethasone DECADRON Generic

Yes 1 fludrocortisone FLORINEF ACETATE Generic

Yes 1 hydrocortisone CORTEF Generic




Yes 1 methylprednisolone MEDROL Generic

Yes 1 prednisolone PRELONE Generic

Yes 1 prednisolone acetate PREDNISOLONE Generic

Yes 1 prednisolone sodium phosphate ORAPRED Generic

Yes 1 prednisolone sodium phosphate ORAPRED ODT Generic

Yes 1 prednisolone sodium phosphate PEDIAPRED Generic

Yes 1 prednisone PREDNISONE Generic

Yes 3 prednisone RAYOS Non-Formulary

Brand

Anabolic Steroid

ST Yes 3 oxymetholone ANADROL-50 Non-Formulary

Brand

Androgens

Yes 1 danazol DANOCRINE Generic

Yes 2 fluoxymesterone ANDROXY Formulary Brand

Yes 2 methyltestosterone ANDROID 10 Formulary Brand

Yes 3 methyltestosterone METHITEST Non-Formulary

Brand

Yes 1 methyltestosterone TESTRED Generic

Yes 1 oxandrolone OXANDRIN Generic

Yes 3 testosterone ANDRODERM Non-Formulary

Brand

Yes 3 testosterone AXIRON Non-Formulary

Brand

ST Yes 1 testosterone ANDROGEL Generic

Yes 1 testosterone TESTIM Generic

Yes 3 testosterone FORTESTA Non-Formulary

Brand

Yes 1 testosterone cypionate DEPO-TESTOSTERONE

Generic




Contraceptives

QL Yes 1 desogestrel & ethinyl estradiol APRI Generic

QL Yes 3 desogestrel & ethinyl estradiol DESOGEN Non-Formulary

Brand

QL Yes 3 desogestrel & ethinyl estradiol ORTHO-CEPT Non-Formulary

Brand

QL Yes 1 desogestrel & ethinyl estradiol RECLIPSEN Generic

QL Yes 1 desogestrel & ethinyl estradiol (biphasic)

KARIVA Generic

QL Yes 1 desogestrel & ethinyl estradiol (triphasic)

CYCLESSA Generic

QL Yes 1 desogestrel & ethinyl estradiol (triphasic)

VELIVET Generic

ST Yes 3 drospirenone SLYND Non-Formulary

Brand

QL Yes 1 drospirenone & ethinyl estradiol GIANVI Generic

QL Yes 1 drospirenone & ethinyl estradiol OCELLA Generic

QL Yes 1 drospirenone & ethinyl estradiol YASMIN Generic

QL Yes 1 drospirenone & ethinyl estradiol YAZ Generic

QL Yes 3 drospirenone & ethinyl estradiol w/ folate

BEYAZ Non-Formulary

Brand

QL, ST Yes 3 drospirenone & ethinyl estradiol w/ folate

SAFYRAL Non-Formulary

Brand

No 1 estradiol cypionate DELESTROGEN Generic

No 1 estradiol valerate DEPO-ESTRADIOL Generic

QL, ST Yes 3 estradiol valerate & dienogest NATAZIA Non-Formulary

Brand




QL Yes 1 ethynodiol diacetate & ethinyl estradiol

KELNOR Generic

QL Yes 1 ethynodiol diacetate & ethinyl estradiol

ZOVIA Generic

QL Yes 2 etonogestrel & ethinyl estradiol NUVARING Formulary Brand

AGE Yes 1 levonorgestrel PLAN B Generic

QL Yes 1 levonorgestrel & ethinyl estradiol LUTERA Generic

QL Yes 1 levonorgestrel & ethinyl estradiol LESSINA Generic

QL Yes 1 levonorgestrel & ethinyl estradiol PORTIA Generic

QL Yes 3 levonorgestrel & ethinyl estradiol NORDETTE-28 Non-Formulary

Brand

QL Yes 1 levonorgestrel & ethinyl estradiol (91-day)

INTROVALE Generic


LOSEASONIQUE Non-Formulary

Brand


SEASONALE Generic


SEASONIQUE Non-Formulary

Brand

QL Yes 1 levonorgestrel & ethinyl estradiol (continuous)

AMYTHYST Generic

QL Yes 3 levonorgestrel & ethinyl estradiol (continuous)

LYPREL Non-Formulary

Brand

QL Yes 1 levonorgestrel & ethinyl estradiol (triphasic)

TRIVORA Generic

QL Yes 3 norelgestromin & ethinyl estradiol ORTHO EVRA Non-Formulary

Brand




QL, ST Yes 1 norelgestromin & ethinyl estradiol XULANE Generic

QL Yes 1 norethindrone CAMILA Generic

QL Yes 1 norethindrone NORA-BE Generic

QL Yes 3 norethindrone NOR-QD Non-Formulary

Brand

QL Yes 1 norethindrone & ethinyl estradiol BALZIVA Generic

QL Yes 3 norethindrone & ethinyl estradiol BREVICON Non-Formulary

Brand

QL Yes 1 norethindrone & ethinyl estradiol JUNEL Generic

QL Yes 1 norethindrone & ethinyl estradiol MICROGESTIN Generic

QL Yes 3 norethindrone & ethinyl estradiol MODICON Non-Formulary

Brand

QL Yes 1 norethindrone & ethinyl estradiol NECON Generic

QL Yes 3 norethindrone & ethinyl estradiol NORINYL 1+35 Non-Formulary

Brand

QL Yes 1 norethindrone & ethinyl estradiol NORTREL 1/35 Generic

QL Yes 1 norethindrone & ethinyl estradiol OVCON-35 Generic

QL Yes 3 norethindrone & ethinyl estradiol OVCON-50 Non-Formulary

Brand

QL Yes 1 norethindrone & ethinyl estradiol (biphasic)

NECON 10/11 Generic

QL Yes 1 norethindrone & ethinyl estradiol (triphasic)

ARANELLE Generic


NORTREL 7/7/7 Generic


ORTHO-NOVUM Non-Formulary

Brand


TRI-NORINYL Non-Formulary

Brand




QL Yes 3 norethindrone & ethinyl estradiol w/ ferrous fumarate

ESTROSTEP FE Non-Formulary

Brand

QL, ST Yes 3 norethindrone & ethinyl estradiol w/ ferrous fumarate

FEMCON FE Non-Formulary

Brand


GENERESS FE Generic


JUNEL FE Non-Formulary

Brand


MICROGESTIN FE Generic

QL, ST Yes 3 norethindrone & ethinyl estradiol w/ ferrous fumarate

MINASTRIN 24 FE Non-Formulary

Brand

QL Yes 3 norethindrone acetate & ethinyl estradiol w/ ferrous fumarate

LOESTRIN 24 FE Non-Formulary

Brand


LOESTRIN FE Non-Formulary

Brand


TILIA Generic

QL, ST Yes 3 norethindrone acetate & ethinyl estradiol w/ ferrous fumarate (biphasic)

LO LOESTRIN FE Non-Formulary

Brand

QL Yes 3 norethindrone-mestranol NORINYL 1+50 Non-Formulary

Brand

QL Yes 3 norethindrone-mestranol ORTHO-NOVUM Non-Formulary

Brand

QL Yes 1 norgestimate & ethinyl estradiol CRYSELLE Generic




QL Yes 1 norgestimate & ethinyl estradiol MONONESSA Generic

QL Yes 3 norgestimate & ethinyl estradiol ORTHO-CYCLEN Non-Formulary

Brand

QL Yes 1 norgestimate & ethinyl estradiol SPRINTEC Generic

QL Yes 1 norgestimate & ethinyl estradiol TRINESSA Generic

QL Yes 3 norgestimate & ethinyl estradiol (triphasic)

ORTHO TRI-CYCLEN Non-Formulary

Brand


TRI-LO-SPRINTEC Generic


TRI-SPRINTEC Generic

QL Yes 3 norgestrel & ethinyl estradiol LO/OVRAL-28 Non-Formulary

Brand

QL Yes 1 norgestrel & ethinyl estradiol LOW-OGESTREL Generic

QL Yes 1 norgestrel & ethinyl estradiol OGESTREL Generic

QL, ST Yes 3 segesterone & ethinyl estradiol ANNOVERA Non-Formulary

Brand

Yes 2 ulipristal ELLA Formulary Brand

Diabetic Agents

Yes 1 acarbose PRECOSE Generic

PA Yes 3 albiglutide TANZEUM Non-Formulary

Brand

PA Yes 1 alogliptin NESINA Generic

PA Yes 1 alogliptin & metformin KAZANO Generic

PA Yes 1 alogliptin & pioglitazone OSENI Generic

PA Yes 3 canagliflozin INVOKANA Non-Formulary

Brand

PA Yes 3 canagliflozin & metformin INVOKAMET Non-Formulary

Brand




ST Yes 1 chlorpropamide CHLORPROPAMIDE Generic

PA Yes 3 dapagliflozin FARXIGA Non-Formulary

Brand

PA Yes 3 dapagliflozin & metformin XIGDUO XR Non-Formulary

Brand

PA Yes 3 dulaglutide TRULICITY Non-Formulary

Brand

PA, QL Yes 2 empagliflozin JARDIANCE 25 MG Formulary Brand

PA Yes 3 empagliflozin & lingaliptin GLYXAMBI Non-Formulary

Brand

PA Yes 3 empagliflozin & metformin SYNJARDY Non-Formulary

Brand

PA Yes 3 ertufliglozin STEGLATRO Non-Formulary

Brand

PA Yes 3 ertugliflozin & metformin SEGLUROMET Non-Formulary

Brand

Yes 3 ertugliflozin & sitagliptin STEGLUJAN

Non-Formulary Brand

PA Yes 3

PA, QL Yes 3 exenatide BYETTA Non-Formulary

Brand

PA,QL Yes 3 exenatide extended-release BYDUREON Non-Formulary

Brand

Yes 1 glimepiride AMARYL Generic

Yes 1 glipizide GLUCOTROL Generic

Yes 1 glipizide & metformin METAGLIP Generic

Yes 1 glipizide extended-release GLUCOTROL XL Generic

No 2 glucagon BAQSIMI Formulary Brand

No 2 glucagon GLUCAGON EMERGENCY KIT

Formulary Brand

No 3 glucagon GLUCAGEN HYPOKIT

Non-Formulary Brand

AGE No 2 glucagon GVOKE Formulary Brand

Yes 1 glyburide DIABETA Generic




Yes 1 glyburide & metformin GLUCOVANCE Generic

Yes 1 glyburide micronized GLYNASE Generic

PA,QL Yes 3 insulin (oral inhalation) AFREZZA Non-Formulary

Brand

ST Yes 3 insulin aspart NOVOLOG Non-Formulary

Brand

ST Yes 3 insulin aspart FIASP Non-Formulary

Brand

ST Yes 3 insulin aspart FIASP FLEXPEN Non-Formulary

Brand

ST Yes 3 insulin aspart protamine & insulin aspart

NOVOLOG MIX 70/30 Non-Formulary

Brand

ST Yes 3 insulin aspart protamine & insulin aspart

NOVOLOG MIX 70/30 FLEXPEN

Non-Formulary Brand

ST Yes 3 insulin degludec TRESIBA Non-Formulary

Brand

Yes 3 insulin degludec/insulin aspart RYZODEG 70/30 Non-Formulary

Brand

PA, QL Yes 3 Insulin degludec/ liraglutide XULTOPHY Non-Formulary

Brand

ST Yes 3 insulin detemir LEVEMIR Non-Formulary

Brand

ST Yes 3 insulin glargine LANTUS Non-Formulary

Brand

ST Yes 3 insulin glargine LANTUS SOLOSTAR Non-Formulary

Brand

ST Yes 3 insulin glargine BASAGLAR Non-Formulary

Brand

PA, QL Yes 3 Insulin glargine/ lixisenatide SOLIQUA Non-Formulary

Brand

ST Yes 3 insulin glulisine APIDRA Non-Formulary

Brand

Yes 3 insulin isophane NOVOLIN N Non-Formulary

Brand

Yes 2 insulin isophane HUMULIN N Formulary Brand




ST Yes 3 insulin isophane HUMULIN N KWIKPEN

Non-Formulary Brand

Yes 3 insulin isophane & regular insulin NOVOLIN 70/30 Non-Formulary

Brand

Yes 3 insulin isophane & regular insulin HUMULIN 50/50 Non-Formulary

Brand

Yes 2 insulin isophane & regular insulin HUMULIN 70/30 Formulary Brand

ST Yes 3 insulin isophane & regular insulin HUMULIN 70/30 KIWKPEN

Non-Formulary Brand

ST Yes 3 insulin lispro HUMALOG Non-Formulary

Brand

ST Yes 3 insulin lispro HUMALOG KWIKPEN Non-Formulary

Brand

ST Yes 3 insulin lispro ADMELOG Non-Formulary

Brand

Yes 3 insulin lispro protamine & insulin lispro

HUMALOG MIX 50/50 Non-Formulary

Brand

ST Yes 3 insulin lispro protamine & insulin lispro

HUMALOG MIX 75/25 Non-Formulary

Brand

ST Yes 3 insulin lispro protamine & insulin lispro

HUMALOG MIX 75/25 KWIKPEN

Non-Formulary Brand

Yes 3 insulin regular NOVOLIN R Non-Formulary

Brand

Yes 2 insulin regular HUMULIN R Formulary Brand

ST Yes 2 insulin regular HUMULIN R U-500 Formulary Brand

ST Yes 3 insulin regular HUMULIN R U-500 KWIKPEN

Non-Formulary Brand

PA Yes 3 linagliptin TRADJENTA Non-Formulary

Brand

PA Yes 3 linagliptin & metformin JENTADUETO Non-Formulary

Brand

PA, QL Yes 3 liraglutide VICTOZA Non-Formulary

Brand

PA, QL Yes 3 lixisenatide ADLYXIN Non-Formulary

Brand

Yes 1 metformin GLUCOPHAGE Generic

PA Yes 1 metformin ER FORTAMET Generic




PA Yes 1 metformin ER GLUMETZA Generic

Yes 3 metformin RIOMET Non-Formulary

Brand

Yes 1 metformin extended-release GLUCOPHAGE XR Generic

PA Yes 3 mifepristone KORLYM Non-Formulary

Brand

ST Yes 3 miglitol GLYSET Non-Formulary

Brand

ST Yes 1 nateglinide STARLIX Generic

Yes 1 pioglitazone ACTOS Generic

Yes 3 pioglitazone & glimepiride DUETACT Non-Formulary

Brand

Yes 3 pioglitazone & metformin ACTOPLUS MET Non-Formulary

Brand

PA Yes 3 pramlintide acetate SYMLIN Non-Formulary

Brand

ST Yes 1 repaglinide PRANDIN Generic

ST Yes 1 repaglinide & metformin PRANDIMET Generic

ST Yes 3 rosiglitazone AVANDIA Non-Formulary

Brand

ST Yes 3 rosiglitazone & glimepiride AVANDARYL Non-Formulary

Brand

ST Yes 3 rosiglitazone & metformin AVANDAMET Non-Formulary

Brand

PA Yes 3 saxagliptin ONGLYZA Non-Formulary

Brand

PA Yes 3 saxagliptin & metformin extended-release

KOMBIGLYZE XR Non-Formulary

Brand

PA Yes 3 sitagliptin & metformin JANUMET Non-Formulary

Brand

PA Yes 3 sitagliptin & simvastatin JUVISYNC Non-Formulary

Brand

PA Yes 3 sitagliptin phosphate JANUVIA Non-Formulary

Brand

PA, QL Yes 3 semaglutide OZEMPIC Non-Formulary

Brand

ST Yes 1 tolazamide TOLINASE Generic




ST Yes 1 tolbutamide ORINASE Generic

Estrogens and Antiestrogens

Yes 3 conjugated estrogens & bazedoxifene

DUAVEE Non-Formulary

Brand

Yes 3 conjugated estrogens & medroxyprogesterone acetate

PREMPHASE Non-Formulary

Brand

Yes 3 conjugated estrogens & medroxyprogesterone acetate

PREMPRO Non-Formulary

Brand

Yes 3 drospirenone & estradiol ANGELIQ Non-Formulary

Brand

ST Yes 3 esterified estrogens MENEST Non-Formulary

Brand

Yes 1 estradiol ESTRACE TAB Generic

Yes 1 estradiol GYNODIOL Generic

ST Yes 3 estradiol & levonorgestrel CLIMARA PRO Non-Formulary

Brand

Yes 1 estradiol & norethindrone ACTIVELLA Generic

ST Yes 3 estradiol & norethindrone COMBIPATCH Non-Formulary

Brand

Yes 3 estradiol & norgestimate PREFEST Non-Formulary

Brand

Yes 3 estradiol acetate FEMTRACE Non-Formulary

Brand

ST Yes 3 estradiol acetate vaginal tablets FEMRING Non-Formulary

Brand

ST Yes 3 estradiol gel DIVIGEL Non-Formulary

Brand

ST Yes 3 estradiol gel ELESTRIN GEL Non-Formulary

Brand

ST Yes 3 estradiol transdermal ALORA Non-Formulary

Brand

Yes 1 estradiol transdermal CLIMARA DIS Generic




Yes 3 estradiol transdermal ESTRADERM Non-Formulary

Brand

ST Yes 3 estradiol transderomal EVAMIST Non-Formulary

Brand

ST Yes 3 estradiol transdermal MENOSTAR Non-Formulary

Brand

Yes 1 estradiol transdermal MINIVELLE Generic

ST Yes 3 estradiol transdermal VIVELLE-DOT Non-Formulary

Brand

Yes 1 estradiol vaginal ESTRACE CREAM Generic

Yes 2 estradiol vaginal ESTRING Formulary Brand

Yes 3 estradiol vaginal VAGIFEM Non-Formulary

Brand

Yes 1 estradiol vaginal YUVAFEM Generic

Yes 1 estradiol vaginal ESTRACE Generic

Yes 1 estrogen, ester/me-testosterone ESTRATEST Generic

ST Yes 3 estrogens, conjugated PREMARIN Non-Formulary

Brand

Yes 3 estrogens, conjugated synthetic a CENESTIN Non-Formulary

Brand

ST Yes 3 estrogens, conjugated synthetic b ENJUVIA Non-Formulary

Brand

ST Yes 2 estrogens, conjugated vaginal PREMARIN CREAM Formulary Brand

Yes 1 estropipate ORTHO-EST Generic

Yes 1 norethindrone acetate & ethinyl estradiol

FEMHRT Generic

Yes 3 ospemifene OSPHENA Non-Formulary

Brand

Yes 1 raloxifene hcl EVISTA Generic

ESTROGEN AND PROGESTIN (COMBINATION PRODUCT)




ST Yes 3 estradiol and progesterone BIJUVA Non-Formulary

Brand

Gonadatropins

Yes 2 nafarelin SYNAREL Formulary Brand

Parathyroid

PA Yes 3 abaloparatide TYMLOS Non-Formulary

Brand

ST Yes 1 calcitonin salmon FORTICAL Generic

ST Yes 1 calcitonin salmon MIACALCIN Generic

PA No 3 teriparatide FORTEO Non-Formulary

Brand

Pitutary

PA Yes 3 corticotropin ACTHAR Non-Formulary

Brand

Yes 1 desmopressin (non-refrigerated) DDAVP Generic

Yes 3 desmopressin acetate STIMATE Non-Formulary

Brand

Progestins

Yes 1 medroxyprogesterone acetate PROVERA Generic

No 1 megestrol acetate MEGACE Generic

Yes 1 norethindrone acetate AYGESTIN Generic

Yes 1 progesterone, micronized PROMETRIUM Generic

Somatotropin Agonists and Antagonists

PA Yes 3 somatropin GENTROPIN Non-Formulary

Brand

PA Yes 3 somatropin HUMATROPE Non-Formulary

Brand

PA Yes 3 somatropin NORDITROPIN Non-Formulary

Brand

PA Yes 3 somatropin NUTROPIN AQ Non-Formulary

Brand

PA Yes 3 somatropin OMNITROPE Non-Formulary

Brand

PA Yes 3 somatropin SAIZEN Non-Formulary

Brand




PA Yes 3 somatropin SEROSTIM Non-Formulary

Brand

PA Yes 3 pegvisomant SOMAVERT Non-Formulary

Brand

PA Yes 3 somatropin ZORBTIVE Non-Formulary

Brand

Thyroid and Antihyroid Agent

Yes 1 levothyroxine LEVOTHROID Generic

Yes 1 levothyroxine LEVOXYL Generic

Yes 1 levothyroxine SYNTHROID Generic

Yes 3 levothyroxine TIROSINT Non-Formulary

Brand

Yes 1 levothyroxine UNITHROID Generic

Yes 1 liothyronine CYTOMEL Generic

ST Yes 3 liotrix THYROLAR Non-Formulary

Brand

Yes 1 methimazole TAPAZOLE Generic

Yes 2 potassium iodide & iodine LUGOL’S SOLUTION Formulary Brand

Yes 1 propylthiouracil PROPYLTHIOURACIL Generic

Yes 3 thyroid ARMOUR THYROID Non-Formulary

Brand

Miscellaneous Therapeutic Agents

Miscellanous Therapeutic Agents

Yes 2 abatacept ORENCIA Formulary Brand

Yes 1 acetylcysteine MUCOMYST-10 Generic

PA Yes 3 adalimumab HUMIRA Non-Formulary

Brand

PA Yes 3 adalimumab HUMIRA citrate free Non-Formulary

Brand

Yes 1 alendronate FOSAMAX Generic

Yes 3 alendronate & cholecalciferol FOSAMAX PLUS D Non-Formulary

Brand

Yes 1 allopurinol ZYLOPRIM Generic

PA Yes 3 amifampridine FIRDAPSE Non-Formulary

Brand

Yes 3 anakinra KINERET Non-Formulary

Brand




PA Yes 2 apremilast OTEZLA Formulary Brand

Yes 1 azathioprine AZASAN Generic

Yes 1 azathioprine IMURAN Generic

PA Yes 3 baricitnib OLUMIANT Non-Formulary

Brand

Yes 3 bedaquiline SIRTURO Non-Formulary

Brand

ST Yes 3 betaine CYSTADANE POWD Non-Formulary

Brand

PA Yes 3 brodalumab SILIQ Non-Formulary

Brand

PA Yes 3 c-1 esterase inhibitor HAEGARDA Non-Formulary

Brand

PA Yes 3 canakinumab ILARIS Non-Formulary

Brand

PA Yes 3 certolizumab Pegol CIMZIA Non-Formulary

Brand

PA Yes 3 cholic acid CHOLBAM Non-Formulary

Brand

No 2 cinacalcet SENSIPAR Formulary Brand

ST Yes 1 colchicine COLCRYS Generic

Yes 1 cyclosporine SANDIMMUNE Generic

Yes 1 cyclosporine, modified NEORAL Generic

PA Yes 3 cysteamine delayed-release PROCYSBI Non-Formulary

Brand

ST Yes 3 cysteamine immediate-release CYSTAGON Non-Formulary

Brand

No 1 dalfampridine AMPYRA Generic

QL, PA Yes 3 dichlorphenamide KEVEYIS Non-Formulary

Brand

PA Yes 3 daflazacort EMFLAZA Non-Formulary

Brand

PA Yes 1 dimethyl fumarate TECFIDERA Generic

PA Yes 3 dupilumab DUPIXENT Non-Formulary

Brand

Yes 1 disulfiram ANTABUSE Generic




ST Yes 1 dutasteride AVODART Generic

Yes 1 dutasteride & tamsulosin JALYN Generic

PA Yes 3 elagolix ORILISSA Non-Formulary

Brand

PA Yes 3 eliglustat CERDELGA Non-Formulary

Brand

PA Yes 3 emicizumab-kxwh HEMLIBRA Non-Formulary

Brand

PA Yes 3 erenumab-aooe AIMOVIG Non-Formulary

Brand

PA Yes 3 etanercept ENBREL Non-Formulary

Brand

ST Yes 1 etidronate DIDRONEL Generic

No 3 everolimus ZORTRESS Non-Formulary

Brand

ST Yes 3 febuxostat ULORIC Non-Formulary

Brand

PA Yes 3 fingolimod GILENYA Non-Formulary

Brand

PA Yes 3 fostamatinib TAVALISSE Non-Formulary

Brand

PA Yes 3 galcanezumab EMGALITY Non-Formulary

Brand

PA Yes 3 guselkumab TREMFYA Non-Formulary

Brand

PA No 3 glatiramer acetate COPAXONE 20 mg Non-Formulary

Brand

No 1 glatiramer acetate COPAXONE 40 mg Generic

No 1 glatiramer acetate GLATOPA Generic

PA Yes 3 golimumab SIMPONI Non-Formulary

Brand

ST Yes 1 ibandronate BONIVA Generic

PA No 3 icatibant FIRAZYR Non-Formulary

Brand

PA Yes 3 immune globulin HYQVIA Non-Formulary

Brand

PA Yes 3 immune globulin HIZENTRA Non-Formulary

Brand




PA Yes 3 inotersen TEGSEDI Non-Formulary

Brand

PA Yes 3 interferon beta-1a AVONEX Non-Formulary

Brand

PA Yes 3 interferon beta-1a PLEGRIDY Non-Formulary

Brand

PA Yes 3 interferon beta-1a REBIF Non-Formulary

Brand

PA Yes 3 interferon beta-1a REBIF REBIDOSE Non-Formulary

Brand

Yes 3 interferon beta-1b BETASERON Non-Formulary

Brand

Yes 2 Interferon beta-1b EXTAVIA Formulary Brand

Yes 2 interferon gamma-1b ACTIMMUNE Formulary Brand

PA Yes 3 ixekizumab TALTZ Non-Formulary Brand

PA Yes 3 lanadelumab TAKHZYRO Non-Formulary

Brand

Yes 3 lanreotide SOMATULINE DEPOT

Non-Formulary Brand

Yes 3 lesinurad ZURAMPIC Non-Formulary

Brand

Yes 1 leflunomide ARAVA Generic

Yes 1 leucovorin LEUCOVORIN Generic

PA Yes 3 l-glutamine ENDARI Non-Formulary

Brand

Yes 2 mesna MESNEX Formulary Brand

No 1

methenamine, sodium biphosphate, phenyl salicylate, methylene blue, and hyoscyamine

URO-MP Generic

Yes 1 methylergonovine maleate METHERGINE Generic

Yes 3 metreleptin MYALEPT Non-Formulary

Brand

Yes 3 mifepristone MIFEPREX Non-Formulary

Brand




PA Yes 3 migalastat GALAFOLD Non-Formulary

Brand

PA No 3 miglustat ZAVESCA Non-Formulary

Brand

Yes 1 mycophenolate mofetil CELLCEPT Generic

Yes 1 mycophenolate sodium MYFORTIC Generic

Yes 3 nitisinone ORFADIN Non-Formulary

Brand

No 1 octreotide acetate SANDOSTATIN Generic

PA No 3 ozanimod ZEPOSIA Non-Formulary

Brand

PA Yes 3 parathyroid hormone NATPARA Non-Formulary

Brand

PA Yes 3 pasireotide SIGNIFOR Non-Formulary

Brand

Yes 1 pediatric multivitamins w/ fluoride POLY-VI-FLOR Generic

Yes 1 pediatric multivitamins w/ fluoride & iron

POLY-VI-FLOR W/IRON

Generic

Yes 1 pediatric vitamins a, c, & d, w/ fluoride

TRI-VI-FLOR Generic

Yes 1 pediatric vitamins a, c, & d, w/ fluoride & iron

TRI-VI-FLOR W/IRON Generic

PA Yes 3 pegvaliase PALYNZIQ Non-Formulary

Brand

PA Yes 2 pentosan polysulfate sodium ELMIRON Formulary Brand

PA Yes 3 risankizumab SKYRIZI Non-Formulary

Brand

ST Yes 1 risedronate sodium ACTONEL Generic

Yes 3 risedronate sodium ATELVIA Non-Formulary

Brand




PA Yes 3 sapropterin dihydrochloride KUVAN Non-Formulary

Brand

PA Yes 3 sarilumab KEVZARA Non-Formulary

Brand

PA Yes 3 secukinumab COSENTYX Non-Formulary

Brand

No 3 sirolimus solution RAPAMUNE Non-Formulary

Brand

Yes 1 sirolimus RAPAMUNE Generic

Yes 3 sodium fluoride FLUORABON BASIC Non-Formulary

Brand

Yes 1 sodium fluoride FLUORITAB Generic

Yes 1 sodium fluoride LURIDE CHEW Generic

Yes 1 sodium fluoride (dental) PREVIDENT Generic

Yes 1 sodium fluoride (dental) PREVIDENT 5000 PLUS

Generic

Yes 1 sodium fluoride drops LURIDE DROPS Generic

Yes 2 stannous fluoride GEL-KAM Formulary Brand

Yes 1 tacrolimus PROGRAF Generic

PA Yes 3 teriflunomide AUBAGIO Non-Formulary

Brand

QL Yes 2 thalidomide THALOMID Formulary Brand

PA Yes 3 tildrakizumab-asmn ILUMYA Non-Formulary

Brand

ST Yes 3 tiludronate SKELID Non-Formulary

Brand

Yes 2 tocilizumab ACTEMRA Formulary Brand

Yes 2 tofacitinib XELJANZ Formulary Brand

PA No 3 upadacitinib RINVOQ Non-Formulary

Brand

PA Yes 3 ustekinumab STELARA Non-Formulary

Brand

PA, QL Yes 3 voxelotor OXBRYTA Non-Formulary

Brand

Respiratory Tract Agents

Antitussives

Yes 1 benzonatate TESSALON PERLES Generic




Yes 1 guaifenesin & codeine CHERATUSSIN AC Generic

No 3 hydrocodone & chlorpheniramine TUSSIONEX Non-Formulary

Brand

No 1 hydrocodone & homatropine HYCODAN Generic

No 1 promethazine & codeine PHENERGAN W/ CODEINE

Generic

No 1 promethazine & dextromethorphan

PROMETHAZINE-DM Generic

No 1 promethazine, phenylephrine & codeine

PHENERGAN VC W/CODEINE

Generic

Yes 3 pseudoephedrine, brompheniramine & codeine

M-END MAX D Non-Formulary

Brand

Anti-Inflammatory Agents

Yes 3 cromolyn sodium GASTROCROM Non-Formulary

Brand

Yes 1 cromolyn sodium INTAL Generic

Yes 1 montelukast SINGULAIR Generic

ST Yes 3 zafirlukast ACCOLATE Non-Formulary

Brand

ST No 1 zileuton ZYFLO CR Generic

ST No 3 zileuton ZYFO Non-Formulary

Brand

Respiratory Agents, Miscellaneous

Yes 3 beclomethasone dipropionate QVAR RediHaler Non-Formulary

Brand

Yes 3 budesonide PULMICORT FLEXHALER

Non-Formulary Brand

Yes 1 budesonide PULMICORT RESPULES

Generic

ST Yes 3 budesonide & formoterol SYMBICORT Non-Formulary

Brand

Yes 2 ciclesonide ALVESCO Formulary Brand

PA Yes 3 Elaxacaftor, tezacaftor & ivacaftor TRIKAFTA Non-Formulary

Brand




ST Yes 3 fluticasone & salmeterol (100/50 mcg)

WIXELA INHUB Generic

Yes 1 fluticasone & salmeterol (250/50 mcg and 500/50 mcg)

WIXELA INHUB Generic

ST Yes 3 fluticasone & salmeterol ADVAIR HFA Non-Formulary

Brand

ST Yes 3 fluticasone & vilanterol BREO ELLIPTA Non-Formulary

Brand

Yes 3 fluticasone propionate FLOVENT DISKUS AER

Non-Formulary Brand

Yes 3 fluticasone propionate FLOVENT HFA Non-Formulary

Brand

ST Yes 3 fluticasone & umeclidinium & vilanterol

TRELEGY ELLIPTA Non-Formulary

Brand

Yes 3 glycopyrrolate & indacaterol UTIBRON NEOHALER

Non-Formulary Brand

ST Yes 3 indacaterol ARCAPTA NEOHALER

Non-Formulary Brand

PA Yes 3 ivacaftor KALYDECO Non-Formulary

Brand

PA Yes 3 lumacaftor& ivacaftor ORKAMBI Non-Formulary

Brand

ST Yes 3 mometasone & formoterol DULERA Non-Formulary

Brand

Yes 2 mometasone furoate ASMANEX Formulary Brand

PA Yes 3 mepolizumab NUCALA Non-Formulary

Brand

Yes 3 nintedanib OFEV Non-Formulary

Brand

PA Yes 3 omalizumab XOLAIR Non-Formulary

Brand

Yes 3 pirfenidone ESBRIET Non-Formulary

Brand

ST Yes 3 roflumilast DALIRESP Non-Formulary

Brand




Yes 3 salmeterol SEREVENT DISKUS Non-Formulary

Brand

Yes 3 sodium chloride HYPERSAL Non-Formulary

Brand

PA Yes 3 tezacaftor & ivacaftor SYMDEKO Non-Formulary

Brand

Yes 2 tiotropium bromide and olodaterol STIOLTO RESPIMAT Formulary Brand

Skin and Mucous Membrane Agents

Anti-infectives (Skin and Mucous Membranes)

ST Yes 1 acyclovir ZOVIRAX Generic

Yes 3 benzoyl peroxide & erythromycin BENZAMYCIN Non-Formulary

Brand

ST Yes 3 butenafine MENTAX Non-Formulary

Brand

Yes 3 butoconazole nitrate (vaginal) GYNAZOLE-1 Non-Formulary

Brand

No 1 ciclopirox LOPROX Generic

No 1 ciclopirox PENLAC Generic

ST Yes 1 clindamycin & benzoyl peroxide BENZACLIN Generic

Yes 1 clindamycin & benzoyl peroxide DUAC Generic

PA Yes 3 clindamycin & benzoyl peroxide ONEXTON Non-Formulary

Brand

Yes 1 clindamycin phosphate (topical) CLEOCIN T Generic

Yes 1 clindamycin phosphate (topical) CLINDAGEL Generic

Yes 3 clindamycin phosphate (topical) EVOCLIN Non-Formulary

Brand

No 1 clindamycin phosphate (vaginal) CLEOCIN Generic

No 1 clotrimazole MYCELEX Generic




ST No 1 clotrimazole & betamethasone LOTRISONE Generic

ST Yes 3 crotamiton EURAX Non-Formulary

Brand

No 1 econazole nitrate SPECTAZOLE Generic

Yes 3 erythromycin (acne acid) AKNE-MYCIN Non-Formulary

Brand

Yes 1 erythromycin (acne acid) ERYGEL Generic

No 1 gentamicin sulfate (topical) GARAMYCIN Generic

Yes 3 hexachlorophene PHISOHEX Non-Formulary

Brand

Yes 1 iodoquinol & hydrocortisone VYTONE Generic

No 1 ketoconazole (topical) NIZORAL Generic

No 1 lindane KWELL Generic

ST No 3 mafenide acetate SULFAMYLON Non-Formulary

Brand

No 1 malathion OVIDE Generic

No 1 metronidazole (topical) METROCREAM Generic

No 1 metronidazole (topical) METROGEL Generic

No 1 metronidazole (topical) METROLOTION Generic

No 1 metronidazole (vaginal) METROGEL-VAGINAL

Generic

No 3 miconazole nitrate & zinc oxide VUSION Non-Formulary

Brand

No 1 mupirocin BACTROBAN Generic

No 3 mupirocin calcium BACTROBAN NASAL Non-Formulary

Brand

Yes 3 na sulfacetm/avobenzone/sulfur ROSAC Non-Formulary

Brand

ST No 1 naftifine cream NAFTIN Generic




ST No 3 Naftifine gel NAFTIN Non-Formulary

Brand

No 1 nystatin (topical) NYSTATIN Generic

ST No 3 oxiconazole nitrate OXISTAT Non-Formulary

Brand

ST Yes 3 penciclovir DENAVIR Non-Formulary

Brand

No 1 permethrin ELIMITE Generic

ST Yes 3 retapamulin ALTABAX Non-Formulary

Brand

No 3 selenium sulfide SELSEB Non-Formulary

Brand

No 3 selenium sulfide SELSUN RX Non-Formulary

Brand

ST Yes 3 sertaconazole nitrate ERTACZO Non-Formulary

Brand

No 1 silver sulfadiazine SILVADENE Generic

Yes 3 spinosad NATROBA Non-Formulary

Brand

ST Yes 3 sulconazole nitrate EXELDERM Non-Formulary

Brand

Yes 1 sulfacetamide sodium (acne) KLARON Generic

Yes 3 sulfacetamide sodium (acne) SEB-PREV Non-Formulary

Brand

Yes 3 sulfanilamide AVC VAGINAL Non-Formulary

Brand

ST No 1 terconazole TERAZOL 7 Generic

ST No 1 terconazole (vaginal) TERAZOL 3 Generic

Anti-inflammatory Agents (Skin and Mucous Membranes)

Yes 1 alclometasone dipropionate ACLOVATE Generic

ST Yes 1 amcinonide CYCLOCORT Generic

ST No 3 bacitracin, polymyxin, neomycin & hydrocortisone

CORTISPORIN Non-Formulary

Brand




Yes 3 benzoyl peroxide & hydrocortisone

VANOXIDE-HC Non-Formulary

Brand

Yes 1 betamethasone dipropionate (topical)

DIPROSONE Generic

Yes 1 betamethasone dipropionate augmented

DIPROLENE Generic

Yes 1 betamethasone valerate LUXIQ Generic

Yes 1 betamethasone valerate VALISONE Generic

ST No 1 calcipotriene & betamethasone TACLONEX Generic

Yes 1 clobetasol propionate CLOBEX Generic

No 1 clobetasol propionate TEMOVATE Generic

Yes 1 clobetasol propionate emollient TEMOVATE E Generic

No 3 clobetasol propionate emulsion OLUX-E Non-Formulary

Brand

ST Yes 1 clocortolone pivalate CLODERM Generic

ST Yes 3 crisaborole EUCRISA Non-Formulary

Brand

QL Yes 1 desonide DESOWEN Generic

ST Yes 1 desoximetasone TOPICORT Generic

ST Yes 1 diflorasone diacetate APEXICON Generic

Yes 3 fluocinolone acetonide CAPEX SHAMPOO Non-Formulary

Brand

Yes 1 fluocinolone acetonide DERMA-SMOOTHE/FS OIL

Generic

Yes 1 fluocinolone acetonide SYNALAR Generic

Yes 1 fluocinonide LIDEX Generic

Yes 3 fluocinonide VANOS Non-Formulary

Brand




Yes 1 fluocinonide emollient LIDEX-E Generic

ST (Tape Only)

Yes 1, 3 flurandrenolide CORDRAN Generic;

Non-Formulary Brand

ST Yes 1 fluticasone propionate (topical) CUTIVATE Generic

ST Yes 3 halcinonide HALOG Non-Formulary

Brand

Yes 1 halobetasol propionate ULTRAVATE Generic

Yes 1 hydrocortisone (intrarectal) CORTENEMA Generic

Yes 3 hydrocortisone (rectal) ANUSOL-HC Non-Formulary

Brand

Yes 1 hydrocortisone (rectal) PROCTOCORT Generic

Yes 1 hydrocortisone (topical) HYTONE Generic

Yes 1 hydrocortisone acetate & urea CARMOL HC Generic

Yes 3 hydrocortisone acetate (intrarectal)

CORTIFOAM Non-Formulary

Brand

Yes 1 hydrocortisone butyrate LOCOID Generic

Yes 3 hydrocortisone butyrate hydrophilic lipo base

LOCOID LIPOCREAM Non-Formulary

Brand

Yes 3 hydrocortisone probutate PANDEL Non-Formulary

Brand

Yes 1 hydrocortisone valerate WESTCORT Generic

Yes 1 mometasone furoate ELOCON Generic

ST Yes 1 nystatin & triamcinolone MYCOLOG II Generic

ST Yes 1 prednicarbate DERMATOP Generic




Yes 1 triamcinolone acetonide (topical) KENALOG Generic

Antipruritics and Local Anesthetics

ST Yes 3 doxepin (antipuritic) ZONALON Non-Formulary

Brand

Yes 3 hydrocortisone & pramoxine ANALPRAM HC Non-Formulary

Brand

Yes 3 hydrocortisone & pramoxine PRAMOSONE Non-Formulary

Brand

Yes 3 hydrocortisone & pramoxine PRAMOSONE-E Non-Formulary

Brand

Yes 3 hydrocortisone & pramoxine PROCTOFOAM-HC Non-Formulary

Brand

ST Yesline 1 lidocaine LIDODERM Generic

No 1 lidocaine (jelly, topical) XYLOCAINE Generic

No 3 lidocaine & hydrocortisone LIDAMANTLE Non-Formulary

Brand

Yes 1 lidocaine & prilocaine EMLA Generic

ST No 3 lidocaine & tetracaine SYNERA PATCH Non-Formulary

Brand

Yes 1 pramoxine PROCTOFOAM Generic

Astringents

Yes 2 aluminum chloride hexahydrate HYPERCARE Formulary Brand

Keratolytic Agents

No 3 sulfacetamide sodium & sulfur AVAR Non-Formulary

Brand

Yes 1 sulfacetamide sodium & sulfur PLEXION Generic

No 3 sulfacetamide sodium & sulfur PLEXION SCT Non-Formulary

Brand

No 1 sulfacetamide sodium & sulfur ROSULA Generic

Yes 1 urea CARMOL Generic

Keratoplastic Agents




ST Yes 3 anthralin DRITHO-CREME HP Non-Formulary

Brand

Yes 3 anthralin ZITHRANOL-RR Non-Formulary

Brand

Cell Stimulants and Proliferants

QL, AGE Yes 1 tretinoin RETIN-A Generic

QL, AGE Yes 3 tretinoin microspheres RETIN-A MICRO Non-Formulary

Brand

Skin and Mucous Membrane Agents, Miscellaneous

ST No 1 acitretin SORIATANE Generic

QL, AGE, ST

Yes 1 adapalene DIFFERIN Generic

QL, AGE, ST

Yes 3 adapalene & benzoyl peroxide EPIDUO Non-Formulary

Brand

QL, AGE Yes 3 alitretinoin PANRETIN Non-Formulary

Brand

Yes 1 ammonium lactate LAC-HYDRIN Generic

ST Yes 3 azelaic acid FINACEA Non-Formulary

Brand

ST Yes 3 azelaic acid (acne) AZELEX Non-Formulary

Brand

Yes 2 becaplermin REGRANEX Formulary Brand

No 3 bexarotene (topical) TARGRETIN Non-Formulary

Brand

PA, QL Yes 3 brimonidine (topical) MIRVASO Non-Formulary

Brand

Yes 1 calcipotriene DOVONEX Generic

Yes 3 calcipotriene SORILUX Non-Formulary

Brand

Yes 2 calcitriol (topical) VECTICAL Formulary Brand

AGE, ST No 3 clindamycin & tretinoin VELTIN Non-Formulary

Brand

AGE, ST No 3 clindamycin & tretinoin ZIANA Non-Formulary

Brand

Yes 2 collagenase SANTYL Formulary Brand

Yes 3 dapsone (topical) ACZONE Non-Formulary

Brand

ST Yes 3 diclofenac epolamine FLECTOR Non-Formulary

Brand




Yes 1 diclofenac sodium VOLTAREN GEL Generic

Yes 3 diclofenac sodium (actinic keratosis)

SOLARAZE Non-Formulary

Brand

ST Yes 3 doxepin (antipuritic) PRUDOXIN Non-Formulary

Brand

Yes 3 doxycycline (rosacea) ORACEA Non-Formulary

Brand

No 3 fluorouracil (topical) CARAC Non-Formulary

Brand

Yes 1 fluorouracil (topical) EFUDEX Generic

Yes 2 fluorouracil (topical) FLUOROPLEX Formulary Brand

Yes 1 imiquimod ALDARA Generic

Yes 3 imiquimod ZYCLARA Non-Formulary

Brand

PA Yes 3 ingenol mebutate PICATO Non-Formulary

Brand

No 1 isotretinoin ACCUTANE Generic

No 1 isotretinoin CLARAVIS Generic

Yes 3 lactic acid (ammonium lactate) LACTINOL Non-Formulary

Brand

Yes 2 methoxsalen 8-MOP Formulary Brand

Yes 1 methoxsalen, rapid OXSORALEN-ULTRA Generic

Yes 2 pimecrolimus ELIDEL Formulary Brand

Yes 1 podofilox CONDYLOX Generic

ST Yes 3 sinecatechins VEREGEN Non-Formulary

Brand

Yes 1 tacrolimus (topical) PROTOPIC Generic

ST Yes 3 tazarotene FABIOR Non-Formulary

Brand

QL, AGE, ST

Yes 3 tazarotene TAZORAC Non-Formulary

Brand

Smooth Muscle Relaxants

Smooth Muscle Relaxants

Yes 1 darifenacin ENABLEX Generic




ST Yes 3 dyphylline LUFYLLIN Non-Formulary

Brand

ST Yes 3 fesoterodine TOVIAZ Non-Formulary

Brand

ST Yes 3 flavoxate FLAVOXATE Non-Formulary

Brand

ST Yes 3 mirabegron MYRBETRIQ Non-Formulary

Brand

Yes 1 oxybutynin DITROPAN Generic

Yes 1 oxybutynin extended-release DITROPAN XL Generic

Yes 3 oxybutynin transdermal OXYTROL Non-Formulary

Brand

Yes 1 solifenacin VESICARE Generic

Yes 1 theophylline UNIPHYL Generic

ST Yes 1 tolterodine DETROL Generic

ST Yes 1 tolterodine extended-release DETROL LA Generic

Yes 1 trospium SANCTURA Generic

Yes 3 trospium extended-release SANCTURA XR Non-Formulary

Brand

Vitamins

Vitamins

Yes 1 calcitriol ROCALTROL Generic

ST Yes 1 doxercalciferol HECTOROL Generic

Yes 1 ergocalciferol DRISDOL Generic

Yes 1 niacin NIACOR Generic

ST Yes 1 paricalcitol ZEMPLAR Generic

Yes 1 phytonadione MEPHYTON Generic



8

8-MOP ............................................................................................. 84

A

abacavir sulfate & lamivudine ........................................................ 8

abacavir sulfate solution ................................................................. 8

abacavir sulfate tablet ..................................................................... 9

abacavir, dolutegravir & lamivudine .............................................. 9

abacavir, lamivudine & zidovudine ................................................ 9

abaloparatide .................................................................................. 68

abatacept ........................................................................................ 69

abemaciclib ..................................................................................... 13

ABILIFY ........................................................................................... 39

ABILIFY DISCMELT ...................................................................... 39

abiraterone ...................................................................................... 13

ABSTRAL ........................................................................................ 30

acalabrutinib ................................................................................... 13

acamprosate ................................................................................... 38

acarbose ......................................................................................... 61

ACCOLATE .................................................................................... 75

ACCU-CHEK .................................................................................. 42

ACCU-CHEK TEST STRIPS ........................................................ 42

ACCUNEB ...................................................................................... 19

ACCUPRIL ...................................................................................... 26

ACCURETIC ................................................................................... 26

ACCUTANE .................................................................................... 84

acebutolol ........................................................................................ 28

ACEON ............................................................................................ 26

acetaminophen & codeine ............................................................ 29

acetaminophen, caffeine, & dihydrocodeine .............................. 29

ACETASOL HC .............................................................................. 48

acetazolamide ................................................................................ 50

acetic acid ................................................................................. 48, 51

acetylcysteine ................................................................................. 69

ACIPHEX ........................................................................................ 53

acitretin ............................................................................................ 83

ACLOVATE ..................................................................................... 79

ACTEMRA ...................................................................................... 74

ACTHAR.......................................................................................... 68

ACTIGALL ....................................................................................... 55

ACTIMMUNE .................................................................................. 72

ACTIQ .............................................................................................. 30

ACTIVELLA .................................................................................... 66

ACTONEL ....................................................................................... 73

ACTOPLUS MET ........................................................................... 65

ACTOS ............................................................................................ 65

ACULAR .......................................................................................... 48

ACULAR LS .................................................................................... 48

acyclovir ...................................................................................... 9, 77

ACZONE ......................................................................................... 83

ADALAT CC .................................................................................... 23

adalimumab .................................................................................... 69

adapalene ....................................................................................... 83

adapalene & benzoyl peroxide .................................................... 83

ADCIRCA ........................................................................................ 28

ADDERALL ..................................................................................... 33

ADDERALL XR .............................................................................. 33

adefovir dipivoxil .............................................................................. 9

ADEMPAS ...................................................................................... 28

ADLYXIN......................................................................................... 64

ADMELOG ...................................................................................... 64

ADOXA .............................................................................................. 5

ADRENACLICK ............................................................................. 19

ADVAIR HFA .................................................................................. 76

ADVICOR ....................................................................................... 22

ADZENYS ER ................................................................................ 33

AFINITOR ....................................................................................... 14

aflcaftadine ..................................................................................... 49

AFREZZA ....................................................................................... 63

AGGRENOX ................................................................................... 20

AGRYLIN ........................................................................................ 20

AIMOVIG......................................................................................... 71

AKNE-MYCIN ................................................................................. 78

AK-TRACIN .................................................................................... 45

AKYNZEO ....................................................................................... 52

albendazole ...................................................................................... 4

ALBENZA ......................................................................................... 4

albiglutide ........................................................................................ 61

albuterol nebulizer solution .......................................................... 19

albuterol sulfate.............................................................................. 19

albuterol sulfate & ipratropium ..................................................... 19

albuterol sulfate tablet ................................................................... 19

alclometasone dipropionate ......................................................... 79

ALDACTAZIDE .............................................................................. 27

ALDACTONE ................................................................................. 27

ALDARA .......................................................................................... 84

ALDOMET ...................................................................................... 25

ALDORIL-25 ................................................................................... 25

alendronate ..................................................................................... 69

alendronate & cholecalciferol ....................................................... 69

alfuzosin .......................................................................................... 18

ALINIA ............................................................................................... 8

alirocumab ...................................................................................... 21

aliskiren ........................................................................................... 25

aliskiren & amlodipine ................................................................... 25

aliskiren & hydrochlorothiazide .................................................... 25

aliskiren & valsartan ...................................................................... 25

aliskiren, amlodipine & hydrochlorothiazide ............................... 25

alitretinoin ....................................................................................... 83

ALKERAN ....................................................................................... 15

allopurinol ....................................................................................... 69

almotriptan ...................................................................................... 35

ALOCRIL......................................................................................... 49

alogliptin .......................................................................................... 61

alogliptin & metformin ................................................................... 61



alogliptin & pioglitazone ................................................................ 61

ALOMIDE ........................................................................................ 49

ALORA ............................................................................................ 66

alosetron ......................................................................................... 52

alpelisib ........................................................................................... 13

ALPHAGAN .................................................................................... 50

ALPHAGAN P................................................................................. 50

alprazolam ...................................................................................... 37

alprazolam extended-release ....................................................... 37

alprazolam orally disintegrating ................................................... 37

ALREX ............................................................................................. 48

ALTABAX ........................................................................................ 79

ALTACE .......................................................................................... 26

ALTOPREV ..................................................................................... 22

aluminum chloride hexahydrate ................................................... 82

ALVESCO ....................................................................................... 75

amantadine ..................................................................................... 36

amantadine ER............................................................................... 36

AMARYL.......................................................................................... 62

AMBIEN ........................................................................................... 38

AMBIEN CR .................................................................................... 38

ambrisentan .................................................................................... 27

amcinonide...................................................................................... 79

AMERGE ......................................................................................... 36

AMICAR .......................................................................................... 20

amifampridine ................................................................................. 69

amikacin liposomal inhalation ........................................................ 4

amiloride .......................................................................................... 43

amiloride & hydrochlorothiazide ................................................... 43

aminocaproic acid .......................................................................... 20

amiodarone ..................................................................................... 24

AMITIZA .......................................................................................... 54

amitriptyline ............................................................................... 39, 40

amitriptyline & perphenazine ........................................................ 39

amlodipine ........................................................................... 22, 23, 25

amlodipine & atorvastatin ............................................................. 23

amlodipine & benazepril ................................................................ 22

amlodipine & olmesartan .............................................................. 23

amlodipine & telmisartan............................................................... 23

amlodipine & valsartan .................................................................. 23

amlodipine, olmesartan & hydrochlorothiazide .......................... 23

amlodipine, valsartan & hydrochlorothiazide ............................. 23

ammonium lactate ................................................................... 83, 84

amoxapine ...................................................................................... 39

amoxicillin................................................................................ 2, 4, 53

amoxicillin & clavulanate potassium .............................................. 4

amoxicillin & clavulanate potassium extended-release .............. 4

amoxicillin, clarithromycin, & lansoprazole ................................. 53

AMOXIL ............................................................................................. 4

amphetamine & dextroamphetamine .......................................... 33

amphetamine & dextroamphetamine extended-release .......... 33

amphetamine extended-release .................................................. 33

amphetamine sulfate ..................................................................... 32

AMPICILLIN ...................................................................................... 5

ampicillin sodium ............................................................................. 5

AMPYRA ......................................................................................... 70

AMRIX ............................................................................................. 18

AMTURNIDE .................................................................................. 25

AMYTHYST .................................................................................... 58

ANADROL-50 ................................................................................. 56

ANAFRANIL ................................................................................... 40

anagrelide ....................................................................................... 20

anakinra .......................................................................................... 69

ANALPRAM HC ............................................................................. 82

ANAPROX ...................................................................................... 31

anastrozole ..................................................................................... 13

ANCOBON ....................................................................................... 7

ANDRODERM................................................................................ 56

ANDROGEL ................................................................................... 56

ANDROID 10 .................................................................................. 56

ANDROXY ...................................................................................... 56

ANGELIQ ........................................................................................ 66

ANNOVERA ................................................................................... 61

ANORO ELLIPTA .......................................................................... 20

ANSAID ........................................................................................... 30

ANTABUSE .................................................................................... 70

anthralin .......................................................................................... 83

antipyrine & benzocaine ............................................................... 51

ANUSOL-HC .................................................................................. 81

ANZEMET ....................................................................................... 52

APEXICON ..................................................................................... 80

APIDRA ........................................................................................... 63

apixaban ......................................................................................... 20

APLENZIN ...................................................................................... 39

APOKYN ......................................................................................... 36

apomorphine .................................................................................. 36

apraclonidine .................................................................................. 51

apremilast ....................................................................................... 70

aprepitant ........................................................................................ 52

APRESOLINE ................................................................................ 25

APRI ................................................................................................ 57

APTIOM .......................................................................................... 34

APTIVUS......................................................................................... 12

ARALEN ............................................................................................ 8

ARANELLE ..................................................................................... 59

ARANESP ....................................................................................... 21

ARAVA ............................................................................................ 72

ARBINOXA ....................................................................................... 4

ARCAPTA NEOHALER ................................................................ 76

arformoterol .................................................................................... 19

ARICEPT ........................................................................................ 17

ARICEPT ODT ............................................................................... 17

ARIKAYCE ....................................................................................... 4

ARIMIDEX ...................................................................................... 13

aripiprazole ..................................................................................... 39

aripiprazole solution ...................................................................... 39

aripiprazole tablet .......................................................................... 39

ARIXTRA ........................................................................................ 20



armodafinil ...................................................................................... 33

ARMOUR THYROID ..................................................................... 69

AROMASIN ..................................................................................... 14

ARTANE .......................................................................................... 37

artemether & lumefantrine .............................................................. 8

ARTHROTEC ................................................................................. 30

artificial tear insert .......................................................................... 51

ASCENSIA BREEZE ..................................................................... 42

ASCENSIA TEST STRIPS ........................................................... 42

asenapine........................................................................................ 39

ASENDIN ........................................................................................ 39

ASMANEX ...................................................................................... 76

aspirin & dipyridamole ................................................................... 20

ASTELIN ......................................................................................... 49

ASTEPRO ....................................................................................... 49

ATACAND ....................................................................................... 25

ATACAND HCT .............................................................................. 25

ATARAX .......................................................................................... 37

atazanavir & cobicistat .................................................................... 9

atazanavir sulfate 150 mg............................................................... 9

atazanavir sulfate 200 mg, 300 mg ............................................... 9

ATELVIA.......................................................................................... 73

atenolol ............................................................................................ 28

atenolol & chlorthalidone............................................................... 28

ATIVAN ........................................................................................... 37

atomoxetine .................................................................................... 38

atorvastatin ............................................................................... 21, 23

atovaquone ....................................................................................... 8

atovaquone & proguanil .................................................................. 8

ATRIPLA ......................................................................................... 10

atropine ............................................................................... 16, 51, 52

atropine sulfate ............................................................................... 16

ATROPINE SULFATE ................................................................... 16

ATROVENT .................................................................................... 17

ATROVENT HFA ........................................................................... 17

AUBAGIO ........................................................................................ 74

AUGMENTIN .................................................................................... 4

AUGMENTIN XR ............................................................................. 4

auranofin ......................................................................................... 55

AURODEX ...................................................................................... 51

AUSTEDO ....................................................................................... 38

AUVI-Q ............................................................................................ 19

AVALIDE ......................................................................................... 26

AVANDAMET ................................................................................. 65

AVANDARYL .................................................................................. 65

AVANDIA ........................................................................................ 65

avapritinib ........................................................................................ 13

AVAPRO ......................................................................................... 26

AVAR ............................................................................................... 82

AVC VAGINAL ............................................................................... 79

AVELOX ............................................................................................ 6

AVINZA ........................................................................................... 31

AVLOSULFON ................................................................................. 7

AVODART ....................................................................................... 71

AVONEX ......................................................................................... 72

AXERT ............................................................................................ 35

AXID ................................................................................................ 53

AXIRON .......................................................................................... 56

axitinib ............................................................................................. 13

AYGESTIN ..................................................................................... 68

AYVAKIT ......................................................................................... 13

AZASAN .......................................................................................... 70

AZASITE ......................................................................................... 45

azathioprine .................................................................................... 70

azelaic acid ..................................................................................... 83

azelaic acid (acne)......................................................................... 83

azelastine ........................................................................................ 49

azelastine & fluticasone ................................................................ 49

azelastine (ophth) .......................................................................... 49

AZELEX .......................................................................................... 83

AZILECT ......................................................................................... 37

azilsartan......................................................................................... 25

azithromycin ............................................................................... 5, 45

azithromycin (ophth) ...................................................................... 45

AZOPT ............................................................................................ 50

AZOR .............................................................................................. 23

AZULFIDINE .................................................................................... 6

B

B & O SUPPRETTES ................................................................... 32

bacitracin & polmyxin B (ophth) ................................................... 45

bacitracin (ophth) ........................................................................... 45

bacitracin, neomycin, polymyxin B & hydrocortisone (ophth) .. 47

bacitracin, polymyxin, neomycin & hydrocortisone ................... 79

baclofen .......................................................................................... 18

BACTRIM DS ................................................................................... 6

BACTROBAN ................................................................................. 78

BACTROBAN NASAL ................................................................... 78

balsalazide ...................................................................................... 52

BALZIVA ......................................................................................... 59

BANZEL .......................................................................................... 35

BAQSIMI ......................................................................................... 62

BARACLUDE ................................................................................. 10

baricitnib .......................................................................................... 70

BASAGLAR .................................................................................... 63

BD INSULIN SYRINGE ................................................................ 43

becaplermin .................................................................................... 83

beclomethasone dipropionate ...................................................... 75

bedaquiline ..................................................................................... 70

BELSOMRA ................................................................................... 38

bempedoic acid .............................................................................. 21

bempedoic acid & ezetimibe ........................................................ 21

benazepril ................................................................................. 22, 25

benazepril & hydrochlorothiazide ................................................ 25

BENEMID ....................................................................................... 45

BENICAR ........................................................................................ 26

BENICAR HCT ............................................................................... 26



BENTYL .......................................................................................... 16

BENZACLIN .................................................................................... 77

BENZAMYCIN ................................................................................ 77

benznidazole .................................................................................... 4

benzonatate .................................................................................... 74

benzoyl peroxide & erythromycin ................................................ 77

benzoyl peroxide & hydrocortisone ............................................. 80

benztropine ..................................................................................... 36

bepotastine ..................................................................................... 49

BEPREVE ....................................................................................... 49

besilfoxacin ..................................................................................... 45

BESIVANCE ................................................................................... 45

BETAGAN ....................................................................................... 50

betaine ............................................................................................. 70

betamethasone dipropionate (topical) ......................................... 80

betamethasone dipropionate augmented ................................... 80

betamethasone valerate ............................................................... 80

BETAPACE ..................................................................................... 29

BETAPACE AF............................................................................... 29

BETASERON ................................................................................. 72

betaxolol .................................................................................... 28, 50

betaxolol hcl .................................................................................... 50

bethanechol chloride ..................................................................... 17

BETIMOL ........................................................................................ 51

BETOPTIC ...................................................................................... 50

BETOPTIC S .................................................................................. 50

betrixaban ....................................................................................... 20

BEVYXXA ....................................................................................... 20

bexarotene ................................................................................ 13, 83

bexarotene (topical) ....................................................................... 83

BEXDELA.......................................................................................... 5

BEYAZ ............................................................................................. 57

BIAXIN ............................................................................................... 5

BIAXIN XL ......................................................................................... 5

bicalutamide .................................................................................... 13

BICITRA .......................................................................................... 43

bictegravir & emtricitabine & tenofovir .......................................... 9

BIDIL ................................................................................................ 27

BIJUVA ............................................................................................ 68

BIKTARVY ........................................................................................ 9

BILTRICIDE ...................................................................................... 4

bimatoprost ..................................................................................... 50

binimetinib ....................................................................................... 13

bismuth subcitrate & metronidazole .............................................. 4

bisoprolol ......................................................................................... 28

bisoprolol & hydrochlorothiazide .................................................. 28

BLEPH-10 ....................................................................................... 46

BLEPHAMIDE ................................................................................ 49

BLOCADREN ................................................................................. 29

blood sugar diagnostic .................................................................. 42

blood-glucose meter ................................................................ 42, 43

boceprevir ......................................................................................... 9

BONIVA ........................................................................................... 71

bosentan ......................................................................................... 27

BOSULIF......................................................................................... 13

bosutinib .......................................................................................... 13

BRAFTOVI ...................................................................................... 14

BREO ELLIPTA ............................................................................. 76

BRETHINE ..................................................................................... 20

BREVICON ..................................................................................... 59

brexpiprazole .................................................................................. 39

BRILINTA ........................................................................................ 20

brimonidine ............................................................................... 50, 83

brimonidine & timolol ..................................................................... 50

brimonidine (topical) ...................................................................... 83

brimonidine tartrate ....................................................................... 50

brinzolamide ................................................................................... 50

brodalumab ..................................................................................... 70

bromfenac (ophth) ......................................................................... 47

bromocriptine.................................................................................. 36

BROVANA ...................................................................................... 19

BRUKINSA ..................................................................................... 16

budesonide ............................................................................... 55, 75

budesonide & formoterol .............................................................. 75

bumetanide ..................................................................................... 43

BUMEX ........................................................................................... 43

BUPHENYL .................................................................................... 43

buprenorphine ................................................................................ 29

buprenorphine & naloxone film .................................................... 29

buprenorphine transdermal .......................................................... 29

buprenorphine& naloxone tablet ................................................. 29

bupropion ........................................................................................ 39

bupropion (smoking deterrent)..................................................... 39

bupropion extended-release ........................................................ 39

bupropion hydrobromide ............................................................... 39

bupropion sustained-release ........................................................ 39

BUSPAR ......................................................................................... 37

buspirone ........................................................................................ 37

busulfan .......................................................................................... 13

butalbital & acetaminophen .......................................................... 29

butalbital, acetaminophen, & caffeine ......................................... 29

butalbital, acetaminophen, caffeine, & codeine ......................... 29

butalbital, aspirin, & caffeine ........................................................ 29

butalbital, aspirin, caffeine, & codeine ........................................ 30

butenafine ....................................................................................... 77

butoconazole nitrate (vaginal) ...................................................... 77

butorphanol tartrate ....................................................................... 30

BUTRANS ....................................................................................... 29

BYDUREON ................................................................................... 62

BYETTA .......................................................................................... 62

BYSTOLIC ...................................................................................... 28

C

c-1 esterase inhibitor ..................................................................... 70

cabergoline ..................................................................................... 36

CADUET ......................................................................................... 23

CAFERGOT ................................................................................... 19



CALAN SR ...................................................................................... 24

calcipotriene .............................................................................. 80, 83

calcipotriene & betamethasone.................................................... 80

calcitonin salmon ........................................................................... 68

calcitriol ..................................................................................... 83, 85

calcitriol (topical) ............................................................................ 83

calcium acetate ........................................................................ 44, 45

CALQUENCE ................................................................................. 13

CAMILA ........................................................................................... 59

CAMPRAL ....................................................................................... 38

canagliflozin .................................................................................... 61

canagliflozin & metformin .............................................................. 61

canakinumab .................................................................................. 70

CANASA.......................................................................................... 52

candesartan .................................................................................... 25

candesartan & hydrochlorothiazide ............................................. 25

cannabidiol ...................................................................................... 38

CANTIL ............................................................................................ 55

capecitabine .................................................................................... 13

CAPEX SHAMPOO ....................................................................... 80

CAPOTEN ....................................................................................... 25

CAPOZIDE ...................................................................................... 25

CAPRELSA ..................................................................................... 16

captopril ........................................................................................... 25

captopril & hydrochlorothiazide .................................................... 25

CARAC ............................................................................................ 84

CARAFATE ..................................................................................... 53

carbachol ......................................................................................... 50

CARBAGLU .................................................................................... 43

carbamazepine ............................................................................... 34

carbamazepine extended-release cap ........................................ 34

carbamazepine extended-release tab ......................................... 34

CARBATROL .................................................................................. 34

carbidopa ........................................................................................ 36

carbidopa & levodopa.................................................................... 36

carbidopa & levodopa extended release .................................... 36

carbidopa, levodopa, & entacapone ............................................ 36

carbinoxamine maleate ................................................................... 4

CARDENE ...................................................................................... 23

CARDIZEM ..................................................................................... 23

CARDIZEM CD .............................................................................. 23

CARDIZEM LA ............................................................................... 23

CARDURA ...................................................................................... 21

carglumic acid................................................................................. 43

cariprazine ...................................................................................... 40

carisoprodol .............................................................................. 18, 30

carisoprodol & aspirin .................................................................... 18

carisoprodol, aspirin, & codeine ................................................... 30

CARMOL ................................................................................... 81, 82

CARMOL HC .................................................................................. 81

carteolol (ophth) ............................................................................. 50

CARTIA XT ..................................................................................... 23

carvedilol ......................................................................................... 28

carvedilol phosphate...................................................................... 28

CASODEX ...................................................................................... 13

CATAFLAM .................................................................................... 30

CATAPRES .............................................................................. 24, 25

CATAPRES-TTS ........................................................................... 25

CECLOR ........................................................................................... 5

cefaclor .............................................................................................. 5

cefadroxil........................................................................................... 5

cefdinir ............................................................................................... 5

cefditoren .......................................................................................... 5

cefixime ............................................................................................. 5

cefixime solution .............................................................................. 5

cefpodoxime ..................................................................................... 5

cefprozil ............................................................................................. 5

CEFTIN ............................................................................................. 5

cefuroxime axetil .............................................................................. 5

CEFZIL .............................................................................................. 5

CELEBREX .................................................................................... 30

celecoxib ......................................................................................... 30

CELEXA .......................................................................................... 40

CELLCEPT ..................................................................................... 73

CELONTIN ..................................................................................... 35

cenegermin-bkbj ............................................................................ 51

CENESTIN ..................................................................................... 67

cephalexin......................................................................................... 5

CEQUA ........................................................................................... 47

CERDELGA .................................................................................... 71

ceritinib ............................................................................................ 13

certolizumab Pegol ........................................................................ 70

CESAMET ...................................................................................... 52

cevimeline hcl ................................................................................. 17

CHANTIX ........................................................................................ 17

CHEMET ......................................................................................... 55

CHERATUSSIN AC....................................................................... 75

chlorambucil ................................................................................... 13

chlordiazepoxide ................................................................ 37, 40, 54

chlordiazepoxide & amitriptyline .................................................. 40

chlorhexidine (mouth-throat) ........................................................ 45

chloroquine phosphate ................................................................... 8

chlorothiazide ................................................................................. 43

chlorpheniramine, phenylephrine & pyrilamine ........................... 4

chlorpromazine .............................................................................. 40

chlorpropamide .............................................................................. 62

CHLORPROPAMIDE .................................................................... 62

chlorthalidone ........................................................................... 28, 43

chlorzoxazone ................................................................................ 18

CHOLBAM ...................................................................................... 70

cholestyramine ............................................................................... 21

cholestyramine light....................................................................... 21

cholic acid ....................................................................................... 70

CHRONULAC ................................................................................ 43

CIBALITH-S .................................................................................... 41

ciclesonide ...................................................................................... 75

ciclopirox ......................................................................................... 77

cilostazol ......................................................................................... 20



CILOXAN ........................................................................................ 46

CIMDUO .......................................................................................... 11

cimetidine ........................................................................................ 53

CIMZIA ............................................................................................ 70

cinacalcet ........................................................................................ 70

CIPRO ......................................................................................... 5, 47

CIPRO HC ...................................................................................... 47

CIPRODEX ..................................................................................... 47

ciprofloxacin .......................................................................... 5, 46, 47

ciprofloxacin & dexamethasone (ophth) ..................................... 47

ciprofloxacin & hydrocortisone (otic) ........................................... 47

ciprofloxacin (ophth) ointment ...................................................... 46

ciprofloxacin (ophth) solution ....................................................... 46

citalopram........................................................................................ 40

citric acid, sodium citrate, & potassium citrate ........................... 43

CLARAVIS ...................................................................................... 84

clarithromycin ............................................................................. 5, 53

clarithromycin extended-release .................................................... 5

CLEOCIN .................................................................................... 5, 77

CLEOCIN HCL ................................................................................. 5

CLEOCIN PEDIATRIC .................................................................... 5

CLEOCIN T ..................................................................................... 77

clidinium & chlordiazepoxide ........................................................ 54

CLIMARA DIS................................................................................. 66

CLIMARA PRO............................................................................... 66

CLINDAGEL ................................................................................... 77

clindamycin & benzoyl peroxide .................................................. 77

clindamycin & tretinoin .................................................................. 83

clindamycin hcl ................................................................................. 5

clindamycin palmitate ...................................................................... 5

clindamycin phosphate (topical) .................................................. 77

clindamycin phosphate (vaginal) ................................................. 77

CLINORIL........................................................................................ 32

clobazam ......................................................................................... 34

clobetasol propionate .................................................................... 80

clobetasol propionate emollient ................................................... 80

clobetasol propionate emulsion ................................................... 80

CLOBEX .......................................................................................... 80

clocortolone pivalate ...................................................................... 80

CLODERM ...................................................................................... 80

clomipramine .................................................................................. 40

clonazepam .................................................................................... 34

clonidine .................................................................................... 24, 25

clonidine extended-release........................................................... 24

clonidine transdermal .................................................................... 25

clopidogrel ....................................................................................... 20

clorazepate ..................................................................................... 37

clotrimazole ............................................................................... 77, 78

clotrimazole & betamethasone ..................................................... 78

clozapine ......................................................................................... 40

CLOZARIL ...................................................................................... 40

COARTEM ........................................................................................ 8

cobimetinib ...................................................................................... 14

codeine ................................................................................ 29, 30, 75

CODEINE SULF ............................................................................ 30

COGENTIN ..................................................................................... 36

COLAZAL ....................................................................................... 52

COL-BENEMID .............................................................................. 45

colchicine .................................................................................. 45, 70

colchicine & probenecid ................................................................ 45

COLCRYS ...................................................................................... 70

colesevelam ................................................................................... 21

COLESTID ...................................................................................... 21

colestipol ......................................................................................... 21

collagenase .................................................................................... 83

COLYTE .......................................................................................... 53

COMBIGAN .................................................................................... 50

COMBIPATCH ............................................................................... 66

COMBIVENT RESPIMAT ............................................................. 19

COMBIVIR ...................................................................................... 11

COMBUNOX .................................................................................. 32

COMPAZINE .................................................................................. 53

COMPLERA ................................................................................... 10

COMTAN ........................................................................................ 36

CONCERTA ................................................................................... 33

CONDYLOX ................................................................................... 84

conjugated estrogens & bazedoxifene ....................................... 66

conjugated estrogens & medroxyprogesterone acetate .......... 66

COPAXONE 20 mg ....................................................................... 71

COPAXONE 40 mg ....................................................................... 71

CORDRAN ..................................................................................... 81

COREG ........................................................................................... 28

COREG CR .................................................................................... 28

CORGARD ..................................................................................... 28

CORLANOR ................................................................................... 24

CORTEF ......................................................................................... 55

CORTENEMA ................................................................................ 81

corticotropin .................................................................................... 68

CORTIFOAM .................................................................................. 81

cortisone acetate ........................................................................... 55

CORTISPORIN ........................................................................ 48, 79

CORTISPORIN-TC ....................................................................... 48

CORTONE ACETATE .................................................................. 55

CORZIDE ........................................................................................ 28

COSENTYX .................................................................................... 74

COSOPT ......................................................................................... 50

COTELLIC ...................................................................................... 14

COTEMPLA XR-ODT ................................................................... 34

COUMADIN .................................................................................... 21

COVERA-HS .................................................................................. 24

COZAAR ......................................................................................... 26

CREON ........................................................................................... 54

CRESEMBA ..................................................................................... 7

CRESTOR ...................................................................................... 22

crisaborole ...................................................................................... 80

CRIXIVAN ....................................................................................... 11

crizotinib .......................................................................................... 14

cromolyn sodium ...................................................................... 49, 75



cromolyn sodium (ophth) .............................................................. 49

crotamiton ....................................................................................... 78

CRYSELLE ..................................................................................... 60

CUPRIMINE .................................................................................... 55

CUTIVATE ...................................................................................... 81

CYCLESSA ..................................................................................... 57

cyclobenzaprine ............................................................................. 18

cyclobenzaprine extended-release .............................................. 18

CYCLOCORT ................................................................................. 79

cyclophosphamide ......................................................................... 14

cycloserine ........................................................................................ 7

CYCLOSET .................................................................................... 36

cyclosporine .............................................................................. 47, 70

cyclosporine (ophth) ...................................................................... 47

cyclosporine, modified ................................................................... 70

CYMBALTA .................................................................................... 40

cyproheptadine ................................................................................. 4

CYSTADANE POWD .................................................................... 70

CYSTAGON .................................................................................... 70

cysteamine delayed-release ......................................................... 70

cysteamine immediate-release .................................................... 70

CYTOMEL ....................................................................................... 69

CYTOTEC ....................................................................................... 53

CYTOVENE .................................................................................... 11

CYTOXAN ....................................................................................... 14

CYTRA-3 ......................................................................................... 43

D

D.H.E.45 .......................................................................................... 18

dabigatran ....................................................................................... 20

daclatasvir ......................................................................................... 9

dacomitinib ...................................................................................... 14

daflazacort ...................................................................................... 70

DAKLINZA ........................................................................................ 9

dalfampridine .................................................................................. 70

DALIRESP ...................................................................................... 76

DALMANE ....................................................................................... 37

dalteparin ........................................................................................ 20

danazol ............................................................................................ 56

DANOCRINE .................................................................................. 56

DANTRIUM ..................................................................................... 18

dantrolene sodium ......................................................................... 18

dapagliflozin .................................................................................... 62

dapagliflozin & metformin ............................................................. 62

dapsone ....................................................................................... 7, 83

dapsone (topical) ........................................................................... 83

DARAPRIM ....................................................................................... 8

darbepoetin alfa ............................................................................. 21

darifenacin ...................................................................................... 84

darolutamide ................................................................................... 14

darunavir & cobicistat ...................................................................... 9

darunavir ethanolate ........................................................................ 9

darunavir/cobicistat/FTC/tenofovir ................................................. 9

dasatinib .......................................................................................... 14

DAURISMO .................................................................................... 14

DAYPRO ......................................................................................... 32

DAYTRANA .................................................................................... 34

DDAVP ............................................................................................ 68

DECADRON ............................................................................. 47, 55

DECLOMYCIN ................................................................................. 5

deferasirox ...................................................................................... 55

deferiprone ..................................................................................... 55

delafloxacin ....................................................................................... 5

delavirdine mesylate ....................................................................... 9

DELESTROGEN ............................................................................ 57

DELSTRIGO ................................................................................... 10

DEMADEX ...................................................................................... 44

demeclocycline ................................................................................ 5

DEMEROL ...................................................................................... 31

DENAVIR ........................................................................................ 79

DEPAKENE .................................................................................... 35

DEPAKOTE .................................................................................... 34

DEPAKOTE ER ............................................................................. 34

DEPAKOTE SPRINKLE ............................................................... 34

DEPEN ............................................................................................ 55

DEPO-ESTRADIOL....................................................................... 57

DEPO-TESTOSTERONE ............................................................. 56

DERMA-SMOOTHE/FS OIL ........................................................ 80

DERMATOP ................................................................................... 81

DERMOTIC .................................................................................... 47

DESCOVY ...................................................................................... 10

desipramine .................................................................................... 40

desmopressin (non-refrigerated) ................................................. 68

desmopressin acetate ................................................................... 68

DESOGEN ...................................................................................... 57

desogestrel & ethinyl estradiol ..................................................... 57

desogestrel & ethinyl estradiol (biphasic) ................................... 57

desogestrel & ethinyl estradiol (triphasic) .................................. 57

desonide ......................................................................................... 80

DESOWEN ..................................................................................... 80

desoximetasone ............................................................................. 80

DESOXYN ...................................................................................... 33

desvenlafaxine extended release ................................................ 40

desvenlafaxine succinate extended release .............................. 40

DESYREL ....................................................................................... 41

DETROL ......................................................................................... 85

DETROL LA ................................................................................... 85

deutetrabenazine ........................................................................... 38

dexamethasone ........................................................... 47, 48, 49, 55

dexamethasone (ophth) solution ................................................. 47

dexamethasone (ophth) suspension ........................................... 47

DEXEDRINE .................................................................................. 33

DEXILANT ...................................................................................... 53

dexlansoprazole ............................................................................. 53

dexmethylphenidate ...................................................................... 33

dexmethylphenidate extended-release ...................................... 33

dextroamphetamine sulfate .......................................................... 33



dextroamphetamine sulfate extended-release........................... 33

dextromethorphan & quinidine ..................................................... 38

DEXTROSTAT ............................................................................... 33

DIABETA ......................................................................................... 62

DIACOMIT ...................................................................................... 35

DIAMOX .......................................................................................... 50

DIAMOX SEQUELS ...................................................................... 50

DIASTAT ......................................................................................... 34

DIASTAT ACUDIAL ....................................................................... 34

diazepam ................................................................................... 34, 37

DIBENZYLINE ................................................................................ 19

dichlorphenamide ........................................................................... 70

diclofenac epolamine ..................................................................... 83

diclofenac potassium ..................................................................... 30

diclofenac sodium .............................................................. 30, 47, 84

diclofenac sodium & misoprostol ................................................. 30

diclofenac sodium (actinic keratosis) .......................................... 84

diclofenac sodium (ophth)............................................................. 47

diclofenac sodium extended release ........................................... 30

dicloxacillin ........................................................................................ 5

dicyclomine ..................................................................................... 16

didanosine ......................................................................................... 9

didanosine solution .......................................................................... 9

DIDRONEL ..................................................................................... 71

difenoxin & atropine ....................................................................... 52

DIFFERIN........................................................................................ 83

DIFICID ............................................................................................. 6

diflorasone diacetate ..................................................................... 80

DIFLUCAN ........................................................................................ 7

diflunisal .......................................................................................... 30

DIFLUNISAL ................................................................................... 30

difluprednate ................................................................................... 47

digoxin ............................................................................................. 24

dihydroergotamine mesylate ........................................................ 18

DILANTIN ........................................................................................ 35

DILAUDID ....................................................................................... 31

diltiazem .......................................................................................... 23

diltiazem extended-release ........................................................... 23

dimethyl fumarate .......................................................................... 70

DIOVAN ........................................................................................... 27

DIOVAN HCT ................................................................................. 27

DIPENTUM ..................................................................................... 52

diphenoxylate & atropine .............................................................. 52

DIPROLENE ................................................................................... 80

DIPROSONE .................................................................................. 80

dipyridamole ................................................................................... 20

DISALCID........................................................................................ 32

disopyramide .................................................................................. 24

disopyramide controlled-release .................................................. 24

disulfiram ......................................................................................... 70

DITROPAN ..................................................................................... 85

DITROPAN XL ............................................................................... 85

DIURIL ............................................................................................. 43

divalproex sodium .......................................................................... 34

divalproex sodium capsule ........................................................... 34

divalproex sodium extended release .......................................... 34

DIVIGEL .......................................................................................... 66

dofetilide .......................................................................................... 24

dolasetron ....................................................................................... 52

DOLOPHINE .................................................................................. 31

dolutegravir ....................................................................................... 9

dolutegravir & lamivudine ............................................................... 9

dolutegravir & rilpivirine .................................................................. 9

donepezil................................................................................... 17, 38

DONNATAL .................................................................................... 55

doravirine ........................................................................................ 10

doravirine, lamivudine, tenofovir .................................................. 10

dornase alfa .................................................................................... 45

DORYX ............................................................................................. 5

dorzolamide .................................................................................... 50

dorzolamide & timolol .................................................................... 50

DOSTINEX ..................................................................................... 36

DOVATO ........................................................................................... 9

DOVONEX ...................................................................................... 83

doxazosin ........................................................................................ 21

doxepin .......................................................................... 37, 40, 82, 84

doxepin (antipuritic) ................................................................. 82, 84

doxepin (sleep) .............................................................................. 37

doxercalciferol ................................................................................ 85

doxycycline ................................................................................. 5, 84

doxycycline (rosacea) ................................................................... 84

doxycycline hyclate ......................................................................... 5

doxycycline monohydrate ............................................................... 5

DRISDOL ........................................................................................ 85

DRITHO-CREME HP .................................................................... 83

dronabinol ....................................................................................... 52

dronedarone ................................................................................... 24

drospirenone ............................................................................ 57, 66

drospirenone & estradiol ............................................................... 66

drospirenone & ethinyl estradiol .................................................. 57

drospirenone & ethinyl estradiol w/ folate .................................. 57

DROXIA .......................................................................................... 14

droxidopa ........................................................................................ 19

DUAC .............................................................................................. 77

DUAVEE ......................................................................................... 66

DUETACT ....................................................................................... 65

dulaglutide ...................................................................................... 62

DULERA ......................................................................................... 76

duloxetine ....................................................................................... 40

DUONEB......................................................................................... 19

dupilumab ....................................................................................... 70

DUPIXENT ..................................................................................... 70

DURAGESIC .................................................................................. 30

DUREZOL ....................................................................................... 47

DURICEF .......................................................................................... 5

dutasteride ...................................................................................... 71

dutasteride & tamsulosin .............................................................. 71

DYAZIDE ........................................................................................ 44



DYMISTA ........................................................................................ 49

DYNACIN .......................................................................................... 6

DYNACIRC ..................................................................................... 23

DYNAPEN ......................................................................................... 5

dyphylline ........................................................................................ 85

DYRENIUM ..................................................................................... 44

E

E.E.S.................................................................................................. 6

E.S.P .................................................................................................. 5

econazole nitrate ............................................................................ 78

ecothiophate ................................................................................... 50

EDARBI ........................................................................................... 25

EDECRIN ........................................................................................ 44

EDLUAR .......................................................................................... 38

edoxaban ........................................................................................ 20

EDURANT ....................................................................................... 12

efavirenz 400 mg, lamivudine & tenofvir ..................................... 10

efavirenz 600 mg ........................................................................... 10

efavirenz 600 mg, lamivudine & tenofvir ..................................... 10

efavirenz, emtricitabine & tenofovir ............................................. 10

EFFEXOR ....................................................................................... 42

EFFEXOR XR................................................................................. 42

EFFIENT ......................................................................................... 20

efinaconazole ................................................................................... 7

EFUDEX .......................................................................................... 84

elagolix ............................................................................................ 71

ELAVIL ............................................................................................ 39

Elaxacaftor, tezacaftor & ivacaftor ............................................... 75

elbasvir & grazoprevir .................................................................... 10

ELDEPRYL ..................................................................................... 37

ELESTAT ........................................................................................ 49

ELESTRIN GEL ............................................................................. 66

eletriptan ......................................................................................... 36

ELIDEL ............................................................................................ 84

eliglustat .......................................................................................... 71

ELIMITE .......................................................................................... 79

ELIPHOS ......................................................................................... 44

ELIQUIS .......................................................................................... 20

ELLA ................................................................................................ 61

ELMIRON ........................................................................................ 73

ELOCON ......................................................................................... 81

eltrombopag .................................................................................... 21

eluxadoline ...................................................................................... 52

elvitegravir, cobicistat, emtricitabine, & tenofovir ...................... 10

EMADINE ........................................................................................ 49

EMBEDA ......................................................................................... 31

EMCYT ............................................................................................ 14

emedastine ..................................................................................... 49

EMEND ........................................................................................... 52

EMFLAZA........................................................................................ 70

EMGALITY ...................................................................................... 71

emicizumab-kxwh .......................................................................... 71

EMLA ............................................................................................... 82

empagliflozin .................................................................................. 62

empagliflozin & lingaliptin ............................................................. 62

empagliflozin & metformin ............................................................ 62

EMSAM ........................................................................................... 37

emtricitabine ............................................................................... 9, 10

emtricitabine & tenofovir ........................................................... 9, 10

emtricitabine, rilpivirine, & tenofovir ............................................ 10

EMTRIVA ........................................................................................ 10

ENABLEX ....................................................................................... 84

enalapril .................................................................................... 25, 26

enalapril & hydrochlorothiazide ................................................... 26

enasidenib ...................................................................................... 14

ENBREL .......................................................................................... 71

encorafenib ..................................................................................... 14

ENDARI........................................................................................... 72

enfuvirtide ....................................................................................... 10

ENJUVIA ......................................................................................... 67

enoxaparin ...................................................................................... 20

entacapone ..................................................................................... 36

entecavir ......................................................................................... 10

ENTOCORT EC ............................................................................. 55

entrectinib ....................................................................................... 14

ENTRESTO .................................................................................... 24

ENULOSE ....................................................................................... 43

enzalutamide .................................................................................. 14

EPANOVA ...................................................................................... 22

EPCLUSA ....................................................................................... 12

EPIDIOLEX ..................................................................................... 38

EPIDUO .......................................................................................... 83

epinastine (ophth) .......................................................................... 49

epinephrine ..................................................................................... 19

EPIPEN ........................................................................................... 19

EPIPEN JR ..................................................................................... 19

EPIVIR ............................................................................................ 11

EPIVIR HBV ................................................................................... 11

eplerenone ...................................................................................... 26

epoetin alfa ..................................................................................... 21

EPOGEN......................................................................................... 21

eprosartan....................................................................................... 26

eprosartan & hydrochlorothiazide................................................ 26

EPZICOM ......................................................................................... 8

EQUETRO ...................................................................................... 34

erenumab-aooe.............................................................................. 71

ergocalciferol .................................................................................. 85

ergoloid mesylates......................................................................... 18

ergotamine & caffeine ............................................................. 19, 35

erlotinib ............................................................................................ 14

ERTACZO ....................................................................................... 79

ertufliglozin ..................................................................................... 62

ertugliflozin & metformin ............................................................... 62

ertugliflozin & sitagliptin ................................................................ 62

ERYGEL ......................................................................................... 78

ERYPED ........................................................................................... 6



ERY-TAB ........................................................................................... 6

ERYTHROCIN .................................................................................. 6

ERYTHROMYCIN ............................................................................ 5

erythromycin & sulfisoxazole .......................................................... 5

erythromycin (acne acid)............................................................... 78

erythromycin (ophth)...................................................................... 46

erythromycin base ....................................................................... 5, 6

erythromycin base delayed-release .............................................. 6

erythromycin ethylsuccinate ........................................................... 6

erythromycin sterate ........................................................................ 6

ESBRIET ......................................................................................... 76

escitalopram ................................................................................... 40

eslicarbazepine .............................................................................. 34

esomeprazole ................................................................................. 53

estazolam ........................................................................................ 37

esterified estrogens ....................................................................... 66

ESTRACE ................................................................................. 66, 67

ESTRACE CREAM ........................................................................ 67

ESTRACE TAB .............................................................................. 66

ESTRADERM ................................................................................. 67

estradiol ................................................. 57, 58, 59, 60, 61, 66, 67, 68

estradiol & levonorgestrel ............................................................. 66

estradiol & norethindrone .............................................................. 66

estradiol & norgestimate ............................................................... 66

estradiol acetate ............................................................................. 66

estradiol acetate vaginal tablets .................................................. 66

estradiol and progesterone ........................................................... 68

estradiol cypionate ......................................................................... 57

estradiol gel .................................................................................... 66

estradiol transdermal ............................................................... 66, 67

estradiol transderomal ................................................................... 67

estradiol vaginal ............................................................................. 67

estradiol valerate ............................................................................ 57

estradiol valerate & dienogest ...................................................... 57

estramustine ................................................................................... 14

ESTRATEST .................................................................................. 67

ESTRING ........................................................................................ 67

estrogen, ester/me-testosterone .................................................. 67

estrogens, conjugated ................................................................... 67

estrogens, conjugated synthetic a ............................................... 67

estrogens, conjugated synthetic b ............................................... 67

estrogens, conjugated vaginal ..................................................... 67

estropipate ...................................................................................... 67

ESTROSTEP FE ............................................................................ 60

eszopiclone ..................................................................................... 37

etanercept ....................................................................................... 71

ethacrynic acid ............................................................................... 44

ethambutol ........................................................................................ 7

ethionamide ...................................................................................... 7

ethontoin ......................................................................................... 34

ethosuximide .................................................................................. 34

ethynodiol diacetate & ethinyl estradiol ...................................... 58

etidronate ........................................................................................ 71

etodolac ........................................................................................... 30

etonogestrel & ethinyl estradiol ................................................... 58

etravirine ......................................................................................... 10

EUCRISA ........................................................................................ 80

EULEXIN......................................................................................... 14

EURAX ............................................................................................ 78

EVAMIST ........................................................................................ 67

EVEKEO ......................................................................................... 32

everolimus ................................................................................ 14, 71

EVISTA ........................................................................................... 67

EVOCLIN ........................................................................................ 77

evolocumab .................................................................................... 21

EVOTAZ ............................................................................................ 9

EVOXAC ......................................................................................... 17

EXALGO ......................................................................................... 31

EXELDERM .................................................................................... 79

EXELON ......................................................................................... 18

exemestane .................................................................................... 14

exenatide ........................................................................................ 62

exenatide extended-release ......................................................... 62

EXFORGE ...................................................................................... 23

EXFORGE HCT ............................................................................. 23

EXJADE .......................................................................................... 55

EXTAVIA ......................................................................................... 72

ezetimibe......................................................................................... 22

ezetimibe & simvastatin ................................................................ 22

ezogaine ......................................................................................... 34

F

FABIOR ........................................................................................... 84

famciclovir ....................................................................................... 10

famotidine ....................................................................................... 53

FAMVIR........................................................................................... 10

FANAPT .......................................................................................... 40

FARESTON .................................................................................... 16

FARXIGA ........................................................................................ 62

FAZACLO ....................................................................................... 40

febuxostat ....................................................................................... 71

felbamate ........................................................................................ 34

FELBATOL ..................................................................................... 34

FELDENE ....................................................................................... 32

felodipine......................................................................................... 23

FEMARA ......................................................................................... 15

FEMCON FE .................................................................................. 60

FEMHRT ......................................................................................... 67

FEMRING ....................................................................................... 66

FEMTRACE .................................................................................... 66

fenofibrate ....................................................................................... 22

fenofibrate, micronized ................................................................. 22

fenofibric acid ................................................................................. 22

fenoprofen calcium ........................................................................ 30

fentanyl film .................................................................................... 30

fentanyl intranasal ......................................................................... 30

fentanyl lozenge ............................................................................. 30



fentanyl sublingual ......................................................................... 30

fentanyl tablet ................................................................................. 30

fentanyl transdermal ...................................................................... 30

FENTORA ....................................................................................... 30

FERRIPROX ................................................................................... 55

fesoterodine .................................................................................... 85

FETZIMA ......................................................................................... 40

FIASP .............................................................................................. 63

FIASP FLEXPEN ........................................................................... 63

fidaxomicin ........................................................................................ 6

filgrastim .......................................................................................... 21

FINACEA ......................................................................................... 83

fingolimod ........................................................................................ 71

FIORICET ....................................................................................... 29

FIORICET W/ CODEINE .............................................................. 29

FIORINAL.................................................................................. 29, 30

FIORINAL W/ CODEINE............................................................... 30

FIRAZYR ......................................................................................... 71

FIRDAPSE ...................................................................................... 69

FLAGYL ............................................................................................. 8

FLAGYL ER ...................................................................................... 8

FLAREX .......................................................................................... 47

flavoxate .......................................................................................... 85

FLAVOXATE .................................................................................. 85

flecainide ......................................................................................... 24

FLECTOR ....................................................................................... 83

FLEXERIL ....................................................................................... 18

FLOMAX.......................................................................................... 19

FLORINEF ACETATE ................................................................... 55

FLOVENT DISKUS AER............................................................... 76

FLOVENT HFA............................................................................... 76

FLOXIN ........................................................................................... 46

fluconazole ........................................................................................ 7

flucytosine ......................................................................................... 7

fludrocortisone ................................................................................ 55

FLUMADINE ................................................................................... 12

fluocinolone acetonide ............................................................ 47, 80

fluocinolone acetonide (otic) ......................................................... 47

fluocinonide ............................................................................... 80, 81

fluocinonide emollient .................................................................... 81

FLUORABON BASIC .................................................................... 74

FLUORITAB .................................................................................... 74

fluorometholone (ophth oint) ........................................................ 47

fluorometholone (ophth) ................................................................ 47

fluorometholone acetate ............................................................... 47

FLUOROPLEX ............................................................................... 84

fluorouracil (topical) ....................................................................... 84

fluoxetine ................................................................................... 40, 41

fluoxymesterone ............................................................................. 56

fluphenazine ................................................................................... 40

flurandrenolide ................................................................................ 81

flurazepam ...................................................................................... 37

flurbiprofen ................................................................................ 30, 47

flurbiprofen (ophth) ........................................................................ 47

flutamide ......................................................................................... 14

fluticasone & salmeterol................................................................ 76

fluticasone & salmeterol (100/50 mcg) ....................................... 76

fluticasone & salmeterol (250/50 mcg and 500/50 mcg) .......... 76

fluticasone & umeclidinium & vilanterol ...................................... 76

fluticasone & vilanterol .................................................................. 76

fluticasone propionate ............................................................. 76, 81

fluticasone propionate (topical) .................................................... 81

fluvastatin ........................................................................................ 22

fluvastatin extended-release ........................................................ 22

fluvoxamine .................................................................................... 40

FML.................................................................................................. 47

FML FORTE ................................................................................... 47

FML OINT ....................................................................................... 47

FOCALIN ........................................................................................ 33

FOCALIN XR .................................................................................. 33

fondaparinux ................................................................................... 20

FORADIL ........................................................................................ 19

formoterol fumarate ....................................................................... 19

FORTAMET .................................................................................... 64

FORTEO ......................................................................................... 68

FORTESTA .................................................................................... 56

FORTICAL ...................................................................................... 68

FOSAMAX ...................................................................................... 69

FOSAMAX PLUS D ....................................................................... 69

fosamprenavir calcium .................................................................. 11

fosfomycin ....................................................................................... 13

fosinopril .......................................................................................... 26

fosinopril & hydrochlorothiazide................................................... 26

FOSRENOL .................................................................................... 44

fostamatinib .................................................................................... 71

FRAGMIN ....................................................................................... 20

FREESTYLE SYSTEM ................................................................. 42

FREESTYLE TEST STRIPS ........................................................ 42

FROVA ............................................................................................ 36

frovatriptan ...................................................................................... 36

FULPHILA ....................................................................................... 21

FURADANTIN ................................................................................ 13

furosemide ...................................................................................... 44

FUZEON ......................................................................................... 10

FYCOMPA ...................................................................................... 35

G

gabapentin ................................................................................ 34, 35

GABITRIL ....................................................................................... 35

GALAFOLD .................................................................................... 73

galantamine hydrobromide ..................................................... 17, 18

galantamine hydrobromide ER .................................................... 18

galcanezumab ................................................................................ 71

ganciclovir ................................................................................. 11, 46

ganciclovir (ophth) ......................................................................... 46

GARAMYCIN.............................................................................. 6, 78

GASTROCROM ............................................................................. 75



gatifloxacin (ophth) ........................................................................ 46

GATTEX .......................................................................................... 55

GAVILYTE-C .................................................................................. 54

GEL-KAM ........................................................................................ 74

gemfibrozil ....................................................................................... 22

GENERESS FE .............................................................................. 60

GENTAK.......................................................................................... 46

gentamicin & prednisolone ........................................................... 47

gentamicin (ophth) ......................................................................... 46

gentamicin sulfate ...................................................................... 6, 78

gentamicin sulfate (topical) ........................................................... 78

GENTROPIN .................................................................................. 68

GENVOYA ...................................................................................... 10

GEODON ........................................................................................ 42

GIANVI ............................................................................................ 57

GIAZO ............................................................................................. 52

GILENYA ......................................................................................... 71

gilteritinib ......................................................................................... 14

glasdegib ......................................................................................... 14

glatiramer acetate .......................................................................... 71

GLATOPA ....................................................................................... 71

glecaprevir & pibrentasvir ............................................................. 11

GLEEVEC ....................................................................................... 14

GLEOSTINE ................................................................................... 15

glimepiride ................................................................................. 62, 65

glipizide ........................................................................................... 62

glipizide & metformin ..................................................................... 62

glipizide extended-release ............................................................ 62

GLUCAGEN HYPOKIT ................................................................. 62

glucagon .......................................................................................... 62

GLUCAGON EMERGENCY KIT ................................................. 62

GLUCOPHAGE ........................................................................ 64, 65

GLUCOPHAGE XR ....................................................................... 65

GLUCOTROL ................................................................................. 62

GLUCOTROL XL ........................................................................... 62

GLUCOVANCE .............................................................................. 63

GLUMETZA .................................................................................... 65

glyburide .................................................................................... 62, 63

glyburide & metformin ................................................................... 63

glyburide micronized...................................................................... 63

glycerol phenylbutyrate ................................................................. 43

glycopyrrolate ........................................................................... 16, 76

glycopyrrolate & indacaterol ......................................................... 76

glycopyrrolate inhalation pow ....................................................... 16

glycopyrrolate nebulizer soln ........................................................ 16

GLYNASE ....................................................................................... 63

GLYSET .......................................................................................... 65

GLYXAMBI ...................................................................................... 62

GOCOVRI ....................................................................................... 36

golimumab ...................................................................................... 71

GOLYTELY ..................................................................................... 54

granisetron ...................................................................................... 52

grass pollen allergen extract (5 glass extract) ........................... 49

GRASTEK ....................................................................................... 50

GRIFULVIN V ................................................................................... 7

griseofulvin microsize ...................................................................... 7

griseofulvin ultramicrosize .............................................................. 7

GRIS-PEG ........................................................................................ 7

guaifenesin & codeine ................................................................... 75

guanfacine ................................................................................ 25, 38

guanfacine extended-release....................................................... 38

guselkumab .................................................................................... 71

GVOKE ........................................................................................... 62

GYNAZOLE-1 ................................................................................ 77

GYNODIOL ..................................................................................... 66

H

HAEGARDA ................................................................................... 70

halcinonide ..................................................................................... 81

HALCION ........................................................................................ 38

HALDOL .......................................................................................... 40

HALFLYTELY ................................................................................. 53

halobetasol propionate ................................................................. 81

HALOG ............................................................................................ 81

haloperidol ...................................................................................... 40

HARVONI ....................................................................................... 11

HECTOROL ................................................................................... 85

HELIDAC .......................................................................................... 4

HEMLIBRA ..................................................................................... 71

heparin ............................................................................................ 20

HEPARIN SODIUM ....................................................................... 20

HEPSERA ......................................................................................... 9

HETLIOZ ......................................................................................... 38

hexachlorophene ........................................................................... 78

HIPREX ........................................................................................... 13

HIZENTRA ...................................................................................... 71

homatropine ............................................................................. 51, 75

HORIZANT ..................................................................................... 35

house dust mite allergen extract ................................................. 49

HUMALOG ..................................................................................... 64

HUMALOG KWIKPEN .................................................................. 64

HUMALOG MIX 50/50 .................................................................. 64

HUMALOG MIX 75/25 .................................................................. 64

HUMALOG MIX 75/25 KWIKPEN ............................................... 64

HUMATIN ......................................................................................... 8

HUMATROPE ................................................................................ 68

HUMIRA .......................................................................................... 69

HUMIRA citrate free ...................................................................... 69

HUMULIN 50/50 ............................................................................ 64

HUMULIN 70/30 ............................................................................ 64

HUMULIN 70/30 KIWKPEN ......................................................... 64

HUMULIN N ............................................................................. 63, 64

HUMULIN N KWIKPEN ................................................................ 64

HUMULIN R ................................................................................... 64

HUMULIN R U-500 ........................................................................ 64

HUMULIN R U-500 KWIKPEN .................................................... 64

HYCAMTIN ..................................................................................... 16



HYCODAN ...................................................................................... 75

HYDERGINE .................................................................................. 18

hydralazine................................................................................ 25, 27

HYDREA ......................................................................................... 14

hydrochlorothiazide.................................... 25, 26, 27, 28, 29, 43, 44

hydrocodone ....................................................................... 30, 31, 75

hydrocodone & acetaminophen ................................................... 30

hydrocodone & chlorpheniramine ................................................ 75

hydrocodone & homatropine ........................................................ 75

hydrocodone & ibuprofen .............................................................. 31

hydrocodone er .............................................................................. 30

hydrocortisone ...................................... 47, 48, 55, 78, 79, 80, 81, 82

hydrocortisone & acetic acid (otic) .............................................. 48

hydrocortisone & pramoxine ......................................................... 82

hydrocortisone (intrarectal) ........................................................... 81

hydrocortisone (rectal) .................................................................. 81

hydrocortisone (topical) ................................................................. 81

hydrocortisone acetate & urea ..................................................... 81

hydrocortisone acetate (intrarectal) ............................................. 81

hydrocortisone butyrate ................................................................ 81

hydrocortisone butyrate hydrophilic lipo base ............................ 81

hydrocortisone probutate .............................................................. 81

hydrocortisone valerate ................................................................. 81

hydromorphone oral suspension ................................................. 31

hydromorphone tablet ................................................................... 31

hydroxychloroquine sulfate ............................................................. 8

hydroxyurea .................................................................................... 14

hydroxyzine hcl............................................................................... 37

hydroxyzine pamoate .................................................................... 37

HYGROTON ................................................................................... 43

hyoscyamine sulfate ................................................................ 16, 17

HYPERCARE ................................................................................. 82

HYPERSAL ..................................................................................... 77

HYQVIA ........................................................................................... 71

HYSINGLA ER ............................................................................... 30

HYTONE ......................................................................................... 81

HYTRIN ........................................................................................... 21

HYZAAR .......................................................................................... 26

I

ibandronate ..................................................................................... 71

IBRANCE ........................................................................................ 15

ibrutinib ............................................................................................ 14

Ibrutinib 140 mg, 280 mg .............................................................. 14

ibuprofen ................................................................................... 31, 32

icatibant ........................................................................................... 71

ICLUSIG .......................................................................................... 15

icosapent ......................................................................................... 22

idelalisib ........................................................................................... 14

IDHIFA ............................................................................................. 14

ILARIS ............................................................................................. 70

iloperidone ...................................................................................... 40

ILUMYA ........................................................................................... 74

imatinib mesylate ........................................................................... 14

IMBRUVICA ................................................................................... 14

IMDUR ............................................................................................ 27

imipramine ...................................................................................... 40

imipramine pamoate ...................................................................... 40

imiquimod ....................................................................................... 84

IMITREX ......................................................................................... 36

immune globulin ............................................................................. 71

Immune globulin ............................................................................ 71

IMPAVIDO ........................................................................................ 8

IMURAN .......................................................................................... 70

INBRIJA .......................................................................................... 37

INCIVEK .......................................................................................... 12

INCRUSE ELLIPTA ....................................................................... 17

indacaterol ...................................................................................... 76

indapamide ..................................................................................... 44

INDERAL ........................................................................................ 29

INDERAL LA .................................................................................. 29

INDERIDE ....................................................................................... 29

indinavir sulfate .............................................................................. 11

INDOCIN ......................................................................................... 31

indomethacin .................................................................................. 31

INFERGEN ..................................................................................... 11

INFLAMASE FORTE ..................................................................... 48

ingenol mebutate ........................................................................... 84

INGREZZA ..................................................................................... 39

INLYTA ............................................................................................ 13

INNOPRAN XL ............................................................................... 29

inotersen ......................................................................................... 72

Inotersen ......................................................................................... 72

INSPRA ........................................................................................... 26

insulin (oral inhalation) .................................................................. 63

insulin aspart .................................................................................. 63

insulin aspart protamine & insulin aspart ................................... 63

insulin degludec ............................................................................. 63

Insulin degludec/ liraglutide .......................................................... 63

insulin degludec/insulin aspart ..................................................... 63

Insulin delivery system .................................................................. 43

insulin detemir ................................................................................ 63

insulin glargine ............................................................................... 63

Insulin glargine/ lixisenatide ......................................................... 63

insulin glulisine ............................................................................... 63

insulin isophane ....................................................................... 63, 64

insulin isophane & regular insulin ................................................ 64

insulin lispro .................................................................................... 64

insulin lispro protamine & insulin lispro....................................... 64

insulin regular ................................................................................. 64

INTAL .............................................................................................. 75

INTELENCE ................................................................................... 10

interferon alfacon-1 ....................................................................... 11

interferon beta-1a .......................................................................... 72

interferon beta-1b .......................................................................... 72

Interferon beta-1b .......................................................................... 72

interferon gamma-1b ..................................................................... 72



INTROVALE ................................................................................... 58

INTUNIV .......................................................................................... 38

INVEGA ........................................................................................... 41

INVIRASE ....................................................................................... 12

INVOKAMET .................................................................................. 61

INVOKANA ..................................................................................... 61

iodoquinol & hydrocortisone ......................................................... 78

IOPIDINE ........................................................................................ 51

ipratropium bromide ....................................................................... 17

irbesartan ........................................................................................ 26

irbesartan & hydrochlorothiazide ................................................. 26

isavuconazonium ............................................................................. 7

ISENTRESS ................................................................................... 12

ISENTRESS HD ............................................................................. 12

isocarboxazid .................................................................................. 40

isoniazid ............................................................................................ 7

ISOPTIN SR ................................................................................... 24

ISOPTO ATROPINE...................................................................... 51

ISOPTO CARBACHOL ................................................................. 50

ISOPTO CARPINE ........................................................................ 51

ISOPTO HOMATROPINE ............................................................ 51

ISOPTO HYOSCINE ..................................................................... 51

ISORDIL .......................................................................................... 27

isosorbide dinitrate ......................................................................... 27

isosorbide dinitrate & hydralazine ................................................ 27

isosorbide mononitrate .................................................................. 27

isotretinoin ....................................................................................... 84

isradipine ......................................................................................... 23

ISTALOL.......................................................................................... 51

itraconazole ...................................................................................... 7

Ivabradine ....................................................................................... 24

ivacaftor ..................................................................................... 76, 77

ivermectin .......................................................................................... 4

ivermectin (topical) ........................................................................... 4

ivosidenib ........................................................................................ 14

ixazomib .......................................................................................... 14

ixekizumab ...................................................................................... 72

J

JAKAFI ............................................................................................ 15

JALYN ............................................................................................. 71

JANUMET ....................................................................................... 65

JANUVIA ......................................................................................... 65

JARDIANCE 25 MG ...................................................................... 62

JENTADUETO ............................................................................... 64

JUBLIA .............................................................................................. 7

JULUCA ............................................................................................ 9

JUNEL ....................................................................................... 59, 60

JUNEL FE ....................................................................................... 60

JUVISYNC ...................................................................................... 65

JUXTAPID ....................................................................................... 22

JYNARQUE .................................................................................... 44

K

KADIAN ........................................................................................... 31

KALETRA ....................................................................................... 11

KALYDECO .................................................................................... 76

KAON .............................................................................................. 45

KAPVAY .......................................................................................... 24

KARIVA ........................................................................................... 57

KAZANO ......................................................................................... 61

K-DUR ............................................................................................. 45

KEFLEX ............................................................................................ 5

KELNOR ......................................................................................... 58

KENALOG ...................................................................................... 82

KEPPRA ......................................................................................... 35

KEPPRA XR ................................................................................... 35

KERLONE ....................................................................................... 28

KERYDIN .......................................................................................... 7

KETEK .............................................................................................. 6

ketoconazole .............................................................................. 7, 78

ketoconazole (topical) ................................................................... 78

ketoprofen ....................................................................................... 31

KETOPROFEN .............................................................................. 31

ketorolac (ophth) ............................................................................ 48

ketorolac tablet ............................................................................... 31

KEVEYIS......................................................................................... 70

KEVZARA ....................................................................................... 74

KHEDEZLA ..................................................................................... 40

KINERET ........................................................................................ 69

KLARON ......................................................................................... 79

KLONOPIN ..................................................................................... 34

KLOR-CON 20 MEQ ..................................................................... 45

K-LYTE/CL ..................................................................................... 45

KOMBIGLYZE XR ......................................................................... 65

KORLYM ......................................................................................... 65

KOSELUGO ................................................................................... 16

K-PHOS NEUTRAL ....................................................................... 45

K-PHOS ORIGINAL ...................................................................... 45

KRISTALOSE ................................................................................. 43

K-TAB 10, KLOR-CON 20 MEQ ................................................. 45

KUVAN ............................................................................................ 74

KWELL ............................................................................................ 78

KYNAMRO ..................................................................................... 22

KYTRIL ............................................................................................ 52

L

labetalol ........................................................................................... 28

LAC-HYDRIN ................................................................................. 83

lacosamide ..................................................................................... 35

LACRISERT ................................................................................... 51

lactic acid (ammonium lactate) .................................................... 84

LACTINOL ...................................................................................... 84

lactulose .......................................................................................... 43

LAMICTAL ...................................................................................... 35



LAMICTAL XR ................................................................................ 35

LAMISIL ............................................................................................. 7

lamivudine ......................................................................... 8, 9, 10, 11

Lamivudine & tenofovir .................................................................. 11

lamivudine & zidovudine ........................................................... 9, 11

lamotrigine ...................................................................................... 35

lamotrigine extended-release ....................................................... 35

lanadelumab ................................................................................... 72

LANOXIN ........................................................................................ 24

lanreotide ........................................................................................ 72

lansoprazole ................................................................................... 53

lanthanum carbonate ..................................................................... 44

LANTUS .......................................................................................... 63

LANTUS SOLOSTAR .................................................................... 63

lapatinib ........................................................................................... 14

LARIAM ............................................................................................. 8

larotrectinib ..................................................................................... 14

LASIX............................................................................................... 44

lasmitidan ........................................................................................ 36

LASTACAFT ................................................................................... 49

latanoprost ...................................................................................... 50

latanoprostene bunod.................................................................... 50

LATUDA .......................................................................................... 41

LAZANDA........................................................................................ 30

ledipasvir & sofosbuvir .................................................................. 11

lefamulin ............................................................................................ 6

leflunomide...................................................................................... 72

lenalidomide .................................................................................... 15

lenvatinib ......................................................................................... 15

LENVIMA ........................................................................................ 15

LESCOL .......................................................................................... 22

LESCOL XL .................................................................................... 22

lesinurad .......................................................................................... 72

LESSINA ......................................................................................... 58

LETAIRIS ........................................................................................ 27

letermovir ........................................................................................ 11

letrozole ........................................................................................... 15

leucovorin ........................................................................................ 72

LEUCOVORIN ................................................................................ 72

LEUKERAN .................................................................................... 13

LEUKINE ......................................................................................... 21

leuprolide acetate ........................................................................... 15

levalbuterol nebulizer solution ...................................................... 19

levalbuterol tartrate ........................................................................ 19

LEVAQUIN ........................................................................................ 6

LEVATOL ........................................................................................ 28

LEVBID ............................................................................................ 16

LEVEMIR ........................................................................................ 63

levetiracetam .................................................................................. 35

levetiracetam extended-release ................................................... 35

levobunolol ...................................................................................... 50

LEVO-DROMORAN ...................................................................... 31

levofloxacin ................................................................................. 6, 46

levofloxacin (ophth)........................................................................ 46

levomilnacipran .............................................................................. 40

levonorgestrel ........................................................................... 58, 66

levonorgestrel & ethinyl estradiol ................................................ 58

levonorgestrel & ethinyl estradiol (91-day) ................................. 58

levonorgestrel & ethinyl estradiol (continuous).......................... 58

levonorgestrel & ethinyl estradiol (triphasic) .............................. 58

levophed (oral inhalation) ............................................................. 37

levorphanol ..................................................................................... 31

LEVOTHROID ................................................................................ 69

levothyroxine .................................................................................. 69

LEVOXYL ....................................................................................... 69

LEVSIN ........................................................................................... 16

LEXAPRO ....................................................................................... 40

LEXIVA ............................................................................................ 11

l-glutamine ...................................................................................... 72

LIALDA ............................................................................................ 52

LIBRAX ........................................................................................... 54

LIBRIUM ......................................................................................... 37

LIDAMANTLE ................................................................................. 82

LIDEX ........................................................................................ 80, 81

LIDEX-E .......................................................................................... 81

lidocaine .................................................................................... 51, 82

lidocaine & hydrocortisone ........................................................... 82

lidocaine & prilocaine .................................................................... 82

lidocaine & tetracaine .................................................................... 82

lidocaine (jelly, topical) .................................................................. 82

lidocaine (mouth-throat) ................................................................ 51

LIDODERM ..................................................................................... 82

lifitegrast .......................................................................................... 48

LIMBITROL DS .............................................................................. 40

linaclotide ........................................................................................ 54

linagliptin ......................................................................................... 64

linagliptin & metformin ................................................................... 64

lindane ............................................................................................. 78

linezolid ............................................................................................. 6

LINZESS ......................................................................................... 54

LIORESAL ...................................................................................... 18

liothyronine ..................................................................................... 69

liotrix ................................................................................................ 69

LIPITOR .......................................................................................... 21

liraglutide................................................................................... 63, 64

lisdexamfetamine ........................................................................... 33

lisinopril ........................................................................................... 26

lisinopril & hydrochlorothiazide .................................................... 26

LITHIUM CARBONATE ................................................................ 40

lithium carbonate capsule ............................................................. 40

lithium carbonate extended release ............................................ 40

lithium citrate .................................................................................. 41

LITHOBID ....................................................................................... 40

LIVALO ............................................................................................ 22

lixisenatide ................................................................................ 63, 64

LO LOESTRIN FE ......................................................................... 60

LO/OVRAL-28 ................................................................................ 61

LOCOID .......................................................................................... 81



LOCOID LIPOCREAM .................................................................. 81

LODINE ........................................................................................... 30

LODOSYN ...................................................................................... 36

lodoxamide tromethamine ............................................................ 49

LOESTRIN 24 FE .......................................................................... 60

LOESTRIN FE ................................................................................ 60

lofexidine ......................................................................................... 38

LOFIBRA CAP ................................................................................ 22

LOFIBRA TAB ................................................................................ 22

LOKELMA ....................................................................................... 44

lomitapide ........................................................................................ 22

LOMOTIL ........................................................................................ 52

lomustine ......................................................................................... 15

LONHALA MAGNAIR .................................................................... 16

LONITEN ......................................................................................... 25

LONSURF ....................................................................................... 16

LOPID .............................................................................................. 22

lopinavir & ritonavir ........................................................................ 11

LOPRESSOR ................................................................................. 28

LOPRESSOR HCT ........................................................................ 28

LOPROX ......................................................................................... 77

lorazepam ....................................................................................... 37

LORBRENA .................................................................................... 15

lorlatinib ........................................................................................... 15

losartan ............................................................................................ 26

losartan & hydrochlorothiazide ..................................................... 26

LOSEASONIQUE .......................................................................... 58

LOTEMAX ....................................................................................... 48

LOTENSIN ...................................................................................... 25

LOTENSIN HCT ............................................................................. 25

loteprednol ...................................................................................... 48

loteprednol & tobramycin .............................................................. 48

LOTREL .......................................................................................... 22

LOTRISONE ................................................................................... 78

LOTRONEX .................................................................................... 52

lovastatin ......................................................................................... 22

lovastatine extended-release ....................................................... 22

LOVAZA .......................................................................................... 22

LOVENOX ....................................................................................... 20

LOW-OGESTREL .......................................................................... 61

loxapine ........................................................................................... 41

LOXITANE ...................................................................................... 41

LOZOL ............................................................................................. 44

lubiprostone .................................................................................... 54

LUCEMYRA .................................................................................... 38

LUDIOMIL ....................................................................................... 41

LUFYLLIN ....................................................................................... 85

luliconazole ....................................................................................... 7

lumacaftor& ivacaftor ..................................................................... 76

LUMIGAN ........................................................................................ 50

LUNESTA........................................................................................ 37

LUPRON ......................................................................................... 15

lurasidone........................................................................................ 41

LURIDE CHEW .............................................................................. 74

LURIDE DROPS ............................................................................ 74

LUTERA .......................................................................................... 58

LUVOX ............................................................................................ 40

LUXIQ .............................................................................................. 80

LUZU ................................................................................................. 7

LYPREL .......................................................................................... 58

LYRICA ........................................................................................... 35

LYSODREN .................................................................................... 15

LYSTEDA ....................................................................................... 20

M

macitentan ...................................................................................... 27

MACROBID .................................................................................... 13

MACRODANTIN ............................................................................ 13

mafenide acetate ........................................................................... 78

MALARONE ..................................................................................... 8

malathion ........................................................................................ 78

maprotiline ...................................................................................... 41

maraviroc ........................................................................................ 11

MARINOL ....................................................................................... 52

MARPLAN ...................................................................................... 40

MATULANE .................................................................................... 15

MAVIK ............................................................................................. 27

MAVYRET ...................................................................................... 11

MAXAIR AUTOHALER ................................................................. 20

MAXALT .......................................................................................... 36

MAXALT MLT ................................................................................. 36

MAXIDEX ........................................................................................ 47

MAXITROL ..................................................................................... 48

MAXZIDE ........................................................................................ 44

mechlorethamine ........................................................................... 15

meclofenamate .............................................................................. 31

MECLOMEN ................................................................................... 31

MEDROL......................................................................................... 56

medroxyprogesterone acetate ............................................... 66, 68

mefenamic acid .............................................................................. 31

mefloquine ........................................................................................ 8

MEGACE ........................................................................................ 68

megestrol acetate .......................................................................... 68

MEKTOVI ........................................................................................ 13

MELLARIL ...................................................................................... 41

meloxicam ....................................................................................... 31

melphalan ....................................................................................... 15

memantine ...................................................................................... 38

memantine er & donepezil ............................................................ 38

M-END MAX D ............................................................................... 75

MENEST ......................................................................................... 66

MENOSTAR ................................................................................... 67

MENTAX ......................................................................................... 77

mepenzolate ................................................................................... 55

meperidine tablet ........................................................................... 31

MEPHYTON ................................................................................... 85

mepolizumab .................................................................................. 76



meprobamate ................................................................................. 38

MEPRON .......................................................................................... 8

mercaptopurine .............................................................................. 15

mesalamine controlled-release .................................................... 52

mesalamine suppository ............................................................... 52

mesalamine suspension ............................................................... 52

mesalamine tablet .......................................................................... 52

mesna .............................................................................................. 72

MESNEX ......................................................................................... 72

MESTION ........................................................................................ 18

MESTION TIMESPAN .................................................................. 18

METADATE CD ............................................................................. 33

METADATE ER .............................................................................. 33

METAGLIP ...................................................................................... 62

metaxalone ..................................................................................... 18

metformin ................................................................ 61, 62, 63, 64, 65

metformin ER ............................................................................ 64, 65

metformin extended-release ......................................................... 65

methadone ...................................................................................... 31

methamphetamine ......................................................................... 33

methazolamide ............................................................................... 50

methenamine hippurate ................................................................ 13

methenamine, sodium biphosphate, phenyl salicylate,

methylene blue, and hyoscyamine ................................... 13, 72

METHERGINE ............................................................................... 72

methimazole ................................................................................... 69

METHITEST ................................................................................... 56

methocarbamol............................................................................... 18

methotrexate ................................................................................... 15

methotrexate sodium ..................................................................... 15

methoxsalen ................................................................................... 84

methoxsalen, rapid ........................................................................ 84

methscopolamine ........................................................................... 17

methsuximide ................................................................................. 35

methyclothiazide ............................................................................ 44

METHYCLOTHIAZIDE .................................................................. 44

methyldopa ..................................................................................... 25

methyldopa & hydrochlorothiazide .............................................. 25

methylergonovine maleate ........................................................... 72

METHYLIN ...................................................................................... 33

methylnaltrexone ............................................................................ 55

methylphenidate ....................................................................... 33, 34

methylphenidate extended-release ............................................. 33

Methylphenidate extended-release disintegrating tablet .......... 34

methylphenidate sustained release ............................................. 34

methylphenidate transdermal patch ............................................ 34

methylprednisolone........................................................................ 56

methyltestosterone ........................................................................ 56

metipranolol .................................................................................... 50

metoclopramide .............................................................................. 55

metolazone ..................................................................................... 44

metoprolol & hydrochlorothiazide ................................................ 28

metoprolol succinate...................................................................... 28

metoprolol tartrate .......................................................................... 28

metreleptin ...................................................................................... 72

METROCREAM ............................................................................. 78

METROGEL ................................................................................... 78

METROGEL-VAGINAL ................................................................. 78

METROLOTION ............................................................................ 78

metronidazole ......................................................................... 4, 8, 78

metronidazole (topical) ................................................................. 78

metronidazole (vaginal) ................................................................ 78

metronidazole extended-release ................................................... 8

metronidazole, tetracycline & bismuth subsalicylate .................. 4

MEVACOR ..................................................................................... 22

mexiletine ........................................................................................ 24

MEXITIL .......................................................................................... 24

MIACALCIN .................................................................................... 68

MICARDIS ...................................................................................... 27

MICARDIS HCT ............................................................................. 27

miconazole nitrate & zinc oxide ................................................... 78

MICROGESTIN ........................................................................ 59, 60

MICROGESTIN FE ....................................................................... 60

MICROZIDE ................................................................................... 44

MIDAMOR ...................................................................................... 43

midodrine hcl .................................................................................. 20

MIFEPREX ..................................................................................... 72

mifepristone .............................................................................. 65, 72

migalastat ....................................................................................... 73

MIGERGOT .................................................................................... 35

miglitol ............................................................................................. 65

miglustat .......................................................................................... 73

MIGRANAL ..................................................................................... 18

milnacipran ..................................................................................... 38

miltefosine......................................................................................... 8

MILTOWN ....................................................................................... 38

MINASTRIN 24 FE ........................................................................ 60

MINIPRESS .................................................................................... 21

MINIVELLE ..................................................................................... 67

MINOCIN .......................................................................................... 6

minocycline ....................................................................................... 6

minoxidil .......................................................................................... 25

mipomersen sodium ...................................................................... 22

mirabegron ..................................................................................... 85

MIRAPEX ........................................................................................ 37

MIRAPEX ER ................................................................................. 37

mirtazapine ..................................................................................... 41

MIRVASO ....................................................................................... 83

misoprostol ............................................................................... 30, 53

mitotane .......................................................................................... 15

MOBIC ............................................................................................ 31

modafinil .......................................................................................... 34

MODICON ...................................................................................... 59

MODURETIC.................................................................................. 43

moexipril .......................................................................................... 26

moexipril & hydrochlorothiazide................................................... 26

mometasone & formoterol ............................................................ 76

mometasone furoate ............................................................... 76, 81



MONODOX ....................................................................................... 5

MONONESSA ................................................................................ 61

MONOPRIL ..................................................................................... 26

MONOPRIL HCT ........................................................................... 26

montelukast .................................................................................... 75

MONUROL ...................................................................................... 13

morphine ......................................................................................... 31

morphine & naltrexone .................................................................. 31

morphine beads ............................................................................. 31

morphine extended-release capsule ........................................... 31

morphine extended-release tablet ............................................... 31

MORPHINE SULFATE .................................................................. 31

MOTOFEN ...................................................................................... 52

MOTRIN .......................................................................................... 31

MOVIPREP ..................................................................................... 53

moxifloxacin ................................................................................ 6, 46

moxifloxacin (ophth) ...................................................................... 46

MS CONTIN .................................................................................... 31

MSIR ................................................................................................ 31

MUCOMYST-10 ............................................................................. 69

MULTAQ ......................................................................................... 24

mupirocin ......................................................................................... 78

mupirocin calcium .......................................................................... 78

MYALEPT ....................................................................................... 72

MYAMBUTOL ................................................................................... 7

MYCELEX ....................................................................................... 77

MYCIFRADIN ................................................................................... 6

MYCOBUTIN .................................................................................... 8

MYCOLOG II .................................................................................. 81

mycophenolate mofetil .................................................................. 73

mycophenolate sodium ................................................................. 73

MYCOSTATIN .................................................................................. 7

MYDAYIS ........................................................................................ 33

MYFORTIC ..................................................................................... 73

MYLERAN ....................................................................................... 13

MYRBETRIQ .................................................................................. 85

MYSOLINE ..................................................................................... 35

N

na sulfacetm/avobenzone/sulfur .................................................. 78

nabilone ........................................................................................... 52

nabumetone .................................................................................... 31

nadolol ............................................................................................. 28

nadolol & bendroflumethiazide ..................................................... 28

nafarelin ........................................................................................... 68

naftifine cream ................................................................................ 78

Naftifine gel ..................................................................................... 79

NAFTIN ..................................................................................... 78, 79

nalbuphine ...................................................................................... 31

NALFON .......................................................................................... 30

naloxone .............................................................................. 29, 32, 39

naloxone nasal spray .................................................................... 39

naltrexone ................................................................................. 31, 39

NAMENDA ...................................................................................... 38

NAMZARIC ..................................................................................... 38

NAPRELAN .................................................................................... 31

NAPROSYN ................................................................................... 31

naproxen ......................................................................................... 31

naproxen sodium ........................................................................... 31

naratriptan....................................................................................... 36

NARCAN ......................................................................................... 39

NARDIL ........................................................................................... 41

NATACYN ....................................................................................... 46

natamycin ....................................................................................... 46

NATAZIA ......................................................................................... 57

nateglinide ...................................................................................... 65

NATPARA ....................................................................................... 73

NATROBA ...................................................................................... 79

NAVANE ......................................................................................... 41

nebivolol .......................................................................................... 28

NEBUPENT ...................................................................................... 8

NECON ........................................................................................... 59

NECON 10/11 ................................................................................ 59

nedocromil sodium (ophth) ........................................................... 49

nefazodone ..................................................................................... 41

nelfinavir mesylate ......................................................................... 11

neomycin sulfate .............................................................................. 6

neomycin, bacitracin & polymyxin b (ophth) .............................. 46

neomycin, colistin, hydrocortisone & thonzonium (otic) ........... 48

neomycin, polymycin b & gramicidin (ophth) ............................. 46

neomycin, polymyxin B & dexamethasone (ophth)................... 48

neomycin, polymyxin B & hydrocortisone (ophth) ............... 47, 48

neomycin, polymyxin B & hydrocortisone (otic) ........................ 48

NEO-POLYCIN ........................................................................ 46, 47

NEO-POLYCIN HC ....................................................................... 47

NEORAL ......................................................................................... 70

NEOSPORIN .................................................................................. 46

neostigmine bromide ..................................................................... 18

nepafenac ....................................................................................... 48

NEPTAZANE .................................................................................. 50

NESINA ........................................................................................... 61

netarsudil ........................................................................................ 51

netupitant & palonosetron ............................................................ 52

NEULASTA ..................................................................................... 21

NEUMEGA ..................................................................................... 21

NEUPOGEN ................................................................................... 21

NEUPRO......................................................................................... 37

NEURONTIN .................................................................................. 34

NEVANAC ...................................................................................... 48

nevirapine solution......................................................................... 11

nevirapine tablet ............................................................................ 11

NEXAVAR ....................................................................................... 16

NEXIUM .......................................................................................... 53

NEXLETOL ..................................................................................... 21

NEXLIZET ....................................................................................... 21

niacin ......................................................................................... 22, 85

niacin & lovastatin .......................................................................... 22



NIACOR .......................................................................................... 85

NIASPAN ........................................................................................ 22

nicardipine ....................................................................................... 23

NICODERM .................................................................................... 17

NICORETTE ................................................................................... 17

nicotine gum ................................................................................... 17

nicotine inhalation .......................................................................... 17

nicotine lozenge ............................................................................. 17

nicotine nasal spray ....................................................................... 17

nicotine patch ................................................................................. 17

nicotine spray ................................................................................. 17

NICOTROL ..................................................................................... 17

nifedipine ......................................................................................... 23

nifedipine extended-release ......................................................... 23

NILANDRON .................................................................................. 15

nilotinib ............................................................................................ 15

nilutamide ........................................................................................ 15

nimodipine ....................................................................................... 23

NIMOTOP ....................................................................................... 23

NINLARO ........................................................................................ 14

nintedanib........................................................................................ 76

niraparib .......................................................................................... 15

NIRAVAM ........................................................................................ 37

nisoldipine ....................................................................................... 23

nitazoxanide ...................................................................................... 8

nitisinone ......................................................................................... 73

NITRO-BID ...................................................................................... 27

NITRO-DUR .................................................................................... 27

nitrofurantoin ................................................................................... 13

nitrofurantoin macrocrystal ........................................................... 13

nitrofurantoin monohydrate ........................................................... 13

nitroglycerin (intra-anal) ................................................................ 27

nitroglycerin aerosol ...................................................................... 27

nitroglycerin solution ...................................................................... 27

nitroglycerin sublingual .................................................................. 27

nitroglycerin topical ointment ........................................................ 27

nitroglycerin transdermal patch .................................................... 27

nitroglycerin transdermal patch 0.8 mg strength ....................... 27

NITROLINGUAL ............................................................................. 27

NITROMIST .................................................................................... 27

NITROSTAT ................................................................................... 27

nizatidine ......................................................................................... 53

NIZORAL ..................................................................................... 7, 78

NOLVADEX .................................................................................... 16

NORA-BE ........................................................................................ 59

NORCO ........................................................................................... 30

NORDETTE-28 .............................................................................. 58

NORDITROPIN .............................................................................. 68

norelgestromin & ethinyl estradiol ......................................... 58, 59

norethindrone ......................................................... 59, 60, 66, 67, 68

norethindrone & ethinyl estradiol ........................................... 59, 60

norethindrone & ethinyl estradiol (biphasic) ............................... 59

norethindrone & ethinyl estradiol (triphasic) ............................... 59

norethindrone & ethinyl estradiol w/ ferrous fumarate .............. 60

norethindrone acetate ....................................................... 60, 67, 68

norethindrone acetate & ethinyl estradiol ............................. 60, 67

norethindrone acetate & ethinyl estradiol w/ ferrous fumarate 60

norethindrone acetate & ethinyl estradiol w/ ferrous fumarate

(biphasic) ................................................................................... 60

norethindrone-mestranol .............................................................. 60

NORFLEX ....................................................................................... 18

norfloxacin ........................................................................................ 6

NORGESIC .................................................................................... 18

norgestimate & ethinyl estradiol ............................................ 60, 61

norgestimate & ethinyl estradiol (triphasic) ................................ 61

norgestrel & ethinyl estradiol ........................................................ 61

NORINYL 1+35 .............................................................................. 59

NORINYL 1+50 .............................................................................. 60

NOROXIN ......................................................................................... 6

NORPACE ...................................................................................... 24

NORPACE CR ............................................................................... 24

NORPRAMIN ................................................................................. 40

NOR-QD ......................................................................................... 59

NORTHERA ................................................................................... 19

NORTREL 1/35 ............................................................................. 59

NORTREL 7/7/7 ............................................................................. 59

nortriptyline ..................................................................................... 41

NORVASC ...................................................................................... 22

NORVIR .......................................................................................... 12

NOVOLIN 70/30 ............................................................................. 64

NOVOLIN N .................................................................................... 63

NOVOLIN R .................................................................................... 64

NOVOLOG ..................................................................................... 63

NOVOLOG MIX 70/30 .................................................................. 63

NOVOLOG MIX 70/30 FLEXPEN ............................................... 63

NOXAFIL........................................................................................... 7

NUBAIN........................................................................................... 31

NUBEQA ......................................................................................... 14

NUCALA ......................................................................................... 76

NUCYNTA ...................................................................................... 32

NUEDEXTA .................................................................................... 38

NULYTELY ..................................................................................... 54

NUPLAZID ...................................................................................... 41

NURTEC ODT................................................................................ 36

NUTROPIN AQ .............................................................................. 68

NUVARING ..................................................................................... 58

NUVIGIL .......................................................................................... 33

NUZYRA ........................................................................................... 6

NYDRAZID ....................................................................................... 7

nystatin .................................................................................. 7, 79, 81

NYSTATIN ...................................................................................... 79

nystatin & triamcinolone................................................................ 81

nystatin (topical) ............................................................................. 79

O

OCELLA .......................................................................................... 57

octreotide acetate .......................................................................... 73



OCUFEN ......................................................................................... 47

OCUFLOX ....................................................................................... 46

OCUPRESS .................................................................................... 50

ODACTRA ...................................................................................... 49

ODEFSEY ....................................................................................... 10

OFEV ............................................................................................... 76

ofloxacin (ophth)............................................................................. 46

ofloxacin (otic) ................................................................................ 46

OGESTREL .................................................................................... 61

olanzapine ....................................................................................... 41

olanzapine & fluoxetine hcl ........................................................... 41

olanzapine orally disintegrating.................................................... 41

OLEPTRO ....................................................................................... 42

olmesartan ................................................................................ 23, 26

olmesartan & hydrochlorothiazide ......................................... 23, 26

olodaterol .................................................................................. 20, 77

olopatadine ............................................................................... 49, 50

olopatadine (nasal) ........................................................................ 50

olopatadine (ophth) ........................................................................ 50

olsalazine ........................................................................................ 52

OLUMIANT ..................................................................................... 70

OLUX-E ........................................................................................... 80

OLYSIO ........................................................................................... 12

omadacycline .................................................................................... 6

omalizumab .................................................................................... 76

ombitasvir, paritaprevir & ritonavir ............................................... 11

ombitasvir, paritaprevir, ritonavir, & dasabuvir........................... 11

omega-3 acid ethyl esters............................................................. 22

omega-3-carboxylic acid ............................................................... 22

omeprazole ..................................................................................... 53

OMNICEF.......................................................................................... 5

OMNIPOD DASHTM SYSTEM KIT AND PODs ......................... 43

OMNIPRED .................................................................................... 48

OMNITROPE .................................................................................. 68

ondansetron .............................................................................. 52, 53

ondansetron (orally disintegrating) .............................................. 53

ONE TOUCH ULTRA 2 ................................................................. 42

ONE TOUCH ULTRA SMART ..................................................... 42

ONE TOUCH ULTRA TEST STRIPS ......................................... 42

ONE TOUCH ULTRAMINI ............................................................ 43

ONE TOUCH VERIO FLEX .......................................................... 42

ONE TOUCH VERIO TEST STRIPS .......................................... 42

ONEXTON ...................................................................................... 77

ONFI ................................................................................................ 34

ONGLYZA ....................................................................................... 65

ONSOLIS ........................................................................................ 30

OPANA ............................................................................................ 32

OPANA ER ..................................................................................... 32

OPIUM ............................................................................................. 32

opium & belladonna alkaloids ...................................................... 32

opium tincture ................................................................................. 32

oprelvekin ........................................................................................ 21

OPSUMIT ........................................................................................ 27

OPTHETIC ...................................................................................... 51

OPTICROM .................................................................................... 49

OPTIPRANOLOL ........................................................................... 50

OPTIVAR ........................................................................................ 49

ORACEA ..................................................................................... 5, 84

ORALAIR ........................................................................................ 49

ORAP .............................................................................................. 41

ORAPRED ...................................................................................... 56

ORAPRED ODT ............................................................................ 56

ORENCIA ....................................................................................... 69

ORENITRAM .................................................................................. 28

ORFADIN ........................................................................................ 73

ORILISSA ....................................................................................... 71

ORINASE ........................................................................................ 66

ORKAMBI ....................................................................................... 76

orphenadrine citrate ...................................................................... 18

orphenadrine, aspirin, & caffeine ................................................. 18

ORTHO EVRA ............................................................................... 58

ORTHO TRI-CYCLEN .................................................................. 61

ORTHO-CEPT ............................................................................... 57

ORTHO-CYCLEN .......................................................................... 61

ORTHO-EST .................................................................................. 67

ORTHO-NOVUM ..................................................................... 59, 60

oseltamivir phosphate ................................................................... 11

OSENI ............................................................................................. 61

OSMOPREP ................................................................................... 54

ospemifene ..................................................................................... 67

OSPHENA ...................................................................................... 67

OTEZLA .......................................................................................... 70

OTREXUP ...................................................................................... 15

OVCON-35 ..................................................................................... 59

OVCON-50 ..................................................................................... 59

OVIDE ............................................................................................. 78

OXANDRIN ..................................................................................... 56

oxandrolone .................................................................................... 56

oxaprozin ........................................................................................ 32

oxazepam ....................................................................................... 38

OXBRYTA ....................................................................................... 74

oxcarbazepine ................................................................................ 35

OXERVATE .................................................................................... 51

oxiconazole nitrate......................................................................... 79

OXISTAT......................................................................................... 79

OXSORALEN-ULTRA ................................................................... 84

oxybutynin....................................................................................... 85

oxybutynin extended-release ....................................................... 85

oxybutynin transdermal ................................................................. 85

oxycodone ...................................................................................... 32

oxycodone & acetaminophen....................................................... 32

oxycodone & acetaminophen er .................................................. 32

oxycodone & aspirin ...................................................................... 32

oxycodone & ibuprofen ................................................................. 32

oxycodone controlled-release ...................................................... 32

OXYCONTIN .................................................................................. 32

oxymetholone ................................................................................. 56

oxymorphone.................................................................................. 32



oxymorphone extended-release .................................................. 32

OXYTROL ....................................................................................... 85

ozanimod ......................................................................................... 73

OZEMPIC ........................................................................................ 65

P

PACERONE .................................................................................... 24

palbociclib ....................................................................................... 15

paliperidone .................................................................................... 41

palivizumab ..................................................................................... 12

PALYNZIQ ...................................................................................... 73

PAMELOR ...................................................................................... 41

PAMINE ........................................................................................... 17

PANCREAZE .................................................................................. 54

pancrelipase (lipase-protease-amylase) ..................................... 54

PANDEL .......................................................................................... 81

PANRETIN ...................................................................................... 83

pantoprazole ................................................................................... 53

papaverine ...................................................................................... 27

PARAFON FORTE DSC ............................................................... 18

parathyroid hormone ..................................................................... 73

PARCOPA ...................................................................................... 36

paregoric ......................................................................................... 52

PAREGORIC .................................................................................. 52

paricalcitol ....................................................................................... 85

PARLODEL ..................................................................................... 36

PARNATE ....................................................................................... 41

paromomycin sulfate ....................................................................... 8

paroxetine ....................................................................................... 41

paroxetine extended-release ........................................................ 41

paroxetine mesylate ...................................................................... 41

pasireotide ...................................................................................... 73

PATADAY ....................................................................................... 49

PATANASE ..................................................................................... 50

PATANOL ....................................................................................... 50

patiromer ......................................................................................... 44

PAVABID ......................................................................................... 27

PAXIL............................................................................................... 41

PAXIL CR ........................................................................................ 41

pazopanib........................................................................................ 15

PEDIAPRED ................................................................................... 56

pediatric multivitamins w/ fluoride ................................................ 73

pediatric multivitamins w/ fluoride & iron .................................... 73

pediatric vitamins a, c, & d, w/ fluoride ....................................... 73

pediatric vitamins a, c, & d, w/ fluoride & iron ............................ 73

PEGANONE ................................................................................... 34

PEGASYS ....................................................................................... 12

pegfilgrastim ................................................................................... 21

pegfilgrastim-jmdb ......................................................................... 21

peginterferon alfa-2a ..................................................................... 12

peginterferon-alfa 2b ..................................................................... 12

PEG-INTRON ................................................................................. 12

pegvaliase ....................................................................................... 73

pegvisomant ................................................................................... 69

PEMAZYRE .................................................................................... 15

pemigatinib ..................................................................................... 15

penbutolol ....................................................................................... 28

penciclovir ....................................................................................... 79

penicillamine ................................................................................... 55

penicillin v potassium ...................................................................... 6

PENLAC .......................................................................................... 77

PENNSAID ..................................................................................... 30

pentamidine ...................................................................................... 8

PENTASA ....................................................................................... 52

pentazocine & naloxone ............................................................... 32

pentosan polysulfate sodium ....................................................... 73

pentoxifylline ................................................................................... 20

PEN-VK ............................................................................................. 6

PEPCID ........................................................................................... 53

perampanel ..................................................................................... 35

PERCOCET ................................................................................... 32

PERCODAN ................................................................................... 32

PERIACTIN ...................................................................................... 4

PERIDEX ........................................................................................ 45

perindopril ....................................................................................... 26

PERIOSTAT ..................................................................................... 5

permethrin....................................................................................... 79

perphenazine ........................................................................... 39, 41

PERSANTINE ................................................................................ 20

PERTZYE ....................................................................................... 54

PEXEVA .......................................................................................... 41

pexidartinib ..................................................................................... 16

phenelzine ...................................................................................... 41

PHENERGAN ............................................................................ 4, 75

PHENERGAN VC ...................................................................... 4, 75

PHENERGAN VC W/CODEINE .................................................. 75

PHENERGAN W/ CODEINE ....................................................... 75

phenobarbital ........................................................................... 38, 55

PHENOBARBITAL ........................................................................ 38

phenobarbital and belladonna alkaloids ..................................... 55

phenoxybenzamine ....................................................................... 19

PHENYTEK .................................................................................... 35

phenytoin sodium extended-release ........................................... 35

phenytoin suspension ................................................................... 35

PHISOHEX ..................................................................................... 78

PHOSLO ......................................................................................... 44

PHOSLYRA .................................................................................... 45

PHOSPHA ...................................................................................... 45

PHOSPHOLINE IODIDE .............................................................. 50

PHRENILIN .................................................................................... 29

PHRENILIN FORTE ...................................................................... 29

phytonadione .................................................................................. 85

PICATO ........................................................................................... 84

PIFELTRO ...................................................................................... 10

pilocarpine ................................................................................ 18, 51

pilocarpine gel ................................................................................ 51

PILOPINE HS ................................................................................. 51



pimavanserin .................................................................................. 41

pimecrolimus .................................................................................. 84

pimozide .......................................................................................... 41

pindolol ............................................................................................ 28

pioglitazone ............................................................................... 61, 65

pioglitazone & glimepiride ............................................................. 65

pioglitazone & metformin .............................................................. 65

PIQRAY ........................................................................................... 13

pirbuterol acetate ........................................................................... 20

pirfenidone ...................................................................................... 76

piroxicam ......................................................................................... 32

pitavastatin ...................................................................................... 22

pitolisant .......................................................................................... 38

PLAN B ............................................................................................ 58

PLAQUENIL ...................................................................................... 8

PLAVIX ............................................................................................ 20

PLEGRIDY ...................................................................................... 72

PLENDIL ......................................................................................... 23

PLETAL ........................................................................................... 20

PLEXION ......................................................................................... 82

PLEXION SCT ................................................................................ 82

podofilox .......................................................................................... 84

POLY HIST FORTE ......................................................................... 4

POLYCITRA-K ............................................................................... 43

polyethylene glycol-electrolyte solution ................................ 53, 54

polymyxin b & trimethoprim (ophth)............................................. 46

POLYSPORIN ................................................................................ 45

POLYTRIM ...................................................................................... 46

POLY-VI-FLOR .............................................................................. 73

POLY-VI-FLOR W/IRON............................................................... 73

pomalidomide ................................................................................. 15

POMALYST .................................................................................... 15

ponatinib .......................................................................................... 15

PONSTEL ....................................................................................... 31

PORTIA ........................................................................................... 58

posaconazole ................................................................................... 7

potassium bicarbonate & potassium chloride ............................ 45

potassium chloride ......................................................................... 45

potassium chloride powder ........................................................... 45

potassium citrate ............................................................................ 43

potassium citrate & citric acid ....................................................... 43

potassium gluconate...................................................................... 45

potassium iodide & iodine ............................................................. 69

potassium phosphate .................................................................... 45

potassium phosphate, monobasic ............................................... 45

POTIGA ........................................................................................... 34

PRADAXA ....................................................................................... 20

PRALUENT ..................................................................................... 21

pramipexole .................................................................................... 37

pramipexole extended-release ..................................................... 37

pramlintide acetate ........................................................................ 65

PRAMOSONE ................................................................................ 82

PRAMOSONE-E ............................................................................ 82

pramoxine ....................................................................................... 82

PRANDIMET .................................................................................. 65

PRANDIN ........................................................................................ 65

prasugrel ......................................................................................... 20

PRAVACHOL ................................................................................. 22

pravastatin ...................................................................................... 22

praziquantel ...................................................................................... 4

prazosin .......................................................................................... 21

PRECOSE ...................................................................................... 61

PRED FORTE ................................................................................ 48

PRED MILD .................................................................................... 48

PRED-G .......................................................................................... 47

prednicarbate ................................................................................. 81

PREDNISOL ................................................................................... 49

prednisolone ................................................................. 47, 48, 49, 56

PREDNISOLONE .......................................................................... 56

prednisolone acetate ............................................................... 48, 56

prednisolone acetate (ophth) ....................................................... 48

prednisolone sodium phosphate ..................................... 48, 49, 56

prednisolone sodium phosphate (ophth) .............................. 48, 49

prednisone ...................................................................................... 56

PREDNISONE ............................................................................... 56

PREFEST ....................................................................................... 66

pregabalin ....................................................................................... 35

PRELONE ....................................................................................... 56

PREMARIN ..................................................................................... 67

PREMARIN CREAM ..................................................................... 67

PREMPHASE ................................................................................. 66

PREMPRO ..................................................................................... 66

PREPOPIK ..................................................................................... 54

pretomanid ........................................................................................ 7

PRETOMANID ................................................................................. 7

PREVACID ..................................................................................... 53

PREVIDENT ................................................................................... 74

PREVIDENT 5000 PLUS ............................................................ 74

PREVPAC ....................................................................................... 53

PREVYMIS ..................................................................................... 11

PREZCOBIX ..................................................................................... 9

PREZISTA ........................................................................................ 9

PRIFTIN ............................................................................................ 8

PRILOSEC ..................................................................................... 53

PRIMAQUINE .................................................................................. 8

primaquine phosphate .................................................................... 8

primidone ........................................................................................ 35

PRISTIQ .......................................................................................... 40

PROAIR HFA ................................................................................. 19

PROAMATINE ............................................................................... 20

PRO-BANTHINE ............................................................................ 17

probenecid ...................................................................................... 45

procarbazine ................................................................................... 15

PROCARDIA .................................................................................. 23

PROCARDIA XL ............................................................................ 23

prochlorperazine ............................................................................ 53

PROCRIT ........................................................................................ 21

PROCTOCORT ............................................................................. 81



PROCTOFOAM ............................................................................. 82

PROCTOFOAM-HC ...................................................................... 82

PROCYSBI ..................................................................................... 70

PRODIGY.................................................................................. 42, 43

PRODIGY TEST STRIPS ............................................................. 42

progesterone, micronized ............................................................. 68

PROGRAF ...................................................................................... 74

PROLIXIN ....................................................................................... 40

PROLOPRIM .................................................................................. 13

PROMACTA ................................................................................... 21

promethazine .............................................................................. 4, 75

promethazine & codeine ............................................................... 75

promethazine & dextromethorphan ............................................. 75

promethazine & phenylephrine ...................................................... 4

promethazine, phenylephrine & codeine .................................... 75

PROMETHAZINE-DM ................................................................... 75

PROMETRIUM ............................................................................... 68

propafenone .................................................................................... 24

propantheline bromide .................................................................. 17

proparacaine ................................................................................... 51

propranolol ...................................................................................... 29

propranolol & hydrochlorothiazide ............................................... 29

propranolol extended-release ...................................................... 29

propranolol sustained-release ...................................................... 29

propylthiouracil ............................................................................... 69

PROPYLTHIOURACIL .................................................................. 69

PROSOM ........................................................................................ 37

PROSTIGMIN ................................................................................. 18

PROTONIX ..................................................................................... 53

PROTOPIC ..................................................................................... 84

protriptyline ..................................................................................... 41

PROVENTIL HFA .......................................................................... 19

PROVERA ...................................................................................... 68

PROVIGIL ....................................................................................... 34

PROZAC ......................................................................................... 40

PROZAC WEEKLY ........................................................................ 40

PRUDOXIN ..................................................................................... 84

pseudoephedrine, brompheniramine & codeine ........................ 75

PULMICORT FLEXHALER .......................................................... 75

PULMICORT RESPULES ............................................................ 75

PULMOZYME ................................................................................. 45

PURINETHOL ................................................................................ 15

PYLERA ............................................................................................ 4

pyrazinamide .................................................................................... 8

PYRAZINAMIDE .............................................................................. 8

pyridostigmine ................................................................................ 18

pyrimethamine .................................................................................. 8

Q

QINLOCK ........................................................................................ 15

QUALAQUIN .................................................................................... 8

QUESTRAN .................................................................................... 21

QUESTRAN LIGHT ....................................................................... 21

quetiapine ....................................................................................... 41

quetiapine extended-release ........................................................ 41

QUINAGLUTE ................................................................................ 24

quinapril & hydrochlorothiazide ................................................... 26

quinapril hcl .................................................................................... 26

quinidine .................................................................................... 24, 38

quinidine gluconate ....................................................................... 24

QUINIDINE SULFATE .................................................................. 24

quinine sulfate .................................................................................. 8

QUIXIN ............................................................................................ 46

QVAR RediHaler ............................................................................ 75

R

rabeprazole ..................................................................................... 53

RAGWITEK .................................................................................... 50

raloxifene hcl .................................................................................. 67

raltegravir ........................................................................................ 12

raltegravir (600mg) ........................................................................ 12

ramelteon ........................................................................................ 38

ramipril ............................................................................................ 26

RANEXA ......................................................................................... 24

ranolazine ....................................................................................... 24

RAPAFLO ....................................................................................... 19

RAPAMUNE ................................................................................... 74

rasagiline......................................................................................... 37

RASUVO ......................................................................................... 15

RAVICTI .......................................................................................... 43

RAYOS ............................................................................................ 56

RAZADYNE .............................................................................. 17, 18

RAZADYNE ER ............................................................................. 18

REBETOL ....................................................................................... 12

REBIF .............................................................................................. 72

REBIF REBIDOSE ........................................................................ 72

RECLIPSEN ................................................................................... 57

RECTIV ........................................................................................... 27

REGLAN ......................................................................................... 55

regorafenib ..................................................................................... 15

REGRANEX ................................................................................... 83

RELAFEN ....................................................................................... 31

RELENZA ....................................................................................... 12

RELISTOR ...................................................................................... 55

RELPAX .......................................................................................... 36

REMERON ..................................................................................... 41

REMODULIN .................................................................................. 28

RENAGEL ....................................................................................... 44

RENVELA ....................................................................................... 44

repaglinide ...................................................................................... 65

repaglinide & metformin ................................................................ 65

REPATHA ....................................................................................... 21

REQUIP .......................................................................................... 37

REQUIP XL .................................................................................... 37

RESCRIPTOR.................................................................................. 9

RESCULA ....................................................................................... 51



reserpine ......................................................................................... 25

RESTASIS ...................................................................................... 47

RESTORIL ...................................................................................... 38

retapamulin ..................................................................................... 79

RETIN-A .......................................................................................... 83

RETIN-A MICRO ............................................................................ 83

RETROVIR ..................................................................................... 12

REVATIO ........................................................................................ 28

revefenacin ..................................................................................... 17

REVIA .............................................................................................. 39

REVLIMID ....................................................................................... 15

REXULTI ......................................................................................... 39

REYATAZ.......................................................................................... 9

REYVOW ........................................................................................ 36

RHEUMATREX .............................................................................. 15

RHOPRESSA ................................................................................. 51

ribavirin ............................................................................................ 12

RIDAURA ........................................................................................ 55

rifabutin .............................................................................................. 8

RIFADIN ............................................................................................ 8

rifampin .............................................................................................. 8

rifapentine ......................................................................................... 8

rifaximin ............................................................................................. 6

rilpivirine ................................................................................ 9, 10, 12

RILUTEK ......................................................................................... 39

riluzole ............................................................................................. 39

rimantadine ..................................................................................... 12

rimegepant ...................................................................................... 36

rimexolone ...................................................................................... 49

RINVOQ .......................................................................................... 74

riociguat ........................................................................................... 28

RIOMET .......................................................................................... 65

ripritinib ............................................................................................ 15

risankizumab .................................................................................. 73

risedronate sodium ........................................................................ 73

RISPERDAL ................................................................................... 41

RISPERDALM-TAB ....................................................................... 41

risperidone ...................................................................................... 41

risperidone orally disintegrating ................................................... 41

RITALIN ..................................................................................... 33, 34

RITALIN LA ..................................................................................... 33

RITALIN SR .................................................................................... 34

ritonavir ...................................................................................... 11, 12

rivaroxaban ..................................................................................... 20

rivastigmine tartrate ....................................................................... 18

rivastigmine tartrate (solution) ...................................................... 18

rizatriptan ........................................................................................ 36

rizatriptan orally disintegrating ..................................................... 36

ROBAXIN ........................................................................................ 18

ROBINUL ........................................................................................ 16

ROBINULFORTE ........................................................................... 16

ROCALTROL .................................................................................. 85

roflumilast ........................................................................................ 76

rolapitant ......................................................................................... 53

ROMYCIN ....................................................................................... 46

ropinirole ......................................................................................... 37

ropinirole extended-release .......................................................... 37

ROSAC ........................................................................................... 78

rosiglitazone ................................................................................... 65

rosiglitazone & glimepiride ........................................................... 65

rosiglitazone & metformin ............................................................. 65

ROSULA ......................................................................................... 82

rosuvastatin .................................................................................... 22

rotigotine ......................................................................................... 37

ROWASA ........................................................................................ 52

ROXICET ........................................................................................ 32

ROXICODONE .............................................................................. 32

ROZEREM ...................................................................................... 38

ROZLYTREK .................................................................................. 14

rufinamide ....................................................................................... 35

ruxolitinib ......................................................................................... 15

RYTHMOL ...................................................................................... 24

RYTHMOL SR................................................................................ 24

RYZODEG 70/30 ........................................................................... 63

S

SABRIL ........................................................................................... 35

sacubitril & valsartan ..................................................................... 24

SAFYRAL ....................................................................................... 57

SAIZEN ........................................................................................... 68

SALAGEN ....................................................................................... 18

salmeterol ................................................................................. 76, 77

salsalate .......................................................................................... 32

SAMSCA ......................................................................................... 44

SANCTURA .................................................................................... 85

SANCTURA XR ............................................................................. 85

SANCUSO ...................................................................................... 52

SANDIMMUNE .............................................................................. 70

SANDOSTATIN ............................................................................. 73

SANTYL .......................................................................................... 83

SAPHRIS ........................................................................................ 39

sapropterin dihydrochloride .......................................................... 74

saquinavir mesylate....................................................................... 12

SARAFEM ...................................................................................... 40

sargramostim.................................................................................. 21

sarilumab ........................................................................................ 74

SAVAYSA ....................................................................................... 20

SAVELLA ........................................................................................ 38

saxagliptin ....................................................................................... 65

saxagliptin & metformin extended-release ................................. 65

scopolamine (ophth) ...................................................................... 51

scopolamine hydrobromide .......................................................... 53

SEASONALE.................................................................................. 58

SEASONIQUE ............................................................................... 58

SEB-PREV ..................................................................................... 79

secnidazole ....................................................................................... 8

SECTRAL ....................................................................................... 28



secukinumab .................................................................................. 74

SEEBRI NEOHALER .................................................................... 16

segesterone & ethinyl estradiol .................................................... 61

SEGLUROMET .............................................................................. 62

selegiline ......................................................................................... 37

selegiline transdermal ................................................................... 37

selenium sulfide ............................................................................. 79

selinexor .......................................................................................... 15

SELSEB .......................................................................................... 79

SELSUN RX ................................................................................... 79

selumetinib ...................................................................................... 16

SELZENTRY .................................................................................. 11

semaglutide .................................................................................... 65

SENSIPAR ...................................................................................... 70

SEPTRA ............................................................................................ 6

SERAX ............................................................................................ 38

SEREVENT DISKUS ..................................................................... 77

SEROMYCIN .................................................................................... 7

SEROQUEL .................................................................................... 41

SEROQUEL XR ............................................................................. 41

SEROSTIM ..................................................................................... 69

SERPASIL ...................................................................................... 25

sertaconazole nitrate ..................................................................... 79

sertraline.......................................................................................... 41

SERZONE ....................................................................................... 41

sevelamer carbonate ..................................................................... 44

sevelamer hcl ................................................................................. 44

short ragweed pollen allergen extract ......................................... 50

SIGNIFOR ....................................................................................... 73

sildenafil .......................................................................................... 28

SILENOR ........................................................................................ 37

SILIQ ................................................................................................ 70

silodosin .......................................................................................... 19

SILVADENE .................................................................................... 79

silver sulfadiazine ........................................................................... 79

simeprevir........................................................................................ 12

SIMPONI ......................................................................................... 71

simvastatin ................................................................................ 22, 65

sinecatechins .................................................................................. 84

SINEMET ........................................................................................ 36

SINEMET CR ................................................................................. 36

SINEQUAN ..................................................................................... 40

SINGULAIR .................................................................................... 75

sirolimus .......................................................................................... 74

sirolimus solution ........................................................................... 74

SIRTURO ........................................................................................ 70

sitagliptin & metformin ................................................................... 65

sitagliptin & simvastatin ................................................................. 65

sitagliptin phosphate ...................................................................... 65

SIVEXTRO ........................................................................................ 6

SKELAXIN ...................................................................................... 18

SKELID ............................................................................................ 74

SKYRIZI .......................................................................................... 73

SLYND ............................................................................................. 57

sodium chloride .............................................................................. 77

sodium citrate & citric acid ............................................................ 43

sodium fluoride ............................................................................... 74

sodium fluoride (dental) ................................................................ 74

sodium fluoride drops .................................................................... 74

sodium oxybate .............................................................................. 39

sodium phenylbutyrate .................................................................. 43

sodium phosphates ....................................................................... 54

sodium picosulfate-mag ox-anhydrous citric acid ..................... 54

sodium polystyrene sulfonate ...................................................... 44

sodium zirconium cyclosilicate..................................................... 44

sofosbuvir ................................................................................. 11, 12

sofosbuvir & velpatasvir ................................................................ 12

sofosbuvir, velpatasvir, voxilaprevir ............................................ 11

SOLARAZE .................................................................................... 84

solifenacin ....................................................................................... 85

SOLIQUA ........................................................................................ 63

SOLODYN ........................................................................................ 6

SOLOSEC ........................................................................................ 8

solriamfetol ..................................................................................... 39

SOMA ........................................................................................ 18, 30

SOMA COMPOUND ............................................................... 18, 30

SOMA COMPOUND W/ CODEINE ............................................ 30

somatropin ................................................................................ 68, 69

SOMATULINE DEPOT ................................................................. 72

SOMAVERT ................................................................................... 69

SONATA ......................................................................................... 38

SOOLANTRA ................................................................................... 4

sorafenib tosylate .......................................................................... 16

SORIATANE ................................................................................... 83

SORILUX ........................................................................................ 83

sotalol .............................................................................................. 29

SOVALDI ........................................................................................ 12

SPECTAZOLE ............................................................................... 78

SPECTRACEF ................................................................................. 5

spinosad .......................................................................................... 79

SPIRIVA .......................................................................................... 17

SPIRIVA RESPIMAT ..................................................................... 17

spironolactone ................................................................................ 27

spironolactone & hydrochlorothiazide ......................................... 27

SPORANOX ..................................................................................... 7

SPRINTEC ..................................................................................... 61

SPRYCEL ....................................................................................... 14

SPS.................................................................................................. 44

STADOL .......................................................................................... 30

STALEVO ....................................................................................... 36

stannous fluoride ........................................................................... 74

STARLIX ......................................................................................... 65

stavudine......................................................................................... 12

STEGLATRO.................................................................................. 62

STEGLUJAN .................................................................................. 62

STELARA ....................................................................................... 74

STELAZINE .................................................................................... 42

STIMATE ........................................................................................ 68



STIOLTO RESPIMAT .................................................................... 77

stiripentol ......................................................................................... 35

STIVARGA ...................................................................................... 15

STRATTERA .................................................................................. 38

STRIBILD ........................................................................................ 10

STRIVERDI RESPIMAT ............................................................... 20

STROMECTOL ................................................................................ 4

SUBOXONE ................................................................................... 29

SUBUTEX ....................................................................................... 29

succimer .......................................................................................... 55

sucralfate suspension .................................................................... 53

sucralfate tablets ............................................................................ 53

sucroferric oxyhydroxide ............................................................... 44

SULAR ............................................................................................. 23

sulconazole nitrate ......................................................................... 79

SULFAC .......................................................................................... 46

sulfacetamide sodium & prednisolone ........................................ 49

sulfacetamide sodium & sulfur ..................................................... 82

sulfacetamide sodium (acne) ....................................................... 79

sulfacetamide sodium (ophth) ointment ...................................... 46

sulfacetamide sodium (ophth) solution ....................................... 46

sulfadiazine ................................................................................. 6, 79

SULFADIAZINE ............................................................................... 6

sulfamethoxazole & trimethoprim .................................................. 6

SULFAMYLON ............................................................................... 78

sulfanilamide ................................................................................... 79

sulfasalazine ..................................................................................... 6

sulindac ........................................................................................... 32

sumatriptan ..................................................................................... 36

sunitinib malate .............................................................................. 16

SUNOSI ........................................................................................... 39

SUPRAX............................................................................................ 5

SURMONTIL .................................................................................. 42

SUSTIVA ......................................................................................... 10

SUTENT .......................................................................................... 16

suvorexant ...................................................................................... 38

SYMAX ............................................................................................ 17

SYMAX DUOTAB .......................................................................... 17

SYMBICORT .................................................................................. 75

SYMBYAX ....................................................................................... 41

SYMDEKO ...................................................................................... 77

SYMFI .............................................................................................. 10

SYMFI LO ....................................................................................... 10

SYMLIN ........................................................................................... 65

SYMMETREL ................................................................................. 36

SYMTUZA ......................................................................................... 9

SYNAGIS ........................................................................................ 12

SYNALAR ....................................................................................... 80

SYNAREL ....................................................................................... 68

SYNERA PATCH ........................................................................... 82

SYNJARDY ..................................................................................... 62

SYNTHROID .................................................................................. 69

SYPRINE ........................................................................................ 55

syringe with needle,disposable .................................................... 43

T

TABLOID......................................................................................... 16

TACLONEX .................................................................................... 80

tacrolimus ................................................................................. 74, 84

tacrolimus (topical) ........................................................................ 84

tadalafil ............................................................................................ 28

TAGAMET ...................................................................................... 53

TAKHZYRO .................................................................................... 72

talazoparib ...................................................................................... 16

TALTZ ............................................................................................. 72

TALWIN NX .................................................................................... 32

TALZENNA ..................................................................................... 16

TAMBOCOR ................................................................................... 24

TAMIFLU......................................................................................... 11

tamoxifen citrate ............................................................................ 16

tamsulosin hcl ................................................................................ 19

TANZEUM ...................................................................................... 61

TAPAZOLE ..................................................................................... 69

tapentadol ....................................................................................... 32

TARCEVA ....................................................................................... 14

TARGRETIN ............................................................................. 13, 83

TARKA ............................................................................................ 23

TASIGNA ........................................................................................ 15

tasimelteon ..................................................................................... 38

TASMAR ......................................................................................... 37

tavaborole ......................................................................................... 7

TAVALISSE .................................................................................... 71

tazarotene ....................................................................................... 84

tazemetostat ................................................................................... 16

TAZORAC ....................................................................................... 84

TAZVERIK ...................................................................................... 16

TECFIDERA ................................................................................... 70

TECHNIVIE .................................................................................... 11

tedizolid ............................................................................................. 6

teduglutide ...................................................................................... 55

TEGRETOL .................................................................................... 34

TEGRETOL XR .............................................................................. 34

TEGSEDI ........................................................................................ 72

TEKAMLO ....................................................................................... 25

TEKTURNA .................................................................................... 25

TEKTURNA HCT ........................................................................... 25

telaprevir ......................................................................................... 12

telbivudine....................................................................................... 12

telithromycin ..................................................................................... 6

telmisartan ................................................................................ 23, 27

telmisartan & hydrochlorothiazide ............................................... 27

temazepam ..................................................................................... 38

TEMODAR ...................................................................................... 16

TEMOVATE .................................................................................... 80

TEMOVATE E ................................................................................ 80

temozolomide ................................................................................. 16

TENEX ............................................................................................ 25

tenofovir .......................................................................... 9, 10, 11, 12



tenofovir 300 mg ............................................................................ 12

tenofovir alafenamide .................................................................... 12

TENORETIC ................................................................................... 28

TENORMIN ..................................................................................... 28

TERAZOL 3 .................................................................................... 79

TERAZOL 7 .................................................................................... 79

terazosin .......................................................................................... 21

terbinafine ......................................................................................... 7

terbutaline sulfate ........................................................................... 20

terconazole ..................................................................................... 79

terconazole (vaginal) ..................................................................... 79

teriflunomide ................................................................................... 74

teriparatide ...................................................................................... 68

TESSALON PERLES .................................................................... 74

TESTIM ........................................................................................... 56

testosterone .............................................................................. 56, 67

testosterone cypionate .................................................................. 56

TESTRED ....................................................................................... 56

tetrabenazine .................................................................................. 39

tetracycline .................................................................................... 4, 6

TETRACYCLINE .............................................................................. 6

tetrahydrozoline .............................................................................. 51

TEVETEN........................................................................................ 26

TEVETEN PLUS ............................................................................ 26

tezacaftor & ivacaftor ............................................................... 75, 77

thalidomide...................................................................................... 74

THALOMID ..................................................................................... 74

theophylline ..................................................................................... 85

thioguanine ..................................................................................... 16

thioridazine...................................................................................... 41

thiothixene ....................................................................................... 41

THORAZINE ................................................................................... 40

thyroid .............................................................................................. 69

THYROLAR .................................................................................... 69

tiagabine .......................................................................................... 35

TIAZAC ............................................................................................ 23

TIBSOVO ........................................................................................ 14

ticagrelor.......................................................................................... 20

TIGAN .............................................................................................. 53

TIKOSYN ........................................................................................ 24

tildrakizumab-asmn........................................................................ 74

TILIA ................................................................................................ 60

tiludronate ....................................................................................... 74

timolol .................................................................................. 29, 50, 51

TIMOPTIC ....................................................................................... 51

TIMOPTIC-XE ................................................................................ 51

timothy grass pollen allergen extract ........................................... 50

tiotropium .................................................................................. 17, 77

tiotropium 1.25 mcg ....................................................................... 17

tiotropium 2.5 mcg ......................................................................... 17

tiotropium bromide and olodaterol ............................................... 77

tipranavir.......................................................................................... 12

TIROSINT ....................................................................................... 69

TIVICAY ............................................................................................ 9

tizanidine ......................................................................................... 18

TOBI .................................................................................................. 7

TOBI PODHALER ........................................................................... 7

TOBRADEX .................................................................................... 49

tobramycin & dexamethasone ointment ..................................... 49

tobramycin & dexamethasone suspension ................................ 49

tobramycin inhalation powder ........................................................ 7

tobramycin inhalation solution ....................................................... 7

tobramycin sulfate (ophth) ointment............................................ 46

tobramycin sulfate (ophth) solution ............................................. 46

TOBREX ......................................................................................... 46

tocilizumab ...................................................................................... 74

tofacitinib ......................................................................................... 74

TOFRANIL ...................................................................................... 40

TOFRANIL-PM ............................................................................... 40

tolazamide ...................................................................................... 65

tolbutamide ..................................................................................... 66

tolcapone ........................................................................................ 37

TOLECTIN 600 .............................................................................. 32

TOLINASE ...................................................................................... 65

tolmetin sodium .............................................................................. 32

tolterodine ....................................................................................... 85

tolterodine extended-release ....................................................... 85

tolvaptan ......................................................................................... 44

TOPAMAX ...................................................................................... 35

TOPAMAX SPRINKLE ................................................................. 35

TOPICORT ..................................................................................... 80

topiramate capsule ........................................................................ 35

topiramate tablet ............................................................................ 35

topotecan ........................................................................................ 16

TOPROL XL ................................................................................... 28

TORADOL ...................................................................................... 31

toremifene ....................................................................................... 16

torsemide ........................................................................................ 44

TOVIAZ ........................................................................................... 85

TRACLEER .................................................................................... 27

TRADJENTA .................................................................................. 64

tramadol .......................................................................................... 32

tramadol & acetaminophen .......................................................... 32

tramadol extended-release .......................................................... 32

TRANDATE .................................................................................... 28

trandolapril ................................................................................ 23, 27

trandolapril & verapamil ................................................................ 23

tranexamic acid .............................................................................. 20

TRANSDERM-SCOP .................................................................... 53

TRANXENE .................................................................................... 37

tranylcypromine sulfate ................................................................. 41

TRAVATAN Z ................................................................................. 51

travoprost ........................................................................................ 51

trazodone .................................................................................. 41, 42

trazodone extended-release ........................................................ 42

TRECATOR ...................................................................................... 7

TRELEGY ELLIPTA ...................................................................... 76

TREMFYA ....................................................................................... 71



TRENTAL ........................................................................................ 20

treprostinil........................................................................................ 28

TRESIBA ......................................................................................... 63

tretinoin ...................................................................................... 16, 83

tretinoin microspheres ................................................................... 83

TREXALL ........................................................................................ 15

TREZIX ............................................................................................ 29

triamcinolone acetonide (topical) ................................................. 82

triamterene ...................................................................................... 44

triamterene & hydrochlorothiazide ............................................... 44

TRIAVIL ........................................................................................... 39

triazolam .......................................................................................... 38

TRIBENZOR ................................................................................... 23

TRICOR ........................................................................................... 22

trientine ............................................................................................ 55

trifluidine/tipiracil ............................................................................. 16

trifluoperazine ................................................................................. 42

trifluridine ......................................................................................... 46

trihexyphenidyl ............................................................................... 37

TRIKAFTA ....................................................................................... 75

TRILAFON ...................................................................................... 41

TRILEPTAL ..................................................................................... 35

TRILIPIX .......................................................................................... 22

TRI-LO-SPRINTEC........................................................................ 61

trimethobenzamide ........................................................................ 53

trimethoprim .......................................................................... 6, 13, 46

trimipramine .................................................................................... 42

TRINESSA ...................................................................................... 61

TRI-NORINYL................................................................................. 59

TRINTELLIX ................................................................................... 42

TRI-SPRINTEC .............................................................................. 61

TRIUMEQ.......................................................................................... 9

TRI-VI-FLOR .................................................................................. 73

TRI-VI-FLOR W/IRON ................................................................... 73

TRIVORA ........................................................................................ 58

TRIZIVIR ........................................................................................... 9

trospium ........................................................................................... 85

trospium extended-release ........................................................... 85

TRULICITY ..................................................................................... 62

TRUSOPT ....................................................................................... 50

TRUVADA ....................................................................................... 10

tucatinib ........................................................................................... 16

TUKYSA .......................................................................................... 16

TURALIO ......................................................................................... 16

TUSSIONEX ................................................................................... 75

TWINJECT ...................................................................................... 19

TWYNSTA ...................................................................................... 23

TYKERB .......................................................................................... 14

TYLENOL W/ CODEINE ............................................................... 29

TYMLOS.......................................................................................... 68

TYZEKA .......................................................................................... 12

TYZINE ............................................................................................ 51

U

UBRELVY ....................................................................................... 36

ubrogepant ..................................................................................... 36

UCERIS........................................................................................... 55

ulipristal ........................................................................................... 61

ULORIC........................................................................................... 71

ULTRACET ..................................................................................... 32

ULTRAM ......................................................................................... 32

ULTRAM ER ................................................................................... 32

ULTRAVATE .................................................................................. 81

umeclidinium ...................................................................... 17, 20, 76

umeclidinium & vilanterol ........................................................ 20, 76

UNIPHYL ........................................................................................ 85

UNIRETIC ....................................................................................... 26

UNITHROID ................................................................................... 69

UNIVASC ........................................................................................ 26

unoprostone isopropyl ................................................................... 51

upadacitinib .................................................................................... 74

urea............................................................................................ 81, 82

URECHOLINE................................................................................ 17

URELLE .......................................................................................... 13

UROCIT-K ...................................................................................... 43

URO-MP ......................................................................................... 72

UROXATRAL ................................................................................. 18

URSO .............................................................................................. 55

URSO FORTE................................................................................ 55

ursodiol ............................................................................................ 55

ustekinumab ................................................................................... 74

UTIBRON NEOHALER ................................................................. 76

V

VAGIFEM ........................................................................................ 67

valacyclovir ..................................................................................... 12

valbenazine .................................................................................... 39

VALCHLOR .................................................................................... 15

VALCYTE ....................................................................................... 12

valganciclovir .................................................................................. 12

VALISONE ...................................................................................... 80

VALIUM ........................................................................................... 37

valproate sodium ........................................................................... 35

valproic acid ................................................................................... 35

valsartan ....................................................................... 23, 24, 25, 27

valsartan & hydrochlorothiazide ............................................ 23, 27

VALTREX ....................................................................................... 12

VALTURNA .................................................................................... 25

VANCOCIN ....................................................................................... 7

Vancomycin capsule ....................................................................... 7

vandetanib ...................................................................................... 16

VANOS ............................................................................................ 80

VANOXIDE-HC .............................................................................. 80

VANTIN ............................................................................................. 5

varenicline....................................................................................... 17



VARUBI ........................................................................................... 53

VASCEPA ....................................................................................... 22

VASERETIC ................................................................................... 26

VASOTEC ....................................................................................... 25

VECTICAL ...................................................................................... 83

VELIVET.......................................................................................... 57

VELPHORO .................................................................................... 44

VELTASSA ..................................................................................... 44

VELTIN ............................................................................................ 83

VEMLIDY ........................................................................................ 12

vemurafenib .................................................................................... 16

venlafaxine ...................................................................................... 42

venlafaxine extended-release ...................................................... 42

VENTOLIN HFA ............................................................................. 19

verapamil ................................................................................... 23, 24

verapamil extended-release cap .................................................. 24

verapamil sustained-release cap ........................................... 23, 24

verapamil sustained-release tab .................................................. 24

VEREGEN ...................................................................................... 84

VERELAN ................................................................................. 23, 24

VERELAN PM ................................................................................ 24

VERZENIO ...................................................................................... 13

VESANOID ..................................................................................... 16

VESICARE ...................................................................................... 85

VEXOL ............................................................................................. 49

VFEND .............................................................................................. 7

VIBERZI .......................................................................................... 52

VICOPROFEN ................................................................................ 31

VICTOZA ......................................................................................... 64

VICTRELIS ....................................................................................... 9

VIDEX ................................................................................................ 9

VIDEX EC ......................................................................................... 9

VIEKIRA .......................................................................................... 11

vigabatrin ......................................................................................... 35

VIGAMOX ....................................................................................... 46

VIIBRYD .......................................................................................... 42

vilazodone ....................................................................................... 42

VIMPAT ........................................................................................... 35

VIOKACE ........................................................................................ 54

VIRACEPT ...................................................................................... 11

VIRAMUNE ..................................................................................... 11

VIREAD ........................................................................................... 12

VIROPTIC ....................................................................................... 46

VISICOL .......................................................................................... 54

VISKEN ........................................................................................... 28

VISTARIL ........................................................................................ 37

VITRAKVI ........................................................................................ 14

VIVACTIL ........................................................................................ 41

VIVELLE-DOT ................................................................................ 67

VIZIMPRO ....................................................................................... 14

VOLTAREN ........................................................................ 30, 47, 84

VOLTAREN GEL ........................................................................... 84

VOLTAREN XR .............................................................................. 30

vorapaxar ........................................................................................ 21

voriconazole suspension ................................................................ 7

voriconazole tablet........................................................................... 7

vorinostat ........................................................................................ 16

vortioxetine ..................................................................................... 42

VOSEVI ........................................................................................... 11

VOSOL ............................................................................................ 51

VOSPIRE ER ................................................................................. 19

VOTRIENT ..................................................................................... 15

voxelotor ......................................................................................... 74

VRAYLAR ....................................................................................... 40

VUSION .......................................................................................... 78

VYTONE ......................................................................................... 78

VYTORIN ........................................................................................ 22

VYVANSE ....................................................................................... 33

VYZULTA ........................................................................................ 50

W

WAKIX ............................................................................................. 38

warfarin ........................................................................................... 21

WELCHOL ...................................................................................... 21

WELLBUTRIN ................................................................................ 39

WELLBUTRIN SR ......................................................................... 39

WELLBUTRIN XL .......................................................................... 39

WESTCORT ................................................................................... 81

WIXELA INHUB ............................................................................. 76

X

XALATAN ....................................................................................... 50

XALKORI ........................................................................................ 14

XANAX ............................................................................................ 37

XANAX XR ..................................................................................... 37

XARELTO ....................................................................................... 20

XARTEMIS XR ............................................................................... 32

XELJANZ ........................................................................................ 74

XELODA ......................................................................................... 13

XENAZINE ...................................................................................... 39

XENLETA ......................................................................................... 6

XIBROM .......................................................................................... 47

XIFAXAN........................................................................................... 6

XIGDUO XR ................................................................................... 62

XIIDRA ............................................................................................ 48

XOLAIR ........................................................................................... 76

XOPENEX HFA ............................................................................. 19

XOPENEX NEBULIZER ............................................................... 19

XOSPATA ....................................................................................... 14

XPOVIO .......................................................................................... 15

XTANDI ........................................................................................... 14

XULANE .......................................................................................... 59

XULTOPHY .................................................................................... 63

XYLOCAINE ............................................................................. 51, 82

XYLOCAINE VISCOUS ................................................................ 51

XYREM ........................................................................................... 39



Y

YASMIN ........................................................................................... 57

YAZ .................................................................................................. 57

YUPELRI ......................................................................................... 17

YUVAFEM ....................................................................................... 67

Z

zafirlukast ........................................................................................ 75

zaleplon ........................................................................................... 38

ZANAFLEX ..................................................................................... 18

zanamivir ......................................................................................... 12

zanubrutinib .................................................................................... 16

ZARONTIN ...................................................................................... 34

ZAROXOLYN ................................................................................. 44

ZARXIO ........................................................................................... 21

ZAVESCA ....................................................................................... 73

ZEBETA .......................................................................................... 28

ZEJULA ........................................................................................... 15

ZELAPAR ........................................................................................ 37

ZELBORAF ..................................................................................... 16

ZEMPLAR ....................................................................................... 85

ZENPEP .......................................................................................... 54

ZEPATIER ...................................................................................... 10

ZEPOSIA ......................................................................................... 73

ZERIT .............................................................................................. 12

ZESTORETIC ................................................................................. 26

ZESTRIL.......................................................................................... 26

ZETIA............................................................................................... 22

ZIAC ................................................................................................. 28

ZIAGEN ......................................................................................... 8, 9

ZIANA .............................................................................................. 83

zidovudine ................................................................................. 11, 12

zileuton ............................................................................................ 75

ziprasidone...................................................................................... 42

ZIRGAN ........................................................................................... 46

ZITHRANOL-RR ............................................................................ 83

ZITHROMAX .................................................................................... 5

ZOCOR ........................................................................................... 22

ZOFRAN ................................................................................... 52, 53

ZOFRAN ODT ................................................................................ 53

ZOHYDRO ER ............................................................................... 30

ZOLINZA ......................................................................................... 16

zolipdem sublingual ....................................................................... 38

zolmitriptan ..................................................................................... 36

zolmitriptan orally disintegrating .................................................. 36

ZOLOFT .......................................................................................... 41

zolpidem .......................................................................................... 38

zolpidem extended-release .......................................................... 38

zolpidem oral spray ....................................................................... 38

ZOLPIMIST ..................................................................................... 38

ZOMIG ............................................................................................ 36

ZOMIG ZMT ................................................................................... 36

ZONALON ...................................................................................... 82

ZONEGRAN ................................................................................... 35

zonisamide ..................................................................................... 35

ZONTIVITY ..................................................................................... 21

ZORBTIVE ...................................................................................... 69

ZORTRESS .................................................................................... 71

ZOVIA .............................................................................................. 58

ZOVIRAX .................................................................................... 9, 77

ZURAMPIC ..................................................................................... 72

ZYBAN ............................................................................................ 39

ZYCLARA ....................................................................................... 84

ZYDELIG......................................................................................... 14

ZYFLO CR ...................................................................................... 75

ZYFO ............................................................................................... 75

ZYKADIA......................................................................................... 13

ZYLET ............................................................................................. 48

ZYLOPRIM ..................................................................................... 69

ZYMAXID ........................................................................................ 46

ZYPREXA ....................................................................................... 41

ZYPREXA ZYDIS .......................................................................... 41

ZYTIGA ........................................................................................... 13

ZYVOX .............................................................................................. 6

60577109_ACA_1557_MarCom_GA_2017_Taglines


NONDISCRIMINATION NOTICE

Kaiser Foundation Health Plan of Georgia, Inc. (Kaiser Health Plan) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also:

• Provide no cost aids and services to people with disabilities to communicate effectively with us, such as: • Qualified sign language interpreters • Written information in other formats, such as large print, audio, and

accessible electronic formats

• Provide no cost language services to people whose primary language is not English, such as: • Qualified interpreters • Information written in other languages

If you need these services, call 1-888-865-5813 (TTY: 711)

If you believe that Kaiser Health Plan 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 by mail at: Member Relations Unit (MRU), Attn: Kaiser Civil Rights Coordinator, Nine Piedmont Center, 3495 Piedmont Road, NE Atlanta, GA 30305-1736. Telephone Number: 1-888-865-5813.

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

200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

http://www.hhs.gov/ocr/office/file/index.html

http://www.hhs.gov/ocr/office/file/index.html



HELP IN YOUR LANGUAGE

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-888-865-5813 (TTY: 711).

አማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-888-865-5813 (TTY: 711).

.ملحوظة : إذا كنت ت تح دث العر بي ة، فإ ن خدمات ال مساعدة اللغ وي ة تت وافر لك بال مجان (Arabic) ال عربي ة

.)711 :TTY( 1-888-865-5813 م رق ب اتصل

中文 (Chinese) 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電

1-888-865-5813（TTY：711）。

توج ه: اگر ب ه زبا ن فارس ی گ ف تگو می کنيد، ت س ه ي الت زب ان ی ب صورت رايگا ن بر ای (Farsi) ف ارس ی

. گيريد ب ماس ت (711 :TTY) 1-888-865-5813 با . اشد ب اهمفر می شما

Français (French) ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-888-865-5813 (TTY: 711).

Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.

Rufnummer: 1-888-865-5813 (TTY: 711).

ગજુ રુ તુ (Gujarati) સચુ

નુ : જો તમો ગજો

રો તો બો લતો હ , ત નન:શલ્ો ક ભ ષો સહો ય સો વ ઓ

તમ ર મ ટો ઉપલબ્ધ છો . ફ ન કર 1-888-865-5813 (TTY: 711).

Kreyòl Ayisyen (Haitian Creole) ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-888-865-5813 (TTY: 711).

हिन्दी (Hindi) ध्यान दे े : यिद आप ििे िेे दी बोलते िे े े तो आपके ललए मुफ्त मे े भाषा सिेायता िे वाएिेे उपलबेध् िेे े। 1-888-865-5813 (TTY: 711) पर कॉल करे े । 日本語 (Japanese) 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-888-865-5813（TTY: 711）まで、お電話にてご連絡ください。

한국어 (Korean) 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-888-865-5813 (TTY: 711) 번으로 전화해 주십시오.



Naabeehó (Navajo) Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dé̖ é̖ ’, t’áá jiik’eh, éí ná hóló̖ , koji̖ ’ hódíílnih 1-888-865-5813 (TTY: 711).

Português (Portuguese) ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-888-865-5813 (TTY: 711).

Pусский (Russian) ВНИМАНИЕ: eсли вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-865-5813 (TTY: 711).

Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-865-5813 (TTY: 711).

Tagalog (Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.

Tumawag sa 1-888-865-5813 (TTY: 711).

Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-865-5813 (TTY: 711).

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